Preservation of periprostatic autonomic nerves during total perineal prostatectomy by intrafascial dissection

A modification of Young's total perineal prostatectomy technique is described to prevent damage to the apical branches of the cavernous nerves. Based on anatomic relationships between investing prostatic fascial layers and the neurovascular bundle, emphasis is placed on division of the apical prostatic urethra between the anterolateral endopelvic fascia and Denonvilliers fascia (intrafascial dissection) in avoidance of the apical nerves. Vertical incision in the fused distal portion of Denonvilliers fascia is necessary to make this dissection atraumatic regarding the adjacent paraprostatic neurovascular bundle. Clinical application of this completely intrafascial prostatic dissection is exemplified. It is concluded that careful modification of Young's technique of total perineal prostatectomy may result in increased postoperative potency rates.     

Specific stimulation of brain serotonin mediated neurotransmission by dexfenfluramine does not restore growth hormone responsiveness in obese women

OBJECTIVE Growth hormone release in response to all known stimuli of GH secretion is blunted in obese subjects. Several studies, using dl-fenfluramine (dl-FF) as a serotoninergic tool, suggest that brain serotonin plays a role in the pathogenesis of this phenomenon. However, the effect of dl-FF appears to be dependent on the stimulus used to induce GH release. Furthermore, dl-FF has catecholamingergic properties apart from its capacity to stimulate serotonin release and to block its re-uptake. In this study, we investigated whether subchronic treatment with the highly selective serotoninergic drug dexfenfluramine (d-FF) affects the GH response to galanin or GHRH in obese subjects. DESIGN The study had a randomized, cross-over, placebo controlled design. d-FF was administered in a dose of 15 mg twice daily during 6 days. On days 5 and 6 of treatment (with either d-FF or placebo) an i.v. bolus injection of 100 μg hGHRH(1-44) or a continuous infusion of p-galanin (40 pmol/kg/min over 40 minutes) were administered in randomized order. All tests were performed in the follicular phase of two consecutive menstrual cycles. PATIENTS Eight obese women (body mass index (BMI) 34.5 ± 3.6 kg/m²); 7 normal weight (BMI 21.9 ± 1.9 kg/m²) age-matched control women. All women had a regular menstrual cycle. None used oral contraceptive drugs. MEASUREMENTS GH response to either stimulus was measured both during treatment with d-FF and during treatment with placebo. RESULTS The GH response to galanin and the response to GHRH were significantly smaller in obese subjects. d-FF significantly reduced the galanin induced GH secretion in obese subjects, but not in normal weight controls. It did not significantly affect GH release in response to GHRH in either group. CONCLUSION This study confirms that GH secretion in response to stimuli with varying mechanisms of action is blunted in obese subjects. A decrease of central serotonin mediated neurotransmission does not appear to play a role in the pathogenesis of this phenomenon.     

Controlled study of inline radiofrequency ablation (ILRFA) assisted transection of ovine liver

BACKGROUND: Liver resection is now a standard treatment for primary and secondary hepatic tumors around the world. Intra-operative blood loss during liver resection is a major factor associated with morbidity and mortality. We have developed a new instrument using radiofrequency energy (ILRFA), which is intended to achieve coagulative ablation in a plane. This plane can then be cut through with a scalpel, ultrasonic dissector, or diathermy with minimal blood loss. MATERIALS AND METHODS: Five sheep were used in this non-recovery experiment. In these sheep we performed five liver resections with the ILRFA and five similar resections using diathermy and suturing as control. Blood loss was measured by determining the difference in the weights of dry sponges and blood stained sponges after resection. RESULTS: ILRFA was successful in achieving coagulative ablation in all cases to a width of 1 cm. The mean blood loss in ILRFA was 43.2 g (SD36) and 221.8 g (SD147) in the control group. The bleeding was significantly reduced in ILRFA group with a P value of 0.005. CONCLUSIONS: Bleeding remains an important complication of liver resection. To reduce bleeding during liver surgery, different techniques have been used. In this study, we have demonstrated that by using ILRFA we can perform liver resections in sheep with minimal blood loss.     

