Evaluation of urodynamic studies by computer

Summary In an attempt to simplify urodynamic evaluation, the data obtained from cystometry, urethral profile and flowmetry were analysed using the ICS recommendations for standardization and terminology. All studies were compiled from check lists feasible for computation. The aim was to establish standards and typical changes for the normal bladder and pathological states to enable automatic readout of computed data. The results did, in fact, show typical changes but failed to establish standard measurements suitable for completely computed diagnoses.     

PTSD among vietnam veterans: An early look at treatment outcome using direct therapeutic exposure

Vietnam combat veteran inpatients were evaluated after being treated in a PTSD special treatment unit. Selected pretreatment measures that included mental and physical problems, combat variables, PTSD symptoms, and the standard MMPI scales found no clinically meaningful differences between a group that was found to be successes and another group found to be failures, based on predetermined cutoff scores on the VETS scale, a reliable outcome measure for veteran patients. At 3 months post-therapy, a significantly greater number of subjects treated with Direct Therapeutic Exposure (DTE) (flooding therapy) as compared to another group treated with a more conventional individual therapy, were identified as successes as opposed to failures, based on the VETs scale. Also, the number of failures was greater for those treated with the more conventional therapy and the number of successess was greater for those treated with DTE, when compared to all other subjects in the sample. These preliminary results were interpreted as indicating that DTE, when offered as part of an inpatient milieu, shows promise as an effective treatment for chronic/severe combat veteran PTSD sufferers.     

Radiographic assessment of cementless hip prostheses: The “ARA” scoring system

Summary Charles Engh and Philippe Massin were the first to distinguish the radiographic patterns produced by the cementless type of hip arthroplasty vs those seen with the PMMA-cemented ones. These fundamental studies produced a new insight into the radiographic features of implants designed to be in direct contact with the host bone, and allowed a better understanding of cementless joint replacement technique. We planned to devise a easy-to-use and reliable system for the assessment of our radiographic data. This system was called ARA (AGORA Roentgenographic Assessment), firstly described in the SOFCOT monograph dedicated to HA-Coated Hip and Knee Replacement. In the analysis of hip arthroplasty radiographs, the questions to be answered could be: (1) Can we observe any changes as compared with the postoperative films? and (2) If so, are the changes normal, or are they to be considered as warning signs of threatening failure/evidence of established implant failure? Where there is no change in the surrounding bone, under conditions of normal physical activity, the implant/host bone system may be considered to be well adjusted, with adequate fixation and a good stress transfer pattern. Any signs that may subsequently appear could be either neutral, reflecting nothing more than an adaptive process, and not affecting the result of the arthroplasty; or adverse, in varying degrees. The step forward consists in setting up a scoring system: it is convenient to start from a total of 6 points, and to award negative points (from 1 to 4) for any of the adverse signs observed. The risk factors are then added up to produce a final score which shows how well the implant is doing in the host bone. Obviously, the score thus obtained will apply only to the time the radiographs were taken, and may change subsequently. The implant/bone system may be rated Excellent (ARA 5 or 6), Good (ARA 4), Fair (ARA 3), or Poor (ARA 2). A score of 5–6 suggests that there is every prospect of durable implant fixation; while a score of less than 2 is conclusive evidence of implant failure. The ARA Score constitutes a first attempt, and will need to be validated in large-scale use. We feel that this easy-to-use score may contribute reliable data that will permit a better understanding of the correlation between radiographic and clinical findings for all stems and cups (HA- and porous metal-coated devices).     

Spinous process-plasty following lumbar laminectomy as a contributing factor to spine stability

A 10-year retrospective study of 41 consecutive patients who underwent spinous process-plasty is presented. We carried out laminectomy of the lumbar spine in cases of spinal stenosis, dorsomedial herniated disc and recurrent disc herniation with firm scars (traumatic and tumour cases are not included). To forestall the development of laminectomy's negative effects on spine stability, we initiated the spinous processes' reconstruction. Two groups of patients who underwent laminectomy form the basis of this presentation, one group with spinous process-plasty (41 patients) and the other (11 patients) without it. On postoperative neutral and dynamic X-ray films we paid attention to horizontal displacements larger than 3 mm and to negative intervertebral angular displacement. Considering such criteria, only 3.8% of those with spinous process-plasty developed a radiographic instability in contrast to 25% of patients without spinous process-plasty. These results support the use of this technique, which provides postlaminectomy lumbar spine stability.     

