Pervenous Atrial Electrode

“Atricor” P-synchronous pacemakers have been installed in 11 patients by the use of pervenous electrodes. At the follow-up, 8 patients still had P-synchronous pacemakers working, whereas in 2 cases “Ectocar” (“demand”) had been installed on account of non-functioning atrial electrodes. One patient received a temporary “demand” pacemaker because of cardiac surgery. In 1 patient, a pervenous atrial electrode has been used for atrial pacing as treatment for sinus bradycardia. This pacemaker has now functioned for 1 year. In 5 patients, surgical replacement of displaced atrial electrodes has been necessary. Proper fixation of the atrial electrode in the subclavian fossa is vital for successful P-synchronous pacing of longer duration.     

Characteristics of giant pituitary adenomas

Summary An analysis of 21 giant pituitary adenomas is presented. Giant pituitary adenomas with a diameter of more than four cm mostly perforate dura and diaphragm, invade the cavernous sinus, and spread extradurally into anterior and middle cranial fossae or into the frontal or temporal lobes. Endocrinologically, a third are prolactinomas, and a half are non-secreting tumours leading to pituitary failure. Clinical, radiological, and operative characteristics lead to the conclusions that multishaped dura-penetrating extension is not due to locally destructive growth, but is the result of late diagnosis. Because radical cure by operation and radiotherapy is hardly likely, early operative treatment is necessary even when an excellent endocrinological response to medical therapy is present.Dedicated to Prof. Dr. Dr. h. c. H. W. Pia on the occasion of his 60th anniversary.     

External beam,sapphire tip contact and interstitial Nd-YAG laser therapy at 1.064 μm on a transplanted adenocarcinoma in mice: A comparative study

This study was undertaken to compare three different techniques for treating transplanted tumours in mice with the Nd-YAG laser—no contact (external beam), interstitial and sapphire tip contact therapy. The aspects studied were macroscopic and microscopic tumour necrosis and haemostasis. Forty C_57B1 male mice were transplanted with the adenocarcinoma AC₇₅₅ and divided into four groups—three experimental (one for each treatment technique) and one control. On the 15th day after transplantation tumours were irradiated with an external, no contact beam (Group I), interstitial therapy (Group II) or contact therapy with a sapphire tip (Group III), each with a light dose of 1200 J. Seventy-two hours later all animals (experimental and control) were killed, the tumours excised, weighed and the extent of necrosis measured macroscopically and microscopically and the blood vessels near the zone of necrosis examined. The best results were obtained in Groups I and II (no contact and interstitial) compared with the controls (p<0.001 andp<0.01 for the tumour weight andp<0.01 andp<0.001 for the percentage of necrosis, respectively). Results from contact therapy were poor for each of the parameters chosen with no significant differences between the treated and control animals although marginally better coagulation was observed in this group. It is concluded that sapphire tip therapy has no advantages for tumour destruction but causes slightly better coagulation at the treatment point. Interstitial therapy warrants further investigation.     

External beam,sapphire tip contact and interstitial Nd-YAG laser therapy at 1.064 μm on a transplanted adenocarcinoma in mice: A comparative study

This study was undertaken to compare three different techniques for treating transplanted tumours in mice with the Nd-YAG laser—no contact (external beam), interstitial, and sapphire tip contact therapy. The aspects studied were macroscopic and microscopic tumour necrosis and haemostasis. Forty C_57B1 male mice were transplanted with the adenocarcinoma AC₇₅₅ and divided into four groups—three experimental, one for each treatment technique and one control. On the 15th day after transplantation tumours were irradiated with an external, no contact beam (group I), interstitial therapy (group II) or contact therapy with a sapphire tip (group III), each with a light dose of 1200 J. Seventy-two hours later all animals (experimental and control) were killed, the tumours excised, weighed and the extent of necrosis measured macroscopically and microscopically and the blood vessels near the zone of necrosis examined. The best results were obtained in groups I and II (no contact and interstitial) compared with the controls (p<0.001 andp<0.01 for the tumour weight andp<0.01 andp<0.001 for the percentage of necrosis, respectively). Results from contact therapy were poor for each of the parameters chosen with no significant differences between the treated and control animals although marginally better coagulation was observed in this group. It is concluded that sapphire tip therapy has no advantages for tumour destruction but causes slightly better coagulation at the treatment point. Interstial therapy warrants further investigation.     

