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Unlabelled: To evaluate results obtained using the protection device technique for osteosintesis or suture of extensor mechanism lesions., Material and Methods: The authors reviewed 18 charts of patients submitted to protection device technique due to traumatic lesion of extensor mechanism that had occurred between the anterior tibial tuberosity and the apical portion of patella. Age ranged from 22 to 69 years, with a mean of 44 years. Male patients prevailed, with 67% of the cases. The most affected spot was, in 83% of the cases, the apical distal third. A protocol was created to collect data, listing the patients and the clinical history from their medical records., Results: The authors observed consolidation of the patella fracture in all 17 patients, and cicatrization of the patellar ligament in one patient. Pain was described in four patients. There were no complications related to the procedure., Conclusion: The protection device showed to be efficient when used in surgical treatment of lesions between the apical patella and the anterior tibial tuberosity, providing active and passive mobility in the early postoperative time.

Objective: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL) reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel., Methods: Fourteen patients with isolated PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scales. Posterior knee laxity was examined with a KT1000 arthrometer., Results: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow-up. In the IKDC evaluation, 3 patients were graded A, 10 were graded B, and 1 patient was graded C., Conclusions: Double bundle arthroscopic PCL reconstruction based on the anatomical positioning of the tunnels, with double semitendinosus tendon and single quadriceps, provides a clinically evident reduction in symptoms and restores satisfactory stability, although no statistically significant difference was found due to the small sample.

Objective: To determine the diagnostic value of ultrasonography and its capabilities in evaluating the involvement of abdominal organs and peripheral lymph nodes, in analyzing the morphological subtypes in lymphomas, in choose the lymph node that is most informative for a histological study., Subject and Methods: 193 patients with lymphomas, including 85 (44%) with lymphogranulomatosis and 108 (56%) with non-Hodgkin's lymphomas who had been treated at the clinical units of the Prof. R.O. Eolyan Hematology Center, Ministry of Health of the Republic of Armenia, in 2006-2009 were examined. Their ultrasound examination was made using Aloka SSD500 apparatuses with 3.5--and 5.0 MHz convex transducers, a Medison SA6000 probe with a 7.0 MHz C3-7ED linear transducer and a 3.5 MHz HL5-9ED convex transducer, an Acuson probe with a 7.0 MHz linear transducer and a 3.5 MHz convex transducer, by applying polyposition gray-scale scanning (B mode) and real-time color Doppler flow mapping., Results: The patients with lymphomas were clinically characterized; data on the nature and extent of the involvements of different anatomic groups of lymph nodes, organs, and systems (spleen, liver, thyroid, etc.) are given., Conclusion: B-mode ultrasonography is an essential component of a comprehensive diagnostic examination in patients with lymphomas. It is important to detect primary lesion foci and to estimate their distribution and extent in the nodal and extranodal organs and systems, mediastinum in the ultrasound diagnosis of lymphomas.

Background: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history., Objective: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN., Design, Setting, and Participants: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade., Measurements: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival., Results and Limitations: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival., Conclusions: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed., (2009 European Association of Urology. All rights reserved.)

Varus deformity of the knee is a determining factor in the development of osteoarthrosis of the medial compartment. Open wedge osteotomy corrects the deformity and has quickly become popular due to the fact that the surgical technique can be easily reproduced, it spares loss of bone tissue in the metaphysiary region, and it does not require muscle dissection, reducing the risk of lesion of the fibular nerve. The objective of this study was to evaluate the characteristics of a new fixation implant (Anthony-K plate - France Bloc S.A, CE n0499, ISO 9001, EN 46001), in terms of its clinical improvement, correction of the deformity, and slope alteration. Twenty adult patients with varus deformity were evaluated, and submitted to open wedge high tibial osteotomy using the Anthony plate, between October 2004 and November 2006. The varus deformity was corrected in all cases, and there was a significant increase in the Lysholm score. Correlation analysis has shown that the greater the preoperative varus deformity, the larger the opening wedge used. Also, the greater the initial posterior tibial slope, the larger the final posterior tibial slope (p=0.0168). There were no complications. The Anthony plate can be considered an alternative in the treatment of medial osteoarthrosis of the varus knee, enabling the correction of the deformity and improvement of the clinical picture. It occurs an increase in posterior tibial slope, similar to that observed with other fixation materials. More studies with the Anthony plate are necessary, after these encouraging results.

