Forms over substance? -- A response to Viafora

Medicine, Health Care and Philosophy -     

Adjunctive treatment of enchondromas with CO2 laser

STUDY DESIGN/MATERIALS AND METHODS: Fourteen enchondromas, in eight patients, involving the tubular bones of the hand, were treated with curettage, CO2 laser sterilization of the tumor margins followed by autologous bone grafting. Average follow-up time was 35.4 months (14-106 months). Average patients age was 29 years. RESULTS: At follow-up there were no clinical recurrences, none had pain, and all patients reported satisfactory hand function without limitations. Minimal decrease in range of motion without functional limitation was encountered following excision of two lesions (14%) in one patient. One patient reported an increase in range of motion after excision. Grip strength was only minimally decreased. There was no radiographic evidence of recurrence. CONCLUSION: The use of CO2 laser is safe and effective as an adjunct to curettage and bone grafting in the management of relatively large enchondromas of the tubular bones of the hand.     

Lateral transperitoneal laparoscopic adrenalectomy

Several laparoscopic approaches to the adrenal gland have been described. The lateral transperitoneal approach has several distinct advantages when contrasted with other techniques for laparoscopic adrenalectomy (LA). We present our technique and results obtained in 50 consecutive transperitoneal LAs. We review 50 consecutive laparoscopic adrenalectomies (28 female, 19 male) performed from 1993 to 1998. S.J. Shichman or R.E. Sosa was either the primary surgeon or the first assistant for all cases. The lateral transperitoneal approach described below was used in all cases. Indications for adrenalectomy included Cushing's syndrome (13), aldosteronoma (15), pheochromocytoma (7), nonfunctioning adenoma (11), hyperplasia (2), and 1 case each of Carney's syndrome and metastasis to the adrenal gland. We performed 5 bilateral, 22 left, and 18 right laparoscopic adrenalectomies. The average time needed for bilateral adrenalectomy was 503 min (range 298–690 min); for left adrenalectomy, 227 min (range 121–337 min); and for right LA, 210 min (range 135–355 min). We demonstrated a yearly trend in lower operative times. The largest adrenal gland removed measured 13.8 × 6.7 × 3.5 cm. Intraoperative blood loss was low. Only one patient received a blood transfusion. Conversion to open adrenalectomy was not required. Postoperative analgesic requirements were low. The average length of stay was 3.8 days for bilateral LA and 3 days for unilateral LA. Complications occurred in 5 patients (2 wound infections, 2 hematomas, and 1 pleural effusion). There was no mortality. Lateral transperitoneal adrenalectomy is a safe and efficient technique for the removal of functional and nonfunctional adrenal masses. This technique is associated with low morbidity, a minimal postoperative analgesic requirement, and a short hospital stay and, in our opinion, is more versatile than the retroperitoneal approach.     

Photodecomposition of DDA

The photodecomposition of aqueous solutions of 2,2-bis (p-chlorophenyl) acetic acid (DDA) was slow in sunlight and rapid in the laboratory, producingp,p-dichlorobenzophenone (DCB),p-chlorobenzaldehyde,P-chlorophenol, and several unidentified polar products.p,p-Di-chlorobenzilic acid, andp,p-dichlorobenzhydrol gave rise to the same photoproducts, while bis-(p-chlorophenyl) methane (DDM) and chlorobenzilate were converted only to DCB. DCB andp-chlorobenzaldehyde proved to be resistant to photodegradation but gradually producedP-chlorobenzoic acid which, in turn, formedp-hydroxybenzoic and benzoic acids, probably the last environmentally detectable links in the long chain of DDT degradation to CO₂ and water.High pressure liquid chromatography (HPLC) proved to be ideal for separating and quantitating the parent compounds and their photoproducts directly from the aqueous photolysates or from methanol solutions of the isolates and standards.Contribution to Regional Project W-45, Environmental Distribution, Transformation, and Toxicological Implications of Pesticide Residues. University of Arizona Agricultural Experiment Station journal series No. 2931.     

Monitoring renal allograft rejection with duplex sonography

Thirty-six renal allograft recipients were monitored by serial duplex Doppler ultrasound studies post-transplant and during early rejection. A separate reproducibility study demonstrated no significant inter- or intra-operator variability in measurements of resistive index of an interlobar artery (RI) (2.1% [1.5%] and 3.2% [2.3%] respectively, mean [standard error] of coefficients of variance). Twenty-one patients had rejection within 3 weeks of transplantation. These grafts showed greater overall rises in the RI, from day 2 to day 5 post-transplant, than the grafts which had no rejection. Eleven of the 21 patients required more than one course of methyl-prednisolone for persistent or recurring rejection. These grafts had higher RI on the day rejection was diagnosed (81 [7.3], median [interquartile range]) compared with the remaining 10 patients (68.6 [8.7]). The 11 grafts with persistent rejection had higher RI (p less than 0.005, Mann-Whitney U-test) on day 2 post-transplant (76 [3.9]) compared with the 10 grafts successfully treated with a single course of methyl-prednisolone (63.2 [10.9]). This study demonstrates that grafts with an RI of greater than 70 on day 2 post-transplant are likely to have rejection requiring additional treatment (sensitivity--100%, specificity--80%). These patients may be candidates for earlier or alternative anti-rejection therapy.     

CAS information services for medicinal chemists

In summary, the medicinal chemist has four new ways to access the information contained in the CAS database: CAS ONLINE, the only structure search system based on the entire CAS Registry database, and three printed services, CA SELECTS, BIOSIS/CAS SELECTS, and CAS Customer-Defined Information Services, which provide abstracts on specialized topics of interest.     

Large Meningioma Complicating Pregnancy

EDITORIAL COMMENT: This case report was accepted for publication because of the clinical lesson it delivers, namely that intracranial tumours, although rare in pregnancy, may as the authors state 'produce a wide variety of symptoms that are difficult to distinguish from the more common symptoms of pregnancy, including nausea, vomiting and headache'. This case suggests that examination of the optic fundi is essential in patients with neurological symptoms even when/especially when there is a history of psychiatric illness.