Testicular function after OPA/COMP chemotherapy without procarbazine in boys with Hodgkin's disease. Results in 25 patients of the DAL-HD-85 study

Gonadal function was evaluated in 25 boys treated for Hodgkin's disease according to the DAL-HD-85 protocol with OPA- or OPA/COMP-chemotherapy (vincristine-prednisone-adriamycine/cyclophosphamide-vincristine-m ethotrexate- prednisone). All boys were in first continuous complete remission for 6 to 45 months at chronological ages varying from 14.0 to 18.9 years. Testosterone, basal and GnRH-stimulated LH- and FSH-levels were measured. Gonadal function was normal in 16 patients treated with 2 cycles of OPA-chemotherapy in Hodgkin stages I-IIA. 9 patients were treated with 2 OPA- and 2 or 4 COMP-cycles of chemotherapy and had received mean cyclophosphamide doses ranging from 2004 to 3722 mg/m2. Again, no major testicular damage was noted, though some patients had increased stimulated LH-levels possibly indicating compensated Leydig cell-insufficiency. Our results demonstrate, that testicular function is not severely affected when patients are treated for Hodgkin's disease without procarbazine even if cyclophosphamide is given in cumulative doses below 3800 mg/m2. The previously documented severe testicular damage in boys treated according to the DAL-studies HD-78 and HD-82 is thus a result of the gonadotoxic action of procarbazine.     

Book reviews

Pediatric Radiology -     

Experimental In Situ Conditioning of the Latissimus Dorsi Muscle for Circulatory Assist by Multichannel Stimulation

Abstract: This study was undertaken to survey the changes in force and fatigue of the latissimus dorsi muscle during transformation into a fatigue–resistant muscle by indirect or nervous multichannel stimulation. In sheep, a silicone chamber connected to a pressure–transducing system was implanted under the left latissimus dorsi muscle. Muscle conditioning was performed by multichannel (carousel) stimulation of the thoracodorsal nerve. The program was started with active periods of 10 min/h producing 10 tetanic contractions/min. It was increased until 70 contractions/min could be performed during 24 h. The changes of muscle force and fatigue were monitored by the silicone balloon system. After a mean period of 22 weeks, fatigue resistance was reached. The fatigueresistant muscle was able to produce a pressure of about 100 mm Hg in the balloon. After finishing the conditioning procedure, muscle forces and the fatigue resistance of the conditioned muscle were evaluated. The conditioned muscle showed only a minimal decrease of force during 20 min. Under a preload of 20 N, it exhibited a maximum tetanic tension of 95 N.     

A new technique for reconstruction of the common bile duct after severe injury by laparoscopic cholecystectomy

Zusammenfassung Schwere Gallengangsverletzungen sind nach laparoskopischen häufiger als nach konventionellen Cholezystektomien zu beklagen. Sie resultieren meist aus technischen Problemen oder unzureichender Identifikation der entsprechenden Strukturen. Das sofortige Erkennen der Gallengangsverletzung ist fur eine entsprechende Therapie ebenso wichtig wie die ädequate chirurgische Technik, die angewendet wird. Hier wird eine neue Methode der Gallenwegrekonstruktion unter Verwendung eines Jejunalkonduits vorgestellt. Das Verfahren wurde bislang bei 5 Patienten mit schweren Gallengangsverletzungen (Typ 3 and 4 nach Bismuth) [2] nach laparoskopischer Cholezystektomie erfolgreich angewendet. Der Verlauf nach nunmehr 9 Monaten bis zu mehr als 2 Jahren war ohne Probleme and vielversprechend. Die Methode der Anwendung des Jejunalkonduits erscheint uns zur Rekonstruktion bei schweren Gallengangverletzungen sehr empfehlenswert.

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A new technique for reconstruction of the common bile duct after severe injury by laparoscopic cholecystectomy

Laparoscopic cholecystectomy involves a higher incidence of severe common bile duct injury than did open cholecystectomy. The severe injuries most often result from technical problems and inadequate exposure. Reconstruction of the bile duct is then possible provided that an immediate diagnosis is made and an appropriate surgical technique is applied. The report focuses on a new method of reconstruction of the common bile duct by interposition of a small jejunal conduit. The procedure was performed in five patients with severe bile duct injury (Bismuth class 3–4) that occurred during laparoscopic cholecystectomy. The outcome after follow-up periods of 9 months to more than 2 years is promising. This method of reconstruction is therefore recommended for severe forms of bile duct injury.

     

Adrenocortical nodular hyperplasia as a cause of Cushing syndrome in the neonatal period]

The case report of a female child born preterm (30th wk of gestation) who developed symptoms of Cushing's syndrome beginning in the neonatal phase is presented. The disease was caused by a unilateral adreno-cortical nodular hyperplasia and was successfully treated by unilateral adrenalectomy. Preoperative treatment with ketoconazole and metyrapone proved to be effective. Symptoms of Cushing's disease including hypertrophic cardiomyopathy were completely reversible within one month after surgery.     

Morbidity and mortality from induced illegal abortion at the University of Nigeria Teaching Hospital, Enugu: a five year review.

Eighty-four cases of illegally induced abortion presented at the University of Nigeria Teaching Hospital (1982-1986), or 4 per 1000 deliveries. Seventy-one percent of the patients were 20 years or younger and 8 out of 10 were nulliparous. Medical practitioners were responsible for one-third of the cases. Presentation and treatment are described. Fifteen women died (179 per 1000 cases). The true number of deaths from abortion in the community is probably higher.     

Weitere Entwicklung der Krebssterblichkeit in Deutschland bis zum Jahr 2010

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