Improved visualization of carcinoid liver metastases by indium-111 pentetreotide scintigraphy following treatment with cold somatostatin analogue

Five patients with hepatic metastases of midgut carcinoid underwent somatostatin receptor scintigraphy with indium-111 pentetreotide before and during treatment with octreotide. Octreotide treatment changed the biodistribution of ¹¹¹In-pentetreotide significantly. Whereas the radioactivity in liver, spleen and kidney decreased, hepatic metastases showed increased contrast. In one patient, liver metastases could only be detected during octreotide treatment. These data suggest that the diagnostic reliability of somatostatin receptor scintigraphy in carcinoid liver metastases is not necessarily compromised by octreotide therapy. Because of different biodistributions, the detection of liver metastases may even be improved during octreotide therapy. Correspondence to: U. Dörr     

Percutaneous aspiration and ethanol sclerotherapy of symptomatic hepatic cysts

Nineteen patients with 49 symptomatic non-neoplastic non-parasitic simple hepatic cysts were subjected to ultrasonographically guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. Small cysts were treated twice, the large ones three times at the same sitting. The volume of alcohol per injection varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one ethanol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. Forty-seven of the 49 cysts could be treated adequately, and did not recur during a follow-up period af 12–40 months. The results indicate that aspiration an and ethanol sclerotherapy is the treatment of choice in patients with symptomatic non-neoplastic simple hepatic cysts or polycystic liver disease. Correspondence to: A. Leinonen     

Lower leg overuse injuries in athletes

Achilles paratenonitis and medial tibial syndrome are the most common specific overuse injuries among athletes in Finland, and they are a problem especially in endurance sports, such as long-distance running and jogging. Conservative treatment is often successful, but if it fails operative treatment is necessary. The surgical methods developed in Finland, which are widely used in the treatment of Achilles paratenonitis and medial tibial syndrome, are presented with clinical follow-up results in this paper. The patients operated on for Achilles paratenonitis were some years older than the patients operated on for retrocalcaneal bursitis (mean 38.4 versus 32.3 years). Results after operation were excellent or good in 92.4% of 291 patients operated on for Achilles paratenonitis, 84.2% of the 63 operated on for retrocalcaneal bursitis and 79% of the 47 operated on for medial tibial syndrome. All the patients treated operatively were patients in whom conservative treatment had failed. In conclusion, operative treatment of Achilles paratenonitis or medial tibial syndrome in athletes is indicated when these complaints do not respond to any type of conservative treatment.     

Elbow synovectomy on patients with juvenile rheumatoid arthritis

Twenty-four primary elbow synovectomies were done between 1991 and 1998 at the authors' institution on 19 patients (15 females, four males) with juvenile rheumatoid arthritis. Five bilateral and 14 unilateral procedures were done. The mean age of the patients was 29 years (range, 11-64 years) at the time of surgery and the mean disease duration was 19 years (range, 2-51 years). Preoperatively radiographic destruction of Larsen Grade 1 was detected in 21% of elbows, Grade 2 in 54%, and Grade 3 in 4%. In 21% of elbows no radiographic destruction was present (Grade 0). The cumulative survival rate of elbow synovectomy was 84% (95% confidence interval, 68-98) at 5 years. Four resynovectomies and two elbow replacement arthroplasties were done during the followup period. Complete pain relief was documented in 44% of patients and subjective outcome was excellent or good in 72% of patients. No significant improvement was observed in functional ability or range of motion in extension and flexion or pronation and supination. The results of the current study (mean followup, 5 years; range, 2-9 years) are slightly worse compared with the short-term results of elbow synovectomy in patients with adult-onset rheumatoid arthritis.     

The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles

OBJECTIVE: To compare the diagnostic imaging findings with the histological lesions in upper pole nephrectomy (UPN) specimens of duplex system ureteroceles, using renal ultrasonography (US) and nuclear renal scintigraphy. PATIENTS AND METHODS: Between 1992 and 2000, 86 patients with a ureterocele in a duplex system underwent surgery. The results from US were reviewed in 84 patients by a radiologist, for echogenicity, parenchymal thinning and hydronephrosis; 77 nuclear renal scans describing the differential function of the upper poles were also reviewed. Fifty-five patients underwent UPN (25 antenatal, 30 postnatal; 18 intravesical, 37 extravesical) and the specimens were available for independent review by a pathologist, describing five histological categories, i.e. chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Histological lesions were categorized as severe (> 25%) or minimal (相似文献   

