Correlation of microproteinuria and histopathological changes in kidney in diabetes mellitus

Single attempt kidney biopsy was successful in 60 cases of diabetes mellitus out of 83. Histopathological evidence of nephropathy was found in 30 (50%) out of 60 (4 of IDDM and 56 of NIDDM). Microproteinuria was a sensitive indicator of histopathological evidence of nephropathy (by biopsy) and should be used as a non invasive method of evidence of kidney involvement in diabetes mellitus regardless of duration of the disease. Routine renal function tests--commonly used indicators of kidney disease in the presence of hypertension were of no value and should not be relied upon. Duration of diabetes mellitus was important correlation with the evidence of the disease and and its severity but nephropathy was found in newly detected cases of diabetes mellitus (NIDDM). Nephropathy was present in case of DM who had retinopathy and is a better factor of correlation.

Hereditary spherocytosis: experience of 145 cases

145 patients were diagnosed to have hereditary spherocytosis (HS) over a period of 25 years. Jaundice (66.9%), fever (65.5%), weakness (44.8%), and abdominal pain (35.8%) were the commonest complaints. 94.5% had splenomegaly (JP-17 cm) and 71.7% had hepatomegaly (JP-6 cm). Spherocytes were detected in the peripheral smears of all patients at presentation on careful examination. 67 patients had been investigated elsewhere and spherocytes missed in 86.6%. Gall stones were seen in 20 of the 54 patients investigated. Family history suggestive of HS was available in only 16.6% of cases, whereas examination and investigations revealed HS in almost all families. Splenectomy was done in all symptomatic patients. In the 39 patients followed up for 1-9 years after splenectomy.

A complex pattern of H2A phosphorylation in the mouse testis

Phosphorylation of H2A histones in mouse testis was examined using testis tubule cultures labeled with 32PO4. Histones were analyzed by two systems of two-dimensional polyacrylamide gel electrophoresis, followed by autoradiography of the gels. Of the 32PO4 detected in histones, 95% was incorporated by certain modified forms of the H2A variants H2A.1 and H2A.X. Phosphorylation sites were mapped to N- and C-terminal regions of the modified variants by SDS gel electrophoresis and autoradiography of peptides generated by cleavage of in vitro-labeled proteins with N-bromosuccinimide. Incorporation rates differed for N- and C-terminal regions from different modified forms, demonstrating a complex pattern of H2A phosphorylation in the mouse testis.

[Surgical treatment of infectious aneurysm of the popliteal artery. Description of a case caused by Campylobacter jejuni and a review of the literature]

The authors describe a case of mycotic aneurysm of the popliteal artery secondary to Campylobacter jejuni-derived infectious endocarditis treated by excision and in situ femoro tibial venous bypass, and take the opportunity to review 14 literature cases of infectious aneurysm of popliteal artery. This diagnosis is most frequently evoked by the development in an infectious setting of a throbbing inflammatory mass in the popliteal fossa. Management is aimed at controlling the infection and insuring proper distal vascularization. Eradication of the infection rests with the excision of the aneurysm and adequate antibiotherapy for at least 6 weeks. Distal vascularization is best provided (2 cases) by extra-anatomical bypass. However, in situ bypassing (9) is possible provided apyrexia and negative blood cultures have been obtained by preoperative antibiotherapy. The material used must be a venous autograft, whenever possible.

