Microscopic changes in the ligated and resected stumps of the uterine vessels during abdominal hysterectomy (author's transl)

30 stumps of the uterine vessels during abdominal hysterectomy were excised with the ligature 10 to 20 minutes after the original ligature. Inspite of the ligature the most important mechanism of hemostasis is an occlusive thrombosis in the lumen of the vessels. In this process damage of the wall of the vessel and the endothelium is very important.     

Abdominal hysterectomy versus transvaginal morcellation for the removal of enlarged uteri

OBJECTIVE: The purpose of this study was to compare the intraoperative and postoperative complications of transvaginal morcellation and abdominal hysterectomy for the removal of moderately enlarged uteri. STUDY DESIGN: An observational study was performed on all uteri weighing > 200 gm removed transvaginally from July 1, 1987, to June 30, 1993. An abdominal hysterectomy control group was selected. RESULTS: There were 50 patients in the vaginal group and 112 in the abdominal group. At a p value < 0.05 there was no statistically significant difference between the two groups for age, parity, obesity, hypertension, insulin-dependent diabetes mellitus, or prior genitourinary surgery. The mean operative time in the vaginal hysterectomy group was 122 minutes and in the abdominal hysterectomy group 148 minutes (p < 0.05). The mean estimated blood loss was 527 and 586 ml, respectively (not significant). Twenty-two percent of the vaginal group and 70% of the abdominal group underwent bilateral oophorectomy (p < 0.05). The mean uterine weights were 335 and 336 gm, respectively (not significant). The mean day of starting a regular diet was 2.1 and 3.6, respectively (p < 0.05). The mean day of discharge was 3.6 and 5.1, respectively (p < 0.05). Complications were similar for the two groups. CONCLUSIONS: In selected patients transvaginal morcellation is a safe and effective alternative to abdominal hysterectomy for the removal of moderately enlarged uteri. The two procedures are comparable in operative time, blood loss, and complications. Both ovaries are more likely to be removed with abdominal hysterectomy. Cosmesis and recuperation may be advantages of the vaginal approach.     

Transient ADP-ribosylation of a 2'-phosphate implicated in its removal from ligated tRNA during splicing in yeast

The last step of tRNA splicing in yeast is catalyzed by Tpt1 protein, which transfers the 2'-phosphate from ligated tRNA to NAD to produce ADP-ribose 1"-2"-cyclic phosphate (Appr>p). Structural and functional TPT1 homologs are found widely in eukaryotes and, surprisingly, also in Escherichia coli, which does not have this class of tRNA splicing. To understand the possible roles of the Tpt1 enzymes as well as the unusual use of NAD, the reaction mechanism of the E. coli homolog KptA was investigated. We show here that KptA protein removes the 2'-phosphate from RNA via an intermediate in which the phosphate is ADP-ribosylated followed by a presumed transesterification to release the RNA and generate Appr>p. The intermediate was characterized by analysis of its components and their linkages, using various labeled substrates and cofactors. Because the yeast and mouse Tpt1 proteins, like KptA protein, can catalyze the conversion of the KptA-generated intermediate to both product and the original substrate, these enzymes likely use the same reaction mechanism. Step 1 of this reaction is strikingly similar to the ADP-ribosylation of proteins catalyzed by a number of bacterial toxins.     

Intravenous administration of Augmentin in the prevention of infectious complications in abdominal hysterectomy

Amoxycillin-clavulanate was used in prophylaxis of infectious complications after abdominal hysterectomy. A group of 29 patients was treated routinely with metronidazol introduced vaginally 2-3 days before surgery. This group was compared with 40 patients who received two perioperative doses of Augmentin intravenously. The incidence of febrile morbidity, urinary tract infection, following antibiotic treatment and pelvic infection were followed in both groups. Patients in the amoxycillin-clavulanic acid group had significantly less infectious morbidity than those in the metronidazol group. The results suggest that antibiotic prophylaxis for abdominal hysterectomy is effective. The prophylactic agent should be bactericide against aerobic and anaerobic bacteria and non-toxic. Amoxycillin-clavulanate (Augmentin) meets all these criteria.     

Changes of callus diameter during axial loading and after fixator removal in leg lengthening

We retrospectively reviewed nine tibial lengthenings in seven achondroplastic patients. The callotasis method was used, and a unilateral type lengthener, either the Dynamic Axial Fixator (Orthofix, Italy; eight legs) or the High Functional Fixator (Matsumoto Co., Japan; one leg), was applied. The distracted length averaged 14.6 (range 10-18) cm. The minimum diameter of the callus was measured using a ruler on anteroposterior and lateral radiographs. The callus diameter ratio (%) was calculated as the callus diameter divided by the original diaphysis diameter. For periods during axial loading and after removal of the fixator in each patient, a single regression line was drawn on the callus diameter ratio data using the least squares method, and the diameter change rate (%/day) was evaluated by inclination of this line. The diameter change rates during axial loading were negative in six legs, but those after fixator removal were positive in all legs, and the latter were significantly greater than the former. The diameter change rates after fixator removal on the anteroposterior radiographs were negatively correlated with the callus diameter ratio at the time of fixator removal (r = 0.84, P = 0.0008). Simple axial loading may not be a sufficient mechanial environment for restoration of the physiological shape, and it is important to be aware that we cannot expect the callus diameter to increase by this means alone.     

