[Results of prostatectomy in the treatment of obstructive benign prostatic hypertrophy]

Aimed to evaluate the results of surgery in patients with obstructive prostatic hypertrophy, we studied the clinical and flow measure results from 51 patients undergoing prostatectomy (31 TUR, and 20 retropubic prostatectomies). It was shown that prostatectomy significantly improved the irritation (63% of patients), and most importantly, the obstructive (89%) symptoms. Peak flow increased in 100% of patients while maximum flow percentile in 92% of patients. Post-operative results showed no correlation to the patients' age, duration of evolution or severity of urinary symptoms, weight of prostate removed or histology of the prostate. Our results were compared with those obtained with other therapeutical options, and it was demonstrated that prostatectomy (both retropubic and RUT) are, clinically and urodynamically, the most effective procedure in the treatment of obstructive prostate hypertrophy.

Morphometric changes in GH-immunoreactive adenohypophyseal cells induced by intraventricular administration of colchicine to adult rats

In order to elucidate whether the gender differences observed in the somatotropic cells of adult rats are mediated by hypothalamic neuropeptides, a morphometric analysis was made of the GH-immunoreactive cells of adult rats treated intraventricularly with colchicine. The morphometric and morphological findings obtained were correlated to the basal serum levels of GH at the time of sacrifice. Treatment with colchicine was seen to increase serum GH levels; this increase was accompanied by an increase in the intensity of the reaction of the GH-cells and, morphometrically, an increase in their size due to an increase in the nuclear area, but with no significant changes in the cytoplasmic area. The results suggest that in the absence of somatostatin and GRF the basal release of GH is elevated in a similar fashion in both sexes, in turn suggesting that gonadal steroids might act at hypothalamic level on the release of somatostatin and, indirectly, on the intracellular pool of GH and hormonal secretion.

Weekly First-Line Chemotherapy of Metastatic Breast Cancer with Cyclophosphamide and Epirubicin

Forty-six patients with metastatic breast cancer who had not received previous chemotherapy for advanced disease entered a phase II trial of weekly chemotherapy with cyclophosphamide (250 mg/m2) + epirubicin (25 mg/m2) for 16 weeks. The overall response rate was 61 % (95 % confidence limits, 47-75 %), with 10 complete and 17 partial responses. Toxicity was mild and confined to nausea and vomiting and asymptomatic neutropenia (except in 2 cases). Sixty-three per cent of patients had no side effects. Weekly cyclophosphamide + epirubicin is an active and nontoxic regimen for patients with metastatic breast cancer who have had no prior anthracycline-containing adjuvant chemotherapy.

Sex-specific response of the vasopressin-reacting neurons of the paraventricular nucleus of the rat hypothalamus following chronic administration of met-enkephalin

Using the peroxidase-antiperoxidase immunocytochemical technique, a morphometric study of the magnocellular neurons of the Paraventricular nucleus of the rat hypothalamus, reactive to specific anti-vasopressin rabbit serum, was made. Following systemic and chronic administration of met-enkephalin the number of immunoreactive neurons was higher, especially in females. Additionally, in the females, it was possible to observe an increase in the immunoreactivity and the presence of well-stained fibres. These findings suggest, especially in females, a blockage in the release of vasopressin, facilitating its immunocytochemical visualization.

Morphometrical variations of prolactin cells in response to prolonged and systemic administration of Met-enkephalin in female rats

A stimulatory effect on prolactin secretion had been describe after acute and systemic administration of met-enkephalin, but the effects of this opioid after chronic administration has not been reported, and the response of mammotroph cells is not clear. As a complement to previous studies, a morphometric analysis (light and electron microscopy) was carried out on prolactin cells from female rats treated chronically with met-enkephalin. Clear features of cellular hyperactivity appeared after chronic and systemic administration of the opioid, and these persisted for two weeks. The changes consisted in increases of cellular, cytoplasmic and nuclear areas, volume and surface densities of the Golgi complex and rough endoplasmic reticulum, as well as the numbers of exocytotic figures. These morphological alterations were paralleled by an increase in serum prolactin levels as detected by RIA. It is concluded that the increase in the synthesis and secretory activity of prolactin cells following chronic and systemic administration of met-enkephalin is very similar to those observed after acute and intraventricular administration.

[Postoperative analgesia using the intravenous PCA technique. Results in the first 400 patients treated at a general hospital]

INTRODUCTION

PCA (patient controlled analgesia) has represented a remarkable advance in the treatment of postoperative pain. In this work we describe our experience with this analgesic technique.

