Transabdominal ultrasonography in the evaluation of patients with advanced prostatic carcinoma: effects of castration and of chronic administration of a gonadotropin releasing hormone agonistic analogue

Twenty-two patients with advanced prostatic carcinoma were subjected either to orchiectomy (group I, n = 5) or to chronic administration of a gonadotropin releasing hormone agonistic analogue D, Ser (TBU)6, des Gly-NH2(10) LHRH nonapeptide (HOE 766) (group 2, n = 17). Plasma testosterone was similar in both groups prior to treatment (group 1: 636 +/- 129.29, group 2: 580.85 +/- 37.57; X +/- SE). The levels attained in group I were significantly lower (P less than .05) than those of group 2 through eight weeks of follow-up but were similar by the third month. Prostatic size (cm2) as estimated by transabdominal ultrasonography did not differ between the two groups prior to treatment (group 1: 23.6 +/- 3.35, group 2: 21.4 +/- 1.97; X +/- SE). Both therapies resulted in a decrease of prostatic size that was significantly more pronounced (P less than .05) in group I compared with group 2 by the first and third month; by the six month, there was no statistical difference in the prostatic size attained with either therapeutic modality. Persistent suppression of prostatic size was documented in all patients of group 2 chronically (up to 24 months) treated with HOE 766 even when there was evidence of uninhibited or progressive bony metastases. The above data 1) indicate the efficacy of the HOE 766 in inducing medical castration and prostatic shrinkage in advanced carcinoma of the prostate, 2) document the usefulness of transabdominal ultrasound in the follow-up of such patients, and 3) suggest a relationship between the rapidity of tumor shrinkage and Leydig cell suppression.     

Histological changes observed in an Arachnia propionica infection of mice

The pathological changes associated with actinomycosis in mice caused by Arachnia propionica have been described. Abscess formation in the liver was the predominant gross and microscopic alteration produced by this organism. Liver abscesses were evident 3 days post challenge and simply enlarged with time. There was no evidence of spontaneous abscess healing. Additionally, multinucleated giant cells were found in an enlarged spleen.     

美味猕猴桃根正丁醇提取物对小鼠急性肝损伤的保护作用

为研究美味猕猴桃根正丁醇提取物（BEAD）对四氯化碳（CCl4）、D-半乳糖胺致肝损伤小鼠血浆转氨酶活性的影响。采用CCl4、D-半乳糖胺灌胃建立小鼠实验性肝损伤模型，以不同剂量BEAD和阳性对照药联苯双酯灌胃治疗，测定小鼠血浆中丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）活性。结果表明不同剂量BEAD对CCl4、D-半乳糖胺造成的小鼠急性肝损伤ALT、AST活性升高具有降低作用，BEAD中、高剂量能显著降低ALT、AST的含量，与模型对照组相比，P〈0．01。说明BEAD中高剂量对小鼠急性肝损伤具有保护作用。     

128. Zur Problematik des Coeliacakompressionssyndroms

Zusammenfassung Das allgemein unter die Angina intestinalis eingeordnete Coeliacakompressionssyndrom hat bisher noch keine eindeutige pathophysiologische Erklärung gefunden. Seine Pathophysiologie wird an Hand der Literatur und 19 eigenen Patienten diskutiert mit folgenden Schlußfolgerungen: 1. Das klinische Erscheinungsbild des Kompressionssyndroms unterscheidet sich wesentlich von der Symptomatologie der Angina intestinalis. 2. Die von der Angina intestinalis her bekannte Pathophysiologie sowie die klinischen und experimentellen Erfahrungen mit der Kompression des Truncus coeliacus sprechen gegen eine vasculär-ischämische Ätiologie. 3. Eine wesentlichere pathogenetische Bedeutung scheint dem im Bereich der Kompression gelegenen Ganglion coeliacum zuzukommen.     

