Nephron‐sparing surgery for small incidental renal cell carcinoma

Background : Nephron‐sparing surgery is currently an accepted treatment for renal cell carcinomas in patients with bilateral tumours, solitary kidneys and when overall renal function is impaired or at risk from medical disease. Its role in patients with a normal contralateral kidney remains controversial. Methods : The authors’ experience in 23 patients undergoing partial nephrectomy for small peripheral lesions between 1995 and 2000 is reported here. Results : Twenty‐three patients (13 men and 10 women) with a mean age of 56 years underwent partial nephrectomy. All but three of these patients had a normal contralateral kidney. Mean operating time was 141 min with a mean reduction of haemoglobin of 28 g/dL. Three patients required transfusion. Serum creatinine did not change significantly between preoperative and postoperative values. Two JJ stents were placed prophylactically during surgery to minimize urinary leak. There were no intraoperative or early postoperative deaths and at mean follow up of 16 months there was no evidence of recurrent tumour in 23 patients. Seventeen per cent of lesions removed were benign. Conclusions : Partial nephrectomy for small peripheral lesions is a safe procedure with low morbidity. No definite recurrences are evident at an early stage of follow up, although longer review (probably more than 10 years) will be required to assess cancer‐specific survival following this procedure.     

Electrophysiological studies on the effects of intrathecal morphine on nociceptive neurones in the rat dorsal horn

We have studied the effects of intrathecal morphine on the responses of 38 dorsal horn neurones in the intact rat under halothane anaesthesia to A and C fibre electrical stimulation and to natural stimuli applied to their receptive fields. Morphine selectively reduced the C fibre and pinch evoked activity in a dose-dependent naloxone-reversible manner with an ED50 of 7 nmoles. The 'wind-up' of neurones to repetitive stimulation was little altered except with the highest doses (50-150 nmoles) tested. By contrast, the A fibre evoked responses of the neurones were only slightly reduced by morphine and both the tactile responses and receptive field size to innocuous stimuli enhanced for certain cells. The results are discussed in relation to the spinal actions of opiates and their clinical applications.     

A state-wide assessment: marital stability and client outcomes.

This paper presents results of Missouri's first statewide evaluation of alcohol and drug treatment programs. The study utilized a 1-year follow-up sample of 242 respondents to explore the nature and patterns of post-treatment functioning. This paper focuses on the impact of client marital stability on post-treatment substance use. The data supported the expected result that marital status was related to post-treatment relapse. Further analysis suggests that transitional periods between marriage and divorce are especially important in understanding the pattern of relapse after treatment. Multivariate analysis indicates that the marital status effect is important both directly and in interaction with program completion. The data suggest that attention to transitional states and interpersonal functioning should be incorporated into client follow-up.