Surgical treatment of circumferential hemorrhoids

A technique is described to remove circumferential hemorrhoids avoiding incontinence, anal stenosis, formation of anal ectropion, and formation of skin tags.     

Intersphincteric surgical access to the rectum for the treatment of villous adenomas

Intersphincteric surgical access is proposed to treat villous adenomas of the posterior rectal wall, not accessible to an endoanal approach, in which anterior resection is not suitable because of the poor general condition of the patient.     

Ovarian follicular cysts: a potential source of false positive diagnoses in ovarian cytology.

The cytology samples of 22 benign ovarian cysts aspirated during laparoscopy (16) or laparotomy (6) were evaluated for clinicopathologic correlations. Clinically, most patients were evaluated for chronic pelvic pain. The cysts ranged in size from 1 to 5 cm (average 2.4 cm), and were described as having benign appearance. Cytologically, small granulosa cells arranged in clusters or isolated had granular cytoplasm with occasional microvacuoles. The nuclei were round to oval, uniform, and eccentrically placed. They had granular chromatin with chromocenters and one to two micronucleoli. Relative nuclear area averaged 50%. Mitoses were present in all but two cases, ranging from 0 to 38 mitoses per 10 high power fields (average 7.2 mitoses per 10 high power fields). Present in some cases were mesothelial cells and histiocytes. Three cases with follow-up histopathology specimens revealed two follicular cysts and a collapsed cyst without discernible lining. The immature appearance of the granulosa cells, the granular chromatin, and the presence of mitoses often suggested cytologically the possibility of a neoplastic process. Recognition of the cytopathology features, knowledge of the clinical history, and the laparoscopic findings may reassure the pathologist about the benign nature of the cysts.     

Hepatitis B infections in the Arsi region of Ethiopia

In a sample of inhabitants of the Arsi region of Ethiopia prevalence of hepatitis B is around 80% in the age group 20–24. In addition to age, sex and size of family, exposure to tribal practices is a determinant of seropositivity in this group accounting for as much as 20'% of the total burden of the infection.Waiting for a mass vaccination campaign, presently unrealistic in this area of the world, health education, as part of a comprehensive primary health care program, has to be considered as a potentially effective preventive tool.     

Platelet met-enkephalin immunoreactivity and 5-hydroxytryptamine concentrations in migraine patients: effects of 5-hydroxytryptophan, amitriptyline and chlorimipramine treatment

In thirty patients with common migraine the platelet concentrations of met-enkephalin immunoreactivity (ME) (76 ± 9 pg/mg protein) were similar to those in 23 healthy volunteers (77 ± 5), suggesting that there is no alteration in the ME pool in this biochemical compartment in migraine. Chronic treatment (4 weeks) with drugs that interfere with 5-hydroxytryptamine (5-HT) synthesis or uptake induced the expected changes in platelet 5-HT levels, i.e. a rise following administration of the 5-HT precursor 5-hydroxytryptophan (daily dose: 300–500 mg, n = 9) and a decrease after amine uptake inhibition by amitryptyline (30–75 mg, n = 7) and even more by chlorimipramine (30–50 mg, n = 9). Platelet ME concentrations rose by up to ∼90% over the basal values after either 5-hydroxytryptophan (significantly from week 2) or amitriptyline (at week 2) and were unchanged after chlorimipramine, indicating that 5-HT and ME concentrations in platelets can vary independently. The high platelet ME levels following 5-hydroxytryptophan and amitriptyline cannot be explained at present. They might be due either to increased ME synthesis, possibly in the megakaryocyte, or to decreased utilization by platelets or both.     

Increased high density lipoprotein cholesterol in obstructive pulmonary disease (predominant emphysematous type)

Since increased levels of high density lipoprotein-cholesterol (HDL-C) seem to be protective against coronary heart disease, there is increasing interest in mechanisms whereby HDL-C levels can be increased. Recent studies suggest that exercise can elevate HDL-C. Patients with chronic obstructive pulmonary disease (COPD), who are usually considered as leading sedentary lifestyles, have an increased work of breathing and their respiratory muscles may be considered to be under a chronic exercise load. Twenty-nine male patients with COPD were selected on the basis of their clinicalphysiologic data, which suggested a predominant emphysematous component of their disease. Clinical features and pulmonary function studies characterized the patients as having relatively pure emphysema (i.e., pink puffers): weight 98% ± 4% (SE) of ideal body weight; absence of cough and sputum; no evidence of cor pulmonale; overinflation in each patient by chest roentgenogram and either curvilinear lines or bullae in 25 of 29 patients; arterial oxygen tension, 62.7 ± 1.4 mm Hg; arterial carbon dioxide tension, 39.8 ± 1.3 mm Hg; severely reduced expiratory flow rate for the midportion of the forced expiratory curve, 0.27 ± 0.02 LPS; overinflation with a residual volume to total lung capacity ratio of 67% ± 1.5% (normal <35%); marked loss of elastic recoil with a transpulmonary pressure at total lung capacity of 14.9 ± 1.82 cm H20 (normal > 19) and a coefficient of retraction of 1.9 ± 0.27 cm H20/liter (normal range 2.5–8.5); minute ventilation (VE) of 10.8 ± .24 liters (normal 6.37 ± 0.9); oxygen consumption (Vo₂) of 251 ± 9 ml (normal 230 ± 30); ventilatory equivalent (V E/Vo₂), 44 ± 1.9 (normal 20–30). Levels of HDL-C were 72 ± 4 mg/dl vs. 54 ± 3 mg/dl for controls matched for age, obesity index, alcoholic intake, smoking history, and race. The HDL-C levels in the patient group were similar to those reported by other workers for long distance runners, and cross country skiers. We suggest these data provide another link between increased levels of HDL-C and exercise.