Hypoactive sexual desire disorder in postmenopausal women.

Decreases in sex hormone levels with menopause may bring about a number of consequences in women's general health and sexual well-being, especially when levels decline suddenly and prematurely, as in surgical menopause. In addition to the well-established role of estrogens in preserving the biological basis of sexual response, there is emerging evidence that androgens are significant independent determinants affecting sexual desire, activity and satisfaction, as well as mood, energy and other components of women's health. Hypoactive sexual desire disorder (HSDD), a persistent absence of sexual fantasies or thoughts and/or desire for and receptivity to sexual activity that causes personal distress, is experienced by some postmenopausal women. Even though conventional hormone therapy with estrogens or estrogens and progestogens may be effective for vaginal atrophy, increasing vaginal lubrication and reducing dyspareunia, it has not been shown to consistently increase sexual desire or activity and many women with sexual dysfunction remain unresponsive. Several recent, large, phase III studies have shown that the addition of transdermal testosterone to conventional hormone therapy can be helpful in surgically menopausal women presenting with HSDD. After 24 weeks of treatment in these studies, testosterone-treated women experienced significantly greater increases in satisfying sexual activity and sexual desire, and greater decreases in distress, than placebo-treated women. Accurate clinical assessment and individualized management of sexual symptoms are fundamentally important for all menopausal women with HSDD or other sexual problems.     

A modified Viernstein and Kelly surgical technic for correcting chronic recurrent peroneal tendon dislocation

An operative technique modified after Viernstein and Kelly for the treatment of chronic, recurrent peronal tendon dislocation is presented, which has been performed successfully in 15 cases. Principal elements of this technique are an improvement of the bony containment of the tendons within the shallowed, malleolar sulcus and the use of the outer layer of the dislocation pouch as superior retinaculum. This is achieved by inserting the outer layer underneath a dorsally displaced, bony lamella of the outer malleolus.     

Buchbesprechungen

Ohne Zusammenfassung     

Metabolisches Syndrom und kardiovaskuläre Komplikationen

The term metabolic syndrome (MetS) describes a clinical condition with insulin resistance and/or visceral obesity. In adipose tissue a number of substances are produced (substrates, hormones, cytokines) favouring insulin resistance and the development of MetS. Due to special biochemical characteristics and location within the body, visceral adipose tissue plays an exceptional role in these metabolic changes. Since insulin resistance and all components of the MetS are cardiovascular risk factors, a high risk for atherosclerotic diseases results with respect to coronary artery disease, stroke and to a lesser extent peripheral occlusive disease. Usually the treatment of the MetS consists of changes in life-style. Since malnutrition and physical inactivity are the main reasons for the development of MetS, a correction of life-style proves to be a causative and effective treatment. If changes in life-style are not successful pharmacotherapy is indicated. The therapeutic goal may be at risk if the considered risk factor improves and insulin resistance deteriorates.     

Identification and overlapping expression of multiple unconventional myosin genes in vertebrate cell types.

Myosin diversity in the human epithelial cell line Caco-2BBe, the porcine epithelial cell line LLC-PK1 (CL-4), human peripheral blood leukocytes, and human liver was analyzed. PCR amplification yielded 8-11 putative myosins (depending on the cDNA source) representing six distinct myosin classes. Analysis of clones obtained by hybridization screening demonstrated that the original PCR products correspond to bona fide myosins, based on the presence of sequences highly conserved in other myosins. RNase protection analysis confirmed mRNA expression of 11 myosins in Caco-2BBe cells. Immunoblot analysis showed that at least 6 myosin immunogens are expressed in Caco-2BBe cells. The results reveal the existence of at least 11 unconventional human myosin genes, most of which are expressed in an overlapping fashion in different cell types. The abundance of myosins suggests that the myosin I vs. myosin II paradigm is inadequate to explain actin-based cellular motility.     

Homologous meniscus transplantation

Summary The increase in severe ligament injuries of the knee has led to consideration of the need for meniscal transplantation in reconstructive operations for chronic rotational instability. Transplantation of the medial meniscus was carried out in two groups of 15 sheep. In one group lyophilised, -sterilised allogenic menisci were transplanted and these underwent a complete remodelling in 48 weeks. In the other group, deep frozen allogenic menisci were used and these remained fully functional without remodelling. We then carried out meniscal transplantation in 22 patients who were followed-up for a mean of 14 months. Arthroscopy was possible in two-thirds of the cases at an average of 8 months after operation. Both types of transplanted menisci, lyophilised and deep frozen, decreased in size, as small as a regenerated meniscus in some cases. In general the deep frozen menisci showed better results.

---

Résumé L'augmentation de fréquence des graves traumatismes ligamentaires du genou a conduit à envisager la transplantation méniscale dans les opérations reconstructrices pour instabilité rotatoire chronique. La transplantation du ménisque interne a été réalisée dans deux groupes de 15 moutons. Dans un groupe on a utilisé des ménisques allogènes lyophylisés et stérilisés aux rayons , qui ont présenté, à la 48ème semaine, une transformation complète. Dans l'autre groupe, on a transplanté des ménisques allogènes réfrigérés à –30° C et ceuxci sont restés parfaitement fonctionnels, sans transformation. Nous avons réalisé une transplantation méniscale chez 22 malades, qui ont eté suivis 14 mois en moyenne. Dans les deux-tiers des cas une arthroscopie a été possible vers le 8ème mois après l'opération. Les deux types de ménisques, lyophylisés et réfrigérés, diminuent de volume pour devenir aussi grêles, dans quelques cas, qu'un ménisque régénéré. Dans l'ensemble les ménisques conservés au froid donnent les meilleurs résultats.

