Primary hypertrophic pyloric stenosis. A are form and stomach outlet stenosis in the adult

A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. Diagnosis of benign pyloric stenosis was made preoperatively and the patient was successfully treated by Finney pyloroplasty. Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.     

Natürlicher Verlauf bei Hüftdysplasie und Operationsergebnisse

Background

The prevalence of hip dysplasia in epidemiological studies ranges from 1–20%. The associated deformity is a risk factor for secondary osteoarthritis (OA) of the hip.

Objective

What is the natural course of hip dysplasia and is it influenced by cofactors? How successful are corrective surgical procedures?

Material and methods

Analysis of published investigations up to 2018 which provide data about the natural course of hip dysplasia and the results of the most important surgical treatment procedures.

Results

The vast majority of published studies confirm a correlation between hip dysplasia and OA. The risk of OA increases with reduced acetabular coverage and severity of instability (subluxation). Long-term survival and functional results after pelvic osteotomies are meanwhile very good, if the procedure is performed in young or middle-aged patients with good congruency of the joints and no relevant OA. Additional deformities (e.?g. cam deformity or femoral torsional malalignment) should be simultaneously addressed and the acetabular fragment needs optimal positioning. Only a few studies with small patient cohorts and short observation times are currently available on the isolated arthroscopic treatment of borderline dysplasia.

Discussion

The importance of hip dysplasia as an established risk factor for secondary OA and the good results of reorientation pelvic osteotomies justify surgical correction when considering the identified indication criteria. Due to a low but relevant potential for complications, surgery should currently not be recommended for asymptomatic patients in adulthood. Potentially relevant cofactors are important for estimation of the natural course as well as the indications for surgical correction.

     

Diagnostic and therapeutic management of symptomatic cholecystolithiasis and pre-operatively suspected choledocholithiasis

The goal of this study was to examine the effectiveness of endoscopic retrograde choledocho-pancreatography (ERCP) at the Unfallkrankenhaus Berlin in the setting of pre-operative suspicion of choledocholithiasis. The predictive value of various pathologic findings with regard to choledocholithiasis was to be determined in this patient population.All patients treated operatively for symptomatic cholecystolithiasis between August 2000 and August 2001 were evaluated retrospectively for the following variables: age, gender, operative strategy, intra-operative cholangiography, sonographic findings, occurrence of choledocholithiasis.In 21.4 % of 196 patients who underwent cholecystectomy (n = 42) a pre-operative ERCP was performed. In 19 of these 42 patients, no pathology was found on ERCP. The percentage of therapeutic pre-operative investigations was 47.6 % (n = 20). In 3 patients, a juxtapapillary diverticulum was seen.69.9 % of the operations (n = 137) were performed laparoscopically. 167 patients (85.2 %) underwent intra-operative cholangiography. In 4 patients, the ERCP was performed post-operatively. The indication for 3 of those 4 examinations was an abnormal intra-operative cholangiogram. Complications occurred in 4 of the 46 patients who underwent ERCP (8.7 %). Choledocholithiasis was found in 12.2 % (n = 24) of all 196 patients.The pathologic finding with the highest positive predictive value for the diagnosis of choledocholithiasis was the finding of a dilated common bile duct to more than 8 mm diameter (PPV 75 %). Among laboratory variables investigated in this study, the elevation of serum bilirubin level exhibited the highest positive predictive value (PPV 39.2 %).     

Structural changes in the course of bone conservation measured by pulsed nuclear magnetic resonance techniques

Summary Conservation of bone leads to structural changes of the tissues, such as increase of SH-groups and acidity. At the same time, a decrease in enzyme activity is observed. These alterations in the macromolecular structures are accompanied by changes of distribution of the tissue water. Using the technique of pulsed nuclear magnetic resonance (NMR), it is possible to evaluate the state of water in the tissue.In this work we measured the spin-lattice relaxation times (T₁) of tissue water protons as a parameter for structural changes in the course of conservation. Three different techniques of bone conservation were applied, in which the results of all measurements showed a significant decrease of T₁. In addition, we found a slight but not significant increase in the total tissue water content during the conservation period.By using the method we present, evidence of structural changes in bone tissue can be obtained in a simple but effective manner.

