Effects of Nd-YAG laser on platelet function in vitro: A comparative study using the spectraprobe, ‘hot tip’ and bare fibres

The effects of Nd-YAG laser irradiation on platelet function in vitro were studied using platelet rich plasma obtained from the blood of healthy volunteers. Laser delivery was effected via the bare optical fibre, thermal hot tip fibre and spectraprobe and the effects of these probes on platelet function were compared. Fall in platelet count and mean platelet volume (MPV) were proportional to increasing energy delivery with all three probes, the effect being maximal with the spectraprobe, moderate with the hot tip and least with the bare optical fibre. A significant decrease in percentage aggregation of platelets in response to added ADP, collagen and ristocetin with increasing energy delivery was also observed with all three probes. The formation of preformed aggregates, however, showed an increase proportional to energy delivery with all three probes.The differential effects of the various probes used in this study on platelet function may enhance our understanding of the complex role played by platelets in the pathogenesis of complications such as arterial thrombosis and re-occlusion after laser angioplasty.     

Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study

Introduction The objective of this clinical trial was to determine whether there is a skill dependence for the total amount of radiation exposure to orthopaedic surgeons caused by fluoroscopy during intramedullary fracture fixation.Materials and methods Surgical teams were assigned to either the Senior group or the Junior group according to their professional qualification and clinical appointment. Twenty-two long-bone shaft fractures were stabilized with intramedullary nails. The radiation exposure was measured at different body locations including fingers, trunk and head by means of thermoluminescent LiF:Mg,Cu,P detectors. The total time of fluoroscopy was registered for each operation.Results Mean time of fluoroscopy per operation was 4.43 min for the Senior group and 6.95 min for the Junior group. The surgeons hands were exposed to markedly higher doses (range 0–2.88 mSv Senior group; 0–11.94 mSv Junior group) than their trunk and head (range 0–0.27 mSv Senior group; 0–0.38 mSv Junior group). After analysis of variance, differences between both groups proved to be statistically significant for all fingers measured (p0.02) and for the total time of fluoroscopy (p=0.019).Conclusions Generally, the hands are at higher risk than are the trunk and the head, and this finding is independent of surgical skills. However, an additional hazard is created for the less experienced surgeon by a highly varying and poorly predictable exposure of the hands and time needed for fluoroscopy. Thus, the use of radiation is more consistent and standardized with a skilled surgeon.     

Intrarenal reflux

Summary The radiographic appearances and dynamics of intrarenal reflux have been defined in an experimental study of the pig's kidney. Intrarenal reflux occurs only with refluxing papillae and is an all-or-none phenomenon when the threshold figure of 10–15 mm Hg is exceeded. Increasing intrapelvic pressure leads to increasing density of the radiographic shadow but new areas of intrarenal reflux are not produced.     

Uterine preservation during surgery for uterovaginal prolapse: a review

The traditional surgical treatment for uterovaginal prolapse has been vaginal hysterectomy. For many reasons, women may request uterine preservation at the time of prolapse surgery. The purpose of this paper is to review the medical literature pertaining to the role of uterine preservation during reconstructive surgery for uterovaginal prolapse. A MEDLINE search of literature in the English language (1966 to current) was carried out using the keywords hysterectomy, hysteropexy, uterine preservation, uterine suspension and uterovaginal prolapse. Fourteen articles primarily addressing the surgical repair of uterovaginal prolapse with uterine preservation were included in this review. Papers primarily addressing other forms of pelvic organ prolapse, incontinence or obliterative procedures were excluded. Existing procedures and their clinical outcomes were reviewed. The current literature suggests that uterine preservation during surgery for uterovaginal prolapse may be an option in appropriately selected women who desire it; prospective, randomized trials are needed to corroborate this.Abbreviations EBL Estimated blood loss - OR Operating room - PCOS Polycystic ovary syndrome     

Cross-cultural adaptation and validation of the NASS outcomes instrument in Spanish patients with low back pain

