Extrapelvic colon--areas of failure in a reoperation series: implications for adjuvant therapy

A total of 230 patients had planned single or multiple reoperative procedures following "curative" resection of colorectal cancer at the University of Minnesota. The site of the primary lesion was extrapelvic in 91, and later evidence of cancer was found in 58 patients (64%) at re-operation and/or other follow-up. Eight of the 58 (14%) were converted to disease-free status. Incidence and patterns of failure were correlated with initial operative-pathologic extent of disease (87 of the 91 at risk had initial tumor extension beyond the bowel wall, involved nodes or both) and comparisons were made with the previously analyzed rectal reoperation patients. While a component of local-regional failure was more common with rectal lesions (48/74 at risk, 65%), it was not uncommon with extrapelvic primaries (44/91-48%). The incidence of hematogenous metastasis (DM) was equal, but the pattern of initial DM differed (extrapelvic colon--primarily liver; rectum--liver and lung). Peritoneal seeding was a more common component of failure with the extrapelvic primaries (19/91--21% vs 3/74-4%). Since surgery alone is inadequate treatment for many patients with colon as well as rectal cancer, the rationale of adjuvant radiation and systemic therapy, alone or in combination, is discussed.     

Cerebral hemodynamics in patients with moyamoya disease. A study of regional cerebral blood flow by the 133Xe inhalation method

Regional cerebral blood flow was measured by the 133Xe inhalation method in 20 young patients with moyamoya disease and five young healthy volunteers. Most patients showed low values of mean hemispheric blood flow in both hemispheres. Regional cerebral blood flow was at a low value in the upper frontal region and at an almost average value in the posterotemporal and occipital regions, which was different from the "hyperfrontal" pattern in healthy volunteers. Regional cerebral blood flow was reduced evenly by hyperventilation. By 5% CO2 inhalation, regional cerebral blood flow was increased in the temporooccipital regions and was nearly unchanged or decreased in the frontal region.     

Functional inhibition and release: unilateral tachistoscopic performance and stereoelectroencephalographic activity in a case with left limbic status epilepticus

During prolonged nonconvulsive unilateral left limbic status epilepticus, a natural model of functional hemispheric inhibition, we performed two tachistoscopic experiments, a lexical decision task associated with a RVF (left hemisphere) superiority and a facial matching task associated with a LVF (right hemisphere) superiority. We found that epileptic activity in the left hemisphere, especially rhythmic high-frequency "tonic" discharges, inhibited performance on the lexical task but not on the facial matching task. This suggests that only cognitive activity in the discharging hemisphere is inhibited. Strikingly, the best performance of the right hemisphere was obtained while the left hemisphere was most inhibited, suggesting a functional balance of inhibition and release.     

Yohimbine: a new street drug

Following the ingestion of an alleged aphrodisiac known as "yo-yo," a 16-year-old girl experienced an acute dissociative reaction accompanied by weakness, paresthesias, and incoordination. Subsequent symptoms included anxiety, headache, nausea, palpitations, and chest pain. Hypertension, tachycardia, tachypnea, diaphoresis, pallor, tremors, and an erythematous rash were noted on physical examination. Serum epinephrine and norepinephrine levels were found to be elevated. Symptoms resolved spontaneously but lasted approximately 36 hours. The ingested substance was identified as yohimbine. The pharmacology of yohimbine and the treatment of yohimbine poisoning are discussed.     

Ein neues Zeichen zum Nachweis der Schußabgabe durch eigene Hand?

Zusammenfassung Es wird über zwei Fälle von tödlichen Kopfschüssen berichtet (Einschußwunden rechte Schläfe, absolute Nahschüsse, Kaliber 7,65 bzw. 9 mm), bei denen im Spalt des rechten Schultergelenks Blutungen festgestellt werden konnten. Diese werden durch Überdehnung bei Schußabgabe und extremer Gelenkposition erklärt. Sie könnten, sollten sie sich in einem größeren Obduktionsgut bestätigen, ein Hinweis für eigene Hand sein.     

Pathologische Myophosphorylasereaktion bei der malignen Hyperthermie

Zusammenfassung Die Myophosphorylasereaktion (MPR) zeigt bei der malignen Hyperthermie (MH) charakteristische Veränderungen, die in Minutenschnelle entstehen: 1.) eine allgemein stark abgeschwächte Reaktion, 2.) zahlreiche negativ reagierende Fasern, 3.) häufig fleck- und/oder streifenförmig abgeschwächt oder negativ reagierende und streifenförmig verstärkt reagierende Faserabschnitte mit relativ engen Sarkomerenabständen (Zeichen der Hyperkontraktion). Diese morphologischen Befunde mit den kennzeichnenden Streifenfasern sind offenbar für das MH-Syndrom spezifisch! Wichtig ist, daß die derart veränderten Muskelfasern in der Regel bei den anderen Färbungen und Reaktionen unauffällig sind.Wir sahen diese pathologische MPR bei 5 verstorbenen Patienten, einmal unabhängig von einer Anästhesie nach einem Marsch, und bei 19 Schweinen, davon 18mal nach dem Halothantest und einmal bei einem Versuchstier mit gesicherter MH. Sie fehlte bei Schweinen mit negativer Halothanreaktivität und vor dem Halothantest und bei vielen, sehr verschiedenen gesunden und kranken Kontroll- und Vergleichsfällen aus dem bioptischen und autoptischen Untersuchungsgut. Die MPR erlaubt den sicheren Nachweis einer inszenierten oder abgelaufenen MH und damit eine Aufklärung rätselhafter oder scheinbar klarer Todesfälle während oder nach der Narkose oder allgemein nach Streß (human stress syndrome), von denen sicher viele der klinischen Aufmerksamkeit und den üblichen morphologischen Untersuchungsmethoden entgehen. Sie ist nicht geeignet, potentielle Opfer zu erkennen.Mit Unterstützung des Ministeriums f. Gesundheitswesen (HFR Schwangerschaft und frühkindliche Entwicklung, FR Genetische Defekte). Auszugsweise vorgetragen auf dem IV. Internationalen Myologie-Kolloquium in Jena 1984     

