The distribution of extracellular matrix vesicles in healing of rat tibial bone three days after intramedullary injury

Summary The distribution of extracellular matrix vesicles on the third day of bone healing was studied by morphometric analysis of transmission electron micrographs. Detection and grouping of the vesicles was performed according to type, diameter, and distance from the calcified front. The different types were selected as follows: vesicles with electron-lucent contents (empty), vesicles with amorphous electron-opaque contents (amorphic), vesicles containing crystalline depositions (crystal), and vesicles containing crystalline structures with ruptured membranes (rupture). The majority of vesicles were between 0.07 µm and 0.12 m in diameter and were located at less than 3 m from the calcified front. The distribution of the empty, amorphic, crystal, and rupture vesicles was 23.2%, 74%, 2.5%, and 0.3% respectively. Their sequence of arrangement according to diameter was as follows: empty, amorphic, crystal, and rupture, the empty vesicles constituting the smallest and the rupture the largest type. Distances from the calcified front were similar for the empty, amorphic, and crystal vesicles, while the rupture type was located nearest to the front. The present observations support the widely acknowledged hypothesis on the role of extracellular matrix vesicles in mineralization. It is thought that the secretion of empty vesicles from the cell is followed by intravscular accumulation of amorphous Ca and Pi to form a hydroxyapatite crystal that, in turn, ruptures the vesicle's membrane. The maturation process is accompanied by an increase of the vesicular diameter and its approximation to the calcifying front.     

Razabrasion: An alternative approach to perioral rhytides

Persistence of perioral rhytides is a frequent source of patient concern following standard rhytidectomy. Dissatisfaction with the limited results and occasional complications that result from mechanical, manual, and chemical abrasive methods of management prompted application of the steel blade dermal shave technique to this problem. Manual oscillation of a sterile commercial razor blade with depth and width controlled by digital pressure eradicates all but the deepest perioral wrinkles. Eleven patients have undergone razabrasion within the past 19 months without complication. Local anesthesia is sufficient. Topographically distant but synchronous facial operations may be performed safely, but undermining of the shaved facial skin should be avoided for 6 months after razabrasion. Later results will be studied to define the longevity of the effect, but we are encouraged that the method offers the most gentle, most rapid, and best controlled (as to level of dermal shave) current method of tangential dermal splitting. The paper describes the technique of razabrasion of perioral rhytides and reports our early results.     

Correction of the acid-base balance and postoperative diuresis

The significance of the correction of postoperative acidosis for the kidney's excretory activity has been studied on clinical material. The volume of the urine discharged during the first 24 postoperative hours was significantly increased in patients (corrected group) whose acid-base balance had been restored according to careful calculation. Intensified diuresis in the first 12 hours accounted for 70% of this increase. There was no appreciable difference between the corrected and the noncorrected group concerning specific gravity and pH-value of the urine and serum ionogram. Values of urinary electrolytes, as observed in the corrected group, were not essentially different from the usual postoperative values. It is suggested that the correction has no effect on the hormonal factors influencing postoperative renal functions. Readjustment of the acid-base balance facilitates a quicker normalization of tubular function.     

The intercollegiate Basic Surgical Skills Course

Objective: This study was undertaken to establish residents progress in minimal access surgery (MAS) after attending the Intercollegiate Basic Surgical Skills Course (BSSC) by means of the Xitact LS500 laparoscopy simulator assessment program. Methods: Twenty-five surgical residents attended the BSSC in Leiden and Eindhoven, The Netherlands. Before and after the course, participants performed three runs on the Xitact LS500, featuring a standardized laparoscopic cholecystectomy clip-and-cut task. A control group of 25 interns not attending the course also performed two sessions of three runs. Parameters of interest were score and time for completion of task. Results: No significant differences were found within the resident group for the parameters time and score when comparing outcomes pre- and post-BSSC. No significant differences were found comparing time and score between residents and interns on each of the six runs, except for time in run 2. Over six runs, both residents and interns became significantly faster. Conclusions: The Xitact LS500 cholecystectomy simulator did not detect significant improvement in MAS performance among a group of surgical residents attending the BSSC.     

