Uterine adnexal torsion: sonographic findings

Acute torsion of the uterine adnexal structures (ovary and fallopian tube) is a recognized surgical emergency, but rarely has the diagnosis been made preoperatively on the basis of imaging studies. This report describes 16 cases in which the diagnosis was suggested preoperatively on the basis of sonography and subsequently confirmed at surgery. In all of the patients studied, a pelvic or pelvoabdominal mass was present on sonography. These masses had a sonographic texture ranging from cystic to solid, depending on the presence and extent of internal hemorrhage and/or stromal edema. In the majority of patients (13 of 16), adnexal torsion was associated with a preexisting cystic adnexal mass. Eight of these had thin internal septae. The severity of symptoms was variable and did not correlate directly with the sonographic features of the pelvic mass. Consideration of this entity in the proper clinical setting and with the typical sonographic findings will facilitate prospective recognition of adnexal torsion, thereby improving the chances for salvage of the involved adnexal structures.     

Dihydralazine therapy and acetylator phenotype.

The acetylator phenotype was studied in 21 hypertensive patients receiving chronic treatment with dihydralazine and other antihypertensive drugs. Plasma dihydralazine concentrations were measured 6 hours after the morning dose of the drug. There were no significant differences between the slow and fast acetylators 1) in the daily dose of dihydralazine needed, 2) in the concentrations of dihydralazine achieved in plasma, 3) in the dose/concentration-relationship of dihydralazine or 4) in the appearance of side effects. Antinuclear antibodies were found in five patients. Four of them were fast acetylators. The lowest dose/concentration relationship was found in a patient with impaired renal function. According to these results the acetylator phenotype seems to be an unimportant factor in therapy with dihydralazine. More investigation will be needed in order to elucidate the metabolism of dihydralazine.     

近红外光谱技术监测单肺通气时大脑氧合及血供的变化

近红外光谱技术监测单肺通气时大脑氧合及血供的变化梁朝阳赵凤瑞酒古熏左焕宗作者单位：１０００２９北京中日友好医院胸外科（梁朝阳、赵凤瑞、酒古熏），神经外科（左焕宗）从１９９５年９月１日至１９９６年３月３１日，我们应用近年来发展的近红外光谱技术，利用含氧...     

Mucinous pseudocysts of the toes: an effective surgical method of treatment

Mucinous pseudocysts are dome-shaped, fluctuant lesions that may affect the dorsal aspects of the toes. Although synovial involvement cannot usually be demonstrated by histologic examination of biopsy specimens, joint involvement is a causative factor. Arthroplasty of the intermediate phalangeal head is advocated along with excision of the pseudocyst and its underlying pedicle. Conservative approaches rarely provide a permanent cure for mucinous pseudocysts of the toes.     

Evaluation of the new Behring Nephelometer in the measurement of M proteins

The Behring Nephelometer is a new automatic analyzer designed for the measurement of specific proteins. The authors evaluated the nephelometer in the determination of M proteins as compared with immunodiffusion and cellulose acetate electrophoresis. In addition, the effects of sample dilution and antigen excess on the nephelometric measurement of M proteins were studied in 24 patient samples containing a single monoclonal IgG, IgA, or IgM M component. Immunodiffusion cannot be recommended for the determination of M proteins. Nephelometry and protein electrophoresis gave similar results with few exceptions. Sera with immunoglobulin monomer-oligomer pairs involve difficulties in serum electrophoresis. In certain cases, special care must be taken to adjust the nephelometric measurement of the M protein to the most accurate part of the calibration curve. All in all, the new Behring Nephelometer proved precise and reliable in M protein determination without risk of antigen excess.     

Translocations and amplification of the BCL2 gene are detected in interphase nuclei of non-Hodgkin's lymphoma by in situ hybridization with yeast artificial chromosome clones

Translocation of the BCL2 gene in B-cell malignancies carrying t(14;18) and amplification of the BCL2 gene in a cell line (HBL-2) derived from a non-Hodgkin's lymphoma (NHL) were detected specifically in both metaphase spreads and interphase nuclei by fluorescence in situ hybridization (FISH) using yeast artificial chromosomes (YACs). A YAC clone containing the BCL2 gene yA153A6, a 360-kb clone spanning from approximately 60 kb upstream of BCL2 exon 1 to approximately 60 kb 3' of the minor breakpoint cluster region, was used for single-color FISH analysis. Seven patients with NHL and one patient with acute lymphoblastic leukemia were analyzed for BCL2 translocations. Interphase nuclei of NHL patients showed three signals when hybridized with the yA153A6 probe. This was expected because the YAC clone spans the BCL2 breakpoint regions on 18q21.3. In a patient with acute lymphoblastic leukemia, a positive signal for BCL2 was detected on der(14) at band 14q32.33 by single-color FISH with the yA153A6 probe, whereas no signals were detected on der(18). The amplification of BCL2 in the HBL-2 cell line was observed on a characteristic abnormal chromosome 18, add(18)(q23); the periodic pattern of the fluorescent signal of this region was suggestive of an amplicon. Using double-color FISH with YAC clones containing the more centromeric 18q21.3 gene gastrin-releasing peptide (y302F10) and the 14q32.33 gene (IgH; Y6), we detected t(14;18) by showing the juxtaposition of the 18q21.3 and 14q32.33 bands on the derivative chromosome 18. Interphase FISH with these YAC clones provided a rapid procedure for the diagnosis of B-cell malignancies carrying t(14;18). In addition, we showed that translocations and amplification of the BCL2 gene can be detected at the single-cell level.     

