A new modified technique of ureteroureterostomy in rat kidney transplantation.

Different strain combinations of rat are available to study immunological and transplant-related problems in kidney transplant models. Although numerous modifications of surgical techniques for ureteric reconstruction have been evaluated in order to reduce complications and to extend long-term survival, ureteric complications still occur frequently, especially when there is a disproportion in the diameter of donor and host ureters. Instead of using the current nonsplinted ureteroureterostomy, a versatile and rapid technical modification was developed to perform reconstruct the ureters of disproportionate diameter. The overall incidence of ureteric complications was 80% (8/10) using the former method, whereas this rate was significantly reduced to 15% (3/20) using the new method (P < .001). Our modification shows the feasibility of a nonsplinted ureteroureterostomy for the technical, highly demanding rat model of kidney transplantation with an acceptable rate of ureteric complications considering disproportionate differences in diameter between the host and the donor ureter.

Repair of bilateral common iliac artery aneurysm by potentially reversible, unilateral internal iliac artery embolisation followed by endovascular Y-stenting.

Bilateral common iliac artery (CIA) aneurysms are rare, but more frequently symptomatic than abdominal aortic aneurysms (AAA). In elderly patients with coexisting medical problems, transluminal and/or endovascular procedures are preferred to avoid the risk of morbidity and mortality associated with further general anesthesia and surgery. However, bilateral internal iliac artery (IIA) occlusion during endovascular repair might be associated with significant morbidity, including gluteal claudicatio, and ischemia of the sigmoid colon and perineum. In the presented case report we describe the successful repair of bilateral CIA aneurysms by a total transluminal and endovascular approach. The potentially reversible embolisation of the less diseased IIA with detachable latex balloons preceded the implantation of a bilateral endovascular Y-stent. Both CIA aneurysms were successfully excluded from circulation. No complications were noted and the patient could be discharged four days after surgery. Probationary detachable balloon embolisation of the IIA followed by implantation of an endovascular bifurcated stentgraft is a safe technique. It allows clinical monitoring of acute ischemic complications before bilateral IIA occlusion by the stentgraft. In comparison to coil embolisation these balloons may be easier to remove if for instance, an external-internal iliac artery bypass is needed. Percutaneous balloon puncture might be another option to reverse acute ischemia.

A 20-year follow-up of internal carotid artery endarterectomy with bifurcation advancement.

BACKGROUND: Carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. For two last decades, we have been performing endarterectomy of the internal carotid artery with bifurcation advancement. METHODS: From January 1977 until December 1997, all records of patients who underwent internal carotid artery endarterectomy with bifurcation advancement were reviewed. Data were collected from patients charts and by a questionnaire. 160 patients (80.6% men, 19.4% women, average lifetime 65.1 year) underwent a total of 181 endarterectomies with bifurcation advancement. RESULTS: The 30-day mortality was 1.9% and the postoperative stroke plus death rate 3.1%. The incidence of reoperations was 0.6% with an average follow up of 64 months. In one patient (0.6%), a significant restenosis of the repaired carotid artery was observed. The 1, 5 and 10 years neurological death free survival (including early mortality) was 99.3%, 97.2% and 92.5% and the overall survival (including early mortality) was 96.3%, 78.9% and 59.3% (Kaplan-Meier). CONCLUSIONS: The technique of the internal carotid artery endarterectomy by bifurcation advancement is a safe and reliable method for improvement of cerebral blood supply. Or foreign material or autologous vein can thus be avoided. This method offers excellent long term patency and has a notable lack of late restenosis.

Hemocue, an accurate bedside method of hemoglobin measurement?

OBJECTIVE: Evaluate the accuracy of this bedside method to determine hemoglobin (Hb) concentration in general surgery over a wide range of Hb values and to determine potential sources of error. METHODS: Accuracy of Hb measurement using HemoCue (AB Leo Diagnostics, Helsinborg, Sweden) was assessed in 140 surgical blood samples using 7 HemoCue devices in comparison with a CO-Oximeter (IL 482, Instrumentation Laboratory, Lexington, MA). To analyze potential sources of error, packed red cells and fresh frozen plasma were reconstituted to randomized Hb levels of 2-18 g/dL. RESULTS: In the surgical blood samples, the Hb concentration determined by the CO-Oximeter (HbCOOX) ranged from 5.1 to 16.7 g/dL and the Hb concentration measured by HemoCue (HbHC) from 4.7 to 16.0 g/dL. Bias (HbCOOX - HbHC) between HbCOOX and HbHC was 0.6+/-0.6 g/dL (mean +/- SD) or 5.4+/-5.0% (p < 0.001). Also in the reconstituted blood, the bias between HbCOOX and HbHC was significant (0.2+/-0.3 g/dL or 2.1+/-3.2%; p < 0.001). The microcuvette explained 68% of the variability between HbCOOX and HbHC. HemoCue thus underestimates the Hb concentration by 2-5% and exhibits a 8-10 times higher variability with only 86.4% of HbHC being within +/- 10% of HbCOOX. CONCLUSION. Although the mean bias between HbCOOX and HbHC was relatively low, Hb measurement by HemoCue exhibited a significant variability. Loading multiple microcuvettes and averaging the results may increase the accuracy of Hb measurement by HemoCue.

[Recent perceptions about chromosome pairing in meiosis]. / Neue Erkenntnisse über die Chromosomenpaarung in der Meiose.

Recent results from meiotic research in animals are presented with emphasis on the pairing behaviour of autosomes und sex chromosomes. Synaptonemal complex preparations were primarily utilized, that allowed observations of the pairing behaviour of the sex chromosomes is quite remarkable. The structure and function of the synaptonemal complex is discussed and the localization of the pseudo autosomal region on the sex chromosomes is described.

Tropisetron for the prevention of postoperative nausea and vomiting in women undergoing gynecologic surgery.

The aim of this study was to evaluate the efficacy of tropisetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, versus placebo in the prevention of postoperative nausea and vomiting in patients undergoing general anesthesia for gynecologic surgery. Ten minutes before induction of general anesthesia, 80 patients received in a double-blind manner a single intravenous (IV) injection of either 5 mg tropisetron or a matching placebo. Anesthesia was induced with thiopental and maintained with nitrous oxide and enflurane in oxygen. In the first 24 h postoperatively 7 of 40 patients (17.5%) given tropisetron and 16 of 40 patients (40%) receiving placebo vomited (P < 0.05). The incidence of nausea was 30% (12/40) in the tropisetron group and 52% (21/40) in the placebo group (P < 0.05). A total effective antiemetic response showed 26 patients (65%) in the tropisetron group and 16 patients (40%) in the placebo group (P < 0.05). We conclude that tropisetron given IV prior to gynecologic procedures in general anesthesia significantly reduces postoperative nausea and vomiting when compared to placebo without causing any adverse effect.

[Gynecomastia in a goat buck]. / Gynäkomastie beim Ziegenbock.

A 3-year old horned buck of the Toggenburger breed was referred to our clinic with signs of gynecomastia. Cytogenetic abnormalities could not be detected in the karyogram and compared to control animals the buck had normal plasma concentrations of testosterone and estradiol but not prolactin. Hyperprolactinemia has been considered the cause of gynecomastia leaving the semen quality undisturbed.