Mesenteric and omental cysts: An ultrasonographic and clinical study of 15 patients

The clinical and ultrasonographic (US) features of 15 cases of mesenteric or omental cyst are herein described. This series included seven male and eight female patients, whose age ranged from 2–89 years. Correct clinical diagnosis was made in two children only, but preoperative US examination accurately demonstrated the lesion in 11 of 13 patients (85%). These cystic lesions usually had a thin wall, internal septations, and fluid content with sedimentation. Enteric duplication cysts had a relatively thick wall merging with the muscle layer of bowel loop, and multiloculation was noted mainly with cystic lymphangiomas or pseudocysts. The diagnostic and surgical management of these lesions are briefly reviewed and their US appearance is illustrated.     

Management of thoracoabdominal aneurysm type IV.

BACKGROUND: Thoracoabdominal aneurysm type IV (TAA IV) represents only a minority of aortic aneurysms, but as it is an entirely abdominally located aneurysm, vascular surgeons are likely to see such aneurysms in their practice. The current surgical management of TAA IV is reviewed. METHODS: A PubMed/Medline-literature search for TAA IV. RESULTS AND CONCLUSIONS: A detailed preoperative evaluation to determine the rupture and operative risk is required. A threshold size of 5.5-6 cm is recommended for elective repair of TAA IV, which then is adjusted for age and other risk factors. Operative simplicity with the clamp and sew approach to obtain a short aortic cross-clamp time seems to have most support in the literature. The necessity of adjunct treatment to prevent visceral and spinal cord ischemia seems to be needed rarely. Uncomplicated repair has a minimal risk of neurological injury and a low risk of renal failure requiring dialysis in patients without preoperative renal dysfunction or renal artery stenosis. The role of endovascular repair of these aneurysms remains to be established.     

Focal pulmonary edema. Correlation with perfusion lung scan

Pulmonary embolism is diagnosed by a mismatched perfusion-ventilation lung scan. The probability is increased further when there is an associated "hot spot" in the perfusion study caused by focal pulmonary edema.     

Variability of measurements of visual acuity in a large eye clinic

PURPOSE: The aim of this study was to determine the variability of visual acuity in a large eye clinic. METHODS: A cross-sectional study using 50, consecutively presenting adult patients with visual acuity of at least 6/60 and aged between 18 and 75 years was performed. Measurements of visual acuity obtained under normal clinical conditions were compared to measurements obtained using standard clinical research protocols. The variability of visual acuity was assessed by determining the 95% limits of agreement between test and retest measures. RESULTS: There were no significant differences between test-retest measurements of visual acuity, either aided or unaided. Pearson r correlation coefficients between test and retest measurements were high for both aided and unaided visual acuity. The 95% limits of agreement revealed repeatability of about +/-1.5 logMAR or 1.5 lines on a standard logMAR chart. CONCLUSION: In large eye clinics, in order to be confident that a real change in visual acuity has occurred between measurements, a difference of at least 0.15 logMAR (8 letters on a standard logMAR visual acuity chart) is required.     

Interventional treatment of children with portal hypertension secondary to portal vein occlusion.

PURPOSE: To present methods and results of interventional treatment of children with portal hypertension (PH) secondary to portal vein occlusion (PVO). MATERIAL AND METHODS: Five children, four boys and one girl, 8 - 14 years old, with symptomatic PH secondary to PVO were treated. All children had one or more episodes of bleeding from oesophageal varices, enlarged spleen and thrombocytopenia. Partial embolisation of the spleen was performed in four children. Attempts to recanalize the occluded part of the portal vein were done in all children using transjugular (n = 4), transhepatic (n = 4) and transsplenic (n = 3) approaches. RESULTS: All procedures were carried out without serious complications and were followed by normalisation of the platelet count, decrease in splenic size and disappearance of bleeding. Recanalisation of the occluded portal vein with a stent was possible in one child and partial stent recanalisation was possible in another child. Transjugular intrahepatic portosystemic shunt (TIPS) with partly extrahepatic, intraperitoneal route was created in one patient. All children were scheduled for follow-up. During the observation time of 22 months (5 - 46 months), additional balloon dilation and placement of new stents were necessary in two children. CONCLUSION: Interventional procedures are valuable in the treatment of children with symptoms secondary to PVO. Treatment should be customized and scheduled follow-ups of the patients are necessary.     

Continuous infusion cisplatin and etoposide chemotherapy for cancer of unknown primary site (CUPS) in Taiwan, a region with a high prevalence of endemic viral infections

BACKGROUND: To evaluate the efficacy and toxicity of cisplatin/etoposide continuous infusion chemotherapy for cancer of unknown primary site in Taiwan, a region with a high prevalence of endemic viral infections. METHOD: Between April 1994 and February 1996, 20 patients with a diagnosis of CUPS were treated, including 15 males and five females, of average age 63.3 years (range 41-83 years). Continuous intravenous infusion of etoposide 80 mg/m2 and cisplatin 25 mg/m2 was given for 3 days every 3 weeks. Pretreatment tumor marker and viral serology studies were performed for baseline evaluation. Nearly two-thirds of the patients had poorly differentiated carcinoma. The average number of metastatic sites was 2.65 (range 1-4), with liver and lymph node involvement predominating. RESULTS: The overall response rate was 25% (95% CI 17.7-32.3%); 30.7% for poorly differentiated cancers and 25% for well differentiated cancers. Median survival was 4 months (range 1-12 months), 4.8 months for patients attaining partial response. Toxicity was moderate, grade 3 and 4 neutropenia occurred in 55% and grade 3 and 4 thrombocytopenia in 40%; other toxicities were mild. CA125 and CA199 were elevated in more than 50% of patients. Viral serology studies were not significantly different from those of the indigenous population. CONCLUSION: Etoposide and cisplatin combination chemotherapy has modest activity in patients with extensive CUPS and, at the schedule and dosage given, it is associated with moderate toxicity.      

The human epidermis models EpiSkin, SkinEthic and EpiDerm: an evaluation of morphology and their suitability for testing phototoxicity, irritancy, corrosivity, and substance transport.

The commercially available reconstructed human epidermis models EpiSkin, SkinEthic and EpiDerm demonstrate reasonable similarities to the native human tissue in terms of morphology, lipid composition and biochemical markers. These models have been identified as useful tools for the testing of phototoxicity, corrosivity and irritancy, and test protocols have been developed for such applications. For acceptance of these tests by the authorities, prevalidation or validation studies are currently in progress. Furthermore, first results also indicate their suitability for transport experiments of drugs and other xenobiotics across skin. Still, however, the barrier function of these reconstructed human epidermis models appears to be much less developed compared to native skin. Further adaptation of the models to the human epidermis, especially concerning the barrier function, therefore remains an important challenge in this area of research.