Predictive factors for skin telangiectasia following post-mastectomy electron beam irradiation

This study evaluated the predictive factors associated with skin telangiectasia following post-mastectomy electron beam irradiation of the chest wall and regional lymph nodes in patients with breast cancer. From July 1987 to December 1994, 120 women with stages II and III breast cancer received electron beam irradiation following modified radical mastectomy. Doses of 50-50.4 Gy per 25-28 fractions were given to the chest wall (with bolus), the internal mammary nodes, the supraclavicular nodes and the axillary lymph nodes using a 12 MeV or 15 MeV single portal electron beam. 19 patients received an additional 10-16 Gy boost to the surgical scar using a 9 MeV electron beam. Univariate and multivariate analyses for the development of skin telangiectasia showed 5- and 7-year actuarial rates of telangiectasia to be 59% and 72%, respectively. In univariate analysis, an additional surgical scar boost (p=0.023) as well as no treatment interruption (p=0.028) were associated with a significantly increased risk of skin telangiectasia. In multivariate analysis, the only significant independent factor for the development of skin telangiectasia was surgical scar boost (p=0.026); no treatment interruption showed a trend but did not achieve significance (p=0.051). Thus, patients given an additional boost to the surgical scar are more likely to develop skin telangiectasia. Shorter treatment courses may result in a higher probability of skin telangiectasia following electron beam irradiation.

Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta1

Extracorporeal shock-wave (ESW) treatment has been shown to be effective in promoting the healing of fractures. We aimed to determine whether ESW could enhance the growth of bone-marrow osteoprogenitor cells. We applied ESW to the left femur of rats 10 mm above the knee at 0.16 mJ/mm2 in a range of between 250 and 2000 impulses. Bone-marrow cells were harvested after ESW for one day and subjected to assessment of colony-forming unit (CFU) granulocytes, monocytes, erythocytes, megakaryocytes (CFU-Mix), CFU-stromal cells (CFU-S) and CFU-osteoprogenitors (CFU-O). We found that the mean value for the CFU-O colonies after treatment with 500 impulses of ESW was 168.2 CFU-O/well (SEM 11.3) compared with 88.2 CFU-O/well (SEM 7.2) in the control group. By contrast, ESW treatment did not affect haematopoiesis as shown by the CFU-Mix (p = 0.557). Treatment with 250 and 500 impulses promoted CFU-O, but not CFU-Mix formations whereas treatment with more than 750 impulses had an inhibiting effect. Treatment with 500 impulses also enhanced the activity of bone alkaline phosphatase in the subculture of CFU-O (p<0.01), indicating a selective promotion of growth of osteoprogenitor cells. Similarly, formation of bone nodules in the long-term culture of bone-marrow osteoprogenitor cells was also significantly enhanced by ESW treatment with 500 impulses. The mean production of TGF-beta1 was 610 pg/ml (SEM 84.6) in culture supernatants from ESW-treated rats compared with 283 pg/ml (SEM 36.8) in the control group. Our findings suggest that optimal treatment with ESW could enhance rat bone-marrow stromal growth and differentiation towards osteoprogenitors presumably by induction of TGF-beta1.

Experience with a bone bank operation and allograft bone infection in recipients at a medical centre in southern Taiwan

To assess the contamination rate of allograft bones at retrieval and the infection rate of the implanted allograft bone, we audited a bone bank retrospectively and reviewed the medical charts of allograft bone recipients between June 1999 and June 2000 at a medical centre in southern Taiwan. The bone bank did its utmost to minimize allograft contamination with hospital-acquired pathogens by adopting purposefully designed criteria for selection of donors. This protocol included sterilization with soaking of the retrieved allograft in a solution of a first-generation cephalosporin before storage and prophylaxis in recipients with first-generation cephalosporin. The contamination rates at allograft retrieval from living and cadaveric donors were 2.7% and 12.4%, respectively (P<0.001). Culture of 262 specimens taken at allograft implant revealed 12 (4.6%) positive for culture. Of the 12 patients implanted with allograft bones positive for culture, nine (75.0%) had allograft bone infection, while three (25.0%) did not. Among the 250 recipients with sterile allograft bones, four (1.6%) were found to have allograft infection. None of the cases of infection required removal of the allograft bones, and all cases were successfully treated with tailored antimicrobial therapy based on susceptibility tests on isolated bacteria. The overall infection rate was 5.0%, which compared favourably with those in other series. A prospective cohort study is needed to determine which of the varied sterilization methodologies gives the best and/or most cost-effective outcome.

