[Generalised external apical root resorption: aetiology in 3 radio-graphically comparable cases]. / Gegeneraliseerde externe apicale wortelresorptie: etiologie in 3 röntgenologisch vergelijkbare casussen.

There are various types of dental root resorption. Local external apical root resorption is often recognised after orthodontic therapy. However, a generalised form is rare. 3 patients with the rare dental condition 'idiopathic generalised apical external root resorption' were referred and treated within an 8-year period. The prognosis of preserving the dentition is for the most part unfavourable and only a very speculative prediction about (the pace of) progression can be given. No standard treatment protocol is available for this condition. A dental treatment plan should be flexible and individually adjusted to patient's wishes.

[Hemoptysis in Pregnancy]. / Hämoptysen in der Schwangerschaft.

Here we present an extremely rare but important cause of pulmonary hemorrhage during pregnancy. A 41-year-old patient was seen with hemoptysis in the 29th week of her pregnancy which was initially assessed as unspecific inflammation. At the 34th week of pregnancy, she presented again, this time with hemoptoe and dizziness caused by an unknown idiopathic pulmonary AV malformation. The patient underwent extensive interdisciplinary evaluation including bronchoscopy, emergency cesarean section was performed, which was followed by CT scan and VATS/minithoracotomy with segment resection.

[Survey of Specialist Pulmonary Medicine Health Care Structures for Patients with Interstitial Lung Disease in Nordrhein-Westfalen, Germany - A Pilot Project of the Western German Respiratory Society (WdGP)]. / Erfassung der pneumologisch-fachärztlichen Versorgungsstrukturen für Patienten mit interstitiellen Lungenerkrankungen in Nordrhein-Westfalen.

AIM OF THE STUDY: Survey of specialist pulmonary medicine health care structures for patients with interstitial lung disease (ILD) in Nordrhein-Westfalen, Germany. METHODS: The Western German Respiratory Society initiated a voluntary registration of ILD expert centers. Structural quality and processes were evaluated by questionnaire. RESULTS: 49 centers were registered, 46 allowed analysis of their center data (15 pulmonology specialist practices, 34 hospital pulmonology departments). Specialist practices saw a median of 360 ILD patients per year (26 % first diagnosis), hospital departments a median of 105 ILD patients per year (63 % first diagnosis). 10 centers diagnose more than 100 new ILD cases per year. Specialist practices report median 50 bronchoscopies per year, hospital departments median 1396. 78 % of the centers participate in a multidisciplinary ILD case conference. CONCLUSION: Several ILD expert centers were identified in Nordrhein-Westfalen. Outpatient care mainly involves the monitoring of ILD patients, inpatient services focus on complex initial diagnostics or cases with unusual disease behaviour. ILD centers meeting regional health care needs should be supported in their development.

History of dementia and Parkinson's disease in 1st-degree relatives of patients with Alzheimer's disease.

We assessed the family history of dementia and Parkinson's disease in 198 Dutch patients with Alzheimer's disease diagnosed before the age of 70 years, and in 198 age- and sex-matched healthy population controls. Of the Alzheimer patients, 48% had at least 1 1st-degree relative with dementia, compared with 19% of the controls. There were 24 patients and 1 control with 2 or more 1st-degree relatives with dementia, yielding a relative risk of 40.0. More Alzheimer patients than controls had a 1st-degree relative with Parkinson's disease, with a relative risk of 2.9. This study strongly confirms earlier findings of familial aggregation of Alzheimer's disease and provides evidence for familial aggregation of Alzheimer's disease with Parkinson's disease. The latter may point at a joint etiology of these diseases.

Specificity of a cysteine proteinase of Entamoeba histolytica towards the alpha 1-CB2 peptide of bovine collagen type I.

