Postnatal management of infants with antenatally detected hydronephrosis

With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94±5.10 weeks. The mean duration of postnatal follow-up was 26.3±13.56 months (range 3–60 months). The mean APPD of the fetal renal pelvis was 10.35±3.24 mm (5–9 mm in 84 kidneys, 10–14 mm in 96 kidneys and 15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements 5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.     

Outcome of Surgery for Lung Cancer in Young and Elderly Patients

Purpose It has been suggested that lung cancer follows a more aggressive course and has a poorer prognosis in young patients than in elderly patients. We conducted this study to determine whether the basal characteristics and survival of young patients undergoing surgical resection of lung cancer differ from those of elderly patients.Methods Eighty patients who underwent surgery for lung cancer at our hospital between 1989 and 2004 were divided into two groups according to age. Group 1 comprised 50 patients aged 45 years or younger and group 2 comprised 30 patients aged 70 years or older. The patients’ medical records were reviewed with respect to age, gender, histological diagnosis, coexisting diseases, smoking history, postoperative staging, type of operation, and postoperative morbidity, mortality, and survival results.Results The average ages were 40.2 ± 3.77 years (range, 29–45 years) in group 1 and 72.2 ± 2.53 years (range, 70–80 years) in group 2. The incidence of postoperative complications was significantly higher in group 2 (P = 0.02). However, the 5-year survival rates for patients who underwent surgery for non-small cell lung cancer did not differ between groups 1 and 2, at 33.3% versus 21.3%, respectively (P = 0.09).Conclusions The incidence of adenocarcinoma was higher in the young patients, whose prognosis was slightly better than that of the elderly patients. Coexisting diseases and postoperative complications were the major factors that adversely affected the prognosis of the elderly patients.     

Synthesis and antimicrobial activity of some novel derivatives of benzofuran: part 1. Synthesis and antimicrobial activity of (benzofuran-2-yl)(3-phenyl-3-methylcyclobutyl) ketoxime derivatives

The reaction of salicylaldehyde with 1-phenyl-1-methyl-3-(2-chloro-1-oxoethyl) cyclobutane (1) and potassium carbonate was used to prepare (benzofuran-2-yl)(3-methyl-3-phenylcyclobutyl) methanone (2) for the starting reagent purposes. (benzofuran-2-yl)(3-phenyl-3-methyl cyclobutyl) ketoxime (3) was synthesized from the reaction of the compound (2) with hidroxylamine. New derivatives of (benzofuran-2-yl)(3-phenyl-3-methyl cyclobutyl) ketoxime (3) such as, O-glycidylketoxime (4) and O-phenylacylketoxime (5a-c) were obtained very high yields. Alkyl, allyl and aryl substituted N-oxime ethers (6a-e) were obtained from the reaction compound 3 and various halogen contained compounds. The syntheses of the compounds (7a-f) were carried out from the reaction of the compound (4) and different amines such as, isopropyl amine, natrium azide, morpholine and piperazine. All of the synthesized compounds were tested for antimicrobial activity against Staphylococcus aureus ATCC 6538, Staphylococcus epidermidis ATCC 12228, Escherichia coli ATCC 8739, Klebsiella pneumoniae ATCC 4352, Pseudomonas aeruginosa ATCC 1539, Salmonella typhi, Shigella flexneri, Proteus mirabilis ATCC 14153 and Candida albicans ATCC 10231. Among the synthesized compounds (benzofuran-2-yl)(3-phenyl-3-methyl cyclobutyl)-O-[2-hydroxy-3-(N-methylpiperazino)] propylketoxime (7d) was found the most active derivative against S. aureus ATCC 6538. The compounds 2, 5b, 6b, 6c, 7b and 7f showed very strong and the same antimicrobial effect against C. albicans ATCC 10231. Similarly (benzofuran-2-yl)(3-phenyl-3-methylcyclobutyl)-O-benzylketoxime 6a showed good antimicrobial effect against C. albicans ATCC 10231. None of the other compounds exhibited activity against the other test microorganisms.     

