Raloxifene prevents the growth of uterine leiomyomas in premenopausal women

OBJECTIVE: To evaluate the effects of raloxifene administration on uterine leiomyoma size in premenopausal women. DESIGN: Prospective, randomized, open-label, controlled clinical trial. SETTING: Tertiary care unit, University of Vienna, Austria. PATIENT(S): Twenty-five premenopausal women with uterine leiomyomas. INTERVENTION(S): Three months of treatment with raloxifene (180 mg/d) or no treatment. MAIN OUTCOME MEASURE(S): Baseline to end point percent change difference in leiomyoma volume between the therapy and control groups. RESULT(S): Raloxifene treatment prevented the progression of uterine leiomyomas. Compared with no medical intervention, raloxifene resulted in a decrease of myoma volume. Raloxifene was clinically well tolerated. No significant differences were detected in symptoms related to leiomyomas and hormonal status. CONCLUSION(S): In premenopausal women, high-dose raloxifene is well tolerated and inhibits the growth of leiomyomas.     

Surgical complications of esophageal resections: our experience with 168 operations

We performed 346 operations for oesophageal cancer between 1 June 1991 and 31 May 2001. 168 of them were resections. The resection rate was 48.5 percent. The most frequently performed operation was subtotal resection of the oesophagus with the removal of paraesophageal lymph nodes. Reconstruction was usually performed with gastric tube pulled up retrosternally according to Akiyama with cervical oesophago-gastrostomy (135/168). In 24 patients intrathoracic oesophago-gastrostomy and in 9 patients other type of reconstruction was performed. Considerable co-morbidity was present in 88 percent of our patients (148/168). Alcohol dependency was noted in 88 patients however we suspect there were patients who did not admit alcohol abuse. Extended resection i.e. other organs' resection together with the oesophagus was performed in 59 patients. Postoperative recovery was uneventful in 49.4 percent (83/168) of our patients. Surgical complications occurred in 28.6 percent. Anastomotic leak was observed in 21 cases (12.5 percent). The most severe complication was necrosis of an organ used in reconstruction (7 patients, 4.2 percent). 23 patients (13.7 percent) died in the postoperative period, 7 of them (4.2 percent) because of surgical complication. Statistical analysis proved that the R status and the extension of resection had no influence on the frequency of complications and mortality rate except for when the removal of the entire stomach or gastric stump was performed in one sitting with the oesophageal resection. The frequency of anastomotic leakage is grossly affected by the anastomosis technique and whether it was in cervical or in thoracic position.     

Lung biopsy using mediastinoscope in the time of VATS

Patients with diffuse lung disease need lung biopsy for accurate diagnosis and treatment. Both traditional open lung biopsy through a thoracotomy and video assisted thoracoscopic lung biopsy are effective methods for obtaining parenchymal samples. The authors present their surgical method and experience. Thirty patients were operated on for lung biopsy using mediastinoscope between 1999-2003. Lung parenchymal samples were eligible for histological examination. No serious postoperative complications developed. The method is simple, safe and low-cost.     

Anesthetic considerations during liver surgery

This article demonstrates the broad range of considerations that affect the outcome of patients undergoing hepatectomy. The progressive improvements in survival, despite the increasing complexity of the surgery, area testament to advances in both surgery and anesthesia. The key elements include careful patient selection, appropriate monitoring, and mechanical and pharmacologic protection of the liver and other vital organs.     

Snoring and progression of coronary artery disease: The Stockholm Female Coronary Angiography Study

STUDY OBJECTIVES: Snoring is associated with a significant increased risk for acute myocardial infarction and stroke. However, our knowledge of mechanisms is still incomplete. The aim of the study was to investigate the influence of snoring in combination with feelings of tiredness on the 3-year progression of atherosclerosis in women with cardiovascular disease. DESIGN: Repeated quantitative coronary angiograms were carried out with an average time interval of 3.25 years. SETTING: Department of Thoracic Radiology at Karolinska Hospital, Stockholm, Sweden. PARTICIPANTS: The study sample comprised 103 women cardiac patients with repeated, valid, and comparable measurement of quantitative coronary angiograms. MEASUREMENTS AND RESULTS: Absolute luminal diameter (in mm) was measured in 10 predefined coronary segments. Mean segment diameter was calculated as the mean of all diameters measured along a given segment. The change over time was calculated by subtracting the first from the second measurement. Snoring and feelings of tiredness were measured by a short version of the Karolinska Sleep Questionnaire. We found that snoring women, after adjusting for age, waist-hip ratio, smoking, event at hospitalization, education, hypertension and alcohol intake, had a statistically significantly larger progression of atherosclerosis than did nonsnoring women (0.18 mm vs 0.07 mm change; P = .0006). CONCLUSION: Snoring contributes to the atherosclerotic process and should be taken into consideration when treating patients with cardiac disease.     

Rare case of congenital transsphenoidal meningoencephalocele causing respiratory problems

INTRODUCTION: Congenital meningoencephalocele is a rare and severe malformation. AIMS: The authors describe the case of congenital, basal transsphenoidal meningoencephalocele associated with other neurological malformations, which projected between the margins of palatoschisis producing respiratory problems at neonatal age. METHOD: Presented with detailed photo-documentation. RESULTS: Cranial meningoencephalocele reconstruction with an approach of bifrontal craniotomy was performed. The base of skull was closed multilaminarly with auto-graft gained from parietal bone and Lyodura. The closure of nasopharyngeal sac was performed in second sitting. Postoperatively the progression of hydrocephalus was so extensive, that implantation of ventriculo-peritoneal shunt was unavoidable. Later on closure of tracheotomy performed for continued air passage support was done. The authors report the course of disease and the surgeries performed. CONCLUSIONS: Auto-graft from skull bone for closure of large basal-cranial defect proved to be ideal. Prognosis depends on other malformations. Successful treatment needs co-operation of different specialties.     

Examination of the anthraquinone composition in root-stock and root samples of Rubia tinctorium L. plants of different origins

The aim of our work was to identify the anthraquinone derivatives in the underground organs (root-stock and root) of the madder root live plant sortiment Rubia tinctorium L, furthermore to isolate populations the anthraquinone compostitions of which are optimal from therapeutical point of view. In the course of the examinations, we studied the anthraquinone composition in root-stock and root samples of plants originating from 11 different habitats. The identification of the anthraquinone derivatives we carried out after the hydrolysis of these samples with HCl solution, by HPLC method and by use of UV-VIS spectrophotometric and mass spectrometric detection. In the samples we identified 6 anthraquinone-aglicones. The main components were alizarin (9.6-21.8 mg/g), purpurin (3.7-12.3 mg/g), and lucidin (1.8-5.7 mg/g). The total anthraquinone-derivative content varied between 15.6 and 39.4 mg/g. After the evaluation of the results it can be stated that from therapeutical point of view the most favourable biggest ratio of total anthraquinone amount/lucidin amount (11.97) and one of the biggest total anthraquinone-derivative contents (38.1 mg/g) are found in the Rubia tinctorium sample marked R02 originating from Aachen (Germany). These results enable us at the same time to find--through the establishment of further collections and through the exploration of the biodiversity of these--basic material with more favourable composition than at present, especially in relation to lucidin derivatives which are risk factors.