Patterning of perovskite-polymer films by wrinkling instabilities.

Organic-inorganic perovskites are semiconductors used for applications in optoelectronics and photovoltaics. Micron and submicron perovskite patterns have been explored in semitransparent photovoltaic and lasing applications. In this work, we show that a polymeric medium can be used to create a patterned perovskite, by using a novel and inexpensive approach.

Angiographic studies of the totally arterialized rat liver.

Twenty-three angiographies were performed in 20 rats with a totally arterialized liver. The arterialization was obtained by the construction of an end-to-side portacaval shunt (PCS) and an arteriovenous (AV) fistula between the left gastric artery and the portal stump. Microsurgical technique was necessary because of the small diameter of the AV fistula (0.5 mm). The angiographic examinations showed an AV fistula patency rate of 70% and a PCS rate of 100%. A successively increasing diameter of the fistula with dilation of the intrahepatic portal vessels was demonstrated in the rats with a patent arterioportal fistula. Tortuous and irregular vessels were also observed. All these signs suggest an overarterialization which developed despite the use of a very small AV fistula. None of the three rats examined histologically had cirrhosis of the liver. Further research is needed to attempt to avoid or minimize the deleterious effects of overarterialization of the portal tree, while utilizing the advantages of a dual liver blood supply in patients with decompressive PCS.

Pathogenesis of nodular goiter and its implications for surgical management.

Despite sufficient iodine supply, goiter continues to be of considerable surgical significance in formerly endemic countries. It now appears that iodine deficiency and increased thyrotropin stimulation are not the only causes of goiter. Xenotransplantation of human thyroid tissue onto nude mice allowed study of the regulation of growth and function in human goiter tissue. Grafts of human thyroid tissue growing in nude mice could be shown to react to endogenous mouse thyrotropic stimulation and suppression. 131I autoradiographs of xenotransplanted goiter tissue showed as marked a heterogeneity as did the original goitrous tissue prior to transplantation. There was no firm correlation between the morphologic appearance of a follicle and its iodine metabolism. Scintigraphically "cold" and "hot" goiter tissue differed from each other quantitatively but not qualitatively; i.e., both "hot" and "cold" tissue were composed of metabolically active and nonactive follicles. Iodine organification was not completely suppressible by thyroxine treatment; this indicates autonomous functional activity. The distribution of proliferating tissue labeled by 3-H-thymidine did not parallel the distribution of functionally active tissue labelled by 131I. Thyroxine treatment did not completely inhibit 3-H-thymidine incorporation, indicating autonomous growth. Thus, our pathogenetic concept of goiter formation is based on three mainstays: (1) goiter heterogeneity, (2) autonomy of growth and function, and (3) dissociation of growth and function in human goiter tissue. Thus, the surgeon dealing with goiter ought to remove all pathologically altered tissue, i.e., nodular tissue, irrespective of its appearance on scintiscans.

Biosynthesis of the bicycloalternarenes, mixed terpenoids of Alternaria alternata.

By incorporation of [2-13C]-mevalonate, [1-13C]-acetate and [1-13C]-glucose we could reveal that the phytopathogenic fungus Alternaria alternata biosynthesized the mixed terpenoids bicycloalternarenes via the classic mevalonate pathway. The polyketid pathway does not participate in the biosynthesis of bicycloalternarenes, because there is no incorporation of [13C]-acetate into the C-ring of these compounds. The labelling pattern in this nonterpenoid part of bicycloalternarenes after feeding with [1-13C]-glucose and [U-13C6]-glucose, respectively, allows the assumption that metabolites of the shikimate pathway are involved.

[Hyperthyroidism in thyroid cancer. Retrospective study of 53 cases]. / Hyperthyreose bei maligner Struma. Retrospektive Erhebung mit 53 Fällen.

Hyperthyroidism was diagnosed in 53 of 273 thyroid carcinoma patients at the time of their first examination (between 1971 and 1983). This corresponds to 19.5% of these mainly well-differentiated thyroid cancers. In 24 (45%) patients the hyperthyroidism and the thyroid carcinoma were two separate distinct illnesses: of 4 patients with Graves' disease (1.5% of 273), 2 had been operated because of an additional solitary cold nodule, and in the other 2 an occult carcinoma was found intraoperatively. Twenty patients of this group had Plummer's disease: there was a malignant cold nodule within a multinodular goiter with multifocal functional autonomy (MFA)(n = 14) or a carcinoma located near the solitary hot nodule of the toxic adenoma (TA)(n = 6). In these patients the distribution of the different histologies was about the same as in other thyroid cancer patients from this region. The remaining 29 patients (55%) had Plummer's disease, 28 with the classical finding of a solitary toxic adenoma, in which the hot nodule and the malignant tumor were identical. It was possible to confirm this identity histologically in 10 out of 24 cases, retrospectively. Eight of these patients had metastases with radioiodine uptake at the time of the first examination. Of the tumors in this group, 24 were follicular and 5 papillary carcinomas. As a rough estimate, one malignant, scintigraphically hot tumor is found for every 50 benign toxic adenomas. Criteria for the differentiation are: recent growth of the nodule, tumor size of greater than 5 cm diameter or greater than 35 g and an elevated T3-level of less than 0.06 nmol/l/g tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

[Preoperative prediction of the character of strumas]. / Uber die präoperative Voraussage der Dignität von Strumen.

