Prognostic factors for patients with advanced stage serous borderline tumours of the ovary.

BACKGROUND: The aim of this study was to determine the prognostic factors for patients with advanced stage, low malignant potential ovarian tumour (LMPOT). PATIENTS AND METHODS: A retrospective review of 80 patients with serous LMPOT and peritoneal implants treated at or referred to our institution was carried out. RESULTS: Sixty-five patients had non-invasive implants. Fifteen patients had invasive implants. Twenty-nine patients had stage II and 51 patients had stage III disease. Three patients died of evolutive invasive disease and four of complications of treatment. The only prognostic factor of progression to 'evolutive invasive disease' is the pathologic subtype of peritoneal implants. The 5-year rates of evolutive invasive disease in patients with non-invasive implants and invasive implants were 2% and 31%, respectively (P <0.002). CONCLUSIONS: In this series, the only prognostic factor for patients with advanced stage borderline tumour is the type of peritoneal implant. More patients died of the treatment's complications than of the disease itself. The patients' prognosis with non-invasive implants seems to be excellent, and conservative management could be discussed in younger patients.     

胸骨上举术的固定方式与结果

目的：分析胸骨上举术的不同固定方式与手术效果的关系。方法：１４８例经胸骨上举术治疗的漏斗胸患儿，术中分别用自制金属支杠、三点式悬吊和塑料及金属制成的支架背心悬吊固定胸骨。结果：其中８４例患儿获术后６个月至６年（平均２年）随访观察，绝大部分效果满意，仅２例复发。２７例保留金属支杠于术后１０～１２个月拔除者，无复发，外观更满意。结论：胸骨上举术治疗漏斗胸的效果肯定，手术安全。用自制金属支杠固定上举的胸骨操作简便，术后护理方便。保持金属支杠于手术后１０～１２个月才拔除，有利于防止复发，胸廓外形更满意。三点式悬吊固定对较小的轻度患儿适用。支架背心悬吊固定法术后护理不便，影响患儿日常生活，使用受限     

Depiction of anomalous coronary vessels and their relation to the great arteries by magnetic resonance angiography

Three-dimensional respiratory-gated coronary MR angiography (MRA) allowed accurate analysis of the anatomy of the coronary arteries and their relation to the adjacent anatomic structures in two patients with anomalous origin and proximal course of the coronary vessels. Together with functional tests, it decisively influenced further therapy. Received: 16 November 1999; Revised: 4 April 2000; Accepted: 3 May 2000     

Glue embolization of a ruptured celiac trunk pseudoaneurysm via the gastroduodenal artery

Percutaneous transcatheter embolization of splanchnic artery aneurysms is a minimally invasive and alternative therapy to conventional surgical intervention. Due to a high-grade stenosis at the origin of the celiac trunk, a retrograde approach to the celiac trunk pseudoaneurysm via the gastroduodenal artery was necessary. To prevent undesirable embolization into the peripheral left gastric artery initial occlusion of the central portion of the left gastric artery was performed with microcoils using a Tracker catheter. Complete occlusion of the celiac trunk itself and the short adjacent segments of the celiac artery was achieved by using a mixture of N-butyl-2-cyanoacrylate and ethiodized oil as the embolizing agent. Received: 22 June 1999; Revised: 7 September 1999; Accepted: 1 October 1999     

A catheter technique in ophthalmic regional anaesthesia. Cadaver experiments

BACKGROUND: Regional anaesthesia for ophthalmic surgery is generally accomplished by peri- or retrobulbar techniques. Depending on the duration of ophthalmic surgery, reblock might become necessary. Our goal was to invent a catheter technique for ophthalmic regional anaesthesia that enables the user to administer local anaesthetics intraoperatively into the peri- or retrobulbar space continuously. METHODS: Twenty-five adult cadaver orbits of normal size and anatomy were used for the experiments. A flexible catheter was introduced transcutaneously or transconjunctivally into the extra- or intraconal space. Methylene blue solution was injected through the catheter. RESULTS: Using the same transcutaneous retro- and peribulbar technique, it was possible to introduce flexible catheters into a proper position of the cadaver orbits. The injected dye was found intra- or extraconally. CONCLUSION: Examining the spread of the dye in the orbit, we concluded that it is possible to provide ophthalmic anaesthesia for surgery through an indwelling catheter. We proved that continuous or intermittent administration of a local anaesthetic agent into the extra- or inraconal space can be achieved and this technique may allow us to maintain anaesthesia as long as it is necessary.     