Vaccination technique, PPD reaction and BCG scarring in a cohort of children born in Guinea-Bissau 2000-2002

The rates of positive tuberculin skin test (TST) reactions and BCG scarring after BCG vaccination vary between studies and populations. Tuberculin reactivity and BCG scarring may be related to better child survival in low-income countries. We therefore studied determinants for TST reaction and scarring in Guinea-Bissau. In a cohort of children born in suburban Bissau from March 2000 to July 2002, we assessed a Mantoux test with Purified protein derivative (PPD) (SSI, 2 T.U.) at 2 (2689 children), 6 (N=2148) and 12 months (N=1638) of age, and BCG scar was assessed at 2 (N=2698) and 6 months (N=2225) of age. In a subgroup of the children the vaccination technique was monitored by direct observation of post-vaccination wheal and route of administration. Three different types of BCG vaccine supplied by the local Extended Programme on Immunization were used. At 6 months of age the rate of PPD reactors (>1mm) after BCG vaccination was 25% and the rate of scarring was 89%. One BCG strain was associated with fewer PPD reactors (OR=0.54 (0.31-0.91)) and BCG scars (OR=0.13 (0.05-0.37)) and larger post-vaccination wheals produced more PPD reactions (OR 1.21 (95% CI 1.02-1.43)) and BCG scars (OR 1.66 (1.24-2.21)). In the multivariable analyses of BCG-vaccinated children assessed at 6 months of age, monitoring of vaccination technique and type of BCG vaccine were important. This was not changed by control for other determinants, including sex, season, vaccination place, birthplace, ethnic group, low birth weight, place of residence, education and civil status of mother. We reason that vaccination technique and BCG strain are important for PPD reaction and scarring in response to BCG vaccination. Considering that these responses are associated with better infant survival, the importance of monitoring vaccination technique and of different BCG strains should be evaluated with respect to infant mortality.     

Endoscopic seminal vesicle stone removal

Seminal vesicle stones are extremely rare, and few cases have been reported. Treatment requires removal of the stone, generally through an open vesiculectomy. A 31-year-old man presented with perineal pain, painful ejaculation, and infertility of several years' duration. Multiple stones in the seminal vesicle duct system were diagnosed by radiologic examination. We treated the patient by seminal vesicle endoscopic stone removal, thereby obviating organ loss. The composition of the stones was whewellite. To our knowledge, this approach has not been previously reported, and our result may be encouraging for treatment of such pathologic conditions of the seminal vesicles.     

Autochthonous epidemic typhus associated with Bartonella quintana bacteremia in a homeless person

Trench fever, a louse-borne disease caused by Bartonella quintana, is reemerging in homeless persons. Epidemic typhus is another life-threatening louse-borne disease caused by Rickettsia prowazekii and known to occur in conditions of war, famine, refugee camps, cold weather, poverty, or lapses in public health. We report the first case of seroconversion to R. prowazekii in a homeless person of Marseilles, France. This was associated with B. quintana bacteremia. Although no outbreaks of typhus have been notified yet in the homeless population, this disease is likely to reemerge in such situation.     

Parietale Topektomie bei Phantomschmerz — Therapeutischer Erfolg und psychopathologische Bedeutung

Zusammenfassung Ein 59jähriger Patient, dem der linke Arm durch einen Unfall in 5 cm Entfernung vom Schultergelenk amputiert werden mußte, fühlte seit der Operation Phantomschmerzen, teils im Stumpf, teils in den fehlenden Fingern und im fehlenden Arm.Bei dem Patienten wurde subpial in der gegenseitigen Hemisphäre der motorische und sensorische Cortex exzidiert, nachdem durch elektrische Reizung festgestellt worden war, daß von diesem Cortexareal aus sich sensible Effekte im fehlenden Extremitätenabschnitt auslösen ließen.Der Patient blieb nachher frei von den früheren Phantomschmerzen bei einer Beobachtungsdauer von 6 Monaten.Ein besonderes Interesse wird dem Fall in der Beziehung zugesprochen, daß nach der Reizung des Gyrus centralis anterior ein Bewegungsgefühl ohne Bewegungseffekt empfunden wurde.