Objectives: The aim of the study was to evaluate validity, reliability, responsiveness and practicality of the NASS-AAOS (North American Spine Society—American Academy of Orthopaedic Surgeons) questionnaire in patients with low back pain. Methods: The sample included 70 patients with herniated disk, stenosis, chronic low back pain of unknown etiology or acute low back pain. They were assessed twice before treatment (test–retest) and a third measure six months to one year afterwards. Results: The mean time of administration was 24 and 20 min for the test and post-treatment evaluation, respectively. Cronbachs alpha coefficient was between 0.78 and 0.92 on the baseline test and 0.90 or higher on the post-treatment evaluation. The test–retest reproducibility was 0.95 (0.91–0.98) for neurological symptoms, 0.82 (0.63–0.91) for pain/disability and 0.63 (0.25–0.82) for expectations. The associations with other measures and clinical criteria were generally moderate to high and in the expected direction. The effect size for pain/disability in combination with neurological symptoms was 2.02 for patients who improved versus an effect of –0.09 in patients who were stable between test and retest; the area under the curve on this joint scale was 0.81 (0.69–0.90). Conclusions: The instrument is valid, sensitive to clinical changes and reliable for comparisons between groups, but further study is needed for its application in monitoring individual patients.     

The surgical approach to the treatment of incontinence due to drug resistant detrusor instability with particular reference to ‘clam’ ileocystoplasty

Summary The treatment of urge incontinence in patients with detrusor instability who fail to respond to oxybutynin is reviewed. Transvesical injection of the pelvic plexuses with phenol is useful in women over the age of 55 (or thereabouts), but the response rate in younger women is poor and the technique cannot be used in men because of the risk of producing impotence. When the phenol technique fails or is contraindicated, clam ileocystoplasty is almost invariably effective although postoperative voiding dysfunction is common albeit easily corrected. Apart from refractory detrusor instability, the clam technique is applicable to a wide range of urodynamic disorders and is reducing the need for substitution cystoplasty for functional lower urinary tract reconstruction.     

Cauda-filar paraganglioma with ‘silk cocoon’ appearance on spinal angiography

Summary. Silk cocoon appearance on spinal angiography is pathognomonic to differentiate paragangliomas from several vascular tumors and malformations of cauda-filar region.     

42 a. Datengerechte Befunderhebung,Organisation und Archivierung in einer mittleren chirurgischen Abteilung — Konzeption einer Standardisierung

Zusammenfassung Eine standardisierte chirurgische Dokumentation sollte in folgenden Stufen realisiert werden: I. Zentrales I-Zahl-Archiv, gleichzeitig sind fortan alle Routinedokumente mit der 1-Zahl zu kennzeichnen. 2. Einführung des verschlüsselbaren standardisierten Krankenblattes. 3. Für spezielle Probleme Einführung der zugehörigen erweiterten Basisdokumentation. 4. Einsatz abteilungsinterner EDV-Anlagen unter Beachtung international gültiger Schlüsselsysteme.     

Lumbosacral arthrodesis using pedicular screws and ringed rods

Sixty-one patients who had lumbar instability and chronic low back pain or deformity from non-traumatic lumbar pathologies were studied. In all of them a posterior lumbosacral fusion with CUN (Clinic of the University of Navarre) pedicle rod fixation was used. The mean follow-up period was 36 months (range 26–46 months). The consolidation rate was evaluated according to plain and functional radiographs, and a clinical evaluation was made using an analogue pain scale. The rate of fusion was 93.5%. Neurological complications occurred in 3.3%. The incidence of screw failure was 2.3% of all the screws. No other implant failure occurred. The patients rated their clinical results as excellent in 33.8% of the cases, good in 42.2%, fair in 16.9% and poor in 6.7%. CUN instrumentation is a versatile internal fixation system that has been shown to provide satisfactory stability. Furthermore, the clinical results are comparable to those reported in studies in which the most common hardwares were used.     

