Subcutaneous sacrococcygeal myxopapillary ependymoma

A case of subcutaneous sacrococcygeal ependymoma in a child is reported. A review of the literature is made, emphasizing the pediatric population. In contrast to the other forms of ependymomas that generally do not metastasize, the sacrococcygeal variety does disseminate even after many years. Complete local excision is required. Postoperative radiotherapy may be necessary for residual tumor. Long-term follow-up is essential.     

Human DNA topoisomerase II-alpha expression in laparoscopically treated renal cell carcinoma

To investigate whether the expression of Topoisomerase II-alpha (TII-alpha) can serve as a prognostic factor in renal cell carcinoma (RCC), histological sections from 27 renal tumors were stained immunohistochemically for TII-alpha expression. The percentage of positive cells in the area of greatest staining was recorded as the TII-alpha index. TII-alpha nuclear staining was positive in all the samples except one. The mean TII-alpha index was 12.5 for grade 1, 44 for grade 2 and 113 for grade 3 tumors. The mean TII-alpha index was 22.3 in tumors which did not recur and 81 for tumors which recurred during the follow-up period. In this study, a higher TII-alpha index correlated with more aggressive tumor behaviour. However, a large cohort of patients should be assessed before drawing definitive conclusions.     

A new clinical method for the assessment of penile endothelial function using the flow mediated dilation with plethysmography technique

PURPOSE: Penile endothelial function (EnF) is 1 of the major factors involved in the pathophysiology of erectile dysfunction. EnF assessment could offer crucial information on the etiology and degree of severity of cavernosal vascular pathology. In the present study we propose a new technique for the evaluation of penile EnF and test its applicability using strain gauge plethysmography. MATERIALS AND METHODS: A total of 23 healthy subjects (13 younger and 10 older than 40 years) with no history of erectile dysfunction were studied. The flow mediated dilation technique was applied to the arm and penis in both age groups for the assessment of EnF. Baseline blood flow and the sequential flow recordings after rapid cessation of 5 minutes of ischemia were obtained in both organs. RESULTS: Baseline flow in the penis was significantly higher (approximately 3-fold) than that in the forearm and was not affected by age in either organ. Both measures of penile EnF, ie area under the flow-time curve (AUC) and maximal flow obtained after ischemia were significantly lower in the older group compared to the younger group (p <0.01 and p <0.02, respectively). Individual penile AUC and maximal flow were significantly correlated with age (r = 0.55, p <0.01 and r = 0.50, p <0.02, respectively). Finally a positive, significant correlation existed between penile and forearm AUC (p <0.05, r = 0.48). CONCLUSIONS: The implementation of the flow mediated dilation technique using mercury strain gauge plethysmography is simple and applicable for the assessment of penile EnF. Endothelial function parameters in the penis were found to correlate with those in the forearm, thus support for the validity of the technique is given. Further strength for the validity of this procedure in the penis comes from the comparison between the forearm and penis, and the relation to subject age.     

Die perkutane Kompressionsplatte zur Behandlung pertrochantärer Frakturen

Zusammenfassung Operationsziel Anatomische Reposition und minimalinvasive Stabilisierung pertrochantärer Frakturen mit der perkutanen Kompressionsplatte (PCCP). Sofortige postoperative Vollbelastung. Indikationen Pertrochantäre Frakturen. Kontraindikationen Pertrochantäre Frakturen, die nicht geschlossen reponiert werden können, subtrochantäre Frakturen und reverse oblique fractures (AO/OTA 31-A3). Operationstechnik Der Patient wird auf einem Extensionstisch gelagert. Das Femur distal der Fraktur wird durch eine dorsale Repositionshilfe (PORD [posterior reduction device]) unterstützt. Reposition der Fraktur durch geschlossene Manipulation. Perkutanes Einführen der Platte über eine proximale laterale Inzision. Die Platte wird mit Hilfe einer Zange über eine zweite, mehr distal gelegene Inzision an den proximalen Femurschaft angelegt. Einbringen der Gleitschrauben durch die Platte in den Schenkelhals und Sicherung der Platte am Femurschaft mit drei zusätzlichen Schrauben. Abschließend Vervollständigung der Frakturstabilisierung mit einer zweiten Schenkelhalsschraube. Ergebnisse Von 130 Patienten mit einer pertrochantären Fraktur, die zwischen Mai 2000 und Dezember 2001 mit der beschriebenen Technik in der Hadassah-Universitätsklinik für Orthopädische Chirurgie, Jerusalem, Israel, behandelt wurden, konnten 108 in diese Studie eingeschlossen werden. Das Patientenalter lag bei durchschnittlich 81 Jahren (± 8 Jahre). Die durchschnittliche Operationszeit betrug 67 min, der Krankenhausaufenthalt lag bei 11,5 Tagen. 40% der Patienten benötigten während des Krankenhausaufenthalts keine Bluttransfusion, wohingegen 8,3% mehr als drei Erythrozytenkonzentrate erhielten. Komplikationen traten bei vier Patienten auf: in zwei Fällen Implantatversagen, das erfolgreich mit Kompressionshüftschrauben (CHS) behandelt wurde, und eine Pseudarthrose, die mit einer Arthroplastie behandelt wurde. Der vierte Patient hatte eine Beinverkürzung von 3 cm, die mit einer Schuherhöhung ausglichen wurde. Drei Patienten entwickelten eine Infektion, wovon eine ein chirurgisches Débridement erforderte.(Übersetzt von R. Attal, Innsbruck)     

