A case of cystadenocarcinoma of the liver

A case of cystadenocarcinoma of the liver is reported. The patient was a 73-year-old woman in whom a tumor was detected in the lateral segment of the liver during a health examination. Ultrasonograms and computed tomograms showed a multilocular cystic mass. Magnetic resonance imaging (MRI) showed a multilocular lowintensity mass, including a high-intensity portion and a portal branch compressed by the tumor. MRI with gadolinium showed an enhanced cyst wall. The cystic part of the tumor became smaller and the solid part became larger over a 1-month period, indicating that the tumor was malignant. Subsegmentectomy (S₃) was performed and cystadenocarcinoma with cystadenoma was diagnosed by histopathological examination. Identification of changes in the appearance of a tumor should be helpful for the differential diagnosis of cystadenoma and cystadenocarcinoma.     

Comparison of costs of different anaesthetic techniques

The costs of anaesthetic drugs, intravenous agents as well as gases, were studied for different anaesthetic techniques in a medium-sized operative procedure, cholecystectomy. Three anaesthetic breathing systems were used: a non-rebreathing system, a circle absorber system with medium fresh gas flows of 3-6 l/min, and a low-flow circle system. Anaesthesia without volatile inhalation agents used with a low-flow technique was the least expensive, and anaesthesia with isoflurane in a non-rebreathing system was the most expensive. The costs of anaesthesia without volatile inhalation agents in a non-rebreathing system, enflurane anaesthesia in a circle system with medium fresh gas flows, and isoflurane anaesthesia with low-flow technique were similar.     

Influence of fracture criteria on the outcome of a randomized trial of therapy

Based on a presumption that the morphometric approach to vertebral fracture assessment is beset by false positive deformities, it has been suggested that more stringent criteria should be used to assess vertebral fracture outcomes in clinical trials of osteoporosis therapies. We applied a variety of criteria in the reanalysis of a randomized trial of sodium fluoride therapy for women with established osteoporosis. Although progressively more severe criteria reduced the cumulative incidence of a new vertebral fracture in both those receiving a placebo and the fluoride-treated patients, differences between the two groups were not magnified and none of the suggested approaches produced a statistically significant result. These findings indicate that the false positive rate associated with morphometric assessment of vertebral fractures is not so great as supposed from theoretical considerations that assume independence among the measurements. Our findings also provide some reassurance that differences in the criteria used to define a vertebral fracture are not the controlling influence in the likelihood that a particular clinical trial will find a result favoring one treatment over another.     

Control of hormonal treatment of carcinoma of the prostate

Summary Hormone therapy still has a central role in the treatment of carcinoma of the prostate. The present study is concerned with the possibility of controlling the administration of hormones by estimation of plasma testosterone and LH levels. Plasma testosterone levels were determined by a new modification of competitive protein binding method, and LH by a conventional radioimmunoassay.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.     

Rare case of the hyaline vascular type of Castleman''s disease of the kidney

Castleman's disease (CD) is a rare disorder characterized by a benign proliferation of lymphoid tissue. Most cases tend to present as a mediastinal mass. A few extrathoracic cases involving nodal and extranodal locations have previously been reported. To the best of our knowledge, however, only one case of CD of the kidney has been published in an English report. We herein report a rare case of CD presenting as a left renal tumor. A 70-year-old male was examined by computed tomography for a follow-up for colonic diverticulitis and a left renal mass measuring 2.0 cm in diameter was incidentally found. The patient underwent a left partial nephrectomy for a left renal mass and a histopathological analysis demonstrated the hyaline vascular type of CD. Based on our findings, CD should be included in the differential diagnosis of renal tumors.     

Imaging of Dermatofibrosarcoma Protuberans of Breast

Abstract: Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45‐year‐old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high‐density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians. A solitary mixed echogenicity and ill‐defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP.     

The Retroperitoneoscopic Repair of a Lumbar Hernia of Petit Case report and Review of Literature

In this paper, we comment on a patient who consulted us because of his «lower backpain» together with the appearance of a small swelling at the left side. Anamnesis and clinical examination were suggestive and further simple diagnostic methods confirmed the exceptional diagnosis of a «lumbar hernia of Petit». We describe the retroperitoneoscopic approach of this hernia, its reduction and the fixation of a polypropylene mesh at the surrounding structures with a Tacker. This approach provided a good postoperative comfort, a shorter hospital stay and an early recovery of autonomy and activity.

