Control of hormonal treatment of carcinoma of the prostate

Summary Hormone therapy still has a central role in the treatment of carcinoma of the prostate. The present study is concerned with the possibility of controlling the administration of hormones by estimation of plasma testosterone and LH levels. Plasma testosterone levels were determined by a new modification of competitive protein binding method, and LH by a conventional radioimmunoassay.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.     

Rare case of the hyaline vascular type of Castleman''s disease of the kidney

Castleman's disease (CD) is a rare disorder characterized by a benign proliferation of lymphoid tissue. Most cases tend to present as a mediastinal mass. A few extrathoracic cases involving nodal and extranodal locations have previously been reported. To the best of our knowledge, however, only one case of CD of the kidney has been published in an English report. We herein report a rare case of CD presenting as a left renal tumor. A 70-year-old male was examined by computed tomography for a follow-up for colonic diverticulitis and a left renal mass measuring 2.0 cm in diameter was incidentally found. The patient underwent a left partial nephrectomy for a left renal mass and a histopathological analysis demonstrated the hyaline vascular type of CD. Based on our findings, CD should be included in the differential diagnosis of renal tumors.     

胫骨上端三维有限元模型的建立

目的 建立胫骨上端的三维有限元模型，以期为膝关节三维有限元的建立和研究，提供方法学和研究平台。方法 根据螺旋CT扫描图像，利用Ansvs有限元软件的由下向上的点、线、面、体的建模原则，对胫骨上端的三维有限元模型进行重建.结果 建立了胫骨上端的三维有限元模型。结论 本研究所建立的胫骨上端的三维有限元模型，能逼真地反应胫骨上端的真实几何结构。     

A case of cystadenocarcinoma of the liver

A case of cystadenocarcinoma of the liver is reported. The patient was a 73-year-old woman in whom a tumor was detected in the lateral segment of the liver during a health examination. Ultrasonograms and computed tomograms showed a multilocular cystic mass. Magnetic resonance imaging (MRI) showed a multilocular lowintensity mass, including a high-intensity portion and a portal branch compressed by the tumor. MRI with gadolinium showed an enhanced cyst wall. The cystic part of the tumor became smaller and the solid part became larger over a 1-month period, indicating that the tumor was malignant. Subsegmentectomy (S₃) was performed and cystadenocarcinoma with cystadenoma was diagnosed by histopathological examination. Identification of changes in the appearance of a tumor should be helpful for the differential diagnosis of cystadenoma and cystadenocarcinoma.     

Comparison of costs of different anaesthetic techniques

The costs of anaesthetic drugs, intravenous agents as well as gases, were studied for different anaesthetic techniques in a medium-sized operative procedure, cholecystectomy. Three anaesthetic breathing systems were used: a non-rebreathing system, a circle absorber system with medium fresh gas flows of 3-6 l/min, and a low-flow circle system. Anaesthesia without volatile inhalation agents used with a low-flow technique was the least expensive, and anaesthesia with isoflurane in a non-rebreathing system was the most expensive. The costs of anaesthesia without volatile inhalation agents in a non-rebreathing system, enflurane anaesthesia in a circle system with medium fresh gas flows, and isoflurane anaesthesia with low-flow technique were similar.     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Influence of fracture criteria on the outcome of a randomized trial of therapy

Based on a presumption that the morphometric approach to vertebral fracture assessment is beset by false positive deformities, it has been suggested that more stringent criteria should be used to assess vertebral fracture outcomes in clinical trials of osteoporosis therapies. We applied a variety of criteria in the reanalysis of a randomized trial of sodium fluoride therapy for women with established osteoporosis. Although progressively more severe criteria reduced the cumulative incidence of a new vertebral fracture in both those receiving a placebo and the fluoride-treated patients, differences between the two groups were not magnified and none of the suggested approaches produced a statistically significant result. These findings indicate that the false positive rate associated with morphometric assessment of vertebral fractures is not so great as supposed from theoretical considerations that assume independence among the measurements. Our findings also provide some reassurance that differences in the criteria used to define a vertebral fracture are not the controlling influence in the likelihood that a particular clinical trial will find a result favoring one treatment over another.     

