Anatomical considerations of selective pudendal neurectomy

The pudendal nerve was examined in 100 cadavers of both sexes. Because of the variable number of trunks of the pudendal nerve, 5 types were distinguished: one-trunked; two-trunked, rectopudendal; two-trunked, pudendo-penile (or-clitoridal); three-trunked, recto-perineo-penile (or-clitoridal); four-trunked, recto-perineo-perineopenile (or-clitoridal). The authors' suggestions make it possible to perform selective pudendectomy, consisting in denervation of the sphincter urethrae muscle by neurectomy of the perineal branches of the pudendal nerve.     

The epidemiology of logging injuries in the northwest

Logging is among the most hazardous forms of employment. However, a comprehensive review of severe logging injuries and their outcome has apparently not been previously undertaken. In the present study we review 51 consecutive injured loggers requiring transfer to a regional Level I trauma center. The average age was 34 years and the mode of injury in 67% was being struck by a falling or rolling log. Orthopedic intervention was required most frequently (49%), with neurologic injury in 43%. Two patients died (4%), both secondary to severe head injury, and both survived less than 24 hours. Importantly, while most severely injured patients survived, they required long hospitalizations and had a 58% permanent disability, with more than half of these being brain or spinal cord related. Although the overall number of workers involved in logging is small, the young average age, the work years lost, and the high risk of permanent disability support continued strong efforts to improve overall safety. Particularly, the high incidence of head injury argues strongly for improved and increased use of safety helmets, which may significantly impact the mortality and morbidity of logging accidents.     

A case of cysticercosis of the IV cerebral ventricle]

A case of cysticercosis in fourth ventricle is described. After surgical cyst removal the medical treatment with praziquantel was instituted.     

Avantage double mobility press--fit cup in total hip arthroplasty]

The Avantage double mobility press-fit cup was devised by Dr. Bousquet in the 70's to bring reasonable response to a problem of recurrent dislocation after total hip arthroplasty. The cup is attached to the femoral head by a bipolar polyethylene liner. The polyethylene liner moves freely inside a shiny--polished metal cup. The angular range of motion before impingement is increased by the mobility of the liner. The double connection (cup-liner, liner-head) reduces the stress on the metal cup and improve the stability of the prosthesis. The solution has proved to be efficient in reducing dislocation risk and maintains at the same time the appropriate range of motion. Between January 2004 and November 2005, 113 hip arthroplasties in 108 women with use of the double mobility cup were performed. The cemented version of the Avantage cup was inserted in 15 patients (mean age--76.9 years). Uncemented, HA coated implant was used in 98 patients (with mean age of 55 years). The mean follow-up was 20.4 months. No one patient was lost to follow-up. No postoperative dislocation was observed during follow-up. There was no unwanted leg lengthening greater than 1 cm. The Avantage cup may be indicated in any primary total hip arthroplasty especially in those with increased risk of postoperative dislocations. This cup enables a correct balance of the hip without a need of the unwanted lengthening of the leg.     

Rat sponge implant model: a new system for evaluating angiogenic gene transfer

Therapeutic angiogenesis, either by protein injection or gene therapy, holds considerable promise for the treatment of coronary and peripheral artery diseases. Given the large number of angiogenic genes available, a simple, well defined, standard system to compare the relative angiogenic efficacy of such genes would be valuable. We have employed a replication-deficient adenovirus vector (complete E1a-, partial E1b- and partial E3-) to deliver the beta-galactosidase (beta-gal, AdLacZ) reporter gene or the human VEGF121 gene (AdGV VEGF121.10) to a rat sponge implant model of angiogenesis. beta-gal staining results reveal a transfection efficiency as high as 60% 24 h after 2x1010 particle units AdLacZ injection. Our results also indicate that a single injection of 2x1010 particle units of AdGVVEGF121.10 in the sponge results in >10, 000 pg VEGF protein expression per milligram of sponge tissue 24 h later. VEGF121 protein concentrations decreased 10-fold within 3 days and 100-fold within 7 days after injection. Significant VEGF121 protein levels were still detectable 14 days after initial virus injection. The high level of gene transfection efficiency was accompanied by enhanced angiogenesis in the sponge, a tissue devoid of any vessels before implantation. Compared to control (AdNull: adenovirus vector without the VEGF gene), AdGVVEGF121.10 induced a 2- to 3-fold up-regulation of angiogenesis at 7 and 14 days post vector injection as determined by both increased capillary number and increased tissue ingrowth. The angiogenic effects of AdGVVEGF121. 10 were dose-related in this model system. These findings demonstrate a dose-related angiogenic response to adenovirus-mediated gene therapy in this model.     