Purpose: We evaluated urinary collecting system invasion as a prognostic parameter of renal cell carcinoma., Materials and Methods: A total of 1,124 patients who underwent nephrectomy for a renal tumor at 5 European centers were included in this retrospective study. Several variables were analyzed including urinary collecting system invasion, age, sex, TNM stage, Fuhrman grade, histological subtype, Eastern Cooperative Oncology Group performance status and cancer specific survival., Results: There were 771 males (68.6%) and 353 females (31.4%) in this study, and median age was 61 years (range 14 to 88). Median tumor size was 6 cm (range 1 to 24). Tumors were organ confined and Fuhrman grade was recorded as 1 or 2 in 67.1% and 62.3% of cases, respectively. Symptoms were present at diagnosis, and Eastern Cooperative Oncology Group performance status was 1 or more in 50.3% and 16.1% of the cases, respectively. Median followup was 43 months (range 1 to 299). At the end of followup 246 patients (21.9%) died of cancer. In 132 cases (11.7%) urinary collecting system invasion was noted. Urinary collecting system invasion was associated with symptoms, TNM stage, Fuhrman grade, tumor size (p <0.001) and Eastern Cooperative Oncology Group performance status (p = 0.003), but not with histological subtype (p = 0.7). On univariate analysis TNM stage, Fuhrman grade, symptoms, Eastern Cooperative Oncology Group performance status, tumor size and urinary collecting system invasion (p = 0.0001) were significant predictors of cancer specific survival. Urinary collecting system invasion was an independent prognostic parameter only in the setting of pT1-T2 tumors. When the urinary collecting system was invaded the 5 and 10-year probabilities of survival were 43% and 41%, respectively., Conclusions: Urinary collecting system invasion appears to be an independent prognostic parameter of organ confined renal cell carcinoma. Our data support the need to integrate this parameter in further TNM revisions.

The study was performed to determine factors affecting successful sperm retrieval by testicular sperm extraction in patients with nonmosaic Klinefelter's syndrome (KS). From May 2001 to February 2007, 27 azoospermic patients were diagnosed as having nonmosaic KS. All patients underwent sperm testicular extraction. Patient's age, testicular volume, serum follicle-stimulating hormone (FSH) and inhibin B were assessed as predictive factors for successful sperm recovery. Of the 27 Klinefelter's patients examined, eight (29.6%) had successful sperm recovery. The comparisons of serum FSH, inhibin B and testicular volume between patients with and without successful sperm retrieval did not show any statistical significance. The patients with successful sperm recovery were significantly younger (28.6 +/- 3.11 years) than those with failed attempts (33.9 +/- 4.5 years, P = 0.002). The rate of positive sperm retrieval was significantly higher in patients younger than 32 years compared with patients older than 32 years (P = 0.01, chi-squared test). The study showed that clinical parameters such as FSH, inhibin B and testicular volume do not have predictive value for sperm recovery in patients with KS. The mean age of our patients with successful sperm recovery was significantly lower than that of men with unsuccessful results. Testicular sperm extraction or testicular sperm aspiration should be performed before the critical age of 32 years.

Objective: To evaluate our early experience with neoadjuvant therapy (sunitinib or sorafenib) in advanced renal cell carcinoma (RCC), to explore the effect on both tumour biology and potential for downstaging advanced tumours, as systemic therapy for RCC has historically resulted in little if any primary tumour response, but recent experience with targeted therapy suggests otherwise., Patients and Methods: The preliminary experience with neoadjuvant therapy for the surgical management of RCC was reviewed at two large referral centres. Several unique patients were identified who had a novel response to systemic therapy that altered the surgical strategy., Results: Four patients who had targeted therapy before surgery are described and in whom there were effects on tumour biology not seen previously with chemotherapy and cytokine therapy. The selected patients who had neoadjuvant targeted therapy had shrinkage of a tumour thrombus in the inferior vena cava, nodal involvement, renal fossa recurrence and tumour within a solitary kidney., Conclusions: The introduction of new molecular agents has revolutionized the treatment of patients with metastatic RCC. Responses to targeted therapy within the primary tumour, tumour thrombus, renal fossa recurrence, and lymph node metastases are novel findings not seen during treatment with immunotherapeutic-based strategies. This might be a signal for urological surgeons to re-evaluate the paradigm for the surgical management of advanced RCC. Potential applications are presented to encourage further investigations with targeted therapy in the neoadjuvant setting.

