Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques

OBJECTIVE

To report our experience in the surgical management of patients with large adrenal masses and describe the key steps in performing radical resections, which are especially demanding where thrombi extend into the inferior vena cava (IVC).

PATIENTS AND METHODS

From 2003 to 2007, 14 patients presented with large adrenal mass, and underwent surgical extirpation. In five patients thrombi extended into the IVC, causing Budd–Chiari syndrome in one.

RESULTS

The median (range) patient age was 48 (40–58) years. The excision was radical with negative tumour margins in all cases. Cardiopulmonary bypass (CPB) was required in one case with adherent intra‐atrial thrombus. The mean blood loss was 500 (250–1500) mL except in the patient who required CPB. Morbidity included pleural effusion (three patients) and postoperative pneumonia (two), which responded to conservative management. All patients were alive and free of disease at a median follow‐up of 12 (5–42) months.

CONCLUSIONS

Surgical extirpation of large adrenal masses requires technical experience to optimize outcome. Total tumour excision is the only therapeutic option in such cases and provides acceptable results in survival and quality of life.     

Homer2 and Homer3 interact with amyloid precursor protein and inhibit Abeta production

The study of Amyloid Precursor Protein (APP) processing has been the focus of considerable interest, since it leads to Aβ peptide generation, the main constituent of neuritic plaques found in brains of Alzheimer's disease patients. Therefore, the identification of novel APP binding partners that regulate Aβ peptide production represents a pharmaceutical target aiming at reducing Αβ pathology. In this study, we provide evidence that Homer2 and Homer3 but not Homer1 proteins interact specifically with APP. Their expression inhibits APP processing and reduces secretion of Aβ peptides. In addition, they decrease the levels of cell surface APP and inhibit maturation of APP and β-secretase (BACE1). The effects of Homer2 and Homer3 on APP trafficking to the cell surface and/or on APP and BACE1 maturation could be part of the mechanism by which the expression of these proteins leads to the significant reduction of Aβ peptide production.     

Laser-Assisted Blepharoplasty and Inferior Lateral Retinaculum Plication: Skin Contraction Versus Skin Traction

Blepharoplasty is one of the most commonly performed operations in plastic surgery, especially among middle-aged patients. Ablative lasers, especially the carbon dioxide laser, assist in tissue cutting and hemostasis. These lasers also offer skin resurfacing with its unique advantages despite the prolonged downtime. The authors present their laser-assisted blepharoplasty experience and the recent addition of one simply performed, inferior lateral retinaculum plication to the procedure (single suture traction technique, SSTT). Hence, the need for laser skin resurfacing of the lower eyelid has been reduced due to the skin traction applied, avoiding the long period required for resolution of erythema and potential hyperpigmentation. Furthermore, the tightening effect on the canthal ligament offers a more youthful look to the surgically treated eye. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Levetiracetam in tardive dyskinesia: an open label study.

Levetiracetam (LEV), a novel antiepileptic drug, has demonstrated antidyskinetic effect in preclinical animal models of Parkinson's disease (PD) and in one open label study in PD patients with levodopa-induced dyskinesia. The acute antidyskinetic effects of LEV in patients with tardive dyskinesia were evaluated in an open label study. Eight patients received oral LEV (1,000 mg/day) for 1 month and blinded evaluations were performed at baseline and at the end of the treatment period. A significant reduction of the abnormal movements was recorded while psychiatric symptoms did not worsen and the adverse event profile was benign. LEV may be efficacious for the treatment of tardive dyskinesia and deserves further clinical testing.     

Effect of auditory rhythmic cuing on gait kinematic parameters of stroke patients

The emotional and psychological benefits of musical experiences for human behavior are well documented by research in music therapy and psychology of music. It is also documented that music and rhythm have been utilized universally to accompany motor activity. The effect, however, of music and rhythm on motor activity including mechanics of hemiparetic gait has not been investigated. The purpose of this study was to investigate the effect of auditory rhythmic cuing on gait kinematic parameters of stroke patients. Eight subjects were studied over three trials. For each trial, a baseline walk without rhythm and a walk with rhythm as pacemaker, matched to the step cadence of the baseline walk, was videotaped with two 60 Hz videocameras. Three dimensional coordinates of ten body points were calculated by combining the images of the two cameras utilizing the direct linear transformation (DLT) method. The raw position data was digitally smoothed before being submitted to further analysis. Repeated measures ANOVA and paired t-tests revealed positive modifications in gait patterns due to musical rhythmic cues; specifically: (1) the stride lengths and hip joint range of motion (ROM) of the affected/non-affected sides became more symmetrical; and (2) center of mass (CM) vertical displacement decreased. These results support the presence of an entrainment effect of auditory rhythmic cuing on hemiparetic gait.     

The pedicled superficial temporalis fascial flap: a new method for reconstruction in otologic surgery.

OBJECTIVES: Our goal was to describe a novel fascial flap of the temporal region and its use for reconstruction in otologic and neurotologic surgery. METHODS: The superficial temporalis fascia has an axial blood supply derived from the middle temporal artery and can be raised independently from the overlying temporoparietal fascia or the underlying deep temporalis fascia. This flap was used on 15 consecutive patients to solve a wide variety of reconstructive problems after otologic procedures. RESULTS: No additional morbidity was observed from the use of this flap. There were no complications related to the reconstruction. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. Follow-up ranges from 2 to 25 months. CONCLUSIONS: This fascial flap provides a wide surface area of tissue on a narrow-based pedicle capable of a wide arc of rotation. It provides thin, pliable tissue that can be adapted to the needs of various reconstructive otologic/neurotologic problems.     

Direct rupture of splenic hydatid cyst without volume loss: report of a unique case

We present a rare case of primary spleen Echinococcus cyst with rupture evidence due to trauma. The cyst presented with an echogenic pattern at ultrasound examination but subsequent CT study revealed calcification of the cyst wall and signs of rupture. Serological tests were positive for echinococcus and eosinophilia defined. Volume changes of hydatid cyst were not discernible in the imaging studies despite evidence of rupture. Both imaging methods may suggest the diagnosis unless typical diagnostic features are present. Hydatid disease was confirmed histologically on the specimen after surgical excision of the cyst.     

Acute Q fever lobar pneumonia: a case report

Q fever is a zoonotic disease caused by Coxiella burnetii-an obligate, Gram-negative, intracellular bacteria. Acute febrile illness, hepatitis, and atypical pneumonia are the three most common manifestations, whereas lobar pneumonia is rarely reported among acute Q fever patients. We report a case of acute Q fever with lobar pneumonia and multi-organ involvement.