Minilaparotomy as surgical approach for aortoiliac occlusive disease -- single center initial experience.

PURPOSE: The purpose of this study was to emphasize the benefits and indications of performing minilaparotomy as surgical approach for occlusive aortoiliac disease. MATERIAL AND METHOD: From January 2011 to July 2012, a total of 23 patients (19 men and 4 women), with a median age of 60 years (range 49-75) diagnosed with aortoiliac occlusive disease(n=22) or abdominal aneurysm (n=1), were included in a retrospective non-randomized clinical study. Among these patients 11 underwent aortic bypass procedure by minila parotomy approach (ML group) and 12 patients by standard laparotomy(SL group). Demographic and clinical data, operative data, postoperative recovery data and complications were analysed according to these two groups of patients. Follow-up consisted of clinical examination and duplex scanning at 1, 3,6 and 12 months postoperatively. RESULTS: There were no significant differences between the minilaparotomy and standard laparotomy control groups concerning clinical and demographical data. Two surgical conversions to standard laparotomy were necessary (18.18%) in the ML group due to technical difficulties. The mean operative time was shorter in the ML group (124 ± 22 minutes) and the mean aortic clamping time was similar between the two groups.Major differences between the two lots were observed postoperatively;mean blood loss was more important in the SL group (550 ml) than in the ML group (350 ml) (statistical significance p=0.001, Student test). Patients who have undergone standard laparotomy required more fluids (10000 Â+-2000 ml) in comparison to the other group (6000 ± 1000 ml) p value=0.0001, while the duration of nasogastric suction and period before resuming a liquid diet was both shorter in the ML group (1.1 ± 0.5 days) than those from the SL group (2.5 ± 0.6 days) p value=0.001. The period spent in the ICU was significantly shorter for the ML lot of patients and the median hospitalization time was 5.6 days for patients in ML group,whereas in the SL group the median hospitalization time was 8.9 days (Student test - p value 0.01). We had no 30-day mortality in any of the groups included in the study. One patient from the ML group was readmitted in postoperative day 43 and re-operated on for a prosthetic limb graft thrombosis.Two patients were lost to follow-up and the mean follow-up was 9 ± 1.5 months. CONCLUSIONS: Minilaparotomy as surgical approach for aortic diseases is a feasible, safe procedure on selected patients.

Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program.

AIM: The Vein Consult Program is an international, observational, prospective survey aiming to collect global epidemiological data on chronic venous disorders (CVD) based on the CEAP classification, and to identify CVD management worldwide. The survey was organized within the framework of ordinary consultations, with general practitioners (GPs) properly trained on the use of the CEAP classification. METHODS: Screening for CVD was to be performed by enrolling in the survey all consecutive outpatients >18 years whatever the reason for consultation, to record patient's data and classify them according to the CEAP, from the stage C0s to C6. The program enrolled 6232 GPs 91545 subjects were analysed. Their mean age was 50.6±16.9 years, younger patients being in the Middle East and older ones in Europe, and the proportion of women was higher than that of men. RESULTS: The worldwide prevalence of CVD was 83.6%: 63.9% of the subjects ranging C1 to C6, and 19.7% being C0s subjects. C0s patients were more frequently men whatever the age and the geographical zone. C1-C3 appeared to be more frequent among women whatever the country but the rate of severe stages (C4-C6) did not differ between men and women. GPs consider CVD subjects as patients eligible to specialist referral beginning from C2 but some geographical disparities were observed. CONCLUSION: The VCP survey provides reliable results on CVD global epidemiology and shows that CVD affects a significant part of the populations worldwide, underlining the importance of adequate screening for CVD and training of both GPs and specialist physicians.

Spontaneous recanalization in deep venous thrombosis: a prospective duplex ultrasound study.