Purpose: The purpose of this article is to report our experience concerning the indications and results for combined liver-kidney transplantation in our centre., Material and Method: From July 1991 to October 2006, 26 patients underwent combined liver-kidney transplantation in our establishment. This group comprised 16 men and 10 women with a mean age of 50.1 years (range: 19 to 68 years). The main indications were as follows: hepatorenal polycystic disease, type I hyperoxaluria, cirrhosis associated with end-stage renal failure., Result: The median follow-up was 62.73 (+/-50.9) months. Only two patients of this series died, one at 70 months from gastric cancer, and the other at 89 months from cerebral metastases. Nine patients developed surgical complications (29%). Liver function was normal in the 24 surviving patients. Only one case of loss of renal graft was observed at 12 years and this patient is currently on dialysis. The mean creatinine level in these patients (apart from the dialysed patient) at the last follow-up visit was 120.3 (+/-30.43)micromol/l., Conclusion: Combined liver-kidney transplantation can be performed with acceptable morbidity and mortality and excellent long-term results.

The first measurements of double-hadron production in deep-inelastic scattering within the nuclear medium were made with the HERMES spectrometer at DESY HERA using a 27.6 GeV positron beam. By comparing data for deuterium, nitrogen, krypton, and xenon nuclei, the influence of the nuclear medium on the ratio of double-hadron to single-hadron yields was investigated. Nuclear effects on the additional hadron are clearly observed, but with little or no difference among nitrogen, krypton, or xenon, and with smaller magnitude than effects seen on previously measured single-hadron multiplicities. The data are compared with models based on partonic energy loss or prehadronic scattering and with a model based on a purely absorptive treatment of the final-state interactions. Thus, the double-hadron ratio provides an additional tool for studying modifications of hadronization in nuclear matter.

The Hermes experiment has investigated the tensor spin structure of the deuteron using the 27.6 GeV/c positron beam of DESY HERA. The use of a tensor-polarized deuteron gas target with only a negligible residual vector polarization enabled the first measurement of the tensor asymmetry A(d)zz and the tensor structure function b(d)1 for average values of the Bjorken variable 0.01< <0.45 and of the negative of the squared four-momentum transfer 0.5 GeV2 < <5 GeV2. The quantities A(d)zz and b(d)1 are found to be nonzero. The rise of b(d)1 for decreasing values of x can be interpreted to originate from the same mechanism that leads to nuclear shadowing in unpolarized scattering.

Single-spin asymmetries for semi-inclusive electroproduction of charged pions in deep-inelastic scattering of positrons are measured for the first time with transverse target polarization. The asymmetry depends on the azimuthal angles of both the pion (phi) and the target spin axis (phi(S)) about the virtual-photon direction and relative to the lepton scattering plane. The extracted Fourier component sin((phi+phi(S))(pi)(UT) is a signal of the previously unmeasured quark transversity distribution, in conjunction with the Collins fragmentation function, also unknown. The component sin((phi-phi(S)(pi)(UT) arises from a correlation between the transverse polarization of the target nucleon and the intrinsic transverse momentum of quarks, as represented by the previously unmeasured Sivers distribution function. Evidence for both signals is observed, but the Sivers asymmetry may be affected by exclusive vector meson production.

Double-spin asymmetries of semiinclusive cross sections for the production of identified pions and kaons have been measured in deep inelastic scattering of polarized positrons on a polarized deuterium target. Five helicity distributions including those for three sea quark flavors were extracted from these data together with reanalyzed previous data for identified pions from a hydrogen target. These distributions are consistent with zero for all three sea flavors. A recently predicted flavor asymmetry in the polarization of the light quark sea appears to be disfavored by the data.

Purpose: To determine whether the presence of calcification in the cavernous segment of the internal carotid artery seen on head computed tomography (CT) performed in the emergency department shows any relationship to the existence of systemic disease. Significant and consistent relationships could be used as predictors in suggesting the presence of systemic disease in those patients receiving head CTs for unrelated symptoms., Methods: A retrospective investigation was performed on 295 consecutive patients presenting to the Massachusetts General Hospital emergency department for head CT scan during the course of 1 month. Head CT images were analyzed for carotid siphon calcifications. Data regarding multiple predictors of disease including gender, age, hypertension, diabetes, smoking, hypercholesterolemia, cardiac disease, and alcohol and intravenous drug abuse were abstracted from the medical record for each patient., Results: Strong univariate correlation was noted in the comparison between the presence of carotid siphon calcification and gender, age, diabetes, hypertension, smoking, and cardiac disease while alcohol and intravenous drug abuse correlated poorly. Multivariate models including categorized age and gender demonstrated a consistently strong interaction with diabetes, cardiac disease, and smoking while hypertension and hypercholesterolemia showed a loss of significance. Interaction term analysis indicated a strong (ie, significant) interaction between gender and both hypertension and hypercholesterolemia., Conclusions: Carotid siphon calcifications are strong predictors of existing medical disease in simple cases. In patients with a combination of diseases, a strong interaction between covariates is noted, suggesting a more complex interaction contributing to the formation of carotid siphon disease.

