Comparison of rat liver preservation with Eurocollins and a modified University of Wisconsin solution: transplantation and isolation of hepatocytes for culture

The efficiency of Eurocollins or modified University of Wisconsin (UW) solution (MUW) in preserving rat livers was compared. After cold storage with one of the solutions, the livers were transplanted or perfused by collagenase for isolation of hepatocytes. Five of the 6 rats receiving a graft preserved with MUW versus none of the 6 rat receiving a graft preserved with Eurocollins solution survived 24 h or more. A significantly greater number of hepatocytes were isolated from livers preserved with MUW than from livers preserved with Eurocollins solution. This suggests a better reperfusion of MUW-preserved livers by collagenase resulting from less endothelial injury. LDH release by cultured hepatocytes, ketone body production and stimulation by glucagon were not significantly different between the two groups. These results confirm the superiority of MUW solution over Eurocollins in preserving liver grafts. They suggest that the advantage of MUW solution results from better protection of vascular endothelium rather than of hepatocytes.     

Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgery.

BACKGROUND. Because of the rarity of adrenocortical carcinoma, survival rates and prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors in all patients treated during a 12-year period by its members. METHODS. One hundred fifty-six patients (95 women, 61 men) with a mean age of 47 years were included. Functional symptoms were found in 52% of patients, and hormonal studies revealed secreting tumors in 62% of cases. Ninety-four percent of the patients underwent resection of the adrenal tumor, and 20% of them had extensive resection because of invasive cancers. Complete resection was achieved in 127 patients (81%) and incomplete resection in 29 patients. Mean tumor weight was 714 gm (range, 12 to 4750 gm), and the mean diameter was 12 cm (range, 3 to 30 cm). The results of the tumor staging were stage I, eight patients (5%); stage II (local disease), 75 patients (48%); stage III (locoregional disease), 39 patients (25%); and stage IV (metastases), 34 patients (22%). RESULTS. The 5-year actuarial survival rates were 34% overall, 42% in curative group, 53% in local cancer group, 24% in regional disease group, and 27% in the reoperated group. One-year actuarial survival rate of the palliative group was 9% (median survival, 6 months). Multivariate analysis showed that better prognosis occurred in patients younger than 35 years of age (p = 0.01) and in patients with androgen-secreting tumors, precursor-secreting tumors, or nonsecreting tumors (p = 0.003). Mitotane improved the survival rate only in patients with metastases who received it after operation (vs non-mitotane-treated patients [p < 0.05]). CONCLUSIONS. In this study age, extent of disease, aspect of the surgical resection, and type of hormonal secretion influenced survival.     

Primary lung cancer in young patients: a study of 82 surgically treated patients.

The aim of this study was to evaluate the prognosis for surgically treated young patients with primary lung cancer, a prognosis generally considered to be very poor. Eighty-two patients less than 40 years of age were operated on at Marie-Lannelongue Hospital between 1982 and 1990. There were 72 male and 10 female patients. Ten patients (12%) had never smoked, whereas 48 patients (59%) had smoked for more than 20 pack-years. The lung cancer was asymptomatic in 27 patients (33%) and symptomatic in the others. Adenocarcinoma was found in 42% of the patients, epidermoid carcinoma in 28%, mixed cell carcinoma in 16%, small cell carcinoma in 8.5%, and undifferentiated large cell carcinoma in 6%. Among the 69 resected tumors, 22 were stage I, ten were stage II, 32 were stage IIIa, and five were stage IIIb. The resection was considered complete and curative in 56 patients (68%) and noncurative in 26 (32%) either because of an incomplete resection (12 in stage IIIa; 1 in stage IIIb) or because of an exploratory thoracotomy only (13). The overall actuarial 5-year survival rate was 41%, and the actuarial 5-year survival for patients who had a complete resection was 56%. The actuarial 5-year survival rates were as follows: patients in stage I, 70%; stage II, 54%; stage IIIa, 28%; stage IIIb, 0%; and patients having exploratory thoracotomy only, 18%. These survival rates are similar to those of patients older than 40 years with similar stages of disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Costal chondroma and chondrosarcoma

The aim of this study was to report two cases of chondrosarcoma located on the chest wall, in order to emphasize the difficulty encountered by the pathologist to differentiate a chondrosarcoma from a chondroma and the importance, in our opinion, of performing a large resection with wide margins in all cases.     

