Interpersonal variability and present diagnostic dilemmas in Bosniak classification system.

Objective: The purpose of the study was to evaluate the management and interpersonal variability of Bosniak classification and demonstrate the present diagnostic dilemmas.

Material And Methods: One-hundred and four patients with 113 complex renal cystic masses (26 Bosniak II,15 IIF,28 III and 44 IV) were included and analysed between April 1996 and May 2009.In total, 71 cystic masses were characterized by two radiologists in consensus initially as the first diagnosis (group 1), and then by a radiologist (group 2) and a urologist (group 3) independently in a blinded fashion.

Spinal epidural lubricant grease collection mimicking traumatic spinal epidural hematoma.

We report an unusual case of a patient with an epidural fluid collection with signal characteristics mimicking an epidural hematoma. The patient presented with myelopathy caused by thoracic spinal cord compression after a traumatic injury to the chest and back. The injury was caused by high-pressure injection of industrial-grade lubricant grease.

Conquering the third ventricular chamber.

Surgery within the third ventricle was a special challenge early in the conception of the discipline of neurosurgery due to a lack of diagnostic methods and difficulty in reaching and removing lesions affecting this vital region. Walter Dandy and Harvey Cushing performed pioneering approaches of the third ventricular region. The authors have reviewed the previously undisclosed efforts of Cushing to approach the third ventricle through a direct review of his available patient records at the Cushing Brain Tumor Registry.

Use of the thyrocyte sodium iodide symporter as the basis for a perchlorate cell-based assay.

Perchlorates are strong oxidants widely employed in military and civilian energetic materials and recently have been scrutinized as persistent environmental pollutants. The perchlorate anion, ClO(4)(-), is a well-known and potent competitive inhibitor of iodide transport by the sodium iodide symporter (NIS) expressed in the basolateral membranes of thyroid follicular cells (thyrocytes). Iodide uptake by thyroid follicular cells is rapid and reproducible.

Mutational replacement of Leu-293 in the class C Enterobacter cloacae P99 beta-lactamase confers increased MIC of cefepime.

The class C beta-lactamase from Enterobacter cloacae P99 confers resistance to a wide range of broad-spectrum beta-lactams but not to the newer cephalosporin cefepime. Using PCR mutagenesis of the E. cloacae P99 ampC gene, we obtained a Leu-293-Pro mutant of the P99 beta-lactamase conferring a higher MIC of cefepime (MIC, 8 microg/ml, compared with 0.

[Clinical and histopathologic picture of acute appendicitis in children].

A retrospective study of the clinical and histopathological picture of acute appendicitis in children confirms agreement of the evaluation of the finding on the appendix made by the surgeon and pathologist in 72.2% and disagreement in 27.8%.

[Blunt tracheobronchial injuries in children].

Blunt tracheobronchial injuries in children are rare and are associated with many diagnostic problems. Based on the successful outcome in a seven- and a twelve-year-old patient operated within 12 hours after the accident the authors discuss the development of the symptomatology and early clinical, X-ray, bronchoscopic and CT diagnosis of rupture which are, if intensive care and early treatment of the injury are ensured, the basis for preserving normal pulmonary function and ensure prevention of sequelae due to obstruction and infection. The children were admitted to hospital for 22 and 14 days resp.

[An abdomino-scrotal hydrocele].

Abdominoscrotal hydrocele is encountered rarely in child age. The authors present an account on two patients with abdominoscrotal hydrocele in a three- and fifteen-year-old boy. They discuss its development, draw attention to the not very marked clinical manifestations, diagnostic pitfalls and the contribution of sonography to diagnosis.

Selection and characterization of beta-lactam-beta-lactamase inactivator-resistant mutants following PCR mutagenesis of the TEM-1 beta-lactamase gene.

Mechanism-based inactivators of beta-lactamases are used to overcome the resistance of clinical pathogens to beta-lactam antibiotics. This strategy can itself be overcome by mutations of the beta-lactamase that compromise the effectiveness of their inactivation. We used PCR mutagenesis of the TEM-1 beta-lactamase gene and sequenced the genes of 20 mutants that grew in the presence of ampicillin-clavulanate.

[The clinical picture of acute appendicitis in children].

The authors describe 3860 child patients operated on account of acute appendicitis and analyse the data with regard to age, sex, year of incidence and surgical finding. The highest incidence of acute appendicitis is between 8 and 11 years with a peak at the age of 10 years. It is more frequent in boys (58.