Laparoscopic appendectomy—is it worthwhile?

Background: Clinical diagnosis of acute appendicitis is most difficult in fertile-age women. In this patient group up to 50% of open appendectomies are negative for appendicitis. We conducted a randomized study to compare laparoscopic and open appendectomy in young female patients with suspected acute appendicitis. Methods: Fifty female patients between the ages of 16 and 40 years presenting with acute right lower abdominal pain were randomized, 25 to laparoscopy and 25 to an open appendectomy. Diagnostic accuracy, rate of negative appendectomies, safety, and final outcome were compared in the two groups. Results: Diagnosis was established in 96% of patients in the laparoscopic group and in 72% in the open group. There were 11 (44%) unnecessary appendectomies in the open group, but only one (4%) in the laparoscopic group (p < 0.0005). Conclusions: In young women with right lower abdominal pain, laparoscopy can give precise diagnosis and reduce the rate of negative appendectomies. Received: 18 March 1996/Accepted: 12 June 1996     

Prevention of amlodipine absorption by activated charcoal: effect of delay in charcoal administration

Aims The purpose of this study was to investigate the effect of activated charcoal on the absorption of amlodipine, with special reference to delayed charcoal administration.
Methods Thirty-two healthy volunteers, eight subjects in four parallel groups, ingested 10 mg of amlodipine on an empty stomach. Activated charcoal (25 g in 300 ml of water) was ingested either immediately afterwards or 2 h or 6 h after amlodipine, or amlodipine was ingested with 300 ml of water only (control). Plasma concentrations and the cumulative excretion of amlodipine into urine were measured by GC-MS for 96 h and 72 h, respectively. In addition, adsorption of amlodipine to charcoal was studied in vitro .
Results Activated charcoal administered immediately after amlodipine reduced the amlodipine AUC(0,96 h) and the 72-h urinary excretion by 99% ( P <0.0005). After a delay of 2 h in charcoal administration the AUC(0,96 h) was reduced by 49% ( P =0.001), but after a delay of 6 h the reduction was 15% only ( P =NS). At a charcoal: drug ratio of 5:1, about 90% of amlodipine was adsorbed by charcoal in vitro; at ratios of 10:1 and 20:1, adsorption was practically complete.
Conclusions Activated charcoal almost completely prevented amlodipine absorption when administered immediately after amlodipine ingestion. Charcoal also markedly reduced amlodipine absorption when given 2 h after amlodipine; in amlodipine overdose, administration of charcoal may be beneficial even later. We conclude that administration of activated charcoal is the method choice to prevent absorption of amlodipine in amlodipine overdose.     

High concentrations of atrial natriuretic peptide and brain natriuretic peptide in rat pericardial fluid and their reduction by reserpine in vivo

We determined concentrations and molecular sizes of natriuretic peptides in rat pericardial fluid and plasma by use of specific radioimmunoassays (RIA) and gel filtration HPLC. Our study shows that pericardial fluid forms a local extracellular storage of immunoreactive (ir) atrial natriuretic peptide (irANP) and brain natriuretic peptide (irBNP) near the heart where these peptides can be found in high concentrations in vivo. The concentrations of irANP, irBNP and NH₂-terminal fragment of proANP (irNT-proANP) in pericardial fluid were 9.8 ± 3.7, 0.49 ± 0.47 and 28.9 ± 11.8 nmol/l, respectively. IrBNP had the lowest (20 ± 11) and irANP the highest (90 ± 32) concentration ratio between pericardial fluid and plasma. The elution positions of irANP, irBNP and irNT-proANP in pericardial fluid and plasma were similar as examined by gel filtration HPLC. Furthermore, we show that the reduction of noradrenaline content of the heart muscle by reserpine reduces concentration of irANP in pericardial fluid by 39.6% and in plasma by 30.3% when compared to respective control group values. The concentration of irBNP is reduced by 44.1 % in pericardial fluid but in plasma its reduction was not statistically significant. Vasoactive peptides released into the interstitial space and from there into pericardial fluid may have a more active role in the regulation of cardiac function than previously considered.