Ureteral injuries associated with gynecologic surgery: prevention and management

Gynecologic surgery is responsible for most of the ureteral injuries that occur. The "easy" operation--the "simple" abdominal hysterectomy--and not the technically difficult pelvic one, is responsible for most ureteral injuries. Total abdominal hysterectomy accounts for almost 50% of the genitourinary fistulas and perhaps 80-99% of all surgical ureteral injuries. This problem will persist until a most important surgical axiom is applied routinely during the accomplishment of all pelvic operations: With all dissections, the contiguous structures subject to injury must be exposed. This step not only will avoid injuries to the ureter but also will facilitate an equally important aspect, that is, urinary tract injuries must be recognized at the time of operation. With recognition and adequate repair, problems such as fistula formation and serious morbidity (and litigation) can be avoided almost entirely. Because the gnecologic surgeon frequently will find that urologic consultation is not available at the time of urinary tract injury, he or she must be aware of and familiar with the various ureteral reconstructive procedures that may be required. The gynecologic surgeon must devote time and study to the management of urinary tract injuries before their occurrence. All pelvic surgeons eventually will encounter ureteral problems. The methods of bladder mobilization and ureteroneocystostomy should be within the ability of all who operate within the pelvis. When extensive damage has occurred and a urologist is not available, the gynecologist who is unfamiliar with the more demanding techniques (that is, ureteroureterostomy, bladder flaps, ileal conduits) should avoid additonal damage to the urinary tract and accomplish a simple catheter ureterostomy, deffering the definitive repair for a urologist.     

A new method for deep reflex muscular massage

As professionals, dentists should continue to learn and improve our skills throughout our careers. Continued competency testing, however, will neither assure nor accurately measure this process. It isn't necessary, won't improve the public's dental health, and would be very expensive.     

Adolescent female craniofacial morphology associated with advanced bilateral TMJ disc displacement

The aim of this study was to determine if cephalometric measurement differences occurred between two groups of similarly aged female adolescents which differed with respect to their diagnoses of temporomandibular joint disc position on magnetic resonance images (MRI). One group consisted of 17 female adolescents exhibiting complete bilateral disc displacement affecting the temporomandibular joints (TMJ), while the second group of 17 female adolescents was diagnosed as having bilateral normal disc position on MRI. Independent sample t-tests identified statistically significant differences in cephalometric measurements between the two groups, but no age difference between the two groups was evident. The group with bilateral total disc displacement exhibited the following significant angular differences from the group with normal disc position: an increased mandibular and palatal plane relative to sella-nasion; posterior rotation of the mandible as illustrated by an increased angle between the posterior border of the mandibular ramus and sella-nasion; and a decrease in Rickett's facial axis. Significant differences in linear cephalometric variables were also evident between the two groups. Total posterior facial height and ramus height were reduced in the totally disc displaced group. Furthermore, a slight increase in the middle anterior facial height was noted, with a decrease in the posterior cranial base vertical height in the totally disc displaced group.     

Changes in the rabbit temporomandibular joint associated with posterior displacement of the mandible

We report a detailed evolutionary study of the RNase P- and RNase MRP- associated RNAs. The analyses were performed on all the available complete sequences of RNase MRP (vertebrates, yeast, plant), nuclear RNase P (vertebrates, yeast), and mitochondrial RNase P (yeast) RNAs. For the first time the phylogenetic distance between these sequences and the nucleotide substitution rates have been quantitatively measured.The analyses were performed by considering the optimal multiple alignments obtained mostly by maximizing similarity between primary sequences. RNase P RNA and MRP RNA display evolutionary dynamics following the molecular clock. Both have similar rates and evolve about one order of magnitude faster than the corresponding small rRNA sequences which have been, so far, the most common gene markers used for phylogeny. However, small rRNAs evolve too slowly to solve close phylogenetic relationships such as those between mammals. The quicker rate of RNase P and MRP RNA allowed us to assess phylogenetic relationships between mammals and other vertebrate species and yeast strains. The phylogenetic data obtained with yeasts perfectly agree with those obtained by functional assays, thus demonstrating the potential offered by this approach for laboratory experiments.     

Ureteral obstructions and leaks after renal transplantation: outcome of percutaneous antegrade ureteral stent placement in 44 patients

Gene E-L, a chimeric lysis construct from bacteriophages phi X174 and MS2 lysis proteins E and L, respectively, was subjected to internal deletions to create a series of new E-L clones with altered lysis or killing properties. The lytic activities of the parental genes E. L. E-L and the internal truncated forms of E-L were investigated in this study to characterize the different lysis mechanisms, based on differences in the architecture of the different membrane spanning domains. Electron microscopy and release of marker enzymes for the cytoplasmic and periplasmic spaces revealed that two different lysis mechanisms can be distinguished depending on penetrating of the proteins either the inner membrane or the inner and outer membranes of Escherichia coli. Several candidates, which share efficient lysis properties, have biotechnological applications in terms of cell disruption.     

Congenital absence of the pericardium: displacement of the heart associated with tricuspid insufficiency

This report describes a patient with congenital absence of the left pericardium with displacement of the heart into the left pleural space and associated tricuspid insufficiency. Excision of the ruptured chordae, plication of the flail anterior leaflet, and tricuspid annuloplasty rendered a competent tricuspid valve.     

