Deep sclerectomy ab externo with implant: description of surgery technique

The authors present the modified associated technique of deep sclerectomy ab externo with implant. The indications, advantages and disadvantages are presented.     

The evaluation of the usefulness of phacotrabeculectomy as the only surgery for glaucoma and cataract patients

PURPOSE: To evaluate IOP changes after phacotrabeculectomy. MATERIAL AND METHODS: 24 glaucoma patients (27 eyes) with coexistence of cataract. Age: 56-79 years. Mean IOP level before surgery: 23.2 +/- 2.4 mm Hg. In all cases phacotrabeculectomy was performed. Follow-up ranged from 3 to 12 months. RESULTS: IOP decrease after surgery was achieved: mean decrease 7.1 +/- 2.3 mm Hg after 3 months and 5.5 +/- 2.4 mm Hg, and 4.1 +/- 2.1 mm Hg after 6 and 12 months, respectively. CONCLUSION: Phacotrabeculectomy combines all advantages of phacoemulsification and creates perspective for IOP normalization.     

Potential anti-anxiety, anti-addictive effects of LY 354740, a selective group II glutamate metabotropic receptors agonist in animal models

Despite there being a lot of biochemical data about metabotropic glutamate (mGlu) receptors, our knowledge of the behavioural effects of mGlu receptor agonists/antagonists is still inadequate. LY 354740 is a systemically active agonist of group II mGlu receptors. After peripheral administration, LY 354740 produced anxiolytic-like effects in the conflict drinking test in rats and a four-plate test in mice. It was also found that LY 354740 decreased spontaneous locomotor activity in mice, but did not disturb motor coordination. In behavioural models of depression including the despair test and a tail suspension test, LY 354740 did not produce antidepressant-like effects. LY 354740 inhibited the naloxone-induced symptoms of morphine withdrawal in morphine-dependent mice. The above results indicate that agonists of group II mGlu receptors may play a role in the therapy of anxiety and/or drug-dependence states. The brain sites of action of LY 354740 need to be identified and the mechanism of both the above described effects remains to be elucidated.     

2,3-Dihydrobiflavone from Ginkgo biloba

From the yellow leaves of Ginkgo biloba 2,3-dihydrosciadopitysin (5,5',7'-trihydroxy-7,4',4'-trimethoxy-3',8'-flavanone/flavone) was isolated as a mixture of two diastereomers. Its structure was elucidated employing 2D NMR techniques.     

Intraoperative laparoscopic complications

PURPOSE: The aim of this study was to assess various intraoperative and postoperative complications associated with laparoscopic colorectal surgery. Specifically, the impact of surgical experience and procedure type on complications was analyzed. METHODS: All patients who underwent laparoscopic surgery were analyzed by age, sex, surgical indications, procedure performed, procedure length, intraoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and length of hospital stay. Patients were classified for type of procedure and chronologically into four consecutive groups. Procedures were also categorized into four different groups: GI, total abdominal colectomies; GII, segmental resections; GIII, diverting procedures; GIV, others (abdominoperineal resection, Hartmann's creation or closure, anterior resection, and rectopexy). RESULTS: Between August 1991 and October 1995, 167 patients of a mean age of 49.6 (15–88) years underwent laparoscopic colorectal procedures. All procedures were electively performed. Common indications for surgery included inflammatory disease in 70 (42 percent), neoplasia in 56 (33 percent), functional bowel disorders in 30 (18 percent), and other forms of colorectal disorders in 11 (7 percent) patients. The most significant variable affecting intraoperative laparoscopic complication rate was surgical experience measured as the time interval during which surgery was performed (P=0.02). Total complication rate decreased from 29 percent during the first period to 11 percent by the second period (P<0.04) and 7 percent during the third period (P<0.005). Thus, the learning curve appeared to have required more than 50 cases to achieve. Moreover, even after performance of 94 (1991–1993) procedures in GI and GIV, these procedures were associated with higher complication rates than were those procedures in GII and GIII (P=0.04). CONCLUSION: Surgical experience and case selection are the most critical variables by which the surgeon can decrease the intraoperative laparoscopic complication rate.     

