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[Synthesis of peptide fragment of melittin and the function of rheumatoid arthritis cure].

To retain the anti-rheumatoid arthritis activity of melittin and to reduce the hemolysis and hypersusceptibility caused by melittin, a deletion peptide of melittin was synthesized. Its ant-inflammation effect was observed . A hydrophile peptide fragment of melittin was synthesized by standard solid-phase method. The product was analyzed by HPLC and MS. The relevant hemolysis and hypersusceptibility were tested. The rabbits' model of immune arthritis were established and treated. The results showed that the hemolysis rate for peptide fragment was less than 5%, the hypersusceptibility rate was less than 8%. The hydrophile peptide fragment of melittin may retain anti-rheumatoid arthritis activity and reduce the melittin-induced hemolysis and hypersusceptibility.

Animals↗

Resection therapy of malignant tumours of the shoulder girdle.

Based on 30 resections in the shoulder region, operation techniques and results are precisely described with a view to curing and functioning. In the case of radical resections the rate of recurrences and cures in patients are the same as the rate of ablations. As the function of the hand is not impaired, this is a considerable advantage over amputations, although the cosmetic result of a resection may appear insufficient. In humerus resections bending contractures may frequently occur in the elbow joint and previous radiation may occasionally cause interior decubitus and exculceration. With an endoprosthetic replacement of the proximal humerous complications may be avoided, as experience with ceramic implants proved in 3 cases.

Adolescent↗

Effect of atrial radiofrequency ablation designed to cure atrial fibrillation on atrial mechanical function.

INTRODUCTION: The effects of linear radiofrequency lesions in the atria for cure of atrial fibrillation on atrial contraction have not previously been quantified. METHODS AND RESULTS: Atrial function was measured before and 30 +/- 24 days after a biatrial ablation procedure designed to cure atrial fibrillation in eight dogs and after a sham procedure in three dogs. Atrial mechanical function was assessed using Doppler diastolic blood flow velocities, atrial systolic pressure wave amplitude, and assessment of atrial contribution to cardiac output estimated by comparison of AV sequential pacing to ventricular pacing at the same heart rate. The mitral Doppler A/E velocity ratio was 1.03 +/- 0.45 before and 0.72 +/- 0.43 after ablation (P = 0.048). The tricuspid A/E ratio was 0.88 +/- 0.17 before and 0.71 +/- 0.12 after ablation (P = 0.04). The estimated atrial contribution to cardiac output was 18% +/- 9% before and 5% +/- 4% after ablation (P < 0.01). The left atrial systolic pressure wave amplitude was 2.8 +/- 1.5 mmHg before and 1.7 +/- 1.0 mmHg after ablation (P = 0.1). These changes were not observed in control dogs. Lesions covered 25% +/- 6% of the atrial endocardial surface. CONCLUSION: Multiple linear radiofrequency lesions in the atria designed to cure atrial fibrillation may impair atrial contractility. Reduced atrial function is partly due to loss of atrial myocardial mass, but regional delays in atrial activation and splinting of the atria by scarring also may contribute.

Animals↗

Vesicoureteric reflux with urethral valves.

A retrospective review was undertaken of 66 boys with posterior urethral valves with regard to incidence and prognostic significance of vesicoureteric reflux. The results indicate that: Regardless of the age of the patient, the existence of bilateral reflux at the time of presentation implies a worse prognosis than does unilateral or no reflux. Reflux which does not stop spontaneously after the valves have been destroyed is generally associated with a functionless and often dysplastic kidney; surgical cure of such reflux is therefore pointless. Reflux stops spontaneously after valve ablation when the involved kidney possesses useful function; surgical cure of reflux is therefore unnecessary. In some cases, however, it remains possible that reflux may continue to damage the kidney during the interval between relief of the urethral obstruction and spontaneous cure of the reflux. Nevertheless, the grossly dilated refluxing ureter is poor surgical material and it is concluded that the best chance of preserving renal function in the majority of boys with urethral valves and reflux lies in endoscopic fulguration of the valves, controlling infection and awaiting spontaneous reflux cure.

Cystoscopy↗

Cryosurgery in difficult to treat basal cell carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is the most common human malignancy. Although BCC has a low mortality, it has a large morbidity. Patients frequently present with difficult to treat BCC because of the lesion itself, the condition of the patient, or both. Satisfactory results have been reported in the cryosurgery of low-risk BCC. There is no agreement, however, about indication, cure rate, technical modalities, and results of cryosurgery in tumors larger than 1 cm, in critical locations, and of aggressive histologic type. OBJECTIVE: The purpose of the study was to establish the cure rate, functional preservation, cosmetic results, acceptance, and complications of cryosurgery in difficult to treat BCC. METHODS: One hundred and thirty six consecutive patients with 171 difficult to treat BCC (because of size, location, nature, or patient condition) were treated by the mixed technique of curettage followed by liquid nitrogen application. RESULTS: After an average follow-up of 5.2 years (6 months to 9.1 years), a cure rate of 91.8% was achieved. The treatment was well tolerated, widely accepted by the patients, of low cost, and with good functional and cosmetic results. Complications were few and minor. CONCLUSION: Cryosurgery is a well-tolerated therapeutic modality that offers an acceptable cure rate and good functional and cosmetic results in difficult to treat BCC.

