Antibodies directed at mouse IL-2-R α and β chains act in synergy to abolish T-cell proliferation in vitro and delayed type hypersensitivity reaction in vivo

The anti-mouse IL-2-R chain mAb TM-1 which, by itself, does not affect IL-2-dependent proliferation throught the high affinity mouse IL-2 receptor, was shown to cooperate in a synergistic way with a set of anti-IL-2-R chain mAbs both in vitro and in vivo. In vitro, when associated at equimolar concentrations, the TM-1/anti- mAb association was four to ten times more efficient at inhibiting the proliferation of the CTL-L2 cell line than was a similar concentration of anti- mAb alone. In addition, a bispecific antibody in which a Fab' fragment of TM-1 was covalently linked to a Fab' fragment of one of the anti- mAb (5A2) was shown to be as efficient as the TM-1/5A2 association. The association of TM-1 with 5A2 was also tested in vivo in a sheep red blood cell-induced delayed type hypersensitivity (DTH) model. TM-1 which, by itself, had no effect on DTH, induced a two- to threefold decrease in the doses of 5A2 required to suppress this cell-mediated immune reaction.     

„Multi-targeting drugs“ und „multi-drug targeting“ beim metastasierten Nierenzellkarzinom

Ohne ZusammenfassungD. Rohde: Vorstandsmitglied der AUO.Association for Urogenital Oncology (AUO): Multi-targeting drug and multi-drug targeting in metastatic renal cell carcinoma. Co-inhibition of EGF-R     

31P and23Na nuclear magnetic resonance study on forebrain ischemia in rats with shift reagent Dy(TTHA)

³¹P and ²³Na nuclear magnetic resonance (NMR) spectroscopy was employed to study the dynamic changes in intracellular high-energy phosphates and sodium during 15min of forebrain ischemia and recirculation in in vivo rat brain. In the presence of the shift reagent Dysprosium triethylenetetramine-N,N,N,N,N,N-hexaacetic and [Dy(TTHA)], the sodium peak separated into two peaks, unshifted and shifted. During 15min of ischemia, the unshifted sodium peak decreased and the shifted sodium peak increased. With recirculation, the unshifted and the shifted sodium peaks returned to the preischemia level within 10min, but the shifted one increased during 30–60min. Intracellular high-energy phosphates and intracellular pH (pHi) decreased during 15min of ischemia and returned to the preischemia levels within 20min of recirculation. We conclude that the decrease in unshifted sodium peak during ischemia is due to the decrease in subarachnoid sodium and the cellular influx of interstitial sodium would be minimum. The increase in shifted sodium peak during ischemia is considered to be due to the dilatation of cerebral blood vessels and the increase in interstitial sodium which was transported from subarachnoid space.(Kurata M: ³¹P and ²³Na nuclear magnetic resonance study on forebrain ischemia in rats with shift reagent Dy(TTHA). J Anesth 7: 325–333, 1993)     

“High spinal” dysrhaphism

Summary High spinal (cervical and upper thoracic) dysrhaphism usually involves either a meningocele or a dermal sinus tract. These high spinal lesions can have a complex intradural anatomy at the level of the lesion (as this case reports) and are associated with an increased incidence of lower spinal occult dysrhaphic anomalies. It is therefore recommended that patients with high spinal dysrhaphism undergo radiological evaluation of the entire spine to identify those patients with intradural anomalies, define the anatomy for surgery, and investigate the lower spine for associated occult anomalies.     

PTSD among vietnam veterans: An early look at treatment outcome using direct therapeutic exposure

Vietnam combat veteran inpatients were evaluated after being treated in a PTSD special treatment unit. Selected pretreatment measures that included mental and physical problems, combat variables, PTSD symptoms, and the standard MMPI scales found no clinically meaningful differences between a group that was found to be successes and another group found to be failures, based on predetermined cutoff scores on the VETS scale, a reliable outcome measure for veteran patients. At 3 months post-therapy, a significantly greater number of subjects treated with Direct Therapeutic Exposure (DTE) (flooding therapy) as compared to another group treated with a more conventional individual therapy, were identified as successes as opposed to failures, based on the VETs scale. Also, the number of failures was greater for those treated with the more conventional therapy and the number of successess was greater for those treated with DTE, when compared to all other subjects in the sample. These preliminary results were interpreted as indicating that DTE, when offered as part of an inpatient milieu, shows promise as an effective treatment for chronic/severe combat veteran PTSD sufferers.     