AIM: The aim of this study was to evaluate the dynamics of the recanalization process (spontaneous fibrinolysis) in completely occlusive deep venous thrombosis (DVT) using duplex ultrasound examination and to investigate the influence of different factors on the evolution of thrombus regression. METHODS: This longitudinal prospective study was done with 74 consecutive patients with completely occlusive acute multilevel DVT, confirmed by echo duplex scan after 1, 3, 6, and 12 months. At each re-evaluation, the degree and the type of recanalization were determined. Efficacy of tinzaparin (175 IU/kg, s.c., q.d. for 7-14 days) and continued with warfarin (12 months at INR 2-3) as well as patients' compliance with compressive elastic hosiery wearing were carefully followed. Relationship between the degree and pattern of recanalization and patients' age, gender, as well as thrombosis etiology and location were determined. RESULTS: Sixty-four patients completed the study. The mean recanalization rate was 39.7% at 1, 64.8% at 3, 82% at 6, and 90.3% at 12 months. Marginal recanalization was more frequently observed, but recanalization pattern was changing during follow-up. CONCLUSIONS: In the case of efficient anticoagulant and compressive therapy, the spontaneous recanalization process of DVT is important from the very first month of evolution, but an almost complete re-permeabilization is observed only after 12 months of treatment. The unilocular, marginal pattern of thrombus lysis is often observed and has better evolution than the multilocular cavernous one. The dynamics of recanalization are characterized by distal-to-proximal extension and in the first 6 months are significantly influenced by patient's gender and thrombosis etiology.

[Results of parathyroidectomy for primary hyperparathyroidism]. / Eredményeink a primer hyperparathyreosis miatt végzett parathyreoidectomiákban.

We have performed 16 operations on 14 patients with primary hyperparathyoidism caused by a solitary parathyroid adenoma in our department between 1st jan. 1990-31 dec. 1999. In each case bilateral neck exploration was carried out. As in one case it was located in ectopic neck position, in the other case papillocarcinoma of the thyroid gland and ectopic parathyroid adenoma in mediastinal position were present, primary hyperparathyroidism persisted, so reoperation was needed. Histological examination proved the presence of adenomin all cases. Diffuse hyperplasia and parathyroid cancer did not occur. Before operation all patients underwent US and seven of them had radionuclide scintigraphy. CT scan aided in its localization with four patients. We did not make use of invasive methods, after the first operation 12 patients showed normal S-Ca levels very quickly. In two cases this level was too high after the operation and reoperation was necessary which resulted in normal Ca levels. Even though the number of our cases is rather modest, all the patients recovered. This may prove that we can successfully cure our patients of modern methods of diagnostics used for meticulous examination alongside with careful preparation of the patients by internal specialists are followed by the standard operative techniques available.

[Surgical treatment of an extremely large sternum protrusion (pectus carinatum)]. / Extrém nagyságú sternum protrusio (pectus carinatum) egyedi sebészi megoldása.

The authors present their special surgical treatment by telling the medical history of one of their patients. Cessation of sternum protrusio was achieved by a "H" shape resection of the anterior cortical plate of the sternum.

[Successful treatment of hepatocellular carcinoma with All-trans-retinoic acid]. / Hepatocellularis carcinoma eredményes All-transz-retinsav kezelése.

A 44-year-old female patient was admitted to our department with diagnosis of malignant lymphoma. The abdominal USG and CT showed multiple liver lesions with partial portal vein thrombosis, moderately increased alfa-fetoprotein (AFP), ASAT, ALAT (2x normal value), serology was negative for HBV and HCV. Liver transplantation was suggested but refused because of portal vein thrombosis. ATRA (45 mg/m2/day orally) was given on the basis of the assumption that HCC and acute promyelocytic leukaemia share similar oncogenic pathway (alter the RAR alpha and beta receptors). She was gained 15 kg-s and has resumed her work as a teacher for the last 20 months. Abdominal CT showed a complete regression of the intrahepatic tumour.

A quorum-sensing system in the free-living photosynthetic bacterium Rhodobacter sphaeroides.

Rhodobacter sphaeroides is a free-living, photoheterotrophic bacterium known for its genomic and metabolic complexity. We have discovered that this purple photosynthetic organism possesses a quorum-sensing system. Quorum sensing occurs in a number of eukaryotic host-associated gram-negative bacteria. In these bacteria there are two genes required for quorum sensing, the luxR and luxI homologs, and there is an acylhomoserine lactone signal molecule synthesized by the product of the luxI homolog. In R. sphaeroides, synthesis of a novel homoserine lactone signal, 7,8-cis-N-(tetradecenoyl)homoserine lactone, is directed by a luxI homolog termed cerI. Two open reading frames immediately upstream of cerI are proposed to be components of the quorum-sensing system. The first of these is a luxR homolog termed cerR, and the second is a small open reading frame of 159 bp. Inactivation of cerI in R. sphaeroides results in mucoid colony formation on agar and formation of large aggregates of cells in liquid cultures. Clumping of CerI mutants in liquid culture is reversible upon addition of the acylhomoserine lactone signal and represents a phenotype unlike those controlled by quorum sensing in other bacteria.

