Surgical removal of bone and muscle metastases of renal cancer

Fifteen men and six women with renal cancer underwent surgical removal of metastatic lesions in bone (19 patients) or muscle (two patients). The operation was carried out 2 years before nephrectomy/renal resection in two patients, on the same occasion in four, and 1-196 months after in 15. Surgical interventions of various kinds were undertaken, resulting in the loss of a lower limb in seven patients and an upper limb in one. The observed 5-year survival was 4 out of 10. Six patients were alive at follow-up, five of them without evidence of disease. Eight of the remaining 15 patients died of an unrelated disease (five without evidence of tumor); the other seven patients died of metastatic tumor disease. Local recurrence was diagnosed, and removed, in two patients. The results compare favourably with reports on surgically removed pulmonary metastases of renal cancer and seem to justify an aggressive attitude towards solitary bone and muscle metastases of renal cancer.     

Effects of halothane, enflurane, and isoflurane on coronary vascular tone, myocardial performance, and oxygen consumption during controlled changes in aortic and left atrial pressure. Studies on isolated working rat hearts in vitro

The effects of equi-anesthetic concentrations of halothane (HAL, n = 11), enflurane (ENF, n = 11) and isoflurane (ISO, n = 10) on cardiac function were studied and compared with a control group (n = 12) in isolated paced rat hearts by means of an antegrade heart perfusion technique. Left atrial pressure (LAP) and mean aortic pressure (MAP) could be altered independently of each other, and aortic flow, coronary flow (CF), and po2 in venous coronary effluent were continuously recorded. Stroke volume (SV), myocardial oxygen consumption (MVO2), and myocardial oxygen extraction were calculated: 1) MAP was altered from 60 to 120 mmHg at a constant LAP (7.5 mmHg), and 2) LAP was varied from 4 to 12.5 mmHg at a constant MAP (80 mmHg). Left ventricular function curves (LVFC) were constructed and the maximal SV (SVmax) was obtained. The LAP needed to perform 75% of the maximal SV (LAP0.75) was estimated to assess the effect of the anesthetics on diastolic function. HAL ENF and ISO decreased SVmax significantly compared to control. This decrease was more pronounced for HAL (41%) compared to both ENF (26%) and ISO (26%). Accordingly, SV, at various levels of MAP, at a constant LAP, was significantly lower for HAL than for both ENF and ISO, while there was no significant difference between the latter two. None of the anesthetics shifted the LVFC to the right, i.e., did not affect diastolic properties. HAL induced the most pronounced decrease in MVO2, while there was no significant difference between ENF and ISO in this respect. Coronary flow (CF), at controlled perfusion pressures, decreased significantly with HAL but not with ENF or ISO compared to control. CF was significantly higher with ISO compared to both ENF and HAL. HAL and ISO, but not ENF, decreased myocardial oxygen extraction significantly compared to control and, thus, increased the myocardial oxygen supply-to-demand ratio.     

Muscle pain in neuromuscular disorders and primary fibromyalgia

Muscle fiber degeneration and regeneration, inflammation in the intramuscular connective tissue and hypoxia in resting muscle are not necessarily associated with pain. However, when sustained or dynamic muscle contractions are performed in an ischaemic muscle, severe pain develops. In the chronic muscle pain syndrome called fibromyalgia (or fibrositis) the most likely cause of the pain is a combination of muscle tension and muscle hypoxia. This conclusion is supported by the finding of a pathological distribution of tissue oxygen pressure in painful muscles and a subjective feeling of muscle tension and muscle stiffness in the majority of patients. A decrease of high energy phosphates is found in biopsies from painful muscle. The most characteristic morphological finding is the so-called ragged red fiber, a finding that can be seen in mitochondrial disorders. The morphological and chemical findings are possibly a consequence of a long standing hypoxia. The possibility that sympathetic nerve activity is important for the development of chronic muscle pain is discussed.     

Granulomatous inflammation of the vulva and penis--a genital counterpart to cheilitis granulomatosa.

3 patients are described, in whom chronic swelling of the external genitals occurred after recurrent infections. The histological findings were identical to those seen in cheilitis granulomatosa, the dermal component of Melkersson-Rosenthal syndrome. The authors suppose that the disease of the 3 patients is a genital counterpart to cheilitis granulomatosa, and the name vulvitis or posthitis granulomatosa is suggested.     

Pelvic lipomatosis causing constriction of the lower urinary tract and the rectum. Case report

Pelvic lipomatosis is a rare condition characterized by excessive accumulation of fat in the pelvis. The symptoms and the course of the disease are related to compression of the lower urinary tract and rectum. The clinical findings and radiological characteristics are described.     

Janus computerised prescribing system provides pharmacological knowledge at point of care – design, development and proof of concept

Objective To develop and verify proof of concept for a user-defined prescribing system with decision support based on one single database consisting of several pharmacological sources. Methods A multidisciplinary working group within the framework of a two-phase project developed the tool. A small-scale pilot study for proof of concept was carried out in an outpatient neurological polyclinic where four experienced physicians used the tool in patient care on a daily basis. Results Automatically generated functions, such as recommended drugs, alerts for interactions, alerts for drug therapy during pregnancy and breast-feeding and a search tool for adverse drug effects, were quickly adopted into the daily outpatient working regime. Functions such as treatment strategies and a link to a producer independent website were less frequently used but still rated as useful and educational. Conclusion Searches for information that can be concentrated in one system saves time. Alerts inevitably draw physicians’ attention to the information. Instant availability to drug recommendations in a computerised prescribing system such as Janus should increase adherence to recommendations, but this needs to be evaluated systematically. Small-scale pilot studies such as the one reported here have been shown to be invaluable in providing the theoretical basis for implementation of the system and for gaining an understanding of the complex change processes involved. Small-scale projects can therefore provided a base for further development and broader implementation of pharmacological tools and services.