Pilonidal Sinus -- Primary Closure also in Case of Abscess?

After excision of pilonidal sinus treatment consists either in open procedure or primary closure. We present the results of 45 consecutive patients (male 29, female 16, age 32 +/- 13 years), who underwent surgery between September 2001 and December 2002. Fourteen patients had simple fistula without infection, 18 had fistulas with putride secretion and 13 had abscess. Primary closure with direct suture was performed in 34 patients (76 %: 13 x simple fistula, 13 x fistula with putride secretion, 8 x abscess). Eleven patients were treated by layopen procedure and secondary wound healing. Wound infection occurred in 13 patients (7 x superficial, 6 x deep). Mean time of postoperative treatment was 15 +/- 3 days after closure and primary healing and 66 +/- 15 days after open proce dure or secondary healing. Mean time out of work was 19 +/- 10 respectively 52 +/- 19 days. A recurrence of fistula occurred in eight patients after primary closure (18 %) and none after open procedure. Also in cases of pilonidal sinus with infection, primary wound closure can be carried out even though the rate of recurrences is higher than after open procedure. A successful primary closure significantly reduces time of illness and time out of work.     

Prediction of necrosis after chemotherapy of advanced germ cell tumors: results of a prospective multicenter trial of the German Testicular Cancer Study Group

PURPOSE: We evaluated the prognostic parameters of necrotic residual tumors after chemotherapy of advanced germ cell tumors to improve on the current indications for surgery. MATERIALS AND METHODS: Between January 1996 and January 2000, in 8 centers of the German Testicular Cancer Study Group, preoperative parameters were assessed to predict necrosis in the residual tumors of 261 patients with retroperitoneal residual tumor resection after first (92%) and second line (8%) chemotherapy. RESULTS: Of 232 evaluable patients 39 had pure seminoma and 5 had viable cancer (1 with seminoma) in the residual tumor. Of the remaining 193 patients with nonseminoma 35% had necrosis, 34% teratoma and 31% had viable carcinoma in the residual tumor. After multivariate analysis and exclusion of patients with seminoma, the 3 parameters independently predictive of necrosis were alpha-fetoprotein before chemotherapy less than 20 ng/ml, and tumor volume before and after chemotherapy. A mathematical model to predict necrosis yielded a test accuracy of 75%, a sensitivity to predict necrosis of 52% and a specificity of 87%. CONCLUSIONS: Patients with pure seminoma should not undergo residual tumor resection because 97% of patients who received adequate chemotherapy were found to have no residual seminoma. In cases of nonseminoma alpha-fetoprotein values before chemotherapy less than 20 ng/ml and a high percentage of shrinkage during chemotherapy reliably predicted only 19% of cases of necrosis. Therefore, this model is clinically irrelevant and patients with minimal residual disease should undergo surgery. New methods are necessary to improve the preoperative selection of patients after chemotherapy.     

Chemokines: multiple levels of leukocyte migration control

The surge in interest in chemokines is explained by the recognition that numerous aspects of immunity are intimately related to leukocyte traffic. Chemokines are leukocyte attractants but also contribute to immune processes that do not directly involve leukocyte migration. Recent progress is most evident in the areas of lymphocyte development, immune response initiation and immune pathology. Important observations have also been reported on chemokine-receptor interactions, signal transduction and cellular responses. New insights into the role of chemokines in leukocyte attraction and relocation will be discussed, with emphasis on the distinct levels of leukocyte migration control that ultimately determine the performance of our immune defense system.     

Reduced penetrance of craniofacial anomalies as a function of deletion size and genetic background in a chromosome engineered partial mouse model for Smith-Magenis syndrome

Smith-Magenis syndrome (SMS) is a multiple congenital anomaly/mental retardation syndrome associated with del(17)(p11.2p11.2). The phenotype is variable even in patients with deletions of the same size. RAI1 has been recently suggested as a major gene for majority of the SMS phenotypes, but its role in the full spectrum of the phenotype remains unclear. Df(11)17/+ mice contain a heterozygous deletion in the mouse region syntenic to the SMS common deletion, and exhibit craniofacial abnormalities, seizures and marked obesity, partially reproducing the SMS phenotype. To further study the genetic basis for the phenotype, we constructed three lines of mice with smaller deletions [Df(11)17-1, Df(11)17-2 and Df(11)17-3] using retrovirus-mediated chromosome engineering to create nested deletions. Both craniofacial abnormalities and obesity have been observed, but the penetrance of the craniofacial phenotype was markedly reduced when compared with Df(11)17/+ mice. Overt seizures were not observed. Phenotypic variation has been observed in mice with the same deletion size in the same and in different genetic backgrounds, which may reflect the variation documented in the patients. These results indicate that the smaller deletions contain the gene(s), most likely Rai1, causing craniofacial abnormalities and obesity. However, genes or regulatory elements in the larger deletion, which are not located in the smaller deletions, as well as genes located elsewhere, also influence penetrance and expressivity of the phenotype. Our mouse models refined the genomic region important for a portion of the SMS phenotype and provided a basis for further molecular analysis of genes associated with SMS.     

