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.     

Association of meningiomas with dural “tails”; Surgical significance

Summary Intracranial meningiomas are characteristically benign tumours with a tendency to recur following surgical resection. Our group is investigating the pathogenesis of meningioma recurrence. In our initial studies we identified two cases of dural tails associated with intracranial meningiomas. Gadolinium-enhanced magnetic resonance images were utilized to identify the dural tails preoperatively. These images aided us in performing a more complete surgical resection of the meningiomas. Histopathological confirmation of meningotheliomatous cell infiltration into the dural tails demonstrates their surgical significance.     

Detection and differentiation of lactate and lipids by single-voxel proton MR spectroscopy

The signals of lactate and lipids partially overlap in single-voxel proton MR spectroscopy (¹HMRS), sometimes making them difficult to differentiate in clinical settings. Our aim in this study was to identify lactate and lipids by varying the echo time (TE). We expect that the accurate detection of lactate and lipids will have high diagnostic value in the diagnosis of brain tumors. Following our protocol, we obtained meaningful ¹HMRS spectra from 213 patients, including 163 patients with brain tumors, between August 1999 and February 2004. ¹HMRS was performed with a TE of 144 ms followed by a TE of 30 ms and/or a TE of 288 ms, if necessary. For the 213 patients, lactate level was negative in 47 patients, positive in 131 patients, and strongly positive in 35 patients. The lipid level was negative in 90 patients, positive in 56 patients, and strongly positive in 67 patients. Based on logistic discriminant analyses of neuro-epithelial tumor WHO grade and lactate and lipid levels, lactate and lipid levels were significant between WHO grades 2 and 3 (P=0.0239) and between grades 3 and 4 (P=0.0347). Lipids are a more significant factor for the discrimination between WHO grades 2 and 3 (P=0.0073) and between grades 3 and 4 (P=0.0048). With our method of varying the TE, it is possible accurately and efficiently to detect lactate and lipids in the brain. We found a significant correlation between lactate and lipid expression and WHO grade of neuro-epithelial tumors.These data were presented at the 22nd Annual Meeting of the Japan Society for Neuro-Oncology, 17–19 October 2004 in Miyagi, Japan.     

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.

     

Neurophysiology of penile erection

Summary In 6 dogs and 6 monkeys electrical stimulation of the cavernous, pudendal and hypogastric nerve was performed to gain better understanding of the erectile neurophysiology. Arterial flow, intracorporeal pressure and venous restriction studies during single and combined neurostimulation demonstrated that initiation and maintenance of erection is a parasympathetic phenomenon. Penile rigidity however, could only be achieved with additional pudendal nerve stimulation resulting in muscular compression of the blood distended cavernous bodies. Detumescence or subsidence of erection is primarily under sympathetic control, due to inhibition of sinusoidal smooth muscle relaxation. On the basis of our observations we conclude that penile erection is dependent upon three neurophysiological mechanisms: 1. the parasympathetic vascular mechanism, the somatomotor muscular mechanism and the sympathetic inhibitory mechanism.Part of this paper was presented at the 9th Symposium of the Association for Experimental Urology of the German Urological society, June 17–18, 1988, Aachen, Federal Republic of Germany     

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.     

19. Das TNM-System in der Chirurgie

Zusammenfassung Für Therapiefolge und prognostische Aussagen ist die Feststellung des Ausbreitungsgrades einer bösartigen Geschwulst entscheidend. Zur Klassifizierung wurde für die meisten Organe international das TNM-System durch die UICC festgelegt. Dabei werden die deskriptiven, klinisch feststellbaren, prätherapeutischen Befunde der Primärgeschwulst (T), der regionalen Lymphknoten (N) und der Fernabsiedlungen (M) gruppiert und in einer TNM-Tumorformel zusammengefaßt. Die Belange operativer Fachdisziplinen bedürfen hier wichtiger Ergänzungen. 50–120 Tumorformeln bei jedem Organkrebs sind eine Voraussetzung zur interdisziplinären Standardisierung der Krebsbehandlung, was an Beispielen dargelegt wird.

