Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer

OBJECTIVE: To evaluate the quality of life (QoL) in patients undergoing anterior resection (AR) or abdominoperineal extirpation (APE) for rectal cancer in a sample of patients recruited from a field trial. SUMMARY BACKGROUND DATA: Abdominoperineal resection has been reported to put patients at higher risk of disruption to QoL than sphincter-preserving surgery. METHODS: Fifty patients treated with AR and 23 patients treated with APE were prospectively followed up. All patients were treated in curative attempt and were disease-free throughout the study. QoL was assessed before surgery and 6 to 9 and 12 to 15 months after surgery. RESULTS: Multivariate analysis of variance and subsequent post hoc comparisons revealed a main effect for time (role function, emotional function, body image, future perspective, and micturition-related problems) and group in favor of APE (sleeping problems, constipation, diarrhea), and a time-by-group interaction (role function). No significant results were obtained for the remaining scores, but patients undergoing APE consistently had more favorable QoL scores than those undergoing AR. Multivariate analysis and post hoc comparisons revealed a particularly poor QoL for patients undergoing low AR. They had a significantly lower total QoL, role function, social function, body image, and future perspective, and more gastrointestinal and defecation-related symptoms than patients undergoing high AR. CONCLUSION: Patients undergoing APE do not have a poorer QoL than patients undergoing AR. Patients undergoing low AR have a lower QoL than those undergoing APE. Attention should be paid to QoL concerns expressed by patients undergoing low AR.     

Orthotopic liver transplantation for complicated HELLP Syndrome

A case of hepatic complication in a pregnant woman suffering from HELLP syndrome resulting in the need for transplantation is reported, and an algorithm for those instances is suggested. According to the literature, this is the 5th report of hepatic complications in HELLP syndrome necessitating liver transplantation. Since all but one of the transplanted patients survived (as opposed to a high mortality in non-transplanted patients), it is concluded, that a timely decision for transplantation is a safe option in this high risk group.     

A study of chromosomal aberrations and chromosomal fragility after recombinant growth hormone treatment

Increased chromosomal rearrangements and chromosomal fragility have been previously observed in lymphocytes of children treated with human GH, implying that treatment could predispose to malignancy. Twenty-four children with classic GH deficiency, neurosecretory GH dysfunction, and Turner syndrome were treated with recombinant human GH (0.3 mg x kg(-1) x wk(-1)). Metaphase cells were assessed for spontaneous chromosomal and chromatid aberrations at baseline and 6 mo into treatment. There were no significant differences in aberrations between baseline and the 6-mo samples. However, the mean frequency of chromatid-type aberrations on a per cell basis was significantly higher than at baseline, 0.0088 versus 0.0064 aberrations per cell (p < 0.024). Two patients contributed inordinately to this increase. A third sample from these two patients was almost identical to their baseline samples. Cells were also irradiated in vitro (3 Gy) to assess chromosomal fragility. After irradiation, no patient showed a significant difference for any aberration type, although there was a significantly lower frequency of ring chromosomes on a per cell basis in the 6-mo samples (p < 0.001). We find no evidence that GH therapy influences spontaneous chromosomal aberrations or chromosomal fragility.     

Gonadentoxizität

Current strategies of cancer treatment, including chemotherapy and radiotherapy, achieve high rates of remission and survival but are often associated with sterility. Therefore, the question arises of how to preserve the fertility of these patients or how to reverse sterility. For men, fertility preservation can be easily done by cryopreservation of sperm. For women, things are more difficult, but different options exist. Before radiotherapy, ovariopexy can be performed. Other possibilities are cotreatment with GnRH analogs to protect the ovaries, and cryopreservation of embryos and oocytes after stimulation with gonadotropins. Although this kind of treatment is possible, it is time-consuming and therefore not an ideal option because the start of cancer treatment must be postponed. However, cryopreservation of ovarian tissue can be done directly after ovarian biopsy by laparoscopy. Later, the ovarian tissue can be retransplanted. Three births have been documented worldwide after cryopreservation and retransplantation of ovarian tissue. In Germany, the first retransplantation of ovarian tissue was recently performed. Fertility-preserving procedures should be offered to patients who are facing fertility loss.     

Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound

Objective To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO₄) and phenytoin on cerebral circulation.
Design Prospective randomised study.
Setting High care obstetric unit, King Edward VIII Hospital, Durban, South Africa.
Participants Twenty-four eclamptic patients: 13 received MgSO, and 11 phenytoin.
Intervention Middle cerebral artery flow velocity waveforms were measured using 2 MH_z pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant.
Results Magnesium sulphate significantly reduced the pulsatility index (   P = 0.002  ) and mean flow velocity (   P = 0.02  ) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO, and phenytoin groups.
Conclusion These findings provide firm evidence that MgSO, relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.     

Restrictive dermopathy: A lethal congenital skin disorder

Restrictive dermopathy is a recently described lethal congential disorder of the skin with an autosomal recessive mode of inheritance. The rigidity of the skin impairs fetal movements in utero and causes arthrogryposis, as well as highly characteristic facial features and pulmonary hypoplasia. We report two cases of restrictive dermopathy in prematurely born infants, describe the typical pathological findings and discuss this disorder in the context of the fetal akinesia/hypokinesia deformation sequence.