We analyzed prospectively collected preoperative data of 278 goiter patients in order to determine predictors of goiter dignity. Aspiration-biopsy-cytology (ABC) revealed to be a good predictor as a result of a regression analysis. Its predictive value could not be improved significantly by combining ABC-data with other preoperative data. Patients with malignant goiters significantly differed from those with benign goiters with respect to age distribution, growth duration of the goiter and its function and texture, whereas sex distribution, nodularity and scintigraphic appearance did not differ significantly in the two groups.

[Experiences with endoscopic placed endoprosthesis in stenosing malignancies of the esophagus and cardia]. / Erfahrungen mit endoskopisch plazierten Endoprothesen bei stenosierenden Malignomen von Oesophagus und Kardia.

Seventy-five patients with obstructing esophagogastric malignancies were palliatively treated by fiberendoscopic insertion of prosthetic tubes. The indications for endoscopic intubation are discussed, the procedure is described. The mortality rate was 6.6%. Complications were obstructions due to food impaction (10), tumor overgrowth (5) or mucosa folds (3), reflux and aspiration (7), dislocation of the prosthesis (5), perforation (1) and desintegration of the tube (1). Normal swallowing was restored in 98% and in general, there was a marked improvement in the quality of life. In summary, we conclude palliative fiberendoscopic intubation as the best existing procedure in patients with an incurable obstructing esophagogastric neoplasm.

[Acute mesenteric ischemia]. / Die akute mesenteriale Ischämie.

83 patients with acute intestinal ischemia are presented. The aim of the study is to characterize anamnestic and clinical signs of this severe disease. Mainly old people with various cardiac illnesses suffer from acute intestinal ischemia. Precise anamnesis sometimes leads to the etiology of the obstruction. Clinical examination may show the extent of the disease. Angiography is mandatory for correct diagnosis. Early recognition and aggressive therapy significantly improve prognosis.

Efavirenz-induced urolithiasis.

We describe the first case of efavirenz-induced urolithiasis in a 47-year-old HIV-positive patient. Urinary obstruction led to pyelonephritis and septic shock, requiring emergency ureteral catheterisation. The subsequent clinical course was favourable, allowing the patient's discharge on day 5. A 7 mm, radio-translucent, non-crystalline, beige stone was extracted during catheterisation. Stone analysis by Fourier transform infrared spectrometry, liquid chromatography and mass spectrometry revealed a stone composed of efavirenz (EFV) metabolites M4, M5, M8 (as described by Mutlib et al. in 1999) and approximately 50% of unspecified proteins. EFV is a non-nucleoside reverse transcriptase inhibitor introduced to European markets in 1999. It is principally metabolised by cytochrome P450 3A4 and 2B6. Of the dose, 14-34% is excreted in the urine, 1% as unchanged drug. The patient had been taking 600 mg EFV per day for 3 years. As EFV-induced urolithiasis has not been reported so far, we would like to draw the attention of the medical community to this potentially severe complication.

[Giant abdominal abscesses--a hitherto unrecognized disease]. / Abdominale Riesenabszesse--eine bisweilen verkannte Affektion.

Two cases of giant intraabdominal supra-colic abscess are described. Since the clinical symptoms are often unimpressive and nonspecific, there was a delay in diagnosis. The causes were unrecognized perforated peptic ulcers in both patients. Pathophysiology, incidence and possible localizations of intraabdominal abscesses are discussed. A review of intraabdominal anatomy is important for an understanding of the peritoneal spaces in which abscesses can occur.

[Cystic liver]. / Die Zystenleber.

Diagnostic workup of progressive upper abdominal pain in patients with polycystic kidney disease may lead to the diagnosis of simultaneous polycystic liver disease. Whereas untreated advanced polycystic kidney disease leads to terminal organ failure, symptoms of polycystic liver are mainly due to local mechanical effects. Impairment of liver function is rare. Polycystic liver and kidneys are an autosomal dominant hereditary disease with variable penetrance. The etiology, clinical aspects, and diagnostic and therapeutic procedures are discussed and illustrated on the basis of three clinical cases and a review of the literature.

Infectious diseases following major disasters.

A recent surge in the general awareness of the extent of disasters has increased concern over the adequacy of our state of preparedness for these events. Outbreaks of infectious disease after a disaster may have significant societal impacts. In preparation, rescuers must anticipate and identify infectious risks, isolate and treat the individuals with infections, and institute measures that will prevent the further spread of infectious diseases. Epidemiological factors may contribute to the spread of infectious disease after a given disaster. A simple microbiological laboratory in the field may be helpful in attempting to direct therapy at specific infectious etiologies. Prior post-disaster experience suggests that mass immunization may not always be valuable in protecting against disease spread acutely, although immunizations may be considered in a limited number of situations. Disaster medical personnel should prepare themselves with appropriate vaccinations and remain in good health; new pathogens must not be brought in by well-meaning relief personnel. Disasters often occur in a Third-World setting where resources are limited and often compromised. Complete recovery from infectious disease outbreaks and restoration of infection control practices may take years when a Third-World population has suffered a major disaster.