Effects of various HTK solution regimens on proteinuria after renal transplantation in dogs

Investigations were carried out by means of an autologous, heterotopic model for kidney transplantation applied to dogs. Duration of cold ischemia was 48 h. Four experimental groups were arranged. During the first 20 min following revitalization of the transplanted kidney, group 1 (HTK solution/80 cm perfusion height) showed a significant glomerular and tubular malfunction. In group 2 (HTK solution/120 cm perfusion height), only four urinary proteins with molecular weights of 25 kDa, 67 kDa, 100 kDa and >100 kDa were found. The excretion of higher molecular proteins receded over the 20-min period of observation. In both group 3 (HTK/aspartate solution) and group 4 (HTK/tryptophan solution) the quantity of excreted glomerular and tubular protein was well above that of group 2. As opposed to the Tryptophan group, a complete restoration of renal function was observed in the Aspartate group after 4 weeks. In general, the standard HTK protective solution delivered with 120 cm perfusion pressure gave the most favorable results, with the lowest levels of proteinuria and a satisfactory recovery of renal function after revitalization.     

82. Fragen der chirurgischen Weiterbildung: Gegenwärtiger Stand

Zusammenfassung Weiterbildung — die Einführung eines approbierten Arztes in ein anerkanntes Fachgebiet — ist im Begriff und System von Ausbildung (des Studenten) und lebenslanger Fortbildung (des fertigen Arztes) zu unterscheiden. Sie schafft das Fundament, auf dem sich Wissen und Können der Angehörigen einer Disziplin aufbauen, und setzt damit Wertmaßstäbe im eigenen Land und über die Grenzen hinaus. Weiterbildungsordnung (WO) und als Richtlinien bezeichnete Ausführungsbestimmungen regeln den Ablauf der Weiterbildung (W). Neu ist im wesentlichen die Verlängerung der Weiterbildungszeit von 5 auf 6 Jahre, die Einführung von Teilgebieten (in der Chirurgie Teilgebiet Kinder-Chirurgie und Teilgebiet Unfall-Chirurgie) mit dem Ziel, abgerundeten Subspezialitäten im Rahmen des Gesamt-Fachgebiets eine Autonomie zu geben, sowie ein umfangreicher Operations-Katalog. Die WO ist damit richtungweisend für die weitere Entwicklung des Fachgebietes und begründet erhebliche Anforderungen sowohl an den Facharzt-Aspiranten als auch an den Erfahrenen, der die W leitet. Die Einführung eines Befähigungsnachweises als einer in der ausschließlichen Kompetenz der ärztlichen Selbstverwaltung gelegenen Abschlußkontrolle wird befürwortet.

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Summary Postgraduate medical education in an approved specialty by definition and set-up differs from both undergraduate medical education and the life-long continuing medical education after completion of training. Postgraduate education in medicine is the basis for the knowledge and proficiency of a specialist and sets standards at home and abroad. Postgraduate education is laid down in principle in the Weiterbildungsordnung and regulated by the Richtlinien. Major innovations are a prolongation of training from 5 to 6 years, the introduction of subspecialties (pediatric surgery, traumatology), in order to give these established groups autonomy within the field of surgery and finally a sizable list of operations to be performed. The new Weiterbildungsordnung will guide the future development of surgery and imposes demands both on those in training and those responsible for it. An examination as "proof of competence"' is recommended, but should remain within the competence of the medical profession.

