100 years guarding the health of the border guards

A Heller-Dor procedure was performed by laparotomy (group A: n = 8) or by laparoscopy (group B: n = 12) after failure of one to 17 sessions of intraluminal dilatations (n = 13) or as a primary treatment of oesophageal achalasia (n = 7). The oesophagomyotomy was extended over the thoracic oesophagus by thoracoscopy in two patients having vigorous achalasia. Injury to the oesophageal mucosa occurred in two group A patients who had previously been dilated. At follow-up (range: 1 to 113 months), 6 patients of group A (75%) and 10 of group B(83.3%) had no residual dysphagia. The four patients (group A: n = 2; group B: n = 2) who complained of heartburn prior to the operation were asymptomatic, only one group A patient developed symptoms of reflux, and oesophageal pH-monitoring was normal in the 6 group B patients investigated at follow-up. The laparoscopic approach reduces the magnitude of the operation, and the magnified overview permits precise dissection of the intraparietal adhesions which may develop after numerous sessions of dilatation.     

The dartos flap as an adjunct in preventing urethrocutaneous fistulas in repeat hypospadias surgery

PURPOSE: Vascularized flaps for repeat hypospadias repair are often limited. We report our experience with the dartos flap in children undergoing secondary hypospadias and complex urethral repair. MATERIALS AND METHODS: The dartos flap is fibroadipose tissue between the scrotal skin and tunica vaginalis layers with its vascular pedicle based at the penoscrotal angle. The flap reaches the distal penile shaft without tension. Eight patients 1 to 17 years old (mean age 6) underwent urethral surgery and an interposed dartos flap procedure in 1994 to 1995. RESULTS: Of 6 patients cosmesis was excellent in 84%, erections were straight in 100%, and urinary streams were of good quality and without fistula in 100% after repeat hypospadias surgery. Following staged repair for anterior urethral valves a urethrocutaneous fistula developed in 1 patient and following urethral duplication repair results were excellent in 1. Mean followup was 1 year. CONCLUSIONS: The dartos flap is easy to mobilize and it provides excellent coverage for repeat proximal hypospadias surgery, since the dartos remains undisturbed. We endorse its use for complex urethral surgery and believe that the extra layer of closure helps to prevent urethrocutaneous fistulas.     

Hypothalamic-pituitary-adrenal axis activity in depressive illness. Its relationship to classification

Serum cortisol response to the 1-mg overnight dexamethasone suppression test was studied in 221 depressed patients and 109 nondepressed psychiatric controls. Nonsuppression distinguished patients with primary unipolar depression (65/146) from patients with secondary unipolar depression (0/42) and nondepressed controls (0/109). Furthermore, nonsuppression distinguished the three familial subtypes of primary unipolar depressive illness: familial pure depressive disease (FPDD; 38/50 patients), sporadic depressive disease (SDD; 24/55 patients), and depression spectrum disease (3/41 patients). Moderate elevations in baseline serum cortisol levels were found in FPDD, SDD, and bipolar depression. Medication did not affect the results. The data suggest that the depressive syndrome is composed of separate illnesses, each of which has a distinctive pattern of hypothalamic-pituitary-adrenal axis activity during the depressed state as well as a specific clinical and familial psychiatric history.     

Catecholamine-induced muscle weakness

Infusions of epinephrine or levarterenol bitartrate into a rabbit nerve-muscle preparation decreased the force of the evoked twitch of anterior tibial and gastrocnemius-soleus muscles. The adverse effect of the catecholamines was not directly on skeletal muscle. The alpha-receptor blocking drug phenoxybenzamine hydrochloride prevented the adverse effect of the catecholamines if it was given prior to catecholamine infusions and unmasked a weak augmentation of twitch tension. Taken with the finding of abnormal accumulation of catecholamine in human dystrophic muscles, the production of an experimental myopathy resembling human dystrophy by the monoamine oxidase inhibitor pargyline hydrochloride, and the finding of excessive levels of catecholamines in the tissues and urine of dystrophic animals, these experiments support the hypothesis that catecholamines could play a pathogenetic role in some dystrophic diseases of muscle.     

Effects of 5 alpha-dihydrotestosterone and methandrostenolone in male guinea pigs

Young adult guinea pigs were studied 6 and 9 weeks after silastic capsules containing 5 alpha-hydrotestosterone (5 alpha-DHT) and methandrostenolone (Dianabol) were implanted. DHT was more effective in causing testicular atrophy and was apparently more androgenically potent in sustaining the size of the seminal vesicles. Both steroids led to hypertrophy of the masseter muscle and increase in gastrocnemius protein concentration. Cardiac tissue was sensitive to the effects of these steroids, particularly to the larger amounts of absorbed Dianabol, in terms of increases in DNA concentration and transient loss of tissue sodium, potassium, and calcium. All alterations in muscle composition occurred in the total absence of change in tissue water. Hypernatremia and hyperkalemia was present in steroid-treated animals with significant loss of urinary potassium in DHT-treated guinea pigs. Adrenal atrophy and the lowering of circulating cortisol was further indicative of effects upon adrenocortical function and the regulation of electrolyte balance.     

Preliminary study of the in vivo motion in the canine shoulder

An instrumented spatial linkage was used to measure the total motion in a canine shoulder as the dog was engaged in a variety of activities, including walking on a level carousel track, as well as over a hurdle, up and down a step, and up and down a ramp placed on the same track. For each activity, the motion data were analyzed, using 2 procedures. First, the linkage data and the joint contour data were combined by computer, and the motion was represented by a series of sequential computer drawings showing the scapular and humeral articular surfaces in their proper relative positions for selected increments of time during the various activities described. As an alternate but approximate method for describing the relative humeral-scapular motion, rotations about 3 mutually perpendicular axes through the average center of the shoulder joint were determined.     

Is colostomy closure a hazardous procedure? A comparison of elemental diet and routine bowel preparation

Morbidity after closure of a colostomy is low if a simple antiseptic technique of intraperitoneal closure is used. In 26 patients there was no example of major wound sepsis and only 2 faecal fistulas both of which rapidly closed spontaneously. A randomized study of preoperative bowel preparation incorporating an elemental diet showed no apparent advantage for this method using our criteria for assessment.