MATERIAL AND METHODS

One hundred patients undergoing thoracic and abdominal surgery were selected after giving information to the medical and nurse personnel. Pharmacologic agents used in this study were morphine (intravenous PCA) and fentanyl (epidural PCA). Starting of the perfusion pump was done by the anesthesiologist at the Recovery Unit and the treatment was continued by the nurse. Every morning the patients were visited and the degree of analgesia was recorded according to the following score: 1: no pain, and 5: intolerable pain. An anesthesiologist was permanently available. Later on, this study was expanded to 400 patients including other types of surgery.

RESULTS

Mean duration of the treatment was 60 hours. The amount of analgesics administered varied among patients and was greater during the first postoperative hours specially in the group of patients treated with fentanyl. The mean degree of pain was 1.5 (grade 1 in 37.5% of cases and grade 5 in 3.5% of patients). Secondary effects were only nausea and vomiting. Inconvenient features of the technique were: patient's difficulties in the management of the technique (3 cases), and spontaneous loss of the program (1 case). Patient's acceptance of the technique was good.

CONCLUSIONS

PCA analgesia has been successfully introduced in our hospital since it is effective, safe, easy to manage.

Met-enkephalin induces fast synaptic plasticity of magnocellular neurons in the rat supraoptic nucleus

A morphometric-ultrastructural study was made of the supraoptic nucleus of rats of both sexes following central administration of met-enkephalin. Ten minutes after met-enkephalin treatment the number of axo-somatic synapses was significantly increased. This effect was more pronounced in female rats than in males and could be prevented by preceding administration of naloxone. Animals that received naloxone followed by met-enkephalin showed a dilation of the rough endoplasmic reticulum into a vesicular shape. Our results provide preliminary evidence for a fast remodeling of synaptic input to magnocellular hypothalamic neurons. It is likely that the known inhibitory action of opioids on the hypothalamo-neurohypophysial system is partly mediated by this plasticity.

Treatment of advanced colorectal cancer with recombinant interferon alpha and fluorouracil: activity in liver metastasis

A cohort of 35 patients with advanced colorectal cancer, not previously exposed to chemotherapy, were included in a phase II study exploring the combination of interferon-alpha, 9 MU subcutaneously three times weekly, and 5-fluorouracil 750 mg/m2/day during 5 consecutive days in continuous intravenous infusion followed with weekly bolus injection of fluorouracil 750 mg/m2. Of 33 cases evaluable for activity; 5 patients achieved partial response and 3 complete response for an overall response rate of 24% (95%; confidence limit 11-42%). Most of the responses were observed in liver metastases, response rate = 30% (95%; CL 13-53%), with little activity observed in other sites; response rate 3% (95%; CL 8-16%), p = .0006. The median time to progression and median overall survival were 16+ (range 1+ to 48+) and 21+ weeks (range 1+ to 52+). All patients were evaluable for analysis of toxicity. Severe mucositis and diarrhea, present in 14 patients were the limiting side effects. Two patients developed progressive renal toxicity and died. Weakness, myalgia, and nonneutropenic fever were observed frequently, one patient developed dementia. This combination is able to induce major responses in patients with advanced colorectal cancer, particularly in liver metastasis. Additional trials evaluating this approach are indicated.

Estrogenic modulation of met-enkephalin-induced prolactin secretion in rats

In order to elucidate the possible role of estrogens in the sex-dependent modulation of met-enkephalin-induced prolactin secretion, and the cellular response at adenohypophyseal level, analyses of serum prolactin levels together with a morphometric study of prolactin-immunoreactive cells were carried out following intraventricular administration of the opioid to estrogen-primed male rats. Administration of the opioid led to an increase in the serum levels of the hormone and, morphometrically, a significant increase in the cellular, cytoplasmic and nuclear areas was observed. When naloxone was administered previously, the above, mentioned changes did not appear, and the values found were similar to those observed in the animals treated only with estrogens. The results suggest that the metenkephalin-induced prolactin secretion is modulated by the gonadal steroid environment.

Sexually dependent changes in rat somatotropic cells following bilateral adrenalectomy

In order to elucidate the existence of gender-related variations in both growth hormone (GH) release and the activity of somatotropic cells following bilateral adrenalectomy, a morphometric analysis was performed on GH-immunoreactive cells from adult male and female rats after bilateral adrenalectomy, correlating the findings with the serum levels of the hormone. The results obtained were compared to those found in untreated animals. Bilateral adrenalectomy was seen to induce a decrease in serum GH levels (p less than 0.01) in male rats; this was accompanied by a significant decrease in cellular area (p less than 0.01), cytoplasmic area (p less than 0.05) and nuclear area (p less than 0.01) and by a decrease in the cytoplasmic immunoreaction intensity of GH cells. By contrast, the above-mentioned changes did not appear in the female rats. These results suggest that the action of glucocorticoids on the synthesis and release of GH depends on the sex of the animal.

