EXTRAPERITONEAL LAPAROSCOPIC PYELOPLASTY: A MULTICENTER STUDY OF 55 PROCEDURES

PURPOSE: We assessed the feasibility, reproducibility and morbidity of retroperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction. MATERIALS AND METHODS: A total of 55 retroperitoneal laparoscopic pyeloplasties were performed at 3 institutions between September 1996 and May 2000 in 33 women and 21 men. Results were analyzed in regard to radiological assessment by excretory urography at 3 months, complications and hospital stay. RESULTS: We performed dismembered pyeloplasty in 48 cases and Fenger plasty in 7 cases. Crossing vessels were noted in 23 patients. The conversion rate was 5.4%. Mean operative time was 185 minutes (range 100 to 260), mean hospital stay was 4.5 days (range 1 to 14) and mean followup was 14.4 months (range 6 to 43.6). The overall complication rate was 12.7%. Complications in 7 patients included hematoma in 3, urinoma in 1, severe pyelonephritis in 1 and anastomotic stricture in 2 requiring open pyeloplasty at 3 weeks and delayed balloon incision at 13 months, respectively. Excretory urography in 50 patients and ultrasound in 4 showed decreased hydronephrosis in 88.9% at 3 months. Normal physical activity and absent pain were reported by 47 patients (87%) 1 month after surgery. CONCLUSIONS: Retroperitoneal laparoscopic pyeloplasty seems to be a valuable alternative to open pyeloplasty for ureteropelvic junction obstruction. The long-term outcome must be assessed before this procedure may be definitively validated.     

Effects of methylprednisolone on the Fc-receptor function of human reticuloendothelial system in vivo

Abstract. To determine whether the Fc-receptor function of reticuloendothelial system (RES) is modified by corticosteroid administration, we studied the spleen to liver uptake ratios of autologous, ⁹⁹Tc-labelled heatdamaged or IgG-coated erythrocytes, injected intravenously into 10 normal volunteers, 4 h after receiving a single dose of 32 mg of methylprednisolone by mouth.
In standard conditions, quantitative scans indicated that the spleen to liver uptake ratios, calculated per unit area 40 min after the injection of labelled erythrocytes, were 13·4 ± 0·6 and 31·2 ± 1·5 (mean values ± -SEM), for the heat-damaged ( n = 7) and IgG-coated red cells ( n = 5) respectively. Four hours after corticosteroid administration, the spleen to liver uptake ratios were significantly reduced in five of ten volunteers. Abnormal ratios correlated with the Fc-receptor function of monocytes measured in vitro using IgG-coated erythrocytes. Indeed, 2–6 h after methylprednisolone was given, the Fc-receptor binding activity of monocytes isolated from the same five subjects was reduced by at least 50%, spontaneously returning to a rather normal value 4–6 h later. The C3-receptor binding activity of these monocytes remained normal, after otherwise identical experimental conditions.
These results show a transient, specific impairment of the Fc-receptor function of RES after methylprednisolone administration, and may therefore explain, in part, the infectious complications occurring in some patients treated by corticosteroids.     

Directional Variability of Stimulation Threshold Measurements in Isolated Guinea Pig Cardiomyocytes: Relationship with Orthogonal Sequential Defibrillating Pulses

BARDOU A.L., ET AL.: Directional Variability of Stimulation Threshold Measurements in Isolated Guinea Pig Cardiomyocytes: Relationship with Orthogonal Sequential Defibrillating Pulses. Reports on delivery of separated orthogonal pulses markedly improving cardiac defibrillation have suggested that the stimulation threshold of heart fibers varies in accordance with their orientation within the electric field. The present work was aimed at investigating the directional variability of stimulation thresholds in isolated guinea pig cardiomyocytes. This variability was measured in 48 single myocytes by rotating each one through a theta (θ) angle between two-fixed parallel electrodes 1.1 cm apart, thus making θ vary between the electric field and the myocyte axis. For θ= 0°, the mean longitudinal current stimulation threshold was 16.92 ± 4.20 mA (n = 48). When θ was increased by increments of 10° up to 90°, the stimulation threshold increased in an exponential way. For θ= 90°, the mean transverse stimulation threshold was 63.23 ± 13.30 mA. These results clearly demonstrate the dependence of isolated cardiomyocyte stimulation thresholds on their orientation within the electric field and may account for the improved efficacy of defibrillation previously observed after delivery of orthogonal pulses.     

Synthesis and properties of dermorphin and an analog of β-endorphin containing the dermorphin sequence

Dermorphin (I) and [D-Ala², Phe³, Gly⁴, Tyr⁵, Pro⁶]-β_c-EP (II) have been synthesized by the solid-phase method (β-EP, camel β-endorphin). Positions I through 7 of II correspond to the sequence of I. Relative potencies of synthetic peptides in the mouse tail-flick test for analgesia by the intracerebroventricular route were: human β-endorphin, 100; camel β-endorphin, 164; I, 450; II, 440. The dermorphin was about 670 times more potent than morphine in the assay. Peptide II represents a rare instance where the enkephalin moiety of β-endorphin has been altered to produce a more potent analgesic.     

Unclassified Haemolytic Anaemia with Splenomegaly and Erythrocyte Cation Abnormalities – A Disease of the Spleen?

An unclassified case of haemolytic anaemia with voluminous splenomegaly is reported. This anaemia was normocytic without any specific morphologic aspect of red blood cells (RBC); Coombs test was negative; the osmotic fragility was normal; the increased autohaemolysis was not affected by the presence of glucose; Hb studies were normal; no RBC enzyme deficiency was found; RBC lipids and membrane proteins were normal; there was a marked reduction in RBC survival with exclusive splenic uptake of erythrocytes. Before splenectomy, RBC cations and water content were abnormal: 1) the RBC water was decreased moderately; 2) the RBC sodium was about twice the normal mean with an increased ²²Na turn-over; 3) the RBC potassium was markedly reduced and ⁴²K influx was twice the normal mean; 4) the RBC calcium content was increased. Splenectomy was followed by rapid disappearance of haemolysis and RBC water and cation disturbances. Because of this extremely rapid disappearance after splenectomy the authors suggest this case of haemolytic anaemia could be a primary disease of the spleen.     

β-Endorphin: synthesis and properties of analogs modified in positions 8 and 31

Four analogs of human β-endorphin (β_h-EP) were synthesized by the solid-phase method: [Gln^8.31]-β_h-EP(I), [Arg⁸, Gln³¹] -β_h-EP(II), [Ala⁸, Gln³¹] -β_h-EP (III), and [Val⁸, Gln³¹]-β_h-EP(IV). Radioreceptor binding assay with use of tritiated β_h-EP as primary ligand gave relative potencies as follows: β_h-EP, 100; I, 200; II, 150; III, 150; IV, 120. Relative potencies in an analgesic assay were: β_h-EP, 100; 1,236; II, 254;III, 116; IV, 121. The side-chain of Glu-8 in β_h-EP can be replaced by a variety of structures without diminishing biological activity.