Extraperitoneal endoscopic pelvic lymph node dissection (EEPLND)

Extraperitoneal endoscopic pelvic lymph node dissection was performed in 60 patients for staging of organ-confined prostatic carcinoma. This procedure has significant advantages over the node dissection performed laparoscopically and should be adopted as the operative approach for staging of prostatic carcinoma.

Postpartum blues: relationship between not-protein bound steroid hormones in plasma and postpartum mood changes

The relationship between non-bound steroid hormone levels in plasma and the occurrence of postpartum mood changes was investigated in 26 newly delivered mothers throughout the first 5 days postpartum. Studies with saliva samples had reported higher concentrations of 17 beta-estradiol and progesterone on the days of symptoms in women experiencing postpartum blues. As there had been a controversy as to how far saliva concentrations reflect free hormone levels in plasma, free hormone levels of 17 beta-estradiol and progesterone were determined in plasma using ultrafiltration. No significant difference concerning free hormone levels could be found between women with and without postpartum blues.

[The costs for a health center in relation to its activities]

OBJECTIVE

To establish a system of attributing costs of Health Centres (HC) in the Primary Care network in function of health care activity.

DESIGN

Crossover study with a descriptive component.

SETTING

Management. Primary Care.

PATIENTS OR OTHER PARTICIPANTS

22 Health Centres open during December 1991 within the Health Area.

MEASUREMENTS AND MAIN RESULTS

Two groups for cost attribution per Health Centre were agreed: articles from Chapter II relating to health care activity and Pharmacy spending-->costs relating to activity (CRA); the remaining articles from Chapter II and Chapter I (staff payments)-->costs not relating to activity (CNRA). Costs relating to activity made up 62.51% of the total cost per HC (2.72% articles from Chapter II and 59.79% Pharmacy). The remaining 37.49% corresponded to costs not relating to activity (1.38% to the remaining articles from Chapter II and 36.11% to staff payments).

CONCLUSIONS

We consider that the attribution of costs in function of the activity per HC is useful for the planning and management of Area resources and assists the application of efficiency criteria in Health Centres.

[Treatment of stage Ta,T1 and Tis bladder tumors using Calmette-Guérin bacillus vaccine]

The authors report a series of 71 patients (sex ratio: 1F/4M, mean age: 68 years) with stage Ta (n = 20), T1a (n = 32), T1b (n = 14) and Tis (n = 5) bladder tumours treated by endoscopic resection followed by a course of intravesical BCG instillation (120 mg/week for 6 weeks). The mean follow-up was 15 months (3-36 months). The overall recurrence rate was 42%. A recurrence occurred in 50% of Ta (median time to recurrence: 10.1 months), 32% of T1a (median: 5.8 months), 65% of T1b (median: 7.3 months) and 20% of isolated Tis (median: 7 months). Disease progression was observed in 9% of stage T1 tumours. The following risk factors for recurrence were identified: stage T1b (p = 0.05), multifocal tumours (p = 0.05), resistance to previous chemotherapy (mitomycin C) (p = 0.001) and association with Tis for stages T1 (p < 0.02). The following risk factors for disease progression were identified: stage T1b (p < 0.001), grade III for stage T1 (p = 0.05) and association with Tis (p < 0.05). Ten patients (14%) developed transient BCGitis. BCG was found to be effective in the prophylaxis of recurrence of stage Ta, T1 and Tis bladder tumours. This treatment is proposed for recurrent stage Ta grade II and III tumours and stage T1 tumours in the presence of recognised risk factors. The high risk of progression for stage T1b grade III tumours associated with Tis demands rigorous surveillance.

