Surgical treatment of cavernous haemangiomas of the liver

Cavernous haemangiomas of the liver were surgically treated in 36 women and 14 men over a 10-year period. The tumours were solitary in 42 cases and multiple in 8. Locations were the right lobe in 39 cases, the left one in 5 and both lobes in 6. The size of the tumours ranged from 0.4 to 14 cm in diameter. Enucleation of tumours was carried out in 29 cases, an atypical liver resection in 19 cases, anatomical lobectomy in 2 cases and a right trisegmentectomy in 1 case. There was no mortality. Morbidity rate seems to be lower in patients who underwent enucleation. The authors indicate the importance of enucleation for removal of liver haemangiomas of various sizes.

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Chirurgische Behandlung kavernöser Hämangiome der Leber

Zusammenfassung Über einen Zeitraum von 10 Jahren wurden kavernöse Hämangiome der Leber bei 36 Frauen und 14 Männern chirurgisch behandelt. Bei 42 Patienten waren die Tumoren solitär, bei 8 multipel. Sie waren in 39 Fällen im rechten, bei 5 Patienten im linken und bei 6 in beiden Leberlappen lokalisiert, ihr Durchmesser betrug 0,4 bis 14 cm. In 29 Fällen wurde eine Enukleation, in 19 eine atypische Leberresektion, in 2 eine anatomische Lobektomie und in einem Falle eine rechtsseitige Trisegmentektomie durchgeführt. Die Mortalität war gleich Null; die Morbiditätsrate scheint bei den Patienten geringer, die mit Enukleation behandelt wurden. Der Beitrag hebt die Bedeutung der Enukleation zur Beseitigung von Leberhämangiomen unterschiedlicher Größe hervor.

     

A comparison of the stressors experienced by parents of intubated and non-intubated children

When children are ill enough to require admission to paediatric intensive care, parents may become distressed about their child's medical condition and this distress may be compounded by the unfamiliar nature of the highly technological environment Parents of children who are sick enough to warrant intubation are particularly likely to be exposed to a frightening array of technological equipment Seventy-one parents of intubated and non-intubated children completed the Parental Stressor Scale Paediatnc Intensive Care Unit (PSS PICU) Overall the findings suggest that parents were most distressed (a) by the painful procedures to which their children were subjected, (b) by the sights and sounds of the intensive care unit and (c) by their children's reactions to intensive care The behaviour of staff towards parents and the way that staff communicated with them caused the least distress When the levels of stress reported by parents of intubated children were compared with those reported by parents of non-intubated children, different patterns of stress were found Painful procedures were a source of greater stress to parents of intubated children whereas the behaviour of staff and the children's reactions to the intensive care experience caused greater stress to the parents of the non-intubated children In general the findings suggest that the needs of parents of non-intubated children are being overlooked, with staff focusing more of their attention on the parents of intubated children     

Microbial degradation of polycyclic aromatic hydrocarbons and polycyclic aromatic nitrogen heterocyclics

Fermentor studies were conducted to examine the microbial degradation of polycyclic aromatic hydrocarbons (PAHs; naphthalene, phenanthrene, anthracene) and a polycyclic aromatic nitrogen heterocyclic (quinoline) using a mixed bacterial culture capable of utilizing these compounds as the sole carbon and energy source for growth. Half-lives for the three PAHs in the cyclone fermentor system ranged from 1 day for naphthalene to 4 days for anthracene. Several major metabolites during the biodegradation of PAHs were also identified. These included 2-hydroxybenzoic acid and 1-naphthalenol (for naphthalene); 1-phenanthrenol and 1-hydroxy-2-naphthalenecarboxylic acid (for phenanthrene); and 3-hydroxy-2-naphthalenecarboxylic acid (for anthracene). Thus our bacterial culture biodegraded the three PAHs by initial hydroxylation of the molecule followed by the eventual cleavage of the ring to yield the ortho- or meta-cleavage intermediates, which would be further metabolized via conventional metabolic pathways. However, biodegradation of the nitrogen-containing polycyclic aromatic hydrocarbon compound quinoline by our culture resulted in the accumulation of 4–5 metabolites, one of which has been identified as 2-quinolinol. Work is in progress to identify the other metabolites from quinoline degradation. © 1992 John Wiley & sons, Inc.     

Surgery of calculous hydrocalyx (Calyceoplastic surgery)

A modified surgical technique for calculous hydrocalyx, based on partial calyceal resection with simultaneous correction of the morphological abnormality responsible for stone formation is described. Access to the calyx is gained by a modified marginopolar resection. The modification developed by the authors consists in carrying the resection line laterally to the vertical axis of teh kidney. The parenchyma is closed by U-shaped “hair-pin” stitches. Preparation of the limbic, pelvic and ureteral areas is abstained from, thus avoiding scarring which might affect renal lymph and blood flow and interfere with urinary transport. The results obtained in 85 cases of calculous hydrocalyx over an 8-year period were satisfactory. The rate of calculous recurrences was not higher than 3.5 per cent.     

