Sciatica of nondisc origin: hydatid cyst of the sciatic nerve. Case report

The authors report on an 81-year-old woman with a primary hydatid cyst located in the posteromedial aspect of the thigh. She presented with sciatica, and the cyst was also associated with neurological dysfunction because of its intra-neural location. Diagnosis of a cyst in a nerve body is very rare, and the one reported here might be the first such case. So far, in all the previously reported cases in which there were also neurological findings, the cysts in the vertebral column were compressing the spinal cord or there was an intrapelvic mass compressing the sciatic nerve. Hydatid cyst should be considered in the differential diagnosis of sciatica, especially when treating patients who live in or have emigrated from areas of the world where Echinococcus granulosus is prevalent.     

Erratum to: An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature

Since publication of our article, "An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature." World J Emerg Surg. 2006, 1: 8 we believe that the case mentioned should have been described as a 'peritoneal encapsulation' rather than 'abdominal cocoon' as concluded in the original publication.     

A New Technique of Biliary Reconstruction After “High Hilar Resection” of Hilar Cholangiocarcinoma with Tumor Extension to Secondary and Tertiary Biliary Radicals

Background  Radical operation for hilar cholangiocellular carcinoma, including extended hepatic resection, seems to improve prognosis by increasing the surgical curability rate. Nevertheless, high postoperative morbidity and mortality have been reported in patients with obstructive jaundice. We describe the technique of “high hilar resection” and a modification of bilioenteric anastomosis for drainage of the multiple secondary or tertiary biliary radicals. Methods  Ten patients with advanced hilar cholangiocellular carcinoma underwent a high hilar resection with complete parenchymal preservation, and the biliary drainage was reconstructed by a sheath-to-enteric hepaticojejunostomy. Because of the technical difficulty caused by anastomosis line in the range of the biliary sheath, a modification was performed by dividing the biliary apertures of segments 5 and 4b. Results  A high hilar resection was successfully performed, and all patients were discharged from the hospital in good condition. No patient died postoperatively. The proximal resection margin was tumor-free in all patients. One patient died after 29 months of peritoneal carcinomatosis. None of the patients developed local recurrence around the hepaticojejunostomy. The remaining nine patients are alive after a mean follow-up of 28.8 months after surgery without any signs of recurrence. Conclusion  In highly selected patients with advanced hilar cholangiocellular carcinoma, a high hilar resection is technically safe and oncologically justifiable. In combination with our new technique of sheath-to-enteric anastomosis, the patients considerably benefit from the preservation of liver parenchyma with low postoperative morbidity and very short in-hospital stay.     

Progressive behavioral deficits in DJ-1-deficient mice are associated with normal nigrostriatal function

Loss-of-function mutations in the DJ-1 gene account for an autosomal recessive form of Parkinson's disease (PD). To investigate the physiological functions of DJ-1 in vivo, we generated DJ-1 knockout (DJ-1^−/−) mice. Younger (< 1 year) DJ-1^−/− mice were hypoactive and had mild gait abnormalities. Older DJ-1^−/−, however, showed decreased body weight and grip strength and more severe gait irregularities compared to wild-type littermates. The basal level of extracellular dopamine, evoked dopamine release and dopamine receptor D2 sensitivity appeared normal in the striatum of DJ-1^−/− mice, which was consistent with similar results between DJ-1^−/− and controls in behavioral paradigms specific for the dopaminergic system. An examination of spinal cord, nerve and muscle tissues failed to identify any pathological changes that were consistent with the noted motor deficits. Taken together, our findings suggest that loss of DJ-1 leads to progressive behavioral changes without significant alterations in nigrostriatal dopaminergic and spinal motor systems.     

Endoscopy-assisted Periacetabular Osteotomy

Periacetabular osteotomy has been recommended for reconstructing symptomatic dysplastic hips in adolescents and young adults, but requires substantial incisions and exposure. To minimize large incisions, we asked whether periacetabular osteotomy could be performed with a mini-incision under direct endoscopic control. We used five fresh-frozen cadaver pelves and developed curved guides and osteotomes for the osteotomy. We were able to perform a periacetabular osteotomy under endoscopic and image intensifier control and to fix the osteotomy with two cannulated screws. We identified no damage to vital structures or intraarticular fracture in any of the five cadavers we subsequently dissected. We believe periacetabular osteotomy may be performed with a mini-incision under direct endoscopic control. Our preliminary observations suggest the approach might be explored in limited prospective clinical trials by experienced individuals. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.