A century of breast cancer surgery

Acetabular roof reconstruction technique for primary cemented THR according to Zuk is presented in a series of 48 patients. No screws or bone bolts were used for cancellous graf fixation. In 30 patients the graft was sufficiently remodeled within 10-12 months, in 16 cases it lasted 1.5-2 years. Longer remodeling time depended on the size of acetabular defect, coexisting conditions and postoperative complications. In 2 cases an autolysis of the graft occurred; one patient underwent prolonged corticosteroid therapy before, the other one was exposed extensively to chemical substances prior to surgery. Aseptic loosening of the acetabular component followed.     

The impact of blood culture reporting and clinical liaison on the empiric treatment of bacteraemia

AIMS: To assess the impact of blood culture results and early clinical liaison on the treatment of patients with bacteraemia. METHODS: 123 patients with significant positive blood cultures were followed over a nine month period in a 620 bed teaching hospital. The impact of early blood culture reporting and clinical liaison on the cost and appropriateness of treatment was assessed. RESULTS: Empiric treatment was started before the Gram stain result in 107 (87%) patients. Treatment was altered on the basis of the Gram stain result in 39 (36%) of these patients, and on culture and sensitivity results in 53 (50%). The spectrum of antibiotic treatment was narrowed in 58 (54%) of these; 20 (19%) on Gram stain result alone. This resulted in a 42% reduction in daily antibiotic costs in patients who had received empiric treatment. Empiric treatment did not follow the hospital antibiotic policy in 49 (46%) of the patients treated. In patients where empiric treatment was not in accordance with hospital policy, 21 (44%) had an isolate resistant to the empiric treatment used; while in patients who received agents in accordance with hospital policy only one (1.7%) had a resistant isolate (p < 0.05). Patients who died (11 (9%)) were less likely to have received empiric treatment in accordance with the antibiotic policy, although this did not reach statistical significance (p = 0.1). CONCLUSION: Early reporting of Gram stain results from blood cultures, combined with early clinical liaison, results in more rational and cost effective treatment.     

The cytological aspects of chronic pancreatitis

Biopsy material of pancreatic tissue using light-optical radioautography and electron microscopy, and the method of high-precise radioautography also, was investigated to study up the pancreatic gland (PG) pathology in chronic pancreatitis (CHP). It was established that CHP is a chronic proliferative-destructive process causing focal generalized fibrosis of PG. All the structural components of organ, and the duct epithelium first of all, are affected in CHP. It gives reason to regard a duct system as a complex independent morphofunctional unit of PG.     

Renal sonography: can it be used more selectively in the setting of an elevated serum creatinine level?

The objectives of our study were to (1) assess the outcomes resulting from the use of sonography in patients referred to our institution's ultrasound laboratory for an elevated serum creatinine level and (2) determine relevant clinical parameters in these patients to better triage them for sonography. We retrospectively identified and determined outcomes of 60 patients (20 women, 40 men; mean age, 61 years; range, 33 to 100 years) referred for sonographic evaluation because of an increased serum creatinine level (> or = 1.3 mg/dL). Ultrasound findings (hydronephrosis, renal size, and echogenicity) were correlated with clinical outcomes. Twenty-one patients (35%) had hydronephrosis, with 14 of these patients confirmed to be obstructed and five not obstructed. Two were indeterminate for obstruction. Eight of 14 obstructed patients were successfully treated. All obstructed patients had a suggestive history for obstruction with at least one of the following: pelvic mass (n = 9), stone disease (n = 4), or flank pain (n = 1). Only 2 of 44 patients, who were not obstructed, had any of these parameters (statistically significant difference, P < 0.0001). Thirty of the patients, who were not obstructed, had more likely alternative causes for renal failure, with sonography having no effect on patient management. Renal size and echogenicity had little effect on patient management. Sonography was efficacious in guiding management in patients with a suggestive history for obstruction (eg, pelvic mass, stone disease, or flank pain) but not in most patients who had no suggestive history and other more likely causes for renal failure.     