The cysteine proteinase of Entamoeba histolytica was shown to hydrolyze the cyanogen bromide peptide alpha 1-CB2 of calf skin collagen type I yielding two split products. Amino acid analyses of the formed peptides and estimation of the amino-terminal residues revealed that the alpha 1-CB2 peptide was exclusively cleaved between Gly10 and Leu11 within the sequence -Arg9-Gly10-Leu11-yielding two peptides with 7 and 29 amino acids, respectively. Under identical conditions the ratio of hydrolysis of the Gly10-Leu11 bond in the alpha 1-CB2 peptide to the Gly23-Phe24 bond within the internal sequence -Arg22-Gly23-Phe24- of bovine insulin B-chain was 100:65. The enzyme was found to split both benzyloxycarbonyl-Arg-Arg-methoxy-2-naphthylamide and benzyloxycarbonyl-Arg-Gly-2-naphthylamide. The ratio of hydrolysis of these substances was 100:11.6. Benzyloxycarbonyl-Gly-Arg-2-naphthylamide was a very poor substrate for the enzyme.

Efficacy of four antihypertensive drugs (clonidine, enalapril, nitrendipine, oxprenolol) on stress blood pressure.

The impact of 4 antihypertensive drug regimens on blood pressure (BP) during everyday life stress and on BP during experimental stress in the laboratory was examined in an open clinical study. Sixty middle-aged men with mild-to-moderate essential hypertension never previously treated were treated either with low-dose clonidine (n = 10), oxprenolol (n = 20), nitrendipine (n = 20) or enalapril (n = 10). Before therapy, all 4 groups did not differ in age, weight, degree of obesity, BP at work site and casual BP measured in the outpatient clinic. After 6 months of effective therapy (casual BP within the normotensive range), casual diastolic BP was identical among the 4 groups, whereas systolic BP was lower in patients treated with clonidine or oxprenolol than in those who received enalapril. A disparate pattern of antihypertensive efficacy among the 4 groups emerged when stress BP was compared, with average ambulatory BP higher in patients receiving clonidine or enalapril than in those who had oxprenolol or nitrendipine. During ambulatory BP monitoring, patients treated with oxprenolol had the lowest level at each level of physical activity and self-reported emotional arousal. During bicycle exercise, patients receiving clonidine had the highest increase in systolic BP and those administered oxprenolol the lowest, whereas the BP response during mental stress was similar among all 4 therapeutic groups. The analysis of the hemodynamic response pattern during mental stress unmasked further disparities. Oxprenolol provoked an abnormal hemodynamic response during mental stress tests (increase in total peripheral resistance), whereas nitrendipine and enalapril preserved the physiological hemodynamic profile (decrease of total peripheral resistance).(ABSTRACT TRUNCATED AT 250 WORDS)

Development and functionality of isoelastic dental implants of titanium alloys.

Two types of isoelastic endosseous dental implants were produced and their functionality was tested. One type consisted of a porous sintered TiTa30 alloy, the other had a special surface structure consisting of titanium wire loops. Their mechanical properties were optimized by the production parameter (sintering and diffusion bonding, respectively). The functionality was tested after insertion into an artificial jaw which had properties corresponding to the natural mandibular. The elastic properties of both implants were similar to the properties of the bone. In addition the implants have a safe anchorage bone ingrowth. In animal experiments using the implant with surface loops it was observed that the bone entered the loops and even extremely small surface cavities in the wire loops.

Relation of hemodynamic reaction during stress to left ventricular hypertrophy in essential hypertension.

To elucidate the impact of increased afterload during physical and mental stress on myocardial hypertrophy, a homogeneous population of 73 patients with untreated mild-to-moderate essential hypertension were enrolled in the current study. Left ventricular mass and cross-sectional area, both determined by 2-D guided M-mode echocardiography, were related to blood pressure measured at rest as well as during various stress situations. Left ventricular mass and cross-sectional area correlated with systolic pressure at work site (r = 0.28 and r = 0.23 respectively, P less than .05) and systolic pressure at complete rest (r = 0.35 and r = 0.33, P less than .01). Neither the response in blood pressure to mental arithmetic or a bicycle exercise test performed in the laboratory, nor blood pressure during both stress tests were significantly related to the degree of left ventricular hypertrophy. In addition, patients with a hyperreactive response to mental arithmetic or to the physical stress test did not disclose a greater left ventricular mass than normoreactors. Examining the hemodynamic response pattern during mental arithmetic, we found that patients with vasoconstriction during mental stress had a greater left ventricular mass than individuals with vasodilation during mental stress (244 +/- 73 v 204 +/- 53 g, P less than .05), but this was due to the impact of obesity on left ventricular mass (analysis of covariance: F = 2.1, P = NS). Thus, blood pressure at work site and at rest, but not blood pressure during mental or physical stress, nor the response of blood pressure to both stress tests, was linked to the degree of left ventricular hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of antihypertensive therapy with isradipine and metoprolol on early markers of hypertensive nephropathy.