[Antepartum prevention and postnatal therapy of respiratory distress syndrome]

The introduction of surfactant in the therapy of respiratory distress syndrome (RDS) reduced mortality and long term complications in very premature infants. Nevertheless, the obstetric management influences critically the outcome. In a prospective study of 116 premature infants with RDS treated with natural surfactant preparations after birth, mortality was significantly reduced by antepartum corticosteroid therapy suggesting a synergistic effect of corticosteroids and surfactant on the immature lung. It is assumed that a preventive administration of surfactant immediately after birth would benefit neonates at risk for RDS more than a delayed surfactant replacement after the development of RDS. But without a reliable assessment of fetal lung maturity before birth more than 50% of our premature infants with birth weights less than 1500 g would be exposed to surfactant unnecessarily. It is important that fetal asphyxia is avoided. Acquired respiratory distress syndrome occur even in premature infants after shock or meconium aspiration and may respond poorly to surfactant replacement. This is also the case in lung hypoplasia or perinatal infection, where the combined efforts of obstetricians and neonatologists are needed to attain better results.

Laparoscopic partial cystectomy for vesical endometrioma

A case of endometriosis is presented involving the urinary bladder successfully treated by laparoscopic partial cystectomy. The laparoscopic surgical technique is fully discussed. Laparoscopic partial cystectomy represents a viable option in the treatment of vesical endometriosis, obviating the need for a formal laparotomy.

High resolution polyacrylamide gel electrophoresis of Physarum polycephalum histones: improved resolution of variants and modified forms

An electrophoresis system providing a good resolution of all basic proteins and their variants or modified forms extracted from Physarum polycephalum nuclei was developed. This two-dimensional polyacrylamide gel electrophoresis system combines the use of an AUT gel containing a preformed gradient of urea in the first dimension and a SDS polyacrylamide gel in the second one.

Extraperitoneal endoscopic inguinal hernia repair

The endoscopic extraperitoneal hernioplasty as reported in this study is a similar repair to that achieved by the conventional preperitoneal repair as described by Stoffa, Nyhus, and Rignault. However, this new repair is completed via a totally extraperitoneal approach. Thus, it eliminates all early and late complications related to the violation of the peritoneal cavity as proposed by other intraperitoneal laparoscopic approaches to hernia repair. This report demonstrates the safety and feasibility of this procedure while offering the patient the advantages of a minimally invasive surgical procedure which can be performed under regional anesthesia.

Neutralizing antibodies against HTLV-I in HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients and asymptomatic carriers

We tested serum specimens from patients with HAM/TSP and asymptomatic HTLV-I carriers from endemic areas of Japan, Jamaica, Colombia, and Chile for neutralizing antibodies against HTLV-I. The data suggest a trend for neutralizing activity to be found more frequently in the sera from HAM/TSP patients than in sera from asymptomatic carriers. The result of this study emphasizes the importance of determining biologic properties of the envelope glycoprotein of HTLV-I.

Extraperitoneal endoscopic pelvic lymph node dissection vs. laparoscopic lymph node dissection in the staging of prostatic and bladder carcinoma

Eighteen patients undergoing laparoscopic pelvic lymphadenectomy were compared with eighteen patients undergoing lymph node dissection performed via a totally extraperitoneal approach called extraperitoneal endoscopic pelvic lymph node dissection. Operative time, nodal yield, and hospital stays were essentially the same in both groups. However, the laparoscopic approach had a greater incidence of morbidity, leading the authors to adopt a totally extra-peritoneal endoscopic approach to pelvic lymph node dissection. Advantages of using an extraperitoneal approach are presented.

Evidence of endogenous regulatory function of transforming growth factor-beta 1 in experimental allergic encephalomyelitis

Experimental allergic encephalomyelitis (EAE) is an autoimmune disease characterized by inflammation and demyelination in the central nervous system (CNS). Administration of transforming growth factor-beta (TGF-beta) has been shown to inhibit EAE. In this study, the possible role of endogenous TGF-beta in the regulation of relapsing EAE produced by the transfer of myelin basic protein-specific T cell lines was assessed. Although TGF-beta is not present in the normal CNS, this cytokine was detected by immunohistology in areas of central nervous system inflammation in both acute and chronic disease. The administration of anti-TGF-beta at the disease onset led to a worsening of the clinical course of EAE and more extensive pathological lesions. These findings provide direct evidence for a role of endogenous TGF-beta in the remissions seen in chronic relapsing EAE.

