The use of latissimus dorsi muscle flap in reconstructive heart surgery

Dynamic cardiomyoplasty is a technique for ventricular assistance indicated for the correction of left ventricle aneurysm and for cardiomyopathies in which heart transplantation is contraindicated. In this article, our first four patients to undergo cardiomyoplasty (from February 1991 until April 1992) with a left latissimus dorsi island flap, rotated into the thorax after a 3-week training period, are reviewed. Therapeutic indications were cardiomyopathy with contraindication for heart transplant in patients 1 and 4 and associated to surgery for left ventricle aneurysm for patients 2 and 3. Patient 1 died 4 months after surgery because of a cerebral embolism when he was at functional class II. The other three patients remain at functional class I, carrying out normal activities. All the data were evaluated with the paired t test. Ejection fraction values (obtained through echocardiography and scintigraphy studies) and maximum minute flow rate of blood (measured with an echo-Doppler) have increased significantly (p < 0.001, p < 0.05, and p < 0.01, respectively) after heart surgery. Clinical improvement has been found after cardiomyoplasty, which correlates with an increase in ejection fraction and maximum minute flow rate of blood.

[Rapidly-growing renal angiomyolipoma associated with pregnancy]

Renal angiomyolipoma is a relatively uncommon entity which can occur either as a solitary angiomyolipoma or associated to a systemic condition such as Bourneville's disease or tuberous sclerosis. Presentation of one case of a large, fast growing renal angiomyolipoma associated to pregnancy, which required surgery during the third month of pregnancy.

Spinal cord compression by amyloid deposits

STUDY DESIGN

Dorsal spinal cord compression caused by amyloid tissue deposits in the posterior vertebral arch and epidural space of the T6-T7 region in a 29-year-old woman is reported.

RESULTS

Studies did not show any primary cause of amyloidosis.

CONCLUSIONS

This case can be classified as primary localized tissue because other causes and amyloid deposits were not discovered. This patient was the youngest person reported to have dorsal spinal cord compression caused by amyloid tissue deposits, and the spinal cord compression was localized in the thoracic region, which occurred in six of the seven cases reported.

[Doctor Francisco Pérez Cascales. Biography and odontologycal chapter of his work]

Given the absence of odontological texts and against the background of the very poor development of this branch of surgery during the XVII century, we have thoroughly investigated the medical, surgical and paediatric texts of the century, all scattered around and of different length, and have bumped against the text of the noteworthy "paediatrician" of the Rénaissance, Francisco Pérez Cascales who, in his "Liber de affectionibus puerorum", tackles, in hand with the Greek and Roman classical authors, only one oral and dental problem: mouth ulcers, and lingers on their aethiology, diagnosis and clinical treatment. We are also remaking the biography of the author, trying to fill in the many blanks found in it and correct the multiple errors through the incorporation of appropriate documents and references.

Surgical treatment for congenital absence of the vagina using tissue expansion

A modification of the Abbe-McIndoe technique for the treatment of congenital absence of the vagina, using a cylindrical tissue expander wrapped in a mesh split-thickness skin graft, instead of a rigid silicone mold, is presented. The expander was kept in place for a period of two to six months and the functional result was 100 percent in all the six patients treated. Our experience led us to change the design of the expander (cylindrical, without ring, 10X4 centimeters) and to place the valve in the inner thigh as the best site for the valve. The age range of the patients was 18 to 27 years, and the final result was good or very good in five of the six women. Only one patient has occasional dyspareunia, which does not prevent sexual intercourse.

[Extracorporeal lithofragmentation and of direct contact. Development of mathematical models for calculating the energy and predicting the fragmentation]

The present experimental 'in vitro' study pursues the development of mathematical equations which, prior to lithofragmentation, would allow to estimate the amount of energy required and to predict the degree of fragmentation for each of the different sources of energy. A total of 114 calculi with 6 different compositions were analyzed by conventional X-rays (Rx), computerized axial tomography (CT) and dual X-ray densitometry (DO). Calculi were then fragmented using 4 different types of energy: electrohydraulic (LEH), piezoelectric (LEP), ultrasounds (US) and pulse laser (LAS). The correlation between imaging techniques parameters on the one side, and the amount of energy used and degree of fragmentation obtained on the other one, allow with a multiple linear regression analysis, both to develop mathematical equations to estimate the amount of energy required, and to predict the fragmentation rate.

