Ruvalcaba-Myhre-Smith Syndrome

In 1980 a syndrome was first described in two adult males, consisting of macrocephaly, pigmented macules on the glans and shaft of the penis, and hamartomatous intestinal polyps. Since then, 10 additional cases have been identified. Herein, we present two new cases and review the cutaneous manifestations as well as additional features in patients with the Ruvalcaba-Myhre-Smith syndrome.     

Bacterio-expert: an integrated system for assisting in the validation of antibiotic sensitivity tests. Retrospective application in 4053 Staphylococcus

Bacterio-expert is a simple expert system for assisting in the validation of antibiotic sensitivity testing. This system is incorporated in a data acquisition and editing program for bacteriologic test (Bacterio program written in Turbo-Pascal for personal computer users by the same authors). The principles of this system are explained and results with 4,053 antibiotic sensitivity tests on Staphylococcus aureus isolates are reported. Approximately 10% of tests required corrections.     

THE INTRODUCTION OF PATIENT-CONTROLLED ANALGESIA INTO AN ISOLATED RURAL HOSPITAL

This study investigated the feasibility of using patient-controlled analgesia (PCA) effectively in a small 70 bed isolated rural hospital. The tirst 50 patients to use a Bard PCA 1, in the Port Lincoln Hospital, South Australia, were studied. The patients consumed morphine at a mean rate of 1.24 mg/h and used PCA for a mean of 48 h. Thirty-eight per cent of patients required treatment for nausea and other complications which is similar to the rate of those in other published series. Visual analogue pain scores showed excellent pain control, generally without evidence of oversedation; however, there was one episode of respiratory depression. Seventy-eight per cent of patients reported that their pain was relieved most or all of the time. The study demonstrated that a PCA service provided by nursing staff, the GP anaesthetist and rural surgeons is feasible in an isolated rural hospital.     

Inhibition of 2-nitropropane-induced rat liver DNA and RNA damage by benzyl selenocyanate

We observed that pretreatment of male F344 rats with benzyl selenocyanate, a versatile organoselenium chemopreventive agent in several animal model systems, decreases the levels of DNA and RNA modifications produced in the liver by the hepatocarcinogen 2- nitropropane. To clarify the mechanisms involved, we pretreated male F344 rats with either benzyl selenocyanate, its sulfur analog benzyl thiocyanate, phenobarbital or cobalt protoporphyrin IX; the latter is a depletor of P450. We then determined (1) the ability of liver microsomes to denitrify 2-nitropropane, (2) effects on 2-nitropropane- induced liver DNA and RNA modifications and (3) amount of nitrate excreted in rat urine following administration of the carcinogen. Pretreatment with benzyl selenocyanate or phenobarbital increased the denitrification activity of liver microsomes by 217 and 765%, respectively, increased liver P4502B1 by 31- and 435-fold, respectively, decreased the levels of 2-nitropropane-induced modifications in liver DNA (29-70% and 17-30%, respectively) and RNA (67-85% and 30-50%, respectively), and increased the 24-h urinary excretion of nitrate by 157 and 209%, respectively. Pretreatment with benzyl thiocyanate had no significant effect on any of these parameters. Pretreatment with cobalt protoporphyrin IX decreased liver P4502B 1 by 87%, decreased the denitrification activity of liver microsomes by 76%, decreased the 24 h urinary excretion of nitrate by 88.5%, but increased the extent of 2-nitropropane-induced liver nucleic acid modifications by 17-67%. These results indicate that the metabolic sequence from 2-nitropropane to the reactive species causing DNA and RNA modifications does not involve the removal of the nitro group. Moreover, they suggest that benzyl selenocyanate inhibits 2-NP-induced liver nucleic acid modifications in part by increasing its detoxication through induction of denitrification, although it is evident that other mechanisms must also be involved.      

218. Perioperatives Risiko nach allgemeinchirurgischen Eingriffen: Erfahrungen mit einer Qualitätssicherung über 4 Jahre

Zusammenfassung Über 52 Monate wurden 4747 allgemeinchirurgische Planeingriffe prospektiv erfasst. Postoperative Komplikationen (Wundinfektion, Pneumonie, Revision, Letalität) wurden mit einem Punktescore bewertet, der die konkrete Zahl der zu erwartenden Komplikationen auf 10 Operationen der gleichen Art wiedergibt. Der Wert einer solchen Erfassung des Komplikationsrisikos zeigte sich in Verlaufsuntersuchungen, bei denen die postoperativen Komplikationen im 4-Monatsrhythmus aufgetragen wurden: Ursachen von Komplikationen konnten erforscht und beseitigt werden.     

Prolactinoma in the male

In a retrospective study the medical records of 13 male patients with macroprolactinomas were evaluated concerning anamnestic data, clinical, endocrinological and localisation-diagnostic findings as well as therapeutic measures. The main symptoms were disturbances of vision and impaired potency and impaired libido, respectively. The ophthalmological complaints nearly exclusively caused the patients to see the doctor. Clinically the signs of hypogonadism were found. The diagnosis was ascertained by increased serum prolactin levels, ophthalmological findings, X-ray of the sella, cranial computed tomography as well as angiography of the carotid. The operative treatment did not show any normalization of the serum prolactin levels. The rate of recidivations after exclusive operative treatment was high. An additional medicamentous therapy with dopamine agonists is nearly always necessary after operation. Whether or not bromocriptine shall be used as primary therapy, must be decided on in the individual case.     

The current status of intrapartum continuous fetal tissue pH measurements

Continuous tissue pH monitoring during labor has now been possible for 15 years. Tissue pH is measured in the intercellular fluid, and the value differs in some cases from the blood pH value because of local capillary flow and local metabolism. The fetal scalp seems to be an area where tissue pH and capillary blood pH values are very close, but in acute acidosis there may be a time lag of 10-15 min before tissue pH is equilibrated. Normal values of scalp tissue pH are 7.38 in early labor declining by 0.016 per hour during the first stage of labor and by 0.12 per hour during the second stage of labor. Tissue pH values below 7.15 are defined as pathological. The correlation coefficient to umbilical artery blood pH (0.71), success rate (67%) and electrode drift (below 0.04) from the largest study of tissue pH monitoring using glass pH electrodes (n = 337) are described.     

Injury of rat renal vessels following extracorporeal shock wave treatment.

The locations of extracorporeal shock wave treatment induced renal vascular injury and the sources of significant renal hemorrhage were determined in a rat model by means of two different vascular casting procedures. Silicone-rubber injected vascular preparations for light microscopy or corrosion casts for scanning electron microscopy were made following gross examination of the treated organs and their contralateral controls. After 1000 shock waves at 18 kV, five out of 20 treated kidneys appeared to be normal or minimally affected, while 15 showed gross evidence of marked vascular injury. Gross interstitial hemorrhage (15/20), subcapsular hematomas (7/20), and hemorrhages into the renal pelvis (5/20) were confirmed by extravasations of casting materials. These could be traced back to their vascular sources in several instances. Disruptions of interlobar and arcuate veins gave rise to most significant interstitial, subcapsular, and renal pelvic extravasations. On a microscopic scale cortical venules were among the most frequently injured vessels. The arterial vasculature was not spared. Arterial injury ranged from complete arcuate occlusion to small afferent arteriolar and glomerular capillary extravasations. The significance of shock wave induced vascular injury is discussed with respect to potential clinical side effects of ESWL.