Natural history of aortoarteritis (Takayasu's disease)

The natural history of aortoarteritis was studied in 88 patients (54 women and 34 men). The average age was 24.0 +/- 8.8 years at onset of symptoms and 28.3 +/- 9.9 years at diagnosis. The follow-up period was 83.6 +/- 74.4 months from onset and 33.2 +/- 37.0 months from diagnosis. Ten patients (11.4%) died during follow-up (0.016 deaths/patient year), and 22 patients (25%) suffered major nonfatal events (0.042 events/patient year). The cumulative survival at 5 and 10 years after the onset was 91.0 +/- 3.3% and 84.0 +/- 5.6% (mean +/- SEM), respectively. The event-free survival rates at the same intervals after onset were 74.9 +/- 5.0% and 64.0 +/- 7.4%, respectively. The overall survival and event-free survival at 10 years after diagnosis was 80.3 +/- 6.5% and 61.6 +/- 7.5%, respectively. Patients with no complications or a mild single complication at diagnosis had a higher event-free survival rate than those with severe single complication or multiple complications at 5 years--97.0 +/- 2.9% and 59.7 +/- 7.3%, respectively (p less than 0.001). Severe hypertension (p less than 0.01), severe functional disability (p less than 0.01), and evidence of cardiac involvement (p less than 0.05) were good predictors of either death or major event on follow-up. These data are useful in making an objective assessment of the prognosis and in planning elective interventions.     

Prospective randomized comparison of mezlocillin therapy alone with combined ampicillin and gentamicin therapy for patients with cholangitis

Forty-six patients with cholangitis were randomized to receive therapy with mezlocillin sodium (24 patients) or a combination of ampicillin sodium--gentamicin sulfate (22 patients). The biliary concentration of mezlocillin was 112 times higher than that of ampicillin and 778 times higher than that of gentamicin. The ratio of the concentration in serum or bile over the minimum inhibitory concentration against aerobic gram-negative bacilli (therapeutic index) was higher for mezlocillin than for either ampicillin or gentamicin. Twenty (83%) of 24 patients were cured following mezlocillin therapy compared with 9 (41%) of 22 patients after ampicillin-gentamicin therapy. The 3 patients with superinfection were in the ampicillin-gentamicin arm of the study. Fewer toxic or adverse effects occurred in association with mezlocillin treatment than with ampicillin-gentamicin treatment. Mezlocillin therapy was more effective, less toxic, and less expensive than treatment with ampicillin and gentamicin for patients with cholangitis.     

Primary arteriovenous fistula between common iliac vessels: ultrasound, computer tomographic, and angiographic findings--a case report

A giant aneurysm of the right common iliac artery presenting with an arteriovenous fistula (AVF) between the iliac artery and iliac vein and deep venous thrombosis of the right lower extremity is reported. The clinical signs and the radiologic and surgical management of the condition are discussed. In addition a brief review of the literature is given.     

Chronic thromboembolic occlusion in the adult can mimic pulmonary artery agenesis

In the first 100 patients operated on for C T-E PH, three were referred with the diagnosis of UPAA having been made elsewhere. We found that many features of these two conditions are so similar that differential diagnosis is very difficult. Shared features may include findings on chest x-ray film, pulmonary angiography, CT scan and MRI studies. Since the two conditions vary substantially with respect to the methods of potential surgical correction, recognition of this possible differential diagnostic dilemma is important.     

Breast-saving operations in breast cancer

Breast preserving surgery or conservative surgery consists at present of a combination of a reduced operation--tumorectomy or wedge resection or subcutaneous mastectomy--with adequate radiotherapy whereby a doses of 40-50 Gy is used with or without an additional booster dose of 10 Gy. Recent studies of 5-year- and 10-year-survival rates after conservative management have been shown to be identical with radical operations (Rotter-Halsted, Patey-Auchincloss). In the Departments of Gynecology and Obstetrics of the Universities of Münster and Rostock the partial bilateral subcutaneous mastectomy with lymphadenectomy and irradiation is the preferred method of conservative management for breast cancer. Indications and technique are discussed.     

Role of muscle neurotization in the reinnervation of murine muscle grafts

Although the reinnervation of muscle grafts has been demonstrated, the question remains as to the source of neurons reinnervating the graft. A muscle graft could be reinnervated by its original neurons (neural neurotization) or by sprouting of axons which supply the intact myofibers of surrounding muscles (muscle neurotization). The objective of this study was to evaluate the role of muscle neurotization in the reinnervation process using both horseradish peroxidase and fluorescent tracers. Observations from 20 muscle grafts indicate that the neurons reinnervating the grafts are from the original motor neuron pool. Thus muscle neurotization may not occur during the reinnervation process.     

Discriminative conditioning-related slow potential and single-unit responses in the frontal cortex of urethane-anesthetized rats

A model is described for obtaining long-term and stable discriminative conditioning-related slow-potential and single-unit responses from the frontal cortex of urethane-anesthetized rats. Responses were recorded and analyzed to reinforced (rewarding medial forebrain bundle stimulation) and non-reinforced tone cues. In the present study, cortical event-related slow potentials provided an adequate index of the level of discriminative conditioning. Single-unit response patterns are described for 57 neurons which demonstrated a discriminative response to either the reinforced or non-reinforced tone cue.