Dual-setting calcium phosphate cement modified with ammonium polyacrylate

alpha-Tricalcium phosphate bone cement, as formerly designed and developed by Driessens et al., consists of a powder composed by alpha-tricalcium phosphate (alpha-TCP) and hydroxyapatite (HA) seeds, and an aqueous solution of Na2HPO4 as mixing liquid. After mixing powder and liquid, alpha-TCP dissolves into the liquid and calcium deficient hydroxyapatite (CDHA), more insoluble than the former, precipitates as an entanglement of crystals, which causes the setting and hardening of the cement. alpha-TCP bone cement offers several advantages in comparison to calcium phosphate bioceramics and acrylic bone cements as bone graft and repairing material, like perfect adaptability to the defect size and shape, osteotransductibility, and absence of thermal effect during setting. The main handicap is its low mechanical strength. Therefore, approaching its mechanical strength to that of human bone could considerably extend its applications. In the present work, an in situ polymerization system based on acrylamide (AA) and ammonium polyacrylate (PA) as liquid reducer was added to alpha-TCP cement to increase its mechanical strength. The results showed that the addition of 20 wt% of acrylamide and 1 wt% AP to the liquid increased the compressive and tensile strength of alpha-TCP bone cement by 149 and 69% (55 and 21 MPa), respectively. The improvement in mechanical strength seems to be caused by a decrease of porosity and the reinforcing effect of a polyacrylamide network coexisting with the entanglement of CDHA crystals. The studied additives do not affect the nature of the final product of the setting reaction, CDHA, but promote the reduction of its crystal size.     

The polymorphic androgen receptor gene CAG repeat,pituitary-testicular function and andropausal symptoms in ageing men

The activity of androgen receptor (AR) is modulated by a polymorphic CAG trinucleotide repeat in the AR gene. In the present study, we investigated hormonal changes among ageing men, and whether the number of AR CAG triplets is related to the appearance of these changes, as well as symptoms and diseases associated with ageing. A total of 213 41-70-year-old men donated blood for hormone analyses (LH, testosterone, oestradiol and SHBG) and answered questions concerning diseases and symptoms associated with ageing and/or androgen deficiency. Of these men, 172 donated blood for the measurement of the CAG repeat length of AR. The CAG repeat region of the AR gene was amplified by polymerase chain reaction (PCR) and the products were sized on polyacrylamide gels. The repeat number was analysed as a dichotomized variable divided according to cut-off limits of the lowest (< or =20 repeats) and the highest quartile (> or =23 repeats), and as a continuous variable. The proportion of men with serum LH in the uppermost quartile (>6.0 IU/L) with normal serum testosterone (>9.8 nmol/L, above the lowest 10%) increased significantly with age (p = 0.01). There were fewer men with this hormonal condition among those with CAG repeat number in the uppermost quartile (> or =23 repeats) (p = 0.03). These men also reported less decreased potency (p < 0.05). The repeat number was positively correlated with depression, as expressed by the wish to be dead (r = 0.45; p < 0.0001), depressed mood (r = 0.23; p = 0.003), anxiety (r = 0.15; p < 0.05), deterioration of general well-being (r = 0.22; p = 0.004), as well as decreased beard growth (r = 0.49; p < 0.0001). A hormonal condition where serum testosterone is normal but LH increased is a frequent finding in male ageing. Only certain types of age-related changes in ageing men were associated with the length of the AR gene CAG repeat, suggesting that this parameter may play a role in setting different thresholds for the array of androgen actions in the male.     

Facial rhytides—subsurfacing or resurfacing? A review

STUDY DESIGN/BACKGROUND AND OBJECTIVES: Currently, ablative laser therapy (with CO2/Er:YAG lasers) is considered an effective and promising method of skin rejuvenation. The induction of collagen synthesis was observed after treatments with the CO2 laser and with the long-pulsed Er:Yag laser. In past years, the undesirable side effects and risks of these methods have led to intensified research efforts in the fields of non-ablative facial rejuvenation as well as subsurfacing by means of non-ablative laser systems and intense pulsed light systems. The objective is to achieve selective, heat-induced denaturalization of dermal collagen that leads to subsequent reactive synthesis of neocollagen but does not damage the epidermis. This article reviews the use of different types of lasers and intense pulsed light sources for the non-ablative treatment of facial rhytides. RESULTS: The results of numerous clinical and histological investigations have recently indicated that these new technologies are successful. Some studies demonstrated remarkable effects with non-ablative systems; others, however, showed only limited cosmetic improvement or none at all. CONCLUSIONS: After critical review and assessment of current literature on the treatment of rhytides, we have found that non-ablative methods do not appear to be a comparable alternative to ablative skin resurfacing in terms of their efficacy and side effects.     