Spin-dependent lepton-nucleon scattering data have been used to investigate the validity of the concept of quark-hadron duality for the spin asymmetry A1. Longitudinally polarized positrons were scattered off a longitudinally polarized hydrogen target for values of Q2 between 1.2 and 12 GeV2 and values of W2 between 1 and 4 GeV2. The average double-spin asymmetry in the nucleon resonance region is found to agree with that measured in deep-inelastic scattering at the same values of the Bjorken scaling variable x. This finding implies that the description of A1 in terms of quark degrees of freedom is valid also in the nucleon resonance region for values of Q2 above 1.6 GeV2.

Exclusive coherent and incoherent electroproduction of the rho(0) meson from 1H and 14N targets has been studied at the HERMES experiment as a function of coherence length (l(c)), corresponding to the lifetime of hadronic fluctuations of the virtual photon, and squared four-momentum of the virtual photon (-Q2). The ratio of 14N to 1H cross sections per nucleon, called nuclear transparency, was found to increase (decrease) with increasing l(c) for coherent (incoherent) rho(0) electroproduction. For fixed l(c), a rise of nuclear transparency with Q2 is observed for both coherent and incoherent rho(0) production, which is in agreement with theoretical calculations of color transparency.

To acquire multiple longitudinal locations in the lower extremity after a single contrast injection, appropriate table translation and contrast injection are required. An approximate model based on constant bolus velocity was developed to describe the space-time course of a contrast bolus in the lower extremity. This model was verified in dynamic MR angiograms acquired in a group of patients using time-resolved 2D MR digital subtraction angiography (MRDSA). From this contrast bolus passage model, a timing algorithm for table translation and contrast injection was developed for bolus chase MRDSA, subsequently validated in bolus chase 2D MRDSA experiments. All targeted major peripheral arteries were well depicted in bolus chase 2D MRDSA using this timing algorithm and a single 15-ml contrast dose.

This article reviews the many facets of toxic epidermal necrolysis. Emphasis is placed on the importance of early diagnosis, burn unit placement, supportive care, and avoidance of systemic steroids. Discussion also includes other therapeutic options and the pathophysiology of the disease.

Using the evoked potentials (EP) studies have been made on functional connections of different fields (CA1, CA3) of the dorsal hippocamp with phylogenetically different parts of the hypothalamus in rabbits. It was shown that during stimulation of both the field CA1 and the field CA3 of the hippocamp, the EP are widely present in nuclear structures of the posterior hypothalamus (supramammilary area, the posterior hypothalamic area, mammilary bodies). In the anterior hypothalamus (area preoptic medialis), the EP were recorded only during stimulation of the field CA1 in the dorsal hippocamp.

Gradually accumulating subconvulsive doses of metrazol give rise to behavioral and electrographic effects close to petit mal epilepsy: slow negative waves and spike-wave complexes on EEG, frozen and myoclonic jerks. Intensification of monoaminergic transmission with apomorphine, DOPA or 5-hydroxytryptophan attenuates, but inhibition (chlorpromazine, haloperidol and p-chlorphenylalanine), on the contrary, increases the subconvulsive effect of the metrazol. Low frequency stimulation of the striatum potentiates, and lesion limits expressiveness of metrazol-induced petit mal. Bilateral electrolytic lesion of the striatum eliminates apomorphine, DOPA and haloperidol action, but slight changes the effects of chlorpromazine, 5-hydroxytryptophan and p-chlorphenylalanine.