The no-reflow phenomenon is a post-mortem artifact

Summary Post-ischemic reperfusion impairment, (no-reflow phenomenon), was studied in rats subjected to 8–30 minutes of global brain ischemia. During ischemia, rapid and complete loss of cerebral blood flow, EEG and³¹P-high energy phosphates (ATP/PCr) was observed.Brain intravascular perfusion defects were examined by injecting carbon blackintravenously in a group of rats with stable cardiopulmonary function and in another group subjected to rapid thoracotomy andintraarterial infusion of the carbon marker. Results indicate that global brain ischemic or non-ischemic control rats givenintraarterial carbon black after thoracotomy had varying degrees of vessel filling defects in brain resulting in pale tissue areas suggestive of impaired perfusion (no-reflow). All rats given carbon blackintravenously whether global brain ischemic or not, showed normal cerebrovascular filling of the carbon black and absence of pale tissue areas. In addition, post-ischemic cerebral reperfusion following 8–30 minutes global brain ischemia can reverse neuroelectric, energy metabolite and cerebral blood flow loss in rats whose cardiopulmonary function is not compromised.These findings indicate that the no-reflow phenomenon is an agonal or post-mortem artifact observed in the presence of cardiopulmonary failure.     

Construct validity

Background: This study was undertaken to establish construct validity of the Xitact LS500, a virtual reality laparoscopic cholecystectomy simulator. The primary research statement is: The clip-and-cut task on the Xitact LS500 virtual reality laparoscopic cholecystectomy simulator mimics the surgical procedure of the clipping and cutting of the cystic duct and artery during the laparoscopic cholecystectomy adequately. Methods: According to the level of experience of the surgeon, an expert group opinion was formed resulting from 37 surgeons having performed over 100 laparoscopic cholecystectomies, and a novice group opinion was formed resulting of 37 surgeons having no experience at all with performing laparoscopic cholecystectomy. Participants received an instructed hands-on tour on the Xitact simulator and performed three formal simulation runs. Results: The novice group is younger and more surgeons are female. Performance scores in the expert group are significantly higher on the second (p value 0.011) and third (p value 0.005) run, compared to the novices scores. Experts are significantly faster on completion of all three runs. There is an increase in score over runs in both groups, which is statistically significant in the expert group. Less than one-third of surgeons in either group are able to correctly predict their performance score as generated by Xitact. Both experts and novices feel it is useful to train with Xitact LS500 in the surgical curriculum. Conclusions: Three hypotheses, formulated to operationalize the primary research statement, could be answered affirmatively. Although further validation studies are needed, the Xitact LS500 simulator seems to be able to discriminate between expert and novice surgeons in this research setting, and thus the construct for this setting is considered to be valid.     

Urethro-vesical function during spinal shock

Summary Twenty spinal shock patients were investigated with simultaneous urethrovesical, anal and rectal pressure recordings and EMG of the external urethral and anal sphincters. Dynamic and static urethral pressure profiles (UPP) were carried out with empty and full bladder. Baldder filling was accompanied by an increased resistance in the internal sphincter zone, which in turn was paralleled in the majority of cases by an elevation of pressure in the membranous urethra without concomitant increase of its EMG activity. This is suggestive of an increased sympathetic activity in the bladder neck area and in the smooth muscle component of the external urethral sphincter. Dynamic pullthrough UPP's displayed higher resistances in the membranous urethra than static interrupted UPP's pointing to the role played by the urethral muscosal receptors in eliciting artefactual results. Higher pressures were recorded in the juxtabulbar portion of the membranous urethra than in its mid portion pointing to a gradient of pressure within the external urethral sphincter itself. The amount of EMG activity recorded in the anal and urethral sphincters at rest was somewhat decreased; high pressures and distinct reflex activity were recorded in both sphincters showing that they escape spinal shock characterized primarily by areflexia. After defining spinal shock a rational explanation based upon neuroanatomical and neurophysiological findings is offered as to why somatic activity of the sacral segments escapes it as evidenced by clincial, urodynamic, and electromyographic recordings.     

Absorptiometry and “osteoporosis”: problems

connecting the dots between diverse clinical and other matters and an updated bone physiology reveals relationships that could modify some ideas about the roles and uses of absorptiometry in osteoporosis work. Herein, absorptiometry means that part of clinical densitometry that depends on X-ray absorption by bone and other tissues, thus excluding ultrasound methods and magnetic resonance imaging. The modifications concern, in part, some limitations of bone mineral density data, the kinds of physiological information that absorptiometry can and cannot provide, the relative importance of bone mass and whole-bone strength, how to define and study bone health and osteoporosis, and two kinds of osteoporotic fractures. As those modifications concern important national health care issues, they deserve answers based on hard evidence. Identifying those modifications might help others to evaluate them.     