     

63. Dauer und Wandel im ärztlichen Ethos

Zusammenfassung Der Vortrag entwickelt zuerst einen allgemeinen Begriff des Ethos [1] und Kategorien zur Erfassung seiner Strukturen [2]. Das klassische hippokratische Ethos zeigt sich dann als Entwurf, welcher ärztliches Handeln als Sache eines, durch praktisch Wissenschaft orientierten Standes im Dienst des privaten Wohls des Patienten normiert [3]. Der Wille, im Wandel der Bedingungen ärztlicher Praxis die Substanz dieses Ethos auf Dauer zu stellen, erfordert a) gegen das Mißverständnis der Medizin als theoretischer Naturwissenschaft die Besinnung aufihren praktischen Charakter, b) gegen die Ausweitung einer bloß sozialen Zielsetzung die Anerkenntnis der Maßstäblichkeit des privaten Verhältnisses zum Patienten, c) gegen die technologisch bedingte Entpersönlichung eine Orientierung am Gesamt der Bedürfnisse des Patienten.     

“Kissing” bilateral large carotid-ophthalmic aneurysms

A case of unruptured bilateral large carotid-ophthalmic aneurysms, which appear to be adjoining and kissing each other when visualized by three-dimensional computed tomographic angiography (3-D CTA), is reported. Although bilateral carotid-ophthalmic aneurysms are not rare, bilateral large ones are quite rare, and direct imaging of kissing aneurysms of this portion has not been reported. Since 3-D CTA is becoming a useful tool for the diagnosis of cerebral aneurysms, we propose that these and similar bilateral large carotid-ophthalmic aneurysms are good candidates for the term kissing aneurysms.     

“Micrografts” for improvement of the frontal hairline after hair transplantation

The frontal hairline is the most important and difficult part of hair reconstruction. A technique is presented that uses micrografts to correct a frontal hairline that looks less than natural, a condition often seen after punch hair grafting (or strip grafting or scalp flaps). With these micrografts, it is possible to produce a natural-looking, soft frontal hairline, hiding an unnatural-looking, dense hairline that starts abruptly with coarse hairs. It is also possible to hide disturbing visible scarring or cobblestoning of the foremost punch grafts and differences in color between the grafted skin and the recipient area.     

HA-coated hip implants: A 10 year follow-up

Summary We started using HA-coated hip prostheses on May 1997 and our personal experience reaches to date 2075 HA hips of which 1898 were primary hips. This study was based upon a consecutive series of 134 consecutive HA cases implanted from May '87 until December '88, at the Clinique Médico-Chirurgicale of Bruay-Labuissière, France. No patient was lost to follow up. 26 patients deceased and of the 104 remaining cases, 58 complete dossiers were available for addressing clinical and radiological scored results. Within the 58 over 10 year cases cohort, mean age was 56 years. Main aetiology was osteoarthritis in 81% and necrosis in 17%, 1 case was a revision one. Femoral component was HA Omnifit stem in all the cases, fitted with Arc 2f cup. No case of loosening nor any mechanical failure was observed within this over 10 yr of FU series, since 4 reoperations were related to 2 stiffnesses and 2 recurrent dislocations with neither retrieval of acetabular nor femoral component.As regards radiographic findings, femoral lysis over 10 yr was none in 48%, limited to neck area in 28%, proximally extended in 24%, as no case of distal lysis was observed. 88% of cups had no lysis at 10 yr of FU. All our 58 10 yr+ cases belonged to the ingrowth confirmed group. Mean values of HHS scores were preoperatively 33.34 ± 12.46 out of 100 pts preoperatively up to 97.6 pts at 10 year. Thus results were excellent in 86%, good in 9%, fair in 5%, and poor in 0%. Mean values according to Merle d'Aubigne score (MDA) were 7.98 ± 1.74 pts out of 18 preoperatively up to 16.90 pts at 10 yr, leading to 84% of excellent, 11% of good, 5% of fair and 0% of poor results.When considering the cumulative survival analysis since 1987, the results at 10 year, based upon the 1922 primary cases reaches 0.9889 ± 0.0061 when considering all types of failures (Mechanical loosening + Clinical failure + Radiological failure). While considering a 10 year follow-up period as a major milestone in terms of hip results, the results of this series may look very encouraging and lead us to remain confident in bioactive coatings.     