[Carotid surgery under locoregional anesthesia]

Eight-five carotid endarterectomies were performed in 77 patients, under regional anaesthesia using 2 different techniques: cervical epidural anaesthesia (35 cases) and cervical plexus block (50 cases). The patients' mean age was 71 years; 80 per cent had arterial hypertension and 41 per cent coronary disease. Transoperative cerebral ischaemia was detected by a 5-minute carotid clamping test, the occurrence of a neurological event indicating that shunting was required. In 62 patients this test was combined with measurement of carotid back pressure. None of the patients needed general anaesthesia. Intraoperative neurological events occurred more frequently (P less than 0.01) when the carotid back pressure was 25 mmHg or less, and 12 temporary shunts were installed for that reason (14.1 per cent). Three neurological events occurred at the end of endarterectomy: no shunt was installed and complete recovery was observed immediately after declamping. No complications ascribable to the anesthetic techniques were recorded. Mortality was nil, and the only neurological morbidity was a brachio-facial deficit which left few sequelae. The frequency of intra- or postoperative arterial hypertension was similar in both groups. Intraoperative hypotension, frequent under epidural anaesthesia, was observed in only one patient who had brachial plexus block (P less than 0.01). The analgesia obtained was equally good with both anaesthetic techniques, but cervical plexus block anaesthesia is easier to perform, had less haemodynamic repercussions and therefore tends to be preferred to cervical epidural anaesthesia. The lack of mortality, low morbidity and absence of systemic complications in this series despite the high number of patients at risk are in favour of this type of anaesthesia, notably for such patients. Moreover, because vigilance is preserved attention can be paid to the quality rather than the rapidity of endarterectomy, which is the best way of preventing embolism.

Complications in 8793 cases of diabetes mellitus 14 years study in Bombay Hospital, Bombay, India

Complications in 8793 hospitalised cases of diabetes in 14 years were present in 81.8 percent. It was equal in both sexes. They did not depend upon religious dietary habits or on economic condition/status of the patient. Hypertension was present in 42.2%. Ischaemic heart diseases in 27.2%. C.V.A. in 9.2% and gangrene and peripheral vascular diseases in 4.2%. Acute & chronic U.T.I. was in 31.4% and uraemia in 4.5% and K.W. Syndrome in 2.5%. In Infection Tuberculosis was in 5.9% and pyogenic skin infection in 4.1%. Vascular and renal complications increased with the duration of diabetes and with age in type II diabetes.

[Arterial substitutes used in peripheral vascular surgery]

Peripheral vascular surgery frequently requires the implantation of substitute arteries for the re-establishment of blood flow. Biological grafts, either authentic (autograft or venous homograft) or processed (bovine heterograft, human umbilical vein) comproise the first group. The venous autograft possesses a real capacity of healing and remains the established standard for small and medium bore conduits. The other biological models lead to unpredictable outcomes. The second group of substitutes is composed of synthetic prostheses made from Teflon R or DacronR. Although of lesser healing capacity, their durability is excellent. Finally, numerous prostheses are under development. Before proceeding to human implantation, it is advisable to evaluate them without prejudice.

Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring

Sutureless colonic anastomosis using a biofragmentable anastomosis ring (BAR) has been evaluated in a prospective randomized comparison with sutures and staples for elective colorectal surgery. One hundred and one patients underwent BAR anastomosis, 85 a sutured anastomosis, and 16 a stapled anastomosis. There were two anastomotic leaks in the patients undergoing BAR anastomosis, seven in patients having a sutured anastomosis, and one in a patient who had a stapled anastomosis. Wound infection occurred in ten BAR patients, ten sutured patients and no stapled patient. There was no statistically significant difference in these or in other postoperative complications between the groups. The BAR was easy to use and is a safe alternative to sutures and staples for large bowel anastomosis.

Prevalence of cerebrovascular accident in 4349 diabetic cases

1. Prevalence of cerebrovascular accident in 4349 cases of diabetes admitted in the Bombay Hospital, Bombay between 1967 and 1975 was in 411 (9.45 percent) cases. 2. Number of males predominated, but was of no significance as compared to the occurrence of cerebrovascular in females. 3. Highest number of cases were in the age group of 61-70 years (statistically significant), which was a decade higher than the age of (51-60 years) maximum number of admitted cases in 4349 cases. The mortality increases with age, highest in age above 70 years-statistically significant. 4. The type and site of cerebrovascular accident had no relation to the age group or sex, duration and severity of diabetes. 5. Cerebrovascular accident was much less in the last 3 months of the year and was highest in the month of June, and is of no statistical significance. 6. Cerebrovascular accident was more prevalent in mild type diabetes, but mortality was higher in severe type of diabetes. 7. Cerebrovascular accident was prevalent in all types of blood pressure, but had highest mortality in severe hypertension. 8. Occurrence of CVA had no relation with the duration of diabetes.

