In vitro susceptibility studies of Malaysian Plasmodium falciparum isolates and clones against schizontocidal drugs

Spasmodic dysphonia (SD) is at present defined as focal dystonia. Botulinum toxin (BT) injection is the treatment of choice for SD. BT is usually injected by a percutaneous route, but a direct, visually guided transoral approach has also been successful. It is not known whether percutaneous injection is as effective as the transoral approach. This article reviews our experience with both techniques of injection on 29 patients with adductor type SD. Since 1992, we have carried out 48 treatment sessions with the transoral technique and 76 treatment sessions with the percutaneous technique. Two patients did not respond to the percutaneous technique despite several attempts, but they did respond to the transoral approach. Globally, transoral technique was superior to percutaneous technique in terms of effectiveness (48 of 48 responses with transoral technique versus 61 of 76 responses with percutaneous approach, p < 0.01). Dosage of BT, duration, and side effects were similar with both techniques. This article also describes a simple, inexpensive device, composed of materials on hand at every hospital, that facilitates the transoral approach.     

Periurethral polytetrafluoroethylene paste injection in incontinent female subjects: surgical indications and improved surgical technique

We present the results with 2 techniques for periurethral polytetrafluoroethylene (Polytef) injection in 21 female subjects with type III stress urinary incontinence. The standard technique included the use of a stainless steel needle for injection, paste "sopping" and a Wolff, Storz or Lewy syringe as an injecting element. Postoperatively, no catheters were left indwelling and all patients were encouraged to urinate following recovery from the anesthesia. The modified technique included the use of a 14F angio-catheter for injection of the paste, paste heating and a Lewy syringe or Mentor gun as injector. Postoperatively, all patients were left with an indwelling suprapubic catheter for 3 to 5 days. A total of 27 injections was performed, including 9 with the standard technique and the last consecutive 18 with the modified technique. Average followup has been 11.4 months. Cure, improvement and no change rates from the preoperative condition were 11%, 22% and 67% with the standard technique and 39%, 17% and 44% with the modified technique, respectively. In the latter group 3 patients had received pelvic radiotherapy as definitive treatment for pelvic malignancies. The overall failure rate in patients with a stable detrusor was 42% compared to 75% in the group with bladder instability and low compliance. Advantages of the modified technique include avoidance in the formation of intraoperative and postoperative fistulas, and easier handling and injection of the heated paste to achieve urethral compression. Improved short-term results with the modified technique indicate that a larger group of patients and long-term followup are essential requirements to determine the true efficacy of this technical modification. Based on these preliminary results, we now prefer the modified technique to the standard technique in the management of type III stress urinary incontinence.     

Ethanol injection: technique and method of performance

The authors describe the technique used in the treatment of autonomously functioning thyroid nodules by percutaneous ethanol injection (PEI). They illustrate the free-hand technique followed in their hospital from January 1990 to October 1992 in a group of 25 patients. Results, advantages and disadvantages of this technique are reported and compared with the ultrasound-guided technique. In the latter, widely used, the needle is positioned in the target nodule by means of an ultrasound probe with a specially designed guiding device which forces the needle in the correct direction. This makes the manoeuver rapid and safe as the needle tip can be easily visualized. In this case, the most important drawback lies in the impossibility of changing the ultrasound scanning plane during the ethanol injection as the probe and the needle are fast together. So the correct spreading modality of ethanol inside the tissue is not completely checked. Another disadvantage is the cost of disposable guiding device necessary in order to avoid contamination. On the other side, in the free-hand technique the needle is aimed at the nodule and inserted during an ultrasound examination without restrain on the probe movements. In this way, it is possible to focus the attention on the critical structures to prevent their damage stopping ethanol injection as soon as a seepage outside the thyroid occurs. Furthermore, this technique is particularly inexpensive as a standard probe is used and the risk of contamination can be avoided by just wrapping the probe with a sterline plastic film.(ABSTRACT TRUNCATED AT 250 WORDS)     