Ureteral injuries in gynecologic surgery

Ureteral injuries are rare but potentially devastating complications of all major gynecologic operations. They occur in straightforward as well as complicated cases, to both experienced and neophyte surgeons. Preoperative IVP or placement of ureteral stents does not prevent ureteral injury, but identification and visualization of the ureters will minimize their incidence. Failure to recognize injuries intraoperatively converts a correctable venial sin into a catastrophic mortal sin, which can lead to serious morbidity, including loss of kidney and even patient death.     

Collagen distribution in human membranous glomerulonephritis

In membranous glomerulonephritis (MGN), thickening of the glomerular basement membrane (GBM) is partly due to the accumulation of basement membrane material between and around immune deposits located on the epithelial aspect of the GBM. We investigated the distribution of type IV collagen chains (1/2, 3, 4, 5, 6) and of types I, III, V, and VI collagen in the glomeruli from 16 patients, by indirect immunofluorescence in 13 and the high-resolution immunogold technique in 6. No changes were detected in stage I MGN. The spiky projections of the GBM in stage II MGN and the basement membrane layers encircling immune deposits in stage III contained the 3, 4, and 5 chains of type IV collagen. In contrast, the 1/2 chains of type IV, as well as type VI collagen accumulated in the subendothelial aspect of the GBM. No significant staining for types I, III, and V collagens or for the 6 chain of type IV collagen was detected. The results show that, as in the normal glomeruli, the different chains of type IV collagen are not co-distributed in the glomerular extracellular matrix in MGN. They also indicate that type IV collagen chains and type VI collagen play an important role in the thickening of the GBM in human MGN.     

Effect of low-phosphate diet on sodium/phosphate cotransport mRNA and protein content and on oocyte expression of phosphate transport

Recently, we have isolated a complementary DNA most likely related to rabbit kidney cortex brush border membrane sodium/phosphate (Na/Pi) cotransport activity [NaPi-1 (1)]. To further elucidate the cellular mechanisms involved in dietary adaptation of renal Na/Pi contransport, we have exposed young rabbits for 2 weeks to either a low phosphate (Pi) diet (LPD) or a high Pi diet (HPD). Initial linear uptake of Na/Pi cotransport in isolated brush border membrane vesicles was increased in rabbits on a LPD compared with those on a HPD. Injection of equal amounts of total mRNA isolated from kidney cortex of LPD or HPD rabbits intoXenopus laevis oocytes resulted in a higher stimulation of Na-dependent oocyte Pi uptake in LPD than HPD preparations. No difference in the content of specific mRNA (NaPi-1 cDNA probe, Northern blots) and of the content of the specific brush border membrane protein (NaPi-1 antipeptide antibody, Western blots) between LPD and HPD preparations was observed. We conclude that chronic dietary Pi deprivation leads to a protein synthesis-dependent alteration of Na/Pi cotransport activity which does not involve a change in the total amount of a protein related to the recently cloned NaPi-1 protein.     

Identification of α1-adrenoceptor subtypes in the dog prostate

Summary The ₁-adrenoceptor subtypes of dog prostate were characterized in binding and functional experiments. In saturation experiments, [³H]prazosin bound to ₁-adrenoceptors with high affinity. In the displacement experiments, unlabelled prazosin and WB4101 biphasically inhibited the binding of 400 pM [³H]prazosin, suggesting the presence of at least two distinct affinity sites for prazosin or WB4101. The proportion of high-affinity sites was approximately 10%. HV723 also recognized two distinct affinity sites but the proportion of high-affinity sites was approximately 20%. From these results the presence of three distinct ₁-adrenoceptor subtypes was suggested: presumably subtypes _1A (high affinity for prazosin and WB4101), _1N (high affinity for only HV723) and _1L (low affinity for the three antagonists) according to the recently proposed ₁-adrenoceptor subclassification. The density of subtype _1L was much higher than that of subtypes _1A and _1N subtypes. In the functional experiments, prazosin, WB4101 and HV723 competitively antagonized the contractile response to noradrenaline with low affinities close to those estimated for the _1L subtypes. These results suggest that the contractile response to noradrenaline in the dog prostate is mediated predominantly through _1L subtype -adrenoceptors.     