Changes in the central hemodynamics in the surgical treatment of abdominal aorta aneurysm

The algorythm of examination and treatment of patients with an abdominal aorta aneurysm was proposed.     

Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity

The extraction of large tissue masses from the abdominal cavity during laparoscopic surgery is a time-consuming, complicated process. A new prototype instrument is introduced that allows quick laparoscopic removal of fibromas, ovaries, or other tissues from the abdomen. A cylinder with a coning knife at its intra-abdominal end is placed inside the trocar sleeve and is rotated by an electrical micro-engine attached to the trocar. Cylindrical tissue blocks are cut step by step out of the main specimen and removed from the peritoneal cavity through the sleeve with a grasping forceps. Tissue removed is suitable for histologic examination. The principal application is morcellation of fibromas, whereas use in ovarian disease is limited. This new device provides a safe and effective approach inside the abdominal cavity.     

Torsion of the adnexa in children: the value of laparoscopy

Experience with adnexal torsion in neonates and children is often disappointing. Delay between the first symptoms and operation is important, and adnexal loss the rule. The authors reviewed their experience and the literature to assess the appropriate diagnostic and therapeutic approach. Diagnostic procedures (standard ultrasonography [US], color Doppler US, computed tomography, magnetic resonance imaging, endorectal US, and diagnostic laparoscopy) are discussed; for neonates and premenarcheal girls a specific surgical approach is proposed. Twenty-seven adnexal torsions treated between 1985 and 1995 in the same institution were retrospectively reviewed. Neonatal (7) and premenarcheal cases (20) were separated. The neonatal cases (7) were all operated upon: 4 adnexectomies, 2 oophorectomies, and 1 detorsion with cystectomy were performed. In the premenarcheal group (20) 8 adnexectomies, 6 oophorectomies, 5 detorsions with cystectomy, and 1 salpingectomy were performed. There were only 6 salvaged adnexa in this series. In the neonatal group, US seemed accurate in predicting complicated cases. Prenatal puncture of large (>40 mm) ovarian cysts is possible. The authors advocate a laparoscopic approach in the first days of life of all uncomplicated cysts independent of size in order to increase the percentage salvaged. In ultrasonic complicated cases a delayed operation is proposed in the premenarcheal group, endorectal US will probably become the diagnostic method of choice for complicated ovaries; other methods were disappointing. In order to increase adnexal salvage, the authors recommend a laparoscopic approach in the emergency situation if a clinical examination is positive as well as better medical (pediatricians, gynecologists) and general (girls, parents) information. They suggest controlateral oophoropexy in cases of torsion of a normal adnexum.     

Disorders in the stumps of amputee patients: MR imaging

Cnidarians (e.g., sea anemones and corals) are the lowest animal group having a nervous system. Previously, we cloned a receptor from sea anemones that showed a strong structural similarity to the glycoprotein hormone (TSH, FSH, LH/CG) receptors from mammals. Here, we determine the genomic organization of this sea anemone receptor. The receptor gene contains eight introns that are all localized within a region coding for the large extracellular N terminus. These introns occur at the same positions and have the same intron phasing as eight introns in the genes coding for the mammalian glycoprotein hormone receptors, indicating that the cnidarian and mammalian receptor genes are evolutionarily related. As with the mammalian receptor genes, the sea anemone receptor gene does not contain introns in the region coding for the transmembrane and intracellular domains. Southern blot analyses show that the cnidarian receptor is coded for by a single gene.     

Schwannoma of the obturatorius nerve as differential diagnosis in cystic adnexa tumors

We report on a case of benign retroperitoneal schwannoma involving the obturator nerve. Discussing the difficulties of diagnosis and treatment the following became clear: 1.) Clinical examination, ultrasound and computed tomography are not helpful to differentiate a retroperitoneal schwannoma from a cystic ovarian tumour; this problem can perhaps be overcome by MR imaging. 2.) The diagnosis should be borne in mind in cases of retroperitoneal tumours of unclear origin. Appropriate surgery is necessary to avoid nerve damage and paralysis.     

Changes in size and shape of chromatin particles after successive removal of histones

The preparations of whole chromatin, chromatin selectively depleted of histone f1, depleted of all lysine-rich histones (f1, f2b, f2a2), and DNA was studied by viscosimetric and light scattering methods. The obtained results were used for calculation of the dimensions and packing ratios of DNA for the preparations studied. The packing ratio in whole chromatin is 7.2 and is almost unaffected by selective removal of histone f1 (6.9), but decreases on successive removal of the remaining four histones, the decrease being dependent more on the quantity than the kind of the dissociated histones.     

Changes in the structural localization of glycogen during glucose resorption

Quantitative changes in the glycogen granula contents of the dog's small intestinal mucosa were investigated with light microscopy using Best-carmin dying. In fasting animals the glycogen could be detected in a patchy arrangement in the supranuclear cytoplasmic region of the enterocytes. During glucose abasorption glycogen appeared in continually increasing quantities also in the lamina propria. Injecting Glucagon (50-100 microgram/15') into the artery of the intestinal loop during glucose absorption, glycogen totally disappeared from the enterocytes, while it remained unchanged in the cells of the lamina propria.