VOLVULUS OF THE STOMACH ASSOCIATED WITH COLON IN THE CHEST

SUMMARY Two cases of intrathoracic hernia of colon and stomach complicated by gastric volvulus are reported.     

OUTCOME OF BURCH COLPOSUSPENSION IN A DISTRICT GENERAL HOSPITAL

SUMMARY Genuine stress incontinence is a problem affecting women of all ages. There are several conservative means of alleviating the condition, but surgical intervention is an alternative when these fail. The Burch colposuspension has become a popular choice of procedure. In this report of 61 patients in a district general hospital, the success rate was high (84%, which compares favourably with the literature). There was a high rate of complications (55%), some of which have not commonly been reported. Burch colposuspension is a good operation for stress incontinence, although patients should be counselled about possible postoperative difficulties.     

Endoscopic resection as treatment of enuresis with posterior urethral valves

25 boys with both nocturnal enuresis and diurnal urgency, underwent a transurethral resection of a posterior urethral valve. Seventeen patients were cured, two improved partially, two did not respond and four were lost to follow-up. The authors recommend a routine voiding cysto-urethrogram in the work-up of enuretic boys, especially when nocturnal enuresis goes with diurnal urgency.     

Radiofrequency Ablation to Improve Survival After Conversion Chemotherapy for Colorectal Liver Metastases

Introduction

Systemic chemotherapy is able to convert colorectal liver metastases (CRLM) that are initially unsuitable for local treatment into locally treatable disease. Surgical resection further improves survival in these patients. Our aim was to evaluate disease-free survival (DFS), overall survival, and morbidity for patients with CRLM treated with RFA following effective downstaging by chemotherapy, and to identify factors associated with recurrence and survival.

Materials and methods

Included patients had liver-dominant CRLM initially unsuitable for local treatment but eligible for RFA or RFA with resection after downstaging by systemic chemotherapy. Chemotherapeutic regimens consisted predominantly of CapOx, with or without bevacizumab. Follow-up was conducted with PET-CT or thoraco-pelvic CT.

Results

Fifty-one patients had a total of 325 CRLM (median = 7). Following chemotherapy, 183 lesions were still visible on CT (median = 3). Twenty-six patients were treated with RFA combined with resection. During surgery, 309 CRLM were retrieved on intraoperative ultrasound (median = 5). Median survival was 49 months and was associated with extrahepatic disease at time of presentation and recurrences after treatment. Estimated cumulative survival at 1, 3 and 4 years was 90, 63 and 45 %, respectively. Median DFS was 6 months. Twelve patients remained free of recurrence after a mean follow-up of 32.6 months.

Conclusion

RFA of CRLM after conversion chemotherapy provides potential local control and a good overall survival. To prevent undertreatment, the involvement of a multidisciplinary team in follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver-dominant CRLM should always be considered.

     

Replacing 99Tcm-DMSA for renal imaging?

We have tried to evaluate the usefulness of an early 99Tcm-MAG3 image, obtained during the second minute after injection of the tracer, in predicting the renal alterations seen on a 99Tcm-DMSA scintigraph, in children clinically suspected of pyelonephritis. It appears that the accuracy of the MAG3 image is population dependent: when, in most of the patients of a study group, DMSA scintigraphy is either normal or very abnormal, the MAG3 image will correctly reflect the DMSA scintigraph. However, when the DMSA alterations are less pronounced, the early MAG3 image will miss the lesions in about 50% of the cases.     

How good is technetium-99m mercaptoacetyltriglycine indirect cystography?

The aim of the present study was to estimate the sensitivity of indirect radionuclide cystography (IRC) performed with technetium-99m mercaptoacetyl-triglycine (MAG3), in comparison with the micturition cystourethrography (MCUG) and direct radionuclide cystography (DRC), for the diagnosis of vesicoureteric reflux. Two groups of patients were selected: group I comprised 40 children who underwent IRC during the acute phase of urinary tract infection and an MCUG 6 weeks later; group II comprised 42 (other) children with known reflux, who underwent IRC and DRC during follow-up. Taking as the reference the total number of refluxing kidneys detected by means of any cystographic technique, ^99mTc-MAG3 ICR missed two-thirds of the refluxing kidneys. Most of the small refluxes were missed, but so too were 50% of the major refluxes. Taking as the reference ^99mTc dimercaptosuccinic acid (DMSA) scintigraphy, MCUG detected 91 % of the patients with DMSA abnormalities on at least one kidney, DRC detected 95%, and IRC detected 46% and 43% respectively, in groups I and II. The use of ^99mTc-MAG3 IRC as the sole technique for the detection of vesicoureteric reflux gives rise to an unacceptable number of false-negative results. Correspondence to: C. De Sadeleer     

Antral gastrin cell hyperplasia in patients with peptic ulcer.

