Resection of pulmonary metastases following chemotherapy for high stage testicular tumors

BACKGROUND: Our objective was to analyze retrospectively our experience with 19 patients who had metastatic germ cell testicular tumor and had undergone resection of pulmonary metastases following chemotherapy. We wished to determine the necessity of thoracic surgery on these patients. METHODS: Of 103 patients in need of postchemotherapeutic surgery for metastatic germ cell testicular tumors, 19 patients (mean age 31) underwent surgery for thoracic masses following cis-platin based chemotherapy. Resection of pulmonary metastases was performed on patients with normal tumor markers after chemotherapy, who did not achieve complete radiological remission. Histopathological findings, correlation with the pathology of abdominal surgery and probable prognostic factors for disease-free and overall survivals were evaluated. RESULTS: Disease-free and overall survival rates were 14/19 (73%) and 16/19 (84%), respectively, within a median follow-up time of 30 months (15-212 months). Patients with and without viable tumor cells in their thoracic histopathological specimen had 40% and 85% disease-free survival rates, respectively (P < 0.05). Eight patients had both abdominal and thoracic postchemotherapy surgery. Only two (25%) of these patients had the same histopathological features at both sites. CONCLUSIONS: All patients with residual thoracic masses must be considered candidates for surgery, because there are no predictive factors to determine the thoracic pathology without surgery. With the resection of the pulmonary metastases only, surgery can be performed without significant morbidity and is essential to select patients for further chemotherapy, to remove all visible masses and to provide histopathological confirmation. Patients with viable tumor cells in the thoracic surgical specimen have a poor prognosis.     

Radiofrequency Ablation of Symptomatic but Benign Ventricular Arrhythmias

Two cases are presented where ablation of severely symptomatic ventricular arrhythmias not responding to medical therapy was accomplished with radiofrequency current application. After a routine programmed stimulation protocol, a quadripolar ablation catheter with a 4-mm tip was advanced percutaneously into the left ventricle in one case and into the right ventricle in the second case; and after precise pace mapping, the arrhythmogenic focus was successfully ablated using radiofrequency current. The postablation ambulatory recording revealed virtual eradication of ventricular ectopy in both cases. In conclusion, in severely symptomatic cases of "benign" ventricular arrhythmias, radiofrequency ablation offers an effective therapeutic alternative.     

Intracellular replication of fusobacteria requires new actin filament formation of epithelial cells

We examined survival and replication of fusobacteria inside epithelial cells. Subconfluent cultures of HaCaT keratinocytes were infected with five bacterial strains representing three Fusobacterium species: F. nucleatum, F. necrophorum, and F. mortiferum. Adhesion and invasion of the bacteria were assayed before and after antibiotic treatment that killed the adhered and extracellular bacteria. The number of live fusobacteria was examined by bacterial culturing after sonication of the epithelial cells. The role of host cell cytoskeleton functions was examined by treating the epithelial cells with cell function inhibitors. Number of viable epithelial cells was measured with the CellTiter96 kit. The tested Fusobacterium species adhered to and invaded the epithelial cells, and multiplied intracellularly for several hours. Thereafter, the intracellular number of bacteria rapidly declined. Concomitantly, viable fusobacteria were detected in the culture medium. Treatment of the infected epithelial cells with an actin formation inhibitor markedly reduced the number of living intracellular fusobacteria. Newly formed actin filaments were seen by confocal microscopy in the epithelial cells associated with the invaded bacteria. Fusobacteria infection did not reduce the number of viable epithelial cells in culture. Thus, fusobacteria are able to adhere to and invade epithelial cells, and survive under aerobic conditions. This property may enable them to survive in mucosa and participate in various disease processes of oral and pharyngeal tissues.     

The Importance of Needle Echogenity in Ultrasound Guided Axillary Brachial Plexus Block: A Randomized Controlled Clinical Study

Objective: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery.Methods: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded.Results: Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N.Conclusion: We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.     

The effect of nitrous oxide diffusion on laryngeal mask airway cuff inflation in children

We studied the effect of nitrous oxide (N₂O) diffusion on size 2 LMA cuff inflation in 52 children, 38±21 months of age. LMA cuffs were inflated with air (Group A) or 65% N₂O, oxygen and halothane (Group B). Cuffs were inflated in a stepwise manner, achieving a cuff leak pressure of 17±4 cm H₂O for all patients. Cuff volume and intracuff pressure increased in Group A (8.5±1.0 ml to 10.8±1.4 ml and 101±36 mmHg to 152±42 mmHg, respectively) and decreased in Group B (8.9±1.0 ml to 6.6±1.5 ml and 90±30 mmHg to 53±37 mmHg, respectively). Cuff leak pressure did not change significantly in either group. We conclude that cuff inflation with a mixture of N₂O/oxygen prevents N₂O diffusion into the cuff, avoiding cuff overinflation without compromising LMA function.     

Excitatory amino acid transporters EAAT‐1 and EAAT‐2 in temporal lobe and hippocampus in intractable temporal lobe epilepsy

Intractable temporal lobe epilepsy (TLE) is an invalidating disease and many patients are resistant to medical treatment. Increased glutamate concentration has been found in epileptogenic foci and may induce local over‐excitation and cytotoxicity; one of the proposed mechanisms involves reduced extra‐cellular clearance of glutamate by excitatory amino acid transporters (EAAT‐1 to EAAT‐5). EAAT‐1 and EAAT‐2 are mainly expressed on astroglial cells for the reuptake of glutamate from the extra‐cellular space. We have studied the expression of EAAT‐1 and EAAT‐2 in the hippocampus and temporal lobe in 12 patients with TLE by immunhistochemistry and densitometry. The expression of EAAT‐1 and EAAT‐2 was reduced to approximately 40% and 25%, respectively, in CA1 of the hippocampus. In the same area, an increased expression of glial fibrillary acid protein (GFAP) at 90% reflected molecular rearrangements and upregulation of GFAP in the existing astrocytes as Ki‐67 staining failed to demonstrate any signs of astrocytic proliferation. The aetiology of the reduced expression of EAAT‐1 and EAAT‐2 remains unclear. The downregulation of EAAT‐1 and EAAT‐2 may be an adaptive response to neuronal death or it may be a causative event contributing to neuronal death. Further studies of the EAATs and their function are needed to clarify the mechanisms and significance of EAAT‐1 and EAAT‐2 disappearance in TLE.     

Right-Sided Versus Left-Sided Radiofrequency Ablation of the His Bundle

Radiofrequency (RFJ ablation of the His bundle was attempted in 30 consecutive patients with atrial flutter or fibrillation. A 7 French quadripolar catheter with a 4-mm distal electrode was advanced from the right femoral vein (21 patients), or subclavian vein (two patients) and positioned across the tricuspid valve. Adequate His-bundle potentials were obtained in all patients. However, in six patients atrioventricular (AV) block could not be obtained after multiple (mean = 8) applications of RF energy from the conventional right-sided approach. In these patients the same catheter was advanced to record a His potential through a retrograde arterial approach. AV block was created in all patients with one to three applications of RF energy. The duration of the procedure was 22 to 90 minutes for the right-sided approach and 5 to 10 for the left-sided approach (P < 0.005). Subsequently, in seven patients a left-sided approach was used first. One to six applications of RF energy were required to create AV block. The radiation exposure time was 3 to 20 minutes. No complications occurred. Conclusions: RF ablation of the His bundle seems easier using a left-sided than a right-sided approach, reduces procedure and radiation time, and avoids recovery of conduction. These data suggest that a left-sided approach, in spite of requiring arterial catheterization, may be preferable to a right-sided approach.