[The usefulness of dual-energy radiographic densitometry (DO) in establishing the composition of calculi]

Dual-energy radiographic bone densitometry is utilized to determine the bone mineral content in patients with osteoporosis. The present in vitro experimental study investigated the usefulness of densitometry in determining stone composition and in evaluating the mineral and non mineral phases of the calculus. For the study we analyzed 114 calculi of 6 different chemical composition (calcium oxalate monohydrate, calcium oxalate dihydrate, magnesium ammonium phosphate, phosphate carbonate, uric acid and phosphate oxalate). The phosphate carbonate calculi had the highest mineral density, whereas the uric acid calculi had the lowest and contained more water. Although densitometry appears to be of little value in determining stone composition, it provides information on the mineral and non mineral phases of the calculus.

[Intracavitary electrocardiography. A useful method for checking the correct localization of central venous catheters]

A placement technique for central venous catheters (CVC) using the intracavitary electrocardiography (ICECG) as well as three different connection systems of the CVC to the electrocardiographic monitor are described. The aim of the present study was to evaluate the correct placement of the CVC by this technique with posterior radiologic confirmation being carried out. The study was undertaken in 30 patients connecting a CVC to a negative electrode of the standard lead II and the positive to the left leg. The CVC was advanced and the changes in the morphology of the "P" wave as it passed along the superior vena cava (SVC) to the right auricle (RA) were observed. In 28 of the 30 patients (93.3%) a biphasic "P" wave (right auricle) was achieved with the CVC being thereafter withdrawn until the SVC (this location was radiologically confirmed posteriorly). In 2 patients (6.6%) a biphasic "P" wave was not obtained and an abnormal position of the CVC was radiologically demonstrated at surgery (one in the ipsilateral subclavian vein and the other had a ring within the right subclavian vein impeding progression). The mean time used in the performance of this technique was 220 +/- 40 s. It is concluded that intracavitary electrocardiography is a simple, easy to learn and perform technique which does not delay surgical procedure and it is a reliable method for placing the end of the CVC.

Gas chromatographic retention of carbohydrate trimethylsilyl ethers. IV. Disaccharides

Trimethylsilyl ethers of seventeen disaccharides were injected on two stationary phases and their retention indices were calculated. Multiple linear regression was used to discuss relationships between retention indices and structural features of disaccharides.

[Small cell (oat cell) carcinoma of the prostate. Presentation of a case and review of the literature]

Prostate small cell carcinoma (SCC) is a rare and fatal condition over which countless enigmas hover both with regard to its origin and biological behaviour as well as to its management, the topic of this paper. We contribute the case of a 69-year old male diagnosed through transrectal biopsy and presenting lung, nodes and bone metastasis who underwent palliative UTR but died within four days of the intervention as a consequence of the metastatic condition. Microscopic and immunohistochemical findings characteristic of this type of tumour are described, emphasising the relevance of diagnosing this entity based on its poor prognosis and different therapeutic approach from that used for typical prostate adenocarcinoma.

Intolerance to sodium metabisulfite in children with steroid-dependent asthma

Oral challenge tests were carried out with sodium metabisulfite solution doses of 5, 10, 25, 50 and 100 mg, dissolved in 20 ml of citric acid, and administered to 20 children aged 7-14 years with steroid-dependent bronchial asthma. A single-blind challenge protocol was performed initially and the positive responses were confirmed by double-blind challenge. Initially, 6 of 20 presented a positive reaction, confirmed in 4 of 20 by double-blind challenge. Only 1 child was clinically suspected of exhibiting intolerance to this agent. The prevalence of the challenge test using sodium metabisulfite in children with steroid-dependent bronchial asthma was 20%.

