Morphometric study of the scapular free flap and the free rib osteomyocutaneous flap

The scapula free flap is often the first choice for reconstruction of bony defects of the facial skeleton. However, the vascularised rib as part of a free rib osteomyocutaneous flap may be a suitable second choice. We have investigated the morphology and clinical dimensions of the 7th rib and the scapula, and the ability of the available bone to carry dental implants. The age and sex of the cadaver, and the donor side, were also recorded. The dimensions of the scapulas and 7th ribs (n = 130 of each) from 65 cadavers were measured at 4 different points using osteometric methods. Examination showed that bone from the scapula and 7th rib were sufficient for placement of implants. The 7th rib gave reliable measurements for both height and width, and a consistent relation between compact and cancellous bone. Although the scapula provided adequate compact and cancellous bone, there were variations depending on the segment of bone chosen. Bones from male cadavers were more suitable for implantation. In both the scapula and the 7th rib ageing had a significant adverse effect in only one dimension. Most points of measurement have satisfactory bony dimensions for insertion of dental implants.     

Cholestatic liver disease. Recognizing the clinical signs

Cholestatic liver disease in women is most often seen as primary biliary cirrhosis, an autoimmune disease that may take many years to cause symptoms and is often a challenge for physicians to identify. Primary sclerosing cholangitis is a cholestatic liver disease with a more straightforward presentation. Most commonly seen in men, this disease may rapidly progress to cirrhosis or to a third common cholestatic disease, cholangiocarcinoma. In this article, Drs Bhatia and Mihas discuss the etiologic and diagnostic features of these entities and explore medical, surgical, and palliative treatment approaches. In all three diseases, liver transplantation is a viable, life-extending therapeutic option.     

History of Biliary Surgery

Since ancient times biliary surgery has been one of the major interests of doctors and other scientists around the world. From the ancient Greeks and Egyptians to the greatest scientists of modern times biliary surgery has advanced remarkably. Especially during the last century huge progress has been made in this field. Minimally invasive surgical techniques have been developed and combined with general anesthesia and antisepsis that have made biliary surgery particularly safe for every patient and have made cholecystectomy one of the most common operations in the world today.     

Giant pancreatic incidentaloma: Report of a case and literature review

INTRODUCTIONAsymptomatic lesions of the pancreas, referred to as ‘incidentalomas’, have appeared with increased frequency in recent years. Giant incidentalomas have rarely been reported in the literature.PRESENTATION OF CASEWe report herein a rare case of a giant cystic pancreatic incidentaloma measuring 12.7 cm × 8 cm, which was found in an otherwise healthy male patient during a routine genitourinary imaging work-up. The patient underwent a distal pancreatectomy and splenectomy; the pathology report demonstrated a giant serous cystadenoma of the body and tail of the pancreas.DISCUSSIONThe management of pancreatic incidentalomas is challenging. While solid lesions almost always warrant surgery, there is ongoing debate concerning the management of cystic lesions that are found incidentally in the pancreas and have no clinical manifestations.CONCLUSIONWe report herein an interesting case of a voluminous incidental cystic pancreatic lesion. The appropriate approach and the decision whether to operate or not in such cases can be puzzling to the physician.     

Diabetic nephropathy and antihypertensive treatment: what are the lessons from clinical trials?

Diabetic nephropathy is the most serious problem among current issues in nephrology, as 40% of the cases of end-stage renal disease are due to this entity. The close relationship between type 2 diabetes and hypertension makes the problem even more severe. The knowledge of the intrarenal effects of angiotensin II and the greater effect of angiotensin converting enzyme inhibitors (ACEI) on reducing albuminuria suggested in the past a trend toward preferable use of these drugs in diabetic nephropathy. The first relevant clinical trials yielded rather poor conclusions because of lack of blind randomization and short duration. Subsequent double-blind studies with adequate numbers of patients and sufficient duration underlined the importance of blood pressure (BP) control as well as the rather poor response of diabetic nephropathy to any treatment. In most of these studies, the changes in albuminuria or microalbuminuria were a substitute end point for the renal function. Three clinical trials using angiotensin II receptor blockers (ARB), planned specifically to monitor the progression of renal damage, have been recently published. They showed better renal protection by ARB, as compared with placebo or calcium channel blockers (CCB), beyond or independently of the BP reduction. Nevertheless, these recent trials, like the previous ones with similar results, invariably demonstrate slightly better control of BP in the groups of the active drug. Another issue is that the vast majority of the patients need so many nonstudy drugs to keep their pressure under control, that the isolation of advantageous effects of certain drugs seems unrealistic.     

An update on red blood cell storage lesions,as gleaned through biochemistry and omics technologies

Red blood cell (RBC) aging in the blood bank is characterized by the accumulation of a significant number of biochemical and morphologic alterations. Recent mass spectrometry and electron microscopy studies have provided novel insights into the molecular changes underpinning the accumulation of storage lesions to RBCs in the blood bank. Biochemical lesions include altered cation homeostasis, reprogrammed energy, and redox metabolism, which result in the impairment of enzymatic activity and progressive depletion of high‐energy phosphate compounds. These factors contribute to the progressive accumulation of oxidative stress, which in turn promotes oxidative lesions to proteins (carbonylation, fragmentation, hemoglobin glycation) and lipids (peroxidation). Biochemical lesions negatively affect RBC morphology, which is marked by progressive membrane blebbing and vesiculation. These storage lesions contribute to the altered physiology of long‐stored RBCs and promote the rapid clearance of up to one‐fourth of long‐stored RBCs from the recipient's bloodstream after 24 hours from administration. While prospective clinical evidence is accumulating, from the present review it emerges that biochemical, morphologic, and omics profiles of stored RBCs have observable changes after approximately 14 days of storage. Future studies will assess whether these in vitro observations might have clinically meaningful effects.