Corrosion of aneurysm clips: Evaluation and clinical implications part II: Individual performance

Summary The intracranial fracture of aneurysm clips due to stress corrosion failure is an increasingly common long term postoperative complication. To study the susceptibility of different clips to this process, we evaluated seven aneurysm clips (Mayfield, Yaargil, Vari-Angle McFadden, Scoville, Heifetz, and Pivot) in vitro. Microstructures, hardness, chemical composition, and susceptibility to stress corrosion failure were all measured by standard metallurgical techniques. Certain clips such as Heifetz, Pivot, and Vari-Angle showed a much greater propensity to stress corrosion failure than the others. As a result of our tests, we recommend that only the clips that show high stress corrosion resistance in in vitro testing should be considered for long term in vivo implantation.Supported in part through an American Heart Association Student Clerkship in Cerebrovascular Disease Award, 1981. Additional support received from the Bauervic Foundation, Detroit, Michigan, and Medical Materials & Devices, Inc., Pittsburgh, Pennsylvania.     

Zur Entwicklung der Hüftluxationsbehandlung im Laufe der Medizingeschichte

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

Notes on male rhytidectomy

Summary Measurements of 100 preauricular hairline distances were done, and a normal average was established. The joined male rhytidectomy and the frontal alternating fusiform excisions are described.     

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

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

Transforming growth factor-β and prostate cancer

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

Premature craniosynostosis a retrospective analysis of a series of 52 cases

Summary A retrospective analysis of a consecutive series of 52 cases with premature craniosynostosis is presented.Excellent functional, cosmetic, and social results could be achieved by resection of prematurely fused sutures and the creation of artificial growth sutures. Pronounced skull deformities have been corrected using the basket handle, the visor plasty, and the T-bone techniques or a combination of several of these skull form correction techniques. The surgical correction of the skull base by the frontal advancement technique in combination with orbitotomy was only necessary in 2 of our cases and could have been considered in 2 additional cases viewed retrospectively.Our results support the hypothesis that the primary cause of skull deformity is the premature closure of vault sutures and not a primary deformity of the skull base.     

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

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

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.     

Computer assisted quantification of vasospasm on angiograms

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

71 b. Akute Cholecystitis — Frühcholecystektomie?

Zusammenfassung Durch kontrollierte Studien ist heute bewiesen, daß die operative Behandlung der akuten Galle bessere Ergebnisse erbringt als eine verzögerte Operation oder eine konservative Behandlung. An der Chirurgischen Universitätsklinik Würzburg wurden von 1969 bis 1983 397 Patienten wegen akuter Galle operiert; die Ergebnisse werden mitgeteilt.     

Secretory territories and rate of matrix production of osteoblasts

The secretory territories of rat osteoblasts on the parietal bone were measured directly using scanning electron microscopy. The mean territory of 4620 cells in 19 fields was 154 m² per osteoblast. The range for the fields was 136 to 177 m² per osteoblast. Four hundred cells were measured individually—for these the mean value per osteoblast was 143 m² with a standard deviation of 33. The daily rate of apposition over an 8 day period was 3.12 m (standard deviation 0.22) measured by tetracycline marking of the mineral front. This gave a daily matrix production rate of approximately 470 m³ per osteoblast.

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Zusammenfassung Die Ausscheidungsbereiche von Ratten-Osteoblasten des Scheitelbeines wurden mit dem Raster-Elektronenmikroskop direkt gemessen. Der durchschnittliche Bereich von 4620 Zellen in 19 Gesichtsfeldern war 154 m² per osteoblast. Der Streubereich lag in den verschiedenen Gesichtsfeldern zwischen 136 und 177 m² per Osteoblast. 400 Zellen wurden einzeln gemessen. Bei diesen war der Durchschnittswert per Osteoblast 143 m², mit einer Standard-Abweichung von 33. Die tägliche Anlagerungsrate während einer Periode von 8 Tagen war 3,12 m (Standard-Abweichung 0,22); sie wurde mittels Tetracyclinmarkierung der Mineralisierungsfront gemessen. Dies ergab eine tägliche Produktionsrate der Matrix von etwa 470 m³ per Osteoblast.

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Résumé Les territoires sécrétoires des ostéoblastes d'os pariétal de rats sont déterminées en utilisant la microscopie électronique à balayage. Le territoire moyen de 4.620 cellules, dans 19 territoires, est de 154 m² par ostéoblaste. Les valeurs extrêmes par champ varient de 136 à 177 m² par ostéoblaste. Quatre cent cellules sont mesurées individuellement; la valeur moyenne par ostéoblaste est de 143 m³ avec une déviation standard de 33. Le taux d'apposition journalier, mesuré par la tétracycline pendant 8 jours, est de 3.12 m (déviation standard 0.22). Ce qui correspond à une production matricielle journalière d'environ 470 m³ par ostéoblaste.

     

Banding of nipples as an augmentation of the suction correction of flat or inverted nipples

Summary Banding the nipples with a split and stretched rubber band or by the use of plaster is supplementary to the suction method for correction of flat or inverted nipples and effectively reduces the number and durations of such suction sessions, substantially improving the results. These procedures are an ideal solution for this condition.     

