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.     

Computer assisted quantification of vasospasm on angiograms

Summary We describe a new computer-based, automated method for the assessment of in vivo cerebral vasospasm. Arterial diameter measurements were performed on post-processed digital substraction angiographic images, using pixel as the unit. Vasospasm which was difficult to detect by visual inspection could be measured by the stenosis quantification program. A computer-assisted method such as we describe might decrease the risk of subjective errors.     

Primary bladder neck obstruction

Summary Primary bladder neck obstruction is not uncommon in young and middle age men. The symptoms are confounding and routine urologic investigation including cystometry, uroflow, voiding cystourethrography and cystourethroscopy often leads to an erroneous diagnosis of psychogenic voiding dysfunction, neurogenic bladder or prostatitis. An accurate diagnosis can be obtained by the simultaneous measurement of detrusor pressure and uroflow, preferably accompanied by radiographic visualization of the lower urinary tract during micturition. Treatment with bladder neck incision is usually curative, but often results in retrograde ejaculation.     

Demonstration of the 5-flap technique

Summary Demonstration of the 5-flap technique which is double opposed Z-plasty and Y – V advancement is presented. A 4×4 gauze serves to demonstrate this technique.The authors dedicate this paper to the dear memory of their teacher, the late Prof. Zvi Neuman, who passed away untimely on March 22, 1977     

Aesthetics of feminizing the male face by craniofacial contouring of the facial bones

The forceful and macho look of a prototypical man may not be unduly appealing to others whom he meets. This forceful look might not even appeal to the individual himself. In order to soften this appearance, a series of operative procedures has been devised for use on the craniofacial skeleton. These surgical steps can be done in a single operation or as a series of multiple operative procedures. Moreover, the needs of some patients may require that only special segments of these procedures be performed. This article presents these operative procedures and describes the feasibility with which they can be performed. Complications and unfavorable outcomes, when they occur, are usually related to unrealistic expectations on the part of the patient. The surgical steps routinely performed are those that contour the forehead, orbits, malar eminence, cheeks, chin, angle of the mandible, and larynx. Three categories of patients are described: the female with a male face; the male with a forceful look; and the patient requesting a gender identity change. The psychosocial, psychological, and behavioral problems leading to the decision for surgery will be the basis of final patient selection.Presented at the 9th Congress of the International Society of Aesthetic Plastic Surgery, New York City, October 1987     

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.     

A Systemic “dumb-bell” haemangiopericytoma

Summary Systemic haemangiopericytoma is a rare soft tissue tumour originating from pericytes which are contractile pericapillary cells, and represents less than one percent of all vascular neoplasms [5]. The most common site of involvement is the thigh followed by the retroperitoneum, while the paraspinal location is very rare [1, 3].We report the first case of systemic dumb-bell haemangiopericytoma illustrated radiologically, which mimick, a dorsal dumb-bell neurinoma.     

Reconstruction of bony defects using the Ilizarov “bone transport” technique

Summary Ilizarov's method of percutaneous transosseous osteosynthesis allows management of complex skeletal deformities using elastic external fixation, atraumatic corticotomy and gradual adaptations between bony fragments. One particular application, useful in the reconstruction of bony defects, is the lift or bone transport technique, in which in fact internal lengthening is carried out. Using some of their first cases as illustrations, the authors describe the technique and its potential problems.     

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.     

Vertical lengthening of the unilateral cleft lip after a triangular flap repair

Summary A triangular flap repair for unilateral cleft lip is stated to have the potential problem of creating a lip that is too long. Although preoperative measurements were performed with calipers, the gap created in the medial segment was directly measured during the procedure, in order to determine the size of the flap more precisely. Ninety patients with complete unilateral cleft lips underwent a triangular flap repair using this method. The symmetry of the Cupid's bow was evaluated at a follow-up period averaging between six years and three months. Sixty-two lips obtained symmetry and the remaining 28 cases showed a lip which was too long; none of the lips were too short. The comparison between 27 primary palate clefts (UCLA) and 63 primary and secondary palate clefts (UCLP) showed no significant difference in the surgical result. The preoperative shortness of the lip on the cleft side was significantly greater in the too long group (5.01 ± 0.95 mm) than in the symmetry group (4.40 ± 0.87 mm). The width of the flap used was significantly larger in the too long group (3.76 ± 0.79 mm) than in the symmetry group (3.42 ± 0.69 mm). The triangular flap repair with intraoperative measurements is considered to be beneficial, although preoperative measurements provide an optimal design in most cases. It is suggested that the use of a wider triangular flap results in a lip which tends to be too long in spite of the preoperative shortness on the cleft side.     