The “syncytial tissue triad”: a model for understanding how gap junctions participate in the local control of penile erection

Summary Recent findings from both clinical and experimental studies document the importance of syncytial relaxation and contraction of corporal smooth muscle to penile erection and detumescence, respectively. However, the mechanism(s) permitting coordinated response generation among the vast array of largely inexcitable corporal smooth muscle cells is unclear. In this report the compelling evidence for a major role of intercellular communication through gap junctions to erectile function is reviewed. Moreover, a novel concept is advanced to explain more fully the putative mechanistic basis for integrative erectile tissue biology. Specifically, the presence of gap junctions; in concert with the autonomic nervous system and myogenic intracellular signal transduction mechanisms, is postulated to form a syncytial tissue triad that is largely responsible for the local modulation of corporal smooth muscle tone. It is reasonable to assume that the existence of this syncytial tissue triad confers a plasticity, adaptability, and flexibility to erectile function that may well account for the observed diversity of mechanisms known to regulate penile erection as well as the multifaceted etiology of erectile dysfunction.     

One for two? Exchanging implanted pulse generators for deep brain stimulation

The use of a dual channel implantable pulse generator (IPG) for deep brain stimulation during de novo implantation is now routine in many centers. When the generator batteries of bilateral single channel generators expire, the issue of whether to exchange two single channel generators for one dual channel generator arises. This presents many debatable clinical, practical and fiscal issues. We discuss these issues and describe the one for two technique we have adopted for exchanging IPGs.     

Primary bladder neck obstruction

Summary Primary bladder neck obstruction is not uncommon in young and middle age men. The symptoms are confounding and routine urologic investigation including cystometry, uroflow, voiding cystourethrography and cystourethroscopy often leads to an erroneous diagnosis of psychogenic voiding dysfunction, neurogenic bladder or prostatitis. An accurate diagnosis can be obtained by the simultaneous measurement of detrusor pressure and uroflow, preferably accompanied by radiographic visualization of the lower urinary tract during micturition. Treatment with bladder neck incision is usually curative, but often results in retrograde ejaculation.     

Percutaneous and Open Renal Revascularizations Have Equivalent Long-Term Functional Outcomes

Atherosclerotic renal artery stenosis is a significant cause of poorly controlled hypertension and progressive renal dysfunction leading to ischemic nephropathy and other end-organ damage. The optimal treatment of renovascular disease contributing to hypertension and renal dysfunction is not known. This study compares the anatomic and functional outcomes of both open and endovascular therapy for chronic, symptomatic atherosclerotic renal artery disease. We performed a retrospective analysis of records from patients who underwent renal arterial interventions, endovascular or open bypass, between January 1984 and January 2004. Principal indications for intervention were hypertension (51%), chronic renal insufficiency (13%), and hypertension and elevated creatinine (36%). A total of 247 patients (109 males; mean age 69±10, range 44–89 years) underwent 314 interventions (109 open procedures; 205 angioplasties, 71% with stent placement). There was a significant difference in 30-day mortality (4% vs. <1%; p < 0.005) between the open and endoluminal groups, but not at 1, 3, or 5 years. Patients in the open group had a higher primary patency rate at 5 years (83±5% vs. 76±6%; p=0.03), but patients in the endoluminal group had a higher assisted primary patency rate at 5 years (92±5% vs. 84±5; p=0.03). There was no significant difference between both treatment groups in cumulative freedom from presenting symptom or in freedom from dialysis and renal-related death. Patients who presented with hypertension were more likely to have shown improvement in their blood pressure with endoluminal intervention at 1, 3, and 5 (59±6% endoluminal vs. 83±5% open; p=0.01) years. From these results we conclude that open repair and endoluminal repair of atherosclerotic renal artery stenosis have similar immediate and long-term functional and anatomic outcomes. Patients who present with hypertension may have greater benefit with an endoluminal repair.Presented at the Twenty-ninth Annual Meeting of the Peripheral Vascular Surgery Society, Anaheim, CA, June 4-5, 2004.     

