Diagnosis of depth of invasion of gallbladder carcinoma with endosonography

We reported on the usefulness of endosonography (EUS) in the diagnosis of the depth of invasion of gallbladder carcinoma. We performed EUS on 69 patients with gallbladder carcinoma: the degree of tumor extension in 17 was m (tumor invading the mucosa), in 5 pm (tumor invading the muscular layer), in 21 ss (tumor invading the subserosa), 14 in se (tumor invading the serosa), and 12 si (tumor extending to adjacent organs). The detection rate of tumors with EUS was 91.3% (63 of 69). All 6 (100%) patients with pedunculated lesions (Ip type) were correctly diagnosed with EUS. Eighteen of 21 patients (85.7%) with broad-based elevated tumors (Is type), and 5 of 7 (71.4%) with flat-elevated lesions (IIa type) were also diagnosed correctly. EUS is a useful modality for the diagnosis of gallbladder carcinoma. In particular, EUS diagnosis of the depth of invasion is reliable in Ip-type lesions. It is recommended that patients with Ip-type lesions undergo laparoscopic cholecystectomy, but in patients with Is-or IIa-type lesions conventional cholecystectomy with lymph node resection should be performed.     

Direct action of estrogen on sequence of progression of human preneoplastic breast disease

Seizures occurred in two patients with probable Alzheimer's disease who were receiving long-term treatment with metrifonate, an irreversible acetylcholinesterase inhibitor. In both patients seizures were associated with discontinuation of short-term agents with high antimuscarinic properties. Hence, abrupt discontinuation of antimuscarinics or anticholinergics with high antimuscarinic properties in patients receiving long-term acetylcholinesterase inhibition therapy may be associated with a reduction of seizure threshold. With increasing administration of acetylcholinesterase inhibitors for patients with Alzheimer's disease, practitioners should be aware of the potential for drug-drug interactions and other complications. In general, it is good medical practice to avoid concomitant administration with centrally acting anticholinergic agents.     

Results of complete correction of various forms of transposition of the great vessels in the infant

Over the past 3 years, a Mustard operation has been performed in 38 infants aged 30 days to 24 months, among them 29 less than one year of age. There were 27 TGV with intact ventricular septum, 8 TGV and VSD, (isolated in 3, and associated with PS in 2 and with coarctation of the aorta in 3), 2 TGV with isolated PS, and 1 TGV with aorta-pulmonary window. The operation was carried out under deep hypothermia, circulatory arrest and limited by-pass, using a pericardial patch in all cases but one. The operative mortality is 8% (3 cases) for the whole group, 7% in infants less than one year of age, and 3% for all TGV with intact ventricular septum. The long term results are reviewed, with a follow-up of 2 to 36 months (mean 17 months).     

Effects of treatment of varicocele on male sterility. Fertility of 84 operated patients

84 men with primary sterility averaging 3.5 years and secondary sterility for 5.5 years with varicocele were treated with Yvanissevich's operation. 43 impregnated their wives within about 15 months, resulting in 33 term births, 9 miscarriages, and 1 extrauterine pregnancy. 80% of the spermograms were oligospermic before the operation. 50% of those whose wives conceived showed improved spermograms, and 37% of the men whose wives failed to conceive had improved spermograms. 50% of the men with normal testicles, 33% of those with unilateral testicular hypoplasia, and 40% of those with bilateral hypoplasia showed improved spermograms. Long thin spermatozoa did not appear to be characteristic of men with varicocele.     

The control of the content of conversation: Reinforcement of statements of opinion.

Two assumptions are made, (a) that "stating an opinion" is a class of behavior that acts as a response, and (b) that statements of agreement with, or para-phrases of, such statements of a speaker act as reinforcing stimuli. It is inferred that the rate at which a speaker states opinions varies with the number of these reinforcing stimuli given by the person with whom he is conversing. Twenty-four experimental conversations on a wide variety of topics were carried out in a variety of places in a group of Ss, most of whom were college students. The expected results appeared. Every S increased in his rate of speaking opinions with reinforcement by paraphrase or agreement. Twenty-one Ss decreased in rate with nonreinforcement. Overall rates of speaking did not change significantly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spiroergometric evaluation of the effectiveness of treatment of cardiac insufficiency with cardiac glycosides

There were 29 patients with rheumatic heart disease and early stages of cardiac insufficiency under observation. Spiroergometry with the "Ergotest" device was conducted in dynamics to check whether the proper dose of the cardiac glycoside had been chosen. The results attest to the considerable improvement in the spiroergometric indices in patients with early stages of cardiac insufficiency who had been treated with digitalis. Spiroergometry yielded important additional criteria of the effectiveness of digitalization, particularly in individuals with normal or diminished rate of cardiac contractions.     

