Transvaginal repair of vesicovaginal fistula using a peritoneal flap.

Even complex vesicovaginal fistulas may be repaired transvaginally. In difficult repairs adjunctive measures have been described to increase the success rate of surgery, including Martius flaps, labial flaps or gracilis muscle flap. We describe a new technique to repair difficult vesicovaginal fistulas via a transvaginal approach.

Maintaining confidentiality in a look-back investigation of patients treated by a HIV-infected dentist.

The spread of human immunodeficiency virus (HIV) from a Florida dentist with acquired immunodeficiency syndrome (AIDS) to several of his patients has generated considerable concern about the risk of HIV transmission during dental treatment. Accordingly, self-reporting of HIV infection and subsequent AIDS by a dentist at our medical center prompted notification and testing of patients at risk. Key features of the notification and testing process were (a) only patients who had undergone procedures deemed to pose appreciable risk of exposure to the dentist's blood were notified, (b) the identity of the dentist was shielded by not including in notification letters any identifying information other than the name of the medical center, and (c) patients' blood specimens were tested promptly for HIV antibodies and results were reported immediately to each patient to minimize the period of anxiety.

The Raz bladder neck suspension in patients 65 years old and older.

We reviewed the charts of 92 women 65 years old and older (mean age 72 years, range 65 to 87 years) who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 17 months. Overall, a successful outcome (cure or rare stress urinary incontinence not requiring protection) was achieved in 81 patients (88%).

The Raz bladder neck suspension: results in 206 patients.

We reviewed the charts of 206 patients who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 15 months. Overall, our results demonstrated a successful outcome (cure or rare stress urinary incontinence not requiring protection) in 186 of 206 patients (90.

Repair of severe anterior vaginal wall prolapse (grade IV cystourethrocele).

The classical approach for the repair of severe anterior vaginal wall prolapse is the use of transvaginal colporrhaphy or, more recently, an abdominal paravaginal repair. Severe cystoceles develop from weaknesses of the levator sling and pubocervical fasciae resulting in 2 main anatomical changes: a central defect between the pubocervical fasciae, and a sliding herniation of the bladder and urethra (paravaginal defect). We developed a new transvaginal technique for the repair of large cystoceles (grade IV) extending outside of the introitus at rest, which includes repair of the central defect by anterior colporrhaphy, and repair of the paravaginal herniation of the bladder base and bladder neck by a needle suspension of these structures.

Rearranging antigen-receptor genes in enriched Reed-Sternberg cell fractions of Hodgkin's disease.

Molecular genetic analysis of rearranging antigen-receptor genes in non-Hodgkin's lymphomas has revealed the clonality and lineage in the majority of cases. In an analogous approach, we sought to apply gene rearrangement analysis to Hodgkin's disease to understand better the clonality and origin of this disorder. However, the putative neoplastic cell of Hodgkin's disease, the Reed-Sternberg cell and its variants, is extraordinarily rare in most cases of Hodgkin's disease.

Molecular pathways of adhesion in spontaneous rosetting of T-lymphocytes to the Hodgkin's cell line L428.

Spontaneous rosetting of T-lymphocytes to Reed-Sternberg cells has been observed both in vitro and in vivo but its molecular mechanism has not been defined. We have investigated such rosetting using the Hodgkin's cell line L428. L428 expresses high levels of LFA-3 and ICAM-1, both of which are ligands for T-cell adhesion.

Rearranged antigen receptor genes in Hodgkin's disease.

Despite intensive efforts using a wide variety of approaches, the cellular lineage and clonality of the abnormal cells of Hodgkin's disease have remained an enigma. In the present study, cell separation techniques that enriched for Reed-Sternberg cells and their variants were used to generate sufficient percentages of abnormal cells to allow detection of rearrangements in these cell fractions. DNA from the involved tissues of eight Hodgkin's disease patients was subjected to Southern blot analysis to detect rearrangements of T cell antigen receptor genes and immunoglobulin genes.

Induction of immunoglobulin secretion in follicular non-Hodgkin's lymphomas: role of immunoregulatory T cells.

B cell neoplasms are clonal expansions of B lymphocytes thought to be frozen at various points along the normal B cell differentiation pathway. We studied cell suspensions from lymph nodes involved by follicular (nodular) non-Hodgkin's lymphoma to determine the capacity of the malignant B cells to secrete immunoglobulin (Ig). Neoplastic B cells from all 14 follicular lymphomas secreted monoclonal immunoglobulin in culture when appropriate signals were provided.

Cutaneous cryptococcosis without evidence of systemic involvement.

As many as 15% of cases of systemic infection with Cryptococcus neoformans have cutaneous involvement. The existence of primary cutaneous disease is controversial. We report a patient with cutaneous cryptococcosis without evidence of visceral involvement at the time of diagnosis.

Surgical outcome for resident and attending surgeons.

We asked whether surgical process and outcome differ for physicians in postgraduate training supervised by attending surgeons compared with attending surgeons alone. All appendectomies performed during a 2 year period in a 320 bed voluntary hospital where either the admitting diagnosis or the preoperative diagnosis suggested acute appendicitis were included in the study. Data were abstracted from medical records and pathology reports.

Diagnosis of diabetic eye disease.

The correct diagnosis of proliferation diabetic retinopathy is essential, because it is a treatable disease and missing the diagnosis can lead to the patient becoming blind. We examined the ability of internists and ophthalmologists to diagnose proliferative retinopathy under optimal conditions. Twenty-three physicians performed retinal examinations on ten diabetic patients and one normal patient with dilated pupils.

Subacute necrotizing lymphadenitis --a clinicopathologic study.

This report describes the clinical and pathologic findings of 21 patients with subacute necrotizing lymphadenitis (N.L.).

Induction of complement receptors in human cell lines derived from undifferentiated lymphomas.

Two Epstein-Barr nuclear antigen-negative cell lines, EW36 and CA46, derived from human undifferentiated lymphomas were exposed to the methylxanthines theophylline and 3-isobutyl-1-methylxanthine. Both compounds markedly increased the proportion of cells which bears complement receptors, whereas other surface markers such as surface immunoglobulin and IgG Fc receptors were unchanged. The inducing agents, hexamethylene bisacetamide and diethylsulfoxide, had a similar effect, but other compounds known to alter intracellular cyclic AMP had no effect on surface markers.

Surgical therapy of variant angina associated with nonobstructive coronary disease.

Patients with variant angina refractory to medical therapy pose a difficult management problem. We report two patients with variant angina who had focal spasm in coronary arteries with fixed obstructions of less than 20% of the luminal diameter. Ischemic episodes were accompanied by malignant ventricular arrhythmias and third degree atrioventricular block.