Tumor necrosis factor-α blocking agent as a treatment for nephrotic syndrome

We report a 13-year-old boy with refractory nephrotic syndrome (minimal change with mesangial proliferation) who failed the standard treatment protocols. There was some temporary response to large steroid doses, but even the Mendoza protocol could not induce remission. We show suppression of the proteinuria with Infliximab (Remicade) with tapering of steroids. Serial serum levels of tumor necrosis factor (TNF)- are shown and discussed. We suggest studying the TNF- blocking agents as optional treatment for nephrotic syndrome.Editorial comment Before the decision was made to accept this report for publication, it was carefully considered by both medical and ethical experts with special regard for the acknowledged relationship between the patient and one of the treating physicians. We believe that this hypothesis paper may be of interest to our readership.     

Laparoscopic cholecystectomy: an approach without pneumoperitoneum

Summary Diagnostic pneumoperitoneum, which has been considered the first step of any laparoscopic procedure, is no longer an absolute necessity. We devised an alternative to pneumoperitoneum or abdominal insufflation by upward and outward traction on the anterior abdominal wall with a hanger lifting method using subcutaneous wiring. Fairly good room was produced intraabdominally, which was enough in which to perform the cholecystectomy procedure. We have successfully performed 40 cases of laparoscopic cholecystectomy with this procedure. No complication was experienced with this method and, moreover, excess instrumentation and complications related to pneumoperitoneum were avoided.     

173. Tierexperimentelle Ergebnisse mit einem voll implantierbaren Distraktionsgerät zur operativen Beinverlängerung

Zusammenfassung Zur operativen Beinverlängerung wurde ein neues Femur-Distraktionsgerät entwickelt. Das Gerät besteht aus einem elektronisch programmierbaren Distraktionsaggregat einschließlich Kraftquelle und einer zweiteiligen Führungsschiene. Das Gesamtsystem ist voll versenkbar und schafft Übungsstabilität während der Distraktionsphase. Die Funktionen Vorlauf — Stop —Rücklauf können transcutan induktiv gesteuert werden. Ein für das Tierexperiment speziell entwickelter Prototyp des Gerätes wurde an Schafen erfolgreich erprobt.     

Correction of the “Simian” forehead deformity

A procedure for the correction of the simian forehead deformity is described.     

Tierexperimentelle Untersuchungen über die Wundheilung unter dem Einfluß von Phenothiazinderivaten

Zusammenfassung Zur Klärung der Frage, ob der Künstliche Winterschlaf in irgendeiner Form Wundheilungsvorgänge beeinflußt, wird die primäre und sekundäre Wundheilung am Meerschweinchen untersucht, die durch Gagen von täglich je 10 mg N-(2-Dimethylaminopropyl)-Phenothiazin (A) und N-(3-Dimethylaminopropyl)-3chlor-Phenothiazin (M) und 20 mg Methylphenylpiperidincarbonyläthylhydrochlorid (D) je Kilogramm bis zu 6 Tagen in den sog. künstlichen Winterschlaf versetzt werden. Die Tiere werden 2,4 und 6 Tage nach den Eingriffen getötet. Das Wundgebiet wird histologisch untersucht und das Ergebnis mit dem an Kontrolltieren gewonnenen verglichen.Die Versuche zeigen, daß in den genannten Zeiträumen bei den Winterschlaftieren gegenüber den Kontrolltieren keinerlei Unterschiede in der Wundheilung auftreten.Während die histologische Untersuchung der Nieren keinen pathologischen Befund ergibt, zeigt der histologische Befund der Leber bei einer großen Zahl der Winterschlaftiere kleinfleckige Massennekrosen im SinneRössles, die bei keinem der Kontrolltiere zu finden sind und deren Genese erörtert wird.     

Tetracycline double-labeling of iliac trabecular bone in 41 normal adults

Summary A histomorphometric evaluation of the iliac crest trabecular bone remodeling was performed after tetracycline double-labeling in 41 normal Danes (12 males and 29 females) aged 19 to 56 years. The fraction of formative (osteoid covered) and resorptive surfaces was unrelated to age but higher in males than in females (P<0.02 andP<0.05, respectively). The appositional rate (0.65±0.12 m/day) was unrelated to age and sex, whereas the fractional labeled surfaces were higher (P<0.01) in the males (0.18±0.08 m²/m²) than in the females (0.12±0.05 m²/m²), and among the females inversely related to age (R=–0.38,P<0.05). The bone formation rate at BMU level (0.50±0.20 m³/m²/day) was unrelated to sex, but among the females inversely related to age R=–0.49,P<0.01). The bone formation rate at tissue level was higher (P<0.02) in the males (0.13±0.07 m³/m²/day) than in the females (0.07±0.03 m³/m²/day) and among the females inversely correlated to age (R=–0.43,P<0.05). The age- and sex-dependent variations in the dynamic parameters underline the importance of a more elaborated normal material.     

110. Management der Verletzungen am distalen Unterschenkel und Fuß

Summary The complex injury of the foot requires immediate decisions. At first the question of vital danger and amputation should be ruled out. The criteria for the conservation of the extremity will be shown. For the most severely injured, primary amputation is indicated, since all attempts of preservation in this group hardly survived. The two-step amputation is recommended: i.e. Guillotine -amputation in the acute phase and muscle plastic stump formation in the regeneration phase. Important principles of treatment are: immediate anatomic reduction and retention of fractures and unstable joints, open wound treatment, delayed closure and reconstructive plastic intervention. A planned second-look-operation is obligatory.     

The intrathecal spread of hyperbaric dibucaine in adolescents

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