Effect of absorption of laser radiation by blood hemoglobin on threshold of destruction of pathological tissue during laser angioplasty

Conclusions 1. Absorption by hemoglobin increases the threshold power density of laser radiation at the outlet of the light guide and, together with scattering of the radiation, determines the range of distances between the irradiated surface and the end of the light guide within which destruction of atherosclerotic formations (the range of working distances) can be obtained.2. For the purpose of laser angioplasty, it is advisable to use light-conducting systems with a numerical aperture of not more than 0.2 at the outlet.3. For an ionic argon laser (=0.488–0.514 ) the range of working distances is limited to something of the order of 1 mm and is mainly determined by absorption of the radiation by hemoglobin. An increase of power causes virtually no change in this value.4. For a solid laser on Nd:YAG (=1.064 ) the range of working distances is limited to something of the order of 1.5–2 mm, and is determined mainly by scattering of the radiation at the outlet of the light-conducting system.All-Union Research Institute of Medical Instrumentation, Moscow. Translated from Meditsinskaya Tekhnika, No. 1, pp. 33–36, January–February, 1989.     

Can the new RCP R0/R1 classification predict the clinical outcome in ductal adenocarcinoma of the pancreatic head?

Purpose

According to the International Union Against Cancer (UICC), R1 is defined as the microscopic presence of tumor cells at the surface of the resection margin (RM). In contrast, the Royal College of Pathologists (RCP) suggested to declare R1 already when tumor cells are found within 1?mm of the RM. The aim of this study was to determine the significance of the RM concerning the prognosis of pancreatic ductal adenocarcinoma (PDAC).

Methods

From 2007 to 2009, 62 patients underwent a curative operation for PDAC of the pancreatic head. The relevance of R status on cumulative overall survival (OS) was assessed on univariate and multivariate analysis for both the classic R classification (UICC) and the suggestion of the RCP.

Results

Following the UICC criteria, a positive RM was detected in 8?%. Along with grading and lymph node ratio, R status revealed a significant impact on OS on univariate and multivariate analysis. Applying the suggestion of the RCP, R1 rate rose to 26?% resulting in no significant impact on OS in univariate analysis.

Conclusions

Our study has shown that the RCP suggestion for R status has no impact on the prognosis of PDAC. In contrast, our data confirmed the UICC R classification of RM as well as N category, grading, and lymph node ratio as significant prognostic factors.     

Complicated Sigmoid Diverticulitis—Hartmann’s Procedure or Primary Anastomosis ?

Introduction : Diverticular disease of the colon is a common condition in developed countries. For perforated diverticulitis Hartmann’s procedure is a safe and quick treatment option. But intestinal restoration needs further interventions. This leads to high complication rates and cost. Therefore a critical evaluation of surgical treatment options is necessary.

Methods : During a period of 18 months 88 patients underwent surgical resection for diverticulitis. Forty patients had emergency surgery. Among those a primary anastomosis was performed in 21 patients. The other 19 patients had interval colostomy. Among 21 patients with primary anastomosis major complications occurred in two patients, vs. twelve in patients with Hartmann’s operation (p = 0.03). In the Hartmann group eight patients had major general complications, vs. one patient in the group with primary anastomosis (p = 0.06). The mean hospital stay was 38 days after Hartmann’s procedure, vs. 13 days for patients with primary anastomosis (p < 0.01).

Conclusion : In emergency surgery for complicated diverticulitis primary anastomosis is not associated with an increased postoperative morbidity. A primary anastomosis reduces the need for further surgical interventions and complex re-operations. Thus, an overall reduction of morbidity, cost, complication rate and hospital stay is possible. Therefore this technique is advantageous for patients and hospitals.     

Early and late postoperative changes in the quality of life after pancreatic surgery

Purpose

To compare health-related quality of life (QoL) before and after surgery for pancreatic disease.

