Exocrine pancreatic secretion in the fasting dog

The American Journal of Digestive Diseases -     

Chirurgische Therapie des Analkarzinoms

The primary therapy of anal cancer is curative radiochemotherapy. Following a confirmed diagnosis the role of the surgeon is the treatment of local complications of anal cancer by securing bowel passage and protection of the perineum by laparoscopic placement of a preternatural anus or stoma. For patients with a persistent or recurrent tumor following radiochemotherapy a clear improvement in the oncological process can be achieved by surgical salvage therapy using an abdominoperineal rectum extirpation. However, this is accompanied by a high morbidity of up to 80%. Of particular importance here are disturbances in wound healing in the perineum; therefore, a primary myocutaneous flap surgery can be used to cover the perineal resection wound and the rate of disturbances in wound healing can be substantially reduced.     

Infertilität bei Männern

Although male reproductive functions are impaired in about half of the infertile couples seeking offspring, even today the examination and treatment of the male partner continues to be neglected. Despite the lack of evidence for a “sperm crisis”, so highly touted in the press, the public remains worried, while the fact that male fertility declines beyond the age of 40 years and is accompanied by increasing genetic risks for the offspring goes largely unnoticed. In addition to a thorough physical examination supplemented by imaging techniques such as ultrasonography of the scrotal organs, semen analysis according to WHO guidelines, hormone determinations, and cyto- and molecular genetic analyses form part of the routine investigation of the infertile male. Few disorders have become subjects of rational treatment, such as hypogonadotropic hypogonadism with gonadotropins or GnRH, treatment of sexually transmitted diseases by antibiotics, and microsurgical reconstruction of blocked seminal ducts. Early treatment of maldescended testes in boys or changing lifestyle (e.g., discontinuation of smoking) are important preventive measures. In the age of evidence-based medicine, most empirical treatments have been demonstrated to be ineffective. Thus, pregnancy rates from patients with varicocele who underwent long-practiced surgical or radiologic interventional therapy were not different from those of patients receiving counseling. At present, in cases of non-obstructive azoospermia or severe oligoasthenoteratozoospermia, intracytoplasmic sperm injection (ICSI) using single sperm derived from semen or extracted from testicular biopsy tissue (TESE) represents the most successful treatment modality, although it remains symptomatic and not curative.     

Determinants of bone strength and fracture incidence in adult Finns: Cardiovascular Risk in Young Finns Study (the GENDI pQCT study)

Summary

Peripheral bone strength and fracture risk were studied in young adult Finns. Peripheral bone measures were associated with risk factors of osteoporosis in young adults and discriminated between those with and without low-energy fractures. In men, trabecular bone loss at peripheral bone sites starts before the age of 40 years.

Purpose

This is a cross-sectional study of the determinants of bone strength and fracture risk in young Finns using peripheral quantitative computed tomography (pQCT) and quantitative ultrasound (QUS).

Methods

pQCT scans were performed in 1,884 subjects at distal and shaft sites of non-dominant radius and left tibia, and QUS measures (n?=?1,415) at the left calcaneus. Lifestyle factors and medical conditions affecting bone health were assessed with questionnaires.

Results

In men, the youngest age cohort had the lowest trabecular volumetric bone mineral density (vBMD) at radius and tibia (difference between the youngest and the oldest, 4.4% and 5.6%, respectively, P?<?0.001) and lowest speed of ultrasound at the calcaneus (difference 0.5%, P?=?0.016). In women, bone traits did not differ by age groups. When sexes were pooled, underweight (relative risk (RR)?=?2.95, P?<?0.001), excess alcohol intake (1.52, P?=?0.036), smoking (1.29, P?=?0.025), Crohn’s disease or inflammatory bowel syndrome (2.43, P?=?0.016), epilepsy (2.54, P?=?0.011), use of corticosteroids (2.01, P?<?0.001) and inactivity (1.34, P?=?0.045) increased the risk of low trabecular vBMD. RRs for low-energy fractures were excess alcohol intake (2.58, P?=?<0.001), anorexia (3.74, P?=?0.041) and hypogonadism (2.08, P?=?0.015). Same risk factors predicted BMD and fractures in both sexes. Trabecular bone mineral content, vBMD and bone strength index showed greatest differences (4–9%; P?<?0.05) between those with and without low-energy fractures.

Conclusions

Peripheral QCT traits are associated with common risk factors of osteoporosis in young Finns and discriminate between those with and without low-energy fractures. In men, trabecular bone loss at peripheral bone sites starts before the age of 40 years.     

