Detrusorectomy with rectus muscle hitch and backing

Purpose:

Bladder autoaugmentation is a procedure that includes detrusoromyotomy or detrusorectomy with an aim to release intact urothelium, which then prolapses and increases bladder capacity and compliance. Covering of the prolapsed urothelium usually is done by using deepithelialized pedicled colonic or gastric patch. The authors present their first experiences with detrusorectomy using rectus muscle for hitch and backing.

Methods:

Between August 1999 and February 2002, autoaugmentation was performed in 19 patients (12 girls and 7 boys) aged 4 to 12 years (median, 8). All patients had a neurogenic bladder with small capacity and poor compliance. Detrusorectomy usually involves the whole upper half of the bladder to achieve regular shape of the huge prolapsed urothelium. Both rectus muscles are dissected from their anterior and posterior sheaths. Urothelium is sutured to the muscle at several points to prevent its retraction and shrinkage. This way, bladder is fixed and hanged on rectus muscles.

Results:

Follow-up was 6 to 35 months (median, 21). The new bladder capacity was increased in all patients and ranged from 190 to 411 ml (median, 313). All patients had clinical improvement and better compliance.

Conclusions:

Detrusorectomy with rectus muscle hitch and backing is a safe and simple procedure. However, long-term results are needed to define value of this procedure.     

Development of a LC method for pharmaceutical quality control of the antimetastatic ruthenium complex NAMI-A

Imidazolium trans-tetrachloro(dimethylsulfoxide)imidazoleruthenium(III) (NAMI-A) is a novel ruthenium complex with selective activity against metastases currently in Phase I clinical trials in the Netherlands. Pharmaceutical quality control of NAMI-A drug substance and lyophilized product warranted the development of an assay for determination and quantification of NAMI-A and degradation products. A high performance liquid chromatography (HPLC) method was developed, consisting of a C18 column with 0.50 mM sodium dodecylsulfate in 3% methanol at pH 2.5 (acidified using trifluoromethanesulfonic acid) as the mobile phase and UV-detection at 358 nm. The HPLC method was proven to be linear, accurate and precise. Stress testing showed that degradation products were separated from the parent compound. By combining results of nuclear magnetic resonance (NMR) and HPLC experiments, one degradation product was identified as the mono-hydroxy species of NAMI-A. HPLC analysis with off-line detection of the eluate with flameless atomic absorption spectrometry (F-AAS) showed that under most conditions, all ruthenium-containing compounds show a peak in the HPLC chromatogram and that all ruthenium applied to the column is recovered quantitatively. For completely degraded solutions of NAMI-A some ruthenium is retained on the column. Suitability of the HPLC method for the pharmaceutical quality control of NAMI-A lyophilized product was demonstrated.     

Congenital microangiopathic hemolytic anemia and thrombocytopenia with unusually large von Willebrand factor multimers and von Willebrand factor-cleaving protease

Infantile or congenital cases of thrombotic microangiopathy have been reported that were familial and characterized by ongoing microangiopathic hemolysis and thrombocytopenia in the absence of regular fresh-frozen plasma transfusions. The authors describe a child with congenital microangiopathic hemolytic anemia and thrombocytopenia (CMHAT) who has received regular fresh-frozen plasma transfusions since infancy and has never had thrombotic complications. von Willebrand factor (vWF)-cleaving protease activity was studied in the patient's pretransfusion and posttransfusion plasma samples as well as in her parents' plasma. The effects of the patient's and a control subject's plasma on human microvascular endothelial cells were also investigated. Unusually large vWF multimers were present in the patient's plasma both before transfusion (thrombocytopenic) and after transfusion. Unlike cases of chronic relapsing thrombotic thrombocytopenic purpura, vWF-cleaving protease activity was present and treatment of cultured human endothelial cells with the patient's plasma did not induce apoptosis. These findings suggest that the patient with CMHAT may represent a different group in the broad spectrum of thrombotic microangiopathies.     

A patient with meningeal carcinomatosis and small cell lung cancer

Cranial metastasis because of lung cancer shows the poor prognosis. Cranial metastasis is common: In order lung, breast, skin, kidney, gastrointestinal system cancer is the 80% of the cause of metastasis. Cranial metastases are common in lung cancer especially in small cell lung cancer. Cranial metastasis can be seen in different location but leptomeningeal infiltration is rare and interesting. Because of this we will describe a case which has been death seven months after diagnose because leptomeningeal infiltration of small cell lung cancer.     