Tumor-promoting effect of GGN-MRP extract from the Maillard reaction products of glucose and glycine in the presence of sodium nitrite in C3H10T1/2 cells

GGN-MRP is an extract from the Maillard reaction products of nitrite with glucose and glycine in the Maillard browning system. No genotoxicity of GGN-MRP in culture hepatocyte was found. A two-stage transformation protocol was used to transform chemically mouse embryo fibroblast C3H10T1/2 cells. To initiate transformation, the cells were treated with benzo[a]pyrene [B(a)P; 0.1 microg/mL], and GGN-MRP (0.01, 0.1, and 1.0 mg/mL) was employed to subsequently complete the transformation process. Malignant transformed foci were formed in B(a)P-initiated and GGN-MRP-promoted C3H10T1/2 cells after 8 weeks. Cells treated with GGN-MRP alone failed to induce transformation. However, cells initiated with B(a)P and promoted by GGN-MRP demonstrated oncogenic properties. Transformed colonies derived from GGN-MRP-treated cells exhibited enhanced growth rate, anchorage independence, and tumorgenicity in animals relative to parent cells. These results indicated that GGN-MRP contains a tumor promoter and may induce tumor promotion by two-stage oncogenesis.

Trigeminal neuralgia caused by nasopharyngeal carcinoma with skull base invasion--a case report

We report a case of nasopharyngeal carcinoma with skull invasion, whose chief complaint was left-sided facial pain, which mimicked trigeminal neuralgia, and in whom there was no palpable neck mass. The magnetic resonance imaging (MRI) revealed an infiltrated lesion with abnormal signal intensity in the left nasopharynx, involving the left retro- and parapharyngeal space. The lesion was pathology-proven through biopsy of the nasopharynx to be a non-keratinizing carcioma. The patient received 6000 rad radiotherapy combined with 5-Fluorouracil(5-FU) and Cisplatin, and has been well after 2 years' follow-up.

Management of patellofemoral arthrosis in middle-aged patients

Patellofemoral arthrosis is one of the most common causes of knee pain in middle-aged patients, and is often associated with patellofemoral malalignment. A correct diagnosis is established by history taking and physical and radiographic examinations of the knee. The initial treatment of choice is conservative treatment, which includes anti-inflammatory drugs, use of a knee brace, quadriceps-strengthening exercises, physical therapy, and modification of activity. Surgery is indicated when patients fail to improve after at least 6 months of conservative treatment and are functionally disabled. Lateral retinacular release and proximal realignment are performed only in selected cases. Distal realignment by anteromedial transfer of the tibial tubercle is the most effective method for treating patients with patellofemoral arthrosis. The magnitude of anteromedial transfer of the tibial tubercle must be individualized, and rigid internal fixation enables immediate postoperative rehabilitation. In knees with patellofemoral arthrosis with no malalignment, a 20-mm anterior displacement without medial transfer of the tibial tubercle is suggested. A 15-mm anterior displacement plus 5 to 10 mm of medial transfer of the tibial tubercle is recommended in knees with patellofemoral arthrosis and mild to moderate malalignment. In knees with severe malalignment, 15 mm of medial transfer and 10 mm of anterior displacement are recommended. A triple osteotomy is considered in knees with patellofemoral osteoarthrosis and patella baja. Patellofemoral resurfacing arthroplasty is only done in carefully selected patients. A patellectomy should be avoided if at all possible. Total knee arthroplasty is indicated in knees with bi- or tricompartmental osteoarthritis.

Traumatic lumbar spinal subdural hematoma--a case report

A 74-year-old woman suffered from lower legs weakness after a motor vehicle accident. Magnetic resonance imaging (MRI) on the seventh posttraumatic day, revealed a lumbar spinal subdural hematoma at the level of L4-5. After surgical intervention to remove the subdural hematoma, the patient made a complete recovery.