Premature craniosynostosis a retrospective analysis of a series of 52 cases

Summary A retrospective analysis of a consecutive series of 52 cases with premature craniosynostosis is presented.Excellent functional, cosmetic, and social results could be achieved by resection of prematurely fused sutures and the creation of artificial growth sutures. Pronounced skull deformities have been corrected using the basket handle, the visor plasty, and the T-bone techniques or a combination of several of these skull form correction techniques. The surgical correction of the skull base by the frontal advancement technique in combination with orbitotomy was only necessary in 2 of our cases and could have been considered in 2 additional cases viewed retrospectively.Our results support the hypothesis that the primary cause of skull deformity is the premature closure of vault sutures and not a primary deformity of the skull base.     

Aesthetic surgery as organopsychic therapy

Summary Abnormal anatomic variations have a wide range from small abnormalties to greater defects. Although these cannot be considered pathologic deformations, they may cause psychic problems in patients already on the border of psychic disease. It is therefore necessary to call them organopsychic alterations. In general, the plastic correction is not carried out exclusively because of aesthetic causes, but also to heal the psychic disease. On this basis, it is justifiable to call these aesthetic interventions organopsychic therapy.     

Learning about combat stress from Homer'sIliad

Vietnam Veterans with severe post-traumatic stress disorder often report the following combat experiences: a leader's betrayal of what's right, lost responsiveness to claims outside a tiny circle of combat-proven comrades, grief and guilt for a dead special comrade, lust for revenge, renunciation of homecoming, feeling already dead, going berserk, dishonoring the enemy, and atrocities. These elements are all in Homer'sIliad account of Achilles, allowing the reader to witness them as they happen, so to speak. Homer's view of healing and regained humanity is discussed in relation to theIliad's final scene. TheIliad offers a cross-cultural look at men in battle, and raises questions about some assumptions in American military culture, particularly regarding grief and the need to degrade the enemy to make men fight. Betrayal of what's right and the berserk state are suggested as key pathogens for PTSD in combat soldiers.     

Ureteral stents — materials and new forms

Summary Three different types of polymers are currently used for self-retained ureteral stents: thermoplastic materials such as polyurethanes, and thermoset elastomers such as silicone and hydrogels. Polyurethane stents are easy to form and have high drainage capacity, whereas silicone shows the best biocompatibility but a lower drainage efficacy than the former. A mock urinary system consisting of a collecting system and a 9-F tube was used to evaluate the flow characteristics of various double-pigtail stents in cases of urinary obstruction. For simulation of an unobstructed urinary system a human urogenital system was used. Inner flow polyurethane stents showed the best drainage as compared with inner flow silicone and outer flow ESWL stents in an obstructed ureter, whereas ESWL stents maintained the best flow in an unobstructed ureter or in respect to conventional stents with obstructed sideports.     

Effects of Cilostazol on Human Venous Smooth Muscle

In this study, we evaluated the effect of therapeutic doses of cilostazol on human venous smooth muscle. Saphenous vein rings (two to four per patient sample) were suspended in tissue baths for isometric tension recordings. At the beginning of the experiment, optimal tension for isometric contraction was achieved for each ring in a stepwise fashion in the presence of norepinephrine (10^–2 M). Norepinepherine was then added cumulatively in half-molar increments and isometric tension developed by the rings was measured, thereby obtaining a dose-response curve. Following washout and reequilibration, the rings were precontracted with a 30-50% submaximal dose of norepinepherine determined from the dose-response curve and allowed to contract until a stable plateau was reached. Cilostazol was then added in a cumulative manner (680-2,720 g/L), and the tension generated was recorded. A total of 76 venous rings were tested, and all relaxed in the presence of cilostazol. The amount of relaxation increased as the concentration of cilostazol increased. Relaxation of 15±1.9% (mean±SEM) at low cilostazol doses (680 g/L) to 37±3% at high cilostazol doses (2,720 g/L) was demonstrated. A second finding of this study was demonstrated when the patient samples were divided according to the presence or absence of risk factors for arteriosclerosis. The specific risk factors examined included diabetes mellitus, smoking, hypercholesterolemia, and hypertension. The presence or absence of hypertension (n=52) or hypercholesterolemia (n=18) did not affect the amount of relaxation of the venous rings. Smokers (n=46) had less relaxation 16±2.4% (680 g/L) to 41±3.6% (2,720 g/L) compared to nonsmokers (n=53) who relaxed 22±3.5% (680 g/L) to 48±5.7% (2720 g/L). This did not reach statistical significance at any concentration cilostazol (p=0.11-0.18). Diabetics (n=53) did have statistically significantly less relaxation at every concentration of cilostazol compared to nondiabetics (n=11, p < 0.05). All venous rings relaxed in the presence of cilostazol. Veins of nondiabetics relaxed statistically significantly more than those of diabetics. Smokers had less relaxation than non-smokers, but this was not statistically significant. We are the first to demonstrate that human venous smooth muscle cells undergo relaxation when exposed to therapeutic concentrations of cilostazol.     

