Pelvic Exenteration: Surgical Aspects and Analysis of Early and Late Morbidity in a Series of 106 Patients

Introduction : The aim of this study was to report the surgical results in a series of pelvic exenterations, its peroperative difficulties, postoperative complications, mortality and long-term complications.

Patients and methods : Between November 1980 and December 2008, pelvic exenteration with curative intent has been performed in 106 patients, 87 female and 19 male, for gynecologic malignancy in 69, intestinal tumors in 29, urologic in 6 and advanced skin carcinomas in 2. The exenteration was performed as primary treatment in only 21 patients, in the others it was for persistent or recurrent tumors after radiotherapy and/or surgery.

Results : In 86 patients a total exenteration was performed and in 55 the resection involved an extension beyond the classical planes of dissection. An incontinent urinary diversion was made in 100 patients, a colo-anal anastomis in 35, omentoplasty was standard and muscle flaps were used in 15 patients. Blood loss necessitating transfusion of more than 10 packed cell units or gauze packing did occur in 27 patients with extended resection. Postoperative complications occurred in 64 patients necessitating relaparotomy in 14. Mortality within 30 days was 2%, in hospital 5% but did not occur in the last 44 patients. During the very long follow-up serious late complications were observed in the kidneys of 12 patients and in the small bowel of 5.

Conclusions : Pelvic exenteration is still a major surgical undertaking with a 60% complication rate but can nowadays be performed with a low mortality. Postoperative complications were related to radiotherapy dose above 50 Gy, extension of dissection, the empty pelvis, the urinary diversion and the small intestine. A protected colo-anal anastomosis should be offered when the pelvic floor can be conserved and muscle flaps should be considered after total infralevatoric exenteration. Bricker’s urinary diversion still is the golden standard. Long-term complications were observed in 40 patients requiring surgery in 19.     

Czech medical personalities in Vienna during the 19th century

Wiener Medizinische Wochenschrift - During the entire 19th century, Czech lands (Bohemia and Moravia) were part of the Austrian Empire (from 1867, Austrian-Hungarian Monarchy). Obviously,...     

Promoting awareness of neonatal menstruation

Neonatal uterine bleeding (NUB) has been carefully studied in the past through case reports, small series, clinical cohort studies, pathology investigations of fetal and neonatal. Following a historical recount, this review summarizes biological mechanisms conditioning NUB, starting from the persistence till birth of an 'ontogenetic progesterone resistance' (OPR), causing decreased responsiveness of target tissues to bioavailable progesterone. Several pregnancy-related conditions, such as preeclampsia, fetal growth restriction, prematurity, post-maturity and even Rhesus or ABO incompatibility, influence the occurrence of NUB. It seems therefore that the phenomenon is precipitated by chronic fetal distress. When present, OPR may persists until telarche; as a consequence, if pregnancy occurs in early teenage, the disorder known as “defective deep placentation” may ensue, increasing the risk of obstetrical syndromes. In the presence of NUB, retrograde shedding into the peritoneal cavity of endometrial stem/progenitor and niche cells may occur. There, given the right environment, these cells can survive and become activated at the time of telarche, causing the specific phenotype of early-onset endometriosis. In conclusion, neonatal menstruation is a fetal distress indicator and can alter the incidence of a variety of pathological conditions later in life. For this reason, it should be carefully recorded and the parents informed.     

Beneficial effect of a novel pentadecapeptide BPC 157 on gastric lesions induced by restraint stress,ethanol, indomethacin,and capsaicin neurotoxicity

Very recently, the integrity of capsaicin somatosensory neurons and their protection were suggested to be related to the activity in nociception of a newly discovered 15-amino acid peptide, BPC 157, shown to have strong beneficial effect on intestinal and liver lesions. Therefore, from this viewpoint, we have studied the gastroprotective effect of the pentadecapeptide BPC 157, on gastric lesions produced in rats by 96% ethanol, restraint stress, and indomethacin. The possible involvement of sensory neurons in the salutary actions of BPC 157 (10µg/kg, 10 ng/kg intraperitoneally) was studied with capsaicin, which has differential effects on sensory neurons: a high dose in adult (125 mg/kg subcutaneously, 3 months old) or administration (50 mg/kg subcutaneously) to neonatal animals (age of the 7 days) destroys sensory fibers, whereas a low dose (500µg/kg intraperitoneally) activates neurotransmitter release and protective effects on the mucosa. In the absence of capsaicin, BPC 157 protected gastric mucosa against ethanol, restraint, and indomethacin application. In the presence of neurotoxic doses of capsaicin, the negative influence of capsaicin on restraint, ethanol, or indomethacin lesions consistently affected salutary activity of BPC 157. However, BPC 157 protection was still evident in the capsaicin-treated rats (either treated as adults or as newborns) in all of these assays. Interestingly, after neonatal capsaicin treatment, a complete abolition of BPC gastroprotection was noted if BPC 157 was applied as a single nanogram-regimen, but the mucosal protection was fully reversed when the same dose was used daily. In line with the excitatory dose of capsaicin the beneficial effectiveness of BPC 157 appears to be increased as well. Taken together, these data provide evidence for complex synergistic interaction between the beneficial effectiveness of BPC 157 and peptidergic sensory afferent neuron activity.     

Age-related cataract

Cataract, opacification of the lens, is one of the commonest causes of loss of useful vision, with an estimated 16 million people worldwide affected. Several risk factors have been identified in addition to increasing age--genetic composition, exposure to ultraviolet light, and diabetes. However, no method to halt the formation of a cataractous lens has been shown to be effective. Nevertheless, advances in surgical removal of cataracts, including small-incision surgery, use of viscoelastics, and the development of intraocular lenses, have made treatment very effective and visual recovery rapid in most cases. Despite these advances, cataract continues to be a leading public-health issue that will grow in importance as the population increases and life expectancy is extended worldwide.