Plasma testosterone and the diagnosis of panhypopituitarism in women.

Plasma testosterone was shown to be a very sensitive index of panhypopituitarism in women. In 18 women, testosterone levels were found to be 0.06 +/- 0.04 ng/ml (mean +/- SD; normal, 0.40 +/- 0.10 ng/ml). In all patients, the values were below 2 SD of testosterone levels found in normal women. Dihydrotestosterone concentrations were similarly modified. Such an important decrease in plasma testosterone was probably due to the additional effect produced by the functional suppression of both sources of testosterone precursors: the adrenals and the ovaries.

Serum sialic acid in malignant tumors, bacterial infections, and chronic liver diseases.

The total serum sialic acid concentration was determined in 2,264 persons with various malignant tumors, bacterial infections, rheumatic diseases, and chronic liver diseases, and in a control group. The thiobarbiturate method according to Warren was used. The upper limit (95% percentile) in the control group was 2.23 mumol/ml. Higher values were found in the groups with neoplasms (mean: 3.04 mumol/ml), inflammatory diseases (e.g., pneumonia: 3.02 mumol/ml), and active rheumatoid arthritis (3.05 mumol/ml). In the group with malignant diseases, the sialic acid concentration at the time of diagnosis was highest for bronchial carcinoma (3.29 mumol/ml) and lowest for breast cancer (2.58 mumol/ml). In chronic liver diseases the mean sialic acid level was lower than in a heterogeneous group of noninflammatory and nonneoplastic diseases. The estimation of the serum sialic acid concentration could be useful in the detection of tumor burden and metastases, and in the evaluation of the later course and prognosis of malignant neoplasms if bacterial/inflammatory and active rheumatoid processes can be excluded.

Local and systemic toxicity of intra-hepatic-arterial 5-FU and high-dose or low-dose leucovorin for liver metastases of colorectal cancer.

In an ongoing prospective study 11 patients with unresectable liver metastases from colorectal carcinoma have been treated with hepatic-arterial infusion of 5-FU (1 g m-2) for 24 h on days 1 to 5 combined with a rapid infusion of high-dose leucovorin (100 mg m-2) (HD-regimen) or low-dose leucovorin (20 mg m-2) (LD-regimen) on days 1, 3 and 5. There was only mild local toxicity grade 1 and grade 2 in both regimen. Twenty-four cycles with high-dose leucovorin and 42 cycles with low-dose leucovorin showed a mild to moderate systemic toxicity, including haematological changes, stomatitis and diarrhoea. We did not see any grade 4 toxicity and no treatment-related fatalities occurred in this series. Eighty per cent reduction of leucovorin dosage leads to a significant decrease in grade 2 and grade 3 haematological and gastrointestinal toxicity.

A hardware architecture using finite-field arithmetic for computing maximum-likelihood estimates in emission tomography.

A special-purpose hardware architecture is proposed to implement the expectation-maximization algorithm to compute, in clinically useful times, the maximum-likelihood estimate of a radionuclide distribution for a positron-emission tomogram from time-of-flight measurements. Two-dimensional convolutions required for forming the estimate are converted into a series of one-dimensional convolutions that can be evaluated in parallel. Each one-dimensional convolution is evaluated using a number-theoretic transform. All numerical calculations are performed using finite-field arithmetic. To avoid the use of large finite fields and to increase parallelism, each convolution is performed by a series of convolutions with small digits in a Galois field. The hardware architecture allows a two-dimensional convolution of dimension NxN to be formed with O(N) operations, permitting one iteration of the expectation-maximization algorithm to be formed in approximately 100 ms when N=128 and the number of view angles is 32.

Magnetic resonance-guided laparoscopic interstitial laser therapy of the liver.