T. AUBREY BOWEN,OCULIST, 1837–93. HIS CHARITABLE BEQUESTS IN VICTORIA

During the economic depression which engulfed Victoria in the 1890s, T. Aubrey Bowen bequeathed 20,000 for division amongst Victorian charitable and benevolent institutions. Five buildings resulting from this bequest were: the Aubrey Bowen Wing at The Victorian Eye and Ear Hospital, the Bowen Memorial Operating Theatre at the Melbourne Hospital, the Bowen Block at the Austin Hospital, the Aubrey Bowen Operating Room and Wards at the Geelong Infirmary and Benevolent Asylum, and the Aubrey Bowen Cottage at the Old Colonists’Homes.     

Diagnosis and management of atypical mycobacterial lymphadenitis in children

One hundred and thirty children with superficial atypical mycobacterial lymphadenitis have been treated between 1958 and 1974. The introduction of Double Mantoux testing has provided a reliable means of differentiating human and bovine from atypical infection and has enabled us to cease the routine use of antituberculous drugs. Adequate local surgical excision has become the treatment of choice.     

Are preoperative sestamibi scans useful for identifying ectopic parathyroid glands in patients with expected multigland parathyroid disease?

Background

The role of preoperative localization studies in patients with hyperparathyroidism and expected multigland disease remains poorly defined. Our study investigates the usefulness of obtaining preoperative sestamibi scans and ultrasonography of the neck in identifying ectopic glands in this group of patients.

286. Die Leberverletzung

Zusammenfassung Anhand von 54 eigenen Fällen mit Lebertrauma, sowie von 3221 Fällen der Literatur wird zu Ursachen, Diagnostik und Therapie der Leberverletzungen Stellung genommen. Die Letalität der penetrierenden Verletzungen liegt bei 4%, die der stumpfen bei 20–40%. Für die Prognose mitentscheidend sind eine rasche Diagnosestellung (Peritoneallavage) und die Anwendung wirkungsvoller Maßnahmen zur Blutstillung (Abklemmen der Aorta bzw. des Leberhilus). Die adäquate Operationstechnik schließt die Leberresektion und die Ligatur der A. hepatica ein.     

Beidseitge A.-vertebralis- Dissektion nach chiropraktischer Behandlungn konservativer Behandlungsmethoden bei Patienten mit Claudicatio spinalis

Zusammenfassung Eine 31-jährige Patientin entwickelte im Anschluss an eine chiropraktische Behandlung der Halswirbelsäule nebeneinander stehende Doppelbilder, eine linksseitige sensomotorische Hemiparese und eine Hemiataxie. Neben einem frischen Hirnstamminfarkt zeigten sich MR-tomographisch Dissektionen beider Aa. vertebrales. Der Fallbericht soll auf diese mögliche neurologische Komplikation zervikaler chiropraktischer Behandlungen hinweisen.     

Kombination einer Endarteriektomie mit offener Stentimplantation bei Tandemstenose der A. carotis interna

The surgical correction of a tandem stenosis of the carotid artery is sometimes difficult, especially if the second stenosis is near or above the skull base. Angioplasty and Stent implantation may offer an alternative to standard surgical procedures in the treatment of carotid stenoses in the future. However, the potential advantages of these endovascular techniques warrant continued evaluation. The application of these techniques in carotid artery tandem stenoses presents specific problems and dangers. We discuss the case of a 78-year-old man with severe carotid stenoses on both sides and an additional symptomatic tandem stenosis above the skull base on the right side. After the surgical correction of the left carotid artery using standard endarterectomy, we performed endarterectomy on the right side in combination with an open Stent implantation.     

Successive ruptures of the ligamenta patellarum in a young Nigerian: a case report

A 34-year-old Nigerian man had successive ruptures of the ligamenta patellarum repaired 2 years after the first injury. One knee was injured at a soccer match, the other 5 months later subsequent to a minor fall. There was no evidence of systemic disease. In spite of delay in effecting treatment, the outcome was satisfactory.     