Post partum blues: depressive disease or pseudoneurasthenic syndrome

Depressive mood disorders following childbirth can be quantified with self-rating and observer-rating scales. During two months, in the period from November 1989 to March 1990, women admitted to the obstetric unit of the University of Würzburg were examined on days 3 and 5 post-partum with the Hamilton Psychiatric Rating Scale for Depression, the Montgomery-Asberg-Depression-Rating-Scale and the Befindlichkeits-Scale by von Zerssen. Results reveal that during the early puerperium, scores on these scales rarely reach the same severity as in major depressive disorder. The clinical picture is no different from emotional-hyperaesthetic hyposthenia following other kinds of physical illness such as endocrine disorders.

Extraperitoneal endoscopic pelvic lymph node dissection

Laparoscopic pelvic lymphadenectomy has been found to be efficacious in the staging of genitourinary cancers. Technological advances in endoscopic instrumentation have allowed an extraperitoneal approach to be performed. Presented are two patients who underwent an extraperitoneal endoscopic lymph node dissection as a staging procedure for prostatic carcinoma. Technical aspects of the procedure and advantages relative to the laparoscopic intraperitoneal approach are discussed.

[Continuous pulsatile subcutaneous gonadotropin stimulation in polycystic ovary syndrome: a therapeutic alternative]

In order to improve the ovarian response to exogenous gonadotropins and to reduce the risk of the ovarian hyperstimulation syndrome and of multiple pregnancies, human menopausal gonadotropin (hMG) was administered by continuous pulsatile subcutaneous (s.c.) infusion via a portable pump. The effectiveness of pulsatile hMG treatment was first demonstrated in a control group comprising 7 females with regular ovulatory cycles, who underwent gonadotropin ovarian superovulation and subsequent IVF/GIFT procedures for tubal or male factor. All pulsatile s.c. hMG cycles were ovulatory and one clinical pregnancy was achieved. In this group, ovarian response was similar following intramuscular (i.m.) and pulsatile s.c. hMG therapy, with a marked reduction of preovulatory serum levels of oestradiol in the pulsatile s.c. hMG cycles. In a prospective study, 11 patients with overt polycystic ovary syndrome (PCO) who failed to ovulate in response to clomiphene, received i.m. hMG ovarian superovulation treatment in 19 cycles and pulsatile s.c. hMG in 21 cycles. Following i.m. hMG treatment, only 10 cycles were ovulatory; 7 cycles had to be cancelled for impending ovarian hyperstimulation syndrome. Following pulsatile s.c. hMG treatment, 15 cycles were ovulatory, only 3 treatment cycles had to be disrupted for multifollicular ovarian response. Both modes of treatment were similar in terms of requirement of hMG ampoules, number of preovulatory follicles, preovulatory serum levels of oestradiol and duration of the preovulatory oestradiol rise. The total duration of hMG treatment was significantly increased following pulsatile s.c. hMG. It is concluded, that in overt PCO syndrome, continuous pulsatile s.c. administration of hMG is an effective method to induce follicular maturation and to achieve ovulations.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential coupling of dopaminergic D2 receptors expressed in different cell types. Stimulation of phosphatidylinositol 4,5-bisphosphate hydrolysis in LtK- fibroblasts, hyperpolarization, and cytosolic-free Ca2+ concentration decrease in GH4C1 cells

