Sixty years of psychosurgery: its present status and its future

STUDY OBJECTIVES: To compare the results of open myomectomy with those of laparoscopic myomectomy, and to assess complications, surgical results, total hospital cost, and morbidity associated with each procedure. DESIGN: Retrospective chart review. SETTING: Private practice of one surgeon, and Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois. PATIENTS: Ninety-eight women with symptomatic uterine leiomyomata. INTERVENTIONS: Forty-nine consecutive laparoscopic myomectomies were performed between 1993 and 1995, and 49 open myomectomies were performed between 1983 and 1995. MEASUREMENTS AND MAIN RESULTS: Indications for both procedures were similar, including menometrorrhagia, pelvic pain, and enlarging myomata. Mean operating time for open myomectomies was 133 minutes versus 264 minutes for laparoscopies (p <0.0001). Mean blood loss was 340 ml and 110 ml, respectively (p <0. 001). The greatest blood loss was 1000 ml in the open group and 800 ml in the laparoscopic group. Uterine size at surgery was 12 to 14 weeks in 42.9% of the open group and 9 to 11 weeks in 51% of the laparoscopy group. The open group incurred a total of 272 hospital days versus 29 days in the laparoscopic group (maximum 25 and 3 days, respectively; mean 5.6 and 0.6 days, respectively; p <0.001). The frequency of postoperative complications was higher in the open group (17) than in the laparoscopic group (5, p = 0.0068). Of patients in whom postoperative adhesions were evaluated, the overall frequency of adhesions was lower in the laparoscopic group. Three women in the open group required postoperative transfusions, compared with none in the laparoscopic group. Seven pregnancies have thus far occurred in the laparoscopic group. Three women delivered at term by elective cesarean section, at which no evidence of uterine dehiscence was found. Estimated average cost of each procedure, expressed in April 1995 dollars using the Consumer Price Index, were $14,461 for open myomectomies and $13,814 for laparoscopies (p = 0.65). Linear regression with residual analysis was performed on costs for both groups and revealed significantly increasing time trend for open myomectomies. During the years of this study, the open procedures increased in price at a rate of $868/year. The cost of laparoscopic myomectomies showed no time trend. CONCLUSIONS: Compared with open myomectomy, laparoscopic myomectomy had lower morbidity, no identifiable trend of increasing hospital cost, minimal hospital stay, and fewer complications.     

Aspiration pneumonitis; progress in understanding its acute pathophysiology and its therapy

Aspiration of gastric contents has been a major cause of acute respiratory failure in adult patients, and its mortality has been very high. Current method of treatment is limited, but the pathogenesis of acid aspiration lung injury has been well studied. The lung injury can be divided into direct and secondary injury. Neutrophils are thought to be a primary mediator of the secondary lung and systemic organ injury. Various substances such as cytokines, complements, and arachidonic acid metabolites, which activate neutrophils, are produced in acid aspiration pneumonitis. In this article, the progress in research of the acute pathophysiology of acid aspiration pneumonitis is reviewed and the possibility of its application to therapy is discussed.     

铅析法及其应用

本文扼要介绍了国内不常见的铅析法的基本概念、过程、特点,并介绍了粗铜、阳极泥、冰铜三种试样的湿法预处理及与铅析法相结合的流程。     

Hyperparathyroidism and its management

Hyperparathyroidism (HPT), resulting from the excess of endogenous parathyroid hormone is cited as one of diseases which cause secondary osteoporosis. HPT consists of primary (1 degree) and secondary (2 degrees) HPT, resulting mainly from chronic renal failure (CRF). HPT is easily distingishable from primary osteoporosis by biochemical measurements. Parathyroidectomy (PTX) is the only option available for the radical cure of 1 degree HPT and more than 10% increase in bone mass occurs after PTX. On the other hand, dietary phosphorus restriction, phosphorus binders, active vitamin D3 metabolites are useful for 2 degrees HPT due to CRF. When these treatments are not effective to inhibit PTH secretion adequately, oral active vitamin D3 pulse therapy, PTX and percutaneous ethanol injection therapy should be considered.     

Porphyria and its investigation

Screening can lead to harmful psychological effects in the screened population--an argument used against abdominal aortic aneurysm (AAA) screening. However, there is no evidence for this in AAA screening. We applied the Hospital Anxiety and Depression Scale (HADS) to a group of men undergoing screening for AAA. The HADS questionnaire was completed by subjects found not to have AAA, subjects with known small aneurysms attending for follow-up scans, subjects with known AAA on waiting lists for surgery, and controls not involved in the screening programme. The groups were well matched for age and the number of additional diseases. There was no significant difference in the distribution of patients for anxiety and depression according to the HADS questionnaire (chi 2 test, P > 0.1). The results from this study suggest that AAA screening does not increase anxiety or depression in the screened subjects--contrary to the argument put forward against screening for this condition.     

Somatostatin and its receptors

Somatostatin-14 and somatostatin-28 are derived from the same peptide, prosomatostatin by the post-translational modification and make a somatostatin family. Recent advance in molecular biology has revealed that somatostatin receptors also constitute a family of structurally-related proteins. The members of the somatostatin receptor family are SSTR1-5, which have different expression pattern, pharmacological characterization and coupling with intracellular second messenger systems. Efficacy of SMS 201-995, a clinically available somatostatin analog, against endocrine tumors seems to be correlated with expression of SSTR2 which has a high affinity for SMS 201-995. Cloning of somatostatin receptors will further facilitate development and application of somatostatin analogs in diagnosis and treatment of tumors.