Geomagnetic reversal in brunhes normal polarity epoch.

The magnetic stratigraphly of seven cores of deep-sea sediment established the existence of a short interval of reversed polarity in the upper part of the Brunches epoch of normal polarity. The reversed zone in the cores correlates well with paleontological boundaries and is named the Blake event. Its boundaries are estimated to be 108,000 and 114,000 years ago +/- 10 percent.

Dinutuximab for the treatment of pediatric patients with neuroblastoma.

Dinutuximab is a monoclonal antibody targeted at disialoganglioside (GD2), a tumor-associated antigen widely expressed in human neuroblastoma cells. The incorporation of dinutuximab into standard treatment regimens for patients with high-risk neuroblastoma has changed the landscape of neuroblastoma therapy. Dinutuximab has shown to be effective in prolonging survival for patients receiving standard multimodal treatment regimens and has now become standard of care during the final phase of treatment. More recently, it has also shown promising efficacy and tolerability in patients with relapsed or progressive neuroblastoma. The most effective way of incorporating dinutuximab into treatment protocols is still being explored, and is the focus of numerous ongoing clinical trials.

A simple diagnostic milk medium for Pseudomonas aeruginosa.

An agar medium containing 10% defatted milk has been tested as a diagnostic medium for Pseudomonas aeruginosa and, in particular, for differentiating between P. aeruginosa and P. fluorescens. Only P. aeruginosa colonies gave clear zones due to hydrolysis of casein together with diffused green pigment. Results on milk agar correlated well with the pattern of results from a variety of conventional tests used to identify this organism. Pigment production of P. aeruginosa on milk agar was better than on special media commonly used to enhance this characteristic. Routine diagnosis of P. aeruginosa is recommended by streaking on a solid medium containing 10% defatted milk granules, 25% nutrient broth, and 2% agar, and examining for clear zones and pigment after 24 hours' incubation.

The use of monofilament suture in vascular surgery.

The blood lost through the suture line holes of vessels closed with braided polyester sutures is compared with that lost when a monofilament polypropylene suture is employed. In a retrospective analysis of blood replacement during saphenous vein aortorenal bypasses, twice as much blood replacement was required when the braided polyester suture was used. Further, ten dogs had one femoral artery reanastomosed with braided polyester suture and the other with monofilament polypropylene. Bleeding was three times greater and lasted six times longer when the braided polyester suture material was utilized.

Bilateral renal artery stenosis and renovascular hypertension.

Experience with the diagnostic evaluation and operative management of 38 hypertensive patients having bilateral renal revascularization is presented. Twenty-four patients had atherosclerotic occlusions and 14 had fibromuscular dysplasia. Renal vein renin assays (RVRA) and/or split renal function studies (SRFS) were performed in 37 of the 38 patients before operation. Although RVRA was negative in 29 percent and SRFS negative in 31 percent, 24 of 26 patients (92 percent) having both tests done had at least one positive study. Twenty-one patients had simultaneous bilateral repairs and 12 had staged bilateral reconstructions. The incidence of technical failures in these two groups was 21 and 9 percent, respectively. Excluding three uncorrected technical failures and two patients with recurrent branch renal artery lesions, 90 percent of patients with atherosclerosis and all patients with fibromuscular dysplasia had a favorable blood pressure response to operation. This study supports the use of both RVRA and SRFS in the diagnostic evaluation of hypertensive patients with renal artery stenosis. If these functional tests lateralize to one side, repair of that side only is recommended. If the functional studies do not lateralize, operation is suggested only when hypertension is severe and is not controlled readily with medications. In this circumstance reconstruction of the side that appears to be diseased most severely is recommended. Contralateral repair is undertaken only when hypertension persists and when repeat functional studies lateralize to the unoperated side.

Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence.

The Registry of Hepatic Metastases has collected data on consecutive patients from 24 institutions who have undergone hepatic resection for colorectal carcinoma metastases. Patterns of recurrence were examined in a subgroup of 607 patients who had undergone curative resection of isolated hepatic metastases. Forty-three percent of these patient have had recurrences in the liver and 31% have had recurrences in the lung (either alone or in combination with other organs). A multivariate analysis showed that patients with positive pathologic margins or bilobar metastases were at an increased risk of having a recurrence in the liver (68% and 64%, respectively). We conclude that: hepatic resection effectively controls hepatic tumor in a substantial number of patients, adjuvant therapy after hepatic resection should be directed at both the lung and liver to significantly increase survival, and patients with positive pathologic margins or bilobar metastases are at an increased risk for hepatic recurrence.

