Ictal fear in temporal lobe epilepsy: surgical outcome and focal hippocampal changes revealed by proton magnetic resonance spectroscopy imaging.

BACKGROUND: Ictal fear (IF) is most frequently associated with epileptic discharges from mesial temporal areas. OBJECTIVES: To determine whether patients with IF were more likely to become seizure free after anteromesial temporal lobe resection compared with those without IF and whether they show more anteriorly pronounced metabolic changes assessed by means of multivoxel magnetic resonance spectroscopy (MRS) along the hippocampal axis. METHODS: Surgical outcome was assessed in 33 consecutive patients with temporal lobe epilepsy after a mean follow-up of 25 months (range, 12-38 months). Proton multivoxel MRS of the hippocampal formation was applied to detect regional differences along the axis of the hippocampus in patients with and without IF. Magnetic resonance tomography showed typical features of hippocampal sclerosis in all patients. RESULTS: Twelve (36%) of the 33 patients reported fear at the beginning of their habitual seizures. Eleven of these patients were seizure free postoperatively. In contrast, only 11 of 21 patients without IF had a favorable outcome. Results of MRS revealed significantly higher pathologic N-acetylaspartate-choline ratios in the anterior portion of the hippocampal formation in patients with than in those without IF, indicating focal metabolic and/or morphologic changes in the head of the hippocampus. CONCLUSIONS: These results indicate the importance of diagnosing auras with IF to provide a more detailed prognosis of the surgical outcome. In addition, our data emphasize that multivoxel MRS is a valuable tool in the presurgical evaluation, as it may reveal different topographical patterns of hippocampal sclerosis.

Magnetic resonance spectroscopy and histopathological findings in temporal lobe epilepsy.

PURPOSE: In some patients with temporal lobe epilepsy, histopathological evaluation of resected brain tissue after surgical treatment may reveal several features indicative of discrete cortical malformations. We sought to determine whether these histopathological features were accompanied by hippocampal changes detectable preoperatively by proton magnetic resonance (MR) spectroscopy and to evaluate their relationship with postoperative outcome. METHODS: In 25 consecutive temporal lobe epilepsy patients who were scheduled for surgical treatment, MR spectroscopy was performed, and resected brain tissue was analyzed histopathologically for the presence of discrete cortical malformations (e.g., microdysgenesis). Outcome was assessed in all patients with an average postoperative period of 26 months. RESULTS: In 13 patients, we found subtle, histopathologically detectable signs of cortical malformation: 6 of them with concomitant hippocampal sclerosis (dual pathology) and 7 without. The latter subgroup had a worse surgical outcome and showed enhanced bilateral and/or contralateral pathological changes in the hippocampal formation when investigated by MR spectroscopy. CONCLUSIONS: These data suggest that by showing contralaterally or bilaterally abnormal spectra, MR spectroscopy might be able to indicate pathological changes in subtle developmental disorders that are possibly more widespread over the brain. This observation may improve noninvasive diagnosis in presurgical evaluation and the neurobiological understanding of cortical malformations in pharmacoresistant temporal lobe epilepsy.

[Laparoscopic varicocele ligation. The comparative assessment of artery-ligating and artery-preserving varicocelectomy]. / Ocena porównawcza leczenia jednostronnych zylaków powrózka nasiennego metoda podwiazania zyly i tetnicy jadrowej oraz metoda podwiazania zyly jadrowej.

