Peri- and postoperative changes in serum levels of four tumor markers and three acute phase reactants in benign and malignant gynecological diseases

Summary Serum levels of squamous cell carcinoma antigen, carcinoembryonic antigen, CA 125, tissue polypeptide antigen, CRP, α₁-antitrypsin and haptoglobin were determined peri- and postoperatively in patients undergoing surgery for benign gynecological disease (n=18) and postoperatively in women operated for cervical carcinoma (n=23). The only significant changes seen after premedication, during anesthesia and during surgery were a decrease in serum concentrations of α₁-antitrypsin and haptoglobin. We found no post-operative changes in the serum levels of squamous cell carcinoma antigen nor in carcinoembryonic antigen values. However, the latter analyte was influenced by smoking habits. Elevated levels of CA 125 and tissue polypeptide antigen were found in the cancer patients, predominantly within the first 1–3 weeks after surgery. These levels decreased to normal values within 4–6 weeks postoperatively. The median intraindividual coefficients of variation for the tumor markers ranged between 15% and 28% in 30 control women not having surgery. In general, it would seem advisable to wait 6 weeks after surgery before monitoring with CA 125 and TPA is started.     

Imaging in chronic achilles tendinopathy: a comparison of ultrasonography,magnetic resonance imaging and surgical findings in 27 histologically verified cases

 Objective. To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. Design. Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. Patients. Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. Results and conclusions. Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter >10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments.     

Aeromonas hydrophila toxins—intestinal fluid accumulation and mucosal injury in animal models

Strains of Aeromonas hydrophila were earlier shown to produce a heat-labile enterotoxin and two cytolytic toxins, alpha- and beta-haemolysin. These investigations have been extended. When separated from the cytolysins, the enterotoxin elicited fluid accumulation in rabbit intestinal loops. The electrolyte and albumin content of the fluid was similar to that of cholera toxin. The enterotoxin was non-injurious to the mucosa. Purified hemolysins did not give a positive loop test. They produced hemorrhagic enteritis with leakage of small amounts of hemorrhagic fluid. In electrolyte and albumin content this fluid differed from the fluid elicited by the enterotoxin. Prostaglandin inhibitors did not reduce the diarrheal response to Aeromonas enterotoxin. The cAMP inhibitor chlorpromazine reduced the fluid accumulation in rat and mice intestinal loops by 60%. Cholera toxin and Aeromonas enterotoxin may have a common pathway in the elicitation of intestinal fluid accumulation. By passage in intestinal loops, strains of A. hydrophila could regain lost enterotoxicity. Experimental diarrhea could not be induced in rabbits and rats with various enterotoxigenic strains of Aeromonas.     

Selective or routine intraoperative cholangiography: A cost-effectiveness analysis

In a retrospective analysis of 819 patients operated on for gallbladder disease, the costs and mortality rates were compared for 2 different strategies: (a) routine use of intraoperative cholangiography, or (b) selective use of intraoperative cholangiography on patients fulfilling at least 1 of 4 common clinical criteria. Selective use led to lower costs and lower mortality rates. The main reason for this outcome was that the benefits of detecting more stones in the bile duct by the routine use of cholangiography were counterbalanced by an increase in costs and risks because false-positive operative cholangiograms led to a greater number of unnecessary choledochotomies.     

Therapeutic efficacy by recombinant human granulocyte/monocyte-colony stimulating factor on mucositis occurring in patients with oral and oropharynx tumors treated with curative radiotherapy

BACKGROUND: Previous studies suggested granulocyte-macrophage-colony stimulating factor (GM-CSF) might be beneficial for radiotherapy-induced mucositis. This trial examined the efficacy of GM-CSF in reducing mucositis of the oral cavity and/or oropharynx compared with conventional treatment. METHODS: Mucositis, documented by a five-grade scale, was defined in patients with tumors of the head-neck. Centers were allowed to use their own preferred fractionation regimen. Randomization to treatment was decided before radiotherapy. Treatment with GM-CSF 4 microg/kg/d subcutaneous, started when patients displayed a mucositis score > or = 1.5. RESULTS: Ninety-two patients entered the study according to intention-to-treat principle. Twenty did not reach a mucositis index of 1.5. Sixty-one patients were included in the statistical analysis. Forty-five percent of the patients randomized to receive GM-CSF had a significant reduction of the mucositis more than one grade compared to 9% of the conventional treated. CONCLUSIONS: In severe mucositis, GM-CSF is more effective than conventional treatment.     

Einfluss der Blockade mit Lokalanästhetika auf die Stimulierbarkeit eines Nerven mit der peripheren Nervenstimulation

Zusammenfassung Es sollte untersucht werden, welchen Einfluss die Injektion einer geringen Menge Lokalanästhestikums an einen Nerven auf dessen Stimulierbarkeit mit der peripheren elektrischen Nervenstimulation hat. Bei 35 Patienten wurde randomisiert und verblindet an den N. ischiadicus entweder Kochsalzlösung oder Lokalanästhetikum injiziert; 30 s und 2 min nach der Injektion wurde die Stromstärke gemessen, die zu vergleichbaren Muskelreaktionen führte. Die Ergebnisse zeigen, dass nach 30 s bzw. 2 min bereits mit einem ausgeprägten Lokalanästhetikumeffekt gerechnet werden muss. Die Sicherheit, die die Nervenstimulation zur Vermeidung von Nervenschäden bietet, ist nicht mehr gegeben, wenn in dem Bereich, in den bereits Lokalanästhetikum injiziert wurde, erneut punktiert und nach weiteren Nerven gesucht wird. Es muss vor der Durchführung einer Regionalanästhesie in Multiinjektionstechnik bei enger anatomischer Beziehung der zu blockierenden Nerven gewarnt werden, da bereits anästhesierte Nerven bzw. Nervanteile eine schlechtere Stimulationsfähigkeit besitzen und somit evtl. bei der zweiten oder dritten Punktion geschädigt werden könnten.     

Do contraceptives influence the incidence of acute pelvic inflammatory disease in women with gonorrhoea?

The influence of different contraceptive techniques on the incidence of pelvic inflammatory disease (PID) in 672 patients with gonorrhoea have been studied. The lowest frequency of PID was found in patients using hormonal contraceptives (Group A), 8.8 per cent compared to 23.5 per cent in patients using intrauterine devices (Group B) and 15.1 per cent in patients using neither technique (Group C). In comparable control groups no significant differences in background factors, such as age, marital status and sexual activity were demonstrated. It is therefore concluded that the significantly lower incidence of PID in patients using hormonal contraceptives compared to the other groups and the high incidence of PID in patients using intrauterine devices is related to the contraceptive technique per se.     

Increased noradrenaline release in rat portal vein during sympathetic nerve stimulation due to activation of presynaptic beta-adrenoceptors by noradrenaline and adrenaline.

With the aim of investigating whether exogenous noradrenaline (NA) and adrenaline (A) can modulate transmitter release via the stimulation of presynaptic beta-adrenoceptors, 3H-release from isolated portal veins was studied after pretreatment with 3H-1-NA, phenoxybenzamine, desipramine and normetanephrine. NA (10 muM) and A (0.05 muM) increased the fractional 3H-release elicited by sympathetic nerve stimulation by 30%. This effect could be blocked by d, 1-propranolol which per se reduced the release by 10%. It is concluded that NA can facilitate its own release via a presynaptic beta-adrenoceptor-mediated positive feed-back mechanism and that adrenaline can stimulate this beta-adrenoceptor-mediated mechanism.