Oxygen tension of the skin of ischemic legs

Using a Kontron Roche Transcutaneous Oxygen Monitor, we measured oxygen tension on the skin of the legs at three sites in patients with peripheral vascular disease and group of controls. Significant decreases in oxygen tension occurred in the patient groups, which correlated well with ankle systolic pressure, with differences between those with claudication and those with rest pain. These results suggest that in limbs with claudication, significant skin hypoxia may exist during rest in spite of reportedly normal skin and muscle blood flow. The progressive decrease in skin oxygen tension down a limb with occlusive vascular disease may play a significant role in skin healing.     

Serum levels of tissue inhibitor of metalloproteinases-2 and of precursor form of matrix metalloproteinase-2 in patients with liver disease

Serum levels of tissue inhibitor of metalloproteinases-2 (TIMP2) and of precursor form of matrix metalloproteinase-2 (proMMP2) were determined in patients with chronic hepatitis and hepatocellular carcinoma by a one-step sandwich enzyme immunoassay. Serum levels of TIMP2 and proMMP2 were significantly higher in patients with chronic liver disease, than in normal controls. Serum levels of TIMP2 showed a weak negative correlation with the serum albumin level and prothrombin time (PT). Serum levels of proMMP2 in patients with chronic hepatitis were strongly correlated with those of type IV collagen and were negatively correlated with PT and serum albumin levels. Serum proMMP2 levels were also significantly correlated with histological stages. These data indicate that serum levels of proMMP2 might be useful in the follow-up of patients with chronic hepatitis.     

Study of the morphology of the cell walls of some strains of lactic acid bacteria and related species

OBJECTIVE: To examine Mycoplasma ovipneumoniae for presence of a capsule and its potential role in adherence. SAMPLE POPULATION: 17 isolates of M ovipneumoniae and 2 isolates of M arginini, recovered from sheep with respiratory tract disease. PROCEDURE: Mycoplasmas were cultured in modified Fills broth medium, ovine fetal lung cells, or ovine tracheal ring explants. Pelleted mycoplasmas or ring cultures infected with mycoplasmas were treated with ruthenium red or polycationic ferritin and visualized by transmission electron microscopy. Reactivity of several lectins with the mycoplasmas was studied by use of a microtitration plate agglutination test. RESULTS: Electron microscopy revealed a large number of M ovipneumoniae cells covered with an electron dense-stained amorphous material suggesting that it was a capsule. Multiple passages of the microorganisms in modified Friis broth medium decreased thickness of the capsule, but not percentage of cells encapsulated. Marked differences were observed when M ovipeumoniae isolates grown in modified Friis broth medium or co-cultured with ovine fetal lung cells were compared for capsular thickness or percentage of encapsulation. In thin sections of ruthenium red-stained tracheal ring cultures, the mycoplasmas appeared to be in close contact with cilia through their capsule. All isolates of M ovipneumoniae reacted strongly with wheat germ agglutinin lectin. CONCLUSIONS: Mycoplasma ovipneumoniae produces a polysaccharide capsule with variable thickness that is dependent on culture conditions and strain. Morphologic observations suggest that this capsule facilitates adherence of the organism to ciliated epithelium.     

Prolonged symptoms of brain dysfunction--adverse effect of levodopa

Symptoms of brain dysfunction occurred in a 67-year-old woman with idiopathic parkinsonism on treatment with levodopa. The adverse effect reappeared in a more severe and prolonged form when she was treated one year later with levodopa in combination with the peripheral decarboxylase inhibitor Ro-4-4602. The symptoms were associated with a markedly altered level of HMPG (a noradrenaline metabolite) in the cerebrospinal fluid.     