[Surgical correction of genital virilization in girls with congenital adrenal hyperplasia].

Based on an analysis of 10 patients after a feminizing operation of a virilized genital in female pseudohermaphroditism caused by congenital adrenal hyperplasia on account of 21-hydroxylase deficiency the authors emphasize in conjunction with multidisciplinary collaboration the necessity of early modification and surgical repair with adjustment of the external genital before the age of two years. An excellent anatomical and cosmetic result of reconstruction with clitoroplasty emphasizes the importance of preserving the clitoris and erectile tissue to ensure adequate social, psychic and sexual development of the patient.

[The human spleen in idiopathic thrombocytopenic purpura].

Idiopathic (autoimmune) thrombocytopenic purpura (ITP, AITP) represents a relatively frequent impairment. It involves a syndrome of various diseases with a shortened thrombocytes survival caused by anti-platelet antibodies. The majority of cases are of secondary character.

[Bacterial flora in the appendix in rabbits with artificially induced acute appendicitis].

The authors present the results of bacteriological analysis of scrapings from the appendical mucosa of 24 rabbits with appendicitis induced by obstruction of the appendix lumen and of 5 rabbits with healthy appendices (controls). In dependence on the duration of inflammation, the recovery of aerobic bacteria was decreasing and that of anaerobic nonsporulating bacteria was increasing. In the group of anaerobic bacteria, gram-negative rods were predominant (number of isolated colonies: 2973 = 79.

[Female sterility after appendicitis in childhood].

The aim of the study was to establish the rate of sterility in women who had been operated on in childhood for perforated and non-perforated appendicitis. The group with perforated appendicitis consisted of 58 women who had been operated on at the age of 3 to 15 years and at the time of the follow-up examination they were in the age range of 23 to 41 years. Of these women 51 were married and 49 of them had one to three children.

[Structural basis of appendiceal function in rabbits].

Enzymo-, immuno- and lactin-histochemical methods were used to study the structure of the rabbit appendix wall. The value of some structural components in the function of this part of the intestine is discussed. Some findings were documented electronmicroscopically.

[Unusual burns in older boys].

The authors give an account a less frequent mechanism of burns in older boys during the domestic manufacture of smoke-boxes from a mixture of sodium dithionite (decolourizer) and urea peroxyhydrate (solid hydrogen peroxide). The chemical reaction explains the development of exogenous heat and the depth of burns. The authors analyze their own material of 16 patients and emphasize early necrectomy and prevention.

[Ileus after appendicitis in children].

A relatively frequent and alarming complication of appendicitis in children is ileus. The authors submit an analysis of 41 cases of ileus with a time interval of 3 days to 8 years after appendectomy. In eight patients conservative treatment was successful, and 33 children were operated with the finding of intraabdominal adhesions (23 times), bands (3 times), abscesses and adhesions (7 times).

[A scanning electron microscopy study of the normal rabbit appendix].

The surface relief of the mucous membrane of the normal rabbit appendix was studied under scanning electron microscopy. Two different types of surface relief were identified. One consisted of relatively regular crests and grooves of the mucosa, the other one exhibited scattered crater-like openings into which "heads of lymphatic nodes" were inserted to varying extent and which were separated from the surface mucosa by broad alveolar cavities.

[Lectin histochemical analysis of the epithelial lining of the appendix in rabbits].

The binding of PSA, PNA, HPA, WGA, Con A, LCL, RCA, SBA, and PHA lectins to epithelial structures of the normal rabbit appendix was studied. Differences were observed in the affinity of some lectins to the epithelium of the intercryptal lining of the rabbit appendix, to the epithelium hemming the glandules and crypts of the domes of Peyer's patches. The obtained results document the difference in the affinity of individual batches of anti-WGA antibodies to this lectin after its binding to the epithelial structures studied.

[Improvised reconstruction of the esophagus in concurrent atresia and nonrotation].

In the course of three years, 1985-1987, 21 children with congenital atresia of the oesophagus were operated, incl. four where the oesophagus had to be replaced by the large intestine. Each operation had unforeseen complications, all children survived, however, and are thriving.

[Surgery in pectus excavatum without fixation aids].

Analysis of 40-year experience with operations for pectus excavatum over the period from 1950-1988 is presented. In a series of 177 children ten different surgical approaches were used in succession. Since 1975 operations were performed exclusively by the method according to Ravitch and Welch which does not apply any fixation splints.