Acute septic arthritis of the hip in children

Thirty-three cases of acute septic arthritis of the hip in children were treated at our hospital from 1986 to 1997. The average follow-up period was 6 years (range 2-11 years). In 17 cases the right hip was affected, and in 16 the left hip. The average duration of symptoms was 5 days (range 1-14 days). Microorganisms were isolated from the blood, joint aspirate, or surgical specimens in 25 cases (76%). Staphylococcus aureus was the most common bacteria found (44%). Those patients with S. aureus infection were older than 1 year of age. There was no significant difference in the final outcome between the younger and the older age groups. Twenty-six out of 33 patients (89%) had a satisfactory outcome. Satisfactory results can also be expected with arthrocentesis and medical treatment if the diagnosis is made early, and antibiotic treatment affords a good clinical response. Four out of 7 cases with an unsatisfactory result were associated with osteomyelitis of the proximal femur. The two most important factors associated with poor results included a delay of definite treatment lasting longer than 5 days and the presence of osteomyelitis of the proximal femur.

[Research on the synthesis and spectroscopy of 2-(2-phenyl propenyl) benzoxazoles]

In this paper the synthetic methods and the substituent effects on yields were discussed. It was found that the yields were not high, and the compounds with electron-drawing groups had higher yields. Some compounds with electron-giving groups such as t-Bu couldn't be synthesized by wittig-horner method. The compounds were characterized by IR, 1H NMR, MS, UV and FL. The experimental results indicated that there was not quantitative substituent effect on IR, the electron-drawing groups had great effect on the chemical shifts of propenyl hydrogen and methyl hydrogen, the strong double-electron fragments existed in MS. Some experimental phenomena of UV and FL were also studied.

Modeling dynamically heterogeneous coupled relaxations

A model describing dynamically heterogeneous relaxation in complex coupled systems is presented. The model predicts the splitting of a high-temperature single Debye relaxation to a low-temperature bimodal relaxation. The bimodal process shows a crossover from a Debye-type relaxation to an approximately stretched-exponential relaxation. Some general features of relaxation in complex systems emerge from the predictions of the model, and a comparison of the model with experiments is reported.

Physical shock wave mediates membrane hyperpolarization and Ras activation for osteogenesis in human bone marrow stromal cells

Physical shock wave (SW) has shown effectiveness on promotion of bone growth. We have recently demonstrated that SW could promote bone marrow stromal cell differentiation toward osteoprogenitor associated with induction of TGF-beta1. We have further demonstrated that SW-induced membrane hyperpolarization and Ras activation acted an early signal for the osteogenesis in human bone marrow stromal cells. An optimal dose of SW treatment at 0.16 mJ/mm(2) for 500 impulses induced a rapid membrane hyperpolarization in 5 min, activation of Ras in 30 min, and cell proliferation in 2 days. The SW-promoted cell growth was related to osteogenesis as demonstrated by increase of bone alkaline phosphatase activity in 6 days and osteocalcin mRNA expression in 12 days. In support that SW-induced Ras activation mediated osteogenesis of human bone marrow stromal cells, we further demonstrated that transfection of bone marrow stromal cells with a dominant negative Ras mutant (Asn-17 ras(H)) abrogated the SW enhancement of osteogenic transcription factor (CBFA1) activation, osteocalcin mRNA expression, and bone nodule formations. These results suggest that physical SW promotes bone marrow stromal cell differentiation toward osteogenic lineage via membrane hyperpolarization, followed by Ras activation and specific osteogenic transcription factor CBFA1 expression. A link between physical SW and biomembrane perturbation-mediated Ras activation may highlight how noninvasive physical agents could be used to promote fracture healing and to rescue patients with osteoporosis and osteopenic disorders in the future.

Three-dimensional ultrasonic images of normal fetus

BACKGROUND

The purpose of this study was to assess the usefulness and feasibility of 3-dimensional (3D) ultrasound for routine fetal observation.