Carcinoma of the prostate: general concepts

The work of Huggins et al more than 40 years ago established the effectiveness of androgenic deprivation in the management of patients with disseminated prostatic cancer. The initial utilization of estrogens was considered appropriate until elevated cardiovascular risk was proven with higher doses. Orchidectomy continues to be an effective method of androgenic suppression, although disadvantages are seen to be its irreversible nature and possible psychologic impact on the patient. Luteinizing hormone-releasing hormone (LHRH) agonists can achieve plasma levels of testosterone similar to surgical castration with minimum inconvenience to the patient. Androgen antagonists act directly on the metabolism of the prostatic cell, obtaining a similar effect to that of castration, with maintenance of testosterone levels in the case of flutamide. The concept of total androgen blockade is one currently receiving attention. Although controversy still remains, it is thought that complete hormone blockade (for example, orchidectomy plus an anti-androgen) may improve survival.

Synthesis and structural, conformational, and pharmacological study of some of esters derived from 3-phenethyl-3-azabicyclo[3.2.1]octan-8-beta-ol and the corresponding N-endo-methyl quaternary derivatives

A series of 8-beta-acyloxy-3-phenethyl-3-azabicyclo[3.2.1]octane and its N-endo methiodides were synthesized and studied by 1H and 13C NMR spectroscopy, and the crystal structure of 8-beta-p-chlorobenzoyloxy-3-phenethyl-3-azabicyclo[3.2.1]octane methiodide (2c) was determined by X-ray diffraction. In CDCl3 solution, 1b-1e display the same preferred conformation. The cyclopentane and piperidine rings adopt an envelope conformation flattened at C-8 and a distorted chair conformation puckered at C-8 and flattened at N-3, respectively, with the N-substituent in the equatorial position with respect to the piperidine ring. In all cases, methylation takes place from the endo position. The ability of the title compounds to antagonize the acetylcholine-induced contraction of guinea pig ileum is also reported. An initial structure-activity relationship is proposed.

Is the routine measurement of ionized calcium worthwhile in patients with cancer?

This study was undertaken to analyse the relationship between total calcium (TCa) and ionized calcium (ICa) in patients with cancer, and to assess the clinical value of routine measurements of ICa in these patients. Serum TCa, ICa, albumin, proteins and creatinine were measured in 188 adult patients with solid malignant tumours. Most of them were out-patients, the Karnofsky score being 80 or above in 67%. The correlation coefficient between ICa and TCa was 0.85 (P less than 0.001) and did not improve after correcting TCa for protein concentration with several published formulae. Although TCa measurements had a global diagnostic accuracy (percent of patients correctly classified) of 90%, they failed to identify a substantial proportion of patients with increased levels of ICa (57% for uncorrected TCa, and 27-57% for protein-corrected TCa). However, the finding of slightly increased ICa levels did not seem to predict the development of frank hypercalcaemia and did not impair the prognosis. According to these results, the routine measurement of ICa in unselected patients with cancer has no clinical usefulness.

Neuromesenchymal hamartoma of the small bowel

We present the case of a long small bowel stricture with pathological features similar to those described as "neuromuscular and vascular hamartoma," showing in addition extensive fatty submucosal infiltration and fibrous intramural nodules. In the controversy about the nature of this disorder, we consider it a separate entity. Taking into account that other mesenchymal tissues than the originally described can participate, we propose the alternative term of "neuromesenchymal hamartoma" of the small bowel.

Severe haemolytic anaemia due to cold anti-'i' antibodies associated with cytomegalovirus infection

A 66 year old patient with multiple myeloma and monoclonal cryoglobulinaemia who developed a severe haemolytic anaemia following a cytomegalovirus infection is reported. The presence of a high titre of anti-'i' cold antibody of IgM subclass is demonstrated. Anti-'i' antibody disappeared when complement-fixation antibody titres against cytomegalovirus decreased. Various pathogenetic mechanisms involved in the development of haemolytic anaemia associated with cytomegalovirus infection are discussed. To our knowledge, this is the first case described in the English language publications associating severe haemolytic anaemia with an anti-'i' antibody after a cytomegalovirus infection in an immunocompromised patient.