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.     

The effect of anaesthesia and surgery for benign disease of the upper urinary tract on circulating leucocyte subpopulations identified with monoclonal antibodies

Summary Circulating lymphocyte subpopulations were monitored, using monoclonal antibodies and flow cytometry, in six patients undergoing surgery for benign disease of the upper urinary tract. A significant decrease in the total number of circulating lymphocytes was observed. This could be attributed to a significant decrease of T cells of both major subsets — the so-called T helper (Th) and T suppressor/cytotoxic (Ts) subpopulations. When the results of the T cell subsets were expressed as a ratio (leu-3a⁺/leu2a⁺, T helper/suppressor) no significant change was noted. In contrast neither B cells nor natural killer (NK) and antibody dependent killer (K) cells were significantly affected. This selective loss of T cells from the circulation may be relevant to post operative infection and should be considered in the course of immunological monitoring.Supported by the Cancer Research Campaign     

Prognostic evaluation before operative extirpation and radiotherapy of solitary brain metastasis

Summary This is a retrospective study of 134 patients operated on for solitary brain metastasis at the University Hospital in Uppsala, Sweden between 1963 and 1982. All the patients underwent postoperative radiation therapy. A statistical evaluation of different prognostic factors was made in order to create a prognostic model, a so-called risk profile, to be used for future patients. The most important factors for the making of risk profiles were found to be the histological diagnosis followed by the location in the brain, then the state on admission and the age at admission in that declining order. All these variables separately and together,i.e., as risk profiles, were matched against the outcome during survival as Karnofsky's scores and against the length of survival time. The results are shown in a diagram giving the surgeon grounds for his decision-making for or against operation and also for pre-operative information.     

Observations on the mode of uptake of thorium dioxide particles by osteoclasts in fracture callus

The ruffled border of osteoclasts in the fracture callus of rat consists of complex infoldings of the plasma membrane forming narrow channels. Absorption of an exogenous, electron-dense compound, thorium dioxide, has been shown to take place via these channels, apparently through membrane flow. The contents of the channels are transferred to lysosomes (specific granules) located subjacent to the ruffled border. In transitional regions adjacent to the ruffled border, uptake of thorium dioxide particles appeared to occur through membrane vesiculation (conventional endocytosis).

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Zusammenfassung Der gekrauste Rand der Osteoklasten im Frakturcallus von Ratten besteht aus komplexen Einstülpungen der Plasmamembran, die enge Kanälchen bildet. Die Absorption einer exogenen, elektronisch dichten Verbindung, Thoriumdioxyd, erfolgt durch diese Kanäle, offenbar durch einen Membranfluß. Der Inhalt der Kanäle wird zu den Lysosomen (spezifische Granula) geführt, welche unter dem gekrausten Rand liegen. In Übergangsgebieten, welche sich neben dem gekrausten Rand befinden, scheint die Aufnahme der Thoriumdioxydpartikel durch Bläschenbildung in der Membran (konventionelle Endocytose) stattzufinden.

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Résumé La bordure en brosse des ostéoclastes de cals de fractures de rats présente des plissements complexes de la membrane cytoplasmique formant des canaux étroits. L'absorption d'un produit exogène opaque aux électrons (des macromolécules de dioxyde de thorium) s'effectue par l'intermédiaire de ces canaux, par un «courant» membranaire. Les contenus des canaux sont transférés à des lysosomes («granules spécifiques»), situés sous la bordure en brosse. Dans des «régions de transition», adjacentes à cette dernière, l'absorption de dioxyde de thorium se fait par «vésiculation membranaire» (endocytose classique).

     

Cranioplasty of an extremely large cranial defect caused by transitional meningioma with a knitted polypropylen-polyester prothesis “Codubix”

Summary The authors report a case of transitional cell meningioma of the convexity which destroyed a large portion of the calvarium and invaded subcutaneous tissue. The tumour was totally removed and a large cranial defect/430 cm² in size/ was filled with a polypropyleno-polyester knitted prothesis Codubix with an excellent result.The problems of chronioplastic closure of such an unusually large skull defect and the advantages of the use of the material Codubix are discussed.     

