Improved pelvicalyceal visualization with multidetector computed tomography urography; comparison with helical computed tomography

Our aim was to compare the quality of pelvicalyceal visualization on computed tomography (CT) urography using a small intravenous contrast material dose, hydration, and high-resolution multidetector CT (MDCT) with that of conventional helical CT. The test (MDCT) group (49 consecutive patients, 98 kidneys) was scanned 5 min following an intravenous bolus of 30 ml of iodinated contrast material. The control (helical CT) group (50 consecutive patients, 95 kidneys) was scanned 5 min following injection of 120–150 ml of intravenous contrast material. Enhancement and quality of calyceal detail were measured using a five-scale grading system (1 for no detail, 5 for cupped calyces). Calyceal attenuation was substantial in both groups (more than 220 Hounsfield units, HU) but less in the test group compared with the control group (mean 475 and 920 HU, respectively), p<0.0001. In the test group, the calyceal attenuation was less than 500 HU in the majority of cases (65/98 kidneys), while the opposite was true for the control group, where calyceal attenuation was more than 750 HU in 50/95 kidneys (p<0.001). The quality of calyceal detail was 3.4/5 in the test group compared with 1.8/5 in the control group (p<0.0001). The combination of hydration, low-contrast dose, and the high image resolution achieved with MDCT significantly improves calyceal visualization in CT urography.     

腰交感神经节射频消融术进针方法的临床研究

目的探讨腰交感神经节射频消融术的进针方法。方法腰交感神经节试验性阻滞有效的患者38例,随机分为:"退针法"和"进针法"两组。前者在X线下定位治疗侧L2-4椎体旁靶点,局麻下射频穿刺针向靶点进针触及椎体至椎体前缘5mm处,给予造影、电刺激测试和局麻药试验性阻滞,成功后行第一次射频消融,等针温度下降后,穿刺针后退5mm再次电刺激测试和射频消融;"进针法"的定位、进针点和角度同"退针法",穿刺针触及靶点至椎体前缘处,行第一次射频消融,等针温度下降后,穿刺针向前推进5mm,再次射频消融。比较观察两组的治疗效果和并发症。结果电刺激测试出现腹股沟异感发生率:"退针法"组比"进针法"组高;术后并发症:"退针法"组比"进针法"组低,两组比较差异有显著性(P<0.05)。治疗7日后VAS评分及总有效率两组间差异无显著性。结论"退针法"射频消融腰交感神经节操作较"进针法"合理且并发症少。     

Fiberendoskopische Verödung von Oesophagusvaricen

Zusammenfassung Anhand einer 2jährigen Erfahrung berichten wir über die fiberendoskopische Verödung von Oesophagusvaricen. 170 Patienten wurden behandelt: 61 Frauen und 109 Männer zwischen 15 und 83 Jahren mit einem Altersgipfel im 5. Dezennium. Ursachen der portalen Hypertension waren in 162 Fällen eine Lebercirrhose und 8mal eine Milzvenen- bzw. Pfortaderthrombose. Die Varicenverödung erfolgte bei 47 Patienten während der Blutungsphase, in 101 Fällen im Intervall und 22mal prophylaktisch. Mit maximal drei Behandlungssitzungen ließen sich die Varicen nach der modifizierten intravasalen Injektionstechnik veröden. Akute Blutungen konnten in 83 % erfolgreich gestillt werden. Die Krankenhausletalität der akut behandelten Patienten betrug 30 %. In der Intervall-Gruppe lag sie bei 5 %. Keiner der prophylaktisch sklerosierten Patienten starb während der Behandlung. Die globale Spätletalität im Zeitraum bis zu 22 Monaten betrug 11,8 %. Häufigste Todesursache war terminale Leberinsuffizienz. Rezidivblutungen traten in 11,2 % auf und endeten bei jedem 5. Fall tödlich. Häufigste Komplikationen stellten Stenosen dar, die in 4 von 16 Fällen bougiert werden mußten. 2mal entwickelten sich oesophagopleurale Fisteln, die mit Bülau-Drainagen beherrscht werden konnten. Die Komplikationsrate betrug insgesamt 10,6 % ohne einen letalen Ausgang.

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Fiberscopic obliteration of esophageal varices

Summary We are reporting our 2 years experience in the fiberscopic sclerotherapy of esophageal varices. 170 patients from 15–83 years of age were treated (61 females and 109 males), the majority being around 50 years of age. In 162 cases, the cause of the portal hypertension was cirrhosis of the liver and in 8 cases thrombosis of the splenic or portal vein. 47 patients were treated during acute bleeding, 101 in the interval, and 22 prophylactically. Using the modified intravascular technique, most varices could be sclerosed after a maximum of three treatments. In 83 %, acute hemorrhages were stopped. The hospital mortality amounted to 30 %, while in the interval group only it was 5 %. None of the prophylactically treated patients died during their stay in hospital. The mortality after an average of 11.2 months amounted to 11.8 %: The main cause was liver failure. Bleeding reoccurred in 11.2 % and resulted in death in every fifth case. The most common complication, namely stenosis, arose in 16 cases and 4 of these necessitated dilation therapy. Esophagothoracic fistulae occurred in 2 cases and could be cured by siphon drainage. The rate of complication amounted to 10.6 %, without any lethal outcome.