METHODS

Eighty-five normal pregnancies with gestational ages of 20-36 weeks were studied. A conventional ultrasound scanner with a specially designed operation unit, frame memory, and 3D probe was the apparatus used in this study. The unit has a circuit board consisting of digital integrated circuit chips designed to make calculations of volume ray tracings for volume rendering in real time. For each fetus, scanning was performed with different levels of opacity in the equation for volume rendering. In areas where there was an inadequate amniotic fluid pocket to perform an adequate examination, the pregnant woman was asked to push the fetus to the opposite side by gently pressing on her abdomen.

RESULTS

Face, limbs, and fingers which are difficult to visualize on conventional ultrasonography could be seen clearly. Extremely satisfactory images were obtained at between 24 and 34 weeks of gestation that produced sonographic pictures easily recognized even by laypersons. Beyond 34 weeks of gestation due to the relative decrease in the size of amniotic fluid pockets, and before 24 weeks of gestation due to frequent fetal movement, the soft tissue of fetuses is thin and its acoustic impedance is virtually the same as that of water, so surface-rendered images are less satisfactory. In addition, the anterior wall placenta, multiple pregnancies, and oligohydramnios made viewing even more difficult.

CONCLUSION

Between 24 and 34 weeks of gestation, 3D ultrasound is a feasible and useful procedure for routine antenatal examination.

Classification for endoscopic treatment of mullerian anomalies with an obstructive cervix

STUDY OBJECTIVE

To describe our classification according to severity of developmental mullerian anomalies with obstructed cervix.

DESIGN

Retrospective review (Canadian Task Force classification II-2).

SETTING

University-based, tertiary-level center for endoscopic surgery.

PATIENTS

Ten women with developmental mullerian anomalies with obstructed cervix.

INTERVENTION

Patients with didelphic uterus with a rudimentary nonfunctional horn and hypoplastic cervix (type 1) underwent hemihysterectomy or diagnostic endoscopy. Those with agenesis of cervix with normal uterus (type 2) had uterovaginal canalization or neocervix with full-thickness skin graft. Women with identical didelphic uteri and hypoplastic cervix (type 3) underwent uterovaginal canalization with or without endometrial ablation or hemihysterectomy. Patients with didelphic uterus with a rudimentary horn and hypoplastic cervix (type 4) had laparoscopic hemihysterectomy. Those with agenesis of the vagina and cervix but with functional endometrium (type 5) had laparoscopic-assisted full-thickness skin graft.

MEASUREMENTS AND MAIN RESULTS

Average duration of surgery was 60 to 210 minutes. There were no intraoperative complications. Patients with type 1 anomaly are continuing infertility treatment. All three patients in type 2 continue to have regular menses without dysmenorrhea. In those with type 3 conditions, hemihysterectomy was performed in one woman and uterovaginal canalization was performed on the hypoplastic cervix in another. After the neocervix was created, endometrial ablation was performed. No evidence of cervical obstruction or hematometra was found in either patient. The patient with type 4 anomaly continues to have regular menstrual periods without dysmenorrhea. Women with type 5 disorder had good healing of vaginal skin grafts.

CONCLUSION

This classification helps identify mullerian anomalies in relation to obstructive cervix. It is useful in categorizing the disorders and determines management strategies and prognosis.

ASSESS-3: a randomised, double-blind, flexible-dose clinical trial of the efficacy and safety of oral sildenafil in the treatment of men with erectile dysfunction in Taiwan

The efficacy and safety of sildenafil were evaluated in a randomised, double-blind, placebo-controlled, flexible-dose study in Taiwanese men aged 26 to 80 y with erectile dysfunction (ED) of broad-spectrum aetiology and more than 6 months' duration. A total of 236 patients were randomised at six medical centres in Taiwan to receive either sildenafil (50 mg initially increased if necessary to 100 mg or decreased to 25 mg depending on efficacy and toleration) (n=119) or matching placebo (n=117) taken on an 'as needed' basis 1 h prior to anticipated sexual activity for a period of 12 weeks. At the end of 12 weeks, the primary efficacy variables relating to the achievement and maintenance of erections sufficient for sexual intercourse, and the secondary efficacy variables, which included: (1) the five separate domains of sexual functioning of the IIEF (International Index of Erectile Function) scale, (2) the percentage of successful intercourse attempts; and (3) a global assessment of erections, were all statistically significantly improved by sildenafil in comparison with placebo (P<0.0001). Treatment-related adverse events occurred in 43.7% of patients receiving sildenafil and 18.8% receiving placebo. The most common adverse events with sildenafil were flushing, dizziness and headache (25.2, 6.7 and 5.9% of patients, respectively), and most were mild in nature. The efficacy and safety of sildenafil in the population of Taiwanese men appears similar to that reported in other studies in western populations.