Role of nitric oxide in modulating neurotransmitter release from rat striatum.

The effect of the nitric oxide synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME) on the basal and stimulation-evoked release of dopamine (DA) and acetylcholine (ACh) was investigated in rat striatum. The experiments were carried out in isolated superfused striatal slices, loaded with either [3H]-dopamine or [3H]-choline. We have found that L-NAME reduced the electrical field stimulation-evoked release of DA, while its enantiomer N-nitro-D-arginine methyl ester (D-NAME) was ineffective. In the presence of the nitric oxide (NO) precursor L-arginine, L-NAME failed to influence DA release. Furthermore, treatment with the N-methyl-D-aspartate (NMDA) receptor antagonist MK-801 completely reversed the effect of L-NAME on striatal DA release. In contrast, L-NAME had no effect on either the basal or the stimulation-evoked ACh release in any experimental conditions studied. Our data indicate that endogenously produced NO is involved in the modulation of striatal DA, but not in ACh release. Furthermore, it seems likely that the modulatory effect of NO is linked to activation of presynaptic NMDA receptors located on the striatal dopaminergic nerve terminals.

The Ile(L229) → Met mutation impairs the quinone binding to the QB-pocket in reaction centers of Rhodobacter sphaeroides.

A spontaneous mutant (R/89) of photosynthetic purple bacterium Rhodobacter sphaeroides R-26 was selected for resistance to 200 µM atrazin. It showed increased resistance to interquinone electron transfer inhibitors of o-phenanthroline (resistance factor, RF=20) in UQo reconstituted isolated reaction centers and terbutryne in reaction centers (RF=55) and in chromatophores (RF=85). The amino acid sequence of the QB binding protein of the photosynthetic reaction center (the L subunit) was determined by sequencing the corresponding pufL gene and a single mutation was found (Ile(L229) → Met). The changed amino acid of the mutant strain is in van der Waals contact with the secondary quinone QB. The binding and redox properties of QB in the mutant were characterized by kinetic (charge recombination) and multiple turnover (cytochrome oxidation and semiquinone oscillation) assays of the reaction center. The free energy for stabilization of QAQB (-) with respect to QA (-)QB was ΔGAB=-60 meV and 0 meV in reaction centers and ΔGAB=-85 meV and -46 meV in chromatophores of R-26 and R/89 strains at pH 8, respectively. The dissociation constants of the quinone UQo and semiquinone UQo (-) in reaction centers from R-26 and R/89 showed significant and different pH dependence. The observed changes in binding and redox properties of quinones are interpreted in terms of differential effects (electrostatics and mesomerism) of mutation on the oxidized and reduced states of QB.

Industrial employee drug screening: a blind study of laboratory performance using commercially prepared controls.

Reference laboratories are an integral component of any industrial employee drug screening program. We evaluated the performance and accuracy of the reference laboratories used by Rockwell International, a large industrial employer with an active drug screening program. A total of 829 commercially prepared control samples containing drugs of abuse, over-the-counter drugs, and analytes found in the normal employee population were disguised as routine submissions to reference laboratories used by nine Rockwell facilities. Analyses of results included compilation of false-positive and false-negative errors per drug per laboratory and a correlation of errors with preliminary and confirmation methods. Error rates of 2% false-positive results and 20% false-negative results were found for all laboratories. The errors were not limited to any one technique nor to any particular drug. The error rates observed suggest the need for routine blind testing programs and increased interaction between industry and laboratories.

Desk-computer program for evaluation of complex equilibria from spectrophotometric data.

The program MINISPEF is designed to run on a desk-computer with 16 kbytes of memory. It can calculate the optimum values of the overall stability constants and molar absorptivities of a maximum of 8 species with compositions M(q)L(p)H(r) (r or q can be zero), or the mixed-ligand complexes formed in the system MA(N) + MB(N) (N = 2, 3 or 4), from spectrophotometric data. The program is based on the authors' program MINIPOT.

A desk-computer program for calculation of the parameters of acid-base titration curves and protonation or metal-complex stability constants from potentiometric data.

The program MINIPOT is designed to run on a desk-computer with 16-kbyte of memory. It can calculate the optimum values of the parameters of a blank acid-base titration in any solvent, and the protonation/deprotonation or overall stability constants of a maximum of four species with compositions H(q)L(p) or M(q)L(p) from potential, titrant volume and analytical concentration data. The program, written in BASIC, is based on the least-squares principle and is capable of simultaneous refinement of a maximum of four parameters.