SPECT Imaging of Brain and Tinnitus-Neurotologic/Neurologic Implications.

Single Photon Emission Computed Tomography (SPECT) of brain with technetium-99m hexamethyl propyleneamine oxine (Tc-HMPAO) is an imaging technique which has been introduced for the identification of abnormalities of regional cerebral blood flow (rCBF) in patients with a central type of subjective idiopathic tinnitus, which was characterized as severe and disabling. These patients demonstrate a negative clinical history, physical examination does not evidence central nervous system disease, and CT/MRI studies of brain were negative. Two typical cases are presented which demonstrate significant regional abnormalities in cerebral perfusion bilateral of temporal, frontal, parietal and hippocampal amygdala regions when compared with normative Tc-HMPAO SPECT of brain data.

An analytic comparison of laparoscopic hernia repair with open "tension-free" hernioplasty.

Two of the most important etiological factors in the development of primary and recurrent inguinal hernias are collagen deficiency and tension on the suture line respectively. These factors can be eliminated by the use of open "tension-free" hernioplasty, advocated by the Lichtenstein Hernia Institute since 1984. In this procedure, the entire floor of the inguinal canal is reinforced by an 8 cm x 16 cm sheet of Marlex mesh that is sutured in place to protect the floor from all future adverse mechanical and metabolic effects without the risk of displacement or folding.

A survey of non-expert surgeons using the open tension-free mesh patch repair for primary inguinal hernias.

Unlabelled: The aim of this study was to learn if general surgeons with no special interest in hernia repairs, using the open tension free repair, could achieve a degree of success comparable to that of the experts.

Materials And Methods: A survey was undertaken of 72 surgeons who were known to be performing an open tension-free onlay mesh patch repair for primary inguinal hernias with no attempt to suture together the edges of the hernia defect. While several European surgeons were included, most were from the United States.

The Lichtenstein open "tension-free" mesh repair of inguinal hernias.

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures. A total reinforcement of the inguinal floor with a sheet of suitable biomaterial and the employment of a "tension-free" technique is a more effective approach.

A simple stapling technique for prosthetic repair of massive incisional hernias.

This article introduces a simpler, faster, and safer method of performing the Stoppa procedure with an articulating stapler. It also encourages use of preperitoneal repair instead of the often unsuccessful onlay mesh repair. The latter repair involves placing the mesh over the abdominal aponeurotic layer and can result in a high incidence of infection, seroma accumulation, and chronic fibrous cyst formation.

Local anesthesia for inguinal hernia repair step-by-step procedure.

Objective: The authors introduce a simple six-step infiltration technique that results in satisfactory local anesthesia and prolonged postoperative analgesia, requiring a maximum of 30 to 40 mL of local anesthetic solution.

Summary Background Data: For the last 20 years, more than 12,000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was the mean of achieving local anesthesia.

Penile condylomata: a gynecological epidemic disease: a review of the current approach and management aspects.

Viral venereal infection caused by human Papillomavirus has reached epidemic state. The proper management of this infection in men is of great benefit, because it may possibly decrease the reservoir of disease in both sexes from which genital condylomata and associated lesions may arise. We report a selection of current knowledge about the epidemiology, etiology, diagnosis, and treatment of male condyloma, occurring predominantly among male consorts of women with genital human Papillomavirus infection.

Ovarian cyst formation in two pre-menopausal patients treated with tamoxifen for breast cancer.

Pre-menopausal tamoxifen treatment causes hyperoestrogen production and ovarian cyst formation. Two pre-menopausal breast cancer patients who were treated with tamoxifen developed both permanent supraphysiological oestrogen concentration and ovarian cysts. Serum oestrogen decreased to post-menopausal concentrations and ovarian cysts completely resolved during and following simultaneous treatment with tamoxifen and gonadotrophin-releasing hormone agonist (GnRHa).

[A five-step technique for local anesthesia in inguinal hernia repair].

One century ago, in his 1990 Annals of Surgery article, Cushing indicated that except for children, all hernias can be repaired under local anesthesia [1]. Since then, local anesthesia has been successfully used for the repair of all reducible groin hernias in adult patients at many centers. For the last 25 years, more than 12000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute.

Patch or plug for groin hernia--which?

