[Surgical management of ovarian ectopic pregnancy]

Ovarian pregnancies represent a small fraction of ectopic gestations. They are especially feared due to their life-threatening intraabdominal hemorrhage. Pre- and intraoperative diagnosis is difficult. Pathogenetically ovarian pregnancy arises from the retention of a fertilized ovum in the ovary. General guidelines for the medical management are missing. In this case report, we diagnosed a subacute ruptured ovarian pregnancy during surgery and performed a partial ovarectomy via operative laparoscopy. Other therapeutic options in managing ovarian ectopic pregnancy will be discussed.

[Sunlight-induced granulomatous reaction to permanent lip liner]

The demand for permanent make up and especially permanent lip liner has increased in recent years in Germany. Information about complications is not available in the medical literature, because tattooing is a trade whose results and problems are not monitored and documented, as is the case for medical procedures. A female patient with permanent lip liner experienced no complications for one year. Then, after intensive sun exposure she developed solid, linear papules along the outer margin of her lips. Histology revealed a granulomatous tissue reaction with a marked lymphohistiocytic infiltrate including epithelioid histiocytes. Treatment with topical steroids over three weeks led to a complete healing without relapse. To the best of our knowledge this is the first report on UV-light-induced granulomatous reaction to permanent lip liner.

Laparoscopic hernia repair?TAPP or/and TEP?

BACKGROUND

Of various endoscopic hernia repair procedures, TAPP and TEP have been selected for routine use.

METHODS

Results from Medline research were analysed.

RESULTS

There is a similar risk for postoperative morbidity for both techniques. The recurrence rate in large single-centre series is between 0% and 3.4%. There were numerous indications for both procedures, whereby a transperitoneal TAPP can also be applied in cases of previous preperitoneal operations.

CONCLUSION

Randomised trials comparing both methods of hernia repair are lacking. Seven non-randomised studies showed no differences in recurrence rate and morbidity. In general the learning curve for is shorter in favour of TAPP repair.

Effect of primary anthracycline-based chemotherapy on disseminated tumor cells in locally advanced breast cancer

BACKGROUND

The leading cause of death from epithelial cancer is metastatic tumor relapse due to early dissemination of tumor cells. In this study we investigated the elimination rate of disseminated tumor cells in bone marrow and the clinical response under primary chemotherapy in locally advanced breast cancer.

PATIENTS AND METHODS

Thirty patients underwent primary anthracycline-containing chemotherapy for breast cancer. For immunocytochemical tumor cell detection in bone marrow, the monoclonal antibody 5D3 was used.

RESULTS

At time of diagnosis, 10/30 (33%) patients had cytokeratin-positive tumor cells in bone marrow. After primary and chemotherapy, 8/30 (27%) patients still tested positive. Clinical complete response (cCR) was observed in 5/30 (17%) patients partial response (cPR) in 12/30 (40%) patients, resulting in an overall rate of clinical response to primary chemotherapy in 57%.

CONCLUSION

Primary chemotherapy in breast cancer is effective regarding the reduction of tumor size but seems incapable of reducing the burden of disseminated tumor cells in bone marrow.

The AESOP robot system in laparoscopic surgery: increased risk or advantage for surgeon and patient?

BACKGROUND

The aim of this study was to examine the advantages and risks of the Automated Endoscopic System for Optical Positioning (AESOP) 3000 robot system during uncomplicated laparoscopic cholecystectomies or laparoscopic hernioplasty.

METHODS

In a randomized study, we examined two groups of 120 patients each with the diagnosis cholecystolithiasis respectively the unilateral inguinal hernia. We worked with the AESOP 3000, a robotic arm system that is voice-controlled by the surgeon. The subjective and objective comfort of the surgeon as well as the course and length of the operation were measured.

RESULTS

The robot-assisted operations required significantly longer preparation and operation times. With regard to the necessary commands and manual camera corrections, the assistant group was favored. The same was true for the subjective evaluation of the surgical course by the surgeon.

CONCLUSIONS

Our study showed that the use of AESOP during laparoscopic cholecystectomy and hernioplasty is possible in 94% of all cases. The surgeon must accept a definite loss of comfort as well as a certain loss of time against the advantage of saving on personnel.

[Juvenile dermatomyositis in the Nice area: a retrospective study 1991-2001]

INTRODUCTION

Juvenile dermatomyositis is a rare disease. We conducted a retrospective chart review on patients with juvenile dermatomyositis diagnosed in the Nice area from 1991 to 2001. Our purpose was to review diagnosis criteria and treatment strategies.

PATIENTS AND METHODS

The cases of juvenile dermatomyositis were identified by phone investigation of physicians of the departments of paediatrics, dermatology, rheumatology and internal medicine.

RESULTS

Seven cases of juvenile dermatomyositis (sex ratio M/W: 0.75, medium age: 7.7 years) were identified. Myalgia and/or weakness were the main reasons for initial consultation. Cutaneous lesions were present in all patients on initial presentation. Muscular enzymes were abnormal in 4 cases out of 7. Muscular biopsy was conducted in 6 patients. In one case, MRI revealed an inflammatory involvement although no clinical or biological sign existed. Systemic corticosteroids was the initial treatment, associated with monthly intravenous immunoglobulins in 5 cases, allowing initial control of the disease in all cases. The other therapies were: methotrexate (3 cases), ciclosporin A (1 case), and chloroquine (2 cases). The evolution was monocyclic in three cases, polycyclic in four cases. With a median follow-up of two years, all the patients are alive: five under treatment, three still in first flare.

