[An accessory spleen as a very rare entity causing a spermatic cord tumor]. / Nebenmilzen als seltene Ursache einer Raumforderung am Samenstrang.

An accessory spleen in the region of the spermatic cord is a very rare entity so that preoperative screening with splenic scintigraphy is not indicated. Sonographically there will always be the suspicion of a malignant tumor so operative exploration of the testes is the therapy of choice. However, it should always been borne in mind that such rare entities can occur in the region of the spermatic cord and if there is any doubt about the identity of the mass an intraoperative rapid section should be performed because in the case of an accessory spleen ablation of the testes is not necessary.

Endothelial nitric oxide synthase dysfunction in diabetic mice: importance of tetrahydrobiopterin in eNOS dimerisation.

AIMS/HYPOTHESIS: Impaired nitric oxide (NO) bioactivity and increased superoxide (SO) production are characteristics of vascular endothelial dysfunction in diabetes. The underlying mechanisms remain unknown. In this regard, we investigated the role of tetrahydrobiopterin (BH4) bioavailability in regulating endothelial nitric oxide synthase (eNOS) activity, dimerisation and SO production in streptozotocin-induced diabetic mice. METHODS: Mouse aortas were used for assays of the following: (1) aortic function by isometric tension; (2) NO by electronic paramagnetic resonance; (3) SO by lucigenin-enhanced chemiluminescence and dihydroethidine fluorescence; (4) total biopterin and BH4 by high-performance liquid chromatography; and (5) eNOS protein expression and dimerisation by immunoblotting. RESULTS: In diabetic mouse aortas, relaxations to acetylcholine and NO levels were significantly decreased, but SO production was increased, in association with reductions in total biopterins and BH4. Although total eNOS levels were increased in diabetes, the protein mainly existed in monomeric form. Conversely, specifically augmented BH4 in diabetic endothelium preserved eNOS dimerisation, but the expression remained unchanged. CONCLUSIONS/INTERPRETATION: Our results demonstrate that BH4 plays an important role in regulating eNOS activity and its functional protein structure, suggesting that increasing endothelial BH4 and/or protecting it from oxidation may be a rational therapeutic strategy to restore eNOS function in diabetes.

Ten year experience with Aspire (Tissuemed) porcine bioprosthesis: single centre experience.

BACKGROUND: Aspire (Tissuemed) bioprosthesis is a third generation porcine bioprosthesis. 10-year outcome of this bioprosthesis is unknown. METHODS: We report our experience of 139 consecutive prosthesis implanted between 1990-1998. The clinical outcome was reviewed retrospectively. RESULTS: 126 patients (67 males and 59 females), mean age 68.4+/-8.4 years underwent 139 valve replacements. Sites of valve implantation included the aortic in 77 patients (61%); mitral in 35 patients (27%); aortic+mitral in 13 patients (10%) and tricuspid in 1 patient (0.8%). 32/126 patients (25%) also underwent concomitant coronary artery bypass grafting (CABG). 30-day mortality for the whole group was 8.7% (11/126) with no valve related deaths. Follow up was 98.4% complete with a mean follow up of 6.1+/-3.3 years (766 patient-years, range 0-10.2 years). Overall 10-year actuarial survival was 41+/-7% (AVR 49+/-10%, MVR 29+/-11%) and this was influenced by pre-operative poor left ventricular function (EF<30%) (p=0.007) and pre-operative NYHA class III/IV (p=0.001). Overall estimated 10-year actuarial freedom from valve related events (Kaplan-Meier) and valve related events expressed as linearised rates (%/patient-year) were: freedom from structural valve failure 97+/-2% (0.26%/patient-year); non-structural dysfunction 98+/-1% (0.13%/patient-year); freedom from prosthetic valve endocarditis 94+/-3% (0.39%/patient-year); freedom from significant haemorrhagic event 82+/-6% (1.33%/patient-year); freedom from thrombo-embolism 90+/-3% (0.91%/patient-year) and freedom from re-operation was 93+/-3% (0.52%/patient-year). CONCLUSION: In our experience Aspire (Tissuemed) porcine bioprosthesis functions satisfactorily at 10-years with low valve related complications. Further follow-up will determine its long-term durability.

Total hip arthroplasty for late hip dislocation in paraplegia.

Late hip dislocation is uncommon, particularly in the context of paraplegia. We report a case in which total hip arthroplasty with a semi-constrained acetabular component was a successful treatment for this condition. A review of the literature revealed that this method of treatment had not been previously described in paraplegics. For patients with late hip dislocation in spastic paraplegia, total hip arthroplasty with a semi-constrained acetabular component, combined with adequate adductor release and obturator neurectomy is recommended. (Hip International 2002; 12: 338-41).