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Résumé La conservation de l'os entraîne des changements de la structure tissulaire, tels qu'une augmentation des groupements SH et une élévation du pH. On observe simultanément une diminution de l'activité enzymatique. Ces altérations des structures macromoléculaires s'accompagnent de changements dans la répartition de l'eau tissulaire. Grâce à la technique de résonance magnétique nucléaire pulsée (RMN) il est possible d'estimer l'état de l'eau dans les tissus.Dans le présent travail, on a mesuré les temps de relaxation du réseau du spin (T₁) des protons de l'eau tissulaire comme critère des changements structuraux lors de la conservation. Trois différentes techniques de conservation osseuse ont été utilisées; les mesures des T₁ ont montré que ces trois techniques déterminent une diminution significative de ce paramètre. Par ailleurs, les auteurs ont trouvé que la quantité totale d'eau tissulaire augmente légèrement mais de façon non significative lors de la période de conservation.En utilisant la méthode exposée ici, la preuve de changements structuraux dans le tissu osseux peut être obtenue de manière simple mais certaine.

     

Traumatische Vertebralisdissektion bei einem 8-Jährigen

Dissections of extracranial brain supplying arteries are a common cause of ischemic strokes in young patients. Accidents are often accountable for that. We report the case of an 8 year old boy with traumatic vertebral dissection after he was bumped while playing football. He developed an ischemia on both sides of the thalamus which was caused by a bilateral system of the vertebral artery. He showed motor eye and progressive neuropsychological deficits. The CT and MRI scan confirmed the diagnosis. The symptoms ameliorated under anticoagulation treatment with intravenous heparin. At the end of the hospital stay, neuropsychological deficits persisted. Doppler ultrasound showed recanalization of the vertebral artery. Further treatment consisted of anticoagulation with marcumar for 6 months.     

Concentration of estrogen and progesterone receptors in normal and neoplastic tissue in patients with laryngeal neoplasm

The analysis of larynx cancer localisation inside the larynx and hypopharynx indicate that there are some places prone to cancerogenesis. Differences in morbidity, organ localisation and prognosis of larynx cancer can be explained not only by exogenic factors but also by endogenic ones, including hormones. The estrogen (ER) hormone receptor concentration and progesterone (PgR) concentration was estimated in the neoplastic tissue in 18 patients (16 men, 2 women). In the control group, in 10 patients (9 men, 1 women) the concentration receptor was assessed in surrounding, macroscopically unchanged tissue. The quality assessment was done both in cytoplasmatic and nuclear receptors. 6 specimens of neoplastic tissue was taken from vocal folds, 7 from vestibular folds, 2 from subglottic space, 2 from epiglottic petiolus and 1 from pyriform sinus. Control group consist of 10 healthy tissue specimens including 4 taken from the vocal cords. 4 from vestibular folds, 2 from free edge of epiglottis. All samples were examined by pathologist. The concentration of cytoplasmatic and nuclei receptors (ER and PgR) was estimated by immunoenzymatic essay by ER-EIA and PgR-EIA monoclonal antibodies (Abbott). The highest concentration of receptors in larynx cancer was stated in tissue coming from vestibular folds and epiglottic petiolus in healthy objects in the region of vestibular folds.     

Changes in antioxidant enzyme activities and lipid peroxidation related to bromoethylamine-induced renal cytotoxicity

BACKGROUND: The effect of bromoethylamine (BEA) administration on lipid peroxidation and on the activities of antioxidant enzymes was studied. METHODS: Adult rats received BEA at 1.2 mmol/kg, a dose that produces renal papillary necrosis. Lipid peroxidation assessed by maximal rate in MDA formation, the activities of catalase, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the levels of non-protein sulfhydryls (NPSH) were measured in renal cortex and papilla of control and BEA-treated animals. RESULTS: After BEA treatment, an increment in lipid peroxidation in papilla and cortex was found after 1.5 and 24 hours of treatment. Catalase activity decreased in both regions, but earlier in cortex. CONCLUSION: These data suggest some role of oxidative stress in the mechanism of BEA-induced papillary necrosis.     

Die Implantation der trabekulär orientierten Hüfttotalendoprothese

Operationsprinzip Zementfreie Implantation eines kraftflu?orientierten Hüfttotal-Endoprothesensystems mit weitgehender Erhaltung der ?Substantia spongiosa?, welche die kraftübertragenden elastomechanischen und biodynamischen Elemente enth?lt. Die dauerhafte Verankerung der Endoprothesenpfanne geschieht über eine gro?fl?chige Integration in der Spongiosa am Acetabulum. Die Femurkomponente der Endoprothese besteht aus einer Tragplatte und verstrebten Pfeilern, die in der gesamten Trochanterregion verankert werden. Der Schenkelhals wird weitgehend erhalten. Die Vernetzung der Endoprothese in der Spongiosa, eine prim?re Rotationsstabilit?t und die Aufnahme von Zugkr?ften im Trochantermassiv erm?glichen eine ann?hernd physiologische Kraftübertragung am Hüftgelenk.