Extraperitoneal approach to laparoscopic Burch colposuspension

STUDY OBJECTIVE

To evaluate 3-year outcomes of extraperitoneal laparoscopic colposuspension in treating genuine stress incontinence.

DESIGN

Retrospective review (Canadian Task Force classification II-2).

SETTING

University-based, tertiary-level center for endoscopic surgery.

PATIENTS

One hundred sixty women with genuine stress incontinence with bladder neck hypermobility.

INTERVENTION

Extraperitoneal space was created with CO2 through a 10-mm midline port 2 cm above the pubic hairline. A pair of sutures was inserted at the level of midurethral and urethrovesical junction, fixing them to Cooper's ligament on each side with proper tension.

MEASUREMENTS AND MAIN RESULTS

Of 160 women, 10 were lost to follow-up. On follow-up questionnaire sent to 150 patients, 148 (98.7%) were pleased with the results of surgery. Stress incontinence was cured in 136 women (90.7%) after a minimum of 3 years' follow-up.

CONCLUSION

Cure rates for extraperitoneal colposuspension were similar to those reported for traditional laparoscopic or laparotomy Burch procedures; however, this is a more direct method to expose the space of Retzius, thus eliminating the need to open and close peritoneum.

Implications of quantitative tumor and nodal regression rates for nasopharyngeal carcinomas after 45 Gy of radiotherapy

PURPOSE

To quantitatively investigate the clinical implications of tumor regression rate (TRR-45) and nodal regression rate (NRR-45) of nasopharyngeal carcinomas (NPC) after receiving 45 Gy of radiotherapy (RT). The values, predictive values, and associated factors of TRR-45 and NRR-45 in NPC are analyzed.

METHODS AND MATERIALS

One hundred one patients with newly diagnosed NPC and who were curatively treated by RT alone were included in the study. Tumor volume and nodal volume before treatment and after 45 Gy were obtained from computed tomographic (CT) scans performed at those times and calculated with the assistance of a computer-based imaging analyzing system. TRR-45 (NRR-45) was defined as the ratio of reduced tumor (nodal) volume after 45 Gy to the initial tumor (nodal) volume. TRR-45 (NRR-45) values were stratified into three groups of slow (below 50%), moderate (between 50% and 75%), and rapid (above 75%) change. After conventional RT with 45 Gy, conformal RT for primary tumors was boosted to 70.2-72 Gy for T1-2 tumors, and 75.6-81 Gy for T3-T4 tumors. RT for residual neck masses was boosted by electron beam to 61-75 Gy.

RESULTS

The mean value of TRR-45 for all patients was lower than that of NRR-45 for the 78 patients with metastatic neck nodes (70% +/- 4.8% vs. 81% +/- 5%, p = 0.003). The 3-year actuarial neck control rate was better than the primary tumor control rate with statistical significance (98% vs. 85%, p = 0.009). No significant statistical differences concerning local control probability, nodal control probability, or survival rate were found among patients with slow, moderate, or rapid TRR-45 or NRR-45. T-stage was the only significant prognostic factor for locoregional control after multivariate analysis. Tumor volume and T-stage were found to have a statistically significant negative correlation with TRR-45. No associated factor was found to be significantly correlated with NRR-45.

CONCLUSION

Slow regression rates of the primary tumor or neck nodes in NPC after receiving 45 Gy of irradiation do not mean ultimately poor radiocurability, but may merely imply slow clearance of the cells damaged during irradiation. The different radiobiological behaviors of the regression rates during treatment, ultimate control probabilities, or associated factors for regression rates of NPC between primary tumors and neck nodes need to be further investigated.

