Prefabrication of bone by vascular induction: an experimental study in rabbits.

The various methods of prefabricating flaps include vascular induction through staged transfer; pretransfer delay, expansion, and grafting; the use of alloplastic materials; and tissue bioengineering. In this experimental study, vascular induction was used to provide an axial vascular pedicle to randomly nourished tissue. Twenty-six New Zealand rabbits, ages and weights ranging between 6 months-1 year and 1.5-3.5 kg, respectively, were used. The sex difference was not considered. The deep inferior epigastric artery and vein were used to carry blood and were placed into a segment of femur to prefabricate the bone. Four weeks later, the viability of the segment of bone prefabricated by new axial pedicle was shown by scintigraphic study, and the new axial pedicle was ready for free transfer.     

Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects

The purpose of this study was to evaluate the effects (common haemodynamic variables, peak cuff pressures, the incidence of reaction ('bucking') during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the endotracheal tube cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I-II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the cuff of the endotracheal tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted ('bucked') in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the endotracheal tube cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.     

Surgical treatment of pulmonary hydatid cysts in children

OBJECTIVE: Hydatid disease is a parasitosis and endemic in many sheepraising areas; it is still an important health problem in Turkey. We report our experience with childhood hydatid cyst and discuss the concepts of treatment. METHODS: The clinical courses of 128 children with thoracic and liver hydatid cyst operated on from 1994 to 2000 were reviewed. The group consisted of 71 boys and 57 girls aged from 8 months to 16 years. Intact cysts were found in 144 patients and ruptured cysts in 68. RESULTS: In the postoperative course we have encountered 20 perioperative complications in 16 patients. The most common complication was residual pleural space and delayed air leakage, which occurred in 9 patients. There was no early death. CONCLUSION: Surgery is the treatment of choice for most patients with pulmonary hydatid disease. The aim of surgery is evacuation of the cyst, removal of the endocyst, and management of the residual cavity. Conservative surgical methods that preserve lung parenchyma should be preferred.     

A new diagnostic method for woven coronary artery

Woven coronary artery is an extremely rare and not clearly defined congenital malformation in which the epicardial coronary artery is divided into multiple thin channels. These multiple channels merge again into a normal conduit. This anomaly is a benign condition because there is normal blood flow after the anomalous segment of the abnormal coronary artery. We describe a woven coronary artery anomaly in the left anterior descending artery (LAD) and its first diagonal (DI) branch causing myocardial infarction that was confused with coronary dissection. The definitive diagnosis was made by optical coherence tomography (OCT). Although woven coronary is a benign anomaly, it may cause myocardial infarction. We used the novel method of OCT for the definitive diagnosis and appropriate treatment of this anomaly.     

Sentinel lymph node detection in early stage cervical cancer: a prospective study comparing preoperative lymphoscintigraphy, intraoperative gamma probe, and blue dye

OBJECTIVE: The objective of this prospective study was to determine the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer using lymphoscintigraphy (LS), gamma probe, and blue dye. METHODS: A total of 32 patients with early stage cervical cancer (FIGO IA2-IIA) who were treated with total abdominal hysterectomy and bilateral pelvic and paraortic lymphadenectomy underwent SLN biopsy. LS was performed on all the patients following the injection of 74 MBq technetium-99m-nanocolloid pericervically. The first appearing persistent focal accumulation on either dynamic or static images of LS was considered to be an SLN. Blue dye was injected just prior to surgical incision in 16 patients (50%) at the same locations as the radioactive isotope injection. During the operation, blue-stained node(s) were excised as SLNs. For gamma probe, a lymph node was accepted as an SLN, if its ex vivo radioactive counts were at least 10-fold above background radioactivity. SLNs, which were negative by routine hematoxylin and eosin (H&E) examination, were histopathologically reevaluated for the presence of micrometastases by step sectioning and immunohistochemical staining with pancytokeratin. RESULTS: At least one SLN was identified for each patient by gamma probe. Intraoperative gamma probe was the most sensitive method with a technical success rate of SLN detection of 100% (32/32), followed by LS 87.5% (28/32) and blue dye 68.8% (11/16), respectively. The average number of SLNs per patient detected by gamma probe was 2.09 (range 1-5). The localizations of the SLNs were external iliac 47.8%, obturatory 32.8%, common iliac 9%, paraaortic 4.4%, and paracervical 6%. Micrometastases, not detected by routine H&E were found by immunohistochemistry in one patient. On the basis of the histopathological analysis, the negative predictive value for predicting metastases was 100%, and there were no false-negative results. CONCLUSIONS: Preoperative LS with radiocolloids, intraoperative lymphatic mapping with blue dye and gamma probe are all feasible methods comparable with each other for SLN detection in early stage cervical cancer patients, but gamma probe is the most useful method in terms of technical success.     

