121. Modifizierte Technik der „Ersatzklappen”-Operation an der V. poplitea bei postthrombotischem Syndrom

Zusammenfassung Die Technik der Ersatzklappen-Operation an der V. poplitea bei postthrombotischem Syndrom wurde vom Initiator durch die Verwendung einer 24cm langen Silicone-Sehne modifiziert. Die Silicone-Sehne wird zwischen A. und V. poplitea durchgezogen, ihr mediales Ende an die Gracilissehne und ihr laterales Ende um die Bicepssehne vernäht. Bei 31 durchgeführten Operationen konnte klinisch und phlebographisch bei allen eine regelrechte Ersatzklappen-Funktion und eine Besserung der venösen Hämodynamik des Beines festgestellt werden.     

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

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

Treatment of alar cartilages: Should the “domes” be interrupted?

The author emphasizes that conservative rhinoplasty techniques are frequently satisfactory, but in certain techniques there is a limit to which nasal tips can be reshaped. In certain circumstances, therefore, interruption of the domes of the alar cartilages is suggested to achieve the most satisfactory aesthetic results.     

Simplified design of the “B” technique mammoplasty

The preoperative design of the B technique mammoplasty is somewhat complicated and less precise than that of other methods of breast reduction. A new maneuver for simplification of the design is presented.     

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.     

Zur Bedeutung von β-hCG im serum als tumormarker fur das magenkarzinom

Zusammenfassung Einleitung: Nach neueren Untersuchungen ist davon auszugehen, daß bei des Hälfte von Patienten mit einem Magenkarzinom -hCG-positive Zellen im Tumor immunhistochemisch gefunden werden können. Ziel war daher, systematisch zu untersuchen, inwieweit -hCG-immunreaktive Magenkarzinome von einem Anstieg des Serum--hCG begleitet werden and dieses damit als Verlaufsparameter zur Verfügung steht. Methode: Bei 54 Patienten mit einem Magenkarzinom wurde zur immunhistochemischen Darstellung ein gegen -hCG gerichteter monoklonaler Antikörper (Fa. Sigma, 1:100) im APAAP-System verwendet. Die Auswertung wurde nach positiver and negatives Reaktion graduiert. Parallel wurde im Serum des Patienten -hCG präoperativ mit einem Enzymimmunoassay (MEIA, Fa. Abbot) bestimmt. Tumor-stadium, Grading and Tumor-lokalisation werden in die Auswertung mit einbezogen. Ergebnisse: Es wird bestätigt, daß 41% (22 von 54) des Karzinome, unabhängig von ihrer Lokalisation im Magen, eine positive immunhistochemische Reaktion gegen -hCG auslösen. Es zeigte sich in Abhängigkeit vom Tumorstadium eine positive -hCG-Immunreaktivität in 27% (6 von 22) des Tumoren ohne Lymphknoten- and Fernmetastasierung (T_1–4 N₀ M₀), in 54% (7 von 13) des Tumoren mit Lymphknotenaber ohne Fernmetastasen (T_1–4 N₁ M₀) und in 47% (9 von 35) des Tumoren mit Fernmetastasierung. Schlecht differenzierte Tumoren (G3–4) waren zu 42% (15 von 36) und gut differenzierte Tumoren (G_1–2) nur zu 39% (7 von 18) positiv. Aber lediglich bei einer Patientin war der -hCG-Spiegel im Serum erhöht. Zusammenfassung: Immunhistochemisch -hCG-positive Magenkarzinome werden vermehrt bei fortgeschrittenem Tumorstadium und Schlecht differenzierten Karzinomen gefunden. Diese Kar zinome scheinen aber nicht in ausreichender Menge -hCG ins Serum abzugeben, was zu serologisch meßbar erhöh-ten Werten führt. -hCG im Serum kann daher nicht als Prognosefaktor bzw. zur Verlaufskontrolle herangezogen werden. Abzuwarten bleibt, inwieweit die -hCG-Expression von Tumorzellen u. U. Einfluß auf die Propose der Patienten besitzt.

