Konsekutive Serie von 100 Colonresektionen mit einer modifizierten fortlaufenden Nahttechnik

Zusammenfassung Es wird anhand einer konsekutiven Serie über eine modifizierte fortlaufende Nahttechnik am Colon berichtet, die gerade bei älteren Patienten eine sichere und rasche Methode der Anastomosierung darstellt. Die klinisch relevante Insuffizienzrate sowie auch die Letalitätsrate betrugen in dieser Serie je 2%, wobei die Ursachen für die Letalität aber keine Folge der Insuffizienz waren. Die Komplikationsrate betrug 11%, die urologischen Komplikationen mit 6% standen hierbei im Vordergrund.

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A consecutive series of 100 resections of the colon using a modified technique of continuous (running away) suture

Summary Based on a consecutive series it is reported about a modified type of continuous suture on the colon, used especially in elderly patients for being a secure and prompt method of anastomosing. The rate of insufficiency and mortality, as far as the clinical relevance is concerned, turns out to be 2% each and there was no relation between mortality and insufficient anastomosis. The complication rate was 11%, whereby the urological complications predominated with 6% of the total.

     

Efficacy and safety of hypromellose in ocular implant surgery

In order to assess the efficacy of hypromellose as a viscoelastic substance in cataract surgery with posterior chamber intraocular lens implantation, we studied a series of 88 cases who underwent surgery with either alternate use of a viscoelastic substance (hypromellose, 39 patients, or sodium hyaluronate, 5 patients) or air (44 patients) in the anterior chamber. Endothelial cell loss was least in the group in which air was used (18 +/- 3% cell loss, mean +/- SEM), compared with hypromellose (26 +/- 3%) and sodium hyaluronate (28 +/- 6%), but the difference in percentage cell loss between the groups did not reach statistical significance. Some operative difficulties were encountered in both groups. In both the air and hypromellose groups there were two patients with an early postoperative rise in intraocular pressure, but this was easily controlled, and in both groups there were two patients with postoperative corneal oedema which soon cleared. Visco-elastic substances used in this study were not shown to be superior to air in protecting the corneal endothelium. For this reason use of hypromellose should be confined to situations where its use is likely to confer some special advantage, as in the presence of a bound-down pupil in patient's with chronic glaucoma or perhaps to facilitate "in the bag" implantation.     

Sulfation of L-selectin ligands by an HEV-restricted sulfotransferase regulates lymphocyte homing to lymph nodes

Lymphocytes home to lymph nodes, using L-selectin to bind specific ligands on high endothelial venules (HEV). In vitro studies implicate GlcNAc-6-sulfate as an essential posttranslational modification for ligand activity. Here, we show that genetic deletion of HEC-GlcNAc6ST, a sulfotransferase that is highly restricted to HEV, results in the loss of the binding of recombinant L-selectin to the luminal aspect of HEV, elimination of lymphocyte binding in vitro, and markedly reduced in vivo homing. Reactivity with MECA 79, an adhesion-blocking mAb that stains HEV in lymph nodes and vessels in chronic inflammatory sites, is also lost from the luminal aspects of HEV. These results establish a critical role for HEC-GlcNAc6ST in lymphocyte trafficking and suggest it as an important therapeutic target.     

The midsagittal area of the corpus callosum and total neocortical volume differ in three inbred strains of mice

Differences in the midsagittal area of the corpus callosum have been reported between human males and females, between handled and nonhandled rats, and both within and between various strains of mice. This measure has, in addition, been related to handedness in humans and "pawedness" in certain strains of mice. The present study investigated the between- and within-strain differences in three inbred strains of mice, two with autoimmune disorders and spontaneously occurring developmental neuropathology, in the midsagittal area of the corpus callosum, the total neocortical volume, and the asymmetry of the neocortex. These morphometric measures were obtained from coronally sectioned celloidin-embedded material from New Zealand Black (NZB/BINJ), BXSB/MpJ, and DBA/2J mouse strains. NZB mice had a total neocortical volume larger than that of either the BXSB or DBA strains, whereas the BSXB mice had a midsagittal area of the corpus callosum larger than that of either of the other two strains. In addition, there was a positive correlation between these two measures. There was no correlation between total neocortical asymmetry and midsagittal area of the corpus callosum in any of the three strains. Finally, there were no differences in any morphometric measure between animals with or without developmental neuropathology in any given strain.     

Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients

Breast carcinoma presenting with axillary metastases and no clinically apparent primary tumor in the breast is an uncommon form of stage II disease. Published studies have been characterized by small numbers and/or limited follow-up information. Although these patients are often looked on individually as having advanced disease, several published reports suggest that their prognosis is not exceptionally grave. The present study evaluated the largest series thus far described, consisting of 48 patients with a median follow-up of 5 years. Each presented with an axillary mass which proved to be metastatic adenocarcinoma, consistent with mammary origin when examined histologically. No patient had a palpable breast tumor. Mammography was negative in 28 patients (76%), and suspicious or positive in nine (24%). Nine (35%) of 26 metastases were positive for estrogen (ER) and progesterone (PR) receptors, 10 (38%) were negative for both receptors, and seven (27%) were ER positive/PR negative. Primary treatment was mastectomy and axillary dissection in 38 cases, 21 with adjuvant chemotherapy. A primary tumor was found pathologically in the breast in 36 cases (75%). Among 34 reviewed primary lesions, 27 (79%) were invasive and seven (21%) were histologically "noninvasive." Measured size was 0.1 to 6.5 cm (median, 1.5 cm). The number of involved lymph nodes was one to 65 with 20 cases having one to three positive and 20 having four or more positive. Follow-up ranged from 5 to 267 months (median, 60 months). Overall, 29 patients (60%) remained alive and disease free; two (4%) were disease free, but died of other causes; and the status of two (4%) was not known. Fifteen patients developed recurrent carcinoma, including 12 (25%) who died of disease. When compared with a matched series of stage II patients with equivalent extent of disease who presented with palpable breast tumors, patients with occult lesions had a more favorable prognosis overall, as well as when stratified by tumor size and nodal status, but the differences were not statistically significant. These results probably reflect the fact that the majority of stage II patients with clinically occult breast carcinoma usually have a grossly measurable invasive tumor detected pathologically. Consequently, the actual pathologic stage, which takes tumor size into consideration, determines prognosis rather than the apparent clinical stage described when the patient is first examined.     

