Laparoscopic surgery of adrenal glands: indications and limits

Over the last four years it has been demonstrated that laparoscopy can be used successfully for adrenalectomy, providing certain advantages over conventional open surgery. The aim of this study was to determine the indications for laparoscopic approach in adrenal surgery. From June 1994 to June 1996 laparoscopic transabdominal flank approaches were proposed in patients with a unilateral 8 cm or less, non-malignant tumors of the adrenal gland. For tumors under 4 cm in diameter only secreting tumors were removed. Among 77 patients requiring ablation of the adrenal gland, 50 (65%) underwent a laparoscopic procedure: 29 Conn adenomas, 10 Cushing adenomas, 6 Pheochromocytomas, 4 incidentalomas. One patient had Cushing's disease and underwent bilateral resection. Mean tumor size was 26 mm (7-75 mm). Malignancy was demonstrated in 2 tumors: one cortisone secreting tumor and one leiomyosarcoma. Conversion was required in 4 cases (8%). Mean operative time for unilateral adrenalectomies was 147 minutes (50-300'). There were no deaths. Morbidity included: one hemorrhage via the trocar orifice requiring reoperation, one infarction of the spleen which regressed spontaneously, one parietal hematoma, and one case of phebitis of the lower limb. The endocrinopathy was successfully cured in all patients with secreting tumors. The 27 other patients underwent open adrenalectomy. Laparoscopic approach was not proposed due to suspected malignancy in 13 cases, previous surgery in 8 cases and multiple, bilateral and/or extra adrenal tumors in 6 cases. Laparoscopic approach to the adrenal gland is the procedure of choice in patients with Conn adenomas, Cushing adenomas and in most cases of pheochromocytomas. It is not indicated for malignant and large tumor (> 8 cm). Currently two-thirds of our patients requiring and adrenalectomy are operated laparoscopically.     

AgNO<Subscript>3</Subscript> spray tests: advantages,weaknesses, and various applications to quantify chloride ingress into concrete. Part 1: Non-steady-state diffusion tests and exposure to natural conditions

Within the framework of the evaluation and the prediction of chloride-induced corrosion risks, simple and rapid AgNO₃ spray tests can be proposed for various issues. This paper forms the first part of a series. In this first part, the Maultzsch procedure (spraying of 0.1-N AgNO₃ solution + K₂CrO₄) as well as the procedure based on the use of a sole AgNO₃ solution have been investigated on a broad range of concretes. These procedures have also been compared to the Collepardi procedure (spraying of 0.1-N AgNO₃ + fluoresceine). The feasibility of these colorimetric techniques on saturated specimens cast in laboratory, after non-steady-state diffusion tests carried out in various conditions, is discussed. In addition, the results obtained from applying such spray tests in field conditions on cores drilled out from various RC test specimens exposed to a marine environment (tidal zone) and to a road and cold environment (freezing-thawing cycles and spraying of deicing salts) are presented. Colorimetric methods have in particular been applied here to the assessment of the average chloride penetration depth and of its evolution versus time (kinetics). Moreover, the detection threshold of these techniques has been investigated in various environments. The possible sources of discrepancy on the results have been analysed.     

Myeloma stem cells in autografting in multiple myeloma

Autologous transplantation has been used increasingly over the last 10 years for the treatment of multiple myeloma. As is the case in other cancers treated by high-dose therapy and stem cell rescue, the contribution of occult tumor cells in the graft to relapse posttransplant remains to be resolved. In this report, we review the biology and differentiation of plasma cells in the context of their significance as an origin of relapse in multiple myeloma.     

Lactate clearance and survival following injury

Previous reports cite optimization of O2 delivery (DO2) to 660 mL/min/m2, O2 consumption (VO2) to 170 mL/min/m2, and cardiac index (CI) of 4.5 L/min as predicting survival. We prospectively evaluated 76 consecutive patients with multiple trauma admitted directly to the ICU from the operating room or emergency department. Patients had serum lactate levels and oxygen transport measured on ICU admission and at 8, 16, 24, 36, and 48 hours. Patients were analyzed with respect to survival (S) versus nonsurvival (NS), lactate clearance to normal (< or = 2 mmol/L) by 24 and 48 hours, hemodynamic optimization as defined above, as well as Injury Severity Score (ISS), ICU stay (LOS), and admission blood pressure. All patients achieved non-flow-dependent VO2. There was no difference in CI, DO2, VO2, or ISS when S was compared with NS. All 27 patients whose lactate level normalized in 24 hours survived. If lactate levels cleared to normal between 24 and 48 hours, the survival rate was 75%. Only 3 of the 22 patients who did not clear their lactate level to normal by 48 hours survived. Ten of the 25 nonsurvivors (40%) achieved the above arbitrary optimization criteria. Fifteen of the survivors never achieved any of these criteria. Optimization alone does not predict survival. However, the time needed to normalize serum lactate levels is an important prognostic factor for survival in severely injured patients.     

Analysis of characteristic odors from human male axillae

A number of studies concerning the analysis of axillary odors have assumed that the characteristic odor produced in the axillae is due to volatile steroids and isovaleric acid. Organoleptic evaluation of Chromatographic eluants from axillary extracts was employed to isolate the region in the chromatogram where the characteristic odor eluted. The odor of the dissolved eluant was eliminated when it was treated with base, suggesting that acids make up the characteristic axillary odor. Subsequent extraction of the pH-adjusted axillary extract in conjunction with organoleptic evaluation of the Chromatographic eluant, preparative gas chromatography, and analysis by GC-MS as well as GC-FTIR showed the presence of a number of C₆ to C₁₁ straight-chain, branched, and unsaturated acids as important contributors to the axillary odor. The major odor component is (E)-3-methyl-2-hexenoic acid. Three homologous series of minor components are also important odor contributors; these consist of the terminally unsaturated acids, the 2-methyl-C₆ to -C₁₀ acids and the 4-ethyl-C₅ to -C₁₁ acids. These types of acids have not been reported previously as components of the human axillary secretions and have not been proposed previously as part of the principal odor components in this area.     

Cellular UDP-glucose deficiency caused by a single point mutation in the UDP-glucose pyrophosphorylase gene

We previously isolated a mutant cell that is the only mammalian cell reported to have a persistently low level of UDP-glucose. In this work we obtained a spontaneous revertant whose UDP-glucose level lies between those found in the wild type and the mutant cell. The activity of UDP-glucose pyrophosphorylase (UDPG:PP), the enzyme that catalyzes the formation of UDP-glucose, was in the mutant 4% and in the revertant 56% of the activity found in the wild type cell. Sequence analysis of UDPG: PP cDNAs from the mutant cell showed one missense mutation, which changes amino acid residue 115 from glycine to aspartic acid. The substituted glycine is located within the largest stretch of strictly conserved residues among eukaryotic UDPG:PPs. The analysis of the cDNAs from the revertant cell indicated the presence of an equimolar mixture of the wild type and the mutated mRNAs, suggesting that the mutation has reverted in only one of the alleles. In summary, we demonstrate that the G115D substitution in the Chinese hamster UDPG:PP dramatically impairs its enzymatic activity, thereby causing cellular UDP-glucose deficiency.