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.     

Management of severe burned-hand deformities at Huê Central Hospital

During the years 1998–2002 there was collaboration between surgeons at Huê Central Hospital and Belgian plastic surgeons coming each year to teach at the Huê Medical School and to work at the Hospital. Of 150 hands deformed after burns admitted to Huê Central Hospital from 1998 to 2003, 52 patients presented with severe hand deformities. The classification of deformities was as follows: dorsal hand contractures—21 hands, palmar hand contractures—9 hands, and wrist contractures—22 hands. The management of these deformities is a combination of surgical treatment, postoperative splinting and physical exercise in order to regain the function of the hand as much as possible. The strategy of surgical procedures is based on the lesions of the individual patient. After releasing the contractures, the raw area is covered by skin grafts and local flaps. There were also 50 osteo-articular procedures. Long-term results: Good 33% (17 hands), Mild 13% (7 hands), Moderate 50% (26 hands) and Poor: 4% (2 hands).     

Parathyroid hormone and its fragments in children with chronic renal failure

Parathyroid hormone (PTH) immunoradiometric assays (IRMA) exhibit cross-reactivity between 1-84 PTH and long carboxyl-terminal-PTH (C-PTH) molecules. C-PTH antagonizes the biological actions of 1-84 PTH and circulates in excess in chronic renal failure (CRF), partially explaining why supra-physiological PTH levels are recommended to maintain bone turnover. Furthermore, the ratio 1-84 PTH/C-PTH may be related to bone turnover. This study characterizes the 1-84 PTH/C-PTH ratio in children with varying severity of CRF and levels of PTH. Two hundred and forty-one children with CRF, managed with the aim of preventing the development of hyperparathyroidism, had PTH measured by intact IRMA and a new more specific Cyclase-Activating-PTH (CAP) IRMA. C-PTH levels were calculated by subtracting CAP-IRMA from intact IRMA. Fifty-three controls with normal renal function were also recruited. Mean intact IRMA correlated with CAP-IRMA (r=0.98), but was higher (P<0.001). The mean 1-84 PTH/C-PTH ratio was lower than controls in dialysis patients (P=0.022) and those with a glomerular filtration rate <30 ml/min per m² (P=0.033). This ratio was comparable to controls when the PTH level was normal, but was lower with PTH levels outside the normal range (P<0.01). These data suggest that CAP-IRMA gives a more accurate assessment of actual PTH levels than intact IRMA in CRF. Maintenance of normal PTH levels throughout the course of CRF permits the maintenance of a normal 1-84 PTH/C-PTH ratio, the clinical significance of which requires further investigation in children.     

Association and Linkage Disequilibrium Analyses Suggest Genetic Effects of Estrogen Receptor α and Collagen IA1 Genes on Bone Mineral Density in Caucasian Women