In a double-blind, randomized trial with 26 male white patients with essential hypertension in World Health Organization Stages I and II, we examined the impact of calcium entry blockade (5 to 10 mg/day isradipine, N = 14) and beta-blockade (100 to 200 mg/day metoprolol, N = 12) on early markers of hypertensive nephropathy before and after 7 weeks' treatment. Excretion of total protein, albumin, alpha 1-microglobuline, and N-acetyl-beta-glucosaminidase (NAG) were measured in the 24-h urine by radial immunodiffusion and fluorimetric method, respectively. Before therapy, 8 of 26 patients had microproteinuria (31%), six had microalbuminuria (22%), six had elevated urinary NAG activity (22%), and three had elevated alpha 1-microglobulin excretion (11%). In these subjects anti-hypertensive therapy led to a fall in proteinuria (296 +/- 56 v 127 +/- 116 mg/day, P less than .01), albuminuria (44 +/- 24 v 25 +/- 12 mg/day, P less than .05), and NAG excretion (45 +/- 22 v 28 +/- 5, P less than .05). The higher the pretreatment value, the greater the fall was in proteinuria (r = +0.55, P less than .01), albuminuria (r = 0.80, P less than .001), and NAG excretion (r = 0.60, P less than .01). We did not observe any significant difference in clinical characteristics, blood pressure, or urinary excretion of protein, albumin, or NAG between the two treatment groups, either before or after therapy. Thus, antihypertensive therapy reduced excretion of total protein, albumin, and NAG activity in hypertensive patients with elevated pretreatment values, potentially indicating reversal of early hypertensive nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Glomus tumor of the stomach. Histologic and ultrastructural features.

A glomus tumor of the stomach was found in a 79-year-old white man who had episodes of upper gastrointestinal bleeding. Clinically, this uncommon gastric tumor mimics most of the benign and malignant lesions of the stomach. The most important aspect of this tumor, therefore, is its histologic identification and differentiation from the more common gastric lesions, most especially malignant tumors. This is of paramount importance because the glomus tumor is essentially benign and does not warrant a radical surgical procedure. The histologic and ultrastructural features of this particular gastric neoplasm are presented and discussed.

Management of carcinoma of anal canal.

The application of various treatment modalities in the management of carcinoma of the anal canal remains controversial. Forty-nine patients were reviewed from the affiliated hospitals of the Medical College of Wisconsin. Exclusions for postoperative deaths, associated vulvar carcinoma, and lack of follow-up left 35 patients for determinate study. The overall 5-year survival rate was 28.6% (10 of 35). When reviewed by stage of disease, a direct relationship between advanced stage and decreased survival (i.e., 60% five-year survival rate with stage I, 25% with stage II, and 14.3% with stage III) was noted. Further reclassification of stage III, nodal involvement, showed the same survival for perirectal nodal involvement as for synchronous inguinal node involvement. Seven of ten 5-year survivors received a combined surgery-radiotherapy approach. In addition, in those patients receiving tumoricidal radiation pre- or postoperatively, no local recurrence was demonstrated. A treatment protocol of abdominal perineal resection, with combined radiation therapy for locally advanced lesions, is proposed.

Necrotizing fasciitis: a preventable disaster.

