Piezosurgery: A safe technique for inferior alveolar nerve mobilization in surgical correction of hemimandibular hyperplasia—Review of the literature and case report

IntroductionPiezoelectric bone surgery is a relatively new alternative for bone-related procedures in oral and maxillofacial surgery. It represents an innovative technique as it offers the maxillofacial surgeon the opportunity to make precise bone cuts without damaging any soft tissue and providing a blood less surgical field. Correction of facial asymmetries is still a major problem in need of an adequate solution. Neurosensory damage to the inferior alveolar nerve can be an adverse effect of surgical correction of hemimandibular hyperplasia. In this case report, piezoelectric cutting device was used to treat a hemimandibular hyperplasia with inferior alveolar nerve preservation.Presentation of caseA 21-year-old female presented with lower facial a symmetry which was started when she was 16 years. Clinical and radiographic examination were done, the patient was diagnosed with hemimandibular hyperplasia. Bone scan revealed normal condylar activity. Piezoelectric device was used to split the lower border cortical plate where the inferior alveolar neurovascular bundle was found within the hyperplastic lower border. After dissection of the neurovascular bundle from the canal; resection to the inner border of the mandible continued. Inferior alveolar neurovascular bundle was secured safely on the lateral border of the mandible and wound closed. Patient had symmetrical facial appearance. Inferior alveolar nerve was intact intra-operatively and the patient didn’t report any parasethesia with 6 months follow up.ConclusionThe use of a piezoelectric device provides surgical results that would not be possible with traditional instruments, not only for the patient's benefit but also for the surgeon’s.     

循证护理在乳癌术后放疗皮肤反应中的应用

目的应用循证护理探讨乳癌术后放疗患者皮肤反应的有效干预方法。方法根据76例患者产生皮肤反应的具体情况，提出护理问题，收集相关证据，结合实际制订切实可行的护理计划，采取相应的护理措施。结果76例患者干预后皮肤反应均得以缓解，减轻了患者的痛苦，患者能顺利完成放射治疗，达到有效的照射剂量。结论应用循证护理找出乳癌放疗患者皮肤损伤因素，采用循证护理寻求科学完整的护理方案，有助于提高护理质量。     

尿动力学在前列腺增生诊疗中的策略及其理论支撑

BPH患者的梗阻性和刺激性下尿路症状多种多样，缺乏特异性。尿动力学检鹰对BPH患者确定膀胱出口梗阻部位及程度、评估逼尿肌功能状态、预测手术疗效和并发症、术后评价疗效及分析并发症的原因均有重要的应用价值，对于合理选择BPH治疗策略的参考作用不可替代。     

Hemopoietic Recovery and Infectious Complications in Breast Cancer and Multiple Myeloma after Autologous CD34<Superscript>+</Superscript> Cell-Selected Peripheral Blood Progenitor Cell Transplantation

Autografting with CD34+ cell-selected peripheral blood progenitor cells (PBPC) is often associated with a prolonged recovery time and a higher incidence of infections. The aim of our study was to evaluate whether underlying disease influences hemopoietic recovery and the infectious complications occurring after transplantation. We studied 19 breast cancer (BC) patients and 17 multiple myeloma (MM) patients entered in a high-dose chemotherapy (HDC) program of tandem autografting with CD34+ cell-selected PBPC. PBPC were collected after mobilizing chemotherapy plus granulocyte colony-stimulating factor and were processed for selection of CD34+ cells. After selection, a median of 53% CD34+ cells was recovered with a median final purity of 92% with no significant differences between the MM (52% and 92%, respectively) and BC (53% and 89%, respectively) patients. Medians of 4.5 x 10(6)/kg CD34+ cells (BC, 4.4 x 10(6)/kg; MM, 5.4 x 10(6)/kg) and 18 x 10(4)/kg colony-forming units-granulocyte-macrophage (BC, 21 x 10(4)/kg: MM, 16 x 10(4)/kg) were reinfused after each HDC. Twenty-six patients (10 MM and 16 BC) underwent tandem autografting, and 10 patients received only 1 autograft because of inadequate collection (5 patients), clinical condition (3 patients), and refusal (2 patients). In the BC patients, the HDC regimen included a high-dose melphalan course followed by an ICE (ifosfamide, carboplatin, and etoposide) course. In the MM patients, the regimen consisted of a course of high-dose melphalan therapy and a course of ICBV (idarubicin, cyclophosphamide [Cytoxan], BCNU, and etoposide) or total body irradiation, etoposide, and Cytoxan. We found a significantly prolonged time for neutrophil recovery to > 500/microL in the MM patients (13 days versus 10 days; P < .002), whereas the times for platelet recovery to > 20,000/microL in the two groups were not different (13 days versus 12 days; not significant). No late engraftment failures and no toxic deaths were observed. The incidences of extrahematologic toxicity were similar for the two patient groups. All patients received similar anti-infection prophylaxis for 3 months after transplantation. After 12 months of observation, we found a statistically significant higher incidence of bacterial infections in MM patients in both the early (77.8% versus 48.6%; P < .034) and the late (41.1% versus 0%; P < .014) posttransplantation periods, whereas the incidences of fungal infections were similar in the two groups. Viral infections consisted of herpes zoster virus infection in 2 patients of each group, and cytomegalovirus infection was observed in 3 MM patients and no BC patients. Our experience demonstrates a prolonged neutrophil recovery time and higher incidences of bacterial and viral infections in MM patients compared with BC patients. These observations, although limited by the small sample size, suggest that the underlying disease may influence the incidence of infections after CD34- cell-selected transplantation and should be considered in the planning of appropriate antimicrobial prophylaxis in the autologous transplantation setting.     