Bioabsorbable miniplating versus metallic fixation for metacarpal fractures

Bioabsorbable implants offer an attractive alternative to metallic implants to stabilize small bone fractures in the hand. Self-reinforced bioabsorbable miniplating for metacarpal fractures was studied in bones from cadavers and compared with standard metallic fixation methods. One hundred twelve fresh-frozen metacarpals from humans had three-point bending and torsional loading after transverse osteotomy followed by fixation using seven methods: (1) dorsal and (2) dorsolateral 2-mm self-reinforced polylactide-polyglycolide 80/20 plating, (3) dorsal and (4) dorsolateral 2-mm self-reinforced poly-L/DL-lactide 70/30 plating, (5) dorsal 1.7-mm titanium plating, (6) dorsal 2.3-mm titanium plating, and (7) crossed 1.25-mm Kirschner wires. In apex dorsal and palmar bending, dorsal self-reinforced polylactide-polyglycolide and poly-L/DL-lactide plates provided stability comparable with dorsal titanium 1.7-mm plating. When the bioabsorbable plates were applied dorsolaterally, apex palmar rigidity was increased and apex dorsal rigidity was decreased. Bioabsorbable platings resulted in higher torsional rigidity than 1.7-mm titanium plating and in failure torque comparable with 2.3-mm titanium plating. Low-profile selfreinforced polylactide-polyglycolide and poly-L/DL-lactide miniplates provide satisfactory biomechanical stability for metacarpal fixation. These findings suggest that bioabsorbable miniplating can be used safely in the clinical stabilization of metacarpal and phalangeal fractures.     

L-arginine supplementation accelerates renal fibrosis and shortens life span in experimental lupus nephritis

BACKGROUND: Inducible, high-output nitric oxide (NO) production has been identified as a central mediator of cell injury in immune-mediated renal disease. In acute anti-thy-1 glomerulonephritis prefeeding with the NO precursor L-arginine increases mesangial cell injury and the subsequent fibrosis. The present study tested the hypothesis that L-arginine supplementation may also be detrimental in chronic, NO-mediated murine lupus nephritis. METHODS: Groups (N = 18) of female MRL/lpr mice with lupus nephritis were fed the following diets: (1) normal protein (22% casein); (2) normal protein and 1.0% L-arginine in the drinking water; (3) low protein (6% casein); (4) low protein + 0.4%l-arginine; and (5) low protein + 1.0% L-arginine. After 40 days mouse survival, albuminuria, matrix accumulation, inflammatory cell infiltration, immunoglobulin G (IgG) deposition, expression of transforming growth factor-beta 1 (TGF-beta 1), fibronectin and plasminogen activator inhibitor-1 (PAI-1) mRNA and protein, anti-DNA antibody titer, inducible nitric oxide synthase (iNOS) mRNA expression, blood amino acid levels, blood urea nitrogen (BUN) concentrations and blood and urinary NOx (nitrite + nitrate) levels were assessed. RESULTS: L-Arginine supplementation increased mortality significantly (P < 0.02). The death rate increased from 0% in the lowest to 50% in the highest L-arginine intake group (normal protein + 1.0% L-arginine). L-Arginine administration increased albuminuria, renal matrix accumulation, TGF-beta 1, fibronectin, PAI-1, blood L-arginine, L-citrulline, BUN and blood and urine NOx levels, while protein restriction reduced these parameters. Renal cell infiltration and iNOS mRNA expression were decreased in the low protein group only. Anti-ds DNA-IgG and renal IgG deposition were comparable in all groups CONCLUSIONS: Increasing L-arginine intake increases the severity of renal fibrosis and the likelihood of death in MRL/lpr mice. The results appear to be at least in part mediated through enhanced cytotoxic NO generation via iNOS. The data suggest that L-arginine restriction should be considered in human immune-mediated renal diseases.