Thromboembolieprophylaxe bei hüftgelenknahen Oberschenkelfrakturen-Ergebnisse einer prospektiven randomisierten Studie zwischen Heparin-DHE und,ASS-DHE

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5g+dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU+0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars sould be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal     

Prognostic importance of the study of venous drainage in cerebral arteriovenous aneurysms

The authors analysed in particular the venous drainage of 370 arteriovenous aneurysms operated during 20 years in neurosurgery at Lille's Hospital. If in many cases the study in details of the different arterious pedicles take an important place in the discussion of the indications and operative technics; in other cases a bad estimate of the interest of careful study of veins can be at the beginning of great disappointments. Also the authors insist on the necessary study of the venous system in totality by seeing after agenesia of some passages, the respective drainage of the angioma and the brain, the existence of a saturation venous phenomenon. The analysis in details of the anatomical and functional distribution of the venous drainage in these malformations can be taken into consideration in the operative decision. The analysis of results in ten preference observations suggest that it is an important element in the arteriovenous aneurisms' evolution and in the final prognostic.     

Tuberculosis of the breast: Report of eight cases

In the 8 cases here reported (Table II), the average age was thirty-two years; youngest twenty years, oldest forty-six years. The nodular type was present in 7, the sclerosing type in one. The left breast was involved in 4, the right in 4. The upper outer quadrant alone was the seat of disease in 2, the inner lower quadrant alone in one, the outer lower quadrant alone in 2, the inner lower quadrant in one, and the outer lower and outer upper quadrants together in 2. The tuberculous mass was fixed in all 8 cases. The overlying skin was attached to the mass in 7 cases and not attached in one case. Pig-skin appearance was present in 6, including the mixed case (II) of carcinoma and tuberculosis, and not present in 2. Retraction of the nipple was present in 5 and not in 3. No case gave a history of discharge from the nipple. The breast was fixed to the chest wall in 5 cases and not so in 3 cases. A sinus was present in 4 cases and absent in 4. Axillary nodes were palpable in 7 cases. Clinical evidence of tuberculosis elsewhere in the body was present in only one case of the 8. The initial symptom was a lump in 6 cases, painful in 2 and not painful in 4 cases of the 6. An acute abscess was the initial symptom in 2 of the 8 cases. Only one case gave a positive past history of tuberculosis and possibly one other (V) who reported adenitis of neck nine years previously. Family history was negative in all cases. Only one case gave a history (VIII) of previous acute inflammation of breast. Five of the 8 cases gave a history of lactation, 6 of the 8 of pregnancy and 2 had never been pregnant. The shortest time from onset to admission to hospital was four weeks: the longest time one and onehalf years. The Wassermann reaction was positive in 3 cases, negative in 4, not recorded in one. The clinical diagnosis was tuberculosis in 2, carcinoma in 6. Tubercle bacilli were demonstrated in none. The diagnosis of tuberculosis of the breast was made by microscopic study of the tissues in all 8 cases. Six of the 8 patients were reported living and well; 1 eight years, 1 four years, 1 two years, and 3 one year each, after the operation. One patient died of shock within twenty-four hours after operation and one (II) died of metastatic cancer fifteen months after operation.     

Incidence of hip fracture in western Sweden 1974-1982. Comparison of rural and urban populations

Several epidemiological studies in northern Europe have shown that fractures in the elderly exceed the expected increase in the aging populations. We have compared the incidence of hip fracture in the rural county of Skaraborg and the city of G?teborg in Sweden. After adjustment for age changes in the population, the incidence of hip fracture in Skaraborg County was lower than in G?teborg during the period 1974-1984. The non-age-related increase in the incidence of fractures found in the city was not confirmed in the rural area.     