Twenty-eight cases of necrotizing fasciitis (NF) were treated in 27 patients. Most commonly these infections were caused by perineal disease, operative procedures, and cutaneous ulcers. Associated chronic diseases were present in 21 patients. Postoperative fasciitis occurred when prophylactic antibiotics were omitted or used inappropriately during clean-contaminated or contaminated procedures and when primary skin closure was done in the presence of intra-abdominal contamination. All but four infections were polymicrobial. The overall mortality rate was 73% (20 of 27). Death was due to persistent would sepsis in nine, systemic septic complications despite apparent local control of the infection in nine, and myocardial infarction in two patients. Five of seven survivors had NF limited to one region (leg, perineum, or abdomen). Only 2 of 15 patients survived when more than one debridement was necessary to control ongoing wound necrosis. Eleven of 12 patients who had a delay in treatment for more than 12 hours died. These results suggest that prompt recognition and treatment of NF are essential for survival. The presence of chronic debilitating diseases may contribute to the uncontrollable nature of both local and systemic infection, further emphasizing the need for early diagnosis. Postoperative fasciitis is potentially preventable by strict adherence to the principles for management of contaminated procedures.

Inguinal hernia repair before and after prostatic resection.

From 1976 through 1981, 864 men had inguinal hernia repairs and 328 had prostatic resections at our Veterans Administration Hospital. Forty-four patients had symptomatic prostatic obstruction that required either transurethral or open prostatic resection within 12 months of hernia repair. Twenty-seven patients had prostatectomy prior to hernia repair, 16 had hernia repair before prostatic resection, and one had simultaneous procedures. There were no urinary tract infections (UTIs) after hernia repair in patients who had had prostatectomy first, while five patients who had hernia repair before prostatectomy developed UTI after hernia repair (P less than 0.01). The incidence of UTI after hernia repair correlated with the need for and duration of bladder catheterization as a result of prostatic obstruction. Complications after prostatectomy were similar regardless of the order of operation. There were no episodes of incarceration or strangulation in patients awaiting hernia repair after prostatectomy. These results suggest that, when an inguinal hernia and symptomatic prostatic obstruction occur together, the performance of prostectomy before hernia repair lowers the risk of morbidity by decreasing the incidence of UTI after hernia repair. This approach does not expose the patient to any additional risk related to the inguinal hernia.

Effects of halothane, enflurane, and nitrous oxide on colon motility.

Previous work from this laboratory has demonstrated that the colon, particularly the left colon, is the major site of persistent postoperative ileus after both minimal and more extensive abdominal operations. Inhalation anesthetics have been implicated in the past as a possible cause of altered postoperative bowel function, but direct evidence of such a role in postoperative ileus is lacking. In this investigation, the effects of three inhalation anesthetic agents, halothane, enflurane, and nitrous oxide, on contractile function of the right and left colon were investigated in monkeys. Enflurane and halothane administration caused cessation of contractions in both the left and right colon; suppression of motor activity continued throughout the period of anesthetic administration. Recovery of normal contractile function occurred relatively promptly after cessation of anesthesia with these drugs. Return of normal contractions was more prompt in the right than in the left colon. Administration of nitrous oxide was not associated with significant suppression of contractile function of either the the right or left colon. None of the three agents studied appear to have any role in typical postoperative ileus.

Postoperative ileus: a colonic problem?

Postoperative electromechanical activity of the gastric antrum, small bowel, right colon, and sigmoid colon was recorded in stumptail monkeys in response to retroperitoneal dissection and transient clamping of the renal pedicle. Bipolar silver electrodes and extraluminal bonded strain gauge transducers were used to record slow-wave and spike discharges and contractions of intestinal smooth muscle. After operation myoelectric activity was decreased transiently in the antrum and for only a few hours in the small bowel. Right colon contractile activity was decreased significantly for 24 hours and that of the sigmoid colon for 72 hours. Postoperative inhibition of bowel motility appears to be most profound and persistent in the colon.

Relationship of duration of postoperative ileus to extent and site of operative dissection.

Postoperative ileus has been thought to be related to intraoperative manipulation of the intestines and to the duration of operative procedures. In order to study the effect of these variables on the postoperative myoelectrical activity of the intestine, six stumptailed monkeys had strain-gauge force transducers and bipolar electrodes placed on gastric antrum, mid-small bowel, right colon, and sigmoid colon. The animals were then subjected to three operations in random order varying in extent and site of dissection: (1) midline incisions, mobilization of right colon and kidney, clamping of renal pedicle, and extensive blunt dissection of right retroperitoneum; (2) the same operation but done on the left side; and (3) midline incision and gentle digital manipulation of the intestines. The first two procedures involved much more intestinal handling and dissection and took five to six times longer than the minimal laparotomy procedure. Postoperative inhibition of bowel motility was most profound and persistent in the colon. The duration and pattern of postoperative ileus in these experiments were independent of the extent, site, and duration of the operative procedure.