Histologic specimen collection in pulmonary hypertension using percutaneous, transvascular biopsy--animal experiment and initial clinical data]

Pulmonary hypertension is a severe multietiological disease largely resistant to treatment. Biopsy is often necessary to establish differential diagnosis. In pulmonary hypertension transbronchial pulmonary biopsy is contraindicated and open lung biopsy is the method of choice. In our paper we report about experimental results in animals and first clinical data on a new biopsy technique (percutaneous transluminal biopsy, PTB) providing access to histology in pulmonary hypertension without the need of surgery. In a subset of animals pulmonary hypertension was produced experimentally. In addition, we carried out the PTB in patients with bronchial carcinoma. Our preliminary results demonstrate that sufficient material could be gained for the histologic evaluation of pulmonary parenchyma and in pulmonary vessels. No complications have been noted so far.     

Percutaneous femoropopliteal graft placement

Femoropopliteal bypass surgery is now recommended for the treatment of long-segment or diffuse superficial femoral artery disease. The authors describe a technique for percutaneous placement of a prosthetic femoropopliteal graft. The technique has been accomplished with conventional polytetrafluoroethylene graft material and a variety of implantation techniques. Technical success was achieved in eight patients who underwent graft placement. Grafts up to 28 cm in length were placed, and graft patency was demonstrated up to 6 months after implantation. Six of the eight patients were asymptomatic during the follow-up period; one patient who had symptoms during this time underwent thrombolysis and redilation of the distal stent, and the symptoms resolved. This study demonstrates the feasibility of percutaneous graft placement in the femoral artery, but durability must be established in relation to traditional bypass surgery before it can be recommended on a wider scale.     

Radiofrequency-thermocoagulation in the treatment of trigeminal neuralgia: analysis of 100 cases

A series of 100 patients suffering from trigeminal neuralgia treated by percutaneous radiofrequency thermocoagulation of the trigeminal ganglion is reported. The authors make some considerations about the basic principles of the thermocoagulation and comment a few important methods of treatment used prior to this new technique. The whole sequency of the surgical procedure is described and its results analysed. The final conclusion is that percutaneous radiofrequency thermocoagulation has become the treatment of choice for trigeminal neuralgia when the clinical treatment is not anymore effective or the side-effects of the drugs contraindicate its use.     

Culturally competent healthcare

External respiratory function (ERF) was studied in 129 patients with restrictive pulmonary processes (tuberculomas, infiltrative and cavernous tuberculosis) before and after surgery. All the patients underwent saving lung resections. Changes in ERF were examined by conventional and the new method telespirography. This technique detects general and individual pulmonary ventilation disorders, which underlie criteria for assessing whether patients with pulmonary tuberculosis can be operated on. The authors show that the outcomes of surgical treatment are determined by the baseline status of the respiratory apparatus generally and each lung specifically. Distinctive features of complicated and uncomplicated postoperative periods are identified. The benefits of the new method are demonstrated.     

Endoscopic wedge-shaped lung biopsy--initial experience

The authors publish their initial experience with wedge-shaped pulmonary biopsy by the endoscopic route. The group is formed by 18 patients who were indicated for the operation on account of a disseminated pulmonary process in order to assess the micromorphological appearance of the affected lung tissue. Two patients developed a complication during operation which therefore was completed by minor thoracotomy. In who patients the authors observed after operation slow expansion of the pulmonary parenchyma. No death after the operation was recorded. The authors assume, based on their initial experience, that this operation will soon be included among common diagnostic operations and will help to facilitate the diagnosis and selection of treatment in patients with disseminated lung disease.     

