Laparoscopic excision of benign dermoid cysts with controlled intraoperative spillage.

Due to the risk of aseptic peritonitis associated with intraoperative rupture of dermoid cysts, many surgeons are reluctant to remove the lesions laparoscopically. In our series, 12 dermoid cysts were removed laparoscopically. Intraoperative spillage occurred in all cases and was managed with copious lavage.

Actions of endogenous endothelin on glomerular hemodynamics in the rat.

Both endothelin (ET) ETA/ETB receptors are distributed in the glomerular microcirculation, but their physiological functions, if any, are unknown. We used a nonpeptide mixed ETA/ETB receptor antagonist (Bosentan) and a selective ETA receptor antagonist (BQ-123) to investigate the glomerular hemodynamic actions of endogenous ET in the anesthetized euvolemic rat. Blockade of ETA and ETB receptors with Bosentan produced a small fall in systemic blood pressure and a large fall in glomerular blood pressure due to a significant increase in preglomerular (afferent) arteriolar resistance.

Coronary artery muscle bridging causing class III angina in a patient with no coronary atherosclerosis.

The significance of coronary artery muscle bridging (MB) has been debated since its first angiographic description by Portsmann and colleagues in 1960 (1). The course is usually benign; however, angina, myocardial infarction, sudden death, arrhythmias, and complete heart block have been reported. In this article, we present a case of coronary artery muscle bridging which caused a patient with no angiographic evidence of atherosclerosis to experience Class III angina.

Symptomatic carotid pathology detected by duplex ultrasound with minimal disease on angiography.

Carotid duplex ultrasound has been shown to give a more thorough picture of carotid plaque morphology than a carotid arteriogram. As a result, the question has arisen regarding what should be done for the patient who presents with classical hemispheric transient ischemic attacks (TIA) with ulcerative carotid plaque as documented by carotid duplex ultrasound, but with minimal disease on arteriography. This article presents a case illustration of this problem.

Spinal nonadrenergic imidazoline receptors do not mediate the antinociceptive action of intrathecal clonidine in the rat.

The intrathecal administration of clonidine to rats results in profound antinociception which is thought to be mediated through an interaction of the agonist with spinal alpha-2 adrenergic receptors. However, clonidine has been shown to also interact with nonadrenergic imidazoline receptors. Consequently, this study was undertaken to determine if nonadrenergic imidazoline receptors are present in the rat spinal cord, and the extent to which they are involved in the antinociceptive action of spinally administered clonidine.

Randomized intergroup comparison of bacillus calmette-guerin immunotherapy and mitomycin C chemotherapy prophylaxis in superficial transitional cell carcinoma of the bladder a southwest oncology group study.

To compare the toxicity and efficacy of intravesical bacillus Calmette-Guérin (BCG) immunotherapy and mitomycin C (MMC) chemotherapy in the prophylaxis of recurrent transitional cell carcinoma, 469 patients with completely resected stage Ta or TI transitional cell carcinoma were enrolled in a randomized Southwest Oncology Group Phase III study. All patients were judged to be at increased risk for tumor recurrence due to having had two occurrences of tumor within 56 weeks, stage T I tumor or three or more tumors within 16 weeks, or concurrent carcinoma in situ. Three hundred and seventy-seven evaluable patients received either 50 mg of Tice BCG in 50 cc saline or 20 mg MMC in 20 cc water weekly for 6 weeks and then monthly to one year.

Pulmonary responses to amiodarone in hamsters: comparison of intratracheal and oral administrations.

Amiodarone (AD) has been shown to produce a transient pulmonary fibrosis in hamsters after intratracheal (i.t.) instillation.

To use dialysis appropriately: the emerging consensus on patient selection guidelines.

When the United States Congress established the Medicare End-Stage Renal Disease (ESRD) Program in 1972, they did not specify patients for whom dialysis would be appropriate. The ESRD program has grown beyond expectation in patient numbers and in costs, partly because patients who were not initially considered by the dialysis community to be candidates are now routinely accepted. The appropriateness of dialysis for some of these patients has been questioned.

Optimal treatment of superficial bladder cancer in 1994.

Bladder cancer, one of the first cancers associated with industrialization, is not unexpectedly increasing in incidence throughout the world. Despite the increasing incidence of bladder cancer, mortality has actually decreased in recent years. In advanced and metastatic bladder cancer, the platinum/methotrexate-based combination of chemotherapy may be responsible for this improved survival.

Thoracic outlet syndrome with arm ischemia as a complication of cervical rib.

Thoracic outlet syndrome is the causative factor in less than 5% of patients with upper extremity ischemia. Congenital bony abnormalities (cervical rib) are most often responsible for the arterial complications of this syndrome. This article presents the case report of a patient who presented with ischemia of an upper extremity caused by embolization from subclavian artery stenosis and an aneurysm secondary to cervical rib.

The "lost lens": a new surgical technique using the Machemer lens.

