Ten Years’ Experience in Surgical Treatment of Right Middle Lobe Syndrome

Purpose: In this study we present the clinical, radiological, pathological, bronchoscopic and surgical results of 40 patients with diagnosis of middle lobe syndrome who were referred to our thoracic surgery unit for surgical intervention in a 10 years period.Methods: Forty patients with obstructive and non-obstructive causes of middle lobe syndrome referred to our thoracic surgery unit. Clinical data were collected from the patients’ records in a ten years period. This study evaluates diagnostic approaches and surgical treatments in right middle lobe syndrome.Results: We studied 23 females (57.5%) and 17 males (42.5%) with a mean age of 31.7. Clinical findings were cough 95%, sputum 80% and intermittent hemoptysis in 50% of patients. Middle lobe collapse was seen in CT scan of all patients. Bronchiectasis was the most common pathologic finding (55%). Tuberculosis was not rare and was final pathology in 20% of patients. In three patients ruptured hydatid cyst was final finding. Surgery was done without mortality and with only minor complications.Conclusion: Lobectomy of right middle lobe is a good therapeutic option in these patients. Due to high prevalence of tuberculosis and hydatid cyst in Middle Eastern countries these two must be considered as causes of middle lobe syndrome.     

Finite element analysis of lordosis restoration with anterior longitudinal ligament release and lateral hyperlordotic cage placement

Purpose

Restoring sagittal alignment is an important factor in the treatment of spinal deformities. Recent investigations have determined that releasing the anterior longitudinal ligament (ALL) and placing hyperlordotic cages can increase lordosis, while minimizing need for 3 column osteotomies. The influences of parameters such as cage height and angle have not been determined. Finite element analysis was employed to assess the extent of lordosis achievable after placement of different sized lordotic cages.

Methods

A 3-dimensional model of a L3–4 segment was used. Disc distraction was simulated by inserting interbody cages mid-body in the disc space. Analyses were performed in the following conditions: (1) intact, (2) ALL release, (3) ALL release + facetectomy, and (4) ALL release + posterior column osteotomy. Changes in segmental lordosis, disc height, foraminal height, and foraminal area were measured.

Results

After ALL resection and insertion of hyperlordotic cages, lordosis was increased in all cases. The lordosis achieved by the shorter cages was less due to posterior disc height maintained by the facet joints. A facetectomy increased segmental lordosis, but led to contact between the spinous processes. For some configurations, a posterior column osteotomy was required if the end goal was to match cage angle to intradiscal angle.

Conclusion

Increased segmental lumbar lordosis is achievable with hyperlordotic cages after ALL resection. Increased cage height tended to increase the amount of lordosis achieved, although in some cases additional posterior bone resection was required to maximize lordosis. Further studies are needed to evaluate the impact on regional lumbar lordosis.

     

A vesicular shuttle: transport of a vesicle within a flexible microtube.

Micromanipulation of the external bilayers of nonionic surfactant vesicles (niosomes) and liposomes allows the formation of tethers, which are fluid state lipid/surfactant lamellar nanotubes. The technique allows investigation of some of the factors affecting tether formation and vesicle-tether interactions. In this paper the movement of a vesicle along, or more precisely in, tethers derived from the vesicle, has been studied. When a vesicle is supported by bipolar tethers, stretching the tether on one side of the vesicle, initiates the movement of the vesicle in the opposite direction, at velocities ranging up to 2.5 microm s(-1) thus creating a 'vesicular shuttle'. Movement of the vesicle occurs inside the tether structures, a process akin to the movement of a sphere in a flexible tube with a diameter much less than that of the sphere. The factors involved in the movement of vesicles in the tethers include the radial stretching and subsequently contraction of the tethers and the minimisation of elastic energies stored in the tether membranes. Vesicle velocity is not constant: there is deceleration near the end of the trajectory. While the relevance to the design of novel delivery systems is as yet tenuous, the system allows vesicle-vesicle collisions to be observed when the vesicle is propelled towards a stationary vesicle, and directly observation of the flow properties of vesicles in flexible 'capillaries', a neglected topic.     

Successful Fixation of an Intertrochanteric Fracture After Hip Resurfacing Arthroplasty Using Cannulated Screws

We report a case of successful treatment of a high, stable intertrochanteric fracture (type 1) in a 59-year-old man. He sustained the injury 8 years after the resurfacing procedure. The fracture was fixed using three 6.5-mm cannulated screws, and he has returned to his normal level of activities 8 months after the fixation. We have shown that fixation with cannulated screws may be an acceptable option for treatment of high trochanteric fractures where a stable anatomical reduction can be obtained. We have also included a review of the literature for other reported surgical treatment options of this complication.     

Metal Concentrations in the Groundwater in Birjand Flood Plain, Iran

The objective of the present study was to investigate the concentration of metals (cadmium, lead, chromium, zinc, copper, and iron) were measured in groundwater at 30 sites from the Birjand flood plain of eastern Iran during the November 2010; identify any relationships between metals and pH, total hardness. Metal concentrations in the groundwater samples were decreased in sequence of Zn > Fe > Cu > Cr > Pb > Cd, respectively. The results showed that the overall mean concentrations of Cd, Pb, and Cr were at 0.000, 0.023, and 0.049 mg l⁻¹, respectively. The mean concentration of Cu, Zn, and Fe were 0.109, 0.192, and 0.174 mg l⁻¹, respectively. Results also indicated that there were correlations among Cd, Cu, and Zn metals.