Verletzungen durch Schuss oder Explosion an der Hand

Gunshot injuries to the hand are rare in Central Europe. As a result of their special trauma morphology they are a serious threat to the functional integrity of the hand and often lead to a loss of function which can be associated with a permanent unfitness to work or disability. Blast injuries to the hand are more common in this part of the world and are usually caused by the inappropriate use of fireworks. This trauma entity is associated with a number of special kinetic features and effects which have therapeutic consequences and should therefore be discussed separately. As a result of the low incidence of these specific types of injuries in times of peace, experience-based expertise is unlikely to be available. The management of gunshot injuries to the hand is a particular challenge to hand surgeons who must have specialist knowledge and skills in order to achieve an optimum outcome. This applies even more so to the treatment of blast injuries to the hand which are associated with far more complex injury patterns. As a rule blast injuries are associated with a high risk of complications and require a rapid assessment and rigorous management of all damaged structures similar to approaches used for infections of the hand. Illustrated by several cases which have been treated at our institution the basic aspects of the development and morphology of these injuries are discussed as well as different treatment options, algorithms and possible treatment outcomes.     

Personality testing in 226 patients with urinary incontinence

Two hundred and twenty-six female patients undergoing investigation for urinary incontinence completed the Eysenck Personality Inventory questionnaire. The results of the questionnaire were correlated with the symptomatology and urodynamic findings. Incontinence and neuroticism were found to be related. No special relationship was found between neuroticism and detrusor overactivity, although this has been reported in other smaller series.     

Comparison of encephalotomograms and computerized tomograms in midline tumours in infants

Summary Even after the introduction of the computerized tomogram, midline tumours in infants may give diagnostic problems. In the present study 41 children with tumours in the midline were investigated by both computerized tomography and encephalotomography. The results could be divided into two groups, according to the method and according to the localization of the space-occupying lesion. The diagnostic procedure may be restricted to computerized tomography in cases with direct signs (density differences, contrast enhancement). In cases showing indirect signs on the computerized tomogram (dislocation of ventricles or cisterns or both), further investigation would appear to be valuable. Encephalotomography is the method of choice in patients with negative or uncertain CT findings and contradictory clinical symptomatology.     

Rotator cuff injuries in the contact athlete

Rotator cuff injuries in contact athletes are typically a result of a different mechanism than that seen with older patients or overhead athletes. This unique mechanism along with the extreme demands of these athletes presents special challenges to the surgeon. Special consideration should be given to in-season rehabilitation to allow the athlete to continue to compete if possible. When this is not possible, or for the out-of-season athlete with a rotator cuff injury requiring surgery, special consideration must be given to obtaining the strongest repair possible. The goal in all aspects of treatment is returning the athlete to full participation safely while minimizing recurrent injury or disability during the recovery process.     

Neuroendocrine characteristics of human Leydig cell tumours

Summary. The neuroendocrine nature of a subset of Leydig cells has already been established. The present investigation deals with neuroendocrine characteristics of Leydig tumour cells. A number of neuroendocrine and neuronal markers were demonstrated in Leydig cell tumours of 7 men aged 25–41 years. The following substances were immunocytochemically tested in Leydig tumour cells: the monoamine-synthesizing enzymes tyrosine hydroxylase and aromatic L-amino acid decarboxylase, the indoleamine serotonin, the calcium-binding protein parvalbumin, the microtubule associated protein-2, neurofilament protein 200, synaptophysin, neuron specific enolase, substance P and neuronal nitric oxide synthase (NOS). Compared to the normal interstitial cells beyond the tumours, all neoplastic cells showed a significantly weaker immunoreactivity for nerve cell markers as well as for testosterone and cyclic guanosine monophosphate (cGMP), which is usually accumulated by nitric oxide (NO). This provides evidence for a certain dedifferentiation of Leydig tumour cells.
However, these results suggest that tumourous development of Leydig cells does not include loss of neuronal phenotype. Moreover, on the assumption that 'neuronal' Leydig cells exist beside 'non-neuronal' ones in normal testicular tissue, we propose the hypothesis that 'neuronal' Leydig cells can transform to tumour cells.     

Solitary enchondroma in a metatarsal bone,an incidental discovery

IntroductionEnchondromas are rare benign bone tumours and their discovery is usually incidental, since in most cases it presents with no symptoms.Presentation of caseA 30 year old male who comes to the office after suffering a forced inversion of the left foot, he has edema of the left lateral malleolus, pain and is unable to walk; no deformities or other alterations are observed and palpable pulses of adequate intensity and frequency are recorded. The radiography shows soft tissue edema and no bone lesions.A tumour is found in the first metatarsal, which was afterwards corroborated by an MRI; once the diagnosis was confirmed, curettage of the lesion was performed with good outcome.Discussion/conclusionMultiple enchondromas and solitary enchondromas, left untreated, can transform into malignant bone tumours like chondrosarcomas, so early detection and treatment, in most cases with lesion curettage and bone grafting, become fundamental for a good prognosis.     