COMMENT

The diagnosis strategy seems relevant because at least 3 criteria of Peter and Bohan were found in 6/7 patients. Muscular biopsy appears fundamental in the diagnosis strategy. MRI was useful when it was conducted but its use has to be assessed. Therapies were those of previous published studies, except for the use of intravenous immunoglobulins as first-line treatment, associated with corticosteroids. This strategy may be justified for corticosteroid-sparing purposes.

CONCLUSION

Working on a real, well-codified strategy of diagnosis and treatment would enhance the uniform management of these patients.

Detection of carbonates in dust shells around evolved stars

Carbonates on large Solar System bodies like Earth and Mars (the latter represented by the meteorite ALH84001) form through the weathering of silicates in a watery (CO3)2- solution. The presence of carbonates in interplanetary dust particles and asteroids (again, represented by meteorites) is not completely understood, but has been attributed to aqueous alteration on a large parent body, which was subsequently shattered into smaller pieces. Despite efforts, the presence of carbonates outside the Solar System has hitherto not been established. Here we report the discovery of the carbonates calcite and dolomite in the dust shells of evolved stars, where the conditions are too primitive for the formation of large parent bodies with liquid water. These carbonates, therefore, are not formed by aqueous alteration, but perhaps through processes on the surfaces of dust or ice grains or gas phase condensation. The presence of carbonates which did not form by aqueous alteration suggests that some of the carbonates found in Solar System bodies no longer provide direct evidence that liquid water was present on large parent bodies early in the history of the Solar System.

Bond-shift rearrangement in solid Li(3)P(7)(monoglyme)(3): a (31)P MAS NMR study

The (31)P MAS NMR spectrum of solid Li(3)P(7)(monoglyme)(3) has been reinvestigated over a wide temperature range (-70 to +77 degrees C) and under conditions of better resolution (Larmor frequency of 162 MHz and spinning rate of approximately 30 kHz) than previously measured (121 MHz and 13 kHz). At low temperatures three spinning sideband (ssb) manifolds are observed: a singlet (centered at -45 ppm relative to 85% H(3)PO(4)) due to the apical atom (A) of the P(7)-cage trianion; a 1 : 1 : 1 triplet (at -110, -117, and -124.5 ppm) due to the negatively charged equatorial (E) atoms, and a one to two doublet (at -161 and -168.5 ppm) due to the basal (B) atoms. These results are consistent with the P(7) cage having nearly, but not perfect, C(3v) symmetry. The compound appears to be well ordered in the solid state with very little structural dispersity. On heating, the NMR lines broaden and eventually coalesce into a single ssb manifold. This behavior is ascribed to bond-shift rearrangement similar to the Cope rearrangement in bullvalene. A MAS 2D exchange experiment and a quantitative analysis of the 1D NMR lineshapes indicate that, unlike in solution where the rearrangement involves a single bond shift at a time, in the solid the process involves a succession of two bond shifts: The first leads to an intermediate species in which the rearranged P(7) cage is inverted, while in the subsequent step a second bond shift takes place that also restores the original orientation of the cage in the lattice. The overall effect of the double bond shift is equivalent to cyclic permutation of the phosphorus atoms within the five member rings of the P(7)-cage. The quantitative analysis of the dynamic lineshapes shows that this cyclic permutation proceeds at a different rate in one ring (k(d)(1)) than in the other two (k(d)(2,3)). The kinetic parameters for these processes are E(a)(1)=18.7 kJ/mol, E(a)(2,3)=58.0 kJ/mol, k(d)(1)(17 degrees C)=k(d)(2,3)(17 degrees C)=10(4) s(-1). No indications for independent threefold molecular jumps of the P(7) cage were found.

Isolation of membrane protein subunits in their native state: evidence for selective binding of chlorophyll and carotenoid to the b(6) subunit of the cytochrome b(6)f complex

Cytochrome (cyt) b-c complexes play a central role in electron transfer chains and are almost ubiquitous in nature. Although similar in their basic structure and function, the cyt b(6)f complex of photosynthetic membranes and its counterpart, the mitochondrial cyt bc(1) complex, show some characteristic differences which cannot be explained by the high resolution structure of the cyt bc(1) complex alone. Especially the presence of a chlorophyll molecule is a striking feature of all cyt b(6)f complex preparations described so far, imposing questions as to its structural and functional role. To allow a more detailed characterization, we here report the preparation of native subunits cyt b(6) and IV starting from a monomeric cyanobacterial cyt b(6)f complex. Spectroscopical and reversed-phase HPLC analyses of the purified cyt b(6) subunit showed that it contained not only two b-type hemes, but also one chlorophyll a molecule and a cyanobacterial carotenoid, echinenone. Evidence for selective binding of both pigments to this subunit is presented and their putative function is discussed.

Bicolor surface reliefs in azobenzene side-chain polymers

Holographic studies in azobenzene side-chain polymers reveal light-induced periodic surface reliefs at temperatures far below the glass transition temperature. We performed experiments with two-color holography on an azobenzene polymer. An intensive and linear polarized homogeneous blue pump beam illuminated the sample, and two red beams-outside the trans-azobenzene absorption-were used to inscribe the grating. A surface relief was obtained only with the pump beam on and only if its polarization was perpendicular to the writing beams. The findings are discussed in the frame of a recent mean-field model.