---

Significance of -hCG in the serum as a tumour marker for gastric cancer

Introduction: Recent investigations indicate that in 50% of patients with gastric cancer, -hCG-posiitive cells can be found in the tumour by immunohistochemical investigations. The objective of this study was to investigate how often -hCG-immunoreactive gastric carcinomas were accompanied by an elevation in serum -hCG, that could have been used as a course control variable. Methods: In 54 patients with gastric carcinoma a monoclonal antibody directed against -hCG was used for immunohistochemical marking in the APAAP system. The evaluation was graded positive or negative. In parallel, serum -hCG was determined preoperatively using an enzyme immunoassay (MEIA). Tumour stage, grading and tumour locallization were determinants in the evaluation. Results: We found that 41% (22 of 54) of the carcinomas induced a :positive immunohistochemical response to -hCG, regardless of their location in the stomach. In relation to tumour stage, a positive -hCG immunoreactivity was apparent in 27% (6/22) of tumours without lymph node or distant metastases (TI -4N0M0), in 54% (7/13) of tumours with lymph node and without distant metastases (T1–4N1 M0) and in 47% (9/35) of tumours with distant metastases. Poorly differentiated tumours (G3–4) were positive in 42% (15/36) and well-differentiated tumors (G1–2) in 39% (7/18) of cases. In only 1 patient was the -hCG, level in serum elevated, however. Conclusions: -hCG-Positive gastric carcinomas are found more frequently in advanced tumour stages and poorly differentiated carcinomas. These carcinomas, however, seem not to excrete -hCG in sufficient amounts to produce measurable serum values. Therefore, -hCG cannot be used a prognostic factor or for course control. The relevance of -hCG expression of tumour cells to the patients' prognosis remains obscure.

     

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.     

Expression of interferon-γ receptors on bladder cancer cells: does it correlate with biological response?

Summary Previously we have shown a differential biological response of three human bladder cancer cell lines (RT4, RT112 and MGH-U1) to gamma interferon (IFN-). The present study examines the relationship between the biological response and the expression of the interferon- receptor on the tumour cell surface. Using a competitive radioligand binding assay and Scatchard analysis, we measured the number and affinity of the IFN- receptors on each of the above cell lines. Individual cells from each line expressed large numbers (29,100–41,800) of high-affinity receptors (k _d =2.4–3.9×10¹⁰M). There was no statistically significant difference in either of these parameters between the three lines. We therfore conclude that the biological response of these bladder lines to IFN- does not relate to the number or affinity of its receptor on the plasma membrane of these tumour cells.     

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.     

The Normal and Malignant Mammary Gland: A Fresh Look with ERβ Onboard

Estrogens are important for the development and function of the normal mammary gland as well as for development of mammary cancer. The frontline therapy for treatment of estrogen receptor (ER)⁴ positive breast cancer is antiestrogens. A second estrogen receptor (ER) is also expressed in the breast but it has not been measured because it is not detected by the immunoassays used to detect ER. In many cell systems ER has actions which are opposite to those of ER and this finding has raised questions about the role of ER in the development and treatment of breast cancer.     

33. Der „kalte” Schilddrüsenknoten

Zusammenfassung Der kalte Schilddrüsenknoten gilt als typischer Verdachtsbefund für ein Schilddrüsencarcinom. Seine tatsächliche Dignität ist mit klinischen Mitteln sowie Szintigraphie und Sonographie letztlich nicht zu klären. Das beste abgrenzende Selektionskriterium ist die Feinnadel-Punktionscytologie, wodurch mit Gültigkeit für das Kropfendemiegebiet etwa die Hälfte als suspekte Befunde von dem anderen Teil hochwahrscheinlich gutartiger Veränderungen getrennt und für die Operationsindikation reserviert werden kann.     

A Prostacyclin Analogue,OP-41483α-CD,Restores the Ability of a β<Subscript>2</Subscript>-Adrenergic Agonist to Stimulate Alveolar Fluid Clearance in Rats

Purpose. It is not yet known whether a prostacyclin analogue can affect alveolar fluid clearance. According to recent studies, high-dose (10^–3M) terbutaline, a ₂-adrenergic agonist, failed to increase alveolar fluid clearance. Therefore, we examined the effects of OP-41483-CD, a prostacyclin analogue, on alveolar fluid clearance in the presence of high-dose terbutaline in rats.Methods. Albumin solution containing Evans blue dye and various drugs was instilled into the alveolar airspaces of isolated rat lungs, which were then inflated with 100% oxygen at an airway pressure of 8cmH₂O. Alveolar fluid clearance was measured by the progressive increase in dye concentrations over 1h.Results. Although 10^–5 and 10^–4M terbutaline increased alveolar fluid clearance, 10^–3M terbutaline did not. OP-41483-CD restored the ability of 10^–3M terbutaline to stimulate alveolar fluid clearance. The effect of OP-41483-CD was consistent with the effect of atenolol, a ₁-adrenergic antagonist. The effect of OP-41483-CD on alveolar fluid clearance was unchanged in lungs inflated with nitrogen. Prostaglandin E (PGE)₁ and PGE₂ analogues had similar effects to OP-41483-CD on alveolar fluid clearance.Conclusion. These results indicate that a prostacyclin analogue restores the ability of high-dose terbutaline to stimulate alveolar fluid clearance.     