Pharmacological treatment of psychosis in epilepsy

Epilepsy is one of the main causes of functional disability, and it is usually associated to psychiatric comorbidity, such as psychosis of epilepsy (POE). POE requires more careful pharmacological treatment, considering the propensity of the antipsychotics (AP) to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptic drugs (AEDs). We discussed the classification and the main types of POE, as well as some characteristics of AP typical and atypical, its potential to decrease the epileptogenic threshold (ET) and possible interactions between AP and AED. Atypical AP, except clozapine, disclosed smaller influence on ET than typical AP. Regarding pharmacokinetic interactions, AEDs are related with a significant increase of the AP metabolism. Therefore, in spite of the risk for AP induced convulsions be dose-dependent, higher doses of AP can be necessary in the treatment of POE.     

Ruptur der V. azygos beim stumpfen Thoraxtrauma

Blunt chest trauma is a common injury in traffic accidents. Thoracic vessel trauma frequently affects intercostal arteries, the aorta and less often the subclavian artery. Azygos vein injury is uncommon and has previously been described in only 19 cases.The 20th case of blunt azygos vein injury due to high energy trauma as a consequence of a traffic accident is reported with a review of the literature. Preoperative diagnosis was performed by computed tomography.Azygos vein injury is rare but potentially lethal (8/20, 40.0%). Chest radiograph with right hemothorax is reported consistently except for two cases. Fractures of ribs and/or thoracic spine (T3-5) were found in nine patients, while neither were found in 11/20 cases. Pathognomonic signs have not been described in the literature.Early resuscitation and immediate thoracotomy with recognition and treatment of azygos vein rupture is necessary to avoid a fatal outcome.     

Short-circuiting effects of K currents on electrical responses of type-1-like astrocytes from mouse cerebral cortex

The membrane potential and membrane input resistance of cortical astrocytes from newborn mice were recorded with and without exposure to 1 mM barium. Barium treatment drastically decreased the membrane response to 0 and 35 mM K+. It also revealed an electrogenic component of the Na+,K(+)-ATPase as evident by a biphasic depolarization as a response to ouabain, which was monophasic without barium presence. Untreated mouse astrocytes reacted with small monophasic depolarizations to GABA and glutamate exposure. Barium-treated astrocytes exhibited additional transient responses to both transmitters, similar to those responses of rat astrocytes as found in the literature. The transmitter responses were not changed by exposure to uptake blockers for both transmitter substances. Thus, this electrophysiological study confirms earlier studies with radioactive K+ fluxes in showing that astrocytes derived from mouse brain are capable of short-circuiting electrogenic components and transmitter responses. This extreme high K+ permeability resembles the one reported for endfeet of retinal Muller cells and dissociated astrocytes from optic nerve.     

Augmentation mit TightRope™ und Grazilissehne nach fehlgeschlagener ACG-Stabilisierung

The treatment of primary failed ac-joint stabilizations and chronic acromioclavicular joint dislocations can be challenging. Different surgical procedures have been described in literature. In this article we present a minimally invasive reconstruction procedure. To restore the coracoclavicular ligaments, a gracilis tendon graft is shuttled through the anatomicdrilled clavicle and coracoid, looped in a figure-eight shape around the clavicula and coracoid and additionally secured with a TightRope? (Arthrex, Naples, FL, USA). This technique allows an optimal stabilization in combination with an anatomic reconstruction of the acromioclavicular ligaments.     

Cloning of cDNA coding for connective tissue activating peptide III from a human platelet-derived lambda gt11 expression library

We report here the cloning of the cDNA coding for platelet connective tissue-activating peptide-III (CTAP-III) from a lambda gt11 expression library prepared using messenger RNA (mRNA) isolated from human platelets. The open reading frame of the clone coded for a protein with 128 amino acid residues. Since the precursor of CTAP-III, platelet basic protein (PBP is 94 amino acids long, the 5'-translated region of the cDNA codes for a leader sequence 34 amino acids long. This leader sequence, like the sequence of mature CTAP-III, shows significant homology to the sequence of platelet factor 4 (PF4), the only other platelet specific alpha-granule protein cloned until now, from a human erythroleukemic (HEL) cell line-derived cDNA library. These leader sequences are probably critical for targeting such proteins to the alpha-granule. Northern blot hybridization with platelet and megakaryocyte mRNA shows a single species mRNA of approximately 0.8 kb, suggesting that the corresponding cDNA is full length. The cloning of platelet specific CTAP-III provides additional evidence for the platelet specificity of the cDNA library used.