Treatment of calcifying tendinitis of the shoulder with shock wave therapy

In a prospective clinical study, the effectiveness of shock wave treatment for calcifying tendinitis in 31 shoulders in 29 patients (14 women and 15 men) with an average age of 52 years was assessed. Each shoulder was treated with 1,000 impulses of shock waves at 14 kV. A 100-point Constant score system was used for evaluation. The overall results of 20 patients (21 shoulders) with 12 weeks followup were no complaints in 23.8%, significantly improved in 38.1%, some improvement in 14.3%, and unchanged in 23.8%. Considerable improvement was observed between 6 and 12 weeks. The results of seven patients with 24 weeks followup were no complaints in two patients, significantly improved in three, and unchanged in two patients. Radiographs showed complete elimination of the calcium deposits in six patients (28.6%), incomplete elimination in two patients (9.5%), and three patients (14.3%) had fragmentation of the calcium deposits. There was no recurrence of calcium deposits observed at 24 weeks. There was a correlation between the functional improvement and the elimination of calcium deposits. There were no device-related problems, systemic or local complications. Low-energy shock wave therapy may offer a new and safer additional nonoperative treatment for patients with calcifying tendinitis of the shoulder.

Effect of shock wave therapy on acute fractures of the tibia: a study in a dog model

The effect of shock wave therapy on acute fractures of the tibia was studied in eight adult dogs. A fracture with a 3-mm gap was created in both tibias and the fractures were fixed internally with a small metallic plate and screws. Each of the right limbs received 2,000 impulses of shock waves at 14 kV whereas the left limbs were used as controls. The evaluations included the callus formations based on serial radiographic examinations at 1, 4, 8, and 12 weeks and histologic examinations at 12 weeks for tissue distribution including bone tissues. Based on radiographic findings, there was no statistically significant difference in the amount of callus formation between the treated and the control groups at 8 weeks or less. However, the radiographic findings at 12 weeks statistically showed more callus formations in the treated group. In histologic examinations, there was significantly more cortical bone formation in the treated group at 12 weeks and the bone tissues were thicker, denser, and heavier. Shock wave therapy enhanced callus formation and induced cortical bone formation in acute fractures in dogs at 12 weeks. The effect of shock wave therapy seemed to be time-dependent at 3 months.

Microlaparoscopically assisted vaginal hysterectomy. A preliminary report

OBJECTIVE

To evaluate the clinical possibility of using a microlaparoscope in laparoscopically assisted vaginal hysterectomy.

STUDY DESIGN

Twenty-five women with different indications for hysterectomy and a uterine size < 14 weeks' gestation underwent laparoscopically assisted vaginal hysterectomy using a microlaparoscope and 2-mm instruments.

RESULTS

Microlaparoscopic procedures included coagulation and separation of infundibulopelvic or uteroovarian round ligaments, vesico-uterine-visceral peritoneal fold dissection, and anterior and posterior colpotomy. The mean operative time, blood loss and length of hospital stay were 84.40 +/- 16.85 minutes, 262.00 +/- 112.99 mL and 3.08 +/- 0.64 days, respectively. No patients developed serious complications, but there were two minor ones.

CONCLUSION

Microlaparoscopy appears to be an efficacious alternative treatment option in well-selected patients undergoing laparoscopically assisted vaginal hysterectomy.

Treatment of nonunions of long bone fractures with shock waves

A prospective clinical study investigated the effectiveness of shock waves in the treatment of 72 patients with 72 nonunions of long bone fractures (41 femurs, 19 tibias, seven humeri, one radius, three ulnas and one metatarsal). The doses of shock waves were 6,000 impulses at 28 kV for the femur and tibia, 3,000 impulses at 28 kV for the humerus, 2,000 impulses at 24 kV for the radius and ulna, and 1,000 impulses at 20 kV for the metatarsal. The results of treatment were assessed clinically, and fracture healing was assessed with plain radiographs and tomography. The rate of bony union was 40% at 3 months, 60.9% at 6 months, and 80% at 12 months followup. Shock wave treatment was most successful in hypertrophic nonunions and nonunions with a defect and was least effective in atrophic nonunions. There were no systemic complications or device-related problems. Local complications included petechiae and hematoma formation that resolved spontaneously. In the authors' experience, the results of shock wave treatment were similar to the results of surgical treatment for chronic nonunions with no surgical risks. Shock wave treatment is a safe and effective alternative method in the treatment of chronic nonunions of long bones.