Free serratus anterior fascia flap for reconstruction of hand and finger defects

Introduction  

Reconstruction of the dorsal surface of hand defects requires thin, pliable, well vascularized tissue with a gliding surface for the extensor tendon course. Also defects of the palmar hand and degloved fingers need non-bulky soft tissue for reconstruction. We present a retrospective analysis of nine patients with free serratus anterior fascia flaps used to cover defects of the palmar and dorsal hand and of degloved fingers.     

Axial rotation and mediolateral translation of the fibula during passive plantarflexion

BACKGROUND: Since the fibula is linked to the ankle as well as the knee joint, its importance for knee and ankle disabilities should be investigated. This study evaluates its movement during range of motion of the ankle. MATERIALS AND METHODS: An instrument, together with the experimental protocol, was devised to determine the relative motion of the fibula in reference to the tibia with motion of the ankle joint on 20 paired lower extremity cadaver specimens. RESULTS: It was demonstrated in all specimens that the fibula had a relative rotation around its longitudinal axis and mediolateral translation with reference to the tibia with ankle motion. The distal end of the fibula rotates more compared to the proximal end. The mediolateral translation of the proximal end of the fibula is rather close to that of the distal end. Although there was no consistent pattern for rotation, dorsiflexion caused lateral translation and plantarflexion caused medial displacement for most of the specimens. CONCLUSION: A novel, invasive but relatively simple test setup was devised. Movement of the fibula which is important for the kinematics and kinetics of the knee and ankle joints was evaluated by this new device. CLINICAL RELEVANCE: Evaluation of the fibula movement in normal lower extremities may lead to better understanding of its dynamic function which could have treatment implications for pathological conditions.     

Sugiura procedure in portal hypertensive children

Bleeding from esophageal varices is an important cause of morbidity and mortality in children with portal hypertension. The treatment protocol is planned according to the etiologic factors underlying the portal hypertension, which may be either intrahepatic or extrahepatic. Although portasystemic venous shunt operations were common previously, they are now regarded as nonphysiologic and are rarely used because of their unexpected results and complications. Today, in many centers, endoscopic procedures have become the first-step treatment modality in bleeding esophageal varices. More complicated surgical procedures, such as devascularization procedures in extrahepatic portal hypertension, and liver transplantation in patients with failing liver, should be performed when conservative measures fail. We followed up 69 patients with portal hypertension with endoscopic sclerotherapy in our department. Here we present a retrospective evaluation of the effect of the Sugiura operation on the prognosis of 12 children (6 with extrahepatic and 6 with intrahepatic portal hypertension) who were not responsive to the sclerotherapy program. No rebleeding was seen in 9 of the 12 (75%) patients after the procedure, and the mortality rate in this series was 1 of 12 (8.3%); this patient died of hepatic failure. Received: November 7, 2000 / Accepted: January 25, 2001     

Feasibility of breast conserving surgery in multifocal breast cancers

Background

Multifocal breast cancers (MFBCs) present a challenge to surgeons. Although its feasibility is still controversial, breast-conserving surgery (BCS) is not contraindicated for MFBCs. The investigators retrospectively evaluated the feasibility of BCS and reviewed histopathologic findings in patients with MFBC.

Methods

A total of 222 patients with MFBC who were treated with either BCS (119 patients) or mastectomy (103 patients) at a single institution between January 2002 and December 2011 were retrospectively evaluated.

Results

The median follow-up time was 55 months (range, 10 to 102 months). Lymphovascular invasion and lymph node involvement were significantly less frequent in the BCS group (48.8% vs 62.2% for lymphovascular invasion, P = .04; 52.1% vs 71.8% for lymph node involvement, P = .002). There were no differences in local recurrence rates between the 2 groups. The overall survival rates were 92% in the BCS group and 72% in the mastectomy group (P = .000).

Conclusions

BCS is a feasible and safe procedure for the removal of multifocal tumors. Extended lymphovascular invasion is associated with mortality in patients who undergo mastectomy.     

The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature

INTRODUCTION

Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression.

PRESENTATION OF CASE

Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest.

DISCUSSION

PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery.

CONCLUSION

In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.