Methods

A retrospective analysis of prospectively gathered data is presented. A total of 174 patients of 230 planned for pancreatic surgery between March and December 2009 at a German high-volume center completed the Short Form-36 (SF-36) Health Survey preoperatively, 133 of them at 3 months and 83 at 24 months after surgery. Data was analysed according to diagnosis and procedure, and compared to German population norms.

Results

QoL in the study group was worse than that of age-matched healthy population at all time points. It decreased continuously in the cancer group, decreased early and showed a trend toward recovery late in patients with benign tumors and chronic pancreatitis. Distal pancreatectomy was the best tolerated and total pancreatectomy the worst tolerated procedure. Older age and development of pancreatic insufficiency affected negatively QoL.

Conclusions

In patients with pancreatic disease, diagnosis determined QoL preoperatively and late after surgery, while in the early postoperative period, type and extent of surgery was the leading factor. Total pancreatectomy had a profound negative effect on QoL and should be reserved for carefully selected patients only.     

The ventilatory-perfusion imbalance in the lung after burns complicated with acute major blood loss — a dog study

Summary The study presented investigates indices of central and regional pulmonary function in dogs after combined trauma (5% full thickness thermal burn with acute blood loss) and during blood transfusion by the intraosteal pumping method. The combined trauma resulted in 100% death of dogs within the first three hours after the injury. Blood reinfusion causes a short-lived beneficial effect. With a relative stabilisation of central hemodynamics pulmonary perfusion decreased to 63% of its initial value. The lung tissue blood filling increased to 158% with a decrease of pulmonary air content to 55.8%, this indicated an initial process of liquid blood parts penetrating into the interstitial space and pulmonary alveoli, which resulted in 65% death of dogs. Correspondence to: Dr. AN. Belyaev     

Clozapine in the treatment of schizophrenic patients: an international multicenter trial

One hundred twenty schizophrenic patients were treated with clozapine for two months in accordance with a standard trial protocol at ten research centers in the USSR, Czechoslovakia, Hungary, Poland, Bulgaria, and in the GDR. The daily dose ranged from 50 mg to 550 mg (mean: 272.1 mg for responders; 298 mg for nonresponders). In 94 patients (78%) the disease was clearly progressive; in 57 (47.5%) it was continuous; in 63 (52.5%) it was episodic. Before the start of clozapine treatment, 95 of the patients (79%) had been receiving other neuroleptics. There was a positive therapeutic response in 80% of the responding patients. The effect of clozapine was closely related to the dominant syndrome structure of the psychosis: a positive response was noted in 89% of patients with delusional, hallucinatory-delusional, and catatonic states and in 60% of patients with affective-delusional syndromes. Moderate side effects were noted in 87 patients (73%). The incidence of side effects reached a peak during the first four weeks of treatment and then declined despite maintenance of or even an increase in the daily clozapine dose. Hematological changes (moderate leukocytosis and thrombocytopenia) were noted in eight patients (6.7%).     

Effect of the anode and cathode of a direct current on the electrical activity of the isolated node of Ranvier in a medium with low sodium concentration and during the action of Novocain

Summary Experiments were performed on single nerve fibers ofRana temporaria. The changes in the value and the form of action potential (AP) proved to be similar both in a low-sodium medium and in a Novocain solution. The action of a dc anode on the node of Ranvier in a low-sodium medium caused only an insignificant rise of the AP amplitude but restored the AP completely in a node treated with Novocain. The cathode placed on the node stressed the AP in both cases. The membrane depolarization critical level (CL) rose both in a low-sodium medium and in a Novocain solution. Direct current cathode raised CL to a still greater degree, whereas the anode, on the contrary, lowered it somewhat. However, complete CL restoration did not occur either in a low-sodium medium or in a Novocain solution. The possible mechanism of the changes occurring in the AP and CL amplitudes during dc polarization in a lowsodium medium and in a Novocain is discussed.(Presented by Active Member AMN SSSR A. A. Vishnevskii) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 57, No. 5, pp. 3–6, May, 1964