Surgical implications of “fixed points”: A new concept in plastic surgery

The dynamic study of surface anatomy brings to light the existence of fixed points. This new concept allows us to better understand the difficult problem of skin excess and the crumpled appearance sometimes seen after liposuction. Understanding this phenomenon will avoid unaesthetic or nonfunctional results of plastic surgery.     

Spinous process-plasty following lumbar laminectomy as a contributing factor to spine stability

A 10-year retrospective study of 41 consecutive patients who underwent spinous process-plasty is presented. We carried out laminectomy of the lumbar spine in cases of spinal stenosis, dorsomedial herniated disc and recurrent disc herniation with firm scars (traumatic and tumour cases are not included). To forestall the development of laminectomy's negative effects on spine stability, we initiated the spinous processes' reconstruction. Two groups of patients who underwent laminectomy form the basis of this presentation, one group with spinous process-plasty (41 patients) and the other (11 patients) without it. On postoperative neutral and dynamic X-ray films we paid attention to horizontal displacements larger than 3 mm and to negative intervertebral angular displacement. Considering such criteria, only 3.8% of those with spinous process-plasty developed a radiographic instability in contrast to 25% of patients without spinous process-plasty. These results support the use of this technique, which provides postlaminectomy lumbar spine stability.     

Replacement of the anterior cruciate ligament

Summary Eighty-seven patients have been examined 2 years on average after knee ligament reconstruction for a torn anterior cruciate ligament. The patients were divided into four groups according to the type of operation that had been carried out. In the first group an extra-articular lateral repair (MacIntosh tenodesis) had been performed, in the second group an intra-articular over-the-top repair using the quadriceps and the patellar tendon, in the third group a modified Eriksson procedure using the patellar tendon, and in the fourth group a combined intra- and extra-articular repair using carbon fibres as a graft. The results of the operations in the different groups are compared. The best results were obtained with the Eriksson procedure, closely followed by the over-the-top repair. Limited range of motion and retropatellar pain resulting from changes in the alignment of the patella were the main problems. The results after the use of carbon fibres were less good. In two cases the graft tore without further trauma, and there were also problems because of restricted range of motion and retropatellar pain. The worst results were found after extra-articular lateral repair, due to insufficient stability in many cases. However, the best results with regard to the range of motion were found in this group.

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Zusammenfassung Es wurden 87 Patienten im Durchschnitt 2 Jahre nach Ersatzplastik bei zerrissenem vorderem Kreuzband und chronischer Instabilität nachkontrolliert. Die Patienten wurden in vier Gruppen eingeteilt. In jeder Gruppe war eine andere Art von Ersatzplastik durchgeführt worden. In der ersten Gruppe war es ein extraartikulärer lateral repair (sog. MacIntosh-Plastik), in der zweiten Gruppe eine intraartikuläre over the top geführte Plastik mit der Quadriceps- und der Patellarsehne, in der dritten eine modifizierte Eriksson-Plastik unter Verwendung der Patellarsehne und in der vierten Gruppe eine kombinierte intra- und extraartikuläre Plastik mit Carbon fibres. Die Resultate der Operationen in allen vier Gruppen werden miteinander verglichen. Die besten Ergebnisse zeigte das Vorgehen nach Eriksson, dicht gefolgt vom over the top-repair. Probleme, die in diesen zwei Gruppen auftraten, betrafen eingeschränkte Kniebeweglichkeit und retropatelläre Schmerzen wegen veränderter Führung der Patella. Die Resultate in der Gruppe mit Verwendung der carbon fibres waren weniger gut. In zwei Fällen ist das Transplantat ohne Trauma gerissen, zudem traten auch hier Beschwerden auf wegen eingeschränkter Beweglichkeit und retropatellärer Schmerzen. Am wenigsten gut waren die Resultate nach extraartikulärem lateral repair. In vielen Fällen konnte durch these Methode keine genügende Stabilität erreicht werden. Andererseits war die Beweglichkeit des Kniegelenkes nach dieser Operation kaum je eingeschränkt.

     

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently spontaneous, required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in spontaneous SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.