Cystosarcoma phylloides treated by excision and immediate reconstruction with silicon implant

A case of cystosarcoma phylloides in an 11-year-old girl is described. Excision was followed immediately by reconstruction with a silicon implant. To the best of our knowledge, this is the first report of this technique in an adolescent girl. The etiology, incidence, diagnosis, and treatment of cystosarcoma phylloides are described.     

Neurovascular island flap reconstruction following high pressure injection injuries of the hand

Adequate, satisfactory treatment of high pressure paint or grease injection of the hand invariably requires wide wound excision. This results quite often in a mutilated, disabled digit or hand, with loss of soft tissue and sensation. We report two such cases, each with a neurovascular island flap used in order to restore adequate soft tissue and sensation.     

Ovulation induction and risk of endometrial cancer: a pilot study

OBJECTIVE: To determine whether women with endometrial carcinoma are more likely to have been exposed to fertility drugs, in particular clomiphene, than healthy population controls. STUDY DESIGN: A nationwide case-control, pilot study. About 128 living women 35-64 years old, with a histologically confirmed diagnosis of endometrial carcinoma that was first diagnosed and reported to The Israel Cancer Registry between 1 January 1989 and 31 December 1992 were enrolled. The controls were 255 women from the same dialing areas selected by random digit dialing. A variety of demographic and clinical parameters were compared between cases and controls. A multivariate logistic model, controlling for age, was used to assess the independent effects of factors found to be significantly associated with endometrial cancer on univariate analysis. RESULTS: About 7 women with endometrial carcinoma (5.5%) and 10 healthy controls (3.9%) reported that they had used any fertility drug (crude odds ratio (OR) 1.4; 95% confidence interval (CI) 0.47-4.2). Use of fertility drugs did not meet the criteria for entry into the logistic model. The following parameters were found to be independently associated with endometrial cancer controlling for age, European-American background OR=2.2, (95% CI 1.3-3.7, P=0.004); nulliparity OR=2.7 (95% CI 1.1-6.5, P=0.03); history of infertility OR=1.8 (95% CI 1.0-3.3, P=0.05); BMI> or =27 OR=2.3 (95% CI 1.4-3.9, P=0.001). The use of oral contraceptives and IUD were found to be protective, OR=0.29 and 0.37, respectively, (95% CI 0.14-0.61, P=0.001 and 0.19-0.70, P=0.003, respectively). CONCLUSIONS: We found no evidence that the use of ovulation induction agents, including clomiphene citrate, are associated with a higher risk of endometrial carcinoma. The association between infertility drugs and endometrial carcinoma should be examined in other, larger studies.     

Diaphragm mobilization for closure of chest wall defects

Locally disseminated breast carcinoma after a simple or radical mastectomy and radiotherapy causes serious surgical problems. Excision of the chest wall obliterates the negative intrapleural pressure, and wound healing within a previously irradiated area is notoriously poor. A new method is described in which the diaphragm is mobilized and reinserted into the defect to allow final resurfacing with a skin graft or locally rotated skin flap. This simple surgical method is advocated when the prognosis is poor and breast reconstruction is not being considered.     

The hemostatic effect of conjugated water-soluble estrogens in rats

Estrogenic steroids have been used as hemostatic agents in various surgical procedures in humans. Their use to reduce bleeding has been based mainly on clinical observation. The present study was carried out to test experimentally whether intravenously administered Premarin reduces capillary bleeding. Skin-graft donor sites in rats served as the standard capillary bleeding source in this controlled double-blind experiment, in which Premarin was found to appreciably reduce capillary bleeding.     

Root length of lateral incisors adjacent to palatally-displaced maxillary cuspids

An evaluation of 70 palatally-displaced cuspids and 106 controls finds significantly shorter lateral incisor adjacent to the palatal cuspids.     

Does birthweight have a role in the effect of episiotomy on anal sphincter injury?

Most professional guidelines advise against routine episiotomy during vaginal delivery, although mounting evidence supports its protective role regarding obstetric anal sphincter injury (OASI). We aimed to study the effect of lateral and mediolateral episiotomies on the rate of OASI in relation to birthweight among nulliparous women undergoing vaginal delivery. A historical cohort study was conducted of all nulliparous women who delivered vaginally at term between 2011 and 2019 at a tertiary university hospital. Women were allocated into two groups: (1) with OASI and (2) without OASI. Episiotomy performance and birthweight groups were analyzed. Overall, 22,250 deliveries were analyzed for inclusion: 18,533 (83.3%) spontaneous vaginal deliveries (SVD), 3222 (14.5%) vacuum-assisted deliveries (VAD) and 495 (2.2%) forceps deliveries. Total episiotomy and OASI rate was 48.2% and 1.7%, respectively. Episiotomy rate was lower in the OASI group as compared to the no OASI group (158 (41.3%) vs. 10,568 (48.3%), OR 0.75, 0.61–0.92, p = 0.006). Median birthweight was higher for OASI group neonates (3355 vs. 3160, p < 0.001). In SVDs, episiotomy decreased the rate of OASI in neonatal birthweight groups of 3000–3499, 3500–3999 and > 4000 g (OR 0.56, 0.38–0.82, p = 0.003; 0.66, 0.45–0.99, p = 0.04 and 0.24, 0.07–0.78, p = 0.01, respectively). In VADs, episiotomy decreased the rate of OASI in the neonatal weight groups of 2500–2999 and 3000–3499 g (OR 0.36, 0.14–0.89, p = 0.02 and OR 0.38, 0.19–0.75, p = 0.004, respectively). Lateral and mediolateral episiotomies are independent modifiable predictors of OASI, protective against OASI in SVDs when neonates weigh > 3000 g and 2500–3499 g in VADs.