34. Akute und chronische Pankreatitis. Morphologische Grundlagen

Zusammenfassung Die akute Pankreatitis zeigt mit der jauchigen Nekrose und der Vielfalt der Fettgewebsnekrosen ein eindrucksvolles Bild. Dennoch sind einige Teilaspekte wenig bekannt und für das Verständnis der Krankheit wichtig, z. B. die häufige Aussparung des Kerns der Drüse. Die anatomischen Äquivalente von Schock, Schmerz, Ileus werden erläutert, auf das Krankheitsbild Pankreatitis ohne Pankreatitis wird kurz eingegangen. Als Komplikationen werden die Chronifizierung und die Pseudocysten dargestellt. Die chronische Pankreatitis bis zur ausgebrannten Drüse mit Stein, Diabetes und möglicherweise Carcinom wird in ihrer Entstehung anatomisch gezeigt.

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Fundamental morphological aspects of acute and chronic pancreatitis

Summary Acute pancreatitis presents an impressive picture, with autodigestic necrosis and various types of necrosis of fat tissue. Nevertheless, some side aspects are little known, although they are important to the understanding of the disease, e.g. the frequent sparing of the kernel of the gland. The anatomical equivalents of shock, pain, ileus are exvlained, and the syndrome of pancreatitis without pancreatitis will be briefly discussed. The complications of progression to a chronic state and of pseudocysts will be shown. The development of chronic pancreatitis leading to the burnt out gland with stones, diabetes and possibly carcinoma will be shown anatomically.

     

71 b. Akute Cholecystitis — Frühcholecystektomie?

Zusammenfassung Durch kontrollierte Studien ist heute bewiesen, daß die operative Behandlung der akuten Galle bessere Ergebnisse erbringt als eine verzögerte Operation oder eine konservative Behandlung. An der Chirurgischen Universitätsklinik Würzburg wurden von 1969 bis 1983 397 Patienten wegen akuter Galle operiert; die Ergebnisse werden mitgeteilt.     

An interpretation of acute changes in plasma45Ca following parathyroid hormone administration to thyroparathyroidectomized rats

Acute changes in plasma calcium and⁴⁵Ca were studied in young adult male thyroparathyroidectomized (TPTX) rats injected with moderate doses of parathyroid hormone (PTH). For plasma calcium changes, comparison was made between rats fasted or fed prior to PTH injection. For plasma⁴⁵Ca changes, the effect of the time of administration of the radionuclide was also studied; this included rats injected with PTH 1 h after radionuclide (1 h⁴⁵Ca), 18 h later (18 h⁴⁵Ca) and more than 6 days later (6 day⁴⁵Ca). The results can be summarized as follows: (1) Plasma calcium changes were greater when PTH was injected into fed rather than into fasted rats. (2) PTH always produced a relative increase (compared to controls tested concurrently) in plasma⁴⁵Ca concentrations. This increase was the same in the 1 h⁴⁵Ca and the 18 h⁴⁵Ca groups. (3) Plasma⁴⁵Ca rose at least temporarily following PTH injection in the 18 h⁴⁵Ca group. (4) The⁴⁵Ca rise following PTH was always greater in fed than in fasted groups. (5) Plasma⁴⁵Ca specific activities (S.A.) tended to rise in the 6 day⁴⁵Ca group and to fall in the 18 h⁴⁵Ca group, following PTH injection. However, the⁴⁵Ca S.A. was always higher in fed than fasted groups. (6) In a few experiments in which³²P was injected with⁴⁵Ca, specific activity changes in plasma⁴⁵Ca following PTH injection werenot accompanied by similar changes in³²P specific activity.These results could not be adequately explained by PTH effects on bone resorption, but the data supported the postulate that PTH controls plasma calcium concentrations by increasing transport of calcium through the osteocyte-lining cell (osteoblast) bone cell complex from the bone fluid compartment to the ECF.     

