Testicular prosthesis insertion following testicular loss or atrophy during early childhood--technical aspects and evaluation of patient satisfaction

INTRODUCTION

The absence of a testis may be a major traumatic experience with possible consequent negative behavioral impact. The current study is aimed to assess young adults who had lost their testicles early in childhood and subsequently underwent testicular prosthesis (TP) implantation at the end of their adolescence.

MATERIALS AND METHODS

Nineteen patients aged 19.4 years on average underwent TP implantation following testicular loss at early childhood. A postal anonymous questionnaire was sent to the patients and 13 (68%) replied.

RESULTS

Average follow-up was 50 months. Sixty-two percent of patients believed TP size were equal or close to the size of their native testicle, while 23% claimed it was too small. Similarly, 54% had the impression its weight was appropriate, while 38% claimed it was too heavy and 38% supposed its location was too high in the scrotum. However, 85% considered it "very comfortable" or "comfortable" and 77% got used to its presence within 1-4 weeks following surgery. All patients precluded any obstacle in intimate relationships. In accordance, all of them would recommend the operation to a friend with a similar problem.

CONCLUSIONS

TP implantation in adolescents with an undeveloped scrotum is a highly successful surgical procedure. The operation positively influences self-confidence, inter-personal interactions and intimate relationships.

Laparoscopic partial nephrectomy: single center experience with 140 patients--evolution of the surgical technique and its impact on patient outcomes

PURPOSE

We analyzed the outcome of laparoscopic partial nephrectomy in 140 patients and defined the evolution of the operative technique and its impact on patient outcomes.

MATERIALS AND METHODS

Preoperative tumor characteristics, intraoperative parameters (blood loss, ischemia time, complication and conversion rates) and postoperative parameters (complications, surgical margins status and followup) were compared between the initial 30 patients (group 1) and the last 110 (group 2). Statistical analysis was done using the Student t test with p <0.05 considered significant. The impact of modifications in the surgical technique on the outcome of surgery is discussed.

RESULTS

Group 1 consisted of exophytic, peripherally located tumors, whereas in group 2 central and hilar tumors were also included. The 2 groups were also different regarding mean tumor size (2.6 vs 3.9 cm p <0.05), conversion rates (10% vs 2.7%, p <0.05), postoperative complication rates (urine leakage 10% vs 1.4% and reoperation 6% vs 1.8%, p <0.05) and positive margins (10% vs 3.6%, p <0.05). Mean warm ischemia time (32 vs 29 minutes) and blood loss (460 vs 510 ml) were similar (each p >0.05). Renal cell carcinoma was found in 78% and 86% of cases, respectively. Overall 7 cases (5%) had focally positive surgical margins, including 3 in group 1 and 4 in group 2. At followup no tumor recurrences were observed.

CONCLUSIONS

Laparoscopic partial nephrectomy is a challenging procedure with potentially major complications. However, accumulated experience and adherence to a standardized surgical technique translate into improved outcomes.

[Acute coronary syndrome. Guideline-conform management by regional and interregional care concepts]

BACKGROUND

The acute coronary syndrome (ACS) with 16% is one of the most common indication for emergency missions. Care of ACS patients in the Heidelberg emergency service region has been carried out since the beginning of 2005 following an interdisciplinary developed concept based on the current guidelines of the German Society for Cardiology (DGK), the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC).

MATERIALS AND METHODS

Evaluation of the emergency diagnostic and therapeutic measures for the diagnosis of ACS before and after the introduction of the ACS care concept, was carried out retrospectively for the years 2004 (group 1) and 2005 (group 2) by electronic data processing of the records stored in the emergency medical services documentaion system (NADOK).

RESULTS

In the years 2004 before (group 1, n=633) and 2005 after (group 2, n=628) introduction of the ACS care concept, there was a comparable basic diagnostic consisting of a 3-lead electrocardiogram (ECG; 95 versus 97%), manual blood pressure measurement (93 versus 95%) and pulse oxymetry (94 versus 91%) as well as a comparable proportion of patients who received a peripheral vene access (99 versus 100%). There were no significant differences between the two groups. However, after the introduction of the ACS concept, the 12-lead ECG was used significantly more often (49 versus 71%, p=0.0001). Furthermore, a guideline-conform medicinal treatment of ACS patients was used inceasingly more often for anticoagulation with heparin/acetylsalicylic acid (75 versus 84%,p=0.0001) and the use of beta-receptor blockers (32 versus 39%, p=0.009) after introduction of the ACS concept.