Endoscopic ureterolithotripsy with the holmium laser

One of the clinical and experimental investigations performed in the urological clinic of the Moscow Medical University and Research Institute of Urology aimed at elucidation of Ho-YAG-laser potential in endoscopic lithotripsy (EL). Russian Ho-YAG laser surgical units CTH-10 and LLT-3 with wave length 2.09 mu were employed. The studies showed that the developed laser units satisfied relevant medical and technical requirements. Low depth of laser impulse penetration (0.4 mm) obtained at EL warrants safety of the adjacent tissues which is essential in crushing fixed ureteroliths in the presence of severe inflammation in the ureteral wall. The conclusion is made that Ho-YAG laser EL is an effective treatment of ureteroliths. Further tests for EL efficacy in affections of the upper urinary tracts are advocated to define a proper place of EL in endoscopic urology.     

Regional cerebral blood flow increases during preparation for and processing of sensory stimuli

The transferrin receptor (TFR) has been detected in tissues characterised by a high degree of proliferation. We have developed a procedure for isolating TFR from human placental tissues by affinity chromatography on transferrin-Sepharose. Using gel filtration and electrophoresis in 7% PAAG, it has been shown that the molecular mass of the protein is 180 kDa. The protein has a subunit structure and is made up of two identical subunits, 90 kDa each. The constant for the protein binding to transferrin is equal to 5 x 10(-9) M. The yield of the protein isolated by the novel procedure exceeds 5-fold that obtained by previously described methods.     

Hydrocephalus in Apert syndrome: a retrospective review

We report six cases of Morgagni hernia diagnosed and operated on in our pediatric surgical unit during a 14-year period. Four children were younger than 1 year and two between 1 and 2 years. Predominance in males was found. Associated congenital pathology was present in 3 children (Down's syndrome, diaphragmatic relaxation, criptorquidia and pyelo-ureteral stenosis). Predominant clinical features were respiratory infections and vomiting. In only one patient clinical onset was with respiratory distress. Plain chest x-ray was the most used diagnostic procedure. In all cases barium enema was performed to confirm the clinical diagnosis. Most frequent surgical approach was a midline supra-umbilical laparotomy. Diaphragmatic defect was left sided in 3 children and right-sided in the other 3. Transverse colon and liver were the most frequent herniated viscera. Postoperative follow-up showed no complications or recidives.     

Meningococcal disease in England and Wales: 1995

The number of laboratory confirmed cases of meningococcal infection in England and Wales rose in 1995 for the first time since 1990. Culture confirmed cases rose to 1459, an increase of 29% over the 1994 total, due largely to increased disease activity in the last quarter of 1995. Cases diagnosed by non-culture methods totalled 431, giving a total of 1890 laboratory confirmed cases. Notifications reported to the Office of Population Censuses and Surveys also increased to a similar extent. Northern regions generally had higher rates of disease activity and greater increases in rates. Meningococcal disease caused by serogroup C strains accounted for the main increase in culture confirmed cases and made up 32% of the total in 1995. Disease caused by C2a strains showed a particularly large increase. A change in the age distribution was noted with a greater proportion of patients in older age groups. Among group B isolates, B4 P1.4 strains continued to be identified most commonly.     

Self as the feminine principle

In analytical psychology, ego is associated with consciousness and the masculine principle. Although the feminine principle generally characterizes the unconscious, it was not assigned a psychic structure equivalent to the ego. This paper proposes a model of the psyche where self and ego are the major modes of psychic experience. The self as the 'being' mode represents the feminine principle and functions according to primary process; the ego represents 'doing', the masculine principle and secondary process. Feminine and masculine principles are considered to be of equal significance in both men and women and are not limited to gender. Jung's concept of the self is related to the Hindu metaphysical concepts of Atman and Brahman, whose source was the older Aryan nature-oriented, pagan religion. The prominence of self in analytical psychology and its predominantly 'feminine' symbolism can be understood as Jung's reaction to the psychoanalytic emphasis on ego and to Freud's 'patriarchal' orientation. In Kabbalah, a similar development took place when the feminine principle of the Shekinah emerged in a central, redemptive role, as a mythic compensation to the overtly patriarchal Judaic religion. In the proposed model of the psyche neither ego nor self represents the psychic totality. The interplay of both psychic modes/principles constitutes the psyche and the individuation process.