Critical appraisal of first-generation renal tumor complexity scoring systems: Creation of a second-generation model of tumor complexity

ObjectiveTo investigate whether a combination of variables from each nephrometry system improves performance. There are 3 first-generation systems that quantify tumor complexity: R.E.N.A.L. nephrometry score (RNS), preoperative aspects and dimensions used for an anatomical (PADUA) classification (PC), and centrality index (CI). Although each has been subjected to validation and comparative analysis, to our knowledge, no work has been done to combine variables from each method to optimize their performance.Patients and methodsScores were assigned to each of 276 patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Individual components of all 3 systems were evaluated in multivariable logistic regression analysis of surgery type (PN vs. RN) and combined into a “second-generation model.”ResultsIn multivariable analysis, each scoring system was a significant predictor of PN vs. RN (P<0.0001). Of the first-generation systems, CI was most highly correlated with surgery type (area under the curve [AUC] = 0.91), followed by RNS (AUC = 0.90) and PC (AUC = 0.88). Each individual component of these scoring systems was also a predictor of surgery type (P<0.0001). In a multivariable model incorporating each component individually, 4 were independent predictors of surgery type (each P<0.005): tumor size (RNS and PC), nearness to the collecting system (RNS), location along the lateral rim (PC), and centrality (CI). A novel model in which these 4 variables were rescaled outperformed each first-generation system (AUC = 0.91).ConclusionsOptimization of first-generation models of renal tumor complexity results in a novel scoring system, which strongly predicts surgery type. This second-generation model should aid comprehension, but future work is still needed to establish the most clinically useful model.     

Effect of electrocautery on fresh human articular cartilage

The use of high energy devices has been suggested for intra-articular surgery. Experimental studies have been performed using the laser and electrocautery. However, clinical application has primarily been with the use of the electrocautery. Electrosurgery is currently being used for lateral retinacular release as well as meniscal surgery. Inadvertent damage to articular cartilage may occur, especially during meniscal resection. The objective of the current study is to assess the effect of the Concept electrocautery with the meniscal cutting electrode on fresh human articular cartilage. Twenty fresh tibial plateaus removed at the time of total knee arthroplasty were subjected to electrocautery currents ranging from 25 to 82.5 W. The articular cartilage was stained with hematoxylin and eosin. The extent of cartilage necrosis was quantitated as a percentage of the thickness of the articular cartilage. A dose response curve was developed. The extent of articular cartilage necrosis with the electrocautery setting of 20 (24.4 W) commonly used for meniscal resection resulted in only an 11.4%-injury to the articular cartilage. At the manufacturer's recommended setting of 24 (27 W), a 16% depth of laceration of the articular cartilage may be anticipated. We conclude that the lowest current setting possible should be utilized for meniscal surgery and the risk of articular cartilage damage from inadvertent injury is not excessive.     

R.E.N.A.L评分在机器人辅助肾部分切除术中的应用

目的:探讨肾脏肿瘤测量评分系统(R.E.N.A.L评分)在机器人辅助腹腔镜肾部分切除术(RALPN)中评估手术成功率和手术结果的价值。方法:2010年3月~2014年5月,回顾性分析我科施行的45例RALPN的手术数据,并进行R.E.N.A.L评分。其中低危组(R.E.N.A.L评分7分)20例,中危组(R.E.N.A.L评分7~9分)15例,高危组(R.E.N.A.L评分≥10分)10例。将三组患者手术成功率、手术数据进行比较。结果:低危组均顺利完成RALPN;中危组13例完成RALPN,2例因行RALPN困难而行机器人辅助腹腔镜根治性肾切除术(RALRN);高危组7例完成RALPN,3例行RALRN。所有手术均在机器人辅助腹腔镜下完成,无中转开放手术。低危组平均手术时间(OT)、热缺血时间(WIT)、失血量(EBL)分别为(65.0±1.4)min、(14.0±0.9)min和(35.0±4.7)ml。中危组平均OT、WIT和EBL分别为(95.0±2.7)min、(22.0±1.6)min和(110.0±7.1)ml。高危组平均OT、WIT和EBL分别为(150.0±4.9)min、(30.0±2.1)min和(320.0±15.6)ml。三组间OT、WIT和EBL的差异有统计学意义(P0.05)。三组患者术后均无并发症出现。结论:对于RALPN,术前R.E.N.A.L评分同样与手术成功率、手术时间、失血量和热缺血时间有关。R.E.N.A.L评分≥10分不应该成为RALPN的禁忌证。