Trends and Predictors for Vagotomy When Performing Oversew of Acute Bleeding Duodenal Ulcer in the United States

Background In the era of Helicobacter pylori treatment, the role of vagotomy in bleeding duodenal ulcers is debatable. National outcomes were evaluated to determine the current surgical treatment and use of vagotomy for bleeding duodenal ulcers. Methods Data from the Nationwide Inpatient Sample (NIS) were used from years 1999 to 2003. Patients were selected using diagnostic codes for acute duodenal ulcer bleed and procedure codes for simple oversew of a bleeding ulcer and vagotomy. Data were analyzed using multiple linear and logistic regression. Results Between 1999 and 2003, 100,931 patients with an acute bleeding duodenal ulcer were identified. Over time, there was a decrease in the number of acute bleeding ulcers (p = 0.027) and a decrease in the number of vagotomies (p = 0.027). A high co-morbidity index [odds ratio (OR), 0.60, p = 0.017], operation in the Midwest (OR 0.50, p < 0.001) and operation in the West (OR 0.68, p = 0.034) were predictive of no vagotomy during surgery for a bleeding duodenal ulcer. Conclusions A vagotomy is not commonly performed during surgical treatment of an acute bleeding duodenal ulcer. This variation in practice was not fully explained by patient characteristics. We must seek new evidence to determine the safety of combined medical and surgical management of this clinical problem. Presented at DDW/SSAT May 20–24, Los Angeles, California.     

Less invasive Achilles tendon reconstruction

Background  

The optimal management of chronic ruptures of the Achilles tendon is surgical reconstruction. Reconstruction of the Achilles tendon using peroneus brevis has been widely reported. Classically, these procedures involve relatively long surgical wounds in a relatively hypovascular area which is susceptible to wound breakdown.     

SOLIS在颈椎前路融合术中的应用

目的 探讨新型颈椎前路融合器(SOLIS)在颈椎前路融合术中的应用效果.方法 对18例脊髓型颈椎病、12例颈椎间盘突出症采用颈椎前路减压融合术,小切口入路(3～4 cm),椎间盘及部分椎体后缘切除后保留椎体终板,植人带自体松质骨的SOLIS.以手术前后X线片及JOA评分评价疗效.结果 30例随访6～18个月,平均12.5个月.置人的SOLIS位置良好,无移动及脱出迹象;病变椎间隙高度恢复正常,未见椎间高度丢失;所有节段均于术后3～8个月骨性融合.术前JOA评分平均10.4分,术后平均14.9分,两者有统计学意义(P＜0.01).结论 颈椎前路融合器SOLIS具有良好的生物相容性,手术创伤小,能有效地恢复颈椎高度,融合率高,融合后稳定性好,神经功能改善优良率高.     

Comparing diffusion-weighted and T2-weighted MR imaging for the quantification of infarct size in a neonatal rat hypoxic–ischemic model at 24 h post-injury

PURPOSE: In a neonatal rat model of hypoxic-ischemic (HI) brain injury, using T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), we aim to determine the best MRI method of lesion quantification that reflects infarct size. MATERIALS AND METHODS: Twenty 7-day-old rats underwent MRI 24h after HI brain injury was induced. Lesion size relative to whole brain was measured using T2WI and apparent diffusion coefficient (ADC) maps, applying thresholds of 60%, 70% and 80% contralateral control hemisphere mean ADC, and at day 10 post-HI on pathology with TTC staining. Multiple linear regression analysis was used to study the relationships between lesion size at MRI and pathology. RESULTS: Lesion size measurement using all MRI methods significantly correlated with infarct size at pathology; using T2WI, r=0.808 (p<0.001), using 80% ADC, 70% ADC and 60% ADC thresholds, r=0.888 (p<0.001), 0.761, (p<0.001) and 0.569 (p=0.014), respectively. Eighty percent ADC threshold was found to be the only significant independent predictor of final infarct volume (adjusted R(2)=0.775). CONCLUSION: At 24h post-HI, lesion size on DWI, using 80% ADC threshold is the best predictor of final infarct volume. Although T2WI performed less well, it has the advantage of superior spatial resolution and is technically less demanding. These are important considerations for experiments which utilize MRI as a surrogate method for lesion quantification in the neonatal rat HI model.     

Arthroscopic tarsometatarsal (Lisfranc) arthrodesis

We describe an arthroscopic approach of tarsometatarsal arthrodesis for post-traumatic arthritis. Five tarsometatarsal portals (medial, P1–2, P2–3, P3–4, P4–5) are identified at the junctional points between the metatarsals by means of image intensifier. The first metatarsocuneiform joint is approached through the medial and P1–2 portal. Articular cartilage is denuded and micro-fracture of subchondral bone is performed with an arthroscopic awl. The second metatarsocuneiform joint is approached through the P1–2 and P2–3 portals and the third metatarsocuneiform joint is approached through the P2–3 and P3–4 portals. The articular surfaces are prepared for arthrodesis. The articulations are kept in desired position and transfixed with 4.0 mm cannulated screws. The fourth and fifth metatarsocuboid articulations are rarely included in the procedure. Arthroscopic arthrodesis or tendon arthroplasty of the lateral column can be performed through the P3–4 and P4–5 portals.     

