Incidental finding of occult hydronephrosis after blunt abdominal trauma

Occult congenital and acquired renal lesions are often discovered during evaluation of patients with haematuria after minor blunt torso trauma. This relatively 'minor trauma', can precipitate severe haematuria and hypovolemic shock. This group of patients frequently presents a difficult diagnostic and therapeutic challenge. We discuss the significance of occult hydronephrosis and minor blunt trauma in one patient.     

Esophageal squamous carcinoma

Squamous cell carcinoma of the esophagus is a tumor with poor prognosis; it is usually in an advanced state when first diagnosed. Because a multimodal treatment approach is currently used, proper tumor staging is essential to determine whether therapy should be directed toward cure or palliation. Important prognostic features of squamous cell carcinoma include the depth of tumor infiltration into or through the esophageal wall and the presence of distant metastases. Imaging strategies should not be limited to visualization of the tumor but also should be directed toward accurate pretreatment staging. In this article, the authors review the use of barium swallow, CT scans, and endoscopic ultrasonography both alone and in combination to visualize and stage esophageal carcinoma. The strengths and limitations of each modality are also discussed.     

Tracheal reconstruction with a vascularized cartilage flap in rabbits

Contribution of 42 patients, aged 57 to 69 (mean age 58) with infiltrant vesical neoplasia who underwent radical cystoprostatectomy according to the technique described by P.C. Walsh (38/42) or radical cystectomy with hysterectomy (4/42). Neoplasia stages were as follows: 7 T2G-III; 13 T3aGII: 15 T3aG-III and 7 T3bG-III. Ten (10) patients, aged between 48 and 70 (mean age 57), with prostate neoplasia who were performed radical prostatectomy using the technique described by the above author, were also ascribed to the last group. Prostate neoplasias were at the following stages: 4 T2c; 5 T3a and 1T3b. T3 stages had been given hormonal therapy prior to the procedure. No patient received radiotherapy. Rectal injury occurred in 2 of the 52 (2/52) patients described. One was a female patient who was being performed cystectomy and hysterectomy plus double adnexectomy. Urinary by-pass in this case was C.F.C. detubulized ureterosigmoidostomy. The second case was a male patient undergoing radical prostatectomy. In both cases pre- and post-operative discharge colostomy was performed. Suture of rectal injury was also done in the patient where colostomy was performed during the procedure. The authors emphasise that no rectal injury that may take place during radical prostatectomy or cystoprostatectomy should be disregarded. They raise and answer questions of great practical interest such as: Is simple suture of the rectum enough? Should the omentum be used in rectal repair? Is it indispensable to perform discharge colostomy? and, is prognosis more serious when the gut is not prepared?     

Circadian variations of the urinary excretion of catecholamines and electrolytes

Concomitant measurements of circadian variations in the urinary excretion of dopamine (DA), homovanillic acid (HVA), norepinephrine (NE), epinephrine (E) as well as of creatinine, sodium and potassium under controlled dietary conditions during relative physical and emotional rest in 13 volunteers have shown that maximum excretion of all these substances occurred in the afternoon period between 14:30h and 18:00h, and minimum excretion in the morning between 4:00h and 5:00h. The changes were in some cases progressive from one collection period to the other, and synchronized for NE and E. DA and HVA excretions fluctuated from subject to subject. Excretory rhythms of sodium and potassium were found to be similar to those of the catecholamines. This can be explained by diurnal changes in renal blood flow and different renal excretory mechanisms of catecholamines. None of the catecholamines correlated with the urinary volume but urinary NE and E positively correlated with urinary creatinine, urinary NE and E with urinary DA and urinary sodium with urinary E. There are some common patterns in the diurnal rhythms of catecholamines and electrolytes but their interrelationship is different for individual catecholamines.     

Patterns of current and lifetime substance use in schizophrenia

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.     

In vitro antioxidant activity of Vietnamese ginseng saponin and its components

To elucidate the antioxidant action of Vietnamese ginseng saponin against free radial-mediated cellular damage, we examined the effect of Vietnamese ginseng saponin on lipid peroxidation in the mouse brain, liver, and liver microsomes by using two in vitro free radical generating systems (iron ferrous+ascorbic acid and iron ferrous+hydrogen peroxide). Free radical-mediated lipid peroxidation was determined by measuring the endogenous and stimulated accumulation of thiobarbituric acid reactive substance (TBA-RS). Vietnamese ginseng saponin (0.05-0.5 mg/ml), as well as vitamin E, significantly inhibited the formation of TBA-RS in tissue homogenates. Panax ginseng saponin, at the same concentration range as Vietnamese ginseng saponin, also had inhibitory action on free radical-mediated lipid peroxidation. However, majonoside-R2, ginsenoside-Rg1 and ginsenoside-Rb1, the main saponin components of Vietnamese ginseng saponin fraction, had no effect on lipid peroxidation. These results suggest that Vietnamese ginseng exerts a protective action against free radical-induced tissue injury and that this effect is attributable to minor components rather than the main saponin components tested.     

An audit of pancreatic pseudocyst management and the role of endoscopic pancreatography

BACKGROUND: A rational algorithm for the management of symptomatic pancreatic pseudocysts is necessary with the increasing availability of radiological, surgical and endoscopic methods of treatment. METHODS: A retrospective audit of the management and outcome of all patients who presented with symptomatic pancreatic pseudocysts to the Auckland Hospital over a 9-year period (1988-96) was made. RESULTS: There were 44 patients (28 men, 16 women; median age 50; range 18-81) in this series. Initial management was not based on pseudocyst size, duration, location, wall thickness, the patients' symptoms and comorbidity, or the aetiology of pancreatitis. Of the 27 patients who had initial conservative management, 15 pseudocysts (56%) completely resolved. Of the 17 patients who were initially or subsequently treated with percutaneous catheter drainage (PCD), 10 pseudocysts (59%) completely resolved without additional treatment. Of the 13 patients initially or subsequently treated by surgery, all but one completely resolved after the first procedure. Two patients were successfully treated with endoscopic pancreatic stent placement. Complications arose in eight patients treated with PCD (47%) and four patients treated with surgery (31%). There was no mortality. The decision for active treatment was not preceded by delineation of the pancreatic duct by ERCP (endoscopic retrograde cholangiopancreatography) in 60% of patients. CONCLUSIONS: More than one-third of all patients with symptomatic pancreatic pseudocysts can be managed conservatively. Surgery yields excellent results but PCD has a high failure rate in patients with an underlying pancreatic duct stricture. A rational management algorithm is presented, based on pre-intervention ERCP, which should improve patient selection and outcome.