---

---

This work received the Müller-SICOT award in 1987     

The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study.

Today the use of pneumatic tourniquet is commonly accepted in total knee arthroplasty (TKA) to reduce perioperative blood loss. There are a few prospective randomised and nonrandomised studies that compare the effect of tourniquet release timing in cementless or cemented unilateral TKA. However, many of these studies show an inadequate reporting and methodology. This randomized prospective study was designed to investigate the efficiency of tourniquet release timing in preventing perioperative blood loss in a simultaneous bilateral TKA study design. To our knowledge, this is the first study of its kind, in which the effect of tourniquet release timing on perioperative blood loss was investigated in simultaneous bilateral cemented TKA to compare both techniques intraindividually. In 20 patients (40 knees) one knee was operated with tourniquet release and hemostasis before wound closure, and the other knee with tourniquet release after wound closure and pressure dressing. We found no significant difference in total blood loss between both techniques (p=0.930), but a significant difference in operating time (p=0.035). There were no postoperative complications at a follow-up of 6 month. Other studies report an increase the blood loss in early tourniquet release and an increase the risk of early postoperative complications in deflation of tourniquet after wound closure. In this study we found no significant difference in perioperative blood loss and no increase of postoperative complications. Therefore, we recommend a tourniquet release after wound closure to reduce the duration of TKA procedure and to avoid possible risks of extended anaesthesia.     

Shock avoidance conditioning and 3H-leucine uptake in a simple vertebrate system.

Myelencephalic grass frogs were trained to avoid shock to a forelimb, in the paradigm of Horridge. Forty-five min after training, these animals reached the criterion for conditioning faster and with fewer mistakes. Yoked control animals exhibited a slight learning deficit 45 min after receiving unavoidable shocks. Thirty min after training there was no difference in total protein content in the neuraxes of trained and yoked animals, but trained animals incorporated relatively more ³H-leucine into presumptive protein. The incorporated radio-activity was largely confined to the half of the neuraxis ipsilateral to the trained limb, but was not consistently confined to any 1 level of the neuraxis. The simplicity of this behavior and the relatively simple neuronal circuitry mediating it recommend this as a useful vertebrate model system for the study of macromolecular correlates of learning.     

Inhibition of endogenous carcinoembryonic antigen (CEA) increases the apoptotic rate of colon cancer cells and inhibits metastatic tumor growth

It has been suggested that carcinoembryonic antigen (CEA) enhances metastatic seeding of colon cancer cells due to its homo- and heterophilic binding properties. Our recent finding that endogenous CEA protects colon cancer cells against apoptosis suggests a more complex role of CEA in cancer progression. In this study we compared the in vitro effects of endogenous CEA on tumor cell aggregation and cell cycle regulation of human HT29 colon cancer cells with the corresponding in vivo effects, i.e. tumor cell seeding and formation of metastatic lesions. Stable expression of CEA targeted ribozymes (Rz) under control of a tet-off promoter system allowed regulation of CEA levels on the mRNA and protein level by 50%. Downregulation of CEA levels inhibited tumor cell aggregation by 70%. In accordance with previous studies [1], reduction of CEA levels increased in vitro the apoptotic rate and reduced colony formation by 30% to 50%. To determine the in vivo effect of CEA-dependent aggregate formation and its growth regulating role under apoptotic stress, HT29 cells with high and low CEA levels, respectively, were injected into nude mice. Immunostaining of lung microsections revealed similar numbers of tumor cells one hour after injection. 24 h later virtually all cells were removed from the lung in both groups. However, after 6 weeks all doxycycline treated mice (Rz off = CEA high) showed 14.5 ± 4.6 metastatic lung lesions/mouse while 0.2 ± 0.2 lesions/mouse appeared in the untreated group (Rz on = CEA low) ( P<0.001). Our study demonstrates a multifunctional role of CEA and indicates a prometastatic role of CEA independent of its adhesive function possibly due to its anti-apoptotic function. This revised version was published online in July 2006 with corrections to the Cover Date.     

Cyt1A from Bacillus thuringiensis restores toxicity of Bacillus sphaericus against resistant Culex quinquefasciatus (Diptera: Culicidae)

The 2362 strain of Bacillus sphaericus, which produces a binary toxin highly active against Culex mosquitoes, has been developed recently as a commercial larvicide. It is being used currently in operational mosquito control programs in several countries including Brazil, France, India, and the United States. Laboratory studies have shown that mosquitoes can develop resistance to B. sphaericus, and low levels of resistance have already been reported in field populations in Brazil, France, and India. To develop tools for resistance management, the Cyt1A protein of Bacillus thuringiensis subsp. israelensis De Barjac was evaluated for its ability to suppress resistance to B. sphaericus in a highly resistant population of Culex quinquefasciatus Say. A combination of B. sphaericus 2362 in a 10:1 ratio with a strain of B. thuringiensis subsp. israelensis that only produces Cyt1A reduced resistance by >30,000-fold. Resistance was suppressed completely when B. sphaericus was combined with purified Cyt1A crystals in a 10:1 ratio. Synergism was observed between the Cyt1A toxin and B. sphaericus against the resistant mosquito population and accounted for the marked reduction in resistance. However, no synergism was observed between the toxins against a nonresistant mosquito population. These results indicate that Cyt1A could be useful for managing resistance to B. sphaericus 2362 in Culex populations, and also provide additional evidence that Cyt1A may synergize toxicity by enhancing the binding to and insertion of toxins into the mosquito microvillar membrane.