South African Fathers Involvement and Their Adolescents’ Sexual Risk Behavior and Alcohol Consumption

Although considerable research has examined the influence of parent-adolescent relationships on the sexual health of adolescents, there is a great need for research to understand the influence of fathers on their children’s HIV sexual risk behavior, particularly in sub-Saharan Africa. We examined how the residence and the involvement of fathers are related to their children’s HIV sexual risk and alcohol consumption behaviors. A cross-sectional survey was completed by 175 sixth-grade adolescents in the Eastern Cape Province, South Africa. Analyses showed that adolescents living with their fathers had fewer sexual partners (B?=?? 0.606, SE?=?0.299, p?=?.043) and consumed alcohol less frequently (B?=?? 0.642, SE?=?0.294, p?=?.029). Adolescents who spent more quality days with their fathers in the past 30 days had fewer sexual partners (B?=?? 0.103, SE?=?0.039, p?=?.008) and had condomless sex less frequently (B?=?? 0.097, SE?=?0.047, p?=?0.041). It was also found that there were significant father-residence?×?child-gender interactions on sexual debut (B?=?1.132, SE?=?0.564, p?=?.045) and on frequency of condomless sex (B?=?? 2.140, SE?=?0.924, p?=?.021). These interactions indicate that boys living with their fathers were less likely to have had vaginal intercourse than girls and that girls living with their fathers were less likely to have unprotected sex than boys. This study highlights the importance of South African fathers’ roles in their adolescent children’s HIV sexual risk and alcohol drinking behaviors and the need to promote father-child relationships for adolescent health. The results suggest that health programs aiming to reduce South African adolescents’ HIV sexual risk behaviors and alcohol consumption consider strategies that target their fathers.

     

Cluster-Randomized Controlled Trial of an HIV/Sexually Transmitted Infection Risk-Reduction Intervention for South African Men

Objectives. We tested the efficacy of a sexual risk-reduction intervention for men in South Africa, where heterosexual exposure is the main mode of HIV transmission.Methods. Matched-pairs of neighborhoods in Eastern Cape Province, South Africa, were randomly selected and within pairs randomized to 1 of 2 interventions based on social cognitive theory and qualitative research: HIV/sexually transmitted infection (STI) risk-reduction, targeting condom use, or attention-matched control, targeting health issues unrelated to sexual risks. Sexually active men aged 18 to 45 years were eligible. The primary outcome was consistent condom use in the past 3 months.Results. Of 1181 participants, 1106 (93.6%) completed the 12-month follow-up. HIV and STI risk-reduction participants had higher odds of reporting consistent condom use (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.03, 1.71) and condom use at last vaginal intercourse (OR = 1.40; 95% CI = 1.08, 1.82) than did attention-control participants, adjusting for baseline prevalence. No differences were observed on unprotected intercourse or multiple partnerships. Findings did not differ for sex with steady as opposed to casual partners.Conclusions. Behavioral interventions specifically targeting men can contribute to efforts to reduce sexual risk behaviors in South Africa.South Africa has more HIV cases than any other country, and like other sub-Saharan countries, has a predominantly heterosexual epidemic.1 In such an epidemic, men have an especially critical role to play: they are the ones who don male condoms, a particularly effective and available means of prevention, and thus control their use. They have, it has been argued, more power than women in relationships2–4 and are responsible for infecting women in many contexts, including forced intercourse and violence.3 Although calls for male responsibility in sexual behavior related to HIV and other sexually transmitted infections (STIs) have been made repeatedly,5–7 to our knowledge, only 1 study has evaluated an intervention created specifically for heterosexual men in South Africa.8 Men who received the gender-based-violence-and-HIV-risk-reduction intervention were more likely to report talking with a partner about condoms and using condoms consistently 1-month postintervention compared with men in an alcohol-and-HIV-risk-reduction control intervention.The present study evaluated an HIV/sexually transmitted infection (STI) risk-reduction intervention for South African men who have intercourse with women. We used a cluster-randomized design to reduce the potential for contamination between treatment arms that would be present if we were to randomize individuals. We randomized randomly selected neighborhoods (i.e., clusters) to a 3-session intervention based on social cognitive theory9 and extensive formative research10 and designed to reduce HIV/STI risk behavior or to a 3-session attention-control intervention designed to promote health by improving diet and physical activity. We hypothesized that the HIV/STI risk-reduction intervention would increase self-reported consistent condom use during vaginal intercourse in the postintervention period, the primary outcome, compared with the attention-control intervention, controlling for baseline condom use.     

Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome

Objective: The aim of this paper is to study clinical characteristics, surgical treatment and outcome of patients with solitary fibrous tumor of the pleura operated in our institutions in a 20-year period. Methods: Clinical records of all patients operated for solitary fibrous tumors of the pleura between 1981 and 2000 were reviewed retrospectively. Tumors were classified as malignant in the presence of at least one of the following criteria: (1) high mitotic activity; (2) high cellularity with crowding and overlapping of nuclei; (3) presence of necrosis; (4) pleomorphism; otherwise they were considered as benign. Results: Sixty patients (mean age 55 years) were operated in this period. None had asbestos exposure. Symptoms were present in 31 cases. Surgical approaches included thoracotomy (n=53), video-assisted thoracoscopy (n=6), and median sternotomy (n=1). Tumors originated from visceral pleura in 48 cases, from parietal, mediastinal or diaphragmatic pleura in seven, two and three cases, respectively; their mean diameter was 8.5 cm. Tumors could be resected with their implantation basis in 49 patients. In the remaining 11, extended resections were performed, including lung parenchyma (lobectomy, n=4, pneumonectomy, n=2), osteomuscular chest wall structures (n=2), diaphragm (n=2), and pericardium (n=1). Two postoperative deaths (due to myocardial infarction and pulmonary embolism, respectively) occurred. Tumors were pathologically benign in 38 cases and malignant in 22 cases. Mean follow-up was 88 months. Resection was complete in all the patients with benign tumors and no recurrence occurred. Resection was considered as complete in 21/22 malignant tumors. Local recurrence was observed in two cases. Both could be successfully managed by iterative exeresis (no extended resection had been initially performed). Metastatic disease (responsible for patient's death) was observed following the only incomplete resection. Actuarial 5- and 10-year survival rates were 97% for benign tumors and 89% for malignant ones. Conclusions: Surgical resection provided cure in all the patients with benign tumors. As insufficiency of exeresis is associated with all recurrences in malignant tumors, completeness of resection is in our experience the best prognostic factor in these forms.     

Parathyroid adenomectomy under local anesthesia with intra-operative monitoring of UcAMP and/or 1-84 PTH

Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia. The intra-operative monitoring which predicts the cure of primary hyperparathyroidism with high accuracy allows the surgeon to conclude the operation with confidence.