Estrogen receptor alpha (ER) and collagen IA1 (COLIA1) genes have been suggested as possibly implicated in reduced bone mineral density (BMD). The present study investigated the occurrence of association and linkage disequilibrium between radiographic hand BMD and polymorphic alleles of ER and COLIA1 genes, in human pedigrees of a Chuvasha population in Russia. The study sample included 463 members of 113 pedigrees, mostly nuclear families. We performed association and transmission disequilibrium test (TDT) analyses of the combined PvuII and XbaI RFLPs alleles on the same chromosome (haplotype) of the ER gene with BMD Z scores of cancellous or cortical bone in the hand phalanges. The association analyses were performed separately for both genders in the parental generation, i.e., fathers (n = 114; average age 64.2 y) and mothers (n = 122; average age 62.7 y). The Px haplotype was associated significantly with lower BMD Z scores in mothers only. The difference between subjects who carried one or two copies of the Px haplotype and those lacking it was 0.68 Z scores, P = 0.003 and 0.51 Z scores, P = 0.025 for cancellous and cortical bone, respectively. Multiple linear regression model with age, height, weight, and Px haplotype status as predictors explained 26.7% and 28.3% of the total observed variance in BMD with Px haplotype as independent predictor explaining 5.9%; P = 0.002 and 3%; P = 0.028 (cancellous and cortical bone, respectively). Results of t-TDT for triads of two parents and just one of their female offspring (but not male offspring) suggested the existence of linkage disequilibrium between the two loci of Px haplotype and BMD trait (P = 0.047). No association was found between polymorphic alleles of COLIA1 gene and BMD, but mothers with combined genotypes of Px haplotype of ER gene and s allele of COLIA1 gene had the lowest mean Z scores (–0.944 and –0.788 for cancellous and cortical bone, respectively). We conclude that the Px haplotype of the ER gene is associated with low BMD values in females, as the phenotype is gender dependent (the association was not observed in males), and the s allele of COLIA1 gene in combination with this haplotype contributes to reduced BMD.     

Die Silicon-Antireflux-Prothese —eine artifizielle Fundoplicatio?

Summary Of all anti-reflux operations fundoplication has proved the most effective method in experimental and clinical examinations [3, 5, 9, 12. 13]. In 1979 Angelchik reported a silicon prosthesis as an anti-reflux barrier which proved effective in examinations on patients. An explanation for these results is still missing [1]. Our examinations in dogs show that: 1. anti-reflux prosthesis is an effective anti-reflux barrier in dogs after circular myectomy; 2. silicon prosthesis proved to be equally as effective as fundoplication with regard to reflux prevention; 3. the mechanism of action is a mechanical one. The difference between silicon prosthesis and fundoplication is, that the fundoplication represents a ring around the LES, which is elastic and is subject to the same regulations as the LES, and that it can relax in a swallowing reflex manner. In the silicon prosthesis the ring-formation is only mechanical.Herrn Prof. Dr. M. Allgöwer zum 65. Geburtstag gewidmet     

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.     

Psychosocial rehabilitation and satisfaction with life in adults with childhood-onset of end-stage renal disease

Little information is available on vocational rehabilitation and satisfaction with the quality of life in adult patients with early onset of end-stage renal disease (ESRD). A sample of 39 patients (mean age =26.7±6, range, 18 to 43 years, n =13 on dialysis, n =26 transplanted successfully) were required to report data on their vocational qualification and employment, and their degree of general and health-related satisfaction with life was surveyed. Data on psychosocial rehabilitation were collected by a structured questionnaire, whereas satisfaction with the quality of life was assessed with the standardized Questionnaire on Satisfaction in Life (FLZ). Fifty-eight percent of the patients had left school with certificates equivalent to high school graduation, 87% had completed vocational training and 67% were in paid employment. Forty-nine percent lived on their own or with a partner and 72% fully or partly earned their own living. The mean general and health-related satisfaction with life is significantly reduced compared to the general population. The patients were least satisfied in the areas partnership/sexuality and family life/offspring in general, as well as physical condition and ability to relax within health-orientated satisfaction. Final mean body height was 167.6±11.9 (SDS –1.54±1.59) for male and 153.77±8.29 for female patients (SDS –1.58±1.54). Thirty-six percent reported to be dissatisfied with their present body height compared to 4% of age-matched healthy controls. Positive perception of quality of life was significantly correlated to satisfaction with adult height ( r =0.41, P =0.008). Vocational rehabilitation of adult patients with early onset of ESRD achieves lower values than among the general population, however, more favorable percentages than among young adult patients or patients with adult onset of ESRD. The patients self-evaluation of both their general and health-related quality of life proves to be clearly muted, which is a clear indication of the physical and psychological strain of living with a chronic disease.