Laparoscopic diagnosis and management of Fitz-Hugh-Curtis syndrome: report of three cases

Perihepatic adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface characterizes Fitz-Hugh-Curtis syndrome (FHCS). FHCS is an extrapelvic manifestation of pelvic inflammatory disease and usually refractory to medical treatment and surgical intervention. With the increased incidence of pelvic inflammatory disease, chronic pelvic pain and sequalae of the process are becoming more common. Herein, we report 3 patients with pelvic inflammatory disease in whom medical treatment failed initially and FHCS was diagnosed via laparoscopy. Laparoscopic lysis of pelvic and perihepatic adhesions, irrigation of the abdomino-pelvic cavity, and antibiotics treatment after surgery successfully relieved these patients' symptoms. FHCS is not a new syndrome but most gynecologists might neglect this condition. Laparoscopy is a less invasive procedure than exploratory laparotomy. We recommend laparoscopy in patients with lower abdominal and right upper quadrant discomfort when other organic disease has been ruled out and medical treatment has failed to relieve symptoms.

Gaseous nitric oxide-induced 8-nitroguanine formation in human lung fibroblast cells and cell-free DNA

A time- and dose-dependent increase in 8-nitroguanine (8-NO(2)-G) was observed in human lung fibroblast cells (MRC-5) after treatment with gaseous NO-saturated buffer. It was also found that treatment with the inhibitor of inducible nitric oxide synthase (iNOS), N(G)-nitro-l-arginine methyl ester, significantly reduced the 8-NO(2)-G level in the gaseous NO-saturated buffer-treated MRC-5 cells. These results provide evidence indicating that NO gas causes DNA damage in mammalian cells, which involves the activation of iNOS and the subsequent generation of endogenous NO. On the other hand, a time- and dose-dependent increase in 8-NO(2)-G was also observed while DNA (isolated from MRC-5 cells) was incubated with gaseous NO-saturated buffer. These results suggest that part of the 8-NO(2)-G formation was due to direct modification of gaseous NO on DNA. Furthermore, an increase in nitrite concentration was found in both cell-free and MRC-5 cell-conditioned medium treated with gaseous NO-saturated buffer. Collectively, gaseous NO induced DNA damage by forming 8-NO(2)-G, a modification performed directly by the treated gaseous NO and indirectly by the following induction of endogenous NO. This effect might be an important pathway in genotoxicity of nitric oxides, and 8-NO(2)-G could act as a specific marker for DNA damage induced by gaseous NO, a common contaminatant in air pollution and cigarette smoke.

Arthroscopy in avulsion fracture of posterior cruciate ligament

BACKGROUND

Surgical reduction of PCL avulsion fracture was performed from posterior approach and arthroscopic treatment was not routinely performed. However, associated intraarticular lesions of meniscus, cartilage, of any other pathologies were very common in PCL injuries. If the treatments of associated intraarticular lesions would improve the results was not known. Under this prospective study, we want to know if arthroscope is valuable in PCL avulsion fractures.

METHODS

From January 1995 to December 1997, there were 29 cases of PCL avulsion fractures. They were grouped according to chart numbers. Group I was even number group and group II was odd number group. Arthroscopic examination was performed in even number group, but not in odd number group. Group I had 13 cases and group II had 16 cases. All the PCL avulsion fractures were repaired from posterior approach and fixed with cancellous screws.

RESULTS

The range of motion, arthrometric data, and Lysholm score were similar in both group after more than 2 years of follow-up. The residual pain was less in arthroscopic group. Arthroscopic examination showed hemarthrosis in all cases of group I; meniscal lesion in 7 cases (54%), osteochondral or chondral lesions in 3 cases (23%), hard medial plica in 3 cases (23%), patellofemoral lesion in 1 case (7.7%), ACL tear in 1 case (7.7%), popliteal lesion in 2 cases (15.4%), lateral opening greater than 1 cm in 5 cases (38.5%). Though the functional results were similar in both groups, the arthroscopic findings in PCL avulsion fracture were negative in only 2 cases.

CONCLUSION

Arthroscopic examination in PCL avulsion fracture can provide valuable information.