不同频率电针刺激对大鼠髌腱血流量变化的影响

目的:探讨分析不同频率电针治疗时肌腱血流的变化及其变化机制。方法:将40只Wistar大鼠分为2Hz组、10Hz组、100Hz组和针刺(10Hz)+阿托品组、针刺(10Hz)+酚妥拉明组。手术剥离出大鼠胫骨粗隆上缘的髌腱,利用超声测定技术,观察针刺足三里和梁丘穴前后髌腱血流量的变化。并采用静脉滴入阿托品和酚妥拉明的方法,对针刺作用机制进行分析。结果:(1)2Hz组和10Hz组在针刺过程中,髌骨腱血流量分别下降至针刺前的82.11±10.8%、49.17±11.63%,针刺停止后,两组血流量却逆转为高于针刺前的水平,以10Hz组上升幅度较为明显;(2)100Hz组针刺过程中,血流量下降至针刺前的37.54±12.79%,针刺停止后血流量未恢复到针刺前的水平;(3)针刺(10Hz)+阿托品组:针刺时血流量降低至44.61±12.01%,停针后血流量未出现增加现象;(4)针刺(10Hz)+酚妥拉明组:针刺时血流量增加至119.73±14.66%,针刺停止后血流量继续增加。结论:(1)电针刺激期间髌腱血流下降,刺激停止后血流量明显增加;(2)中、低频率刺激对血流量增加效果优于高频刺激;(3)针刺对血流量的影响与舒血管神经和缩血管神经的调节有关。     

Pullout reattachment of tibial avulsion fractures of the anterior cruciate ligament: a firm,effective suture-tying method using a tensioner

We describe a firm, effective suture-tying method using a tensioner for reattaching tibial avulsion fractures of the anterior cruciate ligament. Our simple method achieves strong, firm reattachment of the fracture. In addition, it prevents fixation loosening during suture tying effectively. Since pullout repair using nonabsorbable sutures is commonly used to fix various avulsion fractures, the tensioner helps attain strong, firm reattachment of avulsion fractures simply and effectively.     

Periosteal transplantation to the rabbit patella

Autologous periosteal transplantation (without chondrocyte cell transplantation) for treating traumatic articular cartilage defects of the patella gives pain relief in uncontrolled clinical studies. To study the whole transplanted area macroscopically and microscopically, animal studies are motivated. In this pilot study, we reproduce the surgical technique for periosteum transplantation on human patella to a rabbit model. A full-thickness cartilage defect of the whole patella was created in eight adult female rabbits. The defect was treated with autologous periosteal transplantation. After surgery, the rabbits were allowed free activity. This is the difference compared to the treatment in humans, where our group uses CPM for 5 days and non-weight-bearing for 12 weeks. After 21 weeks, there was a diffuse synovitis in all transplanted knees, and in five of eight knees there were signs of osteoarthritis in the patello-femoral joint. Histologically, in three animals, small islands of hyaline cartilage surrounded by fibrocartilage were seen in the transplanted area. In the other five animals, fibrocartilage was the predominant tissue. In contrast to previous experimental studies using a rabbit model, we did not achieve hyaline cartilage resurfacing.     

Biochemical Abnormality Associated with Smith-Lemli-Opitz Syndrome in an Infant with Features of Rutledge Multiple Congenital Anomaly Syndrome Confirms that the Latter Is a Variant of the Former

We describe a female infant with morphologic features of Rutledge multiple-congenital-anomaly syndrome (RMCAS) and biochemical features of Smith-Lemli-Opitz syndrome (SLOS). She had microcephaly with hypoplastic cerebral frontal lobes and cerebellum, agenesis of the splenium of corpus callosum, abnormal facies including hypertelorism with bilateral inner epicanthal folds, a broad nasal bridge with slightly anteverted nares and patent choanae, low set ears and complex conchal formation, high-arched palate and thick maxillary alveolar ridges, and micrognathia. Her chest was broad, genitalia were ambiguous, and uterus was bicornuate. Skeletal abnormalities included a hypoplastic appendicular skeleton, post-axial hexadactyly of the right hand and the left foot, syndactyly of bilateral 2nd-3rd toes and left 5th-6th toes, right talipes varus and left talipes valgus, and fused L5-S1 vertebrae. Congenital heart disease consisted of hypoplastic left heart, coronary sinus agenesis, ostium secundum and ostium primum defects, and a thickened septum primum. The lungs were hypolobated and the kidneys manifested oligopapillary hypoplasia. Total colonic Hirschsprung disease was noted microscopically. Analysis of liver tissue taken at postmortem examination revealed the ratio of 7-dehydrocholesterol and cholesterol to be 143 (expected, 0.28 +/- 0.28). Although initially described as a distinct syndrome, RMCAS was merged with the severe form of SLOS, because of significantly overlapping features [Online Mendelian Inheritance in Man (OMIM) #268670]. The biochemical data showing an excess of 7-dehydrocholesterol and low cholesterol in the liver tissue of our case supports this viewpoint.