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.

---

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.

     

Deformation: Its application to cosmetic facial surgery

The principles of deformation have come to our attention through the study of technical skills in art. It creates emphasis on the motif of a work by transformation and results in the illusionary phenomenon that makes the total appearance more harmonious and impressive. With this artistic technical concept compounded with our surgical experiences, we designed the deformation technique for facial corrective surgery. Introducing some distinctive cases applying this technique, we show its advantages over the see a defect, correct the defect limitations to present surgical techniques and the good effect of the patient's mind and attitudes.Presented at the 17th Annual Meeting of the American Society for Aesthetic Plastic Surgery, Los Angeles, California, April 20, 1983     

Persistent activation of thrombocytes in neurosurgical patients operated for primary brain tumours

Summary A prospective study was designed to investigate whether platelet hyperactivity exists following neurosurgical removal of primary brain tumours. The level of -thromboglobulin (TG), a protein released by platelets during the activation process, was measured in the plasma of 13 consecutive patients prior to surgery (T 1) and on the first (T 2) and seventh (T 3) post-operative days. A significant and sustained increase in TG levels from a baseline of 20.7±1.7 ng/ml (mean ± sem) at T1 to 37.0±5.2 ng/ml (p<0.005) at T 2 and 35.9±3.7 at T 3 (p<0.005) occurred. When patients were grouped according to tumour malignancy, significantly higher TG levels were found in the malignant group at T 2 (51.8±6.3 ng/ml) when compared to the benign group (30.6±6.0 ng/ml) (p=0.025). Postoperative T 3 levels were linearly correlated to T 1 levels (r=0.58, p=0.04).This significant and sustained platelet activation that occurs following brain surgery may be part of the biochemical sequel leading to a hypercoagulable state and thrombo-embolic phenomena (TEP) in these patients.     

“Tear-Drop Augmentation Mastopexy”: A Technique to Augment Superior Pole Hollow

Breast ptosis classification systems focus on the inferior descent of the nipple, as well as the descent and distribution of the breast parenchyma below the inframammary fold. Common problems, such as development of a superior pole hollow and an excessive width of the superior pole, extending into the axilla, are not addressed. Few procedures specifically address these deficiencies, and even less information is available in terms of preventative maneuvers when augmentation is desired as an adjunct. Round implants worsen the problem by creating a superior pole shelf, and anatomic implants are unreliable alternatives. Here, we present a technique—tear-drop augmentation mastopexy—that addresses superior pole hollow, excess superior pole width, as well as breast ptosis and hypomastia. Patients with moderate to severe breast ptosis (Regnaults classification), tubular breast deformity, and deformities secondary to previous breast surgery are included in the study. Skin is deepithelialized through a circumareolar incision, and a skin-fat flap is elevated completely encircling the breast. A 2-cm area of parenchyma is left attached to the skin in the lower half of the breast. Breast parenchyma in the superior half of the breast is then advanced and plicated in a superiomedial direction to move the nipple areolar complex to the desired new position. Care is taken to redefine the pectoralis major muscle at its axillary border. A 3-cm incision is then placed in the inferior part of the parenchyma at the 6 oclock position to create a subpectoral pocket for placement of the implant. The tunnel is then closed to separate the implant pocket from the subcutaneous dissection. Residual dermal flap is used to define, and add durability to the parenchyma reshaping procedure. A 3-0 mersiline (Ethicon, Somerville, NJ) blocking suture is used for a uniform circumareolar skin closure. Patients (n:35), ages 17–48, underwent tear-drop augmentation mastopexy between January 1999 and September 2002 for correction of the breast ptosis, tubular breast deformity, and deformities secondary to previous aesthetic breast surgery. The average follow-up was 2 years. All patients displayed type 1 or 2 (Baker classification) capsules. One subcutaneous hematoma and one subcutaneous seroma were seen, which were both treated by percutaneous aspiration. No submuscular hematomas, infections, skin or nipple losses, or hypertrophic scars were noted. Patient satisfaction was high. A more natural tear-drop breast shape was created with an improvement in the superior pole hollow and narrowing of the superior breast. The smallest breasts did not benefit from this technique for elimination of the superior pole shelf, as correction was proportional to the amount of breast tissue available for superior advancement. The tear-drop augmentation mastopexy is a novel technique for correction of the breast ptosis with augmentation, avoiding problematic development of superior pole hollow and excess superior width. This technique is also well applied to tubular breast deformity as well as to secondary breast procedures. Long-term follow-up demonstrates a safe and reproducible result with high patient satisfaction. This technique may solve several problems associated with breast ptosis surgery, which before were not specifically addressed, and the technique warrants further investigation.     