Composition and calcium binding of proteinpolysaccharides of calf nasal septum and scapula

Proteinpolysaccharide (PP-L) of resting and ossifying zones of calf scapular cartilage and of calf nasal septum cartilage was extracted with aqueous 0.15 M KCl and fractionated into a series of products: PP-L3, PP-L4, PP-L5, PP-L6. An additional proteinpolysaccharide fraction, PP-L2, was extracted from the cartilage residues with hydroxylamine. Differences in chemical composition among corresponding proteinpolysaccharides obtained from the three cartilage sources were, in general, small. The calcium binding capacity of the PP-L, PP-L2, and PP-L3 samples, as measured by equlibrium dialysis, appeared to reflect principally their uronic acid and exchangeable sulfate contents. Application of a cation exchange technique indicated that PP-L from resting and ossifying zones of scapular cartilage had similar affinities for tracer quantities of calcium. However, the affinity of PP-L from both zones of scapular cartilage for tracer quantities of calcium was greater than that of PP-L from nasal septum. The data obtained from this study do not indicate sufficient differences between the chemical composition and calcium affinity of proteinpolysaccharides from resting and ossifying scapular cartilage to account for the calcium uptake in the ossifying zone.This work was supported by the U.S. Atomic Energy Commission and by U.S. Public Health Service Special Fellowship (QTS), 1-F3-GM-16, 179–01.     

Die Beziehungen von Geschwulstart und Lokalisation der Bronchialcarcinome zur Lungenbelüftung und ihre Veränderungen durch exogene Einflüsse (chronische Bronchitis,Pneumonie, Raucher)

Zusammenfassung Es wurde an einem Krankengut von 435 Patienten mit Bronchialkrebs untersucht, ob sich aus klinischen Daten Rückschlüsse auf die Entstehung des Leidens ziehen lassen könnten. Die Vielzahl von Faktoren einerseits und ihre große Kombinationsmöglichkeit andererseits ergab die Forderung, wenige aber eindeutige und konstante Merkmale zu finden. Als solche wurden die Geschwulstlokalisation und der Geschwulsttyp erkannt. Der Vergleich der lokalisatorischen Anordnung der Geschwülste mit der Lungenbelüftung ergab eine bemerkenswerte Parallelität:Die prozentuale Verteilung der Tumoren entspricht der Belüftung der entsprechenden Lungenabschnitte. Die Gleichsinnigkeit von Tumorbefall und Beatmung war für die Lungenflügel und Lungenlappen ebenso nachweisbar wie für verschiedene Abschnitte des Bronchialbaumes. Es wurde daraus gefolgert, daß Belüftung und Tumorbefall in einem ursächlichen Zusammenhang stehen. Darüber hinaus fand sich, daß bei prozentual gleicher Verteilung die Plattenepithelkrebse mehr zentral, die kleinzelligen Geschwulste mehr peripher im Bronchialbaum anzutreffen sind. Diese Beziehung von Tumorlokalisation und Geschwulstart müßte sich in seiner prozentualen Anordnung verschieben, sobald exogene Reize ausreichender Intensität auftreffen.Dieses wurde für die Einwirkungen chronische Bronchitis und Pneumonie sowie Raucher untersucht. Für jede dieser Gruppe stellte sich eine besondere Form der bevorzugten Tumorlokalisation heraus, für Bronchitis und Raucher war das Überwiegen der Plattenepithelkrebse ebenfalls eindeutig nachweisbar. Mit diesen Untersuchungen ist einerseits die Richtigkeit der Auffassung erbracht, daß exogene Reize als die wesentlichen Bedingungen für die Entstehung des Bronchialcarcinoms angesehen werden müssen; andererseits ist damit zugleich gezeigt, daß sich ein ätiologisches Moment für chronische Bronchitis, Rauchen und Pneumonie nicht mehr fortleugnen läßt.Mit 15 Textabbildungen.     