A catheter technique in ophthalmic regional anaesthesia. Clinical investigations

BACKGROUND: Usually general anaesthesia is chosen if ophthalmic surgery of longer duration is expected. Our goal was to introduce a flexible catheter preoperatively into the extra- or intraconal space and to provide sufficient anaesthesia by continuous administration of a local anaesthetic via the catheter. METHODS: The continuous anaesthetic technique was applied in 28 patients undergoing vitreoretinal surgery. An indwelling catheter was introduced in 20 patients into the intraconal and in 8 patients into the extraconal space. In 6 patients, the position of the catheter was controlled by ultrasound examination prior to the injection of the local anaesthetic agent. RESULTS: For all patients adequate anaesthesia could be achieved and maintained with continuous retrobulbar administration (CRA) of a local anaesthetic by catheter. There were two patients who experienced moderate pain intraoperatively during continuous peribulbar administration (CPA). No complications occurred with the placement of the catheters. The catheter did not disturb the surgeon or the process of the ophthalmic surgery. CONCLUSIONS: Continuous administration of a local anaesthetic agent via an indwelling catheter into the intraconal space allowed ophthalmic anaesthesia without time restriction. Thus, CRA is a good alternative to general anaesthesia for patients undergoing long-lasting ophthalmic surgery.     

Marked enhancement of anti-allodynic effect by combined intrathecal administration of the adenosine A1-receptor agonist R-phenylisopropyladenosine and morphine in a rat model of central pain

BACKGROUND: There is often no satisfactory treatment for chronic pain after spinal cord injury. We have previously reported that intrathecal (i.t.) administration of the adenosine A1-receptor agonist R-phenylisopropyl-adenosine (R-PIA) or the opioid morphine has anti-allodynic effects in a model of presumed chronic central pain after photochemically induced spinal cord injury in rats. In the present study, we set out to investigate the possible interaction between i.t. R-PIA and morphine in spinally injured rats. METHODS: Sprague-Dawley rats displaying allodynia-like behaviors to mechanical and cold stimuli after photochemically induced spinal cord injury with minor motor deficits were used. R-PIA and morphine, either alone or in combination, were administered i.t. through an implanted catheter to lumbar spinal cord. RESULTS: Cumulative doses of R-PIA or morphine dose-dependently reduced the mechanical allodynia-like behavior, with a threshold of 1 nmol and 1.5 nmol, respectively. When co-administrated, R-PIA and morphine produced marked suppression of mechanical allodynia at doses of 5 pmol and 7.5 pmol, respectively. The effect of i.t. co-administration of R-PIA and morphine on cold allodynia was comparable to i.t. R-PIA alone. The combination of R-PIA and morphine did not increase adverse effects such as motor deficits in comparison to either drug alone. CONCLUSION: These results demonstrate a supra-additive interaction between the adenosine A1-receptor agonist R-PIA and morphine to reduce mechanical allodynia-like behavior in rats with chronic spinal cord injury. The combination of R-PIA and morphine administered spinally may be superior to R-PIA or morphine alone for treating such pain.     

Complete Removal of Colloid Cyst via CT-Guided Stereotactic Biportal Neuroendoscopy

Four patients harbouring a colloid cyst of the 3rd ventricle were operated on endoscopically. With the "classical" monoportal technique, through a precoronal burr hole only partial removal could be achieved in the first case. As the crucial point of the procedure is the safe dissection of the cyst from the thela chorioidea and from the internal cerebral veins, adequate control of the posterior rim of the foramen of Monro and the roof of the 3rd ventricle is mandatory. Accordingly in other three cases a CT-guided biportal endoscopic technique was applied, which permitted radical removal of the entire cyst with maximum safety. CT-guidance is essential for optimal planning after careful study of the individual anatomy. In this way the rigid scopes are moved exclusively along their own axes throughout the procedure, the resulting brain damage thereby being minimal. With regard to all circumstances of the procedure, the use of flexible endoscopes appears to be inappropriate and biportal endoscopy offers itself as the method of choice.     

CT-Based Needle Marking of Superficial Intracranial Lesions for Minimal Invasive Neurosurgery

A CT-based method of marking superficial intracranial lesions with a needle is presented. This form of neuronavigation can be applied in every neurosurgical centre. Owing to its rapid application it is also suitable for cases of emergency. The neurosurgical approach can be centred precisely over the lesion providing for a minimally invasive operation. The method has proved its efficacy in numerous cases of haematomas and cystic lesions.