Regional activity of galactose-1-phosphate uridyltransferase in rat brain.

The sp act of galactose-1-phosphate uridyltransferase has been measured in individual regions of adult rat brain to see if site-specific differences in enzyme activity can aid in the understanding of brain abnormalities observed in well-treated galactosemic patients. The sp act in the cerebellum, brain stem, and midbrain were higher than in the cortex, hippocampus, and striatum. Activity in the cerebellum was 2-fold greater than that found in the cortex. Steady state levels of mRNA of the enzyme in the cerebellum were twice that of the cortex corresponding to the ratio of enzyme sp act in the two regions. Measurement of the kinetic parameters in tissue from the cerebellum and cortex revealed that the regional specificity in enzyme activity observed in the brain represents differences in the Vmax. Inhibition of the enzyme by uridine and uridine triphosphate was essentially the same for all regions and was not influenced by the 2-fold differences observed in the levels of enzyme. Inhibition by uridine was significantly greater than that for uridine triphosphate.     

Experienced clinical educators improve their clinical teaching effectiveness.

OBJECTIVES: To determine if experienced clinical educators (CEs) can improve their teaching by incorporating 4 literature-based teaching methods into their instruction. METHODS: We trained 7 experienced CEs on the teaching methods during a monthly faculty development program. Each CE recorded use of these methods during 10 months on a personal digital assistant. We compared the CEs' teaching evaluations with those of nonparticipating faculty by analysis of variance at baseline, during the study period, and for 1 year after the study. RESULTS: Reported use of 2 teaching methods (priming and feedback) increased significantly over use at baseline; use of 2 other methods (teaching in the patient's presence and 1-2 focal teaching points) remained constant. Scores on the CEs' teaching evaluations were significantly higher during the study period on 1 item, whereas the comparison group showed no changes. The changes persisted during the follow-up period. CEs reported that the teaching methods focused the learner and teacher, making subsequent encounters more productive. They also found that the act of entering data daily prompted them to reflect on their teaching. CONCLUSIONS: Experienced teachers can be persuaded to incorporate new methods into their daily teaching. Reflection on teaching is enhanced with group support and daily reminders. With these interventions, teaching effectiveness of these experienced educators improved.     

Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma.

Between 1977 and 1987, 519 patients underwent operation for rectal carcinoma. Sixty-three patients underwent intersphincteric resection with direct coloanal anastomosis (CAA), and 77 had an abdominoperineal resection (APR). Curative surgery was achieved in 57 and 65 patients, respectively. Both groups were comparable regarding age, stage of tumors, and localization of tumors. During the mean period of 6.7 years (range: 3 to 13.6 years), all patients were examined according to a predefined follow-up plan. From those patients with curative surgery, 11% presented with pelvic recurrence and 33% with distant metastases after coloanal anastomosis; the rates of recurrence and distant metastases after APR were 17% and 35%, respectively. The corrected 5-year survival rates were 62% following CAA and 53% following APR. Eighty-five percent of the patients with CAA reported good functional results regarding anal continence. Our study demonstrates that the intersphincteric resection with CAA is a valuable surgical technique for rectal carcinoma with the benefit of preservation of continence. It is suitable for neoplasms with high- and medium-grade differentiation (G1 to G2) and a localization that allows a minimum distal clearence of 3 cm.     

The orthopan tomoscintigram — a new application of emission computed tomography for facial bone scanning

The exact regional correlation of findings of facial bone scans, planar or SPECT, to dental orthopan X-ray films (OPT) is difficult because of the very different projection techniques. To improve correlative imaging in this regard a projection algorithm was developed that uses SPECT data of the skull for reconstructing an orthopan tomoscintigraphic projection. Fourteen conventional SPECT slices of the upper and lower jaws were obtained during bone scanning. All mandibular slices were superimposed resulting in a horseshoe shaped structure, which was marked by an ROI which was divided into segments. All 14 SPECT slices were then masked by this segmental ROI, thereby marking the teeth-carrying bone in all slices. The information from this horseshoe like ROI is then transformed into lines. Line by line arrangement results in an orthopan projection, the orthopan tomoscintigram. This new display allows 1:1 true scale superimposition with the X-ray OPT and markedly facilitates correlative imaging.     

Resektion der Vena jugularis interna bei infizierter Thrombose Management einer seltenen Komplikation nach Polychemotherapie bei metastasiertem, testikul?rem Keimzelltumor