Comparison of adrenoceptor subtype expression in porcine and human bladder and prostate

We have quantified and characterized ₁-, ₂-and -adrenoceptor subtypes in porcine bladder detrusor and bladder neck, human bladder detrusor, and porcine and human prostate. ₁-, ₂- and -adrenoceptor were identified in radioligand binding studies using [³H]prazosin, [³H]RX 821002 and [¹²⁵I]iodocyanopindolol, respectively, as the radioligands. In porcine male and female detrusor and bladder neck and male prostate, adrenoceptors were detected in the order of abundance > _{2 1} (not detectable), with no major differences between the sexes or between detrusor and bladder neck. In human detrusor and prostate the order of abundance was > _{2 1} (not detectable) and ₁ > ₂. respectively. The ₂-adrenoceptors in all tissues were homogeneously of the _2A-subtype as evidenced by competition binding studies with yohimbine, prazosin, ARC 239 and oxymetazoline. The -adrenoceptors represented a mixed population with a dominance of the ₂-subtype in all tissues as demonstrated by competition binding with ICI 118,551 and CGP 20,712A. We conclude that pigs may be a suitable model for studies of detrusor function with respect to adrenoceptor expression. They may be less suitable for studies of bladder neck or prostate function.     

Replacement of the anterior cruciate ligament

Summary Eighty-seven patients have been examined 2 years on average after knee ligament reconstruction for a torn anterior cruciate ligament. The patients were divided into four groups according to the type of operation that had been carried out. In the first group an extra-articular lateral repair (MacIntosh tenodesis) had been performed, in the second group an intra-articular over-the-top repair using the quadriceps and the patellar tendon, in the third group a modified Eriksson procedure using the patellar tendon, and in the fourth group a combined intra- and extra-articular repair using carbon fibres as a graft. The results of the operations in the different groups are compared. The best results were obtained with the Eriksson procedure, closely followed by the over-the-top repair. Limited range of motion and retropatellar pain resulting from changes in the alignment of the patella were the main problems. The results after the use of carbon fibres were less good. In two cases the graft tore without further trauma, and there were also problems because of restricted range of motion and retropatellar pain. The worst results were found after extra-articular lateral repair, due to insufficient stability in many cases. However, the best results with regard to the range of motion were found in this group.

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Zusammenfassung Es wurden 87 Patienten im Durchschnitt 2 Jahre nach Ersatzplastik bei zerrissenem vorderem Kreuzband und chronischer Instabilität nachkontrolliert. Die Patienten wurden in vier Gruppen eingeteilt. In jeder Gruppe war eine andere Art von Ersatzplastik durchgeführt worden. In der ersten Gruppe war es ein extraartikulärer lateral repair (sog. MacIntosh-Plastik), in der zweiten Gruppe eine intraartikuläre over the top geführte Plastik mit der Quadriceps- und der Patellarsehne, in der dritten eine modifizierte Eriksson-Plastik unter Verwendung der Patellarsehne und in der vierten Gruppe eine kombinierte intra- und extraartikuläre Plastik mit Carbon fibres. Die Resultate der Operationen in allen vier Gruppen werden miteinander verglichen. Die besten Ergebnisse zeigte das Vorgehen nach Eriksson, dicht gefolgt vom over the top-repair. Probleme, die in diesen zwei Gruppen auftraten, betrafen eingeschränkte Kniebeweglichkeit und retropatelläre Schmerzen wegen veränderter Führung der Patella. Die Resultate in der Gruppe mit Verwendung der carbon fibres waren weniger gut. In zwei Fällen ist das Transplantat ohne Trauma gerissen, zudem traten auch hier Beschwerden auf wegen eingeschränkter Beweglichkeit und retropatellärer Schmerzen. Am wenigsten gut waren die Resultate nach extraartikulärem lateral repair. In vielen Fällen konnte durch these Methode keine genügende Stabilität erreicht werden. Andererseits war die Beweglichkeit des Kniegelenkes nach dieser Operation kaum je eingeschränkt.

     

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.     