Problems in therapy of thoracic esophageal cancer in view of recurrence in the lymph nodes

The forms of recurrence from the first onset were confirmed in 171 out of 776 patients with thoracic esophageal cancer excised at our Department from 1959 to 1987; 87 patients (50.9%) had recurrence in the lymph nodes. Postoperative radiation in order to prevent recurrence in the lymph nodes was useful for the prevention of recurrence in the cervical lymph nodes, but radiation myelopathy/radiation pneumonitis might be of therapeutic difficulty in patients with recurrence in the areas of radiation. Moreover, patients treated by irradiation were apt to be involved in visceral recurrence. Incidence of recurrence in the lymph nodes was less in patients who had dissection in three areas than that in patients who received dissection in one or two. However, recurrence was observed in the border region between the cervix and the thorax, on the left side of the trachea, in the anterior portion and on the left side of the hilum in the areas of dissection. Useful postoperative chemotherapy is desirable in consideration of the fact that recurrence in the lymph nodes was observed at the posterior region of the pharynx, at the temporal region and in the pelvis and that dissemination and visceral recurrence were increased.     

Diagnostic usefulness of endorectal magnetic resonance imaging with dynamic contrast-enhancement in patients with localized prostate cancer: Mapping studies with biopsy specimens

BACKGROUND: New diagnostic criteria for dynamic magnetic resonance (MR) imaging in prostate cancer are presented. The diagnostic usefulness of endorectal MR imaging with dynamic contrast-enhancement in localized prostate cancer and the validity of these criteria were evaluated. METHODS: Eighteen untreated patients who were suspected of localized prostate cancer were included in the study. They received endorectal dynamic MR imaging before systematic sextant needle biopsy. First. a mapping study with the findings of MR images and histopathology of biopsy specimens was performed in eight patients out of 18 to compare the difference in T2-weighted images with the endorectal coil and the body coil in the same individuals. Second, another mapping study was performed in all 18 patients by analyzing the findings of endorectal dynamic MR images. For the diagnosis of prostate cancer in MR imaging, we offered diagnostic criteria from our experience in addition to those in plain T2-weighted images from the literature. RESULTS: The overall diagnostic rates of endorectal dynamic MR imaging were 88.9% in accuracy, 100% in sensitivity, and 81.8% in specificity. In the comparison of the endorectal and body coils in T2-weighted images in eight patients, there was no difference in the diagnostic rates except for one more histopathologic false positive portion in endorectal MR imaging. In the second mapping study in 18 patients, the diagnostic rates were 92.6% in accuracy, 88.9% in sensitivity and 93.3% in specificity. Endorectal dynamic imaging raised the diagnostic sensitivity from 77.8 to 88.9%. CONCLUSION: The data demonstrated the validity of this diagnostic criteria and the diagnostic usefulness of endorectal dynamic MR imaging in localized prostate cancer.     

Recurrent anterior dislocation of the shoulder: Results of Eden-Hybbinette and Putti-Platt operations

The results of surgery in 74 cases of recurrent anterior dislocation of the shoulder are reported. The procedures used were Eden-Hybbinette (E-H) in 48 cases and Putti-Platt (P-P) in 26 cases.

The recurrence rate in the 62 shoulder joints re-examined some 4 years postoperatively was 3/41 in E-H cases and 3/21 in P-P cases. The clinical results were excellent in 46 cases, satisfactory in 11, unsatisfactory in four and poor in one case without notable difference between the methods. A restriction of the outward rotation of more than 10 degrees could be observed in half the cases regardless of method.

Radiographically, the Bankart lesion of the glenoid rim could be observed in two-thirds of the cases and osteoarthrosis of the glenohumeral joint was evident in one tenth. The transplanted bone block used in the E-H reconstruction was still in position in the majority but some degree of resorption could usually be observed. These observations did not correlate with the clinical results.     