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Resumen Teniendo en cuenta que 80% de los casos de hiperparatiroidismo primario se deben a un adenoma único, y puesto que actualmente la mayoría de los adenomas pueden ser visulizados con ultrasonografía, hemos intentado resecar posibles adenomas únicos bajo anestesia local con monitoría intraoperatoria de la AMPc urinaria y de los niveles séricos de PTH 1-84. En los últimos dos años hemos operado 45 pacientes (65 años de edad en promedio) con hiperparatiroidismo primario bajo anestesia local y la demostración ultrasonográfica de un muy posible adenoma único. Se excluyeron de la serie los pacientes con ultrasonografía equívoca, así como los casos asociados con patología tiroidea o enfermedad multiglandular y los pacientes poco cooperadores. Se hizo la determinación de UcAMP (AMP urinaria cíclica) y de 1-84 PTH antes de efectuar la incisión, en el momento de la remoción del adenoma y a intervalos regulares hasta 120 minutos luego de terminada la operación. Los resultados estuvieron disponibles a los 45 a 60 minutos de la toma de la muestra para PTH y a los 60 a 80 minutos para la UcAMP. Se resecaron 42 adenomas a través de una incisión de 2–3 centímetros en un tiempo promedio de 25 minutos, sin efectos adversos, sin morbilidad y con mínima incomodidad para el paciente. Los 42 pacientes aparecieron mormocalcémicos en el seguimiento postoperatorio. La monitoría intraoperatoria predijo regularmente el éxito de la operación. Los tres pacientes restantes, y porque los niveles de las sustancias utilizadas para la monitoría continuaban elevados al final del procedimiento, fueron sometidos a la operación clásica bajo anestesia general, con disección bilateral del cuello. Este novedoso aproche, que puede ser practicado con seguridad, resulta en un tiempo operatorio muy breve y una corta permanencia en el hospital. Evitar la anestesia general resulta satisfactorio para aquellos pacientes que son reacios a aceptar la anestesia general. La monitoría intraoperatoria, que predice la cura del hiperparatiroidismo con un elevado grado de certeza, permite al cirujano completar la operación con la confianza de un buen resultado.

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Résumé Puisque 80% des hyperparathyroïdies primaires sont dues à un adénome solitaire, et puisqu'il est actuellement possible de bien visualiser les parathyroïdes par échographie, nous avons essayé d'opérer sous anesthésie locale en dosant la concentration urinaire d'AMPc (UAMPc) et de PTH 1-84 dans le sérum pendant l'intervention. Dans les deux dernières années, 45 patients (âge moyen 65 ans) ayant une hyperparathyroïdie primaire ont été opérés sous anesthésie locale car l'échographie laissait soupçonner l'existence d'un adénome solitaire. Les critères d'exclusion étaient l'absence d'échographie formelle ou typique, la notion de pathologie multiendocrininne gandulaire (dont l'association à une pathologie thyroïdienne) et la mauvaise coopération des patients. Les dosages de l'U AMPc et la PTH 1-84 étaient déterminés avant l'incision, au moment de l'exérèse de l'adénome et à intervalles réguliers jusqu'à 120 minutes après l'opération. Les résultats étaient disponibles en 45 à 60 minutes en ce qui concerne la PTH, et en 60 à 80 minutes pour l'U AMPc. Quarante-deux adénomes ont été enlevés ainsi par une incision de 2–3 cm. La durée de l'intervention était de 25 minutes; il n'y a eu aucun effet secondaire, pas de morbidité et l'inconfort a été minimal. Les 42 patients ont tous été normocalcémiques. Le monitorage a toujours prédit le succès de l'opération. Chez les trois autres patients, les valeurs de calcémie sont restées élevées en fin d'intervention et ces patients ont été opérés sous anesthésie générale avec une dissection cervicale classique. Cette nouvelle approche est compatible avec un temps d'intervention et d'hospitalistaion courts. L'absence d'anesthésie générale présente un attrait certain pour le malade qui y est réticent. Le monitorage peropératoire qui prédit la cure d'hyperparathyroïdie avec une grande précision permet au chirurgien de terminer l'intervention en toute confiance.

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Presented at the International Association of Endocrine Surgeons in Stockholm, Sweden, August, 1991.     

Effect of low dose rate irradiation on the division potential of cells in vitro. VI. Changes in DNA and in radiosensitivity during aging of human fobroblasts

The sensitivity to low dose rate ionizing radiation increases progressively through the lifespan of human embryonic lung fibroblasts. There is also an increase in the number of alkali-sensitive sites leading to an increase in single-strand breaks and in DNA with low molecular weight during cell lysis. These DNA changes become pronounced at the very end of the lifespan. The correlation between aging, increased radiosensitivity and accumulation of DNA damage is discussed.