Breast abscess caused by Propionibacterium avidum following breast reduction surgery: case report and review of the literature

Propionibacterium avidum was isolated from bilateral breast abscesses following breast reduction surgery. This report highlights the potential pathogenicity of the normal microbial flora following surgical interventions.     

Clinicopathology of pancreaticobiliary maljunction: relationship between alterations in background biliary epithelium and neoplastic development

Background/Purpose

Between 1988 and 2003, 38 patients underwent biliary resection for pancreaticobiliary maljunction (PBM). We reviewed the histopathologic findings for the surgically resected specimens to compare the clinical and pathologic features and assess the relationship between changes in the background biliary epithelium and the development of neoplasms.

Methods

Papillary hyperplasia (PHP) seen in the biliary epithelium of patients with PBM, was classified into grades 0–III in the gallbladder and grades 0–II in the extrahepatic bile duct, according to the extent, and was assessed for links with tumors in the same specimens.

Results

The incidence of gallbladder carcinoma was 13/21 in grades I–II, versus 0/16 in grade III, while the incidence of bile duct carcinoma was 4/20 in grade I versus 0/5 in grade II. Furthermore, these incidences for patients below age 50 years and age 50 or older were 1/18 versus 12/20, and 0/14 versus 6/17, respectively.

Conclusions

PHP of the biliary epithelium in PBM patients is an important precursor lesion, especially for gallbladder cancer, and the risk becomes greater with age, regardless of the type of pancreatobiliary junction (PBJ) and its location in the biliary tract.     

Angiogenesis in hepatocellular carcinoma as evaluated by CD34 immunohistochemistry

ABSTRACT— To clarify the relationship between angiogenesis and hepatocarcinogenesis on progression of hepatocellular carcinoma (HCC), we quantitatively evaluated angiogenesis by CD34 immunohistochemistry in liver cirrhosis (LC), adenomatous hyperplasia (AH), and HCC, and proliferative activity estimated by Ki-67 immunohistochemistry. Angiogenesis was evaluated by CD34 immunohistochemistry using monoclonal antibody HPCA-2, and tumor proliferative activity was evaluated using monoclonal antibody MIB-1. We used an image analysis system to assess the microvessel density as the area percentage of the endothelial area. Angiogenesis was generally observed in HCC and there was no significant difference among all clinical stages and histological grades of HCC. On the other hand, the staining of CD34 was partly observed in sinusoids of AH, although no positive staining was seen in any sinusoids of LC. The proliferative activity was significantly correlated with the clinical stage and histological grade of HCC. Our results indicate that the quantitation of angiogenesis does not provide significant prognostic information in HCC, but that it may have diagnostic value in distinguishing HCC from non-HCC. Meanwhile, AH, which is not morphologically diagnosed as cancer, shows positive staining for CD34, suggesting that some portion of AH contains cancerous characteristics.     

CEUS诊断乳腺癌研究进展

CEUS是纯血池显像,利用血液中含气微泡造影剂在声场中的非线性效应和强烈的背向散射获得对比增强图像,可动态直观地显示肿瘤微血管,已广泛应用于乳腺癌的诊断和疗效评估。CEUS在检出早期乳腺癌和识别前哨淋巴结方面具有较高敏感度和特异度,在评估新辅助化疗疗效、预测乳腺癌分子分型和辅助乳腺癌靶向治疗领域具有广阔的应用前景。本文对乳腺癌CEUS特点及其与生物标志物的关系、CEUS评价新辅助化疗疗效及辅助前哨淋巴结活检术方面的进展进行综述。