Adolescent↗

The anatomic and functional outcomes of defect-specific rectocele repairs.

OBJECTIVE: This study was undertaken to evaluate the anatomic, functional, and quality-of-life effects of site-specific posterior colporrhaphy in the surgical management of rectocele. STUDY DESIGN: In a retrospective observational study 125 patients were studied who had undergone site-specific posterior colporrhaphy between 1995 and 1996, either alone or in conjunction with other pelvic procedures. Physical examination was performed >/=6 months after the operation to assess the anatomic success of the repair. Standardized questionnaires were used to assess quality of life, sexual function, and bowel function. RESULTS: Surgical correction was found at follow-up examination to have been achieved in 82% of eligible patients (73/89). All daily aspects of living improved significantly (P <.05), including ability to do housework (56% improvement or cure), travel (58% improvement or cure), and social activities (60% improvement or cure). Emotional well-being also significantly improved after the operation, as measured by thoughts of embarrassment (57% improvement or cure) or frustration (71% improvement or cure). Sexual function was not affected; however, reports of dyspareunia significantly (P <.04) improved or were cured after the operation in 73% of patients (19/26), worsened in 19% of patients (5/26), and arose de novo in 3 patients. Results showed no other significant differences in vaginal dryness, orgasm ability, sexual desire, sexual frequency, or sexual satisfaction. Bowel symptoms were assessed subjectively and were noted to have significantly improved (P <.008) after the operation. The following improvement or cure rates were obtained: stooling difficulties, 55%; pelvic pain or pressure, 73%; vaginal mass, 74%; and splinting, 65%. CONCLUSION: This study indicates that defect-specific posterior colporrhaphy is equal to or superior to traditional posterior colporrhaphy. This type of repair provides durable anatomic support and is successful in restoring bowel function. It does not detrimentally affect sexual function, may aid in the resumption of sexual activity, and significantly improves quality of life and social aspects of daily living.

Adult↗

Cardiac left ventricular function before and during early thyroxine treatment in severe hypothyroidism.

In some patients with severe hypothyroidism, thyroxine replacement therapy precipitates or aggravates angina pectoris, whereas in other patients angina pectoris is ameliorated or even cured. Cardiac function in eight severely hypothyroid patients was studied by means of radionuclide ventriculography (RNV) at rest and during supine bicycle exercise before thyroxine treatment, and repeated during treatment before and after administration of 160 mg of oral verapamil. There was an exercise-induced fall in left ventricular ejection fraction (LVEF) in two patients before therapy, and in two additional subjects after 17 d on suboptimal doses of thyroxine. Verapamil attenuated the fall and induced a significant increase in LVEF during exercise (P less than 0.014). No abnormal regional cardiac wall movement (RWM) was observed. After 2 months of thyroxine treatment, LVEF increased significantly during exercise both before and after verapamil (P less than 0.012 and P less than 0.005). These findings are indicative of reversible coronary artery dysfunction. We recommend that, if feasible, thyroxine should be supplemented with verapamil during the early phase of treatment.

Adult↗

Cure of cryptococcemia in an immunocompromised patient with lupus nephritis.

The first documented cure of cryptococcosis with cryptococcemia is reported. The patient had systemic lupus erythematosis and had received corticosteroids and immunosuppressive drugs for diffuse proliferative nephritis. She had additional poor prognostic factors including high serum cryptococcal antigen titer, low cerebrospinal leukocyte count, and absence of anticryptococcal antibody. Pulmonary tuberculosis was diagnosed concurrently and subsequently she developed disseminated herpes zoster. During amphotericin B therapy, renal function worsened. Cure of cryptococcosis with cryptococcemia was accomplished despite multiple concurrent infections and transient worsening of renal function.

Adult↗

Functional duodenal obstruction (superior mesenteric artery or cast syndrome) in cerebral palsy.

An 8-yr-old girl with cerebral palsy who was chronically malnourished presented with functional duodenal obstruction (superior mesenteric artery or cast syndrome) proven by barium meal. Six months of feeding through a fluoroscopically positioned gastrojejunal tube generated sufficient weight gain and increase in body bulk to cure the functional obstruction.

Cerebral Palsy↗

Functional ovarian cysts in patients cured of ovarian neoplasms.

Twenty-seven patients with ovarian cancer underwent unilateral salpingo-oophorectomy and were followed for 12-215 months (mean 80) after completion of therapy. Of these, nine patients who received pelvic irradiation subsequently developed ovarian failure. Of the remaining 18 patients who maintained ovarian function, 13 (72%) developed a functional ovarian cyst during the follow-up period. Of these 13 patients, eight were observed until the functional cyst regressed, four were treated with oral contraceptives (OCs) to suppress ovarian function, and one underwent oophorectomy for a large corpus luteum cyst. We recommend that OC pills be considered for suppression of ovarian function in postmenarcheal girls after completion of therapy for ovarian neoplasms. Routine use of OCs may simplify the follow-up of these patients by preventing the formation of functional ovarian cysts. In postmenarcheal patients not treated with OCs, the finding of a unilocular ovarian cyst should be considered to represent a functional cyst, and a trial of OCs for 3 months may result in spontaneous regression. Persistent cysts must be operatively removed.