Morphometric study of the LH-immunoreactive gonadotrophic cells of rats following treatment with methoclopramide

The LH-immunoreactive cells of the adult rat hypophysis were studied morphometrically after chronic treatment with methoclopramide. The morphological features of these cells showed modifications in both male and female rats, after treatment. Additionally, morphometric changes revealed a significant decrease (p less than 0.05) in both cytoplasmic area, which was more evident in the female rats, and nuclear area, with respect to the normal and control animals. These findings suggest that chronic inhibition of the dopaminergic system in rats atrophies LH-immunoreactive gonadotrophic cells of rats.

Plasticity of the interface between oxytocin neurons and the vasculature in late pregnant rats: an ultrastructural morphometric study

Increased numbers of oxytocin-immunoreactive perivascular neurons have been shown to occur in the preoptic region and lateral hypothalamus of female rats around parturition. In the present study, electronmicroscopical immunocytochemistry and morphometry were used to examine such perivascular oxytocinergic neurons as well as those in the classical magnocellular nuclei in late pregnant and lactating rats. In 22 d pregnant animals and in rats killed after 2 d of lactation, numerous oxytocinergic neurons were found in direct apposition to the outer basement membrane of arterioles, venules, and capillaries. The distance between immunoreactive neurons and blood vessels was significantly lower in these animals than in 9 d lactating rats and in ovariectomized controls. It is likely that, around parturition, oxytocinergic perivascular neurons are uncovered by active retraction of glial elements. This plasticity is perhaps facilitated by changing hormonal conditions around parturition. The observed changes seem to be transitory and might reflect altered secretory properties of perivascular oxytocinergic neurons.

Morphological and functional study of the GH-immunoreactive adenohypophyseal cells in ovariectomized rats

In view of the existence of a different secretion pattern of growth hormone (GH) between male and female rats, the aim of the present study was to analyse the role played by ovarian steroid hormones in the modulation of such secretion. To do so, postpubertal female rats were ovariectomized and killed at 30 days after the operation. The basal serum levels of growth hormone together with cell area, cytoplasmic area and nuclear area of the hypophyseal somatotropic cells of normal and ovariectomized rats were compared. The results obtained show that ovariectomy induces a significant decrease (p less than 0.05) in the basal serum levels of GH, accompanied by an increase in cellular and cytoplasmic areas, with no significant differences in nuclear area. Ovariectomy was also accompanied by an increase in reaction intensity and the number of GH-immunoreactive cells (p less than 0.01). These findings point to the shift towards a masculine secretory and morphological pattern following ovariectomy and supports the hypothesis that ovarian steroids intervene in the establishment of a different pattern in females compared to males.

Morphometric changes of specific located vasopressin-reacting parvicellular neurons in the paraventricular nucleus of the rat after adrenalectomy

The morphological-morphometric consequences of bilateral adrenalectomy on vasopressin-reacting neurons of the paraventricular nucleus of the rat hypothalamus were analyzed. Bilateral adrenalectomy led to a dramatic increase in the cellular area as well as the number of immunoreactive cells (when compared to those obtained in normal colchicine-treated animals) in the neurons located in the anterior, medial and periventricular parvicellular subdivisions of the paraventricular nucleus. By contrast, no changes were observed in either the dorsal or lateral parvicellular subdivisions or in any of the magnocellular subdivisions of the paraventricular nucleus.

[New permanent expandable prosthesis for the treatment of urethral stenosis]

The paper presents our initial experience in the treatment of urethral stenosis through implantation of a "Wallstent" self expanding resident prosthesis. A total of eleven prosthesis were placed in 10 patients with excellent results, from a clinical, urodynamic, radiological and endoscopic point of view, in 9 of them after 5 months. We believe that this kind of prosthesis can be a valid alternative to other established therapeutic options in the management of urethral stenosis. Long-term monitoring, however, will be necessary in order to corroborate the excellent results obtained in this short/medium-term observation.

