Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations.

Duplications of the alimentary tract are unusual congenital anomalies that frequently present a diagnostic as well as therapeutic challenge to the surgeon. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. Due to the complicated anatomy and common blood supply shared between the duplication and associated native bowel, appropriate management requires a familiarity with the anatomy and clinical characteristics of this entity. To better define the range of patient characteristics, clinical presentation, and preferred therapy, 20 enteric duplications were reviewed in 17 patients treated at the Children's Hospital Medical Center from 1956 to 1986. Ages of patients ranged from 1 day to 11 years; 60% were less than 2 years of age at initial presentation. Seven duplications in six patients involved alimentary tract structures of foregut derivation (esophagus, stomach, and Parts I and II of duodenum), with a predominance of girls (4 of 6). Most of these patients (67%) presented with moderate to severe acute respiratory distress and a mass present on chest radiograph. In 67% of the patients, the correct diagnosis was established before operation. None required emergency operative intervention. By contrast, 13 duplications in 11 patients were of midgut or hindgut derivation (Parts III and IV of the duodenum, jejunum, ileum, and colon). In this group of patients, 62% of the duplications involved the cecum, 23% involved the ileum, and 16%, the jejunum. Seventy-eight per cent of the patients were boys. The most common symptoms were nausea and vomiting, and the most common sign was a palpable abdominal mass. Emergency operative intervention was required of eight of 11 patients with duplications involving the small bowel and colon. Three patients presented with an intussusception, four with signs and symptoms consistent with acute appendicitis, one with a small bowel obstruction, and two with gastrointestinal hemorrhage due to the presence of ectopic gastric mucosa within the duplication. It was found that two important points must be considered in regard to the management of enteric duplications: (1) the common blood supply shared between the duplication and native bowel must be carefully protected to avoid undue sacrifice of normal bowel, and (2) the presence of heterotopic gastric mucosa in 35% of patients negates internal drainage.(ABSTRACT TRUNCATED AT 400 WORDS)     

Bilateral suprascapular nerve entrapment syndrome due to an anomalous transverse scapular ligament

A rare case is reported of a young woman who suffered from suprascapular nerve entrapment syndrome (SNES) of the right side and two years later developed the same syndrome on the left. At the first operation an anomalous bifid transverse ligament was found and cut. The combination of pressure effect from the congenital defect together with frequent protraction of the shoulder due to her work as a physical education teacher caused triggering of the SNES. The clinical course, electromyographic findings, and differential diagnosis are reported. Cutting of the anomalous ligament on both sides brought relief from pain, weakness, and atrophy of the shoulder muscles, enabling the patient to return to work.     

First-year results of routine alpha-fetoprotein testing on prenatal patients in a family practice

For one year all pregnant women presenting to a family practice clinic for prenatal care were routinely tested for maternal serum alpha-fetoprotein levels (MSAFP). Unexpectedly, 14 (15.7 percent) of 89 tested patients had low MSAFP levels. All 14 pregnant women underwent appropriate diagnostic workups because of the low MSAFP level and were subsequently followed until delivery. Although the literature reports that low MSAFP levels are associated with chromosomal anomalies, none of the 14 women were delivered of infants with anomalies. Reasons for the unexpectedly high rate of abnormal MSAFP levels were investigated. Investigation revealed that normal values for MSAFP tests had been derived from testing performed on high-risk pregnant women who had an inherently higher rate of abnormal pregnancies and, apparently, a different range for normal MSAFP levels than a population of unselected family practice patients. The results of this study demonstrate that it may not be appropriate to apply diagnostic algorithms based on data derived in high-risk subspecialty clinics to unselected patients in a family practice.     

Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux: A 2-Year Follow-Up

BACKGROUND: Saphenous vein reflux is often the underlying anatomic cause of varicose veins. It is necessary to eliminate this reflux originating at the saphenofemoral junction (SFJ) to treat the resultant varicose veins. OBJECTIVE: To report 2-year follow-up results after closing the incompetent greater saphenous vein starting from its junction (SFJ) with the femoral vein using radiofrequency (RF) endoluminal ablation. METHODS: One hundred and forty incompetent greater saphenous veins from 120 patients with an incompetent SFJ and large painful varicosities were treated. Patients were evaluated clinically and with duplex ultrasound at 1 week, 6 weeks, 6 months, 12 months, and 24 months to determine treatment efficacy as well as adverse sequelae. RESULTS: Vein occlusion, defined as the absence of any duplex ultrasound-determined flow, was successfully achieved in 137 of 140 (98%) scanned veins at 1-week follow-up. At the 12-month follow-up, none of the treated patients developed recanalization that was not seen at 6 weeks, with a successful outcome in 90%. At the 24 month follow-up, 19 of 21 patients had complete disappearance of the treated saphenous vein, for a success rate of 90%. Side effects were minimal, and no skin burns or thromboses were observed. CONCLUSION: RF endovenous occlusion allows patients to obtain treatment with the positive attributes of surgery, that is, a single treatment and low rate of recurrent reflux, but without the morbidity, need for general anesthesia, or extensive convalescence associated with vein stripping and ligation surgery. Patient satisfaction was routinely achieved, with 98% of patients indicating a willingness to recommend the RF endovascular procedure to a friend or family member.     

超细β-磷酸三钙/聚-L-乳酸复合材料的制备与骨折内固定器的加工

目的：制备分散性良好的超细β-磷酸三钙(β-TCP)／聚-L-乳酸(PLLA)复合材料及新型可吸收骨折内固定器。方法：通过研磨方法制备β-TCP超细粒子，用一缩二乙二醇作分散剂研磨β-TCP后，再将β-TCP与PLLA超声混合，制得复合材料，经注塑加工制成可吸收骨钉，并采用扫描电镜等方法进行表征。结果与结论：用一缩二乙二醇作分散剂研磨β-TCP后再经超声混合，可以使β-TCP超细粒子在复合材料中分散均匀，粒子大小仅为300nm左右，β-TCP与PLlA基体之间结合良好。超细β-TCP／PLLA复合材料可加工成可吸收骨钉，弯曲强度达到100MPa左右，完全满足松质骨内固定的要求。     

Aberrant expression of tight junction-related proteins ZO-1, claudin-1 and occludin in synovial sarcoma: an immunohistochemical study with ultrastructural correlation.

Synovial sarcoma demonstrates epithelial differentiation, either by light microscopy (biphasic synovial sarcoma) or by immunohistochemical/ultrastructural methods only (monophasic) and poorly differentiated synovial sarcoma. Although the glands of synovial sarcoma are known to have tight junction-like structures, far less is known about junction formation in the spindled component of synovial sarcomas. Additionally, it is unknown whether the tight junctions of synovial sarcoma are normally constituted. The tight junction is a multiprotein complex consisting of numerous proteins that include ZO-1, claudin-1 and occludin. A total of 35 cases of synovial sarcoma (13 biphasic, 14 monophasic and eight poorly differentiated) were immunostained for ZO-1, claudin-1 and occludin using commercially available antibodies, heat-induced epitope retrieval and standard avidin-biotin technique. When available, corresponding electron micrographs were reviewed. For five cases, the presence of either an SYT-SSX1 (three cases) or SYT-SSX2 (two cases) gene fusion was known. Positive cases showed particulate membrane staining. The glands of biphasic synovial sarcomas expressed ZO-1 (13/13), claudin-1 (12/13) and occludin (11/13) in a manner identical to normal glandular epithelia, at the apical portion of the lateral membrane. The spindle cells of biphasic synovial sarcomas showed abnormal circumferential membranous expression of ZO-1 (12/13), claudin-1 (6/13) and occludin (3/13). Monophasic synovial sarcomas expressed ZO-1 in a circumferential pattern (13/14) but less often claudin-1 (4/14) or occludin (3/14). Poorly differentiated synovial sarcomas expressed ZO-1 (8/8) and claudin-1 (6/8) but only rarely occludin (2/8). By electron microscopy, recognizable tight junctions were seen only in glands. No correlation was seen between histologic subtype or fusion type and expression of tight junction proteins. We conclude that the glands of biphasic synovial sarcomas show well-organized, true epithelial tight junctions. In contrast, the spindled cells of all synovial sarcomas show significant abnormalities in the expression and localization of tight junction proteins, suggesting partial and/or aberrant epithelial differentiation.