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TNM system and surgery

Summary Estimation of the pretherapeutic degree of spread of a malignant tumor is essential for decisions on therapy and prognosis. A uniform principle for the classification of tumors of all organs, the TNM System, has been stipulated on an international basis by the UICC. The findings of the primary tumor (T), the regional lymph nodes (N) and the metastases (M) are grouped and defined. The findings are summarized in a so-called TNM Tumor formula. This needs a supplement for the surgical specialties. About 50–120 tumor formulas for each organ tumor are indispensible in the interdisciplinary standardization of tumor treatment; this is discussed with examples.[]

     

Benigner hellzelliger Lungentumor (≫Sugar Tumor≪)

Zusammenfassung Es wird ein Fall eines benignen hellzelligen Lungentumors (sugar tumor) bei einem 69jährigen Mann vorgestellt. In der Weltliteratur wurden bisher nur 16 ähnliche Fälle beschrieben. Probleme der Diagnose sowie der Pathogenese werden erörtert.

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Benign clear cell tumor (sugar tumor) of the lungCase report and review of the literature

Summary A case of a benign clear cell tumor of the lung (sugar tumor) in a 69 year old man is presented. The world literature lists only 16 similar cases to date. Problems concerning diagnosis and pathogenesis are discussed.

     

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.

     

Contractile behaviour of the human pyelo-ureteral musculature

Summary In normal proximal and distal pyeloureteral human strips and in pathological reflux or obstructive segments the influence of repetitive electrical stimulation at frequencies between 0.01 and 200 Hz on their contractile behaviour was studied. Between 0.01 and 1 Hz baseline tone and maximum amplitude of contraction were dependent on stimulation frequencies, but some strips showed an irregular response pattern. At frequencies between 1 and 200 Hz half of the strips showed a typical on and off contraction (at the beginning and end of the stimulus period respectively) separated by a plateau. We consider the off reaction to be a response to an ionic displacement at the end of the stimulus. Spontaneous activity was mostly observed in Tyrode solution and in calix and pyelum. Transmural nerve stimulation did not change the contraction patterns.     

Predicting lethal outcome after severe head injury — A computer-assisted analysis of neurological symptoms and laboratory values

Summary A total number of 58 parameters (laboratory values, neurological symptoms, and vegetative parameters) were evaluated in 150 patients during the first seven days after severe head injury. The patients were divided into two groups, survivors and non-survivors. Eight easily evaluable routine parameters with the most significant differences between the two groups of patients were used for statistical evaluation of a no survival chance score. These highly indicative parameters are serum osmolarity and urea, blood glucose, total bilirubin, motor reaction to stimuli, body temperature, respiratory activity, and pupil reaction. A low survival chance limit was evaluated from each of these parameters by computer analysis. None of the patients in the series survived when three or more of these eight parameters had climbed beyond the limit. So far, the system is able to predict no survival chances in 50.8% of the non-survivors some six days prior to death; 80% of these predictions could be made by the fourth day after injury.     

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.     

The “R.A.R.E.” Technique <Emphasis Type="Italic">(Reverse and Repositioning Effect):</Emphasis> The Renaissance of the Aging Face and Neck

Considering the fixed points of the face (Fig. 1), and in light of the fact that gravity is one of the main factors involved in aging, a new alternative concept in cosmetic surgery is discussed in this paper. In our approach, rejuvenation of the face and neck involves two completely separate procedures. The whole face must be treated homothetically, with an upward (vertical) and deep (subperiosteal) approach, to preserve facial proportions and distances, thus preserving the original facial identity. The facial portion of our rejuvenation surgery becomes a single en bloc and closed procedure, correcting the sagging tissue in the lateral sector, between the fixed zones which must be preserved. The Malaris portion of the Orbicularis Oculi Muscle, (through its strong connections with the skin and the malar fat) has become the key tool of the rejuvenation of the whole face. Then, neck surgery becomes a completely distinct procedure, and is to be performed in an oblique/horizontal direction. We now seek to preserve the very firmly attached neck zones, which are the attachment of the posterior border of the fibrous platysma onto the S.C.M. (Sterno-Cleido-Mastoidien muscle). This will permit a more conservative and less aggressive neck surgery, without any sub-platysmal disection. Over 200 RARE procedures have been performed during almost four years. Improvement in terms of facial rejuvenation is dramatic and the technique is quite safe and predictable. The only possible difficulty involves the patients temporary initial concern about early postoperative appearance. Presented at ASAPS Boston, 2003; (International Symposium Paper Winner). This article was initially submitted for publication in 3rd quarter, 2003.**Homothetia (adj: homothetic): From homos: same; and thesis: position. A geometric term which means conservation of the relations and distances of different points of a figure, after its displacement (syn: to act in concert or in harmony). Homothetia preserves the identity of components during movement, without deformation or change. (Figs. 2A, B, 3A, B).     