Treatment of rupture of the bladder

Herein we review our 6-year experience with operative and non-operative treatment of bladder ruptures. Many ruptured bladders with extraperitoneal and intraperitoneal extravasation of urine can be treated without an operation and with less patient morbidity.     

Association of sex of fetus, sire, month of conception, or year of foaling with duration of gestation in standardbred mares

OBJECTIVE: To determine whether sex of fetus, sire, month of conception, or year of foaling was associated with duration of gestation in mares. DESIGN: Epidemiologic retrospective cohort study. ANIMALS: 500 foalings for 296 Standardbred mares. PROCEDURE: Data for reproductive events from 1986 to 1992 were analyzed. Analyses were conducted to determine whether duration of gestation was associated with sex of fetus, sire, month of conception, or year of foaling. RESULTS: Mean duration of gestation was 343.3 days and was significantly greater for colt fetuses (344.4 days) than for filly fetuses (342.2 days). Sire was associated with duration of gestation; gestation after mating with certain sires was consistently less than 340 days in duration, whereas duration after mating with other sires was consistently more than 350 days. Duration of gestation was associated with month of conception, decreasing by about 2.5 d/mo for mares conceiving later during the breeding season. CLINICAL IMPLICATIONS: Duration of gestation is affected by mating to specific sires and by month of conception. Stallions associated with exceptionally prolonged gestations might be used to breed mares early in the breeding season, whereas stallions associated with shorter gestations might be desirable for mares bred later in the breeding season. Preparations for impending parturition should be more effective and efficient with improved information on expected date of parturition.     

Optimal size of outflow patch in total correction of tetralogy of Fallot

Hemodynamic and angiocardiographic studies were performed in postoperative patients with tetralogy of Fallot. Pressure gradient between the right ventricle and pulmonary artery was correlated with the narrowest area in the pulmonary arterial pathway. Regurgitant fraction was also correlated with regurgitant area which was determined by preoperative area of the pulmonic annulus and width of the outflow patch. Follow-up study of postoperative patients with tetralogy indicated that those with pressure gradient less than 20 mmHg and regurgitant fraction less than 15% could be considered ideally corrected. A table was constructed for determining the most appropriate width of the outflow patch for the ideal correction.     

Spectroscopic analysis of biliary calculi: correlations of the type of calculi and clinical data of 25 consecutive surgical patients

The Authors considering cholelithiasis as an heterogenic pathological entity report their experience of 25 surgical consecutive patients: 20 with cholesterol or combination gallstones and 5 with black pigmented gallstones. In this series the most frequent factors associated with cholesterol gallstones were LDL hypercholesterolemia and hypertriglyceridemia; while the most frequent factors associated with black pigmented gallstones were hepatopathies. The most frequent symptom was dyspepsia. Only the black pigmented and the mixed gallstones were associated with jaundice and pancreatitis. According to the Literature infection is associated to brown pigment gallstones in 95% of cases, in this series infection is rarely associated with other types of gallstones. Treatment with oral bile salts is useful only in pure cholesterol gallstones, so the distinction among different types of gallstones is useful not only for a better knowledge of their pathogenesis but also for a correct choice of the therapeutic options.     

Evaluation of the quality of life of male snorers using the Nottingham Health Profile

It is conceivable that the subjects who have phonatory disorders, in comparison with normal individuals, exert a greater expiratory effort when phonating loudly. Furthermore, we presume that the extent and pattern of the changes in the expiratory effort for increasing vocal intensity may vary according to the types of laryngeal lesions. To prove these hypotheses, we investigated the changes in expiratory effort for increments of the vocal intensity by measuring the expiratory lung pressure. The subjects included 10 each of normal controls, patients with Reinke's edema, and those with recurrent laryngeal nerve paralysis. For the normal controls, the increase in vocal intensity was achieved by slightly increasing the expiratory lung pressure. The patients with Reinke's edema showed a greater increase in expiratory lung pressure, as compared with the normal group. The patients with recurrent laryngeal nerve paralysis exhibited greater expiratory effort with extreme increases in airflow than normal group for louder phonation. It was concluded that the subjects who have phonatory disorders, in comparison with normal individuals, require a greater expiratory effort. This phonatory function test with an increase in voice intensity made the aerodynamic pathologic condition clearer.     