The efficacy of urinary cytology in the detection of urothelial tumours

Summary The sensitivity and specificity of urinary cytology in the detection of urothelial tumours using voided urine and applying simple smear preparation and staining techniques have been assessed. Of the 2704 patients under investigation 207 had urothelial tumours. The first urine analysis was positive in 66% of the patients with urothelial carcinoma; an additional 23% of the patients showed positive cytology in repeat smears, resulting in a sensitivity of 89%. The efficacy of urinary cytology depends on the tumour type: for grade 2 tumours, 79% were cytologically positive, 92% of grade 3 and 98% of the grade 4 tumours. The diagnostic efficacy in cases of carcinoma-in-situ, squamous cell carcinoma and adenocarcinoma was comparable with that of grade 4 carcinomas. Grade 0–1 tumours did not result in positive cytology. In eleven cases of lithiasis and in two cases of cyclophosphamide therapy the cytological diagnosis was positive but no neoplasm could be established histologically; these represent true false positive diagnoses. Thus, the false positive rate, 13 out of 165, was 7.88% and the false negative rate, 61 out of 207, was 29.4% when grades 0–1 were included, but 8.75% (14 out of 160) when grades 0–1 were excluded.     

Lidrekonstruktion

Neoplasia of the eyelid are a special group of tumours of the head and neck. Early diagnosis and histological diagnosis largely avoid destructive surgery but also demand special skills of surgical reconstruction. In our patients 58% of neoplasia of the eyelid region were found to be malignant. In this article various techniques for eyelid reconstruction with respect to functional and aesthetic aspects will be presented.     

胸腔镜辅助腋下小切口手术治疗自发性气胸体会

目的探讨电视胸腔镜(VATS)辅助腋下小切口手术治疗自发性气胸、肺大疱的方法和临床效果。方法2001年至2007年我科在电视胸腔镜配合下经腋下小切口手术治疗自发性气胸96例,回顾性分析本组病例的临床资料,总结手术的适应证、操作要点和疗效,并评价该术式的可行性。结果96例无一例死亡,全部治愈出院,随访5个月~6年,术侧无气胸复发。结论电视胸腔镜辅助腋下小切口术式创伤小,特殊设备要求低,技术容易掌握,治疗自发性气胸、肺大疱的效果好,是适于推广的胸外科微创手术方法。     

Effect of the combination of laser excision and interstitial hyperthermia in palliative therapy of head and neck tumours in the advanced stage of the disease

BACKGROUND AND OBJECTIVES: We evaluated the potential of combining laser excision with laser interstitial hyperthermia in order to improve the quality of life of patients with 3rd or 4th stage malignant head and neck tumours. STUDY DESIGN/MATERIALS AND METHODS: To evaluate the quality of life, we used the 4th version of the University of Washington Quality of Life assessment score modified for head and neck tumours. The study group of 20 patients assessed their condition in a questionnaire, examining 12 aspects of their quality of life before the laser treatment, the second day after, and 6 weeks after the treatment. RESULTS: We observed a gain of 16.41 points, which subjectively represents a 70.32% improvement in the quality of life. CONCLUSIONS: Following this therapy the quality of life significantly improved in patients with primarily low quality of life, whereas the group of patients with less affected quality of life reported a temporary decline in the quality of life after the treatment. To obtain a proper objective indication, we suggest a mathematical modelling of possible gains for the individual patient using the University of Washington Quality of Life classification.     

Praxis arztlicher Kooperation am Beispiel eines speziellen Berichtsbogens

Summary: The cooperation in cases of childlessness between andrologists and gynecologists is an essential of any treatment. In a short communication it was shown that a special investigation form can be helpful for reciprocal information. This investigation form improves the information rate form 10% to 30%. In some cases the form were sent back to the authors but not to the doctor …. a special sign for cooperation?     