Mitral valve repair provides improved outcome over replacement in active infective endocarditis

OBJECTIVES: Mitral repair in active infective endocarditis still remains controversial. Several studies demonstrate the feasibility of mitral repair in infective endocarditis; however, superiority of repair has never been shown. The aim of the investigation was to compare valve repair and valve replacement in respect to the extent of destruction and to analyze survival, recurrent endocarditis, and reoperation (event-free survival). METHODS: Sixty-eight consecutive patients underwent surgical intervention for mitral endocarditis. Thirty-four (50%) patients had valve repair, and 34 (50%) patients had valve replacement. Leaflet destruction involving at least one mitral leaflet was present in 15 (44.1%) patients of the repair group and 11 (32.4%) patients of the replacement group. Repair of the mitral annulus with pericardium was performed in 4 (11.8%) patients in the repair group and 3 (8.8%) patients in the replacement group. Patients in both groups were similar concerning the progression of valvular destructions and comorbidities. RESULTS: Hospital mortality was 11.8% (8 patients). No significant differences were found in all baseline parameters, with the exception of a higher incidence of previous septic embolism and sepsis in the repair group. Actuarial event-free survival at 1 year was 88.2% in the repair group compared with 67.7% in the replacement group, and 5-year event-free survival was 80.4% in the repair group and 54.6% in the replacement group (P = .015). Mitral valve repair remained the superior treatment regarding event-free survival in the multivariate analysis (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .02). CONCLUSIONS: Mitral valve repair offers excellent early and late results and is the preferable treatment option in the surgical therapy of native infective endocarditis.     

Late complication of aortocoronary venous bypass grafting

The problem of symptomatic, diffuse coronary artery disease not amenable to the established methods of medical or revascularizing therapies remains unsolved. Aortocoronary venous bypass grafting is a rare treatment modality bearing considerable risks. We report on a further complication of the method.     

Intimacy needs and chronic illness: strategies for sexual counseling and self-management

Individuals experiencing a chronic illness have many needs and concerns. One area frequently overlooked is that of intimacy. Those experiencing cardiovascular illnesses have concerns about the strain of sexual activity on their heart. Individuals with lung diseases may perceive that sexual activity is no longer possible because of breathing difficulties. Accurate information and strategies for self-management are needed to address the intimacy needs and concerns of these individuals. The purpose of this article is to identify intimacy needs and strategies for sexual counseling for individuals with cardiovascular illnesses such as myocardial infarction, heart failure, implantable defibrillators, hypertension, and for chronic lung problems.     

Protein quality comparison of a new isolated soy protein and milk in chilean preschool children

The protein quality of a newly developed soybean protein isolate (SPF-200) and milk were compared using apparent N digestibility (AND), N balance (ANB) and serum biochemical response to graded levels of N intake (NI). Seven healthy well nourished children aged 35 to 62 months, were given for 8 day periods 1.5, 1.25, 1.0 and 0.75 g protein/kg/day of SPF and milk in decreasing order at a constant energy intake of 100 Kcal/kg/day and a vitamin mineral supplement. AND for SPF ranged from 86 to 70% and for milk 83 to 75%, corresponding to highest and lowest NI, ANB for SPF ranged from 63 to 0 mg/kg/day and for milk from 90 to 28 mg/kg/day. Mean individual regressions of daily ANB and NI were ANB=0.49 NI-54 for SPF and ANB=0.51 NI-34 milk. The slopes were not significantly different. Non significant decreases in serum albumin and urea were observed. A°significant increases in transaminases was noted at the lowest NI for both proteins. Daily protein allowances to retain 39 mg N/kg/day were 1.27 and 0.91 g protein/kg/day for SPF and milk respectively.