Surgical treatment of bilateral hydatid disease of the lung via median sternotomy: experience in 60 consecutive patients

Sixty patients who underwent operation between 1979-1987 for bilateral pulmonary hydatid disease using median sternotomy approach are reported on. Although some authors prefer two-stage thoracotomy and operate on the side with the larger cyst first, or perform simultaneous bilateral thoracotomies, we have preferred one-stage operation via median sternotomy. There were 29 female and 31 male patients, ranging in age from 5 to 55 years (mean 26.4 +/- 6.3). A total of 173 cysts were operated in 120 lungs. The usual operative technique was cystotomy and capitonnage. Operative and postoperative courses were uneventful in all but three cases (5%). The causes of mortality in these patients were excessive hemorrhage, mediastinitis, and septic shock respectively. It is concluded that median sternotomy is a better alternative method for the treatment of bilateral hydatid disease of the lung, as the duration of hospitalisation is shorter, the approach is better tolerated by the patients than thoracotomy, and it possibly prevents a second general anesthesia.     

Improved body-outline imaging technique for localization of sentinel lymph nodes in breast surgery.

Many centers use techniques for localizing the sentinel lymph node (SLN) associated with a breast tumor. Protocols involve the use of an intraoperative probe and blue dye but may or may not include scintigraphy. METHODS: Three methods of body-outline imaging were investigated to aid SLN localization. Body outlines were acquired using a handheld source; a transmission image was acquired from a (57)Co-flood source; and, finally, a new method is described using a (153)Gd-line source attenuation correction for body outline. RESULTS: Method 1 images were of low quality, although 83% of SLNs were visualized. Body outline was unsatisfactory for surgical localization. Method 2 was unsatisfactory because of the lack of a lateral image. Method 3 enabled good presurgical visualization of the SLN (73%) and speeded surgical localization. CONCLUSION: The (153)Gd-line source consistently gives optimal-quality body-outline images. This source is simple, quick, and clearly locates the SLN on multiple projections.     

Effects of hemodialysis on protein metabolism.

Uremic malnutrition, as evidenced by decreased muscle mass, is strongly associated with increased risk of death and hospitalization events in chronic hemodialysis (CHD) patients. Several factors that influence protein metabolism predispose CHD patients to increased catabolism and loss of lean body mass. It has been long suspected that the hemodialysis (HD) procedure is a net catabolic event. Recent studies show that the HD procedure indeed induces a net protein catabolic state at the whole-body level as well as in skeletal muscle. There is evidence to suggest that these undesirable effects are caused by decreased protein synthesis and increased proteolysis. Animal studies suggest that decreased protein synthesis is likely mediated by the significant decrease in plasma amino acid concentrations during HD. On the other hand, increased protein degradation is, at least in part, mediated by the HD-associated inflammatory response.     

Cigarette smoking and Parkinson's disease: a case-control study in a population characterized by a high prevalence of pesticide exposure.

Epidemiological studies have been consistent in showing that cigarette smoking is inversely associated with Parkinson's disease (PD), whereas pesticide use is positively associated with PD. However, the relationship between PD and cigarette smoking remains poorly understood. Our objective was to study the relationship between cigarette smoking and PD in a population characterized by a high prevalence of pesticide exposure. This case-control study was carried out among subjects enrolled in the Mutualite Sociale Agricole, the French health insurance organization for workers connected to the agricultural world. We included 247 cases and 676 controls matched on age, sex, and region of residency. Information on smoking was obtained through in-person interviews. Pesticide exposure was assessed using a case-by-case expert evaluation procedure. We found an inverse relationship between ever cigarette smoking and PD (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4-0.9). The strength of this association increased with the number of pack-years. This relationship was present even when smoking was considered as long as 40 years before PD onset. An inverse association was also present among subjects professionally exposed to pesticides (OR = 0.5; 95% CI = 0.3-0.8) and was independent of the duration of exposure among men. We confirm the inverse association between cigarette smoking and PD in a population characterized by a high prevalence of professional pesticide exposure. The relationship between PD and cigarette smoking was not significantly modified or confounded by exposure to pesticides.     