Non-skeletal determinants of fractures: the potential importance of the mechanics of falls

Bones break because the forces applied to them exceed their strength. For most non-spine fractures, this force results from a fall. Falls generate at least 10 times the energy necessary to fracture the proximal femur, but only 5%–10% of falls in older white women cause fractures and only 1% cause hip fractures. The mechanics of the fall plays a very important role in whether a fracture will occur and which bone will fracture. This review postulates that orientation of the fall and location of the impact determine the type of fracture, and whether a fracture occurs depends on the energy of the fall (distance to impact and weight of the moving parts) and how much of that energy is absorbed by protective responses, the impact surface and soft tissues over the bone. Recent case-control studies support the view that the mechanics of a fall are the most important determinant of whether it will result in a hip fracture.     

Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: A case report and review of literature of the last 20 years

INTRODUCTIONFractures of the carpal bones are often difficult to diagnose and treat due to the complex bone architecture of this region. Hamate fractures, particularly body fractures, are extremely uncommon.PRESENTATION OF CASEWe present a case of a coronal fracture of the hamate associated with a fracture of the base of the fourth metacarpal, which was treated by open reduction and internal fixation.DISCUSSIONSome of hamate body fractures are associated with other injuries like metacarpal fractures. Its diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. This fracture is a very rare lesion that can raise questions about their most adequate diagnostic and therapeutic approaches.CONCLUSIONAfter reviewing the literature, we conclude that there is a high rate of delay in the diagnosis of these lesions, probably due to their rarity and to the lack of radiological studies specifically targeting this region. Despite this, surgical treatment in its different modalities has been shown to have the best clinical and functional results.     

The Retroperitoneoscopic Repair of a Lumbar Hernia of Petit Case report and Review of Literature

In this paper, we comment on a patient who consulted us because of his «lower backpain» together with the appearance of a small swelling at the left side. Anamnesis and clinical examination were suggestive and further simple diagnostic methods confirmed the exceptional diagnosis of a «lumbar hernia of Petit». We describe the retroperitoneoscopic approach of this hernia, its reduction and the fixation of a polypropylene mesh at the surrounding structures with a Tacker. This approach provided a good postoperative comfort, a shorter hospital stay and an early recovery of autonomy and activity.

Furthermore, we give a review of the literature concerning lumbar hernias and the evolution of the different reconstruction techniques.     

Failure of knee osteotomy in a case of neuropathic arthropathy of the knee

Neuropathic arthropathy (Charcot’s joint) is a degenerative process that affects peripheral or vertebral joints as a consequence of a disturbance in proprioception and pain perception. The knee is one of the most frequently affected joints, but even when the diagnosis is made at an early stage there is no consensus on the best treatment options. An early diagnosis of neurosyphilis was made in a 55-year-old woman presenting a delayed union of an asymptomatic Schatzker type IV fracture of the proximal tibia. A medial opening wedge tibial osteotomy was performed to achieve fracture healing, to correct the medial depression of the articular surface, and possibly to avoid an early arthritis typical of the disease. To our knowledge, a knee osteotomy has never been reported at an early stage of neuropathic arthropathy. Even though the clinical and radiographic evaluation performed at 4 months follow-up showed a good stage of healing of the osteotomy and no typical features of neuropathic joint degeneration, at 8 months follow-up the knee was markedly deranged.     

Fractures of the hook of the hamate--a failure of clinical diagnosis

Two cases of a fracture of the hook of the hamate are described in which the diagnosis was clinically missed even though a fracture of the hook was considered. In one patient, the clinical diagnosis was thought to be ulnar wrist instability, and in the other, a pisiotriquetral injury. In one case, the diagnosis was confirmed only by a computerized tomography scan even though lateral tomograms were negative.     

Intraabdominal adhesion formation of polypropylene mesh Influence of coverage of omentum and polyglactin

Background Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated.Methods In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene–polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response.Results We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group.Conclusion The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation.     