The total number of gastrin (G) cells in the stomach was determined by using a histologic counting method and planimetry in ulcerous and nonulcerous patients. The preoperative basal and postprandial serum gastrin values and the gastrin cell mass in the gastrectomy specimen could be compared in 16 surgical patients. There was a significant correlation between the integrated gastrin response to feeding and the total gastrin cell number in the stomach. No correlation was found between the basal serum gastrin level and the total gastrin cell count. A total gastrin cell number higher than 50 million was found in the stomach of three duodenal ulcer patients with preoperative postprandial hypergastrinemia as well as in one patient with normal serum gastrin values. Gastrin cell counts between 6 and 42 million were found in control stomachs and in patients with gastric ulcer. Preoperative feeding tests could be useful to select patients with an elevated antral G cell number.     

Cochlear otosclerosis (otospongiosis): CT analysis with audiometric correlation

Ninety patients who had suspected or confirmed fenestral or cochlear otosclerosis underwent CT examination. Foci of demineralization in the otic capsule were discovered in 20 ears (12 patients). Audiometric studies of the 12 patients revealed sensorineural hearing loss (SNHL) with distinct correlation of CT findings with progressivity and with involvement of the frequency level subtended by the specific area of the cochlea involved. Foci of abnormal increased density, presumably representing the healed phase of this disorder, were found less frequently than expected. There was a predilection for the basilar turn. All patients had static SNHL in the higher frequencies. The healed phase of this disorder is probably not consistently diagnosable with CT.     

Efficacy and tolerability of radiotherapy as treatment for bicalutamide-induced gynaecomastia and breast pain in prostate cancer

OBJECTIVE: To assess the efficacy and tolerability of localised radiotherapy for the treatment of bicalutamide ('Casodex'Casodex' is a trademark of the AstraZeneca group of companies.)-induced gynaecomastia and/or breast pain. METHODS: This open-label, non-comparative, multicentre study included 51 patients receiving bicalutamide 150 mg for the treatment of non-metastatic prostate cancer (T1b-T4, Nx, M0). Patients who developed symptomatic gynaecomastia and/or breast pain received two 6-Gy fractions of external-beam radiation to the breasts and were then assessed at two 3-monthly follow-up visits. RESULTS: 37/51 (72.5%) patients experienced gynaecomastia and 41/51 (80.4%) experienced breast pain, typically within the first 6 months. Twenty seven and 38 patients, respectively, went on to receive breast irradiation. Following radiotherapy, gynaecomastia improved or resolved in 7/27 (25.9%) and 2/27 (7.4%) cases, respectively, and breast pain improved or resolved in 12/38 (31.6%) and 3/38 (7.9%) cases, respectively. No change was observed in 7 patients (25.9%) with gynaecomastia and 12 patients (31.6%) with breast pain, while 9 patients (33.3%) and 8 patients (21.1%), respectively, worsened. Radiotherapy-related adverse events, reported by 18/41 (43.9%) patients, were generally mild and short lived (median duration approximately 5 weeks). CONCLUSIONS: Therapeutic radiotherapy, using two fractions of 6 Gy external-beam radiation to the male breast, improves the intensity of bicalutamide-induced gynaecomastia and/or breast pain in approximately one-third of patients. Adverse events were often mild and short lived.     

The effects of aqueous extracts of Tetracarpidium conophorum seeds on the hormonal parameters of male guinea pigs

ObjectiveTo investigate the effects of the aqueous extracts of the seeds of Tetracarpidium conophorum and the effect of Proviron (12.5 mg/kg) (as standard) on the hormonal parameters of male guinea pigs, compare the effects of the seeds of Tetracarpidium conophorumand Proviron, and screen the phytochemical constituents of the seeds of Tetracarpidium conophorum.MethodsThe hormonal effects of the Tetracarpidium conophorum and Proviron were tested by hormonal assay, using enzyme immuno assay method. This was done by reaction of antibody with serum testosterone and testosterone label, magnetic solid phase separation and colour development step. Phytochemical screening was done using standard procedures.ResultsThe aqueous extract of the Tetracarpidium conophorum seeds (100–400 mg/kg) caused a statistically significant increase (P < 0.05, ANOVA) in the level of testosterone of male guinea pigs, from (2.60 ± 0.06) ng/mL to (3.40 ± 0.05) ng/mL, (3.00 ± 0.60) ng/mL and (3.30 ± 0.45) ng/mL on the 7th, 14th and 21st day of the administration of the extracts, respectively. The highest increase was obtained after the 7th day of treatment [(3.40 ± 0.05) ng/mL]. These effects were very comparable to the effects of Proviron on the testosterone of male guinea pigs, which were obtained to be (2.80 ± 0.01) ng/mL, (2.90 ± 0.16) ng/mL and (3.10 ± 0.30) ng/mL on the 7th, 14th and 21st day, respectively. These effects were dose-and time-dependent. The optimum effect on testosterone level under dose-dependent study [(4.70 ± 0.45) ng/mL] was obtained at 300 mg/kg of Tetracarpidium conophorum after 7 days treatment. Finally, the phytochemical screening of the seeds of Tetracarpidium conophorum revealed the presence of flavonoids, tannin, alkaloids, carbohydrate, volatile oils, terpenoids, saponins and cardiac glycosides.ConclusionThis study supports the claims on the use of the seeds of this plant by traditional medicine practitioners as a fertility agent. However, further studies need to be done to isolate and characterize the active principle(s) responsible for this activity in this plant.