History of liver surgery.

Although battle surgeons had débrided small bits of liver protruding through wounds since ancient times, formal entry into the peritoneal cavity to staunch hemorrhage due to trauma or to remove tumors or drain cysts had to await the advent of general anesthesia and antisepsis. After a burst of pioneering activity from 1880 to 1910, little progress was made until after World War II. In the last 40 years, remarkable advances have been made in the techniques of liver resection, our understanding of liver diseases requiring operation, and our ability to support patients through major resections. Liver transplantation epitomizes the challenges that can now be accepted, and its success augurs well for an increase in liver operations in the future.

The malignant transformation of liver cell adenomas.

OBJECTIVE: To investigate clinical experience with the apparent malignant transformation of benign liver cell adenomas. DESIGN: Retrospective review of personal experience and literature. SETTING: University hospital and affilated community hospitals. PATIENTS: All patients diagnosed with liver cell adenomas over a 30-year period. INTERVENTIONS: Liver resection and/or tumor biopsy. MAIN OUTCOME MEASURES: Gender, age, drug associations, alpha-fetoprotein levels, response to treatment, and survival. RESULTS: Thirteen patients from personal experience and 26 patients from the reports of others had liver cell adenomas that were not resected. Five of these patients subsequently developed hepatocellular carcinoma. CONCLUSIONS: Malignant transformation of a liver cell adenoma is a rare phenomenon, but it does occur. Alpha-fetoprotein levels may be more helpful in diagnosis than expected from previous reports. Solitary benign adenomas should be resected whenever possible. Patients with diffuse multiple tumors should be observed closely over a long period.

Esophageal perforation: an increasing challenge.

Esophageal perforation continues to be a challenge. The overall incidence is rising even though iatrogenic perforations are decreasing. With early diagnosis followed by prompt surgical treatment, most patients can be expected to survive. Roentgenographic contrast studies demonstrated a perforation in all but 1 of our patients who had this examination and should be used early in patients suspected of having an esophageal perforation. The mortality rate is directly related to the interval between perforation and initiation of treatment. Nonoperative treatment, even for cervical esophageal perforations, is not advocated. An aggressive approach, consisting of closure of the perforation and adequate drainage, is indicated for both diagnosis and surgical treatment.

An analysis of the isoenzymes of creatine phosphokinase and lactic dehydrogenase in the esophagus.

Surgical manipulation of muscular organs can cause alterations of the serum isoenzymes of creatine phosphokinase (CPK) and lactic dehydrogenase (LDH), which are frequently used to confirm the diagnosis of myocardial infarction (MI). Since the content of these enzymes and their isoenzymes has not been established for the esophagus, an experiment was conducted to evaluate and compare the enzymes in postmortem specimens from humans and fresh canine specimens. One gram transmural esophageal sections were taken from specimens having no demonstrable disease. All samples were homogenized individually in Ringer's lactate solution and centrifuged, and the supernatants were analysed for the respective isoenzyme distributions by agarose gel electrophoresis. From the study we drew the following conclusions: (1) all three isoenzymes of CPK (including CPK-MB, the myocardialisoenzyme) are present in the esophagus; (2) LDH, the isoenzyme of LDH most prevalent in myocardium, is the least common of the five isoenzymes of LDH in the esophagus; (3) the dog is an appropriate model for studying changes of these isoenzymes after operation; and (4) any potential confusion in diagnosing postoperative MI due to esophageal CPK-MB in the serum can be resolved, theoretically, by analyzing LDH serum isoenzymes. In myocardial infarction, LDH becomes the predominant isoenzyme, whereas esophageal injury should be associated, theoretically, with a serum LDH isoenzyme pattern in which LDH is the least prevalent isoenzyme.

Surgical management of renovascular hypertension in older patients.

In hypertensive patients over 50 years of age, the high prevalence of renovascular hypertension (31 per cent), the low operative risk for its correction (1 to 2 per cent), and the frequency of benefit from operation (80 to 87 per cent) support an aggressive attitude toward screening and management. Diastolic hypertension greater than 105 mm Hg in the older patient warrants investigation. If such a patient has advanced atherosclerosis with evidence of significant cardiac disease or cerebrovascular disease, the indications for operative management of renovascular hypertension correlated with the severity of hypertension, difficulty of control, and imminence of renal function deterioration. If complicating risk factors are not severe, any patient with diastolic hypertension greater than 105 mm Hg is considered an appropriate operative candidate. In contrast, when risk factors are severe, operative management is undertaken only when hypertension is difficult to control or deterioration of renal function is thought to be secondary to the renal artery stenosis. In these patients the risk of operation is obviously greater and the long term benefits are more limited. Nevertheless, based on our experience, we feel the risk of poorly controlled hypertension or impending renal failure is even higher and justifies operative intervention. Hypertension accelerates the progress of atherosclerosis, and halting or slowing the unrelenting course of atherosclerosis is worthwhile objective if this can be done without unnecessary risk.

