Pancreatic pseudocysts: choice of treatment?

Pseudocysts of the pancreas may require drainage or resection during their evolution. External drainage can be considered as a treatment of first resort with low related morbidity. It also offers a means of treating patients with major contraindications for surgery. In our experience, however, only 55% of external drainages prove successful. Therefore, surgical treatment, even at the cost of low-rate morbidity, remains the only final treatment for complications linked to pseudocysts of the pancreas. In the long term, however, these results depend on the etiology of the pseudocysts.     

Long-term follow-up results of alpha-interferon-based regimens in patients with late chronic phase chronic myelogenous leukemia

The aim of this analysis was to evaluate the efficacy of alpha-interferon (alpha-IFN) regimens in late chronic phase (diagnosis >12 months) chronic myelogenous leukemia (CP-CML). Long-term follow-up results were evaluated in 137 patients with Philadelphia chromosome (Ph)-positive late CP-CML. The alpha-IFN programs were sequential studies with human leukocyte alpha-IFN (seven patients), recombinant alpha-IFN alone (15 patients) or with IFN-gamma (29 patients), hydroxyurea (HU) (19 patients), or low-dose cytarabine (Ara-C) (67 patients). Overall, 57% of the patients achieved complete hematological response (CHR), and 7% obtained partial hematological response. Nineteen patients (15% of the 123 evaluable patients) had a cytogenetic response which was major (Ph-positive <35%) in 10 patients (8%). A trend for better responses was observed with shorter disease duration. The median overall survival from start of therapy was 49 months, with an estimated 5-year survival rate of 41%. Some common pretreatment prognostic factors associated with response did not show statistical associations when applied in late CP-CML; however, characteristics such as smaller spleen size, and lower percentages of peripheral blood and marrow blasts and basophils were associated with better survival experience. When patients were subgrouped according to risk, no significant differences in the incidence of cytogenetic response and in survival outcomes were observed among various risk groups. This study confirms that alpha-IFN-based regimens have a modest activity in late CP-CML, and supports the need to develop investigational strategies aimed at improving patient prognosis in this phase.     

Determinants of early and late results of combined valve operations and coronary artery bypass grafting

BACKGROUND: Factors determining the outcome of operative correction of valvular abnormalities combined with coronary artery bypass grafting are still incompletely defined. METHODS: Determinants of early and late (more than 90 days) deaths and event-free survival were studied for combined valve operations and coronary artery bypass grafting in 741 patients using multivariate analysis. RESULTS: Ninety-day survival probability was 89% (95% confidence interval, 87% to 92%). Preoperative risk factors for early death were age, female sex, renal failure, New York Heart Association class IV or V, and mitral insufficiency. The operative risk factor was the duration of aortic cross-clamping. Five- and 10-year survival probabilities were 74% (95% confidence interval, 71% to 78%) and 43% (95% confidence interval, 36% to 50%), respectively. Preoperative risk factors for late death were age, preoperative renal failure, New York Heart Association class IV or V, vessel disease, and nonsinus rhythm. Five- and 10-year event-free survival probabilities were 57% (95% confidence interval, 53% to 61%) and 23% (95% confidence interval, 17% to 28%), respectively. Preoperative risk factors for non-event-free survival were age, female sex, reduced left ventricular function, mitral regurgitation, and pacemaker rhythm. CONCLUSION: The demographic factors of age and female sex; the comorbid condition of renal failure; the cardiac conditions of advanced New York Heart Association class, left ventricular function, mitral regurgitation, vessel disease, and cardiac rhythm; and the operative condition of ischemia time are the most important predictors of clinical outcome after combined valve operations and coronary artery bypass grafting.     