Prognostic significance of depth of invasion in cancer of the larynx

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease-free survival. The tumors with no clinical involvement of regional lymph nodes in neck (NO neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P < .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P = .047) and patient age (P = .113) significantly affected the disease-free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P > .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease-free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease-free survival.     

Stability of hydrophobic nuclei of protein molecules depending of the degree of packing

The values of free energies for the formation of hydrophobic cores with different degree of packing of nonpolar side chains have been calculated. It has been shown that the difference between the values of free energy for tightly packed cores inaccessible to water solvent molecules and the values of free energies for less tightly packed hydrophobic cores whose surface is in contact with the water solvent, is 50-60 kJ/mol and coincides with the value of the enzyme free energy change during its interaction with the substrate.     

Assessment of symphysis morphology as a predictor of the direction of mandibular growth

The purpose of this study was to determine whether symphysis morphology could be used as a predictor of the direction of mandibular growth and to assess growth changes of the symphysis. Cross-sectional data included lateral cephalometric radiographs of 115 adults (58 women, 57 men) with the longitudinal sample a subset of 62 subjects (30 females, 32 males) at four age groups. The direction of mandibular growth was evaluated with seven cephalometric measurements that included Y-axis, SN to mandibular plane, palatal plane to mandibular plane, gonial angle, sum of saddle, articulare and gonial angles, percentage lower facial height, and posterior/anterior face height. The mandibular symphyseal dimensions studied were height, depth, ratio (height/depth), and angle. Symphysis morphology was found to be associated with the direction of mandibular growth, especially in male subjects with symphysis ratio having the strongest relationship. A mandible with an anterior growth direction was associated with a small height, large depth, small ratio, and large angle of the symphysis. Conversely, a posterior growth direction was associated with a large height, small depth, large ratio, and small angle of the symphysis. Symphysis dimensions continued to change until adulthood with male subjects having a greater and later occurring change compared with female subjects.     

Combined surgery and postoperative radiotherapy for carcinoma of the base of radiotherapy for carcinoma of the base of tongue: analysis of treatment outcome and prognostic value of margin status

BACKGROUND: Choice of treatment for base of tongue carcinoma is controversial, with options including surgery alone, radiotherapy alone, or multimodality treatment. Given the highly aggressive nature of these tumors, it has been our institutional policy to manage this disease with combined partial glossectomy (with attempt to avoid laryngectomy if possible) with planned postoperative radiotherapy (RT). We reported on our institutional experience with this approach. METHODS: A retrospective review of the charts of 17 patients with primary base of tongue squamous cell carcinoma treated with surgery and postoperative RT was performed. Patients treated with chemotherapy as part of their management were excluded. All patients underwent partial, hemi-, or subtotal glossectomy; 15/17 patients underwent ipsilateral radical or modified radical neck dissection. All patients received comprehensive postoperative RT (median dose 6000 cGy; range 5040-6920 cGy). Stage distribution was as follows: stage I, 2; stage II, 3; stage III, 2; stage IV, 10. Positive margins for invasive carcinoma were found in 9/17 patients. Median follow-up of surviving patients is 46 months; median follow-up for all patients is 31 months. RESULTS: For the entire group of patients, the actuarial 3-year local-regional control rate was 68%. The actuarial 3-year overall survival rate was 46%. The local-regional control rate was 83% for patients with stage I-III disease versus 50% for stage IV disease. There were no local failures among eight patients with negative margins (local control 100%) compared with an actuarial local control rate of 36% among patients with positive margins (p = .03). Survival, disease-specific survival, and locoregional control were also highly correlated with margin status (p = .003). Late major complications included 5/17 patients requiring permanent G-tubes and/or tracheostomy to prevent aspiration. CONCLUSIONS: Surgery plus postoperative RT is an intensive treatment for carcinoma of the base of tongue which offers high locoregional control in patients in whom negative margins are achieved. Positive margins indicate a high risk of locoregional and systemic failure, and these patients should be considered for innovative clinical trials after surgery.     

转炉炉壳热应力分析

根据实际转炉建立实体模型。以有限元为手段,考虑了炉衬和炉壳材料的物性参数随温度变化的特点和炉衬与炉壳之间膨胀间隙,计算了转炉炉壳在温度载荷和炉衬膨胀压力同时作用下的热应力。所得结果可为转炉炉壳设计提供依据。