CONCLUSIONS

The introduction of a regional care concept leads to an optimisation of guideline-conform prehospital treatment for ACS patients.

Apophysenausriss der Tuberositas tibiae und Fraktur der dorsalen Tibiakopfepiphyse

Avulsion fractures of the tibial tuberosity are rare. In general, juvenile male athletes sustain this fracture. A combination of Ogden type 3A fracture in combination with a posterior fracture of the proximal tibial epiphysis type Salter 2 is described for the first time. The necessity for immediate surgical intervention to prevent secondary soft tissue injury is stressed.

Testicular Fixation Following Torsion of the Spermatic Cord—Does it Guarantee Prevention of Recurrent Torsion Events?

PURPOSE

Patients with history of testicular torsion who have undergone orchiopexy may rarely present with acute scrotum due to recurrent episodes of torsion. Most of the reports in the literature regarding this scenario refer to the era when absorbable sutures were used for testicular fixation. Herein, we review our experience in recent years, focusing upon the surgical technique and sutures' material.

MATERIALS AND METHODS

Between 1991 and 2003, 179 patients were operated on at our institute with the clinical diagnosis of unilateral testicular torsion. They ranged in age between neonates to 45 years old (average age 18). In a comprehensive retrospective study we managed to locate 8 patients who experienced recurrent intravaginal testicular torsion following previous fixation performed in our institute.

RESULTS

The patients who experienced repeat torsion have initially presented at the mean age of 18.5 years old (range 12 to 30) with unilateral twisted testicle (left 3, right 5). Urgent explorations were generally performed, apart from in 2 cases that underwent spontaneous detorsion which was followed by an elective surgery. Testicular fixation was conducted by suturing of the tunica albuginea to the dartos layer by 2 sutures at each side, using chromic 3-zero in the 3 more early cases, followed by the usage of polyglactin 3-zero stitches in 4 subsequent cases and 3 sutures of polypropylene 4-zero for each testicle, thereafter, in the most recent case. The patients presented with repeat torsion, 0.5 to 23 years subsequently (average 7 years), involving either the ipsilateral testicle in 4 cases or the contralateral gonad in 4.

CONCLUSIONS

Recurrent torsion following previous testicular fixation may appear many years following the primary procedure, even in cases in which either polyglactin or, notwithstanding, polypropylene sutures have been applied, in accordance with the common practice used in the last 2 decades. Increased awareness regarding this possibility is imperative for early diagnosis and prevention of testicular loss.

[The laparoscopic approach to renal tumors outcome of 121 laparoscopic radical and partial nephrectomy procedures]

BACKGROUND AND PURPOSE

We present and review a single center experience with laparoscopic renal surgery for renal cancer including laparoscopic radical and partial nephrectomy.

PATIENTS AND METHODS

During the period September 2002 - January 2005, 180 patients underwent laparoscopic renal surgery at our center for several indications. A total of 121 patients underwent radical nephrectomy (76) or partial nephrectomy (45) for solid renal tumors. Their data was recorded and analyzed including age, indication for surgery, operative time, blood loss, intra- and postoperative complications, conversion rates, histological results and outpatient follow-up.

RESULTS

The mean age at surgery was 65 years (range: 21-89 years). The indications for surgery were solid, enhancing renal masses. For tumors larger than 4 cm, a radical nephrectomy was performed. Tumors that were smaller than 4 cm were removed by partial nephrectomy. The mean operative time was minutes (range: 70-280 minutes) and the mean blood loss was 220 cc (range: 30-700 cc). The mean blood loss was significantly lower in the radical nephrectomy group (120 cc) than in the partial nephrectomy group (320 cc). In eight patients major intraoperative complications were noted including injury of the hilar vessels (5 cases), inferior vena cava (1 case), large bowel and spleen (one patient) and duodenum (1 case). Conversion to open surgery was needed in nine patients (7.4%), four in the radical nephrectomy and five in the partial nephrectomy group. Major postoperative complications were recorded in two patients who underwent radical nephrectomy (pneumothorax and incarcerated inguinal hernia) and in two patients who underwent partial nephrectomy (urine leakage). The pathological examination demonstrated renal cell carcinoma in 109 cases, oncocytoma in 6 cases, angiomyolipoma in 2 cases, sarcoma of the kidney and metastasis from lung cancer in one case each and a hemorrhagic cyst in one case. In all patients who underwent radical nephrectomy negative surgical margins were obtained, in three patients after partial nephrectomy the surgical margins were focally involved by tumor. The mean tumor size was 5.1 cm and 3.1 cm after radical or partial nephrectomy respectively. During follow-up, none of the patients developed local or distant recurrence.

