Cigarette smoke impairs elastin resynthesis in lungs of hamsters with elastase-induced emphysema

The severity of pulmonary emphysema can be affected by exposure to cigarette smoke in several ways. Inactivation of alpha-1-antitrypsin and recruitment of leukocytes to lung airways shifts the protease-antiprotease balance towards increased elastolytic activity. The present study demonstrates an additional effect of cigarette smoke inhalation and retardation of the repair process and of the neosynthesis of cross-linked elastin. Hamsters with elastase-induced emphysema, exposed to cigarette smoke for 1 wk immediately after elastase administration, showed a 40% reduction of 14C-lysine incorporation into the elastin-specific cross-links, desmosine, and isodesmosine. Concomitantly, there was a decrease in the level of lung lysyl oxidase to that observed in uninjured control animals, in sharp contrast to the sevenfold increase in lysyl oxidase activity in hamsters with elastase-induced emphysema recovering under atmospheric conditions. These findings suggest that impairment of the production of lysyl oxidase and the resynthesis of cross-linked elastin by smoke inhalation exacerbates alveolar destruction.     

Operative correction of penile deviation with the Nesbit procedure and with Schroeder-Essed technique

60 patients with a marked penile deviation [40 because of a congenital penile deviation (CPD) and 20 as a result of the Peyronie's disease] were questioned about the result of the operation by means of a questionnaire in a retrospective study with an average follow-up of 45 month. The Nesbit procedure had been used with 49 of these 60 patients, the modified Schroeder-Essed technique had been used with 11 patients. There were 15 patients (25%) in all, who suffered a relapse. In spite of the continual use of non-absorbable suture material with the Schroeder-Essed technique, the number of relapses was in this group plainly higher than in the Nesbit group (55% and 18% respectively). In our opinion this is caused by the insufficient tensile strength of pure plications. Regardless of the operating method, patients suffering from IPP showed a higher number of relapses than patients having a CPD (35% and 20% respectively). The reason for this might be the fact that one can never rule out completely the possibility of a further progress of the disease. 71% of the patients in the Nesbit group were satisfied with the results of the operation, in the Schroeder-Essed group there were only 36%. Irrespective of the operating method, IPP patients complained moreoften about late complications and erection problems after the operation and were more rarely satisfied with the result than patients with a CPD (50% and 73% respectively). We put this down to the fact that patients with a CPD and patients suffering from IPP represent very different collectives as far as age structure and morbidity are concerned. IPP patients frequently have erection problems even before the operation. Especially with IPP patients, preoperative erectile disfunction must be excluded, in the case of their occurrence there are to prefer other programmes of therapy.     

The cuffed oropharyngeal airway vs. the laryngeal mask airway: a randomised cross-over study of oropharyngeal leak pressure and fibreoptic view in paralysed patients

We conducted a randomised cross-over study of 20 patients to test the hypothesis that oropharyngeal leak pressure and the fibreoptic view differ between the cuffed oropharyngeal airway and laryngeal mask airway in paralysed patients. We also tested the design premise that inflation of the cuffed oropharyngeal airway cuff elevates the epiglottis from the posterior pharyngeal wall. Both airways were inserted into each patient in random order. Oropharyngeal leak pressure and fibreoptic view were documented at zero volume and after each additional 10 ml up to the maximum recommended volume for each device. The laryngeal mask had a higher maximum (23 vs. 16 cmH2O, p = 0.03), minimum (9 vs. 2 cmH2O, p < 0.02) and overall (17 vs. 9 cmH2O, p < 0.001) oropharyngeal leak pressure compared with the cuffed oropharyngeal airway. The glottic inlet was visible more frequently with the laryngeal mask (96 vs. 39%, p < 0.0001). There was no elevation of the epiglottis from the posterior pharyngeal wall with the cuffed oropharyngeal airway. We conclude that the laryngeal mask forms a more effective seal and provides a better fibreoptic view of the glottic inlet than the cuffed oropharyngeal airway in paralysed patients. Inflation of the cuffed oropharyngeal airway cuff does not cause elevation of the epiglottis.     

吸入麻醉药增加β淀粉样蛋白的寡聚化反应和细胞毒性

背景:多数外科病人都接受过吸入麻醉药,主要是小分子卤代烃和卤代醚类。长期任知功能障碍发生于麻醉和手术后的老年病人。对神经变性疾病如阿尔茨海默病和帕金森病病人来说,以前接受过手术可能也一个是危险诱发因素。作者认为吸入麻醉药可能通过增强肽的持久寡聚化诱发上述疾病。     

Surgical resection and radiation therapy of desmoid tumours of the extremities: results of a supra-regional tumour centre

Purpose

Desmoid tumours of the extremity have a high recurrence rate. The purpose of this study was to analyse the outcome after resection of these tumours with special emphasis on recurrent disease and adjuvant therapeutic strategies.

Methods

In this retrospective study we evaluated prognostic factors for recurrence-free survival after surgical treatment of desmoid tumours of the extremity in 27 patients with an average age of 41 years treated from 1997 to 2009. Adjuvant radiotherapy (50–60 Gy) was given in five cases with primary and in nine patients with recurrent disease. The average follow-up was 64 months.