For over ten years more and more significant role in the diagnostics and clinical treatment of marital infertility have been ascribed to the male factor, which accounts for 30-40% of infertility cases. One of the most common reasons of male infertility is varicocele. Between the years 1994-2000 transperitoneal laparoscopic varicocelectomy was performed in 166 men with unilateral varicoceles. Two methods of surgical correction were administered. In I group--88 men (53%)--testicular artery and vein were ligated, in II group--78 men (47%) only testicular vein was ligated. The success of the treatment was evaluated in two age groups; A--19-30 and B--31-41 years of age. Before the operation in group I and II the sperm count was respectively 18.19?10.51 and 19.05 +/- 10.62 x 10(6)/ml. The percentage of the progressive motility was 18.95 +/- 9.46% in I group and 20.12 +/- 9.08% in II group. The percentage of normal forms was 22.04 +/- 8.42% in I group and 23.02 +/- 9.81% in II group. After 12 months of surgical observation the sperm count was 35.21 +/- 13.46 in I and 31.82 +/- 12.14 x 10(6)/ml, in II group. The percentage of progressive motility increased to 36.48 +/- 15.76% in I group and to 31.26 +/- 10.78% in II group. In both groups the percentage of normal forms was comparable, in I group was 49.11 +/- 26.72% and in II group was 47.15 +/- 17.18%. In both age groups sperm count before operation was respectively: 20.42 +/- 10.20 in A, and 16.42 +/- 9.16 x 106/ml in B. The percentage of progressive motility was in A and B respectively 22.98 +/- 9.91% and 15.38 +/- 9.66%. At percentage of normal forms was respectively 25.62 +/- 8.92 and 18.81 +/- 7.93%. In the end of observation period the improvement of sperm count was observed in A--42.69 +/- 22.36, in B--22.86 +/- 11.76 x 10(6)/ml. The improvement of progressive motility was ia A--43.27 +/- 23.96% and in B--23.09 +/- 17.01%. The improvement of normal forms were in A--55.39 +/- 24.31% and 39.69 +/- 22.29 in group B. The pregnancy rate was; in I group +/- 30.6% in II group--23.1%, in A group--33.3%, in B--group--19.7%. The laparoscopic ligation of the testicular vein and artery produced better improvement of semen characteristics and percentage of pregnancies in comparison with artery sparing technique. The laparoscopic varicocelectomy regardless of the technique allows a significant improvement of semen characteristics and pregnancy rate among the couples, where men were less than 30 years of age.

Evaluation of organ sparing operation results from planned indications in patients with kidney cancer.

An analysis in 53 patients with kidney cancer has been conducted, a group on which kidney sparing operations have been performed. 25 women and 28 men have been examined at the age of 53.7 in the postoperative period of 7 divided by 130 months. The average observation time without any recurrences or metastases was 48.8 months. 5.7% local and 1.9% remote decease related recurrences have been found. The stage of clinical progression and the degree of histological malignancy are factors determining the five-year survival being 98.0%, while without any recurrences or metastases being 88.4%.

Evaluation of organ sparing surgery results in patients with kidney cancer in scheduled operations.

INTRODUCTION: The aim of the study was retrospective analysis of nephron-sparing surgery results of 53 patients, performed due to unilateral small kidney tumors in the period of 1988-1998. MATERIAL AND METHODS: The patients were followed-up according to EORTC directions for 20 to 143 months after the surgery. We have treated 25 women and 28 men of the average age of 53.7. In ten patients partial nephrectomy was performed and the remaining 43 had the tumor enucleated. RESULTS: The average observation time without any recurrences and metastases was 63.8 months, in 5.7% of patients local disease related recurrences and in 1.9% remote recurrences have been found. CONCLUSIONS: 1. Nephron-sparing surgery is a safe alternative to radical surgery in tumors of up to 4 cm in diameter. 2. Prospective 10-year survival time in our patients was 98%, including 92% of patients remaining without recurrence or metastases. 3. Positive prognostic factors are incidental diagnosis of a tumor and low staging and grading of a tumor.

[Evaluation of the value of laparoscopy and retroperitoneoscopy in urology. Personal observations]. / Ocena wartosci laparoskopii i retroperitoneoskopii w urologii. Doswiadczenia wlasne.

The aim of this paper is retrospective evaluation of the results and complications after videoscopic operations in patients with urogical diseases. The analysis was performed in 229 patients aged between 4 and 71 years. Among them 210 transperitoneal and 19 retroperitoneal operations were carried out. Complications were noted in 16 (7.0%) and postoperative morality in 0%. The reverse of the operations was performed in three patients (1.3%). The average time of the operations was 60.3 min. (25-185). The average hospitalization time was 3.3 days (2-17). In comparison with classical open surgery videoscopic operations are characterized by less invasiveness, less complicated course, shorter hospitalization time and recovery to active professional live.

[Results of intraperitoneal, laparoscopic colposuspension using Burch's method for stress incontinence in women]. / Wyniki przezotrzewnowej, laparoskopowej kolposuspensji sposobem Burcha w wysilkowym nietrzymaniu moczu u kobiet.

Laparoscopic colpoureterosuspension is a feasible surgical procedure for correcting the stress incontinence in women. A total of 41 patients underwent pelvis laparoscopic procedure. The average age of the patients was 55.4 years (range between 40 and 68 years). The mean operative time was 65 minutes. Laparoscopic intraperitoneal ureterocolposuspension is characterized by 87.6% early postoperative success rate. To carry out laparoscopic Burch's is operation is not more difficult than open surgery, but early optimistic results need a longer follow-up to estimate efficacy of this procedure.