Positioning for clinical dental hygiene care. Preventing back, neck and shoulder pain

Spasmodic dysphonia is a focal dystonia that effects the proximal muscles (adduction dystonia) or dilatory (abduction dystonia) of the larynx. Botulinum toxin (BTX), generally delivered by percutaneous injection, is the treatment of choice. Recently, use has been made of a transoral route of delivery, with BTX injected through a curved device with visual control. It remains to be determined which route is better. Percutaneous injection is simple and well-tolerated, but the transoral route is theoretically more effective. We assessed the efficacy of both techniques in 19 patients with adduction dystonia, conducting 55 treatment sessions by percutaneous injection and 20 by transoral injection. All the transoral treatments were effective (20/20, 100%), but only 81% (45-155) of the percutaneous treatments were (p < 0.05). Two patients who had doubtful responses after percutaneous delivery improved considerably when the transoral approach was used. In spite of its greater complexity, the transoral approach is probably more effective than the percutaneous route. We describe a curved device for transoral injection that is composed of simple elements available at any health center.     

The diagnosis and treatment of liver abscesses

An analysis of results of treatment of 15 patients with abscesses of the liver of different genesis is given in the article. The ultrasonic method of examination was shown to be highly efficient for diagnosis of liver abscesses. The authors stress the necessity of differential approach to treatment of such patients based on etiopathogenesis of the disease. In most cases the method of choice for treatment of liver abscesses was found to be the percutaneous puncture and drainage under control of echography.     

Accessory artificial circulation in complex treatment of experimental acute toxic pulmonary edema

In experiments on 50 dogs with toxic acute edema of the lung, induced with intravenous injection of 0.1% silver nitrate, the authors have studied the efficacy of accessory artificial circulation and "conservative" therapy. During the perfusion a discharge of the right portions, adequate extracorporeal gas metabolism, normalization of blood gas and acid-base balance were noted; an intensity of pulmonary edema is descreased. An intensive therapy for pulmonary edema was found to be more effective in association of "conservative" treatment with venoarterial perfusion and blood oxygenation.     

Plasma lipids, HDL and apolipoproteins, and coronary heart disease in men less than 50 years old. A case-control study

Therapeutic interventions in the skeletal system are an essential part of interventional radiology. Although in terms of figures these procedures are applied less frequently, they are very effective. Percutaneous transarterial embolization of a spinal tumor is well-established interventional treatment. It is primary treatment for preoperative devascularization, but also for palliation of pain and for reduction of tumor volume. As an alternative access for embolization, direct percutaneous puncture of a vertebra is used. A new and promising technique is vertebroplasty, the percutaneous injection of acrylic surgical cement in destroyed vertebrae. The present paper discusses indications, technique, results and complications of these interventional therapeutic modalities in the treatment of primary and secondary spinal tumors.     

A note on lactobacilli and beta-glucuronidase activity in the intestinal contents of mice

The authors present a detailed account of a technique of peripheric anesthesia of the lower limb, obtained with a single transcutaneous injection, blocking lumbar and sacral plexus, by a paravertebral way. Encouraging results have been reached in the treatment of both old (no cerebral or cardiorespiratory depressant effects) and young patients, which are frequently under day-hospital treatment. According to their experience, this technique is simple, easy to perform and less dangerous if compared to anesthesia obtained by spinal approach.     

The role of apitherapy in the combined treatment of patients with chronic nonspecific lung diseases]

The authors suggest that apitherapy should be used in the treatment of patients with chronic non-specific pulmonary diseases (ChNPD) in order that it might be more effective. Apitherapeutic complex (bee venom and bee keeping apiculture produce) has been applied to the treatment of 104 ChNPD patients. High effectiveness of apitherapy in a combined treatment of ChNPD patients was demonstrated as was their stimulating and normalizing influence on the function of the adrenals.     

A technic for laparoscopic gastrostomy

The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform.     

Potent HIV protease inhibitors incorporating high-affinity P2-ligands and (R)-(hydroxyethylamino)sulfonamide isostere

We performed percutaneous balloon pericardiotomy and pulmonary valvuloplasty in a woman affected with cardiac and pericardial involvement from a primary pulmonary adenocarcinoma. Pericardial window was indicated for a recurrent, symptomatic, pericardial effusion. Valvular stenosis was severe and related to metastatic infiltration of cardiac tissue. Open surgery was avoided and the procedures were completed in two steps under local anesthesia in less than 60 min. The patient had no recurrence of pulmonary stenosis or pericardial effusion at 7 months post treatment. Transcatheter techniques are successful in helping to manage malignant diseases with cardiac metastasis, particularly in critically-ill patients. It may become the preferred treatment for avoiding a more invasive procedure for patients with a limited life expectancy.     