Zur Entwicklung der Hüftluxationsbehandlung im Laufe der Medizingeschichte

Zusammenfassung Die historische Entwicklung der ärztlichen Heilmaßnahmen zur Hüftgelenksreposition bei der typischen angeborenen Verrenkung ist ein interessantes Spiegelbild der gesamten Medizingeschichte und der Orthopädie im besonderen. Schon Hippokrates hat auf Grund recht guter pathologisch-anatomischer Sachkenntnis in seinem bedeutenden Werk i — über die Einrichtung der Gelenke — ein ebenso einfaches wie zweckmäßiges Extensionsverfahren am luxierten Bein dargestellt. Nach einer auffallend langen Zeitspanne resignierter Beschränkung auf rein palliative Therapie folgte eine radikal-aktive Ära der operativ-chirurgischen Reposition der kongenitalen Hüftluxation — vor allem repräsentiert durch die blutige Einrenkungsmethode von Hoffa und Lorenz. Erst die klinischen Mißerfolge dieses heroischen Vorgehens mit seiner Möglichkeit eines genauen bioptischen Studiums der weichgewebigen und artikulären Skeletsituation schufen die Grundlage zur Entwicklung der klassischen unblutigen Repositionsmethode, um deren Primat zwischen dem Italiener Paci und Adolf Lorenz eine heftige Kontroverse entstand. Zur stabilen Retention der eingerenkten Luxationshüfte wurden in der Folgezeit sehr verschiedenartige Gipsfixationen und Spreizapparate empfohlen — am bekanntesten die Lorenzprimärstellung, die weniger forcierte Langeposition und das geniale Schedelaufrad. Die moderne Orthopädie hat für die operative Korrektur unblutig nicht zu reponierender Hüftluxationen, etwa beim Vorliegen eines weichgewebigen Interpositums, oder bei unbefriedigendem Behandlungsergebnis eine ganze Reihe chirurgischer Hilfsoperationen — jeweils mit ganz spezieller Indikation — zur Verfügung: Die blutige Einrenkung, die Pfannendachplastik bei mangelhafter knöcherner Formsicherung des Acetabulums, die Femurosteotomie bei bestehender Oberschenkeldeformität im Sinne einer Coxa valga oder pathologischer Antetorsion des proximalen Femurendes — schließlich die Arthroplastik mit oder ohne Endoprothese bei schmerzhaft-kontrakten Spätzuständen. Als ultima ratio kann in besonders schweren Fällen ein stabiles beschwerdefreies Standbein durch Arthrodese geschaffen werden. Selbstverständlich werden heute auch sämtliche bewährten sonstigen physikalischen Hilfsmittel und Heilverfahren — aktive und passive Gymnastik, temporäre Gamaschenextension und Apparatentlastung, Massage und Bäderbehandlung — zur Verbesserung von Form und Funktion der Luxationshüften in den großen Kreis therapeutischer Möglichkeiten einbezogen.Die Arbeit wurde auf die Initiative und unter der Leitung von Herrn Prof. Dr. Rupprecht Bernbeck, München, verfaßt.     

Transforming growth factor-β and prostate cancer

Summary This review focuses on the possible role of transforming growth factor- isoforms 1–3 (TGF) in prostate cancer. TGF1 appears to inhibit the cellular proliferation of normal prostate cells. Surprisingly, TGF1 is overexpressed in prostate cancer. To help explain this apparent paradox, it has been revealed that with tumor progression, prostate cancer cells acquire reduced sensitivity to the growth-inhibitory effects of TGF1. Aberrations of the TGF1 signaling pathway at the prereceptor, receptor, or postreceptor level may lead to prostate cancer cell resistance to TGF1 growth inhibition. Indirectly, elevated levels of TGF1 may induce host effects that may be beneficial to prostate tumor growth by suppressing the immune system, promoting angiogenesis and extracellular matrix formation, and enhancing metastatic potential. Consequently, TGF1 appears to be important in prostate carcinogenesis and tumorigenicity. TGF2 and TGF3 are only briefly presented as very little is known about their role in prostate cancer.     

