[Video-assisted theloscopic electroincision of a high teat stenosis]. / Videoassistierte theloskopische Elektroinzision einer hohen Zitzenstenose.

Results of surgery of high teat stenosis remained disappointing until nowadays. The aim of this pilot study was to elaborate a new theloscopic surgical resection. A 5.5 year old swiss milk cow was suspected to have posttraumatic high teat stenosis. Diagnosed was ascertained by teat sonography. Animal was sedated and local anesthesia was performed at the base of the teat. After a teat side incision, resectoscope was introduced. Stenosis was electro-divided under continuity saline-solution irrigation and coagulation of bleeding vessels. After a follow-up period of 4 months, the cow was milked without residual. No intercurrent infections occurred. There were no signs of recurrence in the control teat sonography. Theloscopic electroresection of teat stenosis is a possible new, surgical, minimal invasive, option, to treat high teat stenosis.

A new operative method to treat high teat stenoses in dairy cows.

OBJECTIVE: To evaluate in a pilot study an alternative technique using theloscopic surgery in the management of proximal teat stenoses of dairy cows. MATERIALS AND METHODS: The study included three lactating dairy cows (mean age 3.5 years) with a stenotic fibrous lesion in the proximal region of a teat. The lesions were suspected to be of traumatic origin and the diagnoses were confirmed by ultrasonography. For surgery, the cows were sedated and the base of the teat anaesthetized. The resectoscope was introduced through an incision in the teat cistern. The surgical area was continuously irrigated with saline solution and the stenotic lesions electroresected. Haemorrhage was controlled whenever possible by electrocoagulation. RESULTS: In two cows, the procedure was successful and resulted in normal milk flow. One of the two cows was slaughtered soon after the operation for reasons unrelated to udder health. The other cow could be milked normally at a follow-up examination 4 months later and on ultrasonography, there was no recurrence of the stenotic lesions. In both cows, there was no evidence of concurrent intramammary infection. In the third cow, the procedure had to be discontinued because of severe intraoperative haemorrhage. CONCLUSIONS: Video-assisted theloscopic electroresection of fibrotic teats is a promising, novel and minimally invasive technique for the surgical correction of the glandular part of the cistern. It should be considered as an alternative to conventional surgical methods in valuable dairy cows.

Endocrine treatment prior to radical retropubic prostatectomy in patients with T3 prostate cancer: a retrospective study of 22 patients.

Twenty-two patients with locally advanced prostatic carcinoma stage T3, N0, M0 have been treated with LH-RH agonists during a mean time of 5 months prior to radical retropubic prostatectomy. Although tumors appeared to be confined to the organ in 68% of the patients after endocrine treatment, pathological examination of the surgical specimens showed in 89% evidence of extraprostatic disease, which questions the clinical impression of 'downstaging'. A disparity between the tumor grade of the biopsy and that of the operative specimen as well as an increased size of tumor-involved lymph nodes despite endocrine treatment led us to speculate that a certain proportion of patients will bear the risk of disease progression during preoperative androgen deprivation. Furthermore, there was local recurrence early in the postoperative course and at the high rate of 39%.

Retroperitoneal malignant fibrous histiocytoma. Report of two cases.

We present 2 cases of malignant fibrous histiocytoma (MFH) of the retroperitoneum. Only 12-14% of all MFH occur in the retroperitoneum. Both patients were operated with the diagnosis of a kidney tumor. The surgical exposure showed a tumor arising from the retroperitoneum, infiltrating or surrounding the kidney. We would like to emphasize that large tumors of the retroperitoneum which resemble kidney tumors can also arise from mesenchymal tissue.

Induction of circulating tumor necrosis factor cannot be demonstrated during septicemic salmonellosis in calves.

The concentration of tumor necrosis factor in the circulation of calves, which were infected with Salmonella typhimurium and exhibited septicemia as indicated by clinical signs and blood culture, was measured with a radioimmunoassay. These levels were compared with those in calves before infection and in other calves that had received an intravenous dose of gram-negative endotoxin. The tumor necrosis factor levels measured in samples taken during septicemia were not different from those in samples from infected nonsepticemic calves or samples from calves before infection. In contrast, the levels of tumor necrosis factor rose rapidly in calves after treatment with endotoxin by intravenous injection.

[Long-term postoperative course and surgical indications in patients with hypertrophic obstructive cardiomyopathy]. / Postoperativer Langzeitverlauf und Operationsindikation bei Patienten mit hypertropher obstruktiver Kardiomyopathie.

Operative results and late follow-up of 63 patients undergoing surgery for hypertrophic obstructive cardiomyopathy (HOCM) were analyzed in relation to the surgical indication. There were 64 postoperative follow-ups because one patient had two myectomy operations. 27 patients without limiting symptoms (group A) were operated on because of a pressure gradient of more than 50 mm Hg. 31 patients (group B) underwent myectomy operation because of limiting symptoms, and 5 patients (group C) required additional surgery because of mitral incompetence or left ventricular aneurysm. Comparison of preoperative clinical and hemodynamic data indicate that patients of group B were in a more advanced stage of disease than patients of group A. Operative mortality was low, with one perioperative death. Operative complications were rare, and after adequate treatment caused no significant morbidity. The left ventricular systolic pressure gradient was relieved in almost every case, with simultaneous reduction of left ventricular enddiastolic pressure. With a few exceptions the patients experienced longstanding improvement of symptoms. Durability of symptomatic improvement and survival were significantly better in patients of group A. Late results in patient group C were unfavorable, mainly because of the additional lesions requiring surgery. Atrial fibrillation and congestive heart failure were relieved by surgery, but recurrence was frequent in late follow-up. Ventricular arrhythmia during postoperative follow-up was common in both group A and group B, without obvious prognostic significance. In the light of these results the operative indications were reconsidered. Surgery is indicated in patients with limiting symptoms not responding to medical therapy, if a left ventricular pressure gradient of more than 50 mm Hg is present. Simultaneous mitral incompetence of severe degree requires primary mitral valve replacement by low profile prostheses. Risk factors, such as reanimation for ventricular fibrillation or a family history of sudden death, may militate in favour of surgical treatment. The operative indication is doubtful in patients with a high left ventricular pressure gradient but without consistent symptoms and without additional risk factors.

Surgical treatment versus medical treatment in hypertrophic obstructive cardiomyopathy.

Sixty-three patients operated upon for HOCM and 49 patients selected for non-surgical treatment have been followed-up for 15 years. Pre-operatively, surgical patients had a higher left ventricular outflow tract gradient at rest and, on the average, more severe symptoms than non-surgical patients. Septal myectomy relieved the pressure gradient and symptoms more consistently than long-term treatment with beta-blockers or verapamil. Within an average observation time of 7 1/2 years, there was late deterioration or death in almost half of the non-surgical patients but in less than one-quarter in the operated patients. The 10 year mortality rate was 80% in the surgical series and 71% in the non-surgical series. In operated patients, pre-operative symptomatic status was significantly related to early and late mortality. In medically treated patients, mortality was unrelated to symptoms; however, it was significantly lower in patients receiving long term treatment with beta-blockers or verapamil. In conclusion, a high basal pressure gradient associated to limiting symptoms is a clear-cut indication for surgery. Other indications are more debatable. In medically treated patients, long-term administration of beta-blockers or verapamil is beneficial even without symptoms as it appears to improve prognosis.