Steroid hormone receptors in human adipose tissues.

Administration of glucocorticoid, estrogen, and progesterone is followed by changes in human adipose tissue distribution, morphology, and function. Therefore, specific receptors for these hormones were determined in different regions of human adipose tissue using ligand techniques, with separation of bound and free hormone by chromatography, absorption techniques, or isoelectric focusing, as well as protein quantitation with monoclonal antibodies against human estrogen and progesterone receptors. Furthermore, mRNAs were measured by solubilization hybridization technique with glucocorticoid, estrogen, and progesterone receptor cRNA probes for human receptors. Saturable specific cytosolic glucocorticoid binding was found. Quantitative analyses indicated more binding sites and mRNAs in intraabdominal than sc adipose tissue samples. In contrast, neither specific estrogen or progesterone binding, cytosolic or nuclear receptor protein, nor mRNAs for these receptors could be identified in abdominal, femoral, or omental adipose tissues. Parallel control experiments confirmed the presence of both estrogen and progesterone receptors in rat adipose tissues. It was concluded that while glucocorticoid receptors are clearly present in human adipose tissues, female sex hormone receptors are not present in quantities detectable with presently available methods. Effects of these hormones on human adipose tissue might, therefore, be mediated via a minute nondetectable quantity of receptors, the glucocorticoid receptor, or indirect mechanisms.

Metabolism of mammary, abdominal, and femoral adipocytes in women before and after menopause.

In 23 women before and 11 after menopause, adipocyte size, lipoprotein lipase activity, and lipolytic responsiveness to norepinephrine were compared in different regions of adipose tissue. In premenopausal women femoral adipocytes were characterized by a higher lipoprotein lipase activity than abdominal or mammary adipocytes. On the other hand, lipolytic responsiveness and sensitivity in the latter two was higher than in femoral tissue. In postmenopausal women no differences in lipoprotein lipase or lipolysis were found among the three regions. Consequently, menopause in women seemed to be associated with a diminution of not only the increased lipoprotein lipase activity of femoral adipocytes, but also of the high lipolytic response in abdominal and mammary adipose tissue. It is therefore suggested that female sex steroid hormones exert regionally specific effects, ie, increasing lipoprotein lipase in femoral adipocytes, which therefore become enlarged. It also seems possible that stimulation of lipolysis in abdominal and mammary adipocytes is an effect of sex steroid hormones. From the results obtained it is hypothesized that the secondary sex characteristics of adipose tissue distribution in women might be caused by regionally specific effects of sex steroid hormones on adipocyte metabolism.

Elective lymph node dissection in stage I cutaneous malignant melanoma of the head and neck. A report from the Swedish Melanoma Study Group.

The effect of elective lymph node dissection in patients with cutaneous malignant melanoma of the head and neck was investigated in a retrospective study. Of 517 patients in clinical stage I, 84 underwent elective dissection of the ipsilateral neck lymph nodes. In six of these patients, lymph node metastases were demonstrated at histopathological examination. There was a slight reduction in the incidence of recurrent disease in the regional lymph nodes in the group of patients who had undergone elective lymph node dissection, but this difference was not statistically significant. No significant differences were seen between the two groups regarding overall survival of disease-related survival.

Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals.

In 20 male-to-female transsexual patients, a neovagina has been constructed using a combination of penile and scrotal flaps. By dissecting the dorsal vessels and nerves of the penis from the base to the tip, the blood supply and sensation to the glans have been preserved. After resection of the corpora cavernosa, the glans has been left as an innervated island flap and repositioned as a clitoris. There were few complications. Circulatory problems in the flaps resulted in short vaginas in three patients. Stricture of the urethral meatus and excessive length of the urethra were easily corrected with another operation in three patients. Nineteen of the patients expressed an excellent sexual sensation of the clitoris, and all 20 were very satisfied with both the cosmetic and functional results.

Prognosis for localized cutaneous melanoma treated with wide excision only, with special reference to development of regional node metastases.

