Study design: Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients. Objectives: To analyze the effectiveness of neurogenic bladder reinnervation in spinal cordinjured patients through artificial creation of sprouting (intercostal nerve to spinal nerve root anastomosis). Setting: Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. (At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.) Methods: A total of 11 patients with spinal cord injury of the L1 level were operated on in the late (chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20-21 cm, and transferred to the vertebral canal. The S2-S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation. Results of urodynamic studies: Bladder capacity (ml) before operation -489779, after operation -350739, urine volume (ml) before -18.2717, after -306.4739.8, residual urine (ml) before -459799.4, after -50711.8. Detrusor tone (rel. units) before -0.671.5, after 1.270.2; voiding pressure (cmH 2 O) before -4.475.2, after -30.574.9. Force of detrusor contraction before -575.8, after -32.875.5. Sphincter resistance (cmH 2 O) before -6.573.8, after -21.174.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of reflex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted. Conclusion: These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.

Twenty gastrointestinal lipomata in 18 patients are reviewed: 15 located in the colon, 3 in the distal ileum, one in the duodenum, and one in the stomach. They were found most frequently in European-born, elderly women and presented with variable abdominal symptomatology. Four lipomata were removed during endoscopy, the remainder at laparotomy, partial colectomy being performed in 10 cases. All, except 2 subserosal types, were located in the submucosa, and their average size was 2.7 cm diameter. Microscopically, none showed true encapsulation, and all were composed of mature fat cells without cellular atypia. In spite of nonspecific changes at endoscopy, one-half of the cases showed, on microscopic examination, atrophy of the overlying glands and a prominent eosinophilic and/or lymphoplasmocytic infiltration of the lamina propria. Two large subserosal lipomata were associated with Crohn's disease. In addition, in 39% of cases, malignant tumours, either single or double, were present in the gastrointestinal tract or elsewhere. Gastrointestinal "lipomata" are located in the sites of normal fatty infiltration in the elderly; these growths could be a local aging or reactive process of the intestinal wall rather than true neoplasms without any potential malignancy. However, coexistent malignancies should be carefully searched for in elderly patients with colonic lipoma.

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Thrombosis of upper extremity arteries is most commonly due to atherosclerosis of the proximal subclavian artery, trauma, or catheter-related injury. In the absence of an identifiable cause, a search for a hypercoagulable state is indicated. Hematologic manifestations of human immunodeficiency virus (HIV) infection and AIDS are frequent occurrences (Coyle TE. Med Clin N Am 1997;81:449-476). The most important of these are cytopenias (anemia, neutropenia, and thrombocytopenia). The incidence and severity of cytopenia are generally correlated to the stage of the HIV infection. In addition, various coagulation abnormalities have been reported in HIV-infected patients. Apart from thrombocytopenia, these have included a prolonged APTT due to the presence of lupus anticoagulant, an increased prevalence of protein S and heparin cofactor II deficiency, and hypoalbuminemia-related fibrin polymerization defects (Toulon P. Ann Bio Clin (Paris) 1998;56:153-160). HIV infection has also been associated with endothelial dysfunction. Although for the most part asymptomatic, elevated D-dimer levels have been found in HIV-infected patients, suggesting the existence of a prethrombotic state. In fact, clinical thrombosis eventuates in 2% of these patients (Toulon, 1988). Documented thromboses have involved both veins and arteries. We hereby present a patient who developed an acute thrombosis of his brachial artery as the initial manifestation of HIV infection.

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