Pancreatic xanthomatous neuropathy associated with hyperlipidemia: a cause of abdominal pain mimicking chronic pancreatitis

"Hyperlipidemic crisis" is a term used to describe episodic abdominal pain in patients with hyperlipidemia. The morphologic correlates of this phenomenon have not been investigated and the etiology of the disorder is uncertain. We report a unique histologic finding in the pancreas of a 34-year-old woman with a 17-year history of episodic abdominal pain, sometimes accompanied by hyperamylasemia. At the age of 18 years, grossly elevated cholesterol and triglyceride levels were documented and type V hyperlipidemia was diagnosed. At the age of 34 years, subtotal pancreatectomy was performed for intractable abdominal pain. Histologic examination identified an increased number of enlarged pancreatic nerves that were infiltrated by foamy macrophages and encircled by fibrous tissue; endoneurial infiltration with macrophages occasionally split nerves into individual fascicles. Otherwise, the pancreas had only minimal fibrosis, nesidioblastosis, mucinous metaplasia of some pancreatic ducts, and scattered small collections of chronic inflammatory cells, subtle features suggesting very mild chronic pancreatitis. We propose that this novel xanthomatous neuropathy mimicked pancreatitis and was one of the underlying pathophysiologic mechanisms of abdominal pain in this patient. Further studies are necessary to document the prevalence of this new entity in patients with hyperlipidemia and to correlate its occurrence with "hyperlipidemic crisis" in those individuals.     

The late results of organ-saving operations in T1,2 N0M0 kidney cancer

Examination of patients with dizziness has been performed with an original computer nystagmus analyzer which consists of an alternating current amplifier, analog-digital transformer, personal computer with special software. The technique of electronystagmography in optokinetic and bithermal tests was applied. The programs provide good quality of recording nystagmic reactions and protect from artefacts of different origin. All the nystagmic responses are measured with identification of the extremums indicating the beginning and end of each nystagmic cycle. The amplitude, duration and speed of the slow and fast nystagmic components are calculated both for the overall nystagmogram and its fragments. The computer analysis of nystagmograms provides rapid and accurate differential diagnosis of various types of vestibular dysfunction.     

Functional results of surgical repair of chronic duodenal insufficiency associated with duodenal ulcer

The results of 312 patients examination in late follow-up period after conduction of the organ preserving intervention, gastric resection and reconstructive operation with chronic duodenal insufficiency correction, concurrent with duodenal ulcer, its acute complications, postvagotomy and postresection syndrome are adduced. An excellent and good result was noted in 70.2% of patients, fair--in 23.4%, bad--in 6.4%.     

Simple and infected pancreatic pseudocysts. Methods of ultrasonography-guided percutaneous needle aspiration: results

The adaptive control of behaviour requires brain mechanisms for the selection (i.e. activation and suppression) of responses, as well as mechanisms for the modulation of the response vigour. The concept of motivation postulates the existence of brain centres that regulate the selection and strength of behavioural responses. The present paper provides examples from the behavioural neurosciences for brain mechanisms that lead to adaptive changes of an organisms responsiveness to external stimuli. The mammalian startle response is a simple defensive behaviour which is mediated by an oligosynaptic pathway located in the lower brainstem. The startle response is enhanced by aversive states (fear, anxiety) and attenuated by appetitive states (pleasure), which can be regarded as an example of motivational priming. Furthermore, the startle response is inhibited by a weak sensory stimulus presented shortly before the startling stimulus. The suppression of startle by a prepulse is an example of sensorimotor gating, a principle that is important for the hierarchical organisation of behaviour. This paper describes the neuronal mechanisms underlying the modulation (prepulse inhibition and fear potentiation) of the startle response in rats, and discusses the possible adaptive significance of these different phenomena of behavioural plasticity.     

Cognitive operations associated with individual differences in affect intensity.

There are individual differences in the characteristic intensity of affective response to the same emotion-evoking event. The processes whereby individuals come to experience strong or mild emotional responses when exposed to the same affect-provoking stimuli are still unclear. In these studies, we propose that individual differences in affect intensity are associated with certain cognitive operations that involve personalizing, generalizing, and selective abstraction were hypothesized to discriminate subjects high and low in affect intensity. Two studies replicated support for the hypothesis that subjects high on affect-intensity dimension engage in more personalizing/empathic and more generalizing/elaborative cognitive operations than do subjects low on the affect-intensity dimension. The same cognitive operations discriminated groups high and low in affect intensity in response to both positive and negative emotional stimuli. Also, the cognitions that discriminated subjects high and low in affect intensity occurred only in response to affective stimuli; neutral stimuli did not evoke divergent cognitive operations for these groups. Finally, a high degree of consistency was found in the use of emotion-relevant cognitive operations across positive and negative stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The late results of the conservative and surgical treatments of chronic periodontitis of the permanent teeth in children and adolescents