Adolescent↗

[Dietetics and the health and fitness cult. The risks of dietetics in the Welfare State].

We shall analyse the reasons why various matters related to diet have become a type of a purification ritual in the welfare society. In order to explain this circumstance three historic moments in the use of diet shall be studied: a) Diet as an explicit means in the care of the soul. Besides its function in the care of the body, diet was used in ancient times as a specific remedy to improve both the psychic and moral aspects of the mental faculties. b) Diet as an implicit remedy in moral well-being. From the Renaissance onwards diet no longer had this explicit function in curing the soul, however it tacitly retained a certain effect on the moral factors. c) Diet as an instrument of the health and fitness cult. Despite the scientific configuration of dietetics in the second half of the nineteenth century, old function of diet remained mutatis mutandis with regards to the moral sphere of the subject. Factors such as the development of how thinness or fatness was viewed at this time and the resulting explosion of interest in controlling body-weight, which acquired characteristics of pseudo-religious activity, may explain this fact. In this way the old idea of "you are what you eat" coexists with the more modern one of "you eat what you are".

Diet Fads↗

Laryngeal reconstruction and survival after function-sparing laryngectomy for selected T3 and T4 lesions.

Most patients lost their vocal ability after ablative surgery for the laryngeal cancer. Total laryngectomy has a history of over 100 years, hence many surgeons are accustomed to the en bloc organ resection and the loss of ability for communication after surgery. The recent advance of surgery introduces the concept and technique of radical cure and functional preservation of the cancer-afflicted-organ at the same setting. For lesions of late T categories (T3, T4), the maintenance of normal function after wide resection to ensure radicality demands a special technique to repair the crippled larynx. For this purpose a local osteomuscular flap was designed to reconstruct a functioning larynx. The surgical manoeuvre was described and the result proved to be successful. The outcome of 138 patients with T3 and T4 laryngeal carcinomas following conservation laryngectomy was analyzed. The five-year survival rate was 69% for supraglottic type and 75% for glottic type. The quality of life was much improved.

Adult↗

[Diagnosis and treatment and prevention of iatrogenic functional aphonia].

OBJECTIVE: To discuss the diagnosis, treatment and prevention of iatrogenic functional aphonia. METHODS: Twenty three patients who either lost their voice or only could whisper after surgery in other hospitals were included in this study as the first group, history was well collected and laryngostroboscopy performed. All cases were confirmed as iatrogenic functional aphonia patients and received phonation therapy. In another group of patients who received vocal cord surgery in our hospital from 2003 to 2005, speaking was restricted while not prohibited after surgery, voice quality was closely observed, and 1028 cases were included. RESULTS: All 23 cases of functional aphonia were cured with phonation therapy. No iatrogenic functional aphonia occurred in the second group of patients. CONCLUSIONS: The iatrogenic functional aphonia can be caused by post operative mistreatment and could be cured with phonation therapy, and it is preventable if speaking is not strictly prohibited after surgery.

Adult↗

Factors in the outcome of transsphenoidal surgery for prolactinoma and non-functioning pituitary tumour, including pre-operative bromocriptine therapy.

Radical transsphenoidal surgery in 58 patients with large non-functioning pituitary tumours relieved pressure symptoms and disconnection hyperprolactinaemia without loss of pituitary function, and verified the diagnosis. Pre-operative bromocriptine did not cause any shrinkage of non-functioning tumours (n = 8), even up to 48 weeks. Thirty-two patients not given postoperative radiotherapy are being followed-up, and although two show minor CT scan evidence of tumour regrowth, for the others the delay in radiotherapy is enabling reproduction where required. In 20 patients with non-invasive macroprolactinomas radical surgery caused no loss of pituitary function but cured eight, of whom one has relapsed; none of eight invasive prolactinomas was cured by surgery. Pre-operative bromocriptine caused marked size reduction in seven of seven macroprolactinomas, but if continued beyond 6 weeks induced tumour fibrosis and uneven shrinkage which made surgery dangerous and unproductive. Selective transsphenoidal surgery relieved hyperprolactinaemia in 70% of patients with meso- (n = 15) or microprolactinoma (n = 24) usually without loss of pituitary function: the relapse rate was 1 per 88 patient years of follow-up. Invasive prolactinomas, and macroprolactinomas showing uneven shrinkage with a short (up to 4 weeks) course of bromocriptine should have radiotherapy rather than surgery, while the patients most suited to surgery are those with mesoprolactinomas, or some macroprolactinomas with compact intrasellar shrinkage after short-term bromocriptine. Microprolactinomas generally did not benefit from surgery as compared to conservative therapy. In none of the tumour groups were the surgical findings an accurate predictor of postoperative pituitary function.

Adenoma↗