The effect of whole-gut lavage on colon motility and gastrocolic response in a monkey.

The effects of thorough colon lavage on fasting electrical control and response activities, as well as on muscular contractions, were recorded from the right, transverse, mid, and left colon of four conditioned monkeys. The gastrocolic response of monkeys to feeding is most prominent in the right and transverse colon in both duration and frequency of contractions. The response is reduced in midcolon and is just discernible in the left colon in fasted but otherwise unprepared animals. After lavage of the colon, a gastrocolic response to feeding is vigorously present throughout the colon. The removal of colonic content by lavage also leads to an increase in the duration of the gastrocolic response. These experimental observations are consistent with the results noted in humans in similar although less systematic experiments. Although the mechanism is unknown, the presence of stool in the lumen appears to blunt the contractile gastrocolic response of the colon to feeding.

Intestinal motility changes in experimental large bowel obstruction.

Bipolar electrodes for recording electrical discharges of colon smooth muscle and strain gages for recording associated contractions of circular muscle were implanted in six rhesus monkeys. After recovery, baseline records were made. The animals then had an obstruction device implanted in sigmoid colon which resulted in progressive compromise of the lumen terminating in complete obstruction after 13 +/- 2 days. Recording were made daily during development of obstruction. As obstruction became more complete, contraction frequency decreased in right colon, increased in left colon proximal to the obstruction, and was unchanged in left colon distal to the obstruction. The frequency of distentions increased in colon proximal to the obstruction but was unchanged distally. Simultaneous mass actions, a complex of nonperistaltic high amplitude contractions and distentions occurring nearly simultaneously throughout the colon which is not seen in normal colon, appeared in colon both proximal and distal to the obstruction and became more frequent as the degree of obstruction progressed. Colon obstruction results in abnormal motility complexes, but not in hyperperistalsis. Mass actions probably are the basis for colic and rushing bowel sounds noted clinically in colon obstruction.

Chronic pancreatitis: a cause of biliary stricture.

This is a report of our experience with 13 patients who had a distal common duct stricture associated with chronic relapsing pancreatitis. All patients, when first seen, had an elevated alkaline phosphatase level; eight of 13 patients also had an elevated serum bilirubin level. Five of the jaundiced patients had a febrile course; a preoperative diagnosis of acute cholangitis was made in four of these. Eight of the 13 patients have had a choledochoduodenostomy for relief of biliary obstruction; seven of these patients are living and well; one died of continued alcoholism and pancreatitis. One patient had a loop cholecystojejunostomy; decompression was inadequate and death due to septicemia secondary to ascending cholangitis ensued. Four patients have not yet had an operation. Two are symptomatic, but elective operation has been refused. Two have been lost to follow-up. We recommend investigation of the biliary tract in patients known to have chronic relapsing pancreatitis who also have persisting abdominal symptoms and an elevated alkaline phosphatase. If a stricture of the distal common bile duct is identified in the absence of acute pancreatitis, choledochoduodenostomy should be performed.

Effects of vagal cryo-interruption on colon contractions in monkeys.

The influence of the vagus nerve on normal colon contractions, and the distal extent of this influence along the colon, is unknown. It is generally thought that the vagus nerve has little, if any, influence on normal colon contractions, and if there is any effect, it is limited to the proximal colon. The technique of reversible truncal vagotomy by cooling (vagal cryo-interruption) was used to explore the influence, and extent of any influence, of the vagus nerve on contractions of the colon in unanesthetized monkeys. Each monkey was subjected to vagal cryo-interruption in the fasted and fed states. In both states this caused a significant decrease in contractions in the proximal, middle, and distal portions of the colon, compared with baseline control and recovery periods. These studies indicate that the vagus nerve plays a role in normal contractions of the intra-abdominal colon in both the fasted and the fed states and that it also plays a role in the gastrocolic response.