Femur density in alcoholism and after gastrectomy

The bone mineral mass in the distal end of the femur was evaluated in 121 men, half of which were alcoholics. It was demonstrated that in alcoholics the bone mass was significantly decreased but only in combination with previous gastrectomy.Financial support for this study was obtained from Alfred Österlunds Stiftelse and Herman Järnhardts Stiftelse.     

Notes on male rhytidectomy

Summary Measurements of 100 preauricular hairline distances were done, and a normal average was established. The joined male rhytidectomy and the frontal alternating fusiform excisions are described.     

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.     

Small intestinal lymphoma

This paper reviews small intestinal lymphoma. Although a major emphasis is placed on primary small intestinal lymphoma of the Western type, the important topic of lymphoma in celiac disease is discussed. Our own recent experience of 7 patients with lymphoma in celiac disease is presented. The lymphoma of immunoproliferative small intestinal disease (Mediterranean lymphoma) and the associated -chain disease are also reviewed, with emphasis on the differences from the Western type of primary small intestinal lymphoma.

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Resumen Este artículo revisa el tema del linfoma intestinal. Aunque se hace énfasis principal en el linfoma intestinal primario del tipo Occidental, también se discute el tópico relativo al linfoma en la enfermedad celiaca. Se presenta un estudio sobre nuestra experiencia reciente con 7 pacientes con linfoma en enfermedad celiaca. También se revisan la enfermedad inmunoproliferativa del intestino delgado (linfoma Mediterráneo) y la enfermedad de cadena asociada, con énfasis en sus diferencias con el tipo Occidental de linfoma primario del intestino delgado.

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Résumé Cet article est consacré au lymphome de l'intestin grÊle. Bien que centré sur le lymphome primitif (dit lymphome de type occidental) il concerne également le lymphome qui traduit une manifestation d'une maladie immunoproliférative de l'intestin (qualifié de lymphome de type méditerranéen) et ce à partir d'une expérience de 7 malades présentant une maladie coeliaque. Ce second type et la maladie associée de la chainealpha sont également étudiés en s'attachant à souligner les éléments distinctifs qui les séparent du lymphome primitif.

     

Polymeric pyelotomy

A non-toxic, soluble polymeric preparation MAG with controlled period of gelation was synthetized for the extraction of stones from the pyelocalyceal system during surgery for urolithiasis.With respect to toughness the preparation proved superior to the fibrinogenthrombin mixture, used in the so-called fibrin pyelotomy according to Dees. Its biologic testing in animals (rabbits, dogs and pigs) yielded excellent results.By analogy with fibrin pyelotomy we took the liberty to propose the term polymeric pyelotomy.     

Antiandrogenic treatment of benign prostatic hyperplasia: a placebo controlled trial

Summary In a randomized triple-blind multicentre study, injections with the anti-androgenic agent oxendolone were compared with placebo in the treatment of benign prostatic hyperplasia. Thirty patients were treated with weekly injections of oxendolone 200 mg during a 3 months' period, and 30 patients were allocated to placebo treatment. During oxendolone treatment the maximum urinary flow rate increased statistically significantly (from 6.8 ml/s to 8.2 ml/s). However compared to placebo, the oxendolone effect was statistically insignificant. A slight but statistically significant improvement of the symptoms sensation of retention, urgency and frequency, was observed following oxendolone treatment, but an almost identical effect was seen in the placebo group. Following either treatment no change was observed in the residual urine volumes, in prostatic volume as measured by transrectal ultrasonotomography, or in any other therapeutic parameters. Conservative treatment of benign prostatic hyperplasia with the antiandrogen oxendolone in a dose of 200 mg a week cannot be recommended for clinical use.{ogClinical Affairs}{onH. Lundbeck A/S}{cyDenmark}     

A versatile procedure for the closure of small skin defects

The author describes a method for the primary, direct closure of wide skin lesions, combining the lazy S, crown, and the H-advancement flap techniques. The lazy S edges of the flaps permit the satisfactory use of adjacent surrounding skin with good aesthetic results, when the flaps alone would otherwise be placed under too much strain.