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Summary A 59 year old patient whose left arm had had to be amputated, following an accident, approximately 5 cm from the shoulder joint, felt phantom pain from the time of the operation partly in the stump and partly in the phantom fingers and phantom arm. A subpial excision of motor and sensory cortex in the contralateral hemisphere was performed in this patient, after it had been established by electrical stimulation that this cortical area affected the sensory symptoms in the phantom limb. The patient has been followed up for six months since operation and so far remains free from his previous phantom pain. Of special interest in this case was the demonstration that stimulation of the gyrus centralis anterior produced a sensations of movement without movement actually taking place.

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Resumen Un enfermo de 59 años con amputación del brazo izquierdo, después de un accidente, a nivel de unos 5 cms. de la articulación del hombro, empezó a sentir dolores del tipo de miembro fantasma después de la operación. Se realizó una extirpación subpial de corteza motora y sensorial en el hemisferio contralateral, después de confirmar por estimulación eléctrica que éste area cortical afectaba los sintomas sensoriales en el miembro fantasma. Durante los 6 meses transcurridos después de la operación el enfermo no ha presentado el dolor en el miembro fantasma. Tiene un especial interés que la estimulación del giro central anterior producia una sensación de movimiento sin que éste tuviera lugar.

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Résumé Une extírpation focale corticale, sensorielle et motrice, fut entreprise chez un patient âgé de 59 ans qui présentait des douleurs fantômes irréductibles du bras gauche.Quatre années avant l'opération, le bras gauche avait été amputé 5 cm en dessous de l'articulation de l'épaule à la suite d'un accident. De suite après l'opération le malade resentit des douleurs fantômes typiques, en partie dans le moignon même, en partie dans les doigts et le bras manquant. L'administration d'analgésiques, de préparations à base de chlorpromazine de même que des petites interventions chirurgicales n'amenèrent aucune amélioration. Les douleurs empêchèrent le patient de dormir. Après ouverture crânienne par craniotomie centrale droite on pratiqua l'excitation électrique de l'écorce cérébrale. Lors de l'excitation du Gyrus central antérieur le malade accusa des impressions de motilité dans les doigts manquant, l'articulation du poignet et tout le bras, répondant aux localisations correspondantes de l'écorce cérébrale. La stimulation de l'écorce sensorielle n'amena pas de réponse. Une cortectomie sous — pie — mèrienne totale, sensorielle et motrice, fut effectuée dans la zône de représentation du bas gauche. Un mois après l'opération, le malade n'avait plus resenti de douleurs et même les desagréables secousses restèrent absentes. Plus tard apparurent des sensations de légère raideur, de tiraillements et de fatigabilité dans le membre fantôme. La composante douloureuse qui tourmentait la patient n'est pas réapparue.Six mois après l'opération nous avons observé le malade pendant toute une semaine: il ne resentait plus de douleurs et ne réclamait aucun analgésique.Notre cas nous semble présenter un intérêt particulier par le fait même que l'excitation du Gyrus central antérieur avait amené une impression de motilité sans l'effet de mouvement. Cette constatation vient appuyer le point de vue de Pavlov que l'aire de l'écorce cérébrale qui correspond aux mouvements représente un analysateur kinésthétique.

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Riassunto Viene descritto il caso di un paziente di 59 anni al quale, in conseguenza di un incidente, dovette essere amputato il braccio sinistro 5 cm al di sotto dell'articolazione scapolo-omerale. Dopo l'intervento il paziente avvertiva dolori fantasma localizzati in parte al moncone di amputazione, in parte al braccio ed alle dita mancanti. Venne eseguita la resezione sottopiale di alcune aree corticali della regione motrice e sensitiva dell'emisfero opposto, dopo che era stato constatato, mediante stimolazione elettrica, che i fenomeni sensitivi avvertiti provenivano da quelle aree corticali.Il paziente rimase cosí libero dei suoi dolori fantasma per un periodo di osservazione di sei mesi. Il caso presentava un particolare interesse anche per il fatto che la stimolazione della circonvoluzione centrale anteriore ridestava nel soggetto una sensazione di movimento senza provocare in realtà alcun movimento.

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Vortrag auf dem I. Europäischen Neurochirurgen-Kongreß in Zürich, Juli 1959.