High intensity focused ultrasound--a surgical technique for the treatment of discrete liver tumours

The treatment of discrete liver tumours is often a difficult clinical problem. High intensity, focused ultrasound may provide one form of therapy for such disease. The ability to focus ultrasound precisely on a predetermined volume allows the possibility of selective tissue destruction at this position without damage to intervening tissues. We have investigated this both in vivo and in excised liver samples in vitro. Quantitative and qualitative studies have been carried out on the relationship between the ultrasonic exposure and the lesion shape, position and volume. In addition, the highly echogenic nature of the ultrasonic lesion has been studied, in an attempt to determine whether 'real time' observation of the extent of tissue damage is feasible.     

Detection of leptospiral DNA by nucleic acid hybridisation with 32P- and biotin-labelled probes

Dot hybridisation with 32P- and biotin-labelled probes prepared from leptospiral DNA was performed to develop a sensitive and specific diagnostic method for early infection with leptospires. The smallest amounts of leptospiral DNA that could be detected with 32P- and biotin-labelled probes was 1.5 pg and 5 pg, respectively, corresponding to about 750 and 2500 leptospires. Dot hybridisation with a 32P-labelled probe detected leptospiral DNA in sera from all of 14 experimentally infected golden hamsters. The smallest amount of leptospiral DNA detected in these experiments corresponded to about 2500 leptospires. In the test conditions described in this study, the sensitivity of dot hybridisation with a biotin-labelled probe was lower. Little cross-hybridisation was observed with unrelated DNAs which indicates that dot hybridisation could be a useful diagnostic method.     

Effects of diadenosine polyphosphates,ATP and angiotensin II on membrane voltage and membrane conductances of rat mesangial cells

Diadenosine polyphosphates have been shown to influence renal perfusion pressure. As mesangial cells may contribute to these effects we investigated the effects of diadenosine triphosphate (Ap₃A), diadenosine tetraphosphate (Ap₄A), diadenosine pentaphosphate (Ap₅A) and diadenosine hexaphosphate (Ap₆A) on membrane voltage (V _m) and membrane conductance (g _m) in mesangial cells (MC) of normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats in primary and long-term culture. We applied the patch-clamp technique in the fast-whole-cell configuration to measure V _m and g _m. To compare the effects of diadenosine polyphosphates with hitherto known agonists we also tested adenosine 5-triphosphate (ATP) and angiotensin II (Ang II). As there was no significant difference in the V _m values in MC of WKY (–42±1 mV, n=70) and SHR rats (–45±2 mV, n=99) as well as in the agonist-induced changes of V _m, all data were pooled. The V _m of all the cells was –44±1 mV (n=169) and g _m was 15.9±1.8 nS (n=141). Ion-exchange experiments showed the presence of a K⁺ and a non-selective cation conductance in resting MC whereas a Cl^– conductance or a Na⁺selective conductance could not be observed. Ap₃A, Ap₄A, Ap₅A, AP₆A and ATP each at a concentration of 5 mol/l, led to a significant depolarization of V _m by 5±2 mV (n=14), 7±1 mV (n=25), 3±1 mV (n=23), 2±1 mV (n=16), and 14±2 mV (n=23), respectively. For Ap₄A, the most potent diadenosine polyphosphate, we determined the half-maximally effective concentration (EC ₅₀) as 6 mol/l (n=5–25), for ATP as 2 mol/l (n=9–37), and for Ang II as 8 nmol/l (n=6–18). Ap₄A 100 mol/l increased g _m significantly by 55±20% (n=16), 100 mol/l ATP by 135±60% (n=18). The diadenosine polyphosphates examined were able to depolarize V _m (Ang II >ATP> Ap₄A>Ap₃A>Ap₅A>Ap₆A) by activation of a Cl^– conductance and a non-selective cation conductance, as do ATP or Ang II.     

Dental referral of drug addicts

Reasons for drug addicts' non-compliance to dental referral were investigated. Sixty-eight out of 83 addicts referred to the dentist were interviewed. Eighty-one percent intended to go, but only 42% did show up for their first appointment. Mean dental anxiety score (SDAI) was 23.6. An active referral of a non-anxious patient who visited the dentist in the past if in pain appeared least likely to fail. Dental care as an integral part of care for drug addicts is advocated.     

Congenital muscular dystrophy and severe central nervous system atrophy in two siblings

Severe degenerative features of the nervous system of a hitherto unknown kind, associated with a neuromuscular disorder with histopathological features of congenital muscular dystrophy, are reported in two female siblings. The clinical profile was characterized by generalized hypotonia followed by spastic tetraplegia, contractures, polyneuropathy, lack of cognitive development and progressive microcephaly. There was no involvement of the eyes. Neuropathological examination of the brain of one sibling, who died at the age of 30 months, revealed subtotal loss of neurons in the cerebral and cerebellar cortex and in the ventral pons, and secondary loss of myelin in the cerebral and cerebellar subcortical white matter. Sural nerve biopsy in the other sibling, who had a similar neurological affection, showed a lack of large myelinated fibers.This investigation is part of the research program Disorders of the Neuromuscular System of the University of Nijmegen     

Early one-stage orthotopic jejunal pedicle-graft interposition in long-gap esophageal atresia

Since 1988, four children with long-gap esophageal atresia have undergone one-stage orthotopic jejunal pedicle-graft interposition at the age of 2 to 3 months. Obtaining enough jejunal length was no problem and major early complications did not occur. In one patient stenosis of the distal anastomosis was problematic and required corrective surgery. None of the patients demonstrated jejunitis as a result of gastroesophageal reflux. With follow-up periods of 12, 27, 46, and 60 months, all patients are doing well. It is concluded that the jejunum is a better esophageal substitute than is generally appreciated.     

Our experience with Transjugular Intrahepatic Portosystemic Shunt (TIPS)]

The transjugular intrahepatic portosystemic shunt is a relatively new interventional procedure for the treatment of portal hypertension. It helps to stop the hemorrhage from varices. Decreases the risk of rebleeding and the quantity of ascites. 32 patient underwent the intervention from the May of 1995 until October of 1998. Majority of cases belong to Childs'B and C type. In the anamnesis there were 24 alcoholic cirrhosis. Shunt patency, complications and survival were analyzed. TIPS was successfully placed in 27 patients (84%). Portocaval pressure gradient decreased from 22 mmHg to 10.3 mmHg. There was no treatment related mortality. The average follow up was 14 months. In two patients the stents are patent for 36 months. Two stents became stenotic and there were nine occlusions within three years. Hepatic encephalopathy occurred in two cases. The TIPS is a safe, alternative interventional radiological therapy in the cure of portal hypertension without the mortality and morbidity of an open surgical procedure. By the use of TIPS the portosystemic gradient decrease successfully and can be ruled.