Value of frozen sections of lymph nodes in pelvic lymphadenectomy in patients with invasive bladder tumor

AIM: We examined the reliability of classical lymph node evaluation methods. We compared the results of preoperative computed tomography (CT) and perioperative frozen section examination of lymph nodes in patients on whom radical cystectomy was performed because of invasive bladder tumors. METHODS: A total of 142 patients, in whom radical cystectomy was performed because of invasive bladder tumors between the years 1994 and 2005 in our clinic, and 284 pelvic lymph node regions were evaluated retrospectively. For each of the pelvic lymph node region, the conditions of the lymph nodes according to CT and in frozen sections were compared with the final pathology reports of the surgical specimens. RESULTS: Lymph node involvement was found in 36 pelvic regions out of 284 in the final pathology. It had been possible to show only two of the 36 positive lymph nodes in preoperative CT. Frozen section results of the 29 pelvic lymph node regions out of 36 that were involved according to the final pathology were positive also according to frozen section results. On the other hand, in all the 29 lymph node regions those that were positive according to frozen section had lymph node involvement in the final pathology. CONCLUSIONS: We recommend the performance of frozen section examination on obturator plus internal iliac lymph nodes when deciding extended lymph node dissection, and the performance of extended lymph node dissection only if the result is positive.     

Simplified treatment of massive rectal bleeding following prostate needle biopsy

Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound-guided prostate biopsy, but it usually stops spontaneously. We report a case of life-threatening rectal bleeding following this procedure. Bleeding was controlled using an ordinary condom, which was successfully inflated in the rectum over the bleeding site.     

Stimulation of pigmentation in melanoma cells by trimethylpsoralen in the absence of ultraviolet irradiation

The effects of trimethylpsoralen and 8-methoxypsoralen on the pigmentary characteristics of cultured murine melanoma cells were investigated in the absence of ultraviolet irradiation. Stimulation of pigmentation was assayed by gross examination of centrifuged cell pellets, light microscopy of cells, electron microscopy, a biochemical determination of cell tyrosinase activity, and a chemical determination of cell melanin content. It was found that an adequate concentration (10(-5) M) of trimethylpsoralen for an adequate exposure time stimulated pigmentation in the dark, whereas 8-methoxypsoralen in the same experimental setting did not stimulate pigmentation.     

RESPIRATORY EFFECTS OF NITROUS OXIDE DURING ISOFLURANE ANAESTHESIA IN CHILDREN

Respiratory effects of nitrous oxide and isoflurane were studiedin 13 children (mean age 45.6± 19.3 months, mean weight14.9±4.8kg) during surgery under continuous extraduralanaesthesia. Three different anaesthetic states were studied:(1) isoflurane 0.5 MAC in oxygen (27 study periods), (2) isoflurane0.5 MAC with 50% nitrous oxide (32), (3) isoflurane 1 MAC inoxygen (25). End-tidal carbon dioxide (PE¹_CO2) and isoflurane,respiratory indices (tidal volume, VT; minute ventilation, VE;mean inspiratory flow, VI; respiratory frequency f, effectiveinspiratory timing T1/T^tot were measured. The addition of nitrousoxide (comparison of respiratory variables obtained in 25 successiveperiods at(1) and (2)) produced a significant increase in PE'_CO2significant decreases in VT, VE and VI, a significant increasein f. The increase in alveolar concentration of isoflurane ((1)compared with (3) in 25 successive periods) was associated witha significant increase in PE'_CO2 significant decreases in VT,VE, VI and a significant increase in f. The equipotent anaestheticstates (2) and (3) were compared in 21 successive periods. Inchildren, the net result of substituting nitrous oxide for anequal MA C fraction of isoflurane was to produce a smaller decreasein Vr responsible for a smaller decrease in VE without significantchange in respiratory rate.