[Results of Foure's antireflux surgery for bilateral vesico-ureteral reflux in children]. / Wyniki operacji przeciwodplywowej sposobem Foure'a w obustronnym odplywie pecherzowo-moczowodowym u dzieci.

The paper presents the results of the antireflux operation using Foure's method, performed in 27 children with bilateral vesico-ureteral reflux (VUR). The radiologic and laboratory control examinations were done between 14th month and 7.5th year, mean 3.9th year, after operation. The age of these patients ranged 3-12, mean 6.0 years. In 88.9% children complete resolution of the VUR was obtained. In one case (3.7%) the bilateral stricture of the new uretero-vesical junction, and in 2 others (7.4%) recurrent unilateral VUR was found. It is a simple method, which is recommended in patients with a small capacity of the bladder or great inflammatory changes within mucous membrane.

[Evaluation of fertility after surgery for varicocele in boys and adolescents]. / Ocena plodnosci po operacyjnym leczeniu zylaków powrózka nasienego u chlopców i mlodzienców.

Comparative estimation of potential fertility in 66 adolescents with varicocele shows: 1. Improvement of semen parameters in adolescents with over 20 x 10(6) spermatozoa in 1 cc. before operation and preserved spermatogenesis. 2. Increase of ipsilateral testicular volume in 86.4% of boys. 3. Apart from Ivanisevisch technique all applied surgical procedures demonstrate comparatively good results.

[Retrospective evaluation of surgical results in children with a megaureter defect]. / Retrospektywna ocena wyników operacji u dzieci z wada moczowodu olbrzymiego.

We evaluated the efficacy of surgical treatment in 171 children with primary megaureters. Operations were performed between 1980-1997. The average time of follow-up was 7.8 years. The treatment was effective in 149 (87.1%) children. The results were good in 92.8% of cases with obturative type of megaureters and in 81.6% with refluxive type of M.O. The worst results were obtained in children aged under 2 years of live (21.9%). The primary amputation was performed in 48 (28%) children and the secondary in 14 (8.2%) children. In this number 11 was nephrectomies were carried out.

[The usefulness of MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) in cases of obstructive azoospermia]. / Zastosowanie MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) w przypadkach azoospermii obstrukcyjnej.

Till the end of March 1998 first seven trials of MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) in the Ist Chair and Clinics of Obstetrics and Gynecology of the Silesian Medical Academy in Bytom were performed in cooperation with an urologist from the IInd Chair and Clinics of Urology in Zabrze in couples suffering from sterility caused by obstructive azoospermia. In all the cases both contraindications and conditions of MESA-ICSI were respected. Fertilization rate of the MII oocytes was on average 62% and cleavage rate of the fertilized oocytes 76.9%. After embryo transfer at least two pregnancies occurred, from them one is ongoing well. The result of the last procedure is not known yet. The data obtained permit to conclude, that MESA-ICSI makes a real chance to possess their own children by couples with sterility caused by obstructive azoospermia.

Streptomycetes producing daunomycin and related compounds: do we know enough about them after 25 years?

The growing need of highly potent anticancer agents has stimulated the investigation of streptomycetes producing daunomycin-type anthracyclines. This review compares the features of production strains and their mutants and emphasizes the necessity of application of biochemical and biophysical analytical methods for better understanding these microorganisms and, above all, their further improving and practical usage.

Microbial transformation of semisynthetic derivatives of daunomycinone modified in ring A.

Semisynthetic derivatives of daunomycinone with 7,9-isopropylacetal, 7-O-methyl, 7-O-(4-penten-2-yl), and 7-O-(2-hydroxyethyl) substituents were converted by Streptomyces peucetius var. caesius (an adriamycin-blocked mutant) into 7-deoxy-13-dihydrodaunomycinone, while daunomycinone was transformed into 13-dihydrodaunomycinone (predominantly) and 7-deoxy-13-dihydrodaunomycinone. S. coeruleorubidus mutants 24-74 (accumulating aclavinone derivatives instead of daunomycin and related compounds) and 96-85 (producing no anthracycline substances), and S. aureofaciens B-96 (a tetracycline-blocked mutant) transformed the above substrates into the corresponding 13-dihydro derivatives, with the exception of 7,9-isopropylacetal daunomycinone which remained intact. 7-O-Propyn-1-yl daunomycinone was not transformed by any of the strains used under the conditions.