Zusammenfassung Für die Therapie bei infizierten Thrombosen der großen Halsvenen und zentralen Venen gibt es kein standardisiertes therapeutisches Vorgehen. Sowohl konservative als auch aggressive, invasive Therapiestrategien werden beschrieben. Wir präsentieren den Fall einer septischen Thrombose der rechten V. jugularis interna nach einliegendem zentralem Venenkatheter bei einem immunsupprimierten Patienten nach Polychemotherapie wegen eines metastasierten Seminoms des rechten Hodens. Nach konservativem Therapieversuch mit intravenöser antibiotischer Therapie und therapeutischer Heparinisierung wurde wegen des sich verschlechternden septischen Zustandsbildes des Patienten die Indikation zur chirurgischen Intervention gestellt. Intraoperativ war eine Thrombektomie unmöglich, sodass eine vollständige Resektion der rechten V. jugularis interna durchgeführt wurde. Der postoperative Verlauf war komplikationslos. Der histopathologische Befund zeigte eine putride Thrombophlebitis mit ausgeprägter Periphlebitis; die kulturellen Untersuchungen aus dem Wundgebiet und Blutkulturen wiesen übereinstimmend Staphylococcus aureus nach. Vor allem der immunsupprimierte Patient mit Neutropenie und Thrombopenie erfordert ein aggressives chirurgisches Vorgehen zur sicheren und schnellen Befundsanierung. Abstract There is no therapeutic standard for the treatment of septic thrombosis of the central veins. We present a case of septic thrombosis of the right internal jugular vein. The immunocompromised patient had a central venous line for polychemotherapy of metastasized seminoma of the right testis. After conservative therapy with antibiotics and therapeutic heparinization the septic status of the patient worsened rapidly and surgical intervention was planned. Intraoperatively, thrombectomy was not feasible and complete resection of the right internal jugular vein became necessary. Postoperative reconvalescence was uneventful. Histopathological findings showed purulent suppurative thrombophlebitis and marked periphlebitis, mirobiology revealed staph. aureus both in the catheter insertion site and in blood cultures. Especially in immunocompromised patients with severe granulo- and thrombocytopenia, surgery may be attributed with less danger for the patient than prolongued septicemia.     

Total Femur Antibiotic Spacers: Effective Salvage for Complex Periprosthetic Joint Infections

BackgroundA simultaneous periprosthetic joint infection (PJI) of an ipsilateral hip and knee arthroplasty is a challenging complication of lower extremity reconstructive surgery. We evaluated the use of total femur antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers in the staged treatment of such limb-threatening PJIs.MethodsThirteen patients were treated with a total femur antibiotic spacer. The mean age at the time of spacer placement was 65 years. Nine patients had polymicrobial PJIs. All spacers incorporated vancomycin (3.0 g/40 g PMMA) and gentamicin (3.6 g/40 g PMMA), while 8 also included amphotericin (150 mg/40 g PMMA). Eleven spacers were biarticular. Twelve spacers were implanted through one longitudinal incision, while 8 of 12 reimplantations occurred through 2 smaller, separate hip and knee incisions. Mean follow-up after reimplantation was 3 years.ResultsTwelve (92%) patients underwent reimplantation of a total femur prosthesis at a mean of 26 weeks. One patient died of medical complications 41 days after spacer placement. At latest follow-up, 3 patients had experienced PJI recurrence managed with irrigation and debridement. One required acetabular component revision for instability. All 12 reimplanted patients retained the total femur prosthesis with no amputations. Eleven (91%) were ambulatory, and 7 (58%) remained on suppressive antibiotics.ConclusionTotal femur antibiotic spacers are a viable, but technically demanding, limb-salvage option for complex PJIs involving the ipsilateral hip and knee. In the largest series to date, there were no amputations and 75% of reimplanted patients remained infection-free. Radical debridement, antimicrobial diversity, prolonged spacer retention, and limiting recurrent soft tissue violation are potential tenets of success.Level of EvidenceIV.     

Results and 10-year follow-up in patients with squamous cell carcinoma of the penis

Penile malignancies are infrequent but represent a diagnostic and therapeutic challenge as patients tend to disregard early asymptomatic lesions of the disease. Due to the lack of studies involving large patient numbers, the therapeutic concepts for different stages of the disease could not be defined by prospective studies. Long-term results are rare. We present the therapeutic concepts and the 10-year results of our experience with 42 cases of penile carcinoma treated at our institution between 1973 and 1986. Therapy included radical circumcision in 10 cases, local excision of the tumor in 4, partial or total glandular resection in 6 patients, partial penectomy in 20, and total penectomy in 2 cases. Inguinal lymphadenectomy was performed initially in 14 cases with positive histology in 7 patients (50%). Complications included meatal stenosis in 8 cases (19%), urethral stricture in 1 case, death due to fulminant pulmonary embolism in 1 case and local infections in 2 cases. Follow-up of patients with initially nonmetastatic disease showed a progression to death in 4 of 35 patients (11.6%) with a mean survival of 30 (range 11.5-56) months, in patients with initial lymph node metastases progression to death occurred in 5 of 7 patients (71.4%) with a mean survival of 9.76 months (range 9 days to 24 months). Stage-related disease-specific 10-year survival rates are 100% for stages 0 and 1, 90.9% for stage 2, and 20% for stage 3, while no patient in stage 4 survived for 5 years. From our data we conclude that the single most important prognostic factor in the treatment of carcinoma of the penis is lymph node involvement. Therefore increased attention has to be paid to the recognition of early stages of this potentially curable disease.