PubMed · 14841813
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W L CHAMPION, M F FOWLER, R C COLEMAN, T J FLORENCE. 1951. Experimental vesicosigmoidostomy.. https://doi.org/10.1016/s0022-5347(17)68555-0
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Inguinal hernia repair is the most common operation performed in pediatric surgical practice. However, this procedure can be difficult, even in the most experienced hands, and result in complications, especially in small infants. Injury to the bladder is one of the known complications of inguinal herniotomy, especially in infants less than 6 months old. We report the long-term follow-up of a case having bladder injury during inguinal hernia repair at the age of 3 months and at the age of 10 underwent sigmoidocolocystoplasty for augmentation of a small, contracted bladder and high-grade vesicoureteric reflux caused by the bladder injury.
BACKGROUND: Nicotine has been shown to release nitric oxide from nerves in human sigmoid colon. This effect has been used to investigate the innervation and functional relationship of the longitudinal and circular muscle layers. METHODS: Strips of longitudinal and circular muscle were obtained from 19 patients with colorectal cancer. The strips from ten patients were subjected to electrical field stimulation (EFS) in vitro using stimulus parameters for selective stimulation of nerves. The effect of nicotine 1-10 micromol/l on EFS responses was then measured in the presence and absence of a nitric oxide synthase inhibitor, nitro-L-arginine methyl ester (L-NAME) 200 micromol/l. The effect of nicotine on spontaneous activity was investigated in the muscle strips from the other nine patients. RESULTS: Both longitudinal and circular strips responded to EFS with contraction. The time to achieve a peak contractile response (time to peak; TTP) was significantly longer (P<0.001) in circular strips. L-NAME reduced the mean(s.e.m.) TTP in circular muscle from 23.3(2.0) to 17.2(1.5) s (P=0.007) and altered its pattern of response to resemble that of longitudinal muscle. Nicotine 10 micromol/l reduced the contraction to EFS in circular (P<0.001) but not in longitudinal (P=0.347) muscle. The nicotine-induced reduction in circular muscle contraction was blocked by L-NAME 200 micromol/l (P=0.005). CONCLUSION: These findings suggest that nitric oxide release on neural stimulation is greater in circular than in longitudinal muscle.
BACKGROUND AND PURPOSE: To describe the implementation and to evaluate the results of direct segment aperture optimization using the segment outline and weight adapting tool (SOWAT) in intensity-modulated radiotherapy (IMRT) for prostate cancer. PATIENTS AND METHODS: 14 consecutive, unselected patients with localized prostate cancer were entered in a planning study comparing IMRT without and with the use of SOWAT. The clinical target volume (CTV) consisted of the prostate and seminal vesicles in all cases. To create the planning target volume (PTV), a three-dimensional anisotropic margin (10 mm in craniocaudal direction, 7 mm in both other directions) was used. To compare both plans, physical as well as biological endpoints were considered. RESULTS: Considering the CTV, SOWAT resulted in a significantly higher minimal dose together with a higher dose to 95% (D(95)) and 90% (D(90)) of the CTV volume (p < 0.05; Figure 2). Target dose homogeneity was significantly improved (p < 0.001). Tumor control probability (TCP) was significantly increased (p < 0.05). Considering the PTV, D(90) was significantly increased (p < 0.05). Target dose homogeneity was significantly improved (p < 0.05; Figure 1). For rectum, the volumes receiving 50 Gy (R(vol50)), 60 Gy (R(vol60)), or 65 Gy (R(vol65)) as well as the mean dose were significantly lowered after SOWAT (p = 0.0001; Figure 3). Rectal normal tissue complication probability (NTCP) was significantly lower after SOWAT (p = 0.005). Probability of uncomplicated local control (P+) was significantly higher after SOWAT (p < 0.0001). CONCLUSION: SOWAT is a powerful planning tool to increase the therapeutic ratio of IMRT for prostate cancer. It leaves the delivery time unchanged, so that treatments can still be delivered within a time slot of 8 min.