rhVEGF and experimental rat skin flaps: systemic or local administration and morphological characteristics

Skin flap survival is a significant problem in skin surgery; in particular, inadequate arterial or venous blood supply results in necrosis of the distalmost portion. The aim of this study was to evaluate the ability of Vascular Endothelial Growth Factor (VEGF) of modifying the morphological features of skin flaps. Bilateral epigastric skin flaps were raised in 16 Wistar male rats. The epigastric artery and vein of the left flaps were clamped and then injected with rhVEGF (8 rats) or saline (8 rats). The right flaps were not clamped and received rhVEGF or saline systemically. The rats were euthanized on the seventh day and flap skin samples collected. Tissue fragments were subject to immunohistochemical (rhVEGF, VEGFr, VIII factor, CD34 antibodies), ultrastructural and morphostructural investigations. The results showed that rhVEGF improved the condition of flaps and that systemic administration was effective in promoting the development of an adequate vascular network.     

Adult testicular pure yolk sac tumor.

Here we describe the clinical, ultrasonographic and histological features of a rare pure adult yolk sac tumor detected in the right testis of a 44-year-old male. Due to the rarity of this neoplasm (less than 10 cases have been reported), there is no unanimous consensus for therapy following inguinal orchiectomy. We believe that nerve-sparing retroperitoneal lymph node dissection could be potentially curative and useful for future interpretations of this tumor's potential evolution.     

Adjustment to residential placement in Alzheimer disease patients: does premorbid personality matter?

Aim. To evaluate the influence of premorbid personality on adaptation to placement in a long-term care facility. Subjects. Twenty-eight persons with probable Alzheimer disease (AD) residing in an academically affiliated nursing home for 6–9 months. Methods. Premorbid personality was described retrospectively by two informants for each resident using the revised NEO Personality Inventory (NEO-PI-R). Standardized tests and rating scales were used on admission to the facility to assess cognition, mood state, physical dependency and general health. Nurses rated each AD resident's social behaviour, participation in activities and quality of sleep. Results. Poorer adjustment was associated with more severe dementia but better physical health. None of the NEO-PI-R domain scores predicted adjustment. Conclusions. Contrary to popular belief, premorbid personality is relatively inconsequential for an AD patient's adaptation to a long-term care facility. © 1998 John Wiley & Sons, Ltd.     

Post-coma persons emerging from a minimally conscious state with multiple disabilities make technology-aided phone contacts with relevant partners

Post-coma individuals emerging from a minimally conscious state with multiple disabilities may enjoy contact with relevant partners (e.g., family members and friends), but may not have easy access to them. These two single-case studies assessed whether those individuals could make contact with partners through computer-aided telephone technology and enjoy such contact. The technology involved a computer system with special software, a global system for mobile communication modem (GSM), and microswitch devices. In Study I, the computer system presented a 23-year-old man the names of the partners that he could contact, one at a time, automatically. Together with each partner's name, the system also presented the voice of the partner asking the man whether he wanted to call him or her. The man could (a) place a call to that partner by activating a camera-based microswitch through mouth movements or (b) bypass that partner and wait for the next one to be presented. In Study II, the system presented a 36-year-old man the partners’ names only after he had activated his wobble microswitch with a hand movement. The man could place a call or bypass a partner as in Study I. The results showed that both men (a) were able to contact relevant partners through the technology, (b) seemed to enjoy their telephone-mediated communication contacts with the partners, and (c) showed preferences among the partners. Implications of the findings are discussed.     

Use of Simple Exercise Tools by Students with Multiple Disabilities: Impact of Automatically Delivered Stimulation on Activity Level and Mood

This study assessed the impact of automatically delivered stimulation on the activity level and mood (indices of happiness) of two students with multiple disabilities, during their use of a stationary bicycle and a stepper. The stimulation involved a pool of favorite stimulus events which were delivered automatically, through an electronic control system, while the students were active in using the aforementioned exercise tools. Data showed that stimulation had a positive impact on the overall level of activity and indices of happiness of both students. Practical implications and technical aspects of the intervention procedure are discussed.     

Pharmacokinetics and toxicity of an early single intravesical instillation of gemcitabine after endoscopic resection of superficial bladder cancer

BACKGROUND: The tolerability and plasma absorption of gemcitabine administered at 40 mg/ml after small and extensive endoscopic transurethral resection of bladder tumors (TURB) were evaluated. PATIENTS AND METHODS: Nine patients with a history of recurrent superficial bladder cancer were eligible for a single immediate, post TURB, intravesical instillation of gemcitabine. The endoscopic resection was small in 5 patients and extensive in 4. The drug was administered at 40 mg/ml concentration (2000 mg in 50 ml saline) and held in the bladder for 1 hour. Plasma concentrations of gemcitabine and its metabolite (2',2'-difluorodeoxyuridine) were determined with a validated HPLC assay. The blood count and chemistry were performed one day and one week postoperatively. RESULTS: Toxicity was comparable for patients who underwent small or large TURB. The most significant side-effects were grade 2 vomiting and a transient grade 2 leukopenia after small and large TURB respectively. Mean maximum gemcitabine concentrations were 1.47 microg/ml in small TURB and 2.8 microg/ml in large TURB. The highest peak concentration of 4.26 microg/ml was found after extended bladder resection. CONCLUSION: A single, immediate postoperative, intravesical instillation of gemcitabine at high concentration is feasible with acceptable toxicity, and it may be considered as an option taking into account patient performance status, tumor characteristics and TURB extension.     

Short-schedule intravesical gemcitabine with ablative intent in recurrent Ta-T1, G1-G2, low- or intermediate-risk, transitional cell carcinoma of the bladder

OBJECTIVES: Primary objective: to assess ablative efficacy and tolerability of short-schedule intravesical gemcitabine for intact, low- and intermediate-risk, recurrent superficial bladder tumours. Secondary objective: to assess effect on prophylaxis. METHODS: Patients with a diagnosis of recurrence and a history of previous superficial, low- or intermediate-risk bladder tumours were selected for the study. They received 2000 mg gemcitabine in 50 ml, that is 40 mg/ml, intravesically, weekly for 4 wk, followed by resection of any residual lesions. Complete responses consisted of absence of any macroscopic, histologically confirmed, residual lesion, and no response in the presence of residual lesions. The effect on prophylaxis was measured in months as disease-free interval to first recurrence, and as percentage of patients recurring within the first 12 mo. Toxicity was assessed as local and systemic. RESULTS: Of 34 recruited patients, 28 consecutive patients were evaluable, with complete responses observed in 13 of 28 (46.4%) and no response in 15 (53.6%). Median time to first recurrence was 9.1 mo (range: 2.9-26.5) for 19 of 28 (67.8%) patients experiencing recurrence during the first year. Local or systemic toxicity was observed in 9 of 34 (26.4%) patients, resulting in protocol interruption in 6 patients. CONCLUSIONS: Intravesical gemcitabine alone showed ablative efficacy in nearly one half of the patients under study. Drug tolerability was good, both locally and systemically.