     

Dose-dependent activation of Ca2+-activated K+ channels by ethanol contributes to improved endothelial cell functions

BACKGROUND: Regular moderate alcohol (EtOH) intake seems to protect against both coronary artery disease and ischemic stroke, whereas the risk increases with heavy EtOH consumption. Effects of EtOH on endothelial cell function may be relevant to these disparate effects. Potassium channels play an important role in the regulation of endothelial cell functions. Therefore, we investigated whether Ca-activated K channels (BKCa) are modulated by EtOH. Furthermore, we examined whether EtOH-induced changes of endothelial nitric oxide (NO) formation and cell proliferation are due to BKCa activation. METHODS: The patch-clamp technique was used to investigate BKCa activity in cultured human umbilical vein endothelial cells (HUVEC). NO formation was analyzed by using the fluorescence dye 4,5-diaminofluorescein. Endothelial proliferation was examined by using cell counts and measuring [H]thymidine incorporation. RESULTS: EtOH dose-dependently (10-150 mmol/liter) modulated BKCa-activity, with the highest increase of open-state probability at a concentration of 50 mmol/liter (n = 13; p < 0.05). Inside-out recordings revealed that this effect was due to direct BKCa activation, whereas open-state probability was not changed in cell-attached recordings after pertussis toxin preincubation. EtOH (10 and 50 mmol/liter) caused a significant increase of NO levels, which was blocked by the highly selective BKCa inhibitor iberiotoxin (100 nmol/l; n = 30; p < 0.05). Higher concentrations of EtOH (100 and 150 mmol/liter) significantly reduced NO synthesis (n = 30; p < 0.05). Both methods revealed a significant increase of HUVEC proliferation, which was inhibited by iberiotoxin (n = 30; p < 0.05). At a concentration of 150 mmol/liter, EtOH caused a significant reduction of endothelial proliferation. CONCLUSIONS: EtOH directly activates BKCa in HUVEC, leading to an increase of endothelial proliferation and production of NO. These results indicate a possible beneficial effect of low-dose EtOH on endothelial function, whereas higher concentrations must be considered as harmful.     

Outcome after intra- and extra-corporeal laparoscopic appendectomy techniques

Background This study aimed to assess the outcome after intracorporeal (IC) and extracorporeal (EC) laparoscopic appendectomy technique in a single institution over a 5-year period.Methods Records of all children (n = 60) who underwent laparoscopic appendectomy at the Royal Aberdeen Childrens Hospital between February 1997 and March 2002 were retrieved and evaluated. Observations were made regarding operative technique, anesthetic time, intra- and postoperative complications, postoperative analgesic requirement, and postoperative hospital stay.Results There were 30 children in each group who had a similar demographic profile. The magnitude of appendicitis severity in both groups was similar. The mean anesthetic time was 67.8 min for the IC group and 50.7 min for the EC group (p = 0.001). There were no recorded intraoperative complications, although a single case in the EC group required conversion to open procedure. The postoperative analgesic requirement in both groups was similar. The mean postoperative stay was 2.1 days in the IC group and 2.5 days in the EC group. Two postoperative complications were noted in the IC group; one intraperitoneal collection and one postoperative chest infection. Four complications occured in the EC group; one intraperitoneal collection and three minor port-site wound infections.Conclusions The authors experience shows the EC technique to be significantly quicker, although with a slightly increased complication rate. Either technique can be applied safely for acute appendicitis.     

Use of the surgical towel in colorectal hand-assisted laparoscopic surgery (HALS)

The use of laparotomy pads or towels to displace the small intestine away from the operative site is a well-established technique in open surgery; however, its application is unfeasible or extremely challenging in standard laparoscopic surgery. We describe the use of standard surgical towels in hand-assisted laparoscopic surgery (HALS). A Pfannenstiel incision is made and a Gelport hand-access device is assembled. A sterilized surgical towel, 65 × 44 cm in size, is inserted via the Gelport, unfolded, and placed over the bowel loops laparoscopically with the assistance of the hand. The bowel loops are then housed gently in the towel and displaced away from of the operative site. HALS enables the easy insertion and handling of a large surgical towel inside the peritoneal cavity. The towel successfully retracts the small intestine, enabling the surgeon to concentrate the use of his or her hand on the targeted structures. This practical and inexpensive tip adds another advantageous component to the practice of colorectal HALS.     

Assessment of a newer technique for cesarean section

We present a new method for cesarean section that predominantly employs blunt techniques. We used it in 51 patients having a first cesarean section and compared the results with 51 matched controls having a standard technique first cesarean section. Received: 12 April 2001 / Accepted 21 August 2001     

Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out

OBJECTIVES: To describe a new, simple surgical technique for the treatment of female stress urinary incontinence (SUI) and to evaluate its feasibility. METHODS: We have developed a novel surgical treatment of SUI, the transobturator inside-out tension-free urethral suspension, which uses specifically designed surgical tools, and in which a synthetic tape is passed from underneath the urethra, through the obturator foramens, towards the thigh folds, without entering the pelvic region at any time during the procedure. The tape is positioned without tension under the junction between mid and distal urethra. RESULTS: The procedure was carried out in 107 consecutive patients (mean age: 62 years) using the same operative protocol in all case subjects, independently of the patient's size and weight. Mean operative time was 14 min (range: 7-20) in case of isolated SUI treatment. No bladder or urethral injuries and no vascular (hematoma or bleeding) or neurological complications were encountered. CONCLUSIONS: The results of this study indicate that our novel transobturator inside-out surgical technique for treating SUI is feasible, accurate, and quick. This technique avoids damage to the urethra and bladder and, therefore, makes cystoscopy not necessary. Further prospective studies are currently ongoing to determine the efficacy of our new surgical approach for treating SUI.