Pied plat réductible traité par la vis d’expansion du sinus du tarse. À propos de 30 cas

Résumé: Dans un pied plat, lobjectif de larthrorise subtalaire est de rétablir des rapports appropriés entre le talus et le calcanéum par limplantation dun espaceur. Le but de cette étude est dévaluer les résultats de la vis dexpansion du sinus du tarse ainsi que le devenir des pieds au recul. Matériel: Trente patients porteurs de pied plat réductible et symptomatique ont participé à cette étude. Il sagissait de 28 hommes et de 2 femmes. Lindication opératoire a été posée sur la coexistence dun handicap fonctionnel liée à la douleur et de léchec du traitement orthopédique. Lâge moyen au moment de lintervention était de 21 ans. Langle de Djian-Annonier était de 134°. Méthodes: Il sagissait dune étude rétrospective. Létat fonctionnel global était évalué au moyen du score de Kitaoka. Résultats: Le recul moyen était de 4 ans. Plus aucun patient ne portait de chaussure orthopédique. Nous navons pas de remaniements articulaires dégénératifs au recul. Le résultat global était: 20 très bien, 4 bien, 2 passable, 4 mauvais. Discussion: Larthrorise par espaceur du sinus du tarse est un geste techniquement simple permettant une correction podoscopique significative du pied plat qui se maintient à la révision. Conclusion: Cette technique simple permet dobtenir des résultats anatomiques et fonctionnels satisfaisants.* Les figures de cet article sont disponibles en couleur sur le site springerlink.com     

Functional Down-Regulation of β1 and β2 Integrins on Lamina Propria Lymphocytes (LPL) and Tumor-Infiltrating Lymphocytes (TIL) in Colorectal Cancer Patients

Integrins play an important role in various lymphocyte functions. In this study, we isolated lamina propria lymphocytes (LPL) and tumor-infiltrating lymphocytes (TIL) from normal and malignant tissues in patients with colorectal cancer, and examined the expression of 1 and 2 integrins on these lymphocytes quantitatively with two-color flow cytometry. Both LPL and TIL expressed a lower level of common 1 chain (CD29) in CD4 and CD8 subpopulations than did peripheral blood lymphocytes (PBL). Among the associated chains, the expression levels of 1 (CD49a) and 2 (CD49b) were slightly higher, whereas those of 4 (CD49d) and 6 (CD49f) were markedly reduced in LPL and TIL. No significant differences were observed in expressions of any 1 integrin chains between these two lymphocytes populations. Similarly, both L (CD11a) and 2 (CD18) were down-regulated in TIL and LPL with CD8⁺ cytotoxic phenotype, but not in those with CD4⁺ phenotype. CD8⁺ TIL expressed a slightly but significantly higher level of L2 than did CD8⁺ LPL. CD8⁺ LPL and CD8⁺ TIL consistently showed significantly decreased binding to purified ICAM-1, VCAM-1 and HT29 colon cancer cells as compared with CD8⁺ PBL. Although CD8⁺ TIL showed a slightly higher level of adhesion to these substrates than did CD8⁺ LPL, the level was much lower than that in PBL. The expression pattern and functional down-regulation of these integrins may be one of the reasons why TIL cannot eradicate the cancer cells in colorectal cancer.     

Photodynamic therapy and γ-irradiation of tumours: Effect of tumour-cell reoxygenation

The presence of adequate oxygen appears to be essential for photodynamic therapy (PDT) of tumours (1, 2). We used the mouse sarcoma 180 tumour model to investigate how the reoxygenation of the tumour cell population after a single exposure to -irradiation influenced the effect of photodynamic therapy. The combination of -irradiation with PDT leads to a significant enhancement of the therapeutic effect. The best effect is observed when the -irradiation precedes the PDT by 24 h, at which time reoxygenation of the tumour is greatest. Also, there is some enhancement of the effect when PDT is given before -irradiation, although the mechanism of this is not yet clear.