Reduction of lung metastasis by ImH[trans-RuCl4(DMSO)Im]: mechanism of the selective action investigated on mouse tumors

NAMI-A (imidazolium trans-imidazoledimethylsulfoxidetetrachlororuthenate, ImH[trans-RuCl4(DMSO)Im]) is a new ruthenium compound active against lung metastasis of solid metastasizing tumors. We have tested this compound in mice with Lewis lung carcinoma or MCa mammary carcinoma in order to compare the effects on primary tumor and lung metastases with possible alterations of cell cycle distribution of tumor cells. We have also investigated whether there were unequal tissue accumulations of the compound itself at different dose levels ranging from 17.5 to 70 mg/kg/day given for six consecutive days. NAMI-A caused a reduction of metastasis weight larger than that of metastasis number; we explain this finding as the capacity of NAMI-A to selectively interfere with the growth of metastases already settled in the lungs. However, this specificity is not simply related to a larger concentration of NAMI-A in the lungs than in other tissues. Following i.p. treatment, NAMI-A rapidly disappeared from the peritoneal cavity; its low blood concentration may be caused by rapid renal clearance. These data provide further evidence for a selective anti-metastasis effect of the ruthenium complex NAMI-A. The reduction of lung metastasis is followed by a significant prolongation of the host's life-time expectancy, indicating a therapeutic benefit of NAMI-A on lung metastases from solid tumors.     

Tribal differences in diabetes: prevalence among American Indians in New Mexico.

The prevalence of diagnosed diabetes among American Indians in New Mexico with varied genetic and cultural backgrounds is reported. Utilizing community-based registries, the prevalence in persons ages 35 years and older ranged from 9.8 percent among Jicarilla Apache Indians to 28.2 percent among Zuni Indians. All rates were significantly higher than the U.S. rate of 5.3 percent for the same age group. In addition, in three of the five tribal groups examined, the rates of diagnosed diabetes in Indians less than 35 years of age (range from 0.5 percent to 1.3 percent) were significantly higher than the U.S. rate of 0.4 percent for the same age group. The prevalence rates of diagnosed diabetes found in this study of American Indians in New Mexico were intermediate between those for the United States as a whole and the Pima Indians of southern Arizona. Reasons for the variations and the relative contribution of obesity, fitness, or genetic risk in the development of diabetes need further study.     

An evaluation of the occupational health risks to workers in a hazardous waste incinerator

A study was conducted to evaluate the health impact of airborne pollutants on incinerator workers at IZAYDAS Incinerator, Turkey. Ambient air samples were taken from two sampling points in the incinerator area and analyzed for particulate matter, heavy metals, volatile and semi-volatile organic compounds (VOCs and SVOCs) and dioxins. The places where the maximum exposure was expected to occur were selected in determining the sampling points. The first point was placed in the front area of the rotary kiln, between the areas of barrel feeding, aqueous and liquid waste storage and solid waste feeding, and the second one was near the fly ash transfer line from the ash silo. Results were evaluated based on the regulations related to occupational health. Benzene, dibromochloropropane (DBCP) and hexachlorobutadiene (HCBD) concentrations in the ambient air of the plant were measured at levels higher than the occupational exposure limits. Dioxin concentrations were measured as 0.050 and 0.075 pg TEQ.m(-3), corresponding to a daily intake between 0.007 and 0.01 pg TEQ. kg body weight(-1).day (-1). An assessment of dioxin congener and homologue profiles suggested that gaseous fractions of dioxin congeners are higher in front of the rotary kiln, while most of them are in particle-bound phases near the ash conveyor. Finally, the necessity of further studies including occupational health and medical surveillance assessments on the health effects of the pollutants for the workers and the general population in such an industrialized area was emphasized.     

Association of T102C polymorphism of the 5-HT2A receptor gene with pyschiatric status in fibromyalgia syndrome

Serotonin (5-HT) is a key neurotransmitter in the central nervous system. It is suggested that serotonergic dysfunction may be involved in the pathophysiology of fibromyalgia syndrome (FS). In this study, we aimed to investigate T102C polymorphism of the 5-HT2A receptor gene in FS. Fifty-eight patients with FS and 58 unrelated healthy volunteer controls were included in the study. In both groups, the C/C, C/T, and T/T genotypes of the 5-HT gene were represented in 31% (22.4% in controls), 50% (53.4%), and 19% (24.1%), respectively. The 5-HT2A receptor gene polymorphism results were not significantly different between patients and controls (chi squared test, P>0.05). There was a significant correlation between patients with the T/T genotype and the subgroup according to the SCL-90-R test, (analysis of variance, P<0.05). We also saw that patients with the T/T genotype had the lowest pain threshold. CONCLUSION. T102C polymorphism of the 5-HT2A receptor gene is not associated with the etiology of FS. Our results also indicate that the T/T genotype may be responsible for psychiatric symptoms of FS.