BACKGROUND: There is a necessity for an imaging method during laparoscopy to get a three-dimensional access to the target. In this study we evaluated laparoscopic interstitial laser therapy of the liver under magnetic resonance imaging guidance. METHODS: Five domestic pigs underwent laparoscopy in an open-configuration magnetic resonance system. Under simultaneous real-time magnetic resonance imaging interstitial laser therapy was applied to the liver. Magnetic resonance images, macroscopic aspects of the lesions, and light microscopic findings were compared. RESULTS: The interventions could be safely performed. There was no image artifact caused by instruments or by the carbon dioxide. Dynamic gadolinium-enhanced imaging proved to significantly predict the macroscopic volume of the laser lesions. CONCLUSIONS: Magnetic resonance-guided laparoscopic interstitial laser therapy of the liver combines the advantages of minimal invasive surgery and magnetic resonance imaging. Further development should focus on laparoscopic instruments and temperature sensitive sequences.

VATS resection of an oesophageal leiomyoma in a patient with neurofibromatosis Recklinghausen.

A series of reports in the literature suggest an association of neurofibromatosis Recklinghausen with intestinal tumors as carcinoids, leiomyomas and leiomyosarcomas. We present a case of a 23-year-old man with severe cutaneous manifestation of neurofibromatosis. Dysphagia was the main symptom. CT scan suggested the diagnosis of an oesophageal leiomyoma. The oesophageal muscle layers were split and the tumor was enucleated by video assisted thoracoscopic surgery (VATS). The postoperative course was uneventful. The patient was drinking liquids from day 1 and was eating a normal diet from day 3 postoperatively. He was dismissed from the hospital on the 4th postoperative day. We conclude that in patients with neurofibromatosis and oesophageal symptoms an intestinal manifestation of the disease in the oesophagus has to be considered and that VATS resection of intramural and extrinsic oesophageal leiomyomas is the treatment of choice.

[The extent to which ethanol absorption is influenced by an alteration of gastric emptying (author's transl)]. / Die Beeinflussbarkeit der Alkoholresorption durch Anderung der Magenetleerung

Gastric emptying of a 500ml liquid test meal containing 6.2% ethanol and phenol red was studied on two consecutive days in a group of persons without gastroduodenal disease. On the first day an aqueous ethanol solution was administered, whilst on the second day a solution of ethanol in 10% glucose was given in order to delay gastric emptying. Twenty minutes after introduction of the test meal by tube, the gastric contents were recovered by aspiration and a gastroscopic examination was performed. Simultaneously, the amount of ethanol absorbed by the stomach, as well as the ethanol level in the peripheral venous blood was determined over a period of 10 to 90 minutes. Considerable individual variations were observed both in respect to the gastric emptying rate and the level of blood ethanol during the absorptive phase. The absorption rate and blood ethanol curvetion rate and blood ethanol during the absorptive phase. The absorption rate and blood ethanol curve were markedly reduced as a result of a delay in gastric emptying. The tolerance to alcohol may be greatly influenced by the rate of gastric emptying and, consequently, by the composition of alcholic beverages, drinking habits, and food intake.

[Clinical significance of hyperuricaemia in medically-hospitalized women over 50 years of age (author's transl)]. / Bedeutung der Serumharnsäureerhöhung bei Frauen über dem 50. Lebensjahr an einer Internen Krankenabteilung

Hyperuricaemia was detected in 150 female patients over 50 years of age in a medical ward and was studied in detail. Serum uric acid levels over 6.2 mg/100 ml were found in 29.1% of the females of this age group, the incidence of idiopathic hyperuricaemia being 6.4%. The most common causes of urate elevation were the ingestion of diurectics (32%), pulmonary diseases (20%) and idiopathic hyperuricaemia (24%). These findings suggest that treatment with saliuretics, especially in the case of hypertensive cardiovascular disease, requires the control of serum uric acid levels. When serum uric acid levels are found to be elevated, treatment with allopurinol is essential.

Experimental cryosurgery of the liver under magnetic resonance guidance.