Calcium regulation by the chick embryo

An artificial air-chamber was produced in White Leghorn chick embryos on the eighth day of incubation. On day twenty, the concentration of calcium in blood and in yolk was found to be lower in the treated embryos than in controls but concentration in bone was similar in both groups. The histological and microradiographic aspect of bone was also similar in both experimental and control embryos. The decrease in the concentration of calcium in blood and in yolk indicates that the experimental procedure succeeded in producing a decrease in calcium intake by the embryo. The fact that bones remained unaffected tends to support the idea that in case of deficient supply of shell calcium, bones can withdraw the calcium they need from the yolk deposit.     

An improvement in the combined treatment of acute peritonitis]

The object of the research was to study regional lymph circulation in abdominal organs in experimental acute peritonitis and determination of the possibility of including lymphotropic therapy in the complex of measures for the management of patients with acute peritonitis. Regional lymph circulation in the abdominal organs was studied in 45 unbred rats, the effect of various lymphostimulators of regional lymph circulation was studied in 35 rats. Lymphotropic therapy was applied in the complex treatment of 106 patients with acute peritonitis in the clinic. The results of the study showed that lymph circulation in the abdominal organs is markedly disturbed in acute generalized peritonitis, in view of which application of lymph therapy in the complex treatment of patients in the postoperative period is pathogenetically substantiated. Lymph therapy improves microcirculation, promotes early restoration of gastrointestinal activity, reduces the expenditure of antibiotics to one half and one fourth, and shortens the term of inpatient treatment.     

Schwannomas of the peripheral nerve in the hand and the upper limb: Analysis of 14 cases

The Schwannomas are usually considered as enucleable lesions of which the excision under microscope doesn't entail a post-operative deficit. Having frequently observed the inclusion of fascicle in the tumor, we wanted to verify the absence of deficit in a retrospective survey. Our survey is composed of 14 patients operated of schwannoma of the superior member and whose mean age is 53 years old. All patients presented an average of nine months old palpable mass; the pain was present in four cases; paresthesiae in seven cases; irritatif syndrome in ten cases. A preoperative sensory deficit was present in two patients but without any case of preoperative motor deficit. The schwannoma was localized in eight cases in the hand, one case in the forearm, two cases in the elbow, two cases in the arm and one case in the armpit. The affected nerves were the digital ones in six cases, the main trunk of the median nerve in four cases, the trunk of the ulnaire nerve in three cases and the sensory branch of the radial nerve in one case. All tumors have been operated under a microscope. The enucleation was possible without fascicle lesion in six cases. In the eight other cases we have proceeded to a resection of indissociable fascicles. The diagnosis is confirmed by the histologycal examination in all cases. In postoperative, the two patients that presented a preoperative sensory deficit no longer presented it. On the contrary, three patients that didn't have any preoperative deficit presented each a post-operative sensory deficit with in addition a motor trouble in one of cases. We conclude from this survey that there is a risk of peroperative fascicle lesion even when using the microscope. This information is important to consider in the setting of deciding how to proceed before the excision of this benign lesion.     

Scintigraphic image patterns in dysplastic coxarthrosis: Evaluation with reference to radiographic findings in 210 hips

Little is known about scintigraphic image patterns in the various stages of coxarthrosis. We assessed bone scintigraphy in 159 patients (210 hips) with dysplastic arthrosis of the hip. Scintigraphic images were divided into 5 types related to the radiographic stages of the disease. The scintigraphic images showed little, if any, uptake in the stage of prearthrosis. In the early stage, we found an increase in uptake in the weight bearing area in 30% of cases. In the advanced stage, more than half of the cases had an increase in uptake in the medial side of the joint and in the weight bearing area. In the terminal stage, a marked increase in uptake in the weight bearing area was commonest. Since the osteoblastic reaction intensified, a marked increase in uptake was seen not only in the weight bearing area, but also throughout the entire joint. These types of scintigraphic patterns, which change with the stage of coxarthrosis, seem to reflect the natural course of the disease. All hips with rapid progression of the disease showed a marked increase in uptake of radionuclide the entire joint at earlier stages.     