Results

The five-year recurrence-free survival in patients with primary disease was 33 %. Patients with negative resection margins tended to have a better outcome than patients with positive resection margins, but the difference between both groups was not significant (56 vs 14 %, p = 0.145). In patients with positive margins, adjuvant radiotherapy did not significantly improve recurrence-free survival (40 vs 14 %, p = 0.523). Patients with local recurrence had a five-year further recurrence-free survival of 47 %. In those patients further recurrence-free survival was significantly better after adjuvant radiation (89 vs 25 %, p = 0.015). Two thirds of all patients suffered moderate or severe complications due to the treatment regimen.

Conclusions

Compared to desmoids of the trunk or the head and neck region, desmoids affecting the limbs show by far the worst outcome in terms of relapse or treatment-related morbidity. The importance of negative resection margins is still not clear. Particularly in recurrent desmoids adjuvant radiotherapy appears to reduce the further recurrence rate. Therefore, a general use of radiation should be considered for this high-risk group.     

Pelvimetry and patient acceptability compared between open 0.5-T and closed 1.5-T MR systems

Our objective was to compare maternal pelvimetry and patient acceptability between open low-field (0.5-T) and closed 1.5-T MR systems. Thirty women referred for pelvimetry (pregnant: n=15) were scanned twice in the supine position, once in the vertical open system and once in the closed system. Each patient completed a comfort and acceptability questionnaire. Pelvimetric and questionnaire data were compared between systems. Total scan time was double in the open system (7:52±1:47 vs 3:12±1:20 min). Poor image quality in the open system prevented assessment of interspinous and intertuberous diameters in one woman and all measurements in another, both pregnant, with abdominal circumferences >120 cm. The open system was much more acceptable in terms of claustrophobia and confinement (both p<0.01). Claustrophobia interrupted one closed examination. Thirty-three percent of pregnant women in both systems reported fear of fetal harm. Sixty percent of all women preferred the open system, 7% the closed system, and 33% had no preference. Limits of agreement of 3–5% from the mean for all diameters confirmed good pelvimetric reproducibility. Women's preference for open-system MR pelvimetry is feasible with abdominal circumferences ≤120 cm. Electronic Publication     

Prolonged survival in patients with resected non-small cell lung cancer and single-level N2 disease

OBJECTIVES: To test the hypothesis that patients with non-small cell lung cancer and single-level N2 metastases constitute a favorable subgroup of patients with mediastinal metastases, we analyzed the results of the Eastern Cooperative Oncology Group 3590 (a randomized prospective trial of adjuvant therapy in patients with resected stages II and IIIa non-small cell lung cancer) by site of primary tumor and pattern of lymph node metastases. METHODS: Accurate staging was ensured by mandating either systematic sampling or complete dissection of the ipsilateral mediastinal lymph nodes. The overall survival of patients with left lung non-small cell lung cancer and metastases in only 1 of lymph node levels 5, 6, or 7 and right lung non-small cell lung cancer with metastases in only 1 of levels 4 or 7 was compared with that of patients with N1 disease originating in the same lobe. RESULTS: The median survival of the 172 patients with single-level N2 disease was 35 months (95% confidence interval: 27-40 months) versus 65 months (95% confidence interval: 45-84 months) for the 150 patients with N1 disease (median follow-up 84 months, P =.01). However, among patients with left upper lobe tumors, survival was not significantly different between patients with N1 disease and patients with single-level N2 disease (49 vs 51 months, P =.63). The median survival of the 71 patients with single-level N2 metastases without concomitant N1 disease (skip metastases) was 59 months (95% confidence interval: 36-107 months) versus 26 months (95% confidence interval: 16-36 months) for the 145 patients with both N1 and N2 metastases (P =.001). CONCLUSIONS: Survival of patients with left upper lobe non-small cell lung cancer and metastases to single-level N2 lymph nodes is not significantly different from that of patients with N1 disease. The presence of isolate N2 skip metastases is associated with improved survival when compared with patients with both N1 and N2 disease. Survival should be reported by the lobe of primary tumor and metastatic pattern to guide future clinical trial development, treatment strategies, and revisions of the TNM staging system.     

Cholinergic neuronal lesions in the medial septum and vertical limb of the diagonal bands of Broca induce contextual fear memory generalization and impair acquisition of fear extinction

Previous research has shown that the ventral medial prefrontal cortex (vmPFC) and hippocampus (Hipp) are critical for extinction memory. Basal forebrain (BF) cholinergic input to the vmPFC and Hipp is critical for neural function in these substrates, which suggests BF cholinergic neurons may be critical for extinction memory. In order to test this hypothesis, we applied cholinergic lesions to different regions of the BF and observed the effects these lesions had on extinction memory. Complete BF cholinergic lesions induced contextual fear memory generalization, and this generalized fear was resistant to extinction. Animals with complete BF cholinergic lesions could not acquire cued fear extinction. Restricted cholinergic lesions in the medial septum and vertical diagonal bands of Broca (MS/vDBB) mimicked the effects that BF cholinergic lesions had on contextual fear memory generalization and acquisition of fear extinction. Cholinergic lesions in the horizontal diagonal band of Broca and nucleus basalis (hDBB/NBM) induced a small deficit in extinction of generalized contextual fear memory with no accompanying deficits in cued fear extinction. The results of this study reveal that MS/vDBB cholinergic neurons are critical for inhibition and extinction of generalized contextual fear memory, and via this process, may be critical for acquisition of cued fear extinction. Further studies delineating neural circuits and mechanisms through which MS/vDBB cholinergic neurons facilitate these emotional memory processes are needed. © 2015 Wiley Periodicals, Inc.