The feasibility and the advantages of magnetic resonance (MR)-guided interstitial cryosurgery of the liver in an 0.5 Tesla open MR system have been evaluated. Cryosurgery was performed using an Erbocryo PS system with a nonmagnetic cryoprobe of 6 mm diameter. The probe was inserted into the liver parenchyma under real-time MR control. Using continuous MR imaging two freezing cycles of 12 min each were applied. After conventional and dynamic gadolinium-enhanced MR imaging, the animals were sacrificed after 30 min, 3 hr, 24 hr, 7 days, and 21 days. Each lesion was analyzed using light microscopy. A total of seven cryolesions were made in five animals without any complications from cryosurgery. During real-time imaging, cryolesions appeared as a hemispherical growing signal loss with a mean volume of 16.4 cm3. Macroscopic volumes of the lesions showed a good correlation with dynamic enhanced MR images during follow-up, whereas real-time images usually showed an underestimation of the lesion volumes. Cryosurgery of the liver in an open-configuration MR system is a feasible and safe method. MR imaging allows the guidance and the follow-up of cryolesions of the liver with good accuracy.

[Thoracoscopic surgery--experiences with a practical training course using an animal models]. / Thoracoskopische Chirurgie--Erfahrungen mit einem praktischen Trainingskurs am Tiermodell.

Various thoracoscopic procedures have recently become an established method in thoracic surgery. However, a systematic teaching program is lacking. We present our experience with a 1-day training course, using anaesthetized pigs. Thoracoscopic operations, such as pericardial fenestration, wedge resection of the lung, subaortic and mediastinal lymph node dissection and pleurectomy have been exercised in groups of two. 7-12 months following the teaching course 40% of the participants had performed more than ten diagnostic or therapeutic thoracoscopic interventions in clinical situations. We conclude that our course helps participants to successfully apply this technique in clinical practice.

[Laparoscopic cholecystectomy in Switzerland. Critical retrospective evaluation of the first 3,722 cases. Swiss Professional Society of Laparoscopic and Thoracoscopic Surgery]. / Laparoskopische Cholecystektomie in der Schweiz. Kritischer Rückblick auf die ersten 3722 Fälle. Schweizerische Arbeitsgemeinschaft für Laparoskopische und Thorakoskopische Chirurgie.

In a national prospective multicenter study 3722 laparoscopic cholecystectomies (LC) performed by 179 surgeons in 50 Swiss institutions were analysed with special regard to technique and complications. Conversion to open cholecystectomy was necessary in 259 patients (7.0%), either expectively without intraoperative complications (4.5%) or due to intraoperative complications (2.5%). Three patients (0.08%) died within 30 days after operation and a total of 39 patients (1.0%) had to be reoperated. 31 (0.8%) bile duct injuries were registered. Common bile duct (CBD) stones were treated mainly by ERCP. In 8 cases laparoscopic removal of common bile duct stones was attempted and performed successfully in 6 patients. Postoperatively patients were discharged home after a mean of 4.4 days and returned to work after 14.0 days (range: 2-28). Laparoscopic cholecystectomy became the gold standard to remove the gallbladder, but further development is needed, to establish laparoscopic treatment of biliary tract stones in the near future.

[Intraoperative ultrasound--an alternative to cholangiography in laparoscopic cholecystectomy? A prospective study]. / Intraoperative Sonographie--eine Alternative zur Cholangiographie bei der laparoskopischen Cholecystektomie? Eine prospektive Studie.

The aim of this prospective study was the comparison of laparoscopic sonography with intraoperative cholangiography (IOC) during laparoscopic cholecystectomy. A 360 degree-sector scanner with a frequency of 5.5 MHz was used. The examination was successful in all 69 patients entered into the study. In the beginning 19 patients were examined sonographically without subsequent IOC. None of these patients had bile duct stones and their postoperative history was uneventful. In the 50 patients operated on subsequently both laparoscopic sonography and IOC were tried. IOC was not performed due to technical failure in 4 patients and due to allergic reactions to contrast media in one patient. Thirty-one patients demonstrated normal bile ducts without stones in both examinations. Ten patients had dilated ducts without stones. In three cases a stone was seen on IOC and intraoperative sonography. In one case a duodenal diverticulum containing debris, demonstrated by IOC, was the reason for a false positive sonographic finding. Sensitivity and specificity of laparoscopic sonography concerning the visualisation of bile duct stones were 100 and 98%, respectively. The time necessary for the examination was significantly shorter in laparoscopic sonography than in intraoperative cholangiography (p = 0.0001). If these results can be reproduced in a larger population of patients, laparoscopic sonography can be considered a safe, fast and non-invasive alternative to intraoperative cholangiography.

