Injuries to the musculus quadriceps femoris]

The work gives an analysis of results of operative treatment of 63 patients with different injuries of the musculus quadriceps femoris. Problems of diagnostics, surgical strategy and operative technique are discussed depending on the character of injuries (open and closed), their localization and ways of rehabilitation of the patients in the postoperative period.     

Solitary tuberculoma in the tendonous section of the m. quadriceps]

A case of isolated tuberculosis observed in the tensinous part of the quadriceps muscle is reported by the authors. The rarity of the case is pointed out. A few possibilities of the development of this tuberculoma are dealt with. In the authors' case the focus developed probably after haematogenous generalization. One year after the operation the patient is symptomfree and has no complaints.     

The significance of tumor diameter in renal cell carcinoma]

The data of 740 patients who were operated on for renal cell carcinoma between 1975 and 1986 have been evaluated. We studied the relation between tumour size and other factors influencing the prognosis, such as tumour stage, infiltration of renal veins and incidence of metastases at the time of nephrectomy, and between tumour grading and postoperative survival. Sixty-six patients with small tumours were divided in groups according to tumour size: less than 20 mm, less than 25 mm, less than 30 mm, less than 40 mm. All 740 patients were separated into groups according to tumour size: less than 4 cm, 4-6 cm, 6-8 cm, 8-10 cm and greater than 10 cm. Stage pT1 carcinomas (less than 25 mm) occurred in 1.4% of patients and tumours exceeding 10 cm in size in 30%. The prognosis with regard to survival becomes worse the greater the diameter of the tumour: the incidence of renal vein involvement, metastases and higher grades of malignancy increases. Postoperative survival decreases in relation to the increase in tumour size. Carcinomas less than 30 mm in diameter were found to have distant metastases in only 1 case, while invasion of renal veins occurred in 2 cases. In tumours up to 3 cm in diameter, a kidney-preserving tumour resection seems possible without limiting the radicalness of the surgery.     

Effect of prolonged ischaemic time on muscular atrophy and regenerating nerve fibres in transplantation of the rat hind limb

Abstract

Our aim was to test the influence of cold ischaemia on replanted limbs, focusing on muscular atrophy and neurological recovery. Inbred wild-type and green fluorescent protein (GFP) transgenic (Tg) Lewis rats aged 8–10 weeks were used. The amputated limbs were transplanted at several cold ischaemic times (0, 1, 8, 12, 24, 48, and 72 hours). An arterial ischaemic model and a denervation model were used as controls. To study nerve regeneration, a GFP limb was transplanted on to the syngenic wild Lewis rat. These animals were evaluated histologically, electrophysiologically, and immunohistochemically. The longer the ischaemic time, the more evident was atrophy of the muscles. Electrophysiological investigation showed that the latency at 3 weeks was longer in the transplantation models than in the normal controls, particularly in the longer ischaemia group. Larger numbers of migrating Schwann cells were seen in the group with no delay than in the group that had been preserved for 12 hours. Ischaemia after amputation of a limb causes muscle cells to necrose and atrophy, and these changes worsen in proportion to the ischaemic preservation time. A delay in nerve regeneration and incomplete paralysis caused by malregeneration also affect muscular atrophy.     

Does mechanical tension regulate the development of muscular rudiments?

Following destruction of the right anterior member bud on four-day old chick embryos, a study was made of right and left pectoral muscle growth on serial sections stained by ordinary methods. Certain regions were also examined in the electron microscope. Mitotic activity was studied autoradiographically following the injection of thymidine. Early, frank changes in the pectoral muscle on the amputation side were connected with growth, differentiation and organogenesis: regressive processes were also observed.     

