Clinical and experimental status of the metabolic aspects of obstructive jaundice

In the paper, the authors gave an analysis of some aspects of the metabolism in 90 patients, treated surgically for extrahepatic bile tract diseases (in 43 of them obstructive jaundice being noted), and the results of 34 experiments on white rats are summarized. Based on the conducted studies on acid-base balance, electrolyte metabolism and oxidative phosphorylation in hepatic mitochondria in the experiment under various kinds of anesthesia, some recommendations are given for including sodium oxybutyrate in anesthesia, the latter possessing a positive metabolic effect in patients with obstructive jaundice.     

Organization of patient intake at private dental institutions

Nd:YAG laser was used to disrupt Descemet's membrane in rabbits in order to provoke the hypothetical release of angiogenic activity without a significant traumatic inflammation. Corneal vascularization was elicited only with simultaneous administration of heparin, which alone was unable to initiate the growth of new blood vessels. It is probable that basic fibroblast growth factor (bFGF) was released from its depot in Descemet's membrane and its critical concentration was saved by heparin. The importance of Descemet's membrane is highlighted by the fact that a similar lesion of midstroma could not induce angiogenesis even if aided by heparin. However, some other mechanisms cannot be ruled out, as bFGF acts in paracrine and amacrine mode only.     

Flight simulator evaluation of a novel flight instrument display to minimize the risks of spatial disorientation

BACKGROUND: Melanomas arising from the mucous membranes lining the respiratory, digestive, and genitourinary tracts are rare. Women are more commonly affected than are men, mainly because there is no male counterpart for vulvovaginal lesions. The mainstay of therapy is surgery, with little current use of adjuvant modalities in primary therapy. These lesions usually are advanced at initial presentation; consequently, the prognosis is poor, with 5-year survivals well below 50% in most series. METHODS: One hundred and nineteen patients with primary mucosal melanoma were reviewed. They represented 1.1% of the 10,393 melanoma patients seen at Duke University between 1970 and 1995. All data were obtained from the patients' clinic charts and computerized databases. RESULTS: There were 43 tumors arising from the head and neck region, 46 from the urogenital tract, and 30 from the anorectum. A female predominance was observed, with a female-to-male ratio of 2.7:1. All but five of the patients underwent resection with curative intent. Regional or distant metastases, or both, were encountered in 36 patients at the time of presentation. In patients with head and neck and urogenital tumors, local recurrences accounted for most of the treatment failures, whereas systemic recurrences were more common with tumors arising in the anorectum. The age and gender of the patient, anatomic site of origin of the tumor, clinical stage at initial presentation, and ulceration of the primary all clearly affected prognosis. Overall, the probabilities of being alive 1, 5, and 10 years after diagnosis were 80%, 29%, and 15%, respectively. CONCLUSIONS: Widely accepted classification systems are needed so that results from separate institutions can be compared adequately. Multi-institutional trials could help in delineating standardized therapeutic protocols and in establishing the potential roles of emerging modalities in the treatment of this subtype of melanoma.     

Sternal metastases and associated pathological fractures

A review of 839 necropsies revealed 415 cases of malignant neoplasm, 63 of which were found to have evidence of metastatic spread to the sternum. Nineteen of these metastases resulted in pathological sternal fractures. Fine detail radiography proved a quick and accurate technique for detecting these lesions post mortem. The characteristics of pathological sternal fractures were compared with traumatic sternal fractures with respect to deformity and healing. Pathological fractures of the sternum demonstrate a tendency to greater deformity and slower healing than traumatic sternal fractures.