Abnormal motion displacement thresholds are associated with fine scale luminance sensitivity loss in glaucoma

This study tests the hypothesis that abnormal motion displacement thresholds coexist with scotomas on a finer spatial scale than is measurable by conventional Humphrey perimetry. Eighteen patients with primary open angle glaucoma in one eye, and 18 age matched normal controls underwent motion displacement threshold testing and high spatial resolution perimetry. The motion displacement thresholds were significantly elevated in the glaucoma eyes, in 73% this exceeded normal limits. Ten glaucoma eyes had normal Humphrey 24-2 field nearest the motion test site: of these seven had abnormally elevated motion displacement thresholds and six had fine scale threshold depressions detected with high spatial resolution perimetry. This result suggests that glaucomatous elevations of motion displacement threshold may be present in areas of normal Humphrey 24-2 field, and this may coexist with measurable scotomas beyond the resolution of conventional Humphrey perimetry in some, but not all patients.     

Entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis

The authors report a case of entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis. This entrapment neuropathy was found distal to the inferior retinaculum that causes the anterior tarsal tunnel syndrome. Surgical decompression of the deep peroneal nerve that was entrapped by the extensor hallucis brevis relieved the symptoms. This condition, like the anterior tarsal tunnel syndrome, deserves attention.     

Ca2+ transport by reconstituted synaptosomal ATPase is associated with H+ countertransport and net charge displacement

The synaptosomal plasma membrane Ca2+-ATPase (PMCA) purified from pig brain was reconstituted with liposomes prepared by reverse phase evaporation at a lipid to protein ratio of 150/1 (w/w). ATP-dependent Ca2+ uptake and H+ ejection by the reconstituted proteoliposomes were demonstrated by following light absorption and fluorescence changes undergone by arsenazo III and 8-hydroxy-1,3, 6-pyrene trisulfonate, respectively. Ca2+ uptake was increased up to 2-3-fold by the H+ ionophore carbonyl cyanide p-trifluoromethoxyphenylhydrazone, consistent with relief of an inhibitory transmembrane pH gradient (i.e. lumenal alkalinization) generated by H+ countertransport. The stoichiometric ratio of Ca2+/H+ countertransport was 1.0/0.6, and the ATP/Ca2+ coupling stoichiometry was 1/1 at 25 degrees C. The electrogenic character of the Ca2+/H+ countertransport was demonstrated by measuring light absorption changes undergone by oxonol VI. It was shown that a 20 mV steady state potential (positive on the lumenal side) was formed as a consequence of net charge transfer associated with the 1/1 Ca2+/H+ countertransport. Calmodulin stimulated ATPase activity, Ca2+ uptake, and H+ ejection, demonstrating that these parameters are linked by the same mechanism of PMCA regulation.     

Children with asthma have improved pulmonary functions after massage therapy

OBJECTIVE: Opioid withdrawal has been associated with poor fetal growth, preterm delivery, and fetal death. We sought to evaluate the safety of antepartum opioid detoxification in selected gravidas. METHODS: Between 1990 and 1996, women with singleton gestations who reported opioid use were offered inpatient detoxification. Predetoxification sonography was performed to confirm gestational age and to exclude fetuses with growth restriction and oligohydramnios. Women with mild withdrawal symptoms were given clonidine initially, and methadone was substituted if symptoms persisted. Objective signs of withdrawal were treated with methadone from the outset. Antenatal testing was performed once gestations reached 24 weeks. Newborns were observed for signs of neonatal abstinence syndrome and were treated as necessary. Obstetric and neonatal outcome data were collected. RESULTS: Thirty-four gravidas elected to undergo opioid detoxification at a mean gestational age of 24 weeks. The median maximum dose of methadone was 20 mg per day (range 10-85 mg), and the median time to detoxification was 12 days (range 3-39 days). Overall, 20 women (59%) successfully underwent detoxification and did not relapse, ten (29%) resumed antenatal opioid use, and four (12%) did not complete detoxification and opted for methadone maintenance. There was no evidence of fetal distress during detoxification, no fetal death, and no delivery before 36 weeks. Fifteen percent of neonates were treated for narcotic withdrawal. CONCLUSION: In selected patients, opioid detoxification can be accomplished safely during pregnancy.     

Cerebral hemodynamics during carotid massage in patients with carotid sinus syndrome

The effect of cardioinhibition and/or vasodepression on cerebral hemodynamics assessed by transcranial Doppler has been investigated during carotid massage in 11 patients (62-87 years, mean age 72) with carotid sinus syndrome. The patients were tested in the OOO mode (n = 11) with six tested in the DDD mode. Carotid massage in the OOO mode decreased mean arterial pressure by 44% (P < 0.01) and mean cerebral blood flow velocity by 50% (P < 0.01). Although not significant, cerebrovascular resistance increased transiently by 17% during massage, then decreased by 31% upon recovery. Carotid massage in the DDD mode decreased arterial pressure by 30% (P < 0.01), cerebral blood velocity by 23% (P < 0.01), and resistance by 15% (P < 0.05). The decreased cerebral perfusion induced by cardioinhibition and/or vasodepression results from the delayed onset of cerebral autoregulation. Pacing in the DDD mode temporarily assists the critical period preceding the onset of cerebral autoregulation that plays a key role in preventing the deleterious effects of vasodepression.     

Placement of a coated stent in esophagotracheal fistula: initial experience with an "aortic stent"

Clinical and biological pitfalls that lead to incorrect or delayed diagnoses of airport malaria are described based on 7 cases reported from the Paris region in the summer of 1994. We also report the outcome and the epidemiological features of these patients.