Treatment of chronic duodenal ulceration. Effectiveness of colloidal bismuth subcitrate tablets compared with cimetidine

Fifty-eight patients with chronic duodenal ulceration proven at endoscopy consented to enter a trial comparing the effect of colloidal bismuth subcitrate (CBS)tablets with that of cimetidine. Fifty-four patients completed the six-week trial. An endoscopic assessment of healing was made at four weeks. If healing had not occurred, the trial was continued for another two weeks and the endoscopy was repeated. At four weeks, healing at endoscopy was demonstrated in 82% of patients receiving CBS and in 58% of those receiving cimetidine. At six weeks, the healing rates were 93% and 81%, respectively. No side effects were noted in either group. Continued smoking was not found to have an adverse effect on the healing rate of ulcers in either treatment group.     

Oncologic and functional results of supracricoid partial laryngectomy with cricohyoidopexy.

OBJECTIVE: Supracricoid partial laryngectomy with cricohyoidopexy (SPL-CHP) is an alternative technique described for extensive tumors of the larynx that are beyond the limits of classical conservation partial laryngectomy and otherwise would be treated by total laryngectomy. STUDY DESIGN AND SETTING: Forty-six patients with carcinoma of the larynx underwent SPL-CHP between 1991 and 2003. The median age was 54 (range, 37 to 72). In 28 cases both arytenoids were spared; in 17 cases, 1 arytenoid was spared; and in 1 case, 2 arytenoids were resected. Bilateral elective neck dissections were performed in supraglottic carcinomas. In glottic carcinomas, neck dissection was performed in the presence of clinically positive lymph nodes. None of the patients were treated with postoperative radiation therapy. RESULTS: Forty-five patients were successfully decannulated; 1 patient with 2 arytenoids resected could not tolerate decannulation. The mean time for decannulation was 20 days (range, 9 to 60 days) when both arytenoids were spared with SPL-CHP, and 41 days (range, 13 to 150 days) for SPL-CHP when 1 arytenoid was spared. The average time for removal of the feeding tube was 21 days (range, 9 to 60 days) when both arytenoids were spared, and 40 days (range, 16 to 127 days) when 1 arytenoid was spared. The removal time of the feeding tube of the patient with 2 arytenoids resected was postoperative day 63. In 2 patients, aspiration pneumonia occurred as a result of swallowing impairment. In none of the patients temporary or permanent gastrostomy was needed. Two patients had local recurrence and were treated with a total laryngectomy; they are still alive. In 2 patients, secondary primary tumors were detected. The 3-year overall and cause-specific actuarial survival rates were 95.7 % and 87.5 % , respectively. CONCLUSIONS: Although prolonged hospitalization and delaying physiological functions can be termed as disadvantages of SPL-CHP, the operation is a reliable and oncologically valid procedure in selected cases of cancer of the larynx who would otherwise be operated by total laryngectomy.     

Inhibition of inducible nitric oxide synthase prevents shock wave therapy induced renal injury

Objectives: Shock wave lithotripsy treatment (SWT) is not completely free from side effects; one of the accused mechanisms for renal injury during SWT is oxygen- and nitrogen-derived free radical productions. Therefore, we aimed to evaluate the effect of inhibition of nitric oxide (NO) production by N-[3(aminomethyl) benzyl) acetamidine] (1400W), highly selective inducible nitric oxide synthase (iNOS) inhibitor, at SWT-induced kidney damage. Materials and methods: Twenty-four rats those underwent right nephrectomy procedure were divided equally into three groups as control, SWT, and SWT?+?1400W. 1400W was administered at a dose of 10?mg/kg at 2?h prior to SWT procedure and at the beginning of SWT procedure via intraperitoneal route and continued daily for consecutive 3 days. At the end of the fourth day, animals were killed via decapitation and trunk blood and the left kidneys were taken for biochemical and histopathologic evaluation. Results: SWT caused renal tubular damage and increased lipid peroxidation and antioxidant enzyme activities and SWT also significantly increased nitro-oxidative products. Inhibition of iNOS via administration of 1400W ameliorated renal injury and decreased tissue lipid peroxidation (malondialdehyde), superoxide dismutase, glutathione peroxidase and nitrite/nitrate levels (NO_x). In addition, it was seen that histolopathological changes were attenuated in the SWT?+?1400W group when compared to SWT group. Conclusion: SWT-induced renal injury might be due to excessive production of oxygen free radicals and NO production. Inhibition of iNOS attenuates renal injury following SWT treatment. It can be concluded that iNOS inhibitors or peroxynitrite scavengers might be used to protect the kidneys against SWT-induced morphological and functional injuries.