Annales chirurgiae et gynaecologiae. Supplementum最新文献

Twenty cases of adenocarcinoma of the urinary bladder were diagnosed and treated at Oulu University Hospital between 1978 and 1991, comprising nine primary adenocarcinomas (three urachal and six non-urachal) and 11 of extravesical origin (six from the colon, four from the prostate and one from the perineal skin). The prognosis for primary adenocarcinoma after radical surgery was relatively favourable during a follow-up of mean 54 months, but extravesical origin carried a high mortality rate. The diagnostic and therapeutic aspects are discussed.

Bone formation around bioactive glass implants (S56.5P4) in the trabeculous subchondral bone in the distal femur of rabbits was studied by histology and scanning electron microscopy. Three types of tissue: bone, connective and hematopoietic tissue developed around the implants resulting in lamellar new bone covering 76% of the surface of the implants at twelve weeks. Bone formation around implants began as woven bone changing mainly to lamellar, osteon like new bone in contact with the S56.5P4 surface. Endochondral ossification was absent. In the area of bone containing hematopoietic tissue, new bone grew often as a thin layer along the implant surface. However, bone seemed to form adjacent to the implant surface through osteo-conduction. Only 21% of the implant surface was covered by loose connective tissue. Some proteoglycan containing thin fluid filled spaces were seen ten days after implantation. In few areas with apparent breakdown of the implant surface decreased amount or no bone formation was observed. Von Kossa method stained the reaction layer as two parallel dark brown lines, toluidine blue as two blue stripes, whereas van Gieson did not stain the reaction layer at all. In conclusion, the present histological results indicate bone bonding, which is a physico-chemical process observed between S56.5P4 implant and host bone.

The diagnostic value of pharmacotesting in impotence is controversial. The results of high dose prostaglandin pharmacotesting were compared with those of colour duplex Doppler scanning and pharmacocavernometry in 82 impotent patients and 10 control subjects. Based on the results of 10 control subjects, the prostaglandin test was defined as positive if intracavernous pressure 200 minutes after injection of 40 micrograms prostaglandin E1 was > or = 42 mm Hg and negative if intracavernous pressure was < 42 mmHg. The test was repeated in 29 subjects and classified results were consistent in 24 subjects (86%, k = 0.65). The test was negative in 52 out of 56 patients (sensitivity 93%) with vasculogenic impotence (arteriogenic and/or cavernovenous factor involved) and the test was positive in 21 out of 26 patients (specificity 81%) with non-vasculogenic impotence (arteriogenic or cavernovenous factor not involved). The majority, 27 out of 31 patients (87%) with arteriogenic impotence showed simultaneous dysfunction of cavernovenous occlusion mechanism. In conclusion, pharmacotesting with high dose prostaglandin is a useful screening test of vasculogenic impotence.

At present, about 80% of primary, newly diagnosed urinary bladder cancers are local (NOMO), i.e., potentially curable. Not less than two thirds of all are superficial cancers (TIS, Ta, T1), and thus subjects of conservative, local treatments. Carcinoma in situ (TIS/CIS) has three clinical manifestations: 1) primary TIS is found without a previous history of bladder cancer, 2) secondary TIS is found during the follow-up of an earlier cancer, and 3) concomitant TIS is found simultaneously with a papillary tumour. Otherwise, there are controversial diagnostic and therapeutic attitudes on TIS. Concerning the primary diagnosis and grading, the reliance on cytological possibilities varies in separate centres. "Wait-and-see policy" might be justified in mild dysplasia Grade 1, whereas both the TIS Grade 2, and TIS Grade 3, are real malignancies which need a more effective treatment than transurethral resection (TUR) alone. Under a close control, intravesical chemo- and immunotherapy with doxorubicin (ADM), mitomycin C (MMC) and bacillus Calmette-Guérin (BCG) offer an alternative to cystectomy. However, it remains to be seen in the future whether combined or alternating instillations will give a still better return. By contrast, the principal treatment of visible superficial (Ta and T1) cancer is TUR, which can be easily repeated. Most recommended strategy for Grade 3 T1 cancer seems to be the same. Anyhow, the high frequency of recurring tumours and the tendency to simultaneous progression in specific categories of Ta-T1 cancer have led to adjuvant prophylactic instillation treatments. Currently, both local cytostatics (ADM and MMC in the present series), and immunoagents (BCG) have been proven safe.(ABSTRACT TRUNCATED AT 250 WORDS)

Mesenchymal cell stimulation and angiotropic effects suggest a fibrin sealant-mediated enhancement of osteogenesis. For its glueing capacity fibrin sealant is also regularly used in bone surgery. However, its influence on osteoregeneration is debatable. The effect of fibrin sealant on bone matrix gelatin dependent ectopic and orthotopic osteoinduction in rats was studied. Neither biochemical nor histologic parameters revealed a direct influence of fibrin sealant on any osteoinductive process.

To study the effect of hydroxyapatite (HA) granules on new bone formation induced by allogeneic demineralized bone matrix (DBM) and to ascertain the specific dose response of bone regeneration in rabbit calvarial defects, implantation with different doses of DBM, HA granules and a mixture of DBM with HA, respectively, was undertaken. The results showed that the largest quantity of cartilage in the fourth week and woven and remodeled bone covering almost the whole area of the defect in the tenth and twelfth week, was visible in the 20-30 mg but not in the 40 mg DBM groups. New bone formation in the defects implanted with DBM and HA was markedly less than in those implanted with DBM alone and a large amount of fibrous tissue was initiated by HA granules. A significant negative correlation between new bone formation and fibrous tissue ingrowth was noted. HA granules, as disturbing the bone regeneration induced by DBM, are thus not a desirable combination, and a dose-block phenomenon according to the amount of DBM must be anticipated in repairing skull defects.

The clinical efficacy, cardiovascular complications and mortality of polyestradiol phosphate (PEP) 160 mg/month i.m. were compared with the luteinizing hormone releasing hormone (LHRH) analog, buserelin, in a prospective, randomised multicentre study including 147 patients with prostatic cancer. The cumulative non-progression rate at three years was 0.53 in the PEP group and 0.70 in the LHRH group. The mortality from cardiovascular diseases was the same in the two treatment groups. The parenterally given PEP was not associated with an increased risk of cardiovascular complications. The dosage of PEP 160 mg monthly seems, however, to be insufficient in the treatment of prostatic cancer.

A rat subcutaneous model was used to test the osteoinductive efficacy of a composite consisting of natural coral, collagen, a bone morphogenetic protein-like material [termed bone protein (BP)], and basic fibroblast growth factor (bFGF). Results indicated good ossicle formation only when BP was present, whether with or without bFGF. Initially, cartilage and mineralized cartilage were apparent. With time, osteoblastic bone formation and hematopoietic marrow were evident. bFGF may have enhanced the maturation of the ossicles in the early stages. Coral-collagen appears to be a good carrier vehicle for BP and should be tested in a bony site. This would allow the osteoconductive property of coral to be expressed.

Between December 1988 and January 1992, 11 men underwent lower urinary tract reconstruction by means of the hemi-Kock ileal reservoir following radical cystoprostatectomy (ten patients) and subtotal cystectomy (one patient). Six of the 11 patients developed an early postoperative complication, with a fatal outcome in two of them. One patient succumbed to subarachnoidal bleeding and one to septic shock. During the follow-up, another two men died of advanced bladder carcinoma. The late complication rate was low. Most patients regained their continence within six months. A good continence was achieved in all the nine remaining patients during the day and in six of them at night. This experience suggests that the hemi-Kock reservoir is a useful method for the urinary tract reconstruction following cystectomy.