Current role of scapulectomy

Tumors of the scapula are an unusual clinical challenge. Partial or complete resection of the scapula, with its attached musculoaponeurotic tissue, is a seldom used technique for the treatment of primary bone and soft tissue tumors, as well as selected metastatic involvement of the scapula. Scapulectomy may allow wide margins of resection without amputation. The purpose of this study is to review our recent experience with scapulectomy. This study describes the recent experience with scapulectomy by the Section of Surgical Oncology and the Department of Orthopedics at Louisiana State Medical Center (New Orleans, LA). Between 1994 and 1998, 12 patients (between 16 and 79 years of age) underwent a resection of the scapula. Eleven of these patients had soft tissue tumors; one had a metastasis from a thyroid carcinoma. Six of these patients underwent a scapulectomy as a primary treatment, five for recurrence. Six patients also received postoperative radiation and/or chemotherapy. The follow-up ranged from 6 months to 4 years. There was no mortality or wound infection associated with scapulectomy. All patients had normal hand and wrist function after surgery. Three distant recurrences occurred, with no local or regional failures encountered during the follow-up period. Scapulectomy can result in excellent local tumor control. Whereas some loss of active shoulder motion may occur, hand, wrist and elbow function is preserved. Although maintenance of shoulder function should not take precedence over adequacy of resection, scapulectomy remains an excellent procedure for malignant disease that preserves hand, wrist, and elbow function.     

Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany.

BACKGROUND: Although in several epidemiological studies exposure to diesel motor emissions (DME) shows an elevated lung cancer risk, it is still controversial whether DME is a human carcinogen. METHODS: In a pooled analysis of two case-control studies on lung cancer in Germany a total of 3498 male cases with histologically or cytologically ascertained lung cancer and 3541 male population controls were included. Information about lifelong occupational and smoking history was obtained by questionnaire. Drivers of lorries, buses, taxies, diesel locomotives and forklift trucks, bulldozers, graders, excavators, and tractors, were considered as exposed to DME and their cumulative exposure was estimated. All odds ratios were adjusted for smoking and asbestos exposure. RESULTS: The evaluation of lung cancer risk for all jobs with DME-exposure combined showed an odds ratio of OR=1.43 (95%-CI: 1.23-1.67). Most pronounced was the increase in lung cancer risk in heavy equipment operators (OR=2. 31 95%-CI: 1.44-3.70). The risk of tractor drivers increased with length of employment and reached statistical significance for exposures longer than 30 years (OR=6.81, 95%-CI: 1.17-39.51). The group of professional drivers (e.g., trucks, buses, and taxies), showed an increased risk only in West Germany (OR=1.44, 95%-CI: 1. 18-1.76), but not in East Germany (OR=0.83, 95%-CI: 0.60-1.14). DME-exposure in other traffic related jobs (e.g., diesel engine locomotive drivers, switchmen, forklift operators) was associated with an odds ratio of OR=1.53 (95%-CI: 1.04-2.24). CONCLUSIONS: The study provides further evidence that occupational exposure to diesel motor emissions is associated with an increased lung cancer risk.     

Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment

Background: Pars planta vitrectomy has evolved as an alternative method in the treatment of more complicated rhegmatogenous retinal detachments. We report a series of patients who underwent primary vitrectomy with gas tamponade without the use of additional scleral buckling. Methods: A retrospective study of 53 patients with a follow-up of 6–45 months (mean 17.8 months) was carried out. Preoperative findings included unusual, multiple or large breaks, vitreous haemorrhage, proliferative vitreoretinopathy and bullous retinal detachment. Preoperative visual acuity was between light perception and 1.0, with 30% (16/53) of patients with 0.4 or better. Results: Retinal reattachment was achieved in 64% of cases (34/53) with one and in 92% (49/53) with one or more operations. Final visual acuity was between light perception and 1.0, with 41% (22/53) of patients with 0.4 or better. Cataract formation occurred in 86% (37/43) of all patients with a clear lens preoperatively. Macular pucker was noted in 11 % (6/53) and postoperative proliferative vitreoretinopathy causing redetachment in 6% (3/53). Conclusion: With primary vitrectomy, a high final anatomical success rate with few intraoperative complications can be achieved in more complicated forms of rhegmatogenous retinal detachment. The major drawback of the procedure is the high incidence of post-operative cataract formation.     

Small artery reconstruction with a new vascular prosthesis

In the Surgical Department of the University of Erlangen, 307 reconstructions in all areas of the arterial tree were performed with PTFE (GORE-TEX^®) grafts, of which 188 were performed in the femoral-popliteal and femoral-crural areas. Femoral-popliteal bypass grafts above the knee joint remained patent in 93% of the patients during an average follow-up time of 6.7 months. Below the knee joint, the patency rate was 85% during an average follow-up time of 5.6 months. In the proximal aorta, aorta-renal, and aorta-femoral areas, long-term results with the PTFE graft have been excellent.     