Deleterious effects of low-dose oestrogen theraphy on coronary status in patients with prostatic cancer

The effects of oestrogen therapy and of orchidectomy on coronarystauts, as reflected by exercise ECG-testing before and afteryear of tretment, were assessed in a randomized study of patients(N=100) prostatic cancer. Oestrogen was given as polyestradiolphosphate 80 mg i.m. per month in combination with 150 µgor in pre-traetment exercise test results Twelve months afterstart of therapy the oestrogen group showed a significantlygreater depression of the ST-segment during maximal exercisein leads CH₂ (P<0.0005) and CH⁵)P<0.01) compared withthe pre-treatment depression. Twenty-five per cent (N=13) ofthe patients in the oestrogen group suffered cardiovascularcomplications during the yera the of therapy, whereas no suchcomplications were observed in the orchidectomy group. However,even the patients in the oestrogen group who had not sufferedcardiovascular complications had significantly greater depressionsof the ST-segment during exercise both in lead CH₂ (P<0.0005)and in CH₅ (P<0.05). There was no significant change in theST-segment level in the orchidectomy group twelve months aftersurgery. In summary, we found of an induction of myocardialishaemia during treatment with exogenous oestrogens at low dosagein patients with prostatic. This deleterious effect of oestrogenon the coronary status argues against oestrogen therapy, sinceoedtrogen has not been shown to be more beneficial than orhidectomyagainst prostatic carcinoma.     

Potentiation of central effects of L-dopa by an inhibitor of catechol-O-methyltransferase

Summary The effects of a COMT-inhibitor, U-0521, and a MAO-B-inhibitor, l-deprenyl, on L-dopa-induced circling behaviour were compared in 6-OHDA-lesioned rats. The actions of U-0521 and l-deprenyl on the anticataleptic effect of L-dopa were also studied. Both U-0521 and l-deprenyl were found to potentiate L-dopa-induced circling behaviour and anticataleptic effect of L-dopa. In both test systems the L-dopa potentiation of l-deprenyl was longer-lasting than that caused by U-0521. Thus inhibition of COMT, like inhibition of MAO, is able to enhance the central effects of L-dopa. This principle might be beneficial in the treatment of Parkinson's disease especially if COMT-inhibitors with greater performance can be developed.     

Immunologic defects as possible causes of therapeutic failures in children with transposition of the great arteries

Summary Recurrent and severe infections and absence of thymic shadow in X-ray examination were observed in children with the transposition of the great arteries (TGA). Among 45 children (29 boys and 16 girls) with TGA whose age ranged from 3 days to 16 years and who were hospitalized during 1 year, infectious diarrhea was observed in 77.7% cases, urinary tract infections in 44.5%, respiratory tract infections in 42.2%, sepsis in 17.5%, and meningitis in 8.8%. Nine of the children died, sepsis was a cause of death in seven children, and there were postsurgical complications in two children. Immunologic abnormalities in children with TGA included a decreased level of T-lymphocytes and T_29° subpopulation, impaired mitogen-induced lymphoproliferation in vitro, and increased nitro blue tetrazolium (NBT) reduction activity of monocytes. Impaired parameters of cellular immunity correlated with worst clinical status. No disorders of humoral immunity were observed. These observations may be important for forming opinion about proper therapy and the cause of death in children with TGA.All results have been included in T. Marek-Szydowska's doctoral dissertation and were communicated at the 65th Annual Meeting of Deutsche Gesellschaft für Rechtsmedizin, St. Gallen, Switzerland, Sept. 9–13, 1986     

Controversies in plastic surgery: Suction-assisted lipectomy (SAL) and the hCG (human chorionic gonadotropin) protocol for obesity treatment

The advent of SAL (suction-assisted lipectomy) has dramatically increased the number of obese patients coming to our consultation offices. Despite several articles suggesting a conservative approach to fat suction, some reports insinuate that SAL might be a useful tool for obesity treatment. This hypothesis is refuted by a vast body of evidence that concludes that the adipose tissue may regenerate in adult humans. Therefore, surgical procedures are not advised as the method of choice to manage the disease. On the other hand, the terms obesity and being overweight may not be interchangeable. Obesity may be a disease whereas being overweight is asign of the disease. Consequently, proper preoperative selection of candidates for SAL becomes mandatory. The hCG (human chorionic gonadotropin) method for obesity treatment appears to be a complete program for the management of obesity. It contains pharmacologic, dietetic, and behavior modification aspects in a 40-day course of treatment. Some data suggest hCG to be lipolytic, thus explaining former clinical observations regarding body fat redistribution in treated patients. hCG commercial preparations contain -endorphin, an opioid peptide linked to mood behavior. This article speculates on the possible actions of the complex hCG -endorphin in the neuromodulation of mood and energy metabolism. The method comprises a behavior modification that helps in handling the patient better. There are some correlations between a current behavior modification program and the basic guidelines contained in the hCG protocol. Thus, the hCG method appears to be a reasonable alternative in the management of a long-standing, unsolved problem of human metabolism.