Peak expiratory flow measured with the Mini Wright Peak Flow Meter in children

We established pediatric reference values for peak expiratory flow rate (PEFR), using the Mini Wright Peak Flow Meter. The study was based on 1,566 Mediterranean white children, aged 7 to 14 years from Valencia (Spain) schools. Height was the biometric variable with the greatest correlation to PEFR in both sexes; significant differences were noted between males and females. Prediction equations and percentile tables are presented for each sex. The performance of the Mini Wright Peak Flow Meter was compared with that of a spirometer.

The clinical spectrum of hypocalcaemia associated with bone metastases

Malignancy-related hypocalcaemia has received less attention in the literature than the opposite perturbation, hypercalcaemia. Only, scarce and contradictory data exist about hypocalcaemia associated with bone metastases (BMH). We have reviewed the clinical records of 155 patients with bone metastases of solid tumours, 122 of which were followed during the whole course of the disease until death. The frequency of hypocalcaemia ranged from 5 to 13%, depending on the formula used to correct calcium values for protein concentration. BMH was almost exclusively limited to patients with osteoblastic metastases. The frequency of BMH among patients with prostate carcinoma was 13-27%, depending on the formula used. Only two of 60 patients with lytic bone lesions presented hypocalcaemia, and in both cases it was rather mild. The development of hypocalcaemia did not seem to imply a worse prognosis, at least in patients with carcinoma of the prostate. Thus, the prevalence of BMH appears to be higher than is usually considered. Adequate attention should be given to this disorder because of the potentially deleterious effects on several organ systems.

[Pneumococcal endocarditis: apropos of 3 cases]

Streptococcus pneumoniae is a common pathogen in man. The incidence of endocarditis caused by this organism has diminished in the last decades, and now it is an exceptional condition. Three patients with pneumococcal endocarditis are reported. Their clinical and epidemiological features are reviewed and compared with previous literature. One of the instances was due to a strain with high resistance to penicillin; vancomycin was a valid alternative therapy.

Primary repair of extensor tendons with assisted post-operative mobilisation. A series of 48 cases

Forty-eight patients with lesions of the extensor apparatus of the hand were treated by primary repair with assisted post operative mobilisation by means of a dynamic extension, low profile splint. They were divided into three groups: 25 simple wounds of the extensor tendons of the fingers; 14 simple wounds of the extensor tendon of the thumb; 9 complex lesions. The mobility of the tendinous suture and the callus displacement were monitored by means of metallic markers implanted at operation. Functional electromyographic study during physiotherapy permitted refinement of the technique of reeducation by a limitation of the range of flexion of the proximal interphalangeal articulations. The results are divided into 4 categories: excellent 33 (60%), good 9 (16.4%), average 4 (7.3%), bad 9 (16.4%). No complications (infection, loosening of suture, reflex sympathetic dystrophy) were detected in this short preliminary series. The proposed technique produced improvement of only minor significance in comparison with traditional methods, when applied to uncomplicated wounds. Significantly improved results were obtained in the group of patients with complex lesions.

Comparative studies on "acid-stable, heat-stable polypeptides" of ovine, caprine and bovine milks

"Acid-stable, heat-stable polypeptides" (previously called proteose-peptone) of three milk species have been studied. Analysis by polyacrylamide gel electrophoresis revealed that all fractions showed similar patterns. Only bands with the lowest mobilities showed the presence of carbohydrates when stained with Schiff's reagent. These bands had a lower mobility in ewe's and goat's milk than in cow's milk. Gas chromatography/mass spectrometry analysis showed the presence of fucose, mannose, glucose, galactose, glucosamine and galactosamine in the three fractions studied. Acid-stable, heat-stable polypeptides of bovine milk had the lowest carbohydrate content (4 mg/100 mg protein), whereas the highest content was found in ewe's milk (7.30 mg/100 mg protein) mainly as a result of the high galactose, mannose and glucosamine content. The sialic acid content was lower in ewe's and goat's milk (2.68 and 2.98 mg/100 mg protein respectively) than in bovine milk (2.06 mg/100 mg protein).