Prosthetic mesh is becoming widely used in the management of both primary and recurrent groin hernias. Confusion exists as to when to choose which of the two popular forms: patch or plug. Here are presented the indications for each type of tension-free hernia repair based on the experience of over 20 years in the exclusive surgery of groin hernias.

Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines.

This preliminary study examined the possibility of preventing intestinal adhesions to biomaterials while preserving their incorporation with the abdominal wall. White New Zealand rabbits received intraperitoneal implants of different biomaterials for repair of defects created on the abdominal wall. The following biomaterials were used: polypropylene, polyester, expanded polytetraflueroethylene, polypropylene mesh/polypropylene sheeting (polypropylene mesh covered with polypropylene sheeting on the peritoneal side), polypropylene/silastic, polypropylene/polyglactin, polypropylene/polyglycolic acid, and polypropylene/fibrin.

The significance of plasma progesterone levels during early pregnancies achieved after in vitro fertilization (IVF) treatment.

Objective: Corpus luteum steroidogenesis is lower for in vivo ectopic pregnancy than for intrauterine pregnancy. There is a progesterone hallmark level distinguishing between viable intrauterine pregnancy and nonviable or ectopic pregnancy. This study attempts to answer whether this is also true for in vitro fertilization-treated patients.

[Lichtenstein herniotomy].

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and accounts for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial and employment of a "tension-free" technique is a more effective approach.

A critical evaluation of the Lichtenstein tension-free hernioplasty.

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and accounts for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial and employment of a "tension-free" technique is a more effective approach.

Biomaterials for abdominal wall hernia surgery and principles of their applications.

This article focuses special attention on the porosity, cellular permeability and molecular permeability of biomaterials and their effect on infection, host tissue incorporation and seroma formation when mesh is used for the repair of abdominal wall hernias. Furthermore, the general principles of the application of biomaterials, regardless of the technique used for their employment, is discussed.

Infertility due to diseased pelvic peritoneum: laparoscopic treatment.

Thirty-one patients complaining of unexplained infertility for at least 36 months and diagnosed elsewhere were reassessed laparoscopically. After staining their pelvic peritoneum with concentrated methylene blue, they presented with extensive areas of dark blue discoloration, and were diagnosed as suffering from 'diseased pelvic peritoneum'. The levels of peritoneal CA 125 were assessed.

Estrogen and progesterone receptor expression of decidual endometrium in a postmenopausal woman treated with tamoxifen and megestrol acetate.

To the best of our knowledge, this is the first report of in vivo endometrial estrogen and progesterone receptor induction as a result of tamoxifen exposure in a postmenopausal breast cancer patient. The following observations, that the postmenopausal endometrium is sensitive to tamoxifen, that this agent can act as an estrogen-like substance, and that it may cause proliferation of the endometrium in the absence of progestin, may explain the endometrial decidual changes described herein as a protective mechanism against possible neoplastic endometrial changes.

The role of color Doppler flow in the management of nonmetastatic gestational trophoblastic disease.

Three patients with findings suggestive of invasive gestational trophoblastic neoplasm and lung metastasis were assessed by color Doppler transvaginal ultrasound, before and during chemotherapy. The sonographic findings were correlated with beta-hCG levels measured at various stages of treatment. Results were compared with blood flow indices found during normal first trimester pregnancies, and those following elective termination of pregnancy.

The inability of preovulatory ovarian scan to predict multifetal pregnancy occurrence in a follow-up of induction of ovulation with menotropins.

Objective: To establish the predictive role of preovulatory ovarian ultrasonography in the occurrence of multiple pregnancy after hMG and hCG treatment for anovulatory infertility.

Design: Prospective.

Setting: Outpatient Infertility Clinic.

Growth hormone--non multum sed multa (quality, not quantity).

In view of the recent availability of recombinant human growth hormone (GH) and reports of its ability to augment ovulation induction by exogenous gonadotropins, we have surveyed the reproductive physiological role of GH and the family of polypeptides that mediate its action. The clinical studies using GH to improve ovulation induction, although achieving a significant reduction in exogenous gonadotropin administration, show only minor benefits in terms of attainment of pregnancy. An explanation for this phenomenon is suggested, and we provide guidelines for whom GH should be recommended.