Furthermore, we give a review of the literature concerning lumbar hernias and the evolution of the different reconstruction techniques.     

胫骨上端三维有限元模型的建立

目的 建立胫骨上端的三维有限元模型，以期为膝关节三维有限元的建立和研究，提供方法学和研究平台。方法 根据螺旋CT扫描图像，利用Ansvs有限元软件的由下向上的点、线、面、体的建模原则，对胫骨上端的三维有限元模型进行重建.结果 建立了胫骨上端的三维有限元模型。结论 本研究所建立的胫骨上端的三维有限元模型，能逼真地反应胫骨上端的真实几何结构。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Feasibility and morbidity of reversal of Hartmann''s

OBJECTIVE: Reversal of Hartmann's is a major surgical procedure and associated with substantial morbidity and mortality. METHOD: This study retrospectively analysed the data at a single centre over an eight-year period to assess the clinical results and morbidity of reversal of Hartmann's. RESULTS: One hundred and ten Hartmann's procedures were performed during the period. Only 66 (61%) of patients had a reversal. Advanced age and comorbidity were the primary reasons for not reversing. Complications among the 66 patients (36 males and 30 females) who underwent reversal occurred in 26 (41%). There were no deaths. Patients who underwent reversal were ASA 2 (60%), ASA 3 (25%) and ASA 4 (4.6%). Univariate analysis demonstrated a significant association between complications following reversal and ASA grade (P =0.01), and hypertension (P = 0.03) There was no correlation between the patient variables and anastomotic leakage. Multiple logistic regression analysis showed a significant influence of hypertension, smoking and ASA grade on complications. CONCLUSIONS: About 40% of patients who undergo Hartmann's procedure will not have a reversal. Reversal is a feasible operation for selected patients, but there is a high complication rate.     

Use of ceramics of calcum triphosphate in the repair of tibial plateau fractures: a series of 20 cases

Summary In 20 patients operated for displaced fractures of the tibial plateau, we used pieces of ceramics of tricalcium phosphate to fill the bony defect in the tibial metaphysis. Eighteen were followed up with a mean interval of 35 months (24 to 6o months). The other two patients were lost sight of. There were 11 men and 7 women with a mean age of 55 years (2o to 83 years). In 10 cases the injury was a traffic accident (a pedestrian knocked down by a vehicle) and in 8 cases a fall. Subject to a wider study, the ceramics of tricalcium phosphate, thanks to their remarkable biologic properties, appear to be the bone substitutes of choice in the filling of post-traumatic bony defects. However, there is as yet no absolute proof of their superiority.Paper presented at the 1998 meeting of GECO (Arc 1800. Bourg-Saint-Maurice, France)     

Intraperitoneal Rupture of the Ureter as a Cause of Generalized Peritonitis: Report of a Case

We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.     

Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: A case report and review of literature of the last 20 years

INTRODUCTIONFractures of the carpal bones are often difficult to diagnose and treat due to the complex bone architecture of this region. Hamate fractures, particularly body fractures, are extremely uncommon.PRESENTATION OF CASEWe present a case of a coronal fracture of the hamate associated with a fracture of the base of the fourth metacarpal, which was treated by open reduction and internal fixation.DISCUSSIONSome of hamate body fractures are associated with other injuries like metacarpal fractures. Its diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. This fracture is a very rare lesion that can raise questions about their most adequate diagnostic and therapeutic approaches.CONCLUSIONAfter reviewing the literature, we conclude that there is a high rate of delay in the diagnosis of these lesions, probably due to their rarity and to the lack of radiological studies specifically targeting this region. Despite this, surgical treatment in its different modalities has been shown to have the best clinical and functional results.     

Non-skeletal determinants of fractures: the potential importance of the mechanics of falls

Bones break because the forces applied to them exceed their strength. For most non-spine fractures, this force results from a fall. Falls generate at least 10 times the energy necessary to fracture the proximal femur, but only 5%–10% of falls in older white women cause fractures and only 1% cause hip fractures. The mechanics of the fall plays a very important role in whether a fracture will occur and which bone will fracture. This review postulates that orientation of the fall and location of the impact determine the type of fracture, and whether a fracture occurs depends on the energy of the fall (distance to impact and weight of the moving parts) and how much of that energy is absorbed by protective responses, the impact surface and soft tissues over the bone. Recent case-control studies support the view that the mechanics of a fall are the most important determinant of whether it will result in a hip fracture.     