Magnetic resonance pulmonary angiography and direct imaging of embolus for the detection of pulmonary emboli

RATIONALE AND OBJECTIVES: The authors developed a two-dimensional breathhold magnetic resonance (MR) technique for the direct imaging of pulmonary emboli. METHODS: In vitro MR imaging was performed to demonstrate the potential generation of clot-blood contrast by in vivo pulmonary embolism (PE). A two-dimensional magnetization prepared gradient-echo (turbo-FLASH) breathhold technique was designed to directly image intravascular emboli by the selective nulling of the blood signal. A turbo-FLASH pulmonary angiographic breathhold sequence was used to provide spatial localization of detected emboli. Thirteen patients with suspected PE were studied; 6 patients underwent conventional pulmonary angiography (CPA) and the remaining 7 had diagnoses based on findings from other studies. RESULTS: In vitro study of blood clot demonstrated an initial rise and then fall in T1 sufficient to generate clot-blood contrast after eight days of clot formation. All patients with CPA or alternative study evidence of PE were diagnosed as positive with direct embolus imaging MR. There were no false-positive diagnoses. Three additional emboli were detected using the MR technique compared with CPA. The MR pulmonary angiographic sequence provided a useful road map for localization of intravascular emboli but was less sensitive for PE detection than the embolus imaging technique. CONCLUSIONS: The direct imaging of PE is feasible using a simple two-dimensional breathhold technique.     

A modification of hepatic portoenterostomy (Kasai operation) for biliary atresia

BACKGROUND AND AIMS: The aim of the present study was to compare power Doppler imaging with traditional color Doppler imaging and with contrast enhanced computer tomography in the evaluation of intratumoral vascularity of hepatocellular carcinomas at diagnosis and in response to percutaneous ethanol injection. PATIENTS AND METHODS: Sixteen patients with hepatocellular carcinoma underwent colour Doppler, power Doppler and computed tomography at diagnosis. Seventeen patients were studied by the three techniques one month after percutaneous ethanol injection treatment. RESULTS: At baseline evaluation, power Doppler and color Doppler were always in agreement and, with the exception of one case, were also in agreement with the computerized tomography scan. On the contrary, power Doppler and computerized tomography are more sensitive than color Doppler in the evaluation of residual vascularized tumoral tissue after percutaneous ethanol injection. In 3 patients, residual vascularity was demonstrated only by computerized tomography while color and power Doppler were negative. In another 3 cases, a positive power Doppler signal, with a typical arterial Doppler spectrum, was observed while color Doppler and computerized tomography were negative. In these patients, cancer relapse was clinically evident after a few months and treatment was repeated to obtain complete necrosis. CONCLUSIONS: We conclude that only the integration of the results of all these techniques can reliably evaluate tumoral vascularity after percutaneous ethanol injection.     

Percutaneous cecostomy: a new technique in the management of fecal incontinence

A pilot study on the percutaneous introduction of a cecostomy tube for colonic irrigations in the treatment of children with fecal incontinence is described. The results were good, and the technique is recommended for certain patients.     

Evaluation and treatment of head and neck venous vascular malformations

Congenital venous vascular malformations of the head and neck are low-flow, nonproliferative lesions that should be distinguished from hemangiomas. The characteristic history and clinical findings can establish the diagnosis. Direct percutaneous puncture and contrast injection at the time of treatment delineate the lesion and its drainage pattern. Treatment must be individualized according to lesion extent, patient tolerance and physician experience. Sclerotherapy with ethanol has proved to be a successful treatment modality for these lesions, as demonstrated in this study of 57 patients. Surgery is used for treatment of clinically significant residual disease. A multidisciplinary approach to evaluation and treatment is key to successful management.