Bone disorders following total gastrectomy

Bone disorders following gastrectomy were studied by measuring absolute and relative bone mineral density of the Wards triangle, serum 1,25-(OH)₂-D, alkaline phosphatase, and total serum calcium. The subjects were 20 males who had undergone total gastrectomy not more than three months previously (group A₁). Seventeen of these patients were reviewed three years later (group A₂). Absolute and relative bone density were significantly lower in group A₂ than in A₁ (0.52 ± 0.011 g/cm² versus 0.6 ± 0.014 g/cm²,P<0.01 and 85.5 ± 1.4% age-matched control versus 95 ± 1.3%,P<0.01). 1,25-(OH)₂-D was significantly lower in group A₂ than in group A₁ (14.3 ± 0.97 pg/ml versus 20.6 ± 1.02 pg/ml,P<0.01). There was no difference in alkaline phosphatase and calcium serum concentration. The mean weight loss was 6.26 ± 0.57% over the follow-up period, and weight loss correlated with absolute and relative bone density (r=–0.74,P<0.01). There was a positive correlation between 1,25-(OH)₂-D and absolute or relative bone density (r=0.67,r=0.62 andP<0.01). These data suggest that bone density decrease has already occurred three years after total gastrectomy and is positively correlated to 1,25-(OH)₂-D deficiency. As no differences in serum alkaline phosphatase and serum calcium concentration were found, these factors are of little value for the early detection of postgastrectomy bone disorders, whereas weight loss is a valuable screening parameter.     

X-chromosomale Adrenoleukodystrophie

Ohne Zusammenfassung Prof.Dr. J.G?rtner Zentrum Kinderheilkunde, P?diatrie II, Kinderheilkunde mit Schwerpunkt Neurop?diatrie, Universit?tsklinikum, Georg-August Universit?t G?ttingen, Robert-Koch-Strasse 40, 37075 G?ttingen, E-Mail: gaertnj@med.uni-goettingen.de     

Primäre ziliare Dyskinesie

Primary ciliary dyskinesia (PCD) is an autosomal recessive disease characterized by abnormal ciliary motion and impaired mucociliary clearance. The prevalence of PCD is approximately 1:20,000 live births. Since cilia are common in many organs of the body, there is a wide variety of clinical manifestations in patients with PCD. Due to an extensive genetic heterogeneity the course of the disease varies largely, but with increasing age, the clinical symptoms are dominated by repeated respiratory infections and ultimately respiratory insufficiency. In the presence of situs inversus, which is observed in 50% of affected individuals, the diagnosis is easy, In cases of doubt, analyses of the kinetics and infrastructure of the cilia are necessary. The treatment of PCD is symptomatic. With optimal medical and physiotherapeutic management, the prognosis quoad vitam is good and life expectancy is nearly normal.     

Metastases in Cases with Hepatocellular Carcinoma in Relation to Clinicopathologic Features of the Tumour An autopsy study from a low endemic area

In order to study clinicopathologic features of hepatocellular carcinoma (HCC) and their relation to metastatic growth, all autopsied cases with confirmed HCC (n = 490) from a period with a high autopsy frequency in a well-defined population were analyzed. Cirrhosis, usually of micronodular type, was found in 72%. The gross appearance of the tumour was predominantly massive (46%) or multinodular (42%). The tumour involved both liver lobes in 72% or the right lobe alone in 20%. Histologically, trabecular growth (79%) and grade II of differentiation (52%) prevailed. Vascular invasion was noted in 56%, whereas involvement of the biliary tract was unusual (4%). Metastases especially involved lymph nodes (42%), lungs (18%) and skeleton (17%). Increased weight of the liver, multinodular appearance, involvement of both liver lobes, low grade of differentiation and vascular invasion were significantly associated with presence of metastases.     

The traumatic dural sinus injury — a clinical study

Summary In a period of 13 years 978 cases of severe head injuries were operated on in our clinic. An analysis of the medical reports includes injuries of the superficial dural sinus (39 cases=4%): among these injuries of the anterior and central part of the superior sagittal sinus (66 per cent), injuries of the transverse sinus (18 per cent), injuries of the posterior part of the superior sagittal sinus (8 per cent), and combined injuries of different dural sinuses (8 per cent).Clinical data, i.e. the causes of accident, radiological examination results, intracranial lesions, operation technqiues and outcome are analysed and discussed. The analysis of cases with dural sinus injuries shows a high mortality rate (total mortality rate: 16 patients=41%; intra-operative mortality rate: 8 patients=20%).     

Fingerfrakturen

Fractures of the phalanges and the metacarpus are among the most common injuries of the upper extremity, accounting for approximately 10% of all fractures. They are not uncommonly dismissed as trivial trauma, so that the primary treatment is often inadequate. One fourth of all stiff fingers are attributable to a fracture, and in 50% of the cases, the fractures are the result of work-related accidents. This article aims to give an overview of the different types of fracture and their current treatment options (nonsurgical/surgical); special attention is also given to the specific features of phalangeal fracture treatment.     

Molecular Interaction of Droperidol with Human Ether-a-go-go-related Gene Channels: Prolongation of Action Potential Duration without Inducing Early Afterdepolarization

Background: The cardiac safety of droperidol given at antiemetic doses is a matter of debate. Although droperidol potently inhibits human ether-a-go-go-related gene (HERG) channels, the molecular mode of this interaction is unknown. The role of amino acid residues typically mediating high-affinity block of HERG channels is unclear. It is furthermore unresolved whether droperidol at antiemetic concentrations induces action potential prolongation and arrhythmogenic early afterdepolarizations in cardiac myocytes.

Methods: Molecular mechanisms of HERG current inhibition by droperidol were established using two-electrode voltage clamp recordings of Xenopus laevis oocytes expressing wild-type and mutant channels. The mutants T623A, S624A, V625A, Y652A, and F656A were generated by site-directed mutagenesis. The effect of droperidol on action potentials was investigated in cardiac myocytes isolated from guinea pig hearts using the patch clamp technique.

Results: Droperidol inhibited currents through HERG wild-type channels with a concentration of half-maximal inhibition of 0.6-0.9 [mu]m. Droperidol shifted the channel activation and the steady state inactivation toward negative potentials while channel deactivation was not affected. Current inhibition increased with membrane potential and with increasing duration of current activation. Inhibition of HERG channels was similarly reduced by all mutations. Droperidol at concentrations between 5 and 100 nm prolonged whereas concentrations greater than 300 nm shortened action potentials. Early afterdepolarizations were not observed.