Use of ceramics of calcum triphosphate in the repair of tibial plateau fractures: a series of 20 cases

Summary In 20 patients operated for displaced fractures of the tibial plateau, we used pieces of ceramics of tricalcium phosphate to fill the bony defect in the tibial metaphysis. Eighteen were followed up with a mean interval of 35 months (24 to 6o months). The other two patients were lost sight of. There were 11 men and 7 women with a mean age of 55 years (2o to 83 years). In 10 cases the injury was a traffic accident (a pedestrian knocked down by a vehicle) and in 8 cases a fall. Subject to a wider study, the ceramics of tricalcium phosphate, thanks to their remarkable biologic properties, appear to be the bone substitutes of choice in the filling of post-traumatic bony defects. However, there is as yet no absolute proof of their superiority.Paper presented at the 1998 meeting of GECO (Arc 1800. Bourg-Saint-Maurice, France)     

Imaging of Dermatofibrosarcoma Protuberans of Breast

Abstract: Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45‐year‐old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high‐density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians. A solitary mixed echogenicity and ill‐defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP.     

人CCL5基因RNA干扰慢病毒载体的构建

目的 构建人CCL5基因RNA干扰(RNAi)慢病毒载体.方法 根据人CCL5基因信息,构建4个携带RNAi序列的pGCSIL-GFP质粒,与pHelper 1.0、Helper 2.0质粒一起利用293T细胞进行慢病毒包装.用CCL5 RNAi慢病毒载体感染人宫颈癌细胞(Hela),使用RT-PCR方法验证其干扰效率.结果 4个靶点中有3个靶点(a1、a2、a3)在Hela细胞上对CCL5基因的表达都有非常显著的敲减效果,敲减效率均达到95%以上.结论 构建的CCL5 RNAi慢病毒载体在Hela细胞中有较高的敲减效率,提示RNAi技术能够使细胞CCL5基因沉默.     

Outcome of late presentation of injuries of the volar plate of the proximal interphalangeal joint

Abstract

Early recognition and treatment of volar plate injuries within two weeks is reported to give a good outcome, but there is no published information about the consequences of delayed presentation. We present a series of 14 patients with 16 injuries, who presented more than two weeks after the initial injury. All patients were referred to a specialist hand trauma clinic over a 10 months period and were evaluated prospectively and treated with immediate mobilisation by a specialist hand therapist. Mean time to presentation was 27 days (range 14–79) and mean improvement in range of movement was 25° (range 2–52) with mean residual extension lag 10° (range ?4–56). All patients returned to their previous levels of function by the time of discharge. We conclude that it is possible to achieve good outcome without surgical intervention even when the presentation time is four weeks if experienced hand therapists manage the rehabilitation.     

Rupture of the superficial dorsal vein of the penis

Unusual causes of acute penis, such as the rupture of a superficial vein of the penis, can mimic fractured penis. The diagnosis in such cases is mostly after exploration. The author describes a case where a high index of clinical suspicion led to the diagnosis of the rupture of a superficial dorsal vein of the penis without exploration. The patient had a successful recovery with conservative management.     

The importance of the valgus stress test in the diagnosis of posterolateral instability of the knee

BACKGROUND: The diagnosis of posterolateral instability of the knee is often based on a typical indirect mechanism of injury, a history of "giving way" and a positive dial test. Our search of the English literature revealed no mention of including the valgus stress test in the diagnostic protocol for posterolateral instability. HYPOTHESIS: Based on our experience, we hypothesised that a medial collateral ligament (MCL) tear will also produce a positive dial test and that a valgus stress test would provide differential diagnostic information. METHODS: The MCL's of 14 fresh cadaveric knees (7 cadavers) were cut to simulate a grade 3 tear, taking care not to damage the medial retinaculum or the posteromedial stabilisers of the knee. The amount of tibial external rotation (the dial test) was measured for each knee before and after transection of the MCL. RESULTS: The results of the dial test after transection of the MCL were similar to those stemming from a solitary injury to the posterolateral corner. There was a significant increase in external rotation of the knee in 30 degrees and 90 degrees of flexion. More over, external rotation in 30 degrees was significantly greater than external rotation in 90 degrees of knee flexion. CONCLUSIONS: Whenever suspecting a posterolateral complex injury, one has to carefully perform a valgus stress test in 0 degrees and 30 degrees. Although the support of a clinical study is needed in order to make a definite conclusion, the dial test is probably not reliable in the presence of medial instability, and alternative diagnostic measures should be used.