209. Die Behandlung der nichtinfizierten Schaftpseudarthrosen

Zusammenfassung Während bei der reaktiven, elefantenfußartigen Form eine stabile Osteosynthese die Heilung zur Folge hat, sind beim reaktionslosen atrophischen Poeudarthrosetyp zusätzlich zur stabilen Osteosynthese eine Dekortikation und eine Spongiosaplastik notwendig.Im Film werden beide Pseudarthrosetypen an der Tibia mit einer Platte stabilisiert, und zwar einer Zuggurtungsplatte für die elefantenfußartige und einer Neutralisationsplatte für die atrophische Pseudarthrose. Im letzteren Fall erfolgt nach Dekortikation und Spongiosaplastik zusätzlich ein Längenausgleich der um 2,5 cm verkürzten Tibia. Technik der Behandlung der Pseudarthrosen sowie der Verlängerung werden im Schema und in den einzelnen Operationsphasen ausführlich dargestellt.

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The treatment of non-infected pseudarthroses of the tibia

Summary The elephant foot type of reactive pseudarthrosis heals after rigid internal fixation, but the atrophic, non-reactive type requires decortication and an autogenous cancellous bone graft in addition.The film shows stabilization of the tibia with a plate in both types; a tension band plate is used in the case of elephant foot type pseudarthrosis and a neutralizing plate in the atrophic case. In the latter case the tibia has shortened by 2.5 cm, and this is corrected after decortication and the autogenous bone graft are complete. The techniques to be used in the treatment of pseudarthroses and that of lengthening are illustrated in detail, both in diagrams and at various stages of the operation.

     

An immunohistochemical study of glucagonoma conducted on the metastatic lymph nodes from a patient with recurrent metastatic glucagonoma: Report of a case

In this report, we briefly present the case of a 67-year-old woman who developed recurrent glucagonoma with lymph node metastasis. An immunohistochemical study of the metastatic tumor revealed immunoreactivity of glucagon and protein kinase C (PKC)-, -, and - in the tumor cells, two types of which were seen by electron microscopy. One type had abundant secretory granules and mitochondria, while the other had few granules and mitochondria. Some granules were similar to typical A cell granules and others were atypical. An immunoelectron microscopic demonstration revealed PKC-, -, and - immunostaining in the cytoplasm of all the tumor cells, while some secretory granules had PKC immunostaining, and others had no immunostaining. Thus, it appears that metastatic glucagonoma and its associated granules are composed of two types of mature and immature cells or granules. As immunoreactivity of PKC- and - was found in the tumor cells, but not in the normal A cells of the islets of Langerhans, the PKC subspecies and , which are not present in normal pancreatic A cells, may exist in human glucagonoma cells.     

The intrathecal spread of hyperbaric dibucaine in adolescents

We investigated the spread of spinal anesthesia with hyperbaric dibucaine in 20 adolescents aged 9–18yr and 20 adults aged 23–53yr. No significant difference was found between the two groups with regard to height, whereas a statistical significant was found between the two groups with regard to weight. Spinal anesthesia was conducted with Neo-Percamin S^® injected at the L3–L4 interspace through a 25-gauge spinal needle. Injected volumes of the anesthetic solution were calculated from the patients height at 0.01ml·cm^–1. In adolescents, 1.6 ± 0.1ml (mean ± SD) of the anesthetic solution produced 19.4 ± 1.5 spinal segments blocked. In adults, 1.6 ± 0.1ml of the solution produced 13.4 ± 1.6 spinal segments blocked. A high spinal anesthesia above T5 was achieved in 17 (85%) patients in adolescents, whereas such a high level of spinal anesthesia was not experienced in adults. These results suggest that the hyperbaric dibucaine solution for spinal anesthesia in adolescents may have a tendency to produce an unexpectedly extensive spread of anesthesia.(Hirabayashi Y, Shimizu R: The intrathecal spread of hyperbaric dibucaine in adolescents. J Anesth 7: 167–172, 1993)     

Influence of intravesical administration of tumor necrosis factor α and systemic γ-interferon on murine bladder cancer: Lack of dose response

Summary The effect of intravesical administration of high dose recombinant tumor necrosis factor- (rTNF) and in combination with systemic recombinant -interferon (rIFN) on murine bladder cancer was studied. RTNF was given at 12.5 g/mouse on days 7, 11 and 15 after tumor instillation or at 2.5 g/mouse on days 7, 9, 11, 13 and 15. Some groups were also injected i.v., 24-h prior to each rTNF treatment with rIFN at a dose of 1.3 g/mouse. RTNF treatment suppressed tumor growth up to 48% of control, although the difference was not statistically significant. Combined administration of rIFN did not provide additional benefit.     

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.