Maternal pregnancy vomiting and offspring salt taste sensitivity and blood pressure

The purpose of this study was to investigate the relationship between salt taste perception and blood pressure (BP) in normotensive adolescents as modified by maternal fluid losses during the first trimester of gestation. Seventy-two healthy adolescents (42 boys) aged between 9.0–21.1 years, recruited from the population-based RICARDIN study, were included. A maternal questionnaire about the duration of pregnancy, birth weight and vomiting or diarrhoea in the first trimester of gestation was collected. The sample was categorized into: vomiter descendents, those whose mother reported significant vomiting in the first trimester of gestation and non-vomiter descendents the remaining. Height, weight, and standardised BP measurement were recorded. Salt gustatory performance was assessed using a behavioral sensitivity test to determine the lower NaCl gustatory threshold, and a behavioral discrimination test, measuring the ability to distinguish among different saline solutions. Salt taste sensitivity showed a significant correlation with systolic BP (SBP) in vomiter descendents ( r =–0.66; P =0.003), but not in non-vomiter descendents. Adjusted by gender, and actual height and weight, salt sensitivity performance remained significantly related to SBP. An association between descendents SBP and maternal vomiting during gestation exists, adding a new element of evidence to the Barker hypothesis.     

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.     

Hearing people through their pain

The first goal in this clinical and theoretical essay is to specify what it means to hear people through their pain, by articulating intuitions that are seldom put in formal terms. What and how and whom we hear shift depending on whether we are (1) uncovering the facts, (2) appreciating their meaning with another's life, (3) drawing out and enlivening the one who has to live with and make sense of traumatic experience, or (4) engendering, by having others hear that they are heard, enough relatedness to establish a meaningful precedent for their lives. A second goal here is to show how the meaning of trauma changes as hearing deepens. Accordingly, we may hear in people's trauma (1) psychophysical reactions to events; (2) the playing out of themes from a lifetime; (3) violations whose inner message is a demand to awaken beyond self-protective ways of being; and (4) a uniquely powerful opening for communion.To the memory of Robert Laufer, witness to evil and suffering.An earlier presentation of some of these ideas appeared as Menschen durch ihren Schmerz hoeren, trans., S. Rechenberger, in A. Meyer, ed.,Seele und geist. (Flensburg: Flensburger Hefte Verlag, 1993), and under the present title, in two parts,Focusing Folio, 1992–3, 11(4) & 12(1).     

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.     

Colpocleisis: a review

Objective: To summarize published data about colpocleisis and to highlight areas about which data are lacking. Data sources: We conducted a literature search on Medline using Ovid and PubMed, from 1966 to January 2004, using search terms colpocleisis, colpectomy, vaginectomy, pelvic organ prolapse (POP) and surgery, and vaginal vault prolapse and surgery and included articles with English-language abstracts. We examined reference lists of published articles to identify other articles not found on the electronic search. Methods of study selection: We examined all studies identified in our search that provided any outcome data on colpocleisis. Because of the heterogeneity of outcome measures and follow-up intervals in case series, we did not apply meta-analytic techniques to the data. Results: Colpocleisis for POP is apparently successful in nearly 100% of patients in recent series. The rate of reoperation for stress incontinence or POP after colpocleisis is unknown. Concomitant elective hysterectomy is associated with increased blood loss and length of hospital stay, without known improvement in outcomes. Few studies systematically assess pelvic symptoms. The role of preoperative urodynamic testing to direct optimal management of urinary incontinence and retention remains to be established in this setting. Conclusions: Colpocleisis is an effective procedure for treatment of advanced POP in patients who no longer desire preservation of coital function. Complications are relatively common in this group of elderly patients. Prospective trials are needed to understand the impact of colpocleisis on functional outcomes and patient satisfaction.Anne M. Weber is project scientist for the Pelvic Floor Disorders Network.     

Inverted nipple: The new method of correction

A new technique for correcting inverted nipples is described. It consists of the sectioning of the only genetic factor—the resistance of the collagen fibers—by undermining, under the control of a palper. The trophicity of the nipple is assured by a circular umbrella musculocutaneous flap containing the superficial vascular system. A subdermal cutaneous notch blocks the nipple and prevents any recurrence.     

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.