Delayed angiogenesis in aging rats and therapeutic effect of adenoviral gene transfer of VEGF

We have studied an age-related impairment in angiogenesis and evaluated the effect of overexpressing VEGF in this situation. Polyvinyl alcohol sponges were implanted subcutaneously into aged (24-month), adult (12-month), and young (2-month) rats. Blood vessel ingrowth and proliferative activity in the sponges were assessed by histology with immunostaining for von Willebrand's factor and proliferating cell nuclear antigen (PCNA), respectively. The percentage of total sponge area filled with ingrowing fibrovascular tissue was minimal in aged rats, intermediate in adult rats and highest in young rats. A similar pattern was observed for the total blood vessel numbers in the sponges from old to young animals. The percentage of total sponge endothelial cells (ECs) showing proliferative activity (PCNA positive) was lowest in the aged animals, intermediate in the adult rats and highest in the young rats. To further explore the mechanism of impaired angiogenesis in aged animals, we investigated and found a reduced level of endogenous VEGF protein expression in 12-month-old rats compared to that in 2-month-old rats. VEGF121 gene transfer significantly enhanced blood vessel and fibrovascular tissue ingrowth in adult/aged rats. Adenoviral-VEGF gene transfer also significantly stimulated EC proliferation in aged and adult rats. However, identical treatment failed to further stimulate the already more robust angiogenesis in young animals. The different angiogenic response in adult vs. young rats was not due to differences in gene transfer efficiency, since similar levels of human VEGF121 protein was detected in adult and young rats. Our results indicate that the decreased angiogenic response with aging is associated with reduced EC proliferation and reduced endogenous VEGF production. Adenoviral-VEGF121 gene transfer is effective in augmenting angiogenesis, particularly in older animals.     

Prolongation of heart graft survival and spleen suppressor cell activity after donor specific blood transfusions in rats differing across the MHC

The aim of the study was the prolongation of heart allograft survival in rats after DST (donor specific blood transfusion), the characterization of T and B lymphocyte phenotypes in peripheral blood, spleen and lymph nodes and the evaluation of specific and nonspecific suppressor cell activity of spleen and blood lymphocytes of DST rats. Pretreatment of Wistar recipients with one, two and three doses of DST-s prolonged the heterotopic August graft survival to 11.0, 12.3 and 11.4 days, respectively (rats differed across the MHC). Spleen lymphocytes of transfused rats showed significant nonspecific suppressive activity in culture with syngeneic spleen lymphocytes of nontransfused rats stimulated with PHA, but not in culture with blood lymphocytes. Blood lymphocytes of transfused rats did not show any nonspecific suppressive activity. Spleen and blood lymphocytes of transfused rats did not demonstrate any specific suppressive activity in allogeneic MLC. The ratio of W3/25+/OX8+ (Th+/Tsup/cyt+) cells in peripheral blood was found increased in DST rats due to the decrease in the percentage of OX8+ cells whereas the opposite effect was observed with spleen cells (increase in the percentage of OX8+ cells after one DST). The number of OX6+ (Ia positive) cells and B cells in all transfused rats was found unchanged comparing with untreated animals.     

The soluble tumor necrosis factor receptor I is an early predictor of local infective complications after colorectal surgery

The clinical implications of increased cytokine levels after major surgery remain unclear. In this study, systemic concentration of a spectrum of cytokines, including interleukins IL-6, IL-8, IL-10, IL-1ra, and soluble tumor necrosis factor receptor-I (sTNF-RI) was examined in patients with and without postoperative septic complications following colorectal surgery. Although there were no significant changes in IL-1, TNF-, and IL-8 serum levels during the observation period, there was a significant rise in IL-6, IL-1ra, and sTNF-RI concentrations in the entire group of patients between postoperative day 1 and 14. There were no differences between the group without and with local complications when IL-6, IL-1ra, and IL-10 were examined. The serum levels of sTNF-RI, IL-1ra, and IL-6 were found to be sensitive indicators of the pro- and anti-inflammatory response to the surgical trauma, but only sTNF-RI turned out to be a sensitive early marker of local septic postoperative complications in patients with colorectal carcinoma.