In freely moving cats the behavioral and EEG-shifts, accompanied by myoclonic jerks with slow negative waves and spike-wave complexes in the cortexand caudate nucleus, were recorded following a single intramuscular injection of high penicillin doses. The stimulants of catecholaminergic transmission (L-DOPA and apomorphine) inhibited the development of such phenomena but facilitated origination of tonicoclonic cramps. The inhibitors of catecholaminergic synapses (aminazin and haloperidol) exerted reverse effects. The electrolytic injury to the caudate nucleus head also prevented formation of petit mal-like seizures while the threshold low-frequency stimulation of the nucleus increased penicillin effect.

In the freely moving rats stimulants of catecholaminergic tramission (DOPA, apomorphine, d,1-amphetamine, and also their combination with disulfiram) reduced the proconvulsive properties of the caudate nucleus. Under the effect of these substances there occurred a shortening of the cortical electroencephalographic response to a single stimulation of the nucleus in the animals given subconvulsive doses of pentaxylenetetrazol and a reduction of the extent of the spike-wave rhythm induced by the repeated caudate stimuli. On the contrary, inhibitors of catecholaminergic transmission (chlorpromazine, haloperidol, alpha-methyltyrosine and disulfiram) intensified the proconvulsive effect of the caudate nucleus.

The effect of 5-oxytryptophane (5-OT) and of parachlor-phenylalanine (pCPA) on the behaviouristic EEG manifestations of metrazol convulsions in electrostimulation and destruction of the striatum was studied. The effect of the preparations on the myoclonia and the spike-wave rhythm caused by metrazol did not largely depend on the functional condition of the corpus striatum. The capacity of 5-OT to facilitate, and of pCPA to aggravate the course of generalized convulsions and of the postconvulsive state became enhanced in stimulation and was eliminated after the destruction of the striatum.

In chronic experiments with freely moving cats the action of diverse metrazol doses on the d,1-amphetamine-induced stereotype behaviour and the arrest reaction following low frequency stimulation of the caudate nucleus was studied. After injections of metrazol (20--30 mg/kg, i.c.) myoclonic seizure jerks and decreased locomotion occurred. This state was accompanied by depression of the stereotype behaviour and lowered arrest reaction threshold. It is suggested that some behavioural and the EEG metrazol-induced changes may come as a result of the caudate nucleus activation.

The paper is concerned with a clinico-experimental study of the influence of intesified activity in the neostriatum on the EEG indices which may appear during the introduction of increased doses of corazol. In 10 cases with different forms of parkinsonism there was a much easier appearance of clinical and EEG manifestations of convulsive activity, than in normals. In experiments on rats preconvulsive effects were exerted by such neuroleptics as haloperidol unlike apomorphine, possessing opposite properties.

In gradual cumulation of subconvulsive doses of corasole in mice there are certain changes of behaviour and electrographical signs which are close to "petit mal": slow negative waves and peak-wave complexes on the EEG, myoclonic jerks. An increase of monoaminergic transmission of apomorphine, DOPA, or 5--hydroxyhyptophane weakens the preconvulsive effect of corasol, while its inhibition by aminasine, haloperidol and p-chlorphenylalanine on the contrary increases it. A low frequency electric stimulation of the striatum potentiates the expressiveness of corasole "petit mal", while its destruction limits it. A bilateral destruction of the striatum eliminates the action of apomorphine, DOPA and haloperidol but only slightly changes the effect of aminazine, 5-hydroxytryptophane and p-chlorphenylalanine.

A single or rhythmical (1-3/sec) stimulation of the caudate nucleus in unrestrained rats facilitated formation of slow negative waves and the spike-wave complexes in the EEG of the sensory-motor cortex and contralateral neostriatum, as well as development of behavioral disturbances due to subseisure doses of pentylentetrazol. During the low-frequency stimulation of the caudate nucleus or after its cessation, when giving the convulsant drug, regular potentials of the spike-wave type or a general seizure may occur. The caudate nucleus is supposed to be able to participate in the petit mal seizure mechanisms because of its syndhronizing influences on the cortex.

Behaviouristic and EEG-manifestations of pentylentetrazol convulsions were studied in unrestrained rats with preliminarily destroyed striatum. The operation caused no significant disturbance of the appearance of the spike-wave activity, but sharply inhibited provocation of myoclonic and their change into tonico-clonic convulsions. Besides, there was an increase in the threshold, the duration and the severity of the attack; an epileptic status was even observed in 50% of these rats. Striatectomy eliminated the action of catecholaminergic agents (apomorphine, DOPA, haloperidol, chlorpromazine) on the thresholds of myclonic jerks and the attack.