[25 OH CC (25-hydroxycholecalciferol in spasmophilia) (author's transl)]. / Le 25 hydroxycholecalciferol (25 OH CC) dans la spasmophilie.

The level of 25 OH CC in plasma was evaluated in spasmophilia (126 cases) comparatively with normal persons. This level is significantly decreased in spasmophilia. Therapeutic by 25 OH CC of the calcipenic symptoms was tested with good clinical results. Some precautions are necessary when spasmophilia is associated with idiopathic hypercalciura.

[Contribution of radioimmunologic determination of parathyroid hormone (PTH) to the diagnosis of hyperparathyroidism (HPT) (38 cases]. / Apport du dosage radioimmunologique de la parathormone (PTH) pour le diagnostic d'hyperparathyroïdie (H.P.T.) (38 cas)

The P.T.H. radioimmunoassay was done in 38 cases of suspected H.P.T. In confirmed primary H.P.T., the dosage was in positive correlation in 75% of cases; the classic metabolic exploration was in good correlation in 81% of cases. The specificity of the dosage is good but the defect of correlation comes from the antiserum utilised which recognizes the NH2-terminal region of human P.T.H.

[Acquired pseudohypoparathyroidism/(PHP) in adult coeliac disease (MCA)]. / Pseudo-hypoparathyroïdie (php) acquise au cours d'une maladie coeliaque de l'adulte (mca)

One case of chronic hypocalcemia and hyperphosphatemia, with an adult coeliac disease, hight P.T.H. level, very low rate of cyclic A.M.P. in urine, and normal rate of cyclid A.M.P. in plasma is described. It is the question of the pseudohypoparathyroidism acquirec as a result of an adult coeliac disease, because of after seven months of diet without gluten the clinical and biological improvement was observed with the increase of the cyclic-AMP clearance into the normal level and its great reactivity on the administration of exogenous PTH. We think to bring an additional analysis of the trouble of renal receptivity to parathyroid hormone.

[Radioimmunological determination of calcitonin (TCT) in the course of thyroid tumor pathology (84 cases)]. / Dosage radioimmunologique de la calcitonine (T.C.T.) au cours de la pathologie tumorale thyroidienne (84 cas)

The dosage of calcitonin was done in 13 thyroid carcinoma and 71 begnin thyroid tumors. In one case, the preoperative diagnosis of medullary thyroid carcinoma (M.T.C.) was alloved; in one another case of M.T.C. the repeatted dosage allows the evolution survey and the exploration of the family; in a third case, the dosage allows to doubt the diagnosis of M.T.C. in post-mortem. In 71 cases of begnin thyroid tumors, the calcitonin immunoassay is in the normal range. The interest and limits of the preoperative dosage was drawn of this experience.

[Laparoscopic cholecystectomy: results and complications--remaining indications for open cholecystectomy]. / Laparoskopische Cholezystektomie: Resultate und Komplikationen--verbliebene Indikationen zur offenen Cholezystektomie.

Since the introduction in 1987, laparoscopic cholecystectomy (LC) became the method of choice to treat symptomatic cholecystolithiasis. The results of four multicenter studies show a morbidity rate of 3.0% and a mortality rate of 0.05%. Injuries to the common bile duct or to an accessory bile duct occurred in 0.43% of cases and were recognized and treated intraoperatively in 31.3%. Conversion to open cholecystectomy was performed in 4.9%. Patients were discharged to home after 3.0 to 4.4 days (european cases) and returned to full time employment 10 to 14 days following intervention. Indication for primary open cholecystectomy have become rare and include absolute contraindications to perform LC and relative contraindications, including certain cases of severe acute or chronic inflammation, especially when patients previously have undergone upper abdominal surgery.