An assessment of patient-reported outcomes for men with erectile dysfunction: Pfizer's perspective

Patient-reported outcomes (PROs) for men with erectile dysfunction (ED) have blossomed in the published literature and at professional conferences. These outcomes have been central to study the science of ED itself and to evaluate efficacy of treatment for men with ED. In this review article we highlight and distinguish among seven key PROs: the International Index of Erectile Function, for sexual function including erectile function; the Sexual Health Inventory for Men (SHIM), for diagnosis of ED; the Quality of Erection Questionnaire, for satisfaction with quality of erections; the Erectile Dysfunction Inventory of Treatment Satisfaction, for personal evaluation of treatment received; the Self-Esteem And Relationship questionnaire, for emotional well-being; the Erection Hardness Score (EHS), for targeting erection hardness and the Sexual Experience Questionnaire, for erection (both function and quality), individual satisfaction and couples satisfaction. Depending on the purpose of the investigation, all seven PROs have merit for use in clinical trials and at least deserve consideration in clinical practice. The SHIM and the EHS, given their aims and brevity, deserve special consideration in clinical practice. As a unit these seven PROs complement and supplement each other. Which ones to choose in a particular undertaking depends on the objective or purpose of a given study. These PROs acknowledge that sexual dysfunction and its treatment have multiple dimensions. Each of these instruments represents a significant contribution to sexual medicine research and, when used judiciously and appropriately, can help to provide optimal patient care and management.     

ISLAND FLAPS INCLUDING THE BEZIER TYPE IN THE TREATMENT OF MALIGNANT MELANOMA

Despite the trend in current surgical practice in the treatment of melanoma to produce smaller excisional defects, any technique which can introduce a surgical closure that does not require split skin grafting must be of benefit. This paper introduces and illustrates a range of island flap techniques that employ no skin grafting for the treatment of malignant melanoma defects. The new cutaneous island flap described, termed the Bezier or the French Curve, employs a double V-Y appositional closure method, thus giving a more refined reconstructive result that fits into the line of the body curves aesthetically. The design of the Bezier flap is almost identical in size and shape to the excisional defect, with a fascial or muscular base for vascular support. Appropriate guidelines that determine the design and application of this island flap technique are listed. They are illustrated both diagrammatically and clinically. Other flaps illustrated include fasciocutaneous island flaps and myocutaneous island flaps that use a single V-Y flap appositional closure technique. All these flaps were designed with special reference to the derma-tomes, which act as an aid memoire upon which the flaps are marked.     

Immunosuppressive acidic protein in patients with brain tumours: A preliminary report

Summary The present investigation was conducted to document the serum concentrations of immunosuppressive acidic protein (IAP) in patients with intracranial tumours utilizing the single radial immunodiffusion method. Among 46 pre-operative patients, elevated serum levels of IAP were found in nine of 16 patients with gliomas, six of nine patients with metastasis, and two of 21 patients with non-glial, histologically benign intracranial tumours. The mean value of serum IAP in glial or metastatic tumours was found significantly higher than that of either non-glial or normal individuals. It was postulated that serum IAP levels could correlate with a grade of anaplasia and malignancy of the tumour. And it was also of note that serum IAP levels appeared to have a tendency to decrease in response to the treatment. In addition, serum IAP levels were found correlated with the clinical condition and course of disease as evaluated by performance status and erythrocyte sedimentation rate. Therefore, it was suggested that measurement of serum IAP could be, at least in part, useful in validating the histologic analysis of brain tumours, in following responses to treatment when used as a tumour indicator, and in monitoring the progress of the disease in patients in terms of performance status.This work was supported by Grant-in-aid for Scientific Research sponsered by Ministry of Education in Japan (Grant C-60570658).     

Urinary schistosomiasis in Saudi Arabia.

The distribution, aetiology, pathology, and clinical aspects of urinary schistosomiasis are outlined and it is emphasised that mortality from the disease is not due to the parasitic ova passed in the urine and faeces but to the complications caused by fibrotic immunological reactions to the retained ova. The treatment both of these complications and of the infestation itself is discussed. The special circumstances governing the transmission of the disease in Saudi Arabia are described and it is suggested that in view of these the energetic application of hygienic, educational, and therapeutic measures should make the complete eradication of schistosomiasis possible in that country.     

虚拟技术对21世纪微创外科发展的影响

20世纪后期，建立在高新技术基础上的虚拟技术发展迅速，为微创外科的发展提供了强有力的手段，在微创外科领域的应用日益广泛，并对微创外科的发展产生了深远的影响。虚拟技术充实和更新了微创外科的诊疗理念，拓展了微创外科的诊疗范围，提高了微创外科的诊疗效果，并且促进了微创诊疗器械的不断发展和更新。但由于虚拟技术目前尚处于起步阶段，虚拟技术的开发不仅需要高层次复合型人才，还需要借助昂贵的设备和特殊的器械，因此将虚拟技术应用于微创外科领域时，应选择合适的手术适应证，有选择有重点的逐步开展，同时应不断加强虚拟技术的基础和应用研究，努力促使其真正成为微创或无创治疗的有效手段。