Dietary omega-3 fatty acids may be associated with increased neuropathic pain in nerve-injured rats

Certain dietary proteins and oils are capable of decreasing chronic neuropathic pain levels in rats after partial sciatic nerve ligation injury. We tested, for the first time, the role of dietary polyunsaturated fatty acids in suppressing pain in partial sciatic nerve ligation-injured rats. Six groups of male Wistar rats were fed an identical casein-based, fat-free diet for 1 wk preceding partial sciatic nerve ligation injury and for 1 wk thereafter. In addition, rats received, via gavage, 1 mL/day of pure canola, corn, hemp, soy, or sunflower oil, differing significantly in their omega-3 and omega-6 polyunsaturated fatty acid content, or 1 mL of plain water. Responses to tactile and noxious heat stimuli were recorded before and after surgery and a difference score was calculated for each group by subtracting the preoperative from the post-partial sciatic nerve ligation values. Heat hyperalgesia, but not tactile allodynia, was significantly different among the dietary groups (P = 0.005). Heat hyperalgesia of rats fed hemp oil, developing the most robust response, was significantly larger compared with rats fed corn oil, developing the least pain model (difference score: 24.3 +/- 4.1 s versus 6.1 +/- 3.1 s, respectively; P < 0.001). These oils contain similar levels of omega-6 polyunsaturated fatty acids (hemp, 60%; corn, 58%) but their omega-3 levels are 28-fold different (20% versus 0.7%, respectively). A significant correlation was found among dietary levels of omega-3, but not omega-6 or the omega-3/omega-6 ratio, of the six dietary groups and heat hyperalgesia (P = 0.006). We conclude that dietary oil might predict levels of neuropathic pain in rats and that this effect may be associated with dietary omega-3 levels. IMPLICATIONS: We found that certain commonly used oils can have a significant analgesic effect in rats with persistent pain after partial nerve injury. This effect may be associated with the amounts of omega-3 fatty acids consumed by rats.     

The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth

OBJECTIVE: The purpose of this study was to evaluate the relationship between prepregnancy maternal body mass index and spontaneous preterm birth and indicated preterm birth. STUDY DESIGN: This was a secondary analysis of the Maternal-Fetal Medicine Units Network, Preterm Prediction study. Patients were classified into categories that were based on their body mass index. Rates of indicated and spontaneous preterm birth were compared. RESULTS: Five hundred ninety-seven (20.5%) of 2910 women were obese. Obese women had fewer spontaneous preterm births at < 37 weeks of gestation (6.2% vs 11.2%; P < .001) and at < 34 weeks of gestation (1.5% vs 3.5%; P = .012). Women with a body mass index of < 19 kg/m2 had 16.6% spontaneous preterm birth, with a body mass index of 19 to 24.9 kg/m 2 had 11.3% spontaneous preterm birth, with a body mass index of 25 to 29.9 kg/m2 had 8.1% spontaneous preterm birth, with a body mass index of 30 to 34.9 kg/m2 had 7.1% spontaneous preterm birth, and with a body mass index of > or = 35 kg/m2 had 5.2% spontaneous preterm birth (P < .0001). Indicated delivery was responsible for an increasing proportion of preterm births with increasing body mass index (P = .001). Obese women had lower rates of cervical length < 25 mm (5% vs 8%; P = .012). Multivariable regression analysis confirmed a lower rate of spontaneous preterm birth in obese gravid women (odds ratio, 0.57; 95% CI, 0.39-0.83; P = .003). CONCLUSION: Obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.