Introduction: SSAT/AGA/ASGE State-of-the-Art Conference: Necrotizing Pancreatitis: Novel Minimally Invasive Strategies

Background  

Necrotizing pancreatitis is the most severe end of the spectrum of acute pancreatitis. Interventional treatment (i.e., “who, when, and how”) of necrotizing pancreatitis is an ongoing source of considerable controversy. Novel minimally invasive strategies are being increasingly employed to perform pancreatic necrosectomy.     

Perspectives on bone densitometry: Past/present/future

Osteoporosis is defined as a decrease in bone mass and structural changes in bone leading to an increased fracture incidence. Therefore, early diagnosis in terms of prophylaxis and treatment are of great interest. Over the past several decades there has been considerable progress in the development and application of non-invasive methods of bone mass measurements or bone densitometry. This article reviews basic methodology and developments in bone densitometry including the early approaches like radiogrammetry, photo densitometry, neutron activation analysis and compton scattering techniques, present methods like single and dual x-ray absorptiometry and quantitative computed tomography, and recent developments like quantitative ultrasound, magnetic resonance techniques and structural analysis. The widespread interest in bone densitometry will initiate further improvement of established methods and development of new applications.     

Stress/aging: endocrine profiles/reproductive dysfunction in men

Extensive investigations have been carried out on the biology/physiology of stress [13, 18, 20, 25, 35, 48, 49, 53, 55], pathophysiology of aging [41], sexual dysfunction [7, 27] and adrenal insufficiency [4, 31].     

Phalangeal fractures: displaced/nondisplaced

Nonsurgical management is the preferred treatment of stable, extra-articular fractures of the proximal and middle phalanx, most distal phalanx fractures, and, rarely, nondisplaced intraarticular fractures in elite athletes. Techniques that afford maximal strength with minimal dissection, thus allowing earlier return to play, are ideal. Open reduction with internal fixation with plate fixation is most often chosen for unstable phalangeal shaft fractures in high-demand athletes to provide rigid internal fixation and allow immediate range of motion and more rapid return to sport. It is our practice to routinely treat unicondylar fractures with surgery with percutaneous headless compression screws in elite athletes.     

MESRCA/MESRRA: material aspects

Mobile ECMO support for remote cardiac or respiratory assistance (MESRCA and MESRRA) allows mobilization of the medical and paramedical team 24/7 in a very large geographical area. Mobility and autonomy require adapted devices. During many years, teams had to deal with non useful equipment. Recently, thanks to interest of medical world and laboratories, many materials especially suitable for this activity are developed. We describe our local experience and solutions we tented to fi nd to deal with material difficulties.     

Sialoblastoma: clinicopathological/immunohistochemical study

Sialoblastoma is an extremely rare salivary tumor diagnosed at birth or shortly thereafter with significant variability in histologic range and clinical course, so that for an individual case it may be difficult to predict the most appropriate therapy. We detail the case of a toddler noted to have a firm 1-2-cm mass in the left cheek at 21 months. Parotidectomy was performed at 26 months, revealing a sialoblastoma; the resection margins were positive. During the next 10 months, the mass recurred or persisted, necessitating numerous procedures. The tumor was composed of basaloid cells with fine chromatin and other more mature cuboidal epithelial cells. Ductules and solid organoid nests with some tendency toward peripheral pallisading were also noted. There was no perineural invasion; necrosis initially was sparse but increased over time. The mitotic rate also increased from 6 to 7/10 high-power fields in the first resection to 20/10 high-power fields in the last resection. Nuclear pleomorphism increased with time. The MiB1 proliferative index revealed a dramatic increase in the number of labeled nuclei: from 3 cells/10 high-power fields in the first specimen to 94 cells/10 high-power fields for the last specimen. Cytokeratin accentuated the ductal structures. S-100 showed a diffuse staining pattern, with darker staining of the spindled myoepithelial cells. The Her-2-neu protein showed moderate cytoplasmic staining, whereas the p53 showed only occasional labeling of nuclei. This is the first case of sialoblastoma with evidence of increasing anaplasia based on increasing proliferative capacity. Therefore, the distinction between benign and malignant sialoblastomas may not be as well defined as previously thought. The patient's prognosis is likely to be determined by the tumor grade as well as the stage at presentation and the extent of resection.     

Posttraumatische Arthrose: Arthrodese/Endoprothese

Posttraumatic arthrosis of the ankle joint can be tolerated for a long time before the patient asks for operative treatment, whether an endoprosthesis or arthrodesis appears more desirable. Patients’ expectations are relief of pain, plus stability and restored function. Provided a safe technique is used, patients can regain good joint function, as outlined in various studies. This depends on ligamentous stability, solid bone structure and a physiological position of the hindfoot. After arthrodesis even a largely destroyed ankle joint can be pain free, stable and normally functional in terms of weightbearing. Walking ability is particularly good when a good shape of the hindfoot is achieved and the other joints in the lower extremity on the same side are intact.     

Catastropic case management: Thoughts from a teacher/consumer/advocate

Former Chairman of the Board: National Head Injury Foundation; Director, Employee Benefits Program, The Heller School, Brandeis University, Waltham, MA 02254, USA     

The Prolactin/Growth Hormone Receptor Family: Structure/Function Relationships

Prolactin (PRL) and growth hormone (GH)² receptors are members of the cytokine receptor superfamily that are activated by ligand-induced homodimerization. On the basis of this mechanism of activation, hormone antagonists have been developed that block the receptors in an inactive conformation. PRL and GH receptors are non-kinase receptors whose activation of signaling pathways requires participation of receptor-associated kinases, such as Janus kinases or Src kinases. Signal transduction by these receptors mainly involves the JAK/Stat pathway. In this review, we discuss the mechanism of ligand binding and receptor homodimerization as well as the involvement of molecules transducing the hormonal signal. Whenever possible, we attempt to correlate cytoplasmic features of the receptors with association and/or activation of transducer molecules or with a given biological property.