[Neoplasm of the rhinopharynx: our experience]

We present 87 patients with cancer of the nasopharynx treated in the Fundación "Jiménez Díaz" de Madrid, in the last fifteen years. The clinical aspects of the illness, the therapeutic techniques and the results are analyzed. The global survival and the disease free survival at 5 years were 34 and 22% respectively. Survival in patients with squamous cell carcinoma was somewhat better. Distant metastases was presented in 30% of patients. At present 16 patients are alive and free of disease.

Morphometric study of immunoreactive GH-cells of the adenohypophysis of rats treated with Met-enkephalin

Morphological and morphometric changes were found in adenohypophyseal GH immunoreactive cells after intraventricular administration of Met-enkephalin to adult rats of both sexes. Morphologically, following Met-enkephalin treatment, the males showed cells stained intensely and homogeneously in their cytoplasm, while the females showed cells with a weaker degree of staining and a cytoplasm with a granular aspect; previous administration of naloxone prevented the changes observed in the males and intensified the reaction in the females. Morphometrically, in all the groups of animals studied, the males showed a greater cellular area than the females, accompanied by a decrease in the cytoplasmic area but without significant differences in the nuclear area. Met-enkephalin in both sexes produced an increase in cellular area, accompanied by a significant increase in the cytoplasmic area and, although less manifest, in the nuclear area. Neither kind of change appeared when naloxone was administered prior to Met-enkephalin treatment.

The elastic modulus of central and perilimbal bovine cornea

Data on the elastic properties of corneal tissue are needed to define the parameters involved in a model for radial keratotomy. Using bovine corneal tissue, we measured stress-strain relationships of tissue at different locations in the cornea. From this data we calculated Young's modulus of elasticity of five specimens at peripheral and central corneal locations. Increasing levels of stress produced increased resistance to stretch, a property typical of soft biologic materials such as cornea. Linear regression analysis of the data showed that the elastic modulus of the peripheral tissue was greater than that of central tissue at all values of applied stress. These linear relationships were statistically different, using an analysis of covariance, indicating that peripheral corneal tissue is stiffer than central corneal tissue. This information supports the suggestion that a peripheral circular ligament of corneal tissue exists and helps to maintain the curvature of the cornea. It is the disruption of this ligament that is believed to cause some of the change in corneal curvature when radial keratotomy is done.

Sex-specific effects of met-enkephalin treatment on vasopressin immunoreactivity in the rat supraoptic nucleus

The supraoptic nucleus of male and female rats treated with met-enkephalin or naloxone and met-enkephalin was examined with light microscopical immunocytochemistry for Arginine-vasopressin. Both genders exhibited the same distribution of immunostained magnocellular neurons. Met-enkephalin treatment caused an increase in number of immunostained vasopressin neurons. This effect was more pronounced in females than in males. Naloxone treatment diminished immunoreactive cytoplasmic vasopressin in males more effectively than in females. In enkephalin-treated animals numerous vasopressin immunoreactive varicosities appeared within the supraoptic nucleus, but were mostly absent in naloxone-treated animals and in controls. Our results indicate that met-enkephalin treatment either stimulates vasopressin synthesis or inhibits secretion. It is likely that steroid hormones mediate the action of enkephalin on vasopressin secretion in a specific manner.

Study of h-TSH immunoreactive adenohypophyseal cells following treatment with methymazole

The TSH-producing adenohypohyseal cells of Wistar rats were studied after treatment with orally administered methymazole by the PAP immunocytochemical method. These cells were compared with those of normal animals. The effects of methymazole were different in the females to those observed in males. In both sexes, the numerical density (number of TSH cells per 1000 microns 2) increased after treatment. The cellular and cytoplasmic areas increased in the females while they decreased in the males. The nuclear area and the nuclear area/cytoplasmic area ratio increased in the males and decreased in the females following treatment with methymazole. This treatment caused the appearance of large, intensely stained cells, with an eccentric nucleus and cytoplasmic processes accompanied by weakly stained cells that were situated close to blood vessels.

Morphofunctional study of mammotropic cells following intraventricular administration of met-enkephalin

An ultrastructural and morphometric study was carried out on the adenohypophyseal mammotropic cells of rats treated intraventricularly with an acute dose (150 micrograms) of Met-enkephalin. In the female rats, clear features of cellular hyperactivity appeared after opioid administration. The changes affected the Golgi complex, the rough endoplasmic reticulum, the mature and immature secretory granules and the images of exocytosis. Such changes did not appear when naloxone was administered before the opioid, and naloxone induced an increase in the numerical density of lysosomal dense bodies with lipoid inclusions. In the male animals, administration of an identical dose of Met-enkephalin caused only a few significant changes, similar to those observed in the controls. It is concluded that Met-enkephalin administered intraventricularly causes evident modifications in the mammotropic cells of female rats whereas such changes in the male animals are not significant.