[Primary malignant teratoma of the thyroid in adults. Report of 1 case and review of the literature]

Malignant teratomas of the thyroid gland are exceptional in adults. One case is presented. It brings to 11 the total number of cases reported in the literature. The histological diagnosis of these lesions raises few problems, but their histogenesis remains controversial. Their very poor prognosis justifies total thyroidectomy with lymphadenectomy associated with cervical and mediastinal radiotherapy and combination chemotherapy. In the case reported here, this triple therapeutic combination has allowed the disease-free survival of the patient for 27 months after surgery.

[Preoperative skin preparation. A prospective study comparing a depilatory agent in shaving]

Two types of pre-operative skin preparation were compared in a prospective randomized study conducted on 100 patients undergoing elective surgery: 51 patients were shaven (group I) and 49 were prepared with a depilatory agent. In all cases skin preparation was performed on the eve of the operation. Bacterial density, measured immediately before surgery by application of a contact agar preparation was 493 +/- 928 CFU in group I and 386 +/- 670 CFU in group II (NS). Bacterial density was less than 25 CFU in a significantly greater number of group II patients (P less than 0.01). On the second postoperative day, the number of scars without any sign of sepsis was significantly greater in group II patients (P less than 0.05). In addition, the depilatory agent proved bactericidal against 3 pathogenic strains (S. aureus, Pseudomonas aeruginosa and E. coli). Depilation with a chemical agent seems to be a satisfactory method of pre-operative skin preparation. It is more rapid than shaving, it can be applied to areas not easily accessible to razors, and it can often be carried out by the patient himself.

[Refractory cancer pain. Subarachnoid or epidural administration of morphine]

Spinal analgesia, a new method for relieving refractory cancer pain, was tested in 19 patients. A catheter was installed in the subarachnoid (17 cases) or peridural (2 cases) space and connected to a subcutaneous site of injection. The success rate at 10 days was 68%. In 11 patients pain was relieved throughout the course of the malignant disease, with doses that did not exceed 6 mg in 7 patients and 10 mg in the remaining 4 patients. The most severe complications were leakage of the cerebrospinal fluid in 1 case, meningitis after 18 months of injection in 1 case and displacement of the catheter in 3 cases.

[Surgery of duodenal ulcer. In decline?]

The authors report their experience of the surgical treatment of duodenal ulcer disease and its complications over a 10 year period (1976-1986), i.e. 336 cases from a group of 10748 digestive tract endoscopies performed and 1126 duodenal ulcers identified (10.4%). The efficacy of new types of medical treatment (anti-secretory drugs, endoscopic hemostasis techniques, prostaglandins) and the improved follow-up of patients tend, despite the value and proven safety of Parietal-cell Vagotomy (elective procedure in 76% of the group), to modify: the epidemiological aspect of the disease in the sense of a decrease in the rate of ulcers with complications related to stenosis and perforation; the therapeutic aspect with more limited surgical indications. Is this the end of surgery for duodenal ulcer and its complications?

[An original method of making a purse for circular mechanical anastomoses]

A simple and reliable procedure applicable to all segments of the digestive tract, except the oesophagus, is described. A series of superficial U-shaped stitches is inserted along the upper edge of a Kocher's forceps that clamps the entire width of the intestine. The intestine is then cut with a scalpel along the lower edge of the forceps, i.e. on the side opposite to the sutures. After the forceps is released, a purse about 2 mm distant from the intestinal opening is obtained. When the purse is tightened the mucosa, crushed by clamping, does not protrude and therefore does not interfere with the mechanical anastomosis.