CONCLUSIONS

The laparoscopic approach to kidney cancer seems to be safe and oncologically sound. The low morbidity rate together with the inherent advantages of laparoscopic surgery make this approach attractive and we believe it should be considered the new standard of care for renal cancer.

In vitro activity and interaction of clindamycin combined with dihydroartemisinin against Plasmodium falciparum

Combination regimens are considered a valuable tool for the fight against drug-resistant falciparum malaria. This study was conducted to evaluate the antimalarial potential of clindamycin in combination with dihydroartemisinin in continuously cultured and in freshly isolated Plasmodium falciparum parasites, measuring the inhibition of Plasmodium falciparum histidine-rich protein II synthesis. Interaction analysis revealed a synergistic or additive mode of interaction at various concentration ratios in all continuously cultured parasites at the 50% effective concentration (EC(50)) level. Antagonism was not found for any of the culture-adapted parasites. In fresh P. falciparum isolates, a fixed clindamycin-dihydroartemisinin combination exhibited additive activity at the EC(50) and EC(90) levels. The drug mixture showed no significant activity correlation to other commonly used antimalarials. The clindamycin-dihydroartemisinin combination appears to be a promising candidate for clinical investigation.

Extra-large press-fit cups without screws for acetabular revision

This retrospective study reports the 4- to 6-year results of clinical and radiologic follow-up of 60 acetabular revisions using extra-large hemispherical press-fit cups without additional screw fixation. Bone grafts were used in 17 cases. One cup loosened and required re-revision after 12 months. Initial migration was noted in 6 cases, but showed no progression after less than 2 years. In 2 hips that were revised for deep infection, the cups were found incorporated. At final follow-up, 57 hips (95%) were found firmly fixed radiologically. The Harris Hip score improved from a mean of 58.7 points preoperatively to 90.6 points. Provided a high friction coefficient is present, extra-large hemispherical cups offer sufficient stability even in severe cases. Most do not require additional screw fixation.

Cellular profile of cytokine production in a patient with visceral leishmaniasis: gammadelta+ T cells express both type 1 cytokines and interleukin-10

The cytokine profile of CD4+, CD8+ T cells, gammadelta+ T cells and natural killer (NK) cells (CD94+CD3-) was studied in a patient with visceral leishmaniasis (VL). The otherwise healthy, human immunodeficiency virus-negative patient acquired the disease in Tuscany, Italy. Diagnosis was made by demonstration of high concentrations of antibodies against Leishmania antigens in serum. Flow cytometry for the detection of intracellular interferon-gamma (IFN-gamma), interleukin (IL)-2, IL-4, IL-6, IL-10, IL-13 and tumour necrosis factor (TNF)-alpha expression in peripheral blood mononuclear cells stimulated with phorbol 12-myristate 13-acetate and ionomycin was performed, followed by treatment with liposomal amphotericin B. CD4+ cells were identified as major cytokine-expressing cells, capable of producing both type 1 and type 2 cytokines. A high frequency of IL-4- and IL-13-expressing CD8+ cells was noted. NK cells and gammadelta+ T cells, thought to be involved in innate host defences against Leishmania, expressed IFN-gamma and TNF-alpha. Ten per cent of gammadelta+ T cells expressed IL-10, predominantly together with IFN-gamma, suggesting additional immune-regulatory roles for this T-cell subset in VL.

Herpes zoster-associated trigeminal trophic syndrome: a case report and review

The case of a 75-year-old Caucasian woman with a trigeminal trophic syndrome (TTS) is presented and discussed. TTS of the ala nasi subsequent to a herpes zoster infection has not been described previously. We provide a review of the literature with insights into the pathogenesis and current therapeutic strategies.

Dynamic structural disorder of the FeO2 moiety in oxymyoglobin studied by nuclear resonant forward scattering of synchrotron radiation

Oxy- as well as deoxymyoglobin exhibit a pronounced temperature dependence of the quadrupole splitting of the heme iron as detected by conventional Mössbauer spectroscopy. With nuclear resonant forward scattering (NFS) of synchrotron radiation, which can be viewed as Mössbauer spectroscopy in the time domain, it is shown that this spectroscopic behavior, although it is phenomenologically similar in the two cases, is based on completely different physical mechanisms. It is demonstrated that stochastic fluctuations of the iron electric field gradient in MbO(2), which are due to the dynamic structural disorder of the FeO(2) moiety, are the reason for the temperature-dependent alterations of the coherent quantum beat pattern in the NFS spectra of MbO(2), in contrast to deoxyMb where transitions between orbital states of iron take place. This subtle spectroscopic difference cannot be inferred from conventional Mössbauer spectroscopy.