Annular gap junctions in cuboidal ependymocytes of the median eminence of the rat after intraventricular administration of methysergide and thyrotropin releasing hormone

The annular gap junctions in the cuboidal ependymocytes of the median eminence of rats were studied after intraventricular administration (3rd ventricle) of methysergide and thyrotropin releasing hormone. Isolated annular gap junctions were found in the ependymocytes of normal animals. In experimental rats an increase was observed in the number of annular gap junctions at 5 min after administration of the drugs; the increase was more apparent at 10 min postadministration. Likewise, the ependymocytes showed a clear development of the Golgi complex and an increase in the number of vesicles close to the lateral membranes. Accordingly, the increase observed in annular gap junctions could be interpreted as a sign of cellular activity indicative of a greater exchange of substances through the ependymocytes.

Epidural analgesia for post-caesarean pain relief: a comparison between morphine and fentanyl

In 20 post-operative patients who had undergone caesarean section, morphine 2 mg or fentanyl 75 micrograms in 0.9% saline were given epidurally in a randomized study, to compare their effectiveness in providing post-operative pain relief and the incidence of untoward reaction. There was a faster onset of action (P less than 0.01) and the quality of pain relief was substantially better after epidural fentanyl (P less than 0.01). However, the duration of action was markedly longer after epidural morphine (P less than 0.01). There was a significantly greater incidence of urinary retention after morphine administration (P less than 0.05). It is suggested that fentanyl gives better relief of pain than morphine when given epidurally.

Carcinoid syndrome and intravenous cyproheptadine

The anaesthetic management of a patient with the carcinoid syndrome is reported. Important cardiovascular complications occurred immediately after tracheal intubation and during manipulation of metastases. Hypertensive crises were controlled with intravenous cyproheptadine, although hypotension and drowsiness were observed due to its use.

Morphology of the neural lobe of the hypophysis in rats treated with furosemide. II. Pituicytes

Following three days of furosemide administration, the characteristics of the pituicytes in the neural lobe of the rat hypophysis were studied. The pituicytes of the animals which were treated with furosemide and had access to water during the treatment showed scarce cytoplasm organelles, conferring them with a clear appearance (light pituicytes), and a frequent finding was neurosecretory axons enclosed in their own cytoplasm. In the animals deprived of water during treatment, the pituicytes were dense (dark pituicytes) elongated, with a well-developed Golgi apparatus, numerous profiles of smooth endoplasmic reticulum and frequent annular gap junctions. It is concluded that the dehydration induced by the diuretic agent is the cause of the prevalence of the dark pituicytes.

The Meckel cave: computed tomographic study. Part I: Normal anatomy; Part II: Pathology

A formalin-fixed cadaver head with air filling the cisternal and ventricular spaces was scanned by high-resolution computed tomography (CT) in multiple planes (axial, coronal, and sagittal) through the Meckel cave. Correlation of the CT appearance of the Meckel cave was made with an anatomic dissection and whole-head band saw cross-sections. The appearance of the Meckel caves in normal patients was defined using similar high-resolution CT technique with intravenous and intrathecal contrast enhancement. CT techniques allowed consistent and accurate definition of the Meckel cave, the fifth cranial nerve, and adjacent anatomic structures. CT findings of 13 patients with lesions of the Meckel cave are also reviewed, including six trigeminal schwannomas, three meningiomas, two secondary tumors, one glioma, and one congenital fatty tumor. Surgical confirmation was present in 11 cases. Diagnosis and determination of the extent of Meckel cave lesions is possible with the use of high-resolution CT.

Cerebral computed tomography in drowning victims

Computed tomography in two patients who had drowned revealed bilateral basal ganglia and medial temporal lobe low densities. Postmortem examination in one case showed these areas to be necrotic, probably secondary to the hypoxia and hypotension associated with drowning.

Duodenal intubation with secretin stimulus for diagnosis of giardiasis

The use of secretin to facilitate the demonstration of Giardia lamblia in duodenal juice was studied in children under investigation for chronic diarrhoea. 30 children aged 3 months to 13 years, whose stools were negative for G. lamblia, were studied. G. lamblia was demonstrable in a sample of duodenal juice in 1 of the 30 children before an intravenous injection of secretin (1 or 2 mg/kg), but in 9 of the 30 children after secretin. It is concluded that examination of duodenal juice after secretin stimulus is an effective method of showing giardial infestation.