Major amputation for intractable extremity melanoma after failure of isolated limb perfusion.

AIM: The aim of this study was to analyse indications and results of amputation for intractable extremity melanoma after failure of isolated limb perfusion (ILP). METHODS: Between 1978 and 2001, 451 patients with loco-regional advanced extremity melanoma underwent 505 ILPs. Amputation of the affected extremity had to be carried out for intractable recurrent disease in 11 of these patients. RESULTS: The indications for amputation were uncontrollable pain (n=2), extensive loco-regional tumour progression (n=4), loss of ankle function due to local tumour growth (n=1), and ulcerating and fungating lesions, not responding to other treatments (n=4). Four patients developed stump recurrence after amputation. Ten patients died of melanoma metastases after a median of 11 months (range 2-110 months). Two patients survived more than 5 years after amputation. CONCLUSIONS: Major amputation is rarely indicated for intractable extremity melanoma but long-term survival can be achieved in selected patients.     

Stress cardiomyopathy in thromboembolic arterial disease.

Apical ballooning is a novel clinical entity reported in different contexts of physical and psychological stress, which is more common in middle-aged women. Of unknown etiology, the syndrome is characterized by a sudden and transient dilatation of the left ventricular apex in the absence of obstructive atherosclerotic coronary disease or evidence of myocardial necrosis, with total late recovery of ventricular function. The authors report the case of a 53-year-old woman who was admitted to the emergency room with left arm ischemia and low cardiac output, requiring ventilatory support. Left catheterization showed typical medial and apical myocardial dysfunction, with normal coronary arteries. Transesophageal echocardiography revealed a thrombus attached to the lower face of the aortic arch, which probably explained the thromboembolism of the arm but was unlikely to be the cause of the left ventricular dysfunction since there were no enzymatic or electrocardiographic signs of myocardial necrosis and normal wall motion was fully recovered.     

Experimentelle und klinische Studie zur Stabilit?t einer Osteosyntheseplatte für den atrophen Unterkiefer

ZusammenfassungHintergrund Der Anteil an älteren Patienten steigt ständig und damit auch die Zahl traumatischer altersbedingter Verletzungen wie Frakturen des Unterkiefers. Die Frakturversorgung bei älteren Menschen stellt spezielle Anforderungen. Durch das Design einer neu entwickelten Osteosyntheseplatte sollte versucht werden, diese speziellen Gesichtspunkte zu erfüllen.Material und Methoden Im Gegensatz zu den 2.0-Miniplatten (Medartis AG, Basel) besitzt die Pencilbone-2.0-Platte, die aus diesen Miniplatten entwickelt wurde, einen oval geformten Mittelsteg zur Stabilisierung des frakturnahen Knochens und zwei sphärische Gleitlöcher jenseits der Fraktur. An den verstärkten Teil der Osteosyntheseplatte schließen sich jeweils 2 bzw. 3 normale unverstärkte Löcher an, die sich sehr leicht an den frakturfernen Knochen adaptieren lassen. Dies ermöglicht dem Operateur den intraoralen Zugangsweg und eine Handhabung, welche er von der Miniplattenosteosynthese gewohnt ist, bietet aber gleichzeitig eine höhere Stabilität im Vergleich mit den Standard-2.0.-Miniplatten.Ergebnisse und Diskussion Nach experimentellen und biomechanischen Untersuchungen, die alle positive Ergebnisse zeigten, wurde die neue Platte zwischen Oktober 2000 und November 2001 in zwei Kliniken an 16 Frakturen des atrophischen Unterkiefers bei 14 Patienten erfolgreich angewendet. 15 Frakturen heilten primär, lediglich bei einer Fraktur wurde eine neue operative Versorgung wegen Knochendislokation nach erneutem Sturz notwendig.     

The anterolateral neck dissection with special reference to the digastric and hypoglossal tunnels

The elective surgical treatment of the neck for advanced T-stage laryngeal presentations of squamous cell carcinoma is typically the anterolateral neck dissection. Modifications of the anterior-based technique that include the use of digastric and hypoglossal tunnels to establish reliable landmarks result in a reproducible technique. The complex anatomic relationships of the anterior and superior part of the neck dissection are exposed and protected early in the technique, making this approach ideal for use in an academic setting.     