A consecutive series of 564 patients with localized (Stage I) melanoma treated by wide excision only were followed for at least 5 years. The median tumor thickness was 1.50 mm, and 30% were ulcerated. The female/male ratio was 54/46. The overall survival rates were 80% at 5 years and 73% at 10 years. The survival rates were statistically significantly better for females, even when tumor thickness and ulceration were taken into consideration. Twenty percent developed regional node metastases after an average remission period of 13 months. The actuarial survival rates after node dissection were 32% at 5 years and 27% at 10 years. A subgroup with an exceptionally poor prognosis and a high rate of regional node dissemination was looked for. Only 26% of the intermediate thickness group (1.50-3.99 mm, Breslow) developed nodal metastasis, whereas patients with thick lesions (greater than 4 mm) had a metastasis rate of 43%. Patients with thick lesions may therefore benefit more from elective node dissection than patients with lesions of intermediate thickness. Patient characteristics, e.g., sex and tumor characteristics (ulceration), may prove to be of importance in a prospective trial on elective node dissection.

Long-term follow up after sex reassignment surgery.

A long-term follow up of 136 patients operated on for sex reassignment was done to evaluate the surgical outcome. Social and psychological adjustments were also investigated by a questionnaire in 90 of these 136 patients. Optimal results of the operation are essential for a successful outcome. Personal and social instability before operation, unsuitable body build, and age over 30 years at operation correlated with unsatisfactory results. Adequate family and social support is important for postoperative functioning. Sex reassignment had no influence on the person's ability to work.

Excisional biopsy and delayed wide excision versus primary wide excision of malignant melanoma.

In a retrospective study of 269 cutaneous malignant melanomas in stage I the influence of biopsy on survival was studied. Sixty patients were treated with primary wide excision and 209 patients with excisional biopsy followed by wide excision. The 5-year survival rates for the two groups were 75.0% and 82.8% respectively. There was an equal distribution of prognostic factors such as thickness, level of invasion, presence of ulceration, location and maximal size of the tumours in the two groups. As excisional biopsy with subsequent wide excision gives an accurate histopathologic diagnosis and permits a more rational treatment of thin melanomas, this form of treatment is recommended.

Surgical treatment of hyperhidrosis axillae.

58 patients have been operated on for axillary hyperhidrosis by excision of the skin and subcutaneous tissue. The hyperhidrotic area was determined by application of a crêpe paper in the axilla. Either 60% or 90% of the hyperhidrotic area was excised, using a bat-like pattern. Only after excision of 90% of the hyperhidrotic area acceptable results were achieved. In a series of 22 patients with 90% excision bilaterally 18 had excellent results, three were good, and one was poor. The entire series was without complication. The advantage of this technique is its simplicity, freedom from complication, performance on an out-patient basis, and short convalescent time.

Effect on bladder function of diversion of the contents of the small intestine to the urinary bladder in dogs.

The function of the lower part of the urinary tract after diversion of the contents of the small intestine to the bladder was studied in seven mongrel dogs. Cystometries and isobaric bladder volume were recorded. The observation time varied between six and 48 months. An initial decrease of the bladder volume was noted postoperatively. This decrease was more pronounced at the cystometrographic recordings on awake dogs than at the isobaric bladder volume registrations done under general anesthesia. At the six month examination, the bladder volume was unchanged or increased. The initial reduction in the bladder volume could be explained partly by the construction of the ileovesical anastomosis and, to some extent, by an inflammatory reaction of the bladder wall. No signs of progressive inflammatory reaction, leading to contraction of the bladder, were observed in any dog.

Histopathological studies of kidney and bladder after ileovesical diversion in dogs.

The histopathological changes in bladder and kidneys after diversion of the contents of the small intestine to the urinary bladder were studied in 8 mongrel dogs, 6 to 48 months postoperatively. The bladder showed a moderate inflammatory reaction, a slight hyperplasia of the epithelium, and a slight to moderate submucosal fibrosis. These changes did not seem to grow worse with increasing observation time. These results indicated that there were no major risks for progressive bladder contraction. Renal pelvises showed mild chronic inflammation and slight fibrous thickening of the wall. Localized pyelonephritic scarring was observed in one out of 10 kidneys, the other 9 being normal.

Reconstruction of large anterior full-thickness defect in the chest wall after resection of chondrosarcoma.

Radical removal of a chondrosarcoma resulted in a very large full-thickness defect of the anterior chest wall, including the body of the sternum and adjacent parts of the ribs on both sides. The defect was closed with a double layer of Marlex mesh supported by metal bars bridging the gaps between the ends of resected ribs. This prosthesis was covered with bilateral latissimus dorsi muscle flaps and a split-thickness skin graft. The result, from both the functional and the cosmetic points of view, was excellent. The method permits closure of very large chest wall defects, enabling extensive radical removal of malignant tumours to prevent local recurrence.

Surgical treatment of carcinoma of the clitoris.