尿路复合性恶性肿瘤（附21例报告）

报告２１例尿路复合性恶性肿瘤，位于肾盂２例，膀胱１９例。主要临床表现为血尿，绝大多数病人伴有尿路刺激症状。低分化的移行细胞癌（ＴＣＣ）与继发性复合肿瘤有密切关系。２１例中１例为ＴＣＣ复合肉瘤，１１例为ＴＣＣ复合鳞癌，７例为ＴＣＣ复合腺癌，２例为腺癌复合鳞癌。本组２例肾盂肿瘤分别行肾输尿管全长加膀胱袖口状切除术和肾部分切除术，术后存活６个月和１年；膀胱肿瘤１４例行膀胱部分切除术，已生存３年４例，１年２例，未满１年２例，３例１～２年内死亡，失访３例；２例根治性膀胱全切术已生存５年和３年以上；３例行ＴＵＲＢｔ，已生存３年１例，１５年１例，未满１年１例。对尿路复合性恶性肿瘤的组织学、临床和病理特征进行了讨论。     

Cellular basis of decreased rate of longitudinal growth of bone in pseudoachondroplastic dogs.

Regulation of growth of long bones occurs in cartilage growth plates, where proliferation of chondrocytes, matrix synthesis, and an increase in vertical height in the direction of growth all contribute to the final length of a bone. In this study, we tested the hypothesis that an increase in chondrocytic vertical height is a major variable that accounts for the decreased rate of growth of long bones in Scottish deerhound dogs that had pseudoachondroplasia. The diagnosis of pseudoachondroplasia is based, primarily, on the demonstration of alternating electron-dense and electron-lucent lamellae with a periodicity of 100 to 150 nanometers in dilated rough endoplasmic reticulum. These ultrastructural changes are similar to those seen in humans who have pseudoachondroplasia. In Scottish deerhounds that have the disease, growth of bone is approximately 65 per cent of that in normal animals. There were striking differences in the diameters of proliferating and hypertrophic chondrocytes in pseudoachondroplastic animals compared with normal animals. Specifically, the horizontal diameter of proliferating chondrocytes was 22.7 micrometers in normal animals and 11.3 micrometers in pseudoachondroplastic animals. The vertical diameter of proliferating chondrocytes was 4.8 and 7.6 micrometers in normal and pseudoachondroplastic animals. In the distal 100 micrometers of the hypertrophic zone, the mean horizontal diameter of hypertrophic chondrocytes was 29.6 and 19.1 micrometers and the mean vertical diameter was 22.8 and 18.6 micrometers in normal and pseudoachondroplastic animals. All these differences were statistically significant. The changes in vertical height resulted in a significant difference in the incremental difference in vertical height between chondrocytes from the proliferative and hypertrophic zones in normal animals (18.0 micrometers per chondrocyte) and pseudoachondroplastic animals (11.0 micrometers per chondrocyte). Each chondrocyte in the abnormal plates achieved only 61 per cent of the incremental difference of chondrocytes in normal plates. The mean cellular volume of chondrocytes in the hypertrophic zone was 13,050 cubic micrometers in the normal animals and 10,740 cubic micrometers in the pseudoachondroplastic animals. This difference was not statistically significant. These results are discussed in relation to current theories of the role of the shape and change in volume of chondrocytes in the regulation of longitudinal growth of bone.(ABSTRACT TRUNCATED AT 400 WORDS)     