Microsurgical arterialization of degloving injuries of the upper limb

The authors describe a technique in which a microsurgical anastomosis between an artery and a vein in an afferent direction (through a vein graft, when necessary) of a degloved flap is used to revascularize or arterialize the flap. In 3 difficult cases, there was substantial salvage of flap tissue.     

Combined modality treatment of Ewing's sarcoma of the maxilla

BACKGROUND: Primary bone sarcomas arising in osseous structures of the head and neck are rare. These tumors are often incompletely resected and treated with radiotherapy for local control. METHODS: We report a case of a 9-year-old girl with a maxillary Ewing's sarcoma. This patient was successfully treated with neoadjuvant chemotherapy followed by surgical resection and prosthetic reconstruction of the primary site. The surgical approach that was used consisted of a subtotal maxillectomy by means of a facial degloving approach, sparing the orbital contents and the inferior orbital rim and orbital floor. RESULTS: This approach produced excellent cosmetic, functional, and oncologic outcome. The patient remains without evidence of disease recurrence more than 4 years after surgery. CONCLUSIONS: This case illustrates a novel surgical approach to the resection of a maxillary Ewing's sarcoma and highlights the need for a multidisciplinary team approach to the management of head and neck sarcomas in children.     

Temporary inhibition of the initiation of motility of demembranated hamster sperm by high concentrations of ATP

ATP is obligatory for sperm movement. When sperm from the hamster cauda epididymis were washed and exposed to a demembranation and re-activation medium containing 0.5 or 1 mM ATP, the maximal % motility was attained almost immediately. Increasing the ATP concentration to 3 mM caused a 5 min delay in development of maximal re-activation and a change in the beating pattern as indicated by a decrease in the % of forward progressing sperm, decreased linear velocities but unchanged curvilinear velocities. The inhibition of motility initiation by 3 mM ATP was abolished either by the inclusion of trypsin (50 ng/ml) or by a brief pre-incubation of the sperm in the demembranation and reactivation medium before the addition of ATP. However, the beneficial effect of pre-incubation was prevented if trypsin inhibitor was present. This indicates that the inhibition by ATP acts via a trypsin-sensitive regulatory system, and suggests that an endogenous protease activity is necessary to overcome this. Re-activation of sperm from the caput epididymis by all three concentrations of ATP showed similar lag periods which could also be diminished by pre-incubation or trypsin. The results suggest that, in addition to developing their motile capacity during maturation in the epididymis, sperm exonemes change their sensitivity to ATP concentrations.     

About cover of ballistic wounds of distal third of leg in civilian ways

Major causes of ballistic wounds are shooting accidents. Goals of this work are to suggest a position about ballistic wounds of leg's distal third. Reconstruction of ballistic wounds of leg's distal third is difficult, because of lack of laxity and veinous drainage in distal third; and characteristics of ballistic wounds. Ballistic traumas give a temporary cavity, which induce levelled wounds of neurovascular pedicules. We present three cases. One patient benefits from a sural flap, whereas the two others benefit respectively from a free parascapular flap and a free latissimus dorsi flap with free osseous graft. Functional results were considered as good. Treatment of ballistic wounds ask for certain specificities: 1) meticulous evaluation of wounds; 2) evaluation of vascular axis of leg. Debridments are numerous under general anaesthesia before a reconstruction with axial regional flap or free flap, which vessels are anastomosed distant. Reconstruction must be done before the tenth day.     

Analysis of complications after repair of hypospadias

We have reviewed 184 patients after repair of primary hypospadias. They were operated on and followed-up according to a standard protocol, and the senior author (HS) participated in all operations. The patients were reconstructed using a Byars two-stage procedure (n=102) or a Scuderi (n=29) or Mathieu (n=41) single-stage procedure. The rest (n=12) just had a removal of the chordee with realignment of the skin. Complications recorded were haematomas, postoperative infections, malfunction of catheter, urinary retention, fistulas, and strictures. Thirty-eight complications developed in 26 patients and the overall incidence of fistula was 22 in 18 patients (10%). Our findings suggest that the most decisive risk factor for complications is the severity of the primary malformation, because a severe malformation per se is difficult to treat as it requires a long reconstruction; in addition the curvature, shortage of tissue, and extensive surgery generally require a staged reconstruction in these cases. Other factors seem to be of much lesser importance.