Prospective comparison of open<Emphasis Type="Italic">vs</Emphasis>. laparoscopic colon surgery for carcinoma

Laparoscopy for colonic diseases began in 1990 and has established a role in benign disease. Early observations and experiences demonstrated feasibility of laparoscopic surgery for a variety of colonic disease processes, but the applicability to colonic carcinoma was unclear. METHODS: In 1990, we began a comparative study of open (OCR)vs.laparoscopic (LCR) approach to colon cancer. The study progressed 65 months, with 224 patients in OCR group and 191 patients in LCR group. Parameters studied are stage, location, length of specimen, number of lymph nodes resected, margins, postoperative course, wound complications, recurrence rates, and immediate and long-term survival. OCR were standardized by one group, and LCR were standardized by a second group. All patients undergoing LCR were given freedom to choose either OCR or LCR, and informed consent was obtained. RESULTS: Equal or greater lymph node retrieval, resections, and distal margins were evident with LCR. Benefits with LCR were shown with shorter hospitalization (5.7vs.9.7 days), less blood loss, less wound problems (1vs.14), and quicker return of bowel function. Survival, recurrence, and death rates were essentially the same. There were no trocar implants in the LCR group. CONCLUSION: After five years, this study shows that laparoscopy does no harm to the patient, offers comparable oncologic resections, and seems to be patient-friendly, with less pain, quicker return of bowel functions, shortened hospitalization, and quicker return to full activity.     

Pituitary apoplexy: Endocrine,surgical and oncological emergency. Incidence,clinical course and treatment with reference to 799 cases of pituitary adenomas

Summary Authors analised retrospectively the incidence of pituitary apoplexy in a series of 799 pituitary adenomas with respect to the long term follow-up of the patients.Focal vascular abnormalities in histological specimens of tumours, regarded as morphological suggestion of past apoplexy (heamorrhage, ischaemic infarction or necrosis), were established in 113 out of 783 surgical cases (14.4%).Acute clinical onset, justifying the clinical diagnosis of pituitary apoplexy, occurred in 39 patients only (5% of the whole series), 19 of them were subjected to urgent surgical decompression due to severe neurological deficit. The haemorrhagic character of apoplexy was established in most cases requiring immediate surgery.The detailed clinical picture of this condition and its management are discussed with respect to the long term prognosis.On this basis the authors suggest the necessity of surgical treatment in every case of pituitary apoplexy, taking into account not only neurological recovery, but also endocrine and oncological aspects of the disease. The observation that pituitary apoplexy may be a marker of tumour invasiveness (even in small, enclosed adenomas) is highlighted.     

Preliminary evaluation of the Polish tissue adhesive “Chirurcoll/Polfa” in urology

During the past two years, from June 7, 1974 to August 9, 1976, the authors used the Polish tissue adhesive Chirurcoll/Polfa in 60 operated patients. The operations were performed on the solitary kidney, on the kidneys of staghorn calculi, in fixation of a floating kidney and, fixation and elevation of the bladder in women with urinary stress incontinence.In all cases the postoperative course was smooth and the results of operation were satisfactory. None of the patients were re-operated and histological examinations were not performed,     

A dominant form of neuronal ceroid-lipofuscinosis

Summary The study of the ultrastructure of the sural nerve and peripheral blood lymphocytes of a boy with late-infantile neuronal ceroid-lipofuscinosis revealed the presence of curvilinear bodies and fingerprint profiles. The elder sister of the patient died at the age of 7 years after progressive mental and motor deterioration. The same kind of cytoplasmic inclusions was found in the lymphocytes of the father of these children, who had had epilepsy since the age of 32. Clinical data and the results of the ultrastructural study suggest that in the same family two different forms of ceroid-lipofuscinosis appear and that the disease is inherited as an autosomal dominant trait. This family seems to suggest the nosological unity of clinically different forms of ceroid-lipofuscinosis.This work was supported by AMDA grant 1979–1980     

Pharmacokinetic parameters of thiamazole in hyperthyroid patients responding rapidly and slowly to the treatment

Pharmacokinetic parameters of thiamazole were compared in two groups of patients with hyperthyroidism due to Graves-Basedow disease, differing in the period required to achieve clinical euthyrosis (less than 28 days, group R, n = 23, and not less than 35 days, group D, n = 18) after treatment with the "full" dose of the drug. The drug absorption from the GI tract in both groups was similar, but the serum concentrations of the drug (Cmax and AUC) were higher, and distribution volume and total clearance lower in the R than in D group. No evidence was found for the importance of initial plasma levels of thyroxine or triiodothyronine on pharmacokinetic parameters of thiamazole.