一氧化氮在肝硬变大鼠低蛋白血症中的作用

目的探讨一氧化氮（ＮＯ）在肝硬变低蛋白血症中的作用。方法利用硫代乙酰胺（ＴＡＡ）腹腔注射大鼠诱导肝功能的变化，并用辅酶Ⅱ（ＮＡＤＰＨ）硫辛酰胺脱氢酶组织化学法显示不同肝功能时期肝脏一氧化氮合成酶（ＮＯＳ）的分布。结果正常鼠肝脏ＮＯＳ染色阴性；大鼠肝功能异常但无低蛋白血症时，肝小叶周边有少量散在的ＮＯＳ阳性细胞，至肝硬变有明显低蛋白血症时，假小叶内肝细胞均为ＮＯＳ染色阳性；停止注射ＴＡＡ４周后，大鼠肝功能逐渐恢复，但仍有低蛋白血症，此时假小叶内肝细胞仍为ＮＯＳ阳性，仅染色稍浅于肝功能明显异常时。结论肝硬变时肝细胞内ＮＯＳ被激活而产生ＮＯ，后者通过抑制肝细胞合成蛋白质而可能参与肝硬变时低蛋白血症的形成。     

Role of nephrin in renal disease including diabetic nephropathy

Nephrin, a newly described protein, has been localized to the slit membrane between adjacent podocytes of the glomerulus. Its discovery followed the demonstration of the gene NPHS1 and its mutation, resulting in the absence of the protein product, nephrin, in the congenital nephrotic syndrome of the Finnish type. The link between permutations in nephrin expression and proteinuria has been shown in animal models by using neutralizing antibodies or studying mice with inactivation of the nephrin gene. Moreover, the expression of nephrin has been shown to be reduced in various animal models of proteinuric renal disease. The relationship between changes in nephrin expression and proteinuric renal disease in humans is not fully elucidated, with a reduction in expression of this protein reported in a range of renal diseases. Diabetic nephropathy, one of the major causes of end-stage renal disease, is associated with substantial proteinuria and in experimental models with a reduction in slit pore density. In experimental models of diabetes, nephrin expression has been described as being transiently increased in the first 8 weeks of diabetes, followed in longer-term studies with reduced nephrin expression in association with increasing proteinuria. An angiotensin II-receptor blocker has been shown to prevent depletion in glomerular nephrin expression in the diabetic kidney. Human studies in both type 1 and type 2 diabetes suggest down-regulation of nephrin expression in the diabetic kidney and it has been postulated that these changes may play a role in the pathogenesis of diabetic nephropathy, specifically the development of proteinuria in this condition. Although there are other proteins involved in the structure of the epithelial podocyte and specifically the slit pore, nephrin seems to play a pivotal role in preventing passage of protein through the glomerular barrier. Furthermore, it is suggested that the antiproteinuric effects of inhibition of the renin-angiotensin system may partly relate to the effects of these agents on nephrin expression.     

Inhibition of Sperm Maturation Through Intervention of the Carnitine System

Carnitine, acetylcarnitine and carnitine acetyltransferase (E.C.2.2.1.7) are present in 6–120 fold higher concentrations in human spermatozoa than in seminal plasma. Carnitine uptake by epididymal tissue in vitro in the rat is most active in the same segments of epididymis where the highest concentrations of carnitine are found in man. Radiolabelled carnitine is not taken up by mature human spermatozoa. Carnitine suppresses oxygen uptake in bovine ejaculated spermatozoa but not in human ejaculated or in rat or bovine epididymal spermatozoa. These findings indicate that the epididymis contributes to the accumulation of carnitine in caput spermatozoa and that carnitine may not be primarily responsible for the quiescent state of the spermatozoa in the cauda epididymis.
Extensive changes in carnitine uptake in the epididymis can be encouraged by a hormonal treatment which has no effect on the carnitine uptake by the heart. This raises the possibility of interference with the carnitine balance in the epididymis without effecting the pattern of carnitine uptake in other tissues.     