Intermittent self-catheterization

The geriatric population is a challenge to those health professionals who are willing enough to give them a chance. Growing old is just that, a growth process. We should break the pattern of neglecting growth and promoting regression. In 1916, Cabot and Crabtree had foresight into the future of intermittent catheterization when they said, in reference to urinary tract infections, that "there is no subject in which there is so little uniformity of opinion and so much confusion." Through continued education and research, we hope to reverse negative attitudes. With more uniformity in their care, the geriatric population can continue to live a comfortable, socially acceptable life.     

Systemic steroid prophylaxis for cataract surgery in patients with posterior uveitis

Cataract remains difficult to manage in patients with uveitis affecting the posterior segment of the eye due to the high risk of postoperative complications, especially cystoid macular oedema, even in eyes in which inflammation has been completely suppressed preoperatively. A standard regimen of preoperative and perioperative systemic steroid prophylaxis was introduced into the uveitis clinic in order to prevent uveitis-related cystoid macular oedema in the postoperative period. The aim of this study was to assess if this policy resulted in an improvement in the visual recovery. Data from a single consecutive clinical series of 30 extracapsular cataract extraction procedures performed in 24 patients with posterior uveitis were collected retrospectively. Nineteen procedures were performed before and 11 after the introduction of the regimen of steroid prophylaxis. Success was graded according to the Snellen acuity at six months, the number of lines improvement in visual acuity by six months and the time from the operation date for acuity to recover to its best postoperative level. The median visual acuity after six months was 20/30 in the prophylaxis group compared with 20/80 in the controls (p = 0.052), representing a median improvement of five lines in the prophylaxis group and three lines in the controls (not significant). The eyes receiving prophylaxis achieved their best acuity in 1.8 months (median) compared with 5.9 months for the control group (p<0.01). This was not attributable to the longer period of follow-up in the control group and was independent of IOL implantation or the influence of any individual postoperative complication. When pseudophakic eyes were considered in isolation, the median acuity at six months was also better in the prophylaxis group (p = 0.023). The results suggest that preoperative systemic steroid prophylaxis may benefit the patient by hastening postoperative visual recovery independently of IOL implantation.     

Influence of inflammatory reaction in primary fallopian-tube carcinoma (stage-I and stage-ii)

A retrospective evaluation of 68 Fallopian tube carcinomas (FTC) of a period of ten years (1980-1990) in stage I and II was performed. The aim of this study was to evaluate the prognostic impact of various factors. 68 cases were investigated for the prognostic influence of mitotic activity, degree of nuclear anaplasia and inflammatory reaction. Histological grading (p=0.08), and inflammatory reaction (p=0.003) showed to have a prognostic impact for survival in univariate analysis. Whereas, mitotic activity did not show any statistically significant influence. 47 (69%) tissue samples showed a positive inflammatory reaction which correlated with a significantly better outcome compared with tumors without this feature. However, this influence was proved in multivariate analysis for inflammatory reaction only (p=0.01). Although no data on the influence of the inflammatory reaction on prognosis in FTC has been published up to now, we can state that the determination of this factor can be useful for prognosis in this rare but highly aggressive tumor.     

Pharmacologic agents used for nutritional disorders of HIV/AIDS

Weight loss in the HIV patient appears to result from the interplay of poor nutritional intake, altered metabolism, and malabsorption. Rapid weight loss, defined as greater than 4 kg in four months or less, is associated with non-gastrointestinal secondary infection; and slower weight loss is typically associated with diarrheal disorders, malabsorption and villous atrophy. Non-infectious causes of HIV-associated diarrhea may include hyperosmolar tubal feedings, antibiotics, magnesium-containing antacids and supplements, Vitamin C, or sorbitol-containing liquid medications. Antidiarrheal agents fall into three categories: antimotility agents, agents acting directly in the intestinal lumen, and hormonal agents such as octreotide. In one study, 41 percent of the subjects experienced a reduction in diarrhea when treated with octreotide. Nutritional deficits may be associated with painful symptoms of opportunistic infections, side effects of medications, lifestyle issues or psychological issues related to drug treatment. Such deficits can be treated with nutritional supplements, megestrol acetate (Megace), dronabinol (Marinol) and testosterone therapy. One study compared Advera, a recently-released peptide-based nutritional supplement, with a standard formulation, Ensure. It was found to result in better maintenance of body weight with significantly fewer hospitalizations. Recombinant human erythropoietin has been shown to reduce the number of transfusions required in patients receiving zidovudine with low endogenous erythropoietin levels (<500 IU/L). Where it fails to increase the serum hematocrit, iron deficiency is often present. Supplemental iron, given orally as a tablet or liquid, or intravenously as iron dextran, can help resolve this problem.