Effect of prolonged ischaemic time on muscular atrophy and regenerating nerve fibres in transplantation of the rat hind limb

Abstract Our aim was to test the influence of cold ischaemia on replanted limbs, focusing on muscular atrophy and neurological recovery. Inbred wild-type and green fluorescent protein (GFP) transgenic (Tg) Lewis rats aged 8-10 weeks were used. The amputated limbs were transplanted at several cold ischaemic times (0, 1, 8, 12, 24, 48, and 72 hours). An arterial ischaemic model and a denervation model were used as controls. To study nerve regeneration, a GFP limb was transplanted on to the syngenic wild Lewis rat. These animals were evaluated histologically, electrophysiologically, and immunohistochemically. The longer the ischaemic time, the more evident was atrophy of the muscles. Electrophysiological investigation showed that the latency at 3 weeks was longer in the transplantation models than in the normal controls, particularly in the longer ischaemia group. Larger numbers of migrating Schwann cells were seen in the group with no delay than in the group that had been preserved for 12 hours. Ischaemia after amputation of a limb causes muscle cells to necrose and atrophy, and these changes worsen in proportion to the ischaemic preservation time. A delay in nerve regeneration and incomplete paralysis caused by malregeneration also affect muscular atrophy.     

Rupture of the quadriceps tendon

Twelve patients operated for fresh rupture of the quadriceps tendon were re-examined after 5 (2-11) years. The tendon was sutured end-to-end or to the patella. The result was good in seven cases, fair in four and poor in one case of re-rupture, left unrepaired.     

Primary actinomycosis of the quadriceps

Primary actinomycosis of the musculoskeletal system is an unusual occurrence. We report the case of a 14-year-old boy with isolated actinomycosis of the quadriceps. Surgical drainage followed by 6 weeks of treatment with oral tetracycline yielded a good result.     

Tetraplegia in the course of coma from drug intoxication]

It is reported a case of quadriplegia occurring in a 67-year-old women after she commits suicide with flunitrazepam. The patient stayed during around twenty hours unconscious, in the sitting position, with an extreme flexion of the neck on the left side. After injection of flumazenil the patient's consciousness was restored. Nevertheless a complete sensitive and motor deficit at the C4 and C5 level was then observed. Several diagnosis such as peripheral neuropathy, infectious disease, or arterial occlusion were eliminated and we finally postulated that the regulation of the spinal blood flow had likely been disturbed by the prolonged flexion of the neck, the hypotension and the putative respiratory depression. The fact that the patient suffered from cervicarthrosis would have already impaired the spinal blood flow regulation and consequently had probably damaged the spinal cord. No clinical improvement of the quadriplegia was noticed and the patient died in the intensive care unit thirteen days after admission. Such an exceptional complication after a toxic coma remind us the necessity to avoid long lasting vicious position of the cervical spine in anaesthesia and emergency practice.     

The concentration of elastic fibres in the male urethra during human fetal development

OBJECTIVE: To describe the distribution of elastic fibres in the developing male urethra and to provide stereological data of the concentration of elastic fibres in the human urethra. MATERIALS AND METHODS: Urethras were obtained from 10 fresh normal human fetuses at 15-36 weeks of gestation. A place-matched spongy urethra of a 27-year-old normal adult man was also analysed. Samples were fixed in Bouin's solution, embedded in paraffin and histologically processed. The elastic system fibres were evaluated by light microscopy using Weigert's resorcin-fuchsin technique after oxidation. Morphometric values were assessed by the point-counting method. The volumetric density (Vv) of elastic fibres was correlated with fetal age. RESULTS: At 15 weeks the elastic fibres were sparse and homogeneously distributed. The size and thickness of elastic fibres increased with age, mainly in the third trimester of gestation. Elastic fibres formed a randomly orientated network in the trabeculae of the corpus spongiosum. The mean (sem) Vv of elastic fibres in the spongy urethra was 5.2 (0.4)% in the fetus at 15 weeks and 14.8 (1.0)% at 36 weeks. In the urethra of the place- matched young man the Vv was 19.0 (1.3)%. The concentration of elastic fibres in the spongy urethra increased significantly with age. CONCLUSION: The high concentration of elastic fibres in the spongy urethra may partly explain its high extensibility. The progressive increase in elastic fibres during development implies functional adaptation of the fetal male urethra.