Preservation of the spleen using human fibrin seal

Because of the spleen's role in host defence and the recognition of overwhelming post-splenectomy sepsis, the current aim of treatment for splenic injuries is to preserve the spleen. A number of hemostatic agents have been used in an effort to control bleeding but have not proved satisfactory. The authors report the results of an experiment using a two-component fibrin seal on injured rabbit spleens. In female rabbits a longitudinal laceration of the entire spleen was made. After 2 1/2 minutes of continuous hemorrhaging, the spleens were either not treated (5 rabbits) or treated by splenectomy suture repair or fibrin-seal repair. Hemoglobin values were measured preoperatively and 3 days postoperatively. The greatest number of deaths within 14 days occurred in the untreated group. There was no difference in death rate between the treated groups; similarly, there was no difference in blood loss or fall in hemoglobin values. Fewer adhesions formed in the fibrin-seal group than in the others (p less than 0.02). Histopathological examination revealed a greater fibrinoblastic response in the spleens treated with fibrin seal than in the other groups. The authors believe that fibrin seal is an effective and safe hemostatic agent applicable to splenic parenchymal injuries, and that it promotes wound healing and suppresses adhesion formation.     

Analgesic nephropathy in Hungary: the HANS study.

BACKGROUND: The diagnosis of analgesic nephropathy has improved significantly with modern imaging techniques. We reviewed a large portion of the Hungarian dialysis population to obtain additional insight into the problem. METHODS: Twenty-two participating dialysis units enrolled 1400 patients on renal replacement therapy between 1 January 1995 and 1 January 1998. Patients with no known aetiology (n = 284) were interviewed and studied with renal imaging. We assessed the presence of decreased renal mass combined with either bumpy contours, papillary calcification, or both. The subjects studied were interrogated extensively. RESULTS: Our survey suggested analgesic nephropathy in 47 of 1400 patients (3.3%), 3-fold higher than the EDTA database estimate for Hungary. The analgesics most commonly abused were phenacetin-containing mixtures. The driving symptoms were mainly headache and joint pain. Cardiovascular complications were more common than in the rest of the dialysis population, independent of smoking and lipid values (P<0.01). CONCLUSIONS: Phenacetin should be banned. Our study results support the need for longitudinal cohort and case-control studies in Hungary.     

Concomitant administration of cyclosporine and ketoconazole in idiopathic nephrotic syndrome.

BACKGROUND: The deliberate use of ketoconazole to reduce the need for cyclosporine (CsA) is not new, but it is particularly relevant because of the high cost of CsA. Many studies have documented this benefit in renal and cardiac transplants, but this co-administration has not been reported in patients with nephrotic syndrome. METHODS: This retrospective study included 207 nephrotic patients who were steroid resistant, dependent or frequent relapsers and received CsA therapy. Among these patients 153 received daily ketoconazole therapy in a dose of 50 mg with concomitant decrease of one-third of the CsA dose while 54 patients received CsA alone. The majority of our cases were children (179 were below 18 years) and male to female ratio was 1.7:1. RESULTS: The great majority of the study population received the drugs for 1-2 years. Patients who received CsA and ketoconazole were comparable with those who received CsA alone regarding age, sex, duration of renal disease, renal pathology, severity of nephrotic syndrome, renal function, hepatic function and steroid response. Co-administration of ketoconazole significantly reduced mean doses of CsA by 37% after 1 month and 47% at 1 year with overall net cost savings of 37%. Hepatic functions remained within the normal range in both groups. Additionally, co-administration of ketoconazole significantly improved the response to CsA therapy, successful steroid withdrawal and decreased the frequency of renal impairment. CONCLUSIONS: Co-administration of keto with CsA in idiopathic nephrotic patients significantly reduces CsA costs and may improve its response.     

Antibodies to viruses of the herpes group in glomerulonephritis of membranous,membranoproliferative and IgA types

Sera of 25 patients with membraneous glomerulonephritis (MGN), 16 with membranoproliferative glomerulonephritis (MPGN) and 54 with IgA glomerulonephritis (IgA GN) were studied for complement-binding antibodies to herpes simplex virus (HSV), cytomegalovirus (CMV) and antibodies to various Epstein-Barr virus (EBV) associated antigens, as also for the titres of these antibodies. The sera of 220 normal individuals served as controls, 120 controls being used for each case. Anti-HSV titres of ≧1∶64 were found to occur in the sera of all three GN groups in a higher proportion than in those of the controls. This was also valid for the complement-binding antibodies to CM, although here the differences were not invariably significant. IgA antibodies reacting with EBV capside antigen (EBVCA) were likewise of statistically increased frequency in IgA GN, as also in MPGN, and in these two groups the geometric mean of the reciprocal value of the IgA antibody titres was also higher than either in the controls or in MGN. The results of the studies carried out within 6 months after onset of renal disease point to an EBV infection, either fresh or having taken place in the recent past, in 20 cases. These data are compatible with a direct or indirect role of EBV in the production and/or persistence of certain types of GN. The high anti-HSV and CMV titres suggest that in a number of patients with renal disease the immune responses to certain types of the HSV group may be abnormal.