Diagnostic applications of radiolabeled peptides in nuclear endocrinology.

Regulatory peptides are small, readily diffusable and potent natural substances with a wide spectrum of receptor-mediated actions in humans. High affinity receptors for these peptides are (over-) expressed in many neoplasms, and these receptors may represent, therefore, new molecular targets for cancer diagnosis and therapy. This review intends to give an overview of the peptide-based radiopharmaceuticals which are presently already commercially available or which are in advanced stages of their clinical testing so that their broader availability is anticipated soon. Physiologically, these peptides bind to and act through G protein-coupled receptors in the cell membrane. Historically, somatostatin analogs are the first class of receptor binding peptides having gained clinical application. 111In-DTPA-[D-Phe1]-octreotide is the first and only radiopeptide which has obtained regulatory approval in Europe and the United States to date. Extensive clinical studies involving several thousands of patients have shown that the major clinical application of somatostatin receptor scintigraphy is the detection and the staging of gastroenteropancreatic neuroendocrine tumors (carcinoids). In these tumors, octreotide scintigraphy is superior to any other staging method. However, its sensitivity and accuracy in other, more frequent neoplasms is limited. Radiolabeled vasoactive intestinal peptide (VIP) has been shown to visualize the majority of gastrointestinal adenocarcinomas, as well as some neuroendocrine tumors, including insulinomas (the latter being often missed by somatostatin receptor scintigraphy). Due to the outstanding diagnostic accuracy of the pentagastrin test in detecting the presence, persistence, or recurrence of medullary thyroid cancer (MTC), we postulated the expression of the corresponding [i.e., cholecystokinin (CCK-)-B] receptor type in human MTC. This receptor is also widely expressed on human small-cell lung cancer. Indeed, 111In-labeled DTPA derivatives of gastrin showed excellent targeting of CCK-B receptor expressing tissues in animals and patients. A variety of further peptide-based radioligands is currently under development. Summarizing, radiolabeled regulatory peptides have opened new horizons in nuclear oncology for diagnosis (and potential internal radionuclide therapy). Further work will probably reveal a multitude of novel potentially clinically useful peptide-based radioligands.     

Percutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract

Background: Retained biliary stones is a common clinical problem in patients after surgery for complicated gallstone disease. When postoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy are unsuccessful, several percutaneous procedures for stone removal can be applied as alternatives to relaparotomy. These procedures are performed either under fluoroscopic control or with the use of choledochoscopy, but it is also possible to combine these methods. Methods: Since 1994, we have used the percutaneous video choledochoscopic technique for the removal of difficult retained biliary stones via dilated T-tube tract in 17 patients, applying the technique of percutaneous stone extraction used in urology. While waiting for the T-tube tract to mature and after the removal of the T-tube, the dilatation of its tract was 26--30 Fr. Stone removal was carried out using a flexible video choledochoscope and a rigid renoscope under fluoroscopic control, with the aid of Dormia baskets, rigid forceps, and high-pressure irrigation. Results: We performed 23 operative procedures, and the clearance of the biliary ducts was successful in all cases. There were no major complications or deaths. Conclusion: Percutaneous video choledochoscopic--assisted removal of large retained biliary stones via the T-tube tract is a highly effective and safe procedure. Its advantages over other procedures include the ability to visualize the stones and noncalculous filling defects; it also guarantees that the stones can be removed under visual video endoscopic control. It has no problems related to tract or stone size. apd: 21 December 2000     

Management of Esophageal Perforation

Despite recent advances in thoracic surgery, the management of esophageal perforation remains problematical and controversial. Thirty-one patients were treated for an esophageal perforation between 1986 and 1998. The esophageal perforation was iatrogenic in 25 cases, spontaneous in 2, traumatic in 2, and caused by a tumor and tuberculous lymphadenitis in 2 patients. There were 10 cervical, 19 thoracic, and 2 abdominal perforations. The interval from perforation to operation was less than 24 h in 12 patients and more than 24 h in 19 patients. The surgical procedures included a primary repair in 12 patients, a resection in 8, and conservative treatment with minor surgical approaches in 11. The mortality rate was 20% (4/20 patients) in the surgical treatment group and 45.5% (5/11 patients) in the conservative treatment with minor surgery group. The overall mortality was 29% (9/31 patients). The prognosis is thus concluded to depend on the cause and location of the perforation, the presence of underlying esophageal diseases, and the surgical procedure chosen. Received: October 12, 1999 / Accepted: May 30, 2000