[Combined abdominosacral excision of a giant-cell tumor of the os sacrum]. / Kombinierte abdominosakrale Exzision einer Riesenzellgeschwulst des Os sacrum.

In 1967 Localio described a synchronous abdomino-sacral approach for resection of sacrococcygeal chordoma. The patient is placed in the lateral position with the left side up. The incision is carried from a point to the right of the midline above the pubis transversely across the rectus and then obliquely parallel to the inguinal ligament, to end at the midaxillary line. Mobilisation of the rectum and control of the pelvic vessels presents no difficulty. The sacrum is then exposed from the dorsal side by a transverse incision. The possibility to work simultaneously in the two operative fields affords excellent exposure and control of bleeding. This approach has been used by the authors for resection of an abundantly vascularized giant cell tumor of the sacrum.

[Operative strategy in thyroid autonomy and Basedow hyperthyroidism]. / Operationsstrategie bei Schilddrüsen-Autonomie und Basedow-Hyperthyreose.

The different extra- and intrathyroid origin of hyperthyroidism, the advantages of the surgical procedure and the criteria for the extent of thyroid resection determine the operative tactics. For both forms of hyperthyroidism we recommend a rather extended resection of the diseased thyroid gland in order to prevent recurrent hyperthyroidism and recurrent thyroid growth as well. These recurrences require subtotal thyroidectomy for Graves' disease, monolateral partial lobectomy for a so-called toxic adenoma and bilateral partial lobectomy for toxic multi-nodular goiters. With these procedures lesions of the recurrent nerves and parathyroid glands can be prevented.

[Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis]. / Septische Pylephlebitis mit Nachweis von Gas in der Vena portae: seltene Komplikation der Sigmadivertikulitis.

Pylephlebitis, septic thrombosis of the portal vein and its branches, is an infrequent complication of intra-abdominal inflammatory processes which may lead to thrombosis of the portal vein or to liver abscesses. Air in the protal venous system usually predicts a fatal outcome. The survival rate calculated in all reported cases is less than 25%. It is important to detect portal venous gas early. In detection of portal venous gas, ultrasound and computed tomography are more sensitive than plain radiographs. Pylephlebitis used to be a dreaded complication of appendicitis, but the incidence of this disease has greatly declined since the development of antibiotics and modern surgical techniques. We present two cases of pylephlebitis associated with gas in the portal vein as a result of left colonic diverticulitis treated by bowel resection. In spite of the occurrence of portal venous gas, the outcome may be favourable if this disease undergoes prompt surgical treatment.

[Acute appendicitis: avoiding unnecessary laparotomy in young women]. / Appendicitis acuta: Vermeidung der unnötigen Laparotomie bei der jungen Frau.

Eighty-eight consecutive patients undergoing surgery for clinical diagnosis of appendicitis are reviewed. The diagnosis was correct in 71 (85%), incorrect in 17 (15%). Of these 17 patients 5 suffered from other diseases demanding surgical treatment (diverticulitis, cholecystitis, torsion of ovarian cyst, pyosalpinx). Pain migration, local tenderness and WBC greater than 10,000/mm3 were significantly associated with appendicitis, whereas duration of pain, défense musculaire and body temperature did not allow any discrimination. In men, the diagnosis was correct in 42 out of 43, whereas in women only in 34 out of 45. All 11 women with incorrect diagnosis were less than 35 years old. We conclude that the diagnosis of appendicitis is particularly difficult in women younger than 35 years.

Efficient hepatic uptake of chylomicron remnant cholesterol in rats with a portacaval anastomosis.

Portacaval-shunted and sham-operated male rats, fed ad libitum and of similar weight, were studied 2-3 weeks after surgery. At this time serum cholesterol levels did not differ significantly between the two groups, whereas serum triacylglycerols and phospholipids were lower in the shunted group. These animals also showed an increased serum bile acid level and an increased serum estradiol to testosterone ratio. The metabolism of native chyle labeled with [3H]cholesterol and [14C]linoleic acid or of preformed chylomicron remnants with the same labeling was studied in the groups of rats. Ten minutes after intravenous injection of chylomicron remnants 10.6 +/- 0.5% (means +/- SEM, n = 8) of the injected [3H]cholesterol and 7.6 +/- 0.4% of the [14C]linoleic acid were found per 1 g liver in the portacaval-shunted rats; the corresponding figures in the sham-operated group (n = 8) were 6.4 +/- 0.4 and 4.9 +/- 0.3, respectively (p less than 0.001 for both 3H and 14C). Thus, despite a greater than 40% reduction of liver weight induced by the shunting procedure, the total liver uptake of chylomicron remnants was not significantly decreased. The uptake of chylomicron lipids per unit liver weight was normal in the atrophic livers of portacaval-shunted rats also when very large loads of chyle were administered.