Survival after liver resection for secondary tumors.

The results achieved by liver resection for metastatic cancer in more than 400 patients have been studied in a collected review. Certain conclusions seem justified: The liver is no longer the surgeon's "no-man's-land," and local excision of metastatic tumor can achieve clinical cure in some patients. The risk-benefit ratio for hepatic resection for secondaries seems to be shifting in favor of benefit for selected patients with primary colorectal tumors. At present liver resection for tumors metastatic from pancreas, breast, lung, stomach, kidney, reproductive organs, and skin (melanoma) cannot be recommended. Liver resection may play an important part in the multi-modal therapy of children with extensive malignant disease.

Primary benign solid tumors of the liver.

The benign solid primary tumors of the liver separate into three major groups: (1) the most common lesions--small, nodular tumors, often found incidentally with histologic features suggesting a reactive etiology, that never rupture or metastasize, that seem to grow most rapidly in children and pregnant women, and that are probably unrelated to birth control medication; (2) the less common adenomas that are purely epithelial, that most often occur in menstruating females, that often show necrosis and rupture, and that are closely associated with oral contraceptive agents; and (3) very rare tumors, usually mesenchymal, occurring solely in children. The therapeutic and prognostic implications of these tumors are defined based upon a study of 111 patients, all but one of whom have undergone resection.

Automatic clip applier as an aid to liver resection.

The use of an automatic clip applier greatly adds to the safety and speed of liver resection by reducing both operative manipulation and the amount of residual dead tissue and foreign bodies.

Decreasing morbidity after liver trauma.

Fifty-one patients with significant recognized hepatic trauma were treated at Hartford Hospital during a four year period ending May 1973. Seventy-five per cent of the injuries were the result of blunt trauma. Many patients had severe associated injuries and three died in the emergency room before operation could be undertaken. Forty-eight patients underwent laparotomy and various types of repair including sixteen resections of significant volumes of nonviable liver. Three patients died in the operating room, but no patient who left the operating room alive after resection diet. Hematologic, pulmonary, renal, and gastrointestinal complications are analyzed in detail. There were no postoperative intrahepatic or subphrenic abscesses in patients undergoing resection and we believe that this is attributable to changes in technic. This review stresses the technical details of the operations as they may relate to the apparent improvement in morbidity and mortality.

Decreased function of a renal transplant after influenza virus infection.

A sixteen year old female recipient of a renal transplant had decreased renal function one month after an influenza virus infection. An acute rejection episode induced by the viral infection was the probable cause. Renal function in transplant recipients should be carefully monitored for at least one month after viral infection.

Cancer of the cardia.

The records of 157 patients with cardioesophageal carcinoma were reviewed. It is evident that although the prognosis of patients with squamous carcinoma is better than that of patients with adenocarcinoma, neither lesion is compatible with substantial long-term survival. Palliative resection of squamous carcinoma provides satisfactory short-term relief of symptoms. Palliative resection of adenocarcinoma, however, does not afford a similar response. Alternative modes of therapy are suggested.

Liver resection techniques.

Liver resection can be safely accomplished using techniques based on a thorough knowledge of anatomy and the use of readily available tools. Preoperative studies can determine resectability in most cases. An aggressive attitude toward resection of localized primary and secondary malignancies is justified by a 5-year survival rate of 25 to 35 per cent in selected patients. If the possibility of carcinoma has been ruled out, most asymptomatic benign tumors can be watched.

Overview and future prospects.

At present, resection affords highly selected patients with limited liver cancer their only choice for cure. Palliation with currently available agents and techniques often is not successful, but recent advances promise a brighter future.

Treatment of pelvic lymphoceles after renal transplantation by intraperitoneal marsupialization.

Pelvic lymphoceles following renal transplantation occurred in five of 70 recipients and were treated by intraperitoneal marsupialization. There were no complications other than one recurrence, which was successfully managed by a second marsupialization procedure. Intraperitoneal marsupialization avoids the prolonged wound drainage of external drainage methods, and appears to be the treatment of choice for large pelvic lymphoceles.