Distribution of mRNAs for Chromogranins A and B and Secretogranin II in Rat Brain

The mRNA distribution of chromogranins A and B and secretogranin II was determined in rat brain. In Northern blots the oligonucleotide probes used hybridized with single mRNA species of the expected sizes. With tissue hybridization the mRNA signals for these three proteins were found throughout the brain. However, each of the three messages had a distinct distribution, which was exemplified by the fact that in the various regions either all three proteins, a combination of two or only one of them were apparently synthesized. Significant levels of all three mRNAs were found in several regions of the hippocampus and of the amygdala, in some thalamic nuclei and in the pyriform cortex. On the other hand the subiculum contained only the message for chromogranin A, the granule cell layer of the cerebellum only that for chromogranin B, and in posterior intralaminar thalamic and medial geniculate nuclei and in the nucleus of the solitary tract only secretogranin II mRNA was found. The distinct distributions of mRNAs for the chromogranins in various brain regions support the concept that these proteins are propeptides giving rise to functionally active components.

Distribution and intraneuronal trafficking of a novel member of the chromogranin family, NESP55, in the rat peripheral nervous system

NESP55 (neuroendocrine secretory protein of M(r) 55000) is a novel member of the chromogranin family. In the present study, we have investigated the distribution, axonal transport and proteolytic processing of NESP55 in the peripheral nervous system. The amount of NESP55 immunoreactivity in adrenal gland was more than 240 times higher than that in the vas deferens. Double or triple immunostaining demonstrated that NESP55 immunoreactivity was highly co-localized with tyrosine hydroxylase immunoreactivity in bundles of thin axons and postganglionic sympathetic neurons; that NESP55 immunoreactivity also co-existed with vesicular acetylcholine transporter immunoreactivity in large-sized axons in sciatic nerves, and that NESP55 immunoreactivity overlapped with calcitonin gene-related peptide immunoreactivity in some large-sized axons, but NESP55 immunoreactivity was not detected in sensory neurons. Strong NESP55 immunoreactivity was found in cell bodies and axons, but it was not detectable in any terminal region by immunohistochemistry. In crush-operated sciatic nerves, NESP55 immunoreactivity could be found as early as 1 h after operation, and accumulated amounts increased substantially with time. However, NESP55 immunoreactivity was only observed in axons proximal to the crush, but none or very little distal to the crush, which was consistent with the data from radioimmunoassay. Finally, extracts of the normal and crushed sciatic nerve and vas deferens were subjected to high-performance liquid chromatography followed by radioimmunoassay. The results indicate that NESP55 is processed slowly to small peptides (GAIPIRRH) during axonal transport. NESP55 immunoreactivity was only detected in axons proximal to the crush. The data in the present study indicate that NESP55 immunoreactivity is widely distributed in adrenergic, cholinergic, and peptidergic neurons, but not in sensory neurons, and that this peptide is anterogradely, but not retrogradely, transported with fast axonal transport and slowly processed to smaller peptides during axonal transport in the peripheral nervous system.

Quantitative self-organizing maps for clustering electron tomograms

Tomography emerges as a powerful methodology for determining the complex architectures of biological specimens that are better regarded from the structural point of view as singular entities. However, once the structure of a sufficiently large number of singular specimens is solved, quite possibly structural patterns start to emerge. This latter situation is addressed here, where the clustering of a set of 3D reconstructions using a novel quantitative approach is presented. In general terms, we propose a new variant of a self-organizing neural network for the unsupervised classification of 3D reconstructions. The novelty of the algorithm lies in its rigorous mathematical formulation that, starting from a large set of noisy input data, finds a set of "representative" items, organized onto an ordered output map, such that the probability density of this set of representative items resembles at its possible best the probability density of the input data. In this study, we evaluate the feasibility of application of the proposed neural approach to the problem of identifying similar 3D motifs within tomograms of insect flight muscle. Our experimental results prove that this technique is suitable for this type of problem, providing the electron microscopy community with a new tool for exploring large sets of tomogram data to find complex patterns.

[Indications criteria for treatment of distal radius fractures]

To achieve an optimal functional result after distal radius fractures the treatment has to orientate at different criteria. The bone destruction must be analysed. A fracture classification is necessary to use all the variable alternatives of treatment. With the AO classification we are able to describe most of the variable fracture types. Soft tissue damage and osteoporosis must be regarded additionally. The most important criteria however in fracture treatment is the fracture type.