Thirty-eight consecutive patients were treated with either vulvectomy (14) or in combination with groin dissection (24) according to the same treatment protocol. The crude 5-year survival was 50% and the corrected 5-year survival was 66%. Three patients died postoperatively. Endophytic tumor, poor degree of differentiation, and involvement of lymph nodes resulted in higher mortalities. No patient with involvement of deep inguinal or pelvic nodes could be cured. The study concludes that invasive squamous cell carcinoma of the clitoris should be treated, in the same was as the same tumor in other areas of the vulva, with radical surgery.

Management of deep sternal wound infection after cardiac surgery--Hanuman syndrome.

Deep sternal wound infection following open-heart surgery caused sternal osteitis in eight patients and mediastinitis in 27 during 1980-1989. The incidence of such infection was 0.5%. Infection was more common during the last 2 years than in 1980-1987 (0.8% vs. 0.4%), and when bilateral internal mammary artery grafts were dissected (3.2% vs. 0.6% when only one internal mammary artery was used). Cure of mediastinitis was achieved by primary closed irrigation in four of 13 patients and by primary open treatment in five of ten. Muscle flap was employed in totally ten patients and omentum in four before final elimination of infection. Of the 27 patients with mediastinitis, eight (30%) died in the post-operative period of cardiac failure (3 cases), disseminated infection (2), bleeding (2) or aspiration (1). The 5-year survival rate was 43%. Prosthetic value endocarditis caused one late death and necessitated one reoperation. If eradication of postoperative mediastinitis is not achieved by early diagnosis, debridement and closed irrigation, transposition of muscle or omentum should be considered.

Prognostic factors in cutaneous malignant melanoma in stage I. A clinical, morphological and multivariate analysis.

In a retrospective study of 324 cutaneous malignant melanomas in stage I, treated during the years 1959-74, the influence of different morphological and clinical factors on the prognosis was investigated. 223 patients with melanoma in levels II-V, observed for more than five years, were subjected to a multivariate analysis. 180/223 were in levels III-V. The age of the patient, the location of the tumour, its diameter, thickness, infiltration level, presence of ulceration and mitotic activity were shown to be of significant importance for the five-year survival of the 223 patients. Analysis limited to levels III-V disclosed that the diameter and the thickness of the tumour but not the infiltration level significantly influenced the prognosis. However, the sex of the patient, the histogenetic type of the tumour, the cross-sectional profile, vascular invasion and degree of lymphocytic infiltration did not correlate with survival.

Culture of human urothelial cells on a cell-free dermis for autotransplantation.

OBJECTIVE: Techniques for in vitro culturing and autotransplantation have been developed for a variety of human cells and are used today in several fields of medicine. In reconstructive surgery within the genitourinary tract, autologous urothelial cells cultured in vitro could be of considerable value but have not yet been used clinically. The aim of this study was to facilitate transplantation of cultured urothelium by establishing a reliable method for culturing urothel on an immunologically inert and biodegradable structure. METHODS: Normal human urothelial cells were cultured in vitro using a feeder-cell system. To achieve an optimal carrier structure, cells were removed enzymatically from a split thickness skin graft. Human urothelial cells were then seeded on the cell-free dermis and incubated in vitro. The seeded dermis samples were investigated histologically and with immunohistochemical methods at days 7, 14 and 21. RESULTS: The human urothelial cells incubated in vitro reached confluence after 7-10 days and the cells could be cultured through 9 passages with preserved proliferative potential. When the cells were seeded on a cell-free dermis they attached, formed colonies and became confluent and stratified up to three cell layers after 21 days of incubation. The urothelial origin of the cells was confirmed by immunohistochemical staining against cytokeratin. CONCLUSION: The advantages of culturing the urothelial cells on a cell-free dermis include a short time lag until grafts are available, probably facilitated transplantation procedure, transplantation of undifferentiated cells and the formation of a vascularised base under the new urothelium. The method described in this study may be of great value in providing autologous urothelium for reconstructive surgery in the genitourinary tract.

Basal cell carcinoma in children. Case report.

Clinical and pathoanatomic features of two children with basal cell carcinoma, an extremely uncommon disease in childhood, are reported. Clinically these lesions had a benign appearance, similar to a foreign body granuloma and an intradermal naevus, respectively, but histological examination showed a picture typical of basal cell carcinoma. The tumours were radically treated and no recurrence occurred during an observation time of 12 and 42 months, respectively.