Skeletonization and Isolation of the Glissonean and Venous Branches in Liver Surgery With an Ultrasonic Scalpel Technology

This study describes a novel technique for skeletonization and isolation of Glissonean and venous branches during liver surgery using a harmonic scalpel (HS). Hepatic resections with HS were performed with the skeletonization and isolation technique in 50 patients (HS group). Variables evaluated were blood loss, operative time, biliary leak, and morbidity. The results were compared with 50 hepatic resections that were performed using a previously established technique: Cavitron ultrasonic surgical aspirator with electric cautery, ligatures, and hemoclips (NHS group). The HS group had shorter total operative times (285 versus 358 minutes; P = 0.01), less blood loss (389 versus 871 mL; P = 0.034), and less crystalloid infusion (2744 versus 3299 mL; P = 0.027) compared with the NHS group. Postoperative liver function and complication rates were similar when comparing the two groups. These data demonstrate that HS is a simple, easy, and effective instrument for the skeletonization and isolation of vessels during liver transection.Key words: Liver resection, Ultrasonic scalpel, Skeletonization, Cavitation effectVarious devices are available for liver transection, but the availability of comparative data for transection techniques is limited by the diversity of operative procedures. Clamp crushing (CC) and a Cavitron ultrasonic surgical aspirator are widely used for splitting the liver parenchyma,^1,2 and hemostasis is achieved by bipolar coagulation, ligatures, or hemoclips. Various coagulating devices, such as Ligasure,³ Tissuelink,⁴ and the Harmonic Scalpel (HS),^5–7 have recently been developed to aid in liver splitting. The choice of instrument is often based on individual surgeon preference. Higami et al^8,9 described a novel technique to skeletonize and harvest the internal thoracic artery with the HS, and the present study capitalizes on their experience to describe a unique method to skeletonize and isolate the Glissonean and venous branches using an HS.     

Proliferative response of gingival cells to ultrasonic and/or vibration toothbrushes

PURPOSE: To evaluate the effects of ultrasonic and/or vibration toothbrushes on cell proliferation and collagen synthesis. METHODS: In eight dogs, teeth and gingivae were stimulated once a day as follows: the first quadrant with an ultrasonic toothbrush (1.6 MHz); the second one with a mechanical vibratory toothbrush (141 Hz); and the third one with a toothbrush generating both the ultrasound and the vibration. The fourth quadrant served as a control. Proliferative activity and collagen synthesis of gingival cells were evaluated by assaying the expression of proliferating cell nuclear antigen (PCNA) and procollagen type I C-peptide (PIP), respectively. RESULTS: After 5 weeks, ultrasonic or vibratory toothbrushes increased the numbers of PCNA-positive fibroblasts and PIP-positive fibroblasts. Toothbrushing with a combination of ultrasound and mechanical vibration increased the numbers of PIP-positive fibroblasts, total fibroblasts and vascular endothelial cells to a greater extent than the one with only ultrasound alone. Vibratory toothbrush, but not the ultrasonic one, induced an increase in collagen density without gingival overgrowth.     

Does unilateral total hip arthroplasty improve pain and function in the non-operative hip joint?

European Journal of Orthopaedic Surgery & Traumatology - Some reports suggested that the status of the opposite-side hip affects clinical outcomes of unilateral total hip arthroplasty (THA) for...     

Gallbladder aspiration for acute cholecystitis in average-surgical-risk patients

We conducted a retrospective case note review to assess whether or not gallbladder aspiration can be applied as a temporary measure for the treatment of acute cholecystitis in average-surgical-risk patients. Gallbladder aspiration was performed in 79 consecutive average-surgical-risk patients with acute cholecystitis, who had no indications of emergent surgery and who complained of severe colicky pain. Elective surgery became possible in 92% of patients by gallbladder aspiration. The percentage reached 97 when percutaneous cholecystostomy was added (four patients). Emergent surgery was needed in one patient suffering bile leakage following gallbladder aspiration. Colicky pain was controlled soon after the procedure in most cases. Neither major complications nor mortalities were observed in the following surgical therapies. It is suggested that gallbladder aspiration might be applied as a temporary measure for acute cholecystitis in average-surgical-risk patients, although early surgery should remain the primary choice of therapy in such patients.     

Metacarpal bone mineral density,body mass index and lifestyle among postmenopausal Japanese women: relationship of body mass index,physical activity,calcium intake,alcohol and smoking to bone mineral density: the Hizen-Oshima study

The present study was designed to investigate the influence of modifiable risk factors (body weight and lifestyle) for bone loss on bone mineral density (BMD). We examined age-specific changes in metacarpal BMD, and its associations with body mass index and lifestyle among 532 community-dwelling postmenopausal Japanese women. Measurements of the second metacarpal BMD were obtained from the hand radiographs using computer-assisted radiographic absorptiometry. Body height and weight were measured, and body mass index (BMI) was calculated. Physical activity index was calculated using validated questionnaire. Daily calcium intake and amount of ingested alcohol were estimated by semiquantitative food frequency questionnaire. Current smoking status was obtained by questionnaire. Metacarpal BMD decreased significantly with increasing age. Simple correlation analysis indicated that metacarpal BMD correlated significantly with BMI and physical activity index. On the other hand, metacarpal BMD did not correlate with calcium intake and alcohol drinking. Metacarpal BMD in current smokers was not different from that in nonsmokers. Multiple regression analysis showed that increasing age was associated with decreased metacarpal BMD and greater BMI increased metacarpal BMD. However, physical activity, calcium intake, alcohol drinking and current smoking were not significant determinants of metacarpal BMD. Our findings suggest that maintenance of adequate body mass (prevention for leanness) is important for prevention of postmenopausal bone loss.