Dopaminergic D2 receptors are widely regarded as typical inhibitory receptors, as they both inhibit adenylyl cyclase and decrease the cytosolic free Ca2+ concentration ([Ca2+]i) by activating K+ channels. A D2 receptor has recently been cloned (Bunzow, J. R., Van Tol, H. H. M., Grandy, D. K., Albert, P., Salon, J., Christie, M. D., Machida, C. A., Neve, K. A., and Civelli, O. (1988) Nature 336, 783-787) and expressed in two different cell lines, pituitary GH4C1 cells and Ltk- fibroblasts, where it has been shown to induce inhibition of adenylyl cyclase. We have investigated the additional effector systems coupled to this receptor. The responses observed in the two cells lines, which express similar levels of receptors (0.5-1 x 10(5)/cell), were surprisingly different. In GH4C1 cells D2 receptors failed to affect phosphoinositide hydrolysis and induced a decrease of [Ca2+]i. This latter effect appears to be mediated by hyperpolarization, most likely due to the activation of K+ channels. In striking contrast, in Ltk- fibroblasts the D2 receptor induced a rapid stimulation of inositol(1,4,5)-trisphosphate (+73% at 15 s) followed by the other inositol phosphates, and an immediate increase of [Ca2+]i due to both Ca2+ mobilization from internal stores and influx from the extracellular medium. In both GH4C1 and Ltk- cells, the D2 receptor response was mediated by G protein(s) sensitive to pertussis toxin. The increases of inositol trisphosphate and [Ca2+]i observed in Ltk- cells required dopamine concentrations only slightly higher than those inhibiting adenylyl cyclase (EG50 = 25, 29, and 11 nM, respectively) and were comparable in magnitude to the responses induced by the endogenous stimulatory receptor agonists, thrombin and ATP. The results demonstrate that in certain cells D2 receptors are efficiently coupled to the stimulation of phosphoinositide hydrolysis. The nature of receptor responses appears therefore to depend on the specific properties not only of the receptor molecule but also of the cell type in which it is expressed.

A study on the venous drainage of 150 cerebral arteriovenous malformations as related to haemorrhagic risks and size of the lesion

In this paper we study the venous drainage of 150 cerebral arteriovenous malformations (AVM), correlating the number of efferent veins with the symptoms of clinical onset and with the size of the lesions. Statistical analysis demonstrates that those AVM's which in the angiograms show only one draining vein have a high risk of haemorrhage. As the number of drainage veins increases, this bleeding risk decreases, becoming quite low in angiomas with multiple drainage veins, which we denominate "medusa-head angiomas". Statistics also demonstrate that small angiomas (less than 2 centimeter on diameter) usually have only one drainage vein, thus carrying a high risk of haemorrhage. As their size increase, so do the number of veins, and the possibility of haemorrhage decreases.

[Diagnosis and therapy of an in the cesarean section scar implanted early pregnancy]

The diagnosis of a 7 weeks-old pregnancy implanted in the uterine scar after caesarean section is reported. The sonographic findings prompted the adequate intervention without time-loss. The removal of pregnancy prevented the life-threatening complication of rupture of the uterus and enabled the preservation of the uterus and thus the fertility of the patient.

Prednisolone promotes the secretion of progesterone and oestradiol by luteinised granulosa cells independent of human chorionic gonadotropin

An in vitro model based on luteinised granulosa cells gained during an in vitro fertilisation programme examines the question of whether prednisolone, and thus glucocorticoids in general, are capable of exerting an influence on the secretion of oestradiol and progesterone. It can be demonstrated that prednisolone leads to dosage-dependent increases in the concentration of both steroids, even independently of concurrent stimulation by human chorionic gonadotropin. A similar mechanism for aromatase activity of human adipose cells is suggested.

[Initial experiences with hysterosalpingoscintigraphy in normal and pathologic fallopian tube passage]

A prospective study in 38 patients was designed to evaluate the efficacy and reliability of radionuclide hysterosalpingoscintigraphy (HSS) using 99mTc labelled human albumin macroaggregates (HAMA). Following application in the posterior vaginal fornix at the time of ovulation, HAMA normally migrate spontaneously through the uterus and tubes and may be identified after 20 min (range 5-90 min) in the uterine cavity and after 2 hrs (range 40 min - 3 hrs) in the free pelvis, using a gamma camera. When correlated with the findings of conventional contrast hysterosalpingography (HSG), the radionuclide procedure yielded comparable results in females with patent or clearly obstructed tubes. Using 8-10 MBq 99mTc, radiation exposure was estimated to be 0.75 cGy per ovary, which is considerably less than the mean dose absorbed with HSG. As the HSS procedure imitates the migration of spermatozoa by the means of an inert tracer, it allows a direct insight in the mechanisms of passive transport taking place in the uterus and tubes at the period of ovulation. Thus, it reflects the physiological state of the female reproductive tract. On the basis of the scintigraphic findings, equivocal results on HSG have to be re-evaluated, as tubes, which are anatomically patent under high pressure, may be functionally deficient.