Das periostale Wachstum,Hauptmittel zur funktionellen Anpassung des Schenkelhals-Schaft-Winkels (CCD-Winkel)

Zusammenfassung Nach konsequenter Untersuchung vieler Coxa valga-Fälle gemäß physikalischen und biologischen Gesetzen sowie morphologischen Standpunkten muß man als Hauptgestalter des Schenkelhals-Schaft-Winkels das periostale Wachstum betrachten und nicht, wie bis jetzt angenommen, das epiphysäre Längenwachstum.

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The increase in thickness of the bone as a basic means of functional adaptation of the femoral neck

Summary Consistent investigation and analysis of cases of Coxa valga, as well as careful consideration of biological and physical laws should lead to the conclusion that the formation of the CCD-angle is mainly due to the growth of the bone along its width growth caused by the periosteum rather than its elongation.

     

A “reverse genetic” approach to autosomal dominant polycystic kidney disease

Biochemical, anatomical, pathophysiological and clinical studies of autosomal dominant adult-type polycystic kidney disease have cast little light on the underlying biochemical defect which causes the disease. The advent of recombinant DNA technology permits a novel approach to its pathophysiology. In this approach, termed reverse genetics, the mutation which produces the disease is first localised by genetic linkage. This is followed by the identification and cloning of the disease gene itself, and the characterisation of its mutations. The recent assignment of the polycystic kidney disease mutation to the short arm of chromosome 16 is thus the first step in a reverse genetic approach to an understanding of the molecular pathology of this disorder.     

Diagnostic value of automatically interpreted oculopneumoplethysmography

The diagnostic value of the Gee-oculopneumoplethysmography test for the detection of hemodynamically significant carotid artery obstructions has frequently been questioned due to the rather low agreement with arteriography. The kappa-corrected diagnostic accuracy of this test has been reported to be in the range between 0.54 and 0.68. These values indicate a fair to good agreement with arteriography. One of the causes for this rather low agreement is the variability in the interpretation of oculopneumoplethysmography recordings. Automatic analysis of oculopneumoplethysmography recordings might minimize the risks of misinterpretation and might improve the clinical significance of the Gee-oculopneumoplethysmography test. By assessing the signals of a conventional Gee-oculopneumoplethysmography apparatus in a personal computer, this automatic analysis has been realized. In a clinical study (population of 85 patients) the diagnostic value of automatic analysis of oculopneumoplethysmography recordings has been evaluated. The automatically interpreted Gee-oculopneumoplethysmography test had a kappa-corrected diagnostic accuracy of 0.71 on a per side base and of 0.76 on a per patient base.     

Legg-Calvé-Perthes follow-up study

Summary We present here a follow-up study concerning Legg-Calvé-Perthes. This study about 71 hips shows that the Catterall grouping, age and at risk signs are still to be considered as very important prognostical factors.A definitive and indispensable scheme of treatment has not yet been advanced, especially because the right etiology still remains an obscure point. The cited classical prognostic factors however remain all-important.

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Zusammenfassung Die Arbeit berichtet über Spätergebnisse nach konservativer Behandlung der Legg-Calvé-Perthesschen Erkrankung an 61 Hüften bei 60 Patienten. Es zeigt sich, daß die Faktoren Alter und Risiko-Zeichen der Catterall-Klassifikation noch immer die größte prognostische Bedeutung haben, wenngleich auch andere klassische prognostische Faktoren nach wie vor Beachtung verdienen.Ein definitives, unanfechtbares Behandlungsschema gibt es his jetzt noch nicht, besonders wohl auch deshalb, weil die Ätiologie der Erkrankung immer noch ungeklärt ist.

     

Digital subtraction angiography (DSA): New perspectives in angiography

Summary Digital subtraction angiography (DSA) has strongly influenced angiographic procedures. Because it is less invasive it has increased the total number of angiographies in all places where it was introduced. The paper gives an introduction to the procedure explaining the roles of digital and subtraction in DSA. It is written from a technical point of view. The examples are taken from and with the DVI system.     

Reduction mammoplasty: General approach and basic considerations

Reduction mammoplasties must take into consideration volume, mammary base, and forward projection in establishing criteria for a standard breast. Any reduction procedure involves the mammary gland or mass, the skin, and the nipple-areola complex.Since 1969, we have used a dermal vault technique on over 1,200 patients with satisfactory results. It produces a short, well-situated scar, a pleasing form, ideal residual mammary volume, and good stability.