The authors view results of conservative and surgical treatment of constant tooth chronic periodontitis in 90 children and adolescents aged 7-18 20 hemisections, 45 apicoectomies, 10 radix amputations were performed. The patients were followed up 6 months to 5 years. X-ray films show osseous restoration on the maxilla tooth to complete in 5-6 months, on the mandible tooth in over 8 months. The authors describe indications and contraindications to such kind.     

Early and late results of surgical repair of truncus arteriosus

Ninety-two patients had corrective operation for truncus arteriosus between 1967 and 1975. During the first 30 days after surgery, 23 patients died. No significant differences appear between early mortality and sex, type of truncus, variations in pulmonary arterial anatomy, truncal valve regurgitation, associated anomalies, previous operation, or duration of extracorporeal circulation. Greater risk is probably encountered with the higher but still operable levels of pulmonary resistance. Reoperation has been required in three patients. Fifty-nine percent of survivors are symptom-free, with all but two of the remainder (38%) being in NYHA functional class II. The late result is suggestively less satisfactory in patients with significant preoperative truncal valve regurgitation. Some late complications related to deterioration of the earlier aortic homograft conduit may be avoided by use of a porcine valve Dacron conduit. The current operative mortality of 9%, and the well-being of 97% of surviving patients suggest the continued advisability of recommending operation for appropriate patients.     

Pancreatic mucin-producing adenocarcinoma associated with a pancreatic stone: report of a case

We present an autopsy case of an 83-year-old Japanese man with a mucin-producing adenocarcinoma accompanied by pancreatolithiasis in the head of the pancreas. He suffered from obstructive jaundice and died of disseminated intravascular coagulation. He did not normally drink alcohol and had no history of chronic pancreatitis. The autopsy findings revealed a mucinous cystic tumor, composed of multiple dilatated branches, in the head of the pancreas. Histological examinations showed papillary adenocarcinoma, which scirrhously infiltrated the distal common bile duct with perineural invasion and lymph node involvement. He was thus diagnosed to have mucin-producing branch-type cancer in the head of the pancreas. The main pancreatic duct was dilated, and the residual pancreatic tissue showed moderate fibrosis and parenchymal atrophy. A stone was observed in a dilated branch of the primary lesion. To the best of our knowledge, there have only been five previously reported cases of mucin-producing tumor associated with pancreatolithiasis. Intraductal calcification is a major characteristic of chronic pancreatitis, but it is clinically important not to misdiagnose cancers associated with pancreatolithiasis such as chronic pancreatitis.     

Postoperative urine retention and late results following incontinence surgery

Percutaneous cystostomy using a fine calibre (9 Charriere) plastic trocar and cannula has been used in 51 male patients in the early weeks following spinal cord injury. The results are satisfactory. Of the last ten patients none has been catheterised per urethram; eight of these patients are now passing urine satisfactorily using a condom urinal.     

Cerebral vasculitis associated with chronic mucocutaneous candidiasis

Proton nuclear magnetic resonance (1H NMR) was used to study the in vivo metabolism of Trypanosoma cruzi, the pathogen causing American trypanosomiasis (Chagas' disease). Three clones were isolated from a strain of T. cruzi (Bolivia strain), The clones I, II and III and the original strain were characterized according to the spectra of their metabolic pathways to test the hypothesis that clonal evolution of T. cruzi has a major impact on biologically relevant properties of this parasite. T. cruzi (Bolivia strain) excreted acetate, alanine, glycerol, and succinate as major end products, in the proportion 6:4:2:2. Comparing the spectra of T. cruzi clones with the original Bolivia strain revealed both quantitative, as well as qualitative differences in the metabolites excreted: the clones I and II, as opposed to the Bolivia strain and clone III, excreted significant quantities of ethanol.