Anaemia of pregnancy

This paper reports the findings of a cross-sectional study of anaemia in Indian and black women attending an antenatal clinic. Anaemia as defined by current World Health Organization criteria was detected in 13,2% of Indian women in the first trimester of pregnancy, in 28,1% in the second trimester and in 47,0% in the third trimester. Iron deficiency, diagnosed on the basis of low serum ferritin levels (less than 12 ng/ml), was common, the prevalence being 35% in the first trimester and rising to 86% in the third; this demonstrates the effects of the progressively increasing stress on iron metabolism as pregnancy advances. Reduced folate levels (less than 3 ng/ml) were detected in 8,8% of subjects in the first trimester and in 47% in the third. It may therefore be concluded that anaemia was common in this group and that its prevalence increased progressively as pregnancy advanced. Iron deficiency was by far the commonest type of deficiency observed. While folate levels were low in a fair proportion of subjects, evidence of coexistent iron deficiency was found in all of them. It is therefore not clear whether or not a primary nutritional deficiency of folic acid contributed towards the production of anaemia. A similar study was done among pregnant black women. Anaemia was detected in 18,8%, 26,0% and 28,6% of subjects in the three trimesters. Iron deficiency, diagnosed on the basis of low serum ferritin levels, was observed in 19% and 40% of women in the first and third trimesters respectively. Reduced folate levels were found in 8,7% of subjects in the first trimester and in 10% in the third.(ABSTRACT TRUNCATED AT 250 WORDS)     

Involvement of meteorological factors and sex in the occurrence of subarachnoid hemorrhage in Japan

The sex difference in the seasonal occurrence of subarachnoid hemorrhage (SAH) and the association of meteorological factors in Japan were analyzed in 1006 consecutive patients with SAH in Toyama, Japan from 1996 to 2000. The study investigated whether these meteorological factors could explain the seasonality of the incidence of SAH in each sex. Seasonal variation of SAH occurrence peaked in spring in men, but peaked in spring and winter in women. The difference between maximum temperature and minimum temperature was the greatest on the day previous to SAH occurrence in multiple individuals in men, whereas mean humidity was the greatest on that day in women. Interestingly, the difference between maximum temperature and minimum temperature peaked in spring and mean humidity in winter from the meteorological data over the 5 years. The relationship between humidity and occurrence of SAH may explain the sex difference of the incidence of aneurysmal SAH. The humidity change may be a specific and additional meteorological factor for the incidence of SAH in women.     

The Incidence of Osteochondritis Dissecans in the Condyles of the Femur

The incidence of osteochondritis dissecans in the condyles of the femur was studied in a defined population and was found to be twice as common in men as in women; the maximum incidence in both sexes being between the ages of 10 and 20. The site of the lesion in the condyles did not differ between age groups. The incidence of diagnosed cases has increased somewhat in recent years but only in men. The incidence in the population is less than has been suggested in the past.     

Pro-opiomelanocortin gene expression in silent corticotroph-cell adenoma and Cushing's disease

The silent corticotroph-cell adenoma (SCCA) is characterized by the presence of immunoreactive adrenocorticotropic hormone (ACTH) in the tumor tissue in patients without symptoms of Cushing's disease. To elucidate the pathophysiology of SCCA, the expression of pro-opiomelanocortin (a ACTH precursor) genes was studied in a patient with SCCA and in three patients with Cushing's disease. Pro-opiomelanocortin messenger ribonucleic acid (mRNA) was found in the SCCA tissue to a greater degree than in the adenomas of the patients with Cushing's disease. Northern blot analysis revealed that the size of pro-opiomelanocortin mRNA present in the SCCA tissue was indistinguishable from that in the adenomas associated with Cushing's disease. A ribonuclease mapping study indicated that there were no point mutations in the coding sequence of pro-opiomelanocortin mRNA present in the SCCA tissue. Because of the presence of pro-opiomelanocortin mRNA and immunoreactive ACTH in the adenoma tissue, it is proposed that translation of the mRNA and subsequent accumulation of ACTH precursor occurred in the SCCA. Thus, the absence of Cushing's disease symptoms in this SCCA could not be caused by abnormality in the coding sequence of the pro-opiomelanocortin gene or in ribonucleic acid processing. The occurrence of abnormality at or after the translational steps was strongly suggested.