Post-ictal fever: a rare symptom of partial seizures

Although fever may induce seizures, especially in children, its occurrence following epileptic spells has been rarely described, except from generalized convulsive status epilepticus. We present two patients suffering from focal seizures accompanied by episodes of post-ictal fever, and review similar reports in the literature of the last 40 years. Temperature changes following non-convulsive seizures might be induced by gene upregulation occurring in the hypothalamus, the nucleus tractus solitarius, or in other brain regions, producing a local inflammatory response. Direct propagation of electrical discharges seems less consistent with the timing of development of this symptom. Heterogeneity of reported clinical features argues against the assumption of a definite localizing or lateralizing value for post-ictal fever.     

Scintigraphic validation of AC Biosusceptometry to study the gastric motor activity and the intragastric distribution of food in humans

Abnormal intragastric distribution of food (IDF) and a phasic contractility in the proximal stomach have been related to dyspeptic symptoms. Thus, the behaviour of the stomach and the proximal region, in particular, continues to attract attention and demand for reliable and comfortable techniques. The aims of this study were to employ AC Biosusceptometry (ACB) and scintigraphy to evaluate IDF and gastric motor activity in humans. Fifteen healthy volunteers ingested 60 mL of yogurt containing 2 mCi of 99mTc and 4 g of ferrite. Each volunteer had gastric motility and IDF evaluated twice on separate days; on one occasion by ACB and another by scintigraphy. Digital signal processing was performed in MatLab (Mathworks Inc., Natick, MA, USA). Results were expressed as mean +/- SD. Similar results of distal accumulation time (P < 0.001) were obtained for scintigraphy (6.93 +/- 3.25 min) and for ACB (7.04 +/- 3.65 min). Fast Fourier Transform revealed two dominant frequencies (P > 0.9). Besides the well-know frequency of 3 cpm, our results showed identical frequencies in proximal stomach recordings (P < 0.001) for scintigraphic (1.01 +/- 0.01 cpm) and ACB (0.98 +/- 0.06 cpm). In summary, our data showed that scintigraphy and ACB are promising techniques to evaluate several aspects of gastric motility. Moreover, ACB is non-invasive, radiation-free and deserves the same importance as conventional methods for this kind of analysis.     

EBV+ B Lymphoma Cell Lines from Patients with Post-Transplant Lymphoproliferative Disease Are Resistant to TRAIL-Induced Apoptosis

Lymphomas associated with post-transplant lymphoproliferative disease (PTLD) represent a significant complication of immunosuppression in transplant recipients. In immunocompetent individuals, EBV-specific cytotoxic T lymphocytes (CTL) prevent the outgrowth of activated B lymphoblasts through apoptosis induction. Soluble versions of TNF-related apoptosis-inducing ligand/Apo2 ligand (TRAIL) can induce apoptosis in numerous tumor cell types. Given the therapeutic potential of TRAIL, we examined the sensitivity of EBV⁺ spontaneous lymphoblastoid cell lines (SLCL) derived from patients with PTLD to treatment with soluble TRAIL. Despite abundant expression of TRAIL receptors (TRAIL-R), resistance to TRAIL-induced apoptosis was observed in all SLCL examined. This resistance could not be overcome by concomitant treatment with several pharmacological agents. Unlike BJAB positive control cells, for each SLCL tested, cleavage and activation of caspase 8 was inhibited due to failed recruitment of FADD and caspase 8 to TRAIL receptors upon stimulation. Further indicative of a proximal defect, TRAIL receptor aggregation could not be detected on the cell surface of SLCL following ligand engagement. These results suggest that the use of TRAIL for eliminating PTLD-associated tumors may be of limited clinical utility, and illustrate another mechanism by which EBV⁺ B lymphoma cells can evade tumor surveillance at the level of death receptor signaling.