Prevention of secondary lymphedema

After some preliminary remarks upon pathophysiologic and anatomo-surgical aspects, the main complications of axillary lymph-nodal dissection for breast cancer treatment are reported. The role of surgical technique is particularly underlined and also the importance of proper management of wound and surgical drainage post-operatively are pointed out. Author describes, finally, the necessity of an adequate knowledge of lymphatic drainage not only of mammary region, but also of surrounding area, in order to prevent lesions to lymphatic pathways, particularly to those draining upper arm at the same site of breast cancer.     

Effects of typical and atypical antipsychotics on neuropeptide Y in rat brain tissue and microdialysates from ventral striatum

The main goal of this study was to investigate effects of typical (haloperidol) and atypical (risperidone) antipsychotic drugs on brain regional neuropeptide Y (NPY)-like immunoreactivity (-LI) tissue concentrations and on release of NPY-LI in freely moving rats. An additional aim was to explore the effect of d-amphetamine on NPY-LI release following pretreatment with typical and atypical antipsychotics. During a 4-week period, male Wistar rats were fed chow to which vehicle, risperidone (1.15 mg/100 g food or 2.3 mg/100 g food), or haloperidol (1.15 mg/100 g food) were added. In one series of experiments, the animals were sacrificed on day 30 with focused microwave irradiation, the brain regions dissected and extracted for radioimmunoassay of NPY-LI. In another experimental series, probes were inserted into the ventral striatum. The perfusates were collected at 60-min intervals; NPY-LI was determined by radioimmunoassay. Haloperidol significantly increased NPY-LI in hypothalamus and the occipital cortex. In contrast, haloperidol decreased tissue levels of NPY-LI in striatum. Moreover, haloperidol and risperidone also significantly decreased extracellular NPY-LI concentrations in the ventral striatum. d-amphetamine (1.5 mg/kg) significantly increased extracellular NPY-LI in the vehicle group. Both haloperidol and risperidone pretreatments abolished the effect of d-amphetamine. The results show that d-amphetamine as well as haloperidol and risperidone selectively and specifically affect NPY-LI concentrations in brain tissue and microdialysates and that the effect of d-amphetamine is abolished by both typical and atypical antipsychotics.     

Die zentralen Vorgänge beim Richtungshören

Ohne ZusammenfassungMit 3 TextabbildungenMit Unterstützung der Deutschen Forschungsgemeinschaft.     

Retrieval, Maturation, and Fertilization of Immature Oocytes Obtained from Unstimulated Patients with Polycystic Ovary Syndrome

Purpose: Our purpose was to determine whether immature oocytes could be retrieved under local anesthesia, whether these oocytes would mature and fertilize in vitro, and whether adequate endometrium development could be obtained after hormonal supplementation. Methods: Ovum pick-up was performed under local anesthesia. Immature oocytes were cultured and inseminated. To prepare the endometrium, estradiolvalerate was administered in combination with micronized progesterone. Results: Immature oocytes were obtained in all cases. Fifty-six percent (n = 30) of the oocytes developed into metaphase II (MII) after 48 hr of culture, and another 20% reached the MII stage by 72 hr. Normal fertilization was observed in only 10% of oocytes inseminated. No embryonic development occurred, and therefore embryo transfer was not performed in any of the patients. Endometrial microbiopsy was performed in all subjects and endometrial development was considered sufficient in eight patients. Conclusions: We collected immature oocytes from patients with polycystic ovary syndrome without general anesthesia. In vitro maturation of these oocytes seemed adequate but fertilization rates were poor. Sufficient endometrial quality was obtained after hormonal substitution.     

Detection of human cytomegalovirus in urine samples by cell culture,early antigen assay and polymerase chain reaction

Summary With the advent of effective therapy rapid, sensitive and reliable assays for diagnosis of human cytomegalovirus (HCMV) infections are required. In a total of 1,928 urine samples, detection of HCMV-immediate early antigen in a spin amplified microplate culture by a monoclonal antibody and immunoperoxidase staining (EA-assay) was compared with virus isolation in cell culture. Sensitivity of the EA assay was 85.5% and specificity was 99.5% compared with virus isolation. Overall agreement of both assays was 97.8%. In addition, in 235/1,928 urine samples amplification of HCMV-DNA was performed by means of polymerase chain reaction (PCR) using primers from the immediate early (IE1) gene region and 141/1,928 using primers from the late region (LA). The sensitivity of PCR compared with virus isolation was 67.8% for IE1 primers and 94.1% for LA primers (statistical significance: p<0.01, Chi-square-test). Overall agreement between virus isolation and PCR was 88.5% for IE1-PCR and 84.4% for LA-PCR. Discordant results were more often found in adults with acute infection and immunocompromised patients than in infants.