We describe a method of removing a posteriorly dislocated lens involving the use of a Machemer lens to visualize displaced lens remnants. Following core vitrectomy, the lens remnants are brought anteriorly and then removed by phacoemulsification. Lens implantation may then be performed with sulcus fixation.

Use of erythropoietin in premature neonates: controversies and the future.

Objective: To review and evaluate current research on the use of recombinant human erythropoietin (rhEPO) for the treatment of anemia of prematurity (AOP).

Data Sources: A MEDLINE search (1985-September 1994) was used to identify and retrieve pertinent data about erythropoietin's use in premature neonates. Bibliographies in the relevant literature and International Pharmacy Abstracts were reviewed as well.

Attenuation of acute inflammatory effects of silica in rat lung by 21-aminosteroid, U74389G.

Chemical alteration of the glucocorticoid, methylprednisolone, has led to the introduction of a new class of compounds called the 21-aminosteroids (21-ASs). The purpose of this study was to investigate the effect of the 21-AS, U74389G, on silica-induced acute lung injury. Male Fischer 344 rats were treated intraperitoneally with saline or U74389G in a total dose of 15 mg/kg divided into three injections of 5 mg/kg separated by 4 h.

Acute pulmonary inflammation in hamsters following intratracheal administration of amiodarone.

The use of the antiarrythmic drug amiodarone (AD) has been limited by the propensity of the drug to cause severe lung damage. AD has been shown to produce a transient pulmonary fibrosis in hamsters after intratracheal instillation. The goal of this study was to characterize the early inflammatory events associated with the administration of AD.

Repetitive exposure to the hot-plate test produces stress induced analgesia and alters beta-endorphin neuronal transmission within the periaqueductal gray of the rat.

Repetitive exposure of rats to a hot plate induced a novel non-opioid form of stress induced analgesia. The exposure caused a persistent 1.5-2 s increase in tail flick latency which was not attenuated by systemic naltrexone, but was completely inhibited by systemic MK-801.

The treatment of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a common disorder which may result in esophageal ulcers, erosions, strictures and motility disorders if it is not treated promptly. Physician assessment of risk factors and symptoms is essential for accurate diagnosis and determination of appropriate treatment. Mild cases of GERD can be treated with lifestyle modifications and antacid/alginic acid therapy.

Acute nitric oxide blockade amplifies the renal vasoconstrictor actions of angiotension II.

The tone in the renal vasculature is determined by the balance between vasoconstrictor and vasodilator agents. In this study, the effect on renal function was investigated when the acute blockade of the endogenous nitric oxide system was superimposed on a state of high circulating angiotensin II. Studies were conducted in the conscious, unstressed rat measuring renal function before and during acute systemic nitric oxide blockade with nitro-L-arginine methyl ester and with or without concomitant angiotensin II infusion.

Dialysis decisions and the elderly.

It is ironic that the patients who were specifically excluded from dialysis at its inception, the elderly, are now the fastest growing segment of the dialysis population. Just because it is possible to dialyze elderly patients does not mean that it should be done. This article reviews the following topics as they relate to decisions about dialysis treatment in elderly people--medical outcomes, age as a selection criterion, allocation of scarce resources, and withholding and withdrawing dialysis--and presents an approach to reaching decisions about treatment of renal failure in the elderly.

Computed tomographic diagnosis of acute blunt pancreatic transection.

Pancreatic injuries secondary to blunt trauma are challenging to diagnose. In many cases, the diagnosis is missed or delayed due to the subtle symptoms and signs of pancreatic injury. Blunt pancreatic injuries may evolve over a period of time and can be a source of extensive morbidity and mortality.

Practice satisfaction among young West Virginia family physicians.

Young family physicians, those in their first five years of practice, were surveyed to determine their satisfaction regarding various aspects of their practices. A total of 67% of the physicians surveyed responded and the results indicated that most family doctors located in communities where there was a perceived need for their specialty. The survey also showed that two of the most important factors necessary to attract and retain family doctors in rural practice are enhanced third-party reimbursement and the availability of other family physicians to share call.

Spinal epidural metastases: a common problem for the primary care physician.

Spinal metastases are a common complication of cancer that should be managed quickly and aggressively. Most often from lung or breast cancer (or due to lymphoma), they usually seed from blood into vertebrae and extend into the epidural space. The most common presentation is pain and weakness, and the evolution can be rapid with paraplegia within days.

The inhibition of silica-induced lung inflammation by dexamethasone as measured by bronchoalveolar lavage fluid parameters and peroxynitrite-dependent chemiluminescence.

The inhalation of silica has been shown to produce a dramatic inflammatory and toxic response within the lungs of humans and laboratory animals. Currently, no effective treatment exists for workers who may have been exposed to the inhalation of silica. The objective of this study was to develop an animal model in which we could evaluate the effect that anti-inflammatory steroids have on the acute silica-induced pulmonary inflammatory response.

Cancer mortality in West Virginia.

Cancer rates have risen in West Virginia since 1950, especially in men. In the 1980s, the increase was in older citizens and for most cancers. An analysis conducted by Dr.