Long-term Outcome of Cruroplasty Reinforcement with Human Acellular Dermal Matrix in Large Paraesophageal Hiatal Hernia

Background Laparoscopic repair of a large hiatal hernia using simple sutures only for the cruroplasty is associated with a high recurrence rate. The solution was to place synthetic mesh over the cruroplasty thereby decreasing recurrence rates in exchange for complications, such as gastric and esophageal erosions. Our initial report investigated the use of human acellular dermal matrix (AlloDerm) as a more suitable alternative. This study highlights our long-term results > 1 year of cruroplasty reinforcement with AlloDerm in the repair of large hiatal hernias. Methods and Material This is a retrospective study performed at our university. Between 2005 and 2006, 52 consecutive patients with large hiatal hernias had the cruroplasty site reinforced with AlloDerm. The variables analyzed were age, sex, weight, height, hiatal hernia size, operative time, length of hospital stay, follow-up, and postoperative complications. Results The mean for age was 56.7 years, for weight was 87.9 kg, for height 117 cm, for hernia size was 5.75 cm, operative time was 121 min, and for hospital stay was 1.36 days. Complication included pneumothorax, 3 (5.5%); atelectasis, 1 (1.9%); urinary retention, 1 (1.9%); and recurrence, 2 (3.8%). Conclusion Laparoscopic hiatal hernia repair with reinforcement using human acellular dermal matrix can be performed safely with a short hospital stay and low rate of complications, especially a low rate of recurrence.     

Patients with pancreatic adenocarcinoma benefit from staging laparoscopy

Background: Unnecessary laparotomy in patients with advanced pancreatic cancer may both compromise the quality of life and delay the initiation of more appropriate therapy. Very often, peritoneal small liver metastases and true local status cannot be fully determined without surgery. Laparoscopy may spare laparotomy and decrease morbidity for patients with nonresectable advanced disease. The aim of this study was to determine the impact of laparoscopy in patients with potentially resectable adenocarcinoma of the pancreas. Materials and Methods: We reviewed the records of patients undergoing pancreatic surgery at the University of Nebraska Medical Center from October 2001 to April 2005. A total of 59 patients were included in the study. All patients were staged radiographically with a high resolution helical computed tomography scan and their tumors were considered resectable. Thirty-seven patients underwent staging laparoscopy while 22 proceeded directly to laparotomy. Results: Of the 37 patients who underwent laparoscopic staging, 9 (24.3%) were detected to have metastatic disease or advanced tumor; the remaining 28 (75.7%) patients with negative laparoscopy proceeded to laparotomy. Of those, 24 patients (85.7%) underwent pancreatic resection with curative intent, while 4 patients had metastatic or locally advanced disease at subsequent laparotomy which was missed on staging laparoscopy (false negative rate of 14.3%). Of the 22 patients who proceeded directly to laparotomy, 16 (72.7%) received curative Whipple resection and 6 (27.3%) were found to have advanced disease and received bypass procedures or biopsy alone. Conclusion: These findings suggest that staging laparoscopy is beneficial in a significant proportion of patients deemed resectable by routine noninvasive preoperative studies. We plan to add intraoperative laparoscopic ultrasound to our staging protocol in order to decrease the false negative rate.     

Morphometric characteristics and correlation interdependence of the lacrimal sac fossa and nasolacrimal canal in cerebral and facial parts of the skull of various shape

Morphometric characteristics of lacrimal sac fossa (LSF) and nasolacrimal canal (NLC) were studied in 105 macerated skulls of humans of mature age. Extreme shape variants were detected for LSF and NLC inferior foramen. The peculiarities of topographic-anatomical relations of NLC with the neighboring structures of nasal cavity were established. Morphometric characteristics of LSF and NLC were found to be largely determined by the shapes of facial part of the skull, nasal cavity and orbit, and to a lesser extent by the shape of cerebral part of the skull. Some variants of LSF and NLC topographic-anatomical localization were found to exist that could predispose to spreading of an inflammatory process from the adjoining areas. Correlation analysis of morphogenetic relations of LSF and NLC has demonstrated significant dependence of only some dimensions in each of the skull shape variants.     

Identification of neuroleptics by using the characteristics of the spatial organization of the EEG

The electroencephalographic reactions to stelazine, aminazine and haloperidol were studied by the methods of multifactor and multidiscriminant analyses. The specific features of pharmacogenic spatial reorganization of the EEG were revealed for every neuroleptic which made it possible to recognize the drugs in 90.9, 88.9 and 82.9% of cases, respectively.     

Single-stranded DNA mimicry in the p53 transactivation domain interaction with replication protein A

One of many protein-protein interactions modulated upon DNA damage is that of the single-stranded DNA-binding protein, replication protein A (RPA), with the p53 tumor suppressor. Here we report the crystal structure of RPA residues 1-120 (RPA70N) bound to the N-terminal transactivation domain of p53 (residues 37-57; p53N) and, by using NMR spectroscopy, characterize two mechanisms by which the RPA/p53 interaction can be modulated. RPA70N forms an oligonucleotide/oligosaccharide-binding fold, similar to that previously observed for the ssDNA-binding domains of RPA. In contrast, the N-terminal p53 transactivation domain is largely disordered in solution, but residues 37-57 fold into two amphipathic helices, H1 and H2, upon binding with RPA70N. The H2 helix of p53 structurally mimics the binding of ssDNA to the oligonucleotide/oligosaccharide-binding fold. NMR experiments confirmed that both ssDNA and an acidic peptide mimicking a phosphorylated form of RPA32N can independently compete the acidic p53N out of the binding site. Taken together, our data suggest a mechanism for DNA damage signaling that can explain a threshold response to DNA damage.