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Nachweis von humanem Zytomegalievirus in Urinproben mittels Zellkultur, Early-Antigen-Test und Polymerasekettenreaktion

Zusammenfassung Schnelle und verläßliche Teste für die Diagnostik von Zytomegalie- (CMV) Infektionen sind besonders seit dem Aufkommen einer effektiven antiviralen Therapie gefordert. Bei insgesamt 1928 Urinproben wurde der Nachweis von CMV-Frühantigen in Zentrifugationskultur (Mikrotiterplatte) mit einem monoklonalen Antikörper und Immunperoxidase-Färbung (Early-Antigen-Test) mit der herkömmlichen Virusisolierung in Zellkultur verglichen. Die Sensitivität des Early-Antigen-Tests betrug 85,5%, die Spezifität 99,5% im Vergleich zur Virusisolierung. Die Übereinstimmung beider Tests war 97,8%. Zusätzlich erfolgte in 235 der 1928 Urinproben der Nachweis von CMV-DNS mittels Polymerase-Kettenreaktion (PCR) mit Primern aus dem Bereich des viralen Immediate-Early-Gens (IE1) und in 141 der 1928 Proben mit Primern aus dem Bereich des Late-Gens (LA). Im Vergleich zur Virusisolierung erreichte die PCR eine Sensitivität von 67,8% mit IE1-Primern und von 94,1% mit LA-Primern (statistische Signifikanz: p<0.01, Chi-square-Test). Die Übereinstimmung von Virusisolierung und PCR betrug 88,5% (IE1) und 84,4% (LA). Bei Erwachsenen mit akuter Infektion und Immunsupprimierten Patienten waren die Ergebnisse weniger übereinstimmend als bei Kindern.

     

4′-O-Tetrahydropyranyl adriamycin (THP-ADM)-induced modifications of murine peritoneal macrophages

4′-O-tetrahydropyranyl adriamycin (THP-ADM) is a newly synthetized anthracyclin reported to be an efficient oncostatic drug in animals and in humans and which is less cardiotoxic than adriamycin (ADM). Since part of the efficiency of anthracyclins may be due to their immunoregulatory activity, we investigated to what extent THP-ADM had such properties and we observed that THP-ADM stimulates free oxygen radical secretion by murine peritoneal macrophages. They could thus help the control of infections cancer patients have a tendency to develop. Peritoneal macrophages of THP-ADM-treated mice have anin vitro cytostatic activity towards P815 tumor cells higher than normal cells and when stimulated with LPS they secrete more IL-1, an important effector of the immune response.     

Ultrasonic vitrectomy — an alternative technique to presently used mechanical procedures

Summary The liquification of the corpus vitreum by ultrasound is a promising new alternative to presently used mechanical methods of vitrectomy. With regard to the duration time of insonation, as well as to the ultrasonic intensity, there exist thresholds, the exceeding of which causes a discontinuous breakdown of the vitreous frame in a spherical zone around the transducer tip which can be verified by ultrasonic pulse echo methods. Viscosity measurements showed that the vitreous isonified in this area has almost the same viscosity as water whereas its optical transparency remains unchanged. The dependence of the diameter of the liquified zone on insonation time was measured.

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Zusammenfassung Die Verflüssigung des Glaskörpers durch Ultraschall stellt eine vielversprechende Alternative zu gegenwärtig verwendeten mechanischen Methoden zur Vitrektomie dar. Sowohl in Hinblick auf die Beschallungszeit als auch auf die Ultraschallintensität gibt es Schwellwerte, deren Überschreitung zu einem diskontinuierlichen Zerfall des Glaskörpergerüstes in einem kugel-förmigen Bereich um die Sondenspitze führt, der mit Ultraschallechomethoden nachgewiesen werden kann. Viskositätsmessungen zeigten, daß der in diesem Bereich beschallte Glaskörper bei unveränderter optischer Transparenz eine nahezu gleiche Viskosität wie Wasser besitzt. Der Zusammenhang zwischen dem Durchmesser der Verflüssigungszone und der Beschallungsdauer wurde ermittelt.

     

Trachéotomie et traumatisme crânien grave : pour qui ? Pourquoi ? Quand ? Comment ?

The aim of this study is to determine, from the data available in the literature, the indications of tracheostomy in brain injured patients, the incidence and risk factors for complications and the follow-up required until decannulation. The incidence of tracheostomy is 10% in TBI and 50 to 70% in subpopulations with a Glasgow Coma Scale (GCS) below 9. Early complications are not specific. The most frequent late complication is laryngotracheal stenosis, which occurs in 15% and is more frequently observed in the most severe patients with major hypertonia. It is likely that tracheostomy, if needed, should be performed early and the prognosis as to whether it will be required, can be made at the end of the first week. The follow-up of these patients includes surveillance of multiresistant colonisations and systematic performance of fibroscopy before decannulation. Cuffless, small diameters, soft tracheostomy tubes, are preferred on the long-term unless the risk of aspiration remains high.