Influence of the concentration of metipranolol eye drops on the drug concentration in human aqueous humour

The concentration of the metabolite of the beta-blocker metipranolol was determined in the aqueous humour of 89 cataract patients. At 1, 2 or 5 h before surgery, they received one drop (30 l) of a 0.1 % or 0.3% solution of the drug. At 1, 2 or 5 h after the application of 0.1 % metipranolol eye drops, desacetylmetipranolol concentrations of 624.55, 235.29 and 88.02 ng/ ml, respectively, were measured. At the same intervals after the instillation of 0.3% metipranolol eye drops, the respective values of 1289.20, 1120.88 and 327.36 ng/ ml were found. The metabolite concentration in the eye drops and the values measured show no consistent correlation.Offprint requests to: H. Bleckmann     

Effect of photocorrosion on cadmium sulfide suspensions applied in animal inhalation studies with CdS particles

Cadmium sulfide aerosol (90 g Cd/m³) was generated from an aqueous suspension for 12 weeks and the ratio of Cd⁺⁺/Cd_total in the suspension and the resulting aerosol was determined. After 4 weeks the concentration of Cd⁺⁺ in the suspension and the aerosol leveled off at 43.5±11.4% and 35.8±6.8%, respectively. Therefore, lung tumors in rats observed after inhalation exposure to such CdS aerosols (Glaser et al. 1990) may have been caused not only by the effect of CdS but also by the influence of inhaled Cd⁺⁺ or CdSO₄. The contribution of CdS particles to the observed lung tumor rate depends on the bioavailability of CdS retained in the lungs. The photochemical decay of CdS in aqueous suspensions only occurred when exposed to light and adjusting the suspension up to pH 3 did not increase the decomposition rate of CdS. Ethanolic suspensions of CdS are much more stable than aqueous ones and experiments with suspensions kept under shield gases showed that the decay of CdS is not dependent on oxygen.     

Stoff und Applikationsart beim Drogenkonsum Jugendlicher

Zusammenfassung In einer Stichprobe von 382 schweren Drogenkonsumenten wurden Art und Ausmass des Drogenkonsums unter Berücksichtigung der Applikationsart der Stoffe erfragt und die Angaben einer Faktorenanalyse unterworfen. Es bildeten sich drei Faktoren mit den Kurzbezeichnungen «intravenös applizierte illegale Drogen», «oral applizierte illegale Drogen» und «oral applizierte Medikamente». Dies weist darauf hin, dass sich «intravenös spritzen» von den übrigen Applikationsarten eindeutig unterscheidet und dass die Definitionen des Betäubungsmittelgesetzes ein starkes Kriterium für die Einstellung der Drogenkonsumenten den Stoffen gegenüber ist. Pharmakologische Gesichtspunkte und solche der subjektiven Wirkung der Stoffe erlangen daneben kaum sichtbare Bedeutung.

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Drugs and their modes of application — a factor analytic inquiry of drug abuse

Summary In a sample of 382 heavy users mode and extent of drug abuse were inquired. Factor analysis of the data gave three factors named i.v. applicated illegal drugs, oral applicated illegal drugs and oral applicated medicaments for short. Results show that attitudes of the drug users towards their drugs are strongly influenced by the mode of application and the definitions of the drug laws, whereas pharmacological aspects and subjective effects have hardly any demonstrable importance.

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Drogues et leurs modes d'application — une enquête concernant la consommation abusive de drogues utilisant l'analyse factorielle

Résumé Une enquête sur mode et quantité de l'abus de drogues a été faite dans un échantillon de 382 graves consommateurs de drogues. L'analyse factorielle des données mène à trois facteurs abbréviés: «drogues illégales appliquées i.v.», «drogues illégales appliquées per os» et «médicaments appliqués per os». En regardant ces résultats on peut dire que les attitudes des consommateurs envers les drogues sont tout d'abord influencées par la mode d'application et les définitions des lois concernant les narcotiques, pendant que des points de vue pharmacologiques et les effects subjectifs n'ont peu d'importance.

     

Electron microscopic localization of nitric oxide I synthase in the organ of Corti of the guinea pig

Nitric oxide synthase (NOS) activity has been detected previously in the mammalian cochlea at a light microscopic level. Here we present results of electron microscopic analysis for post-embedding immunoreactivity of neural-type NOS I in the cochlea of the guinea pig. Strong enzyme immunoreactivity was identified in the cytoplasm of inner and outer hair cells. Gold-labeled NOS I antibodies were mainly located in electron-dense areas of the cytoplasm, whereas electron-lucent regions of the receptor cells were nearly free from any immunoreactivity. In both types of hair cells anti-NOS I antibodies were also visible in the cuticular plates, hair bundles and nuclei. Further ultrastructural analysis revealed that the submembranous cisternae of the outer hair cells were nearly free from any reaction product, demonstrating that the whole cytoplasm of this hair cell was not immunoreactive. Other NOS I immunoreactivity was identified in the cuticular plates of the inner and outer pillar cells and in the cytoskeletal elements located in the apical parts of Deiter cells, forming the lamina reticularis or in cytoskeletal-containing regions in basal Deiter cells. Anti-NOS antibodies were visible in the nuclei of various cell types. Our findings suggest that nitric oxide produced by NO I synthase in the organ of Corti may act as a modulator of hair cell physiology during the processes of signal transduction with frequence selectivity.     

Alteration of loosely bound calcium in the guinea pig organ of Corti after treatment with diltiazem as calcium channel blocker

After oral administration of the organic calcium channel blocker diltiazem to guinea pigs for 7 days, calcium ions were precipitated with potassium antimonate in the cochleae. The spatial distribution of the precipitates was studied by energy-filtering transmission electron microscopy and the amount of the ultrastructural reaction products formed was determined semiquantitatively by an image processing system. Compared with untreated control ears, the number of the formed precipitates was reduced drastically in the inner hair cells after diltiazem treatment. In addition, electron microscopic analysis revealed that the number of calcium precipitates attached at the basolateral membrane of the outer hair cells was clearly reduced when compared with untreated control specimens. A large number of histochemical reaction products could be identified in the basilar membrane and were also observed in the untreated control specimens. The spatial distribution of the calcium precipitates in the lamina reticularis was not affected by diltiazem treatment and calcium precipitates could be identified within different cell membranes. The technique used was considered to be helpful for identifying calcium channels ultrastructurally in intact undissected tissues and to support light microscopic analyses and patch-clamp electrophysiological measurements.