Laparoscopic management of ovarian cysts

The role of operative laparoscopy in the management of patients with adnexal masses is expanding, offering distinct advantages of lower morbidity, improved postoperative recovery, and reduced cost. Although clinical examination and the results of preoperative work-up often indicate the benign or malignant nature of the cyst, only histology can provide the absolute diagnosis. Advanced operative laparoscopy for management of ovarian cysts, when performed by experienced endoscopic surgeons, is as safe and effective as open techniques.     

Laparoscopic management of ovarian remnant

Ovarian remnant syndrome has become increasingly recognized as a cause of pelvic pain after extirpative surgery. Surgical removal of the ovarian remnant is the optimal treatment. Laparoscopy is safe and effective in managing ovarian remnant syndrome when performed by an experienced laparoscopist.     

Preparation and pharmacokinetics of 11C labeled stavudine (d4T)

Stavudine, a potent antiviral agent for treating human immunodeficiency virus (HIV) infections, was radiolabeled with (11)C by methylation of a specifically designed precursor, 5'-O-(2-tetrahydropyranyl)-5-bromo-2',3'-didehydro-3'-deoxythymidine, with (11)C H(3)I. The radiolabeled drug was isolated by reverse phase HPLC. A total time of approximately 45 minutes was required for synthesis, purification and isolation of (11)C stavudine with chemical and radiochemical purities of greater than 98%. (11)C stavudine was combined with unlabeled drug (2.0 mg/kg) and used to study its pharmacokinetics in rats by measurement of radioactivity in excised tissues. In this species, there was rapid accumulation of drug in all tissue. In all tissues, with the exceptions of testis and brain, highest concentrations of drug were detected at 5 minutes after injection and decreased monotonically thereafter. The peak concentration (microg/g) of stavudine in blood was 1.78 +/- 0.16 and similar levels were achieved in most other tissues; heart 1.66 +/- 0.11, lung 1.60 +/- 0.15, liver 2.13 +/- 0.17, spleen 1.61 +/- 0.15, adrenal 1.47 +/- 0.20, stomach 1.40 +/- 0.11, GI tract 1.44 +/- 0.14, skeletal muscle 1.38 +/- 0.15 and bone 1.30 +/- 0.16. Much higher peak concentrations were achieved in kidney; 7.23 +/- 0.57 microg/g. Concentrations in testis were lower and remained relatively constant over 1 hour; peak 0.62 +/- 0.14 microg/g at 15 min Brain concentrations were low but increased monotonically over time; peak 0.26 +/- 0.02 microg/g at 60 min. Future PET studies with this radiopharmaceutical will allow in vivo measurements of the pharmacokinetics of stavudine in both animal models and human subjects.     

Cervical tuberculous spondylitis associated with systemic lupus erythematosus

STUDY DESIGN: A case report of cervical tuberculous spondylitis associated with systemic lupus erythematosus (SLE). Infection is a frequent problem in SLE, especially in patients hospitalised with the complications of the disease. Tuberculous spondylitis very rarely occurs in SLE patients, and cervical involvement has not been previously reported. CASE REPORT: A 54-year-old female patient was admitted to our hospital with a complaint of neck pain radiating to her shoulder of 2 months' duration. The neurological examination was completely normal and radiological investigations revealed narrowing, angulation and destruction of the end plates of the 5th and 6th cervical vertebrae. She has received corticosteroid and colchicine treatment for the diagnosis of SLE during the last 10 years. The anterior cervical approach was used and pyogenic material was debrided from the C5-6 intervertebral space, and an otogenous bone graft with a Smith Robinson type fusion was performed. CONCLUSION: High doses of corticosteroids are implicated as a risk factor for infection in SLE patients. Early diagnosis and appropriate medical and surgical treatment, as well as increased awareness of higher susceptibility to opportunistic infections, such as tuberculous spondylitis, are keystones for decreasing morbidity and mortality in patients with SLE.     

Goldenhar's Syndrome (oculo-auriculo-vertebral dysplasia) with congenital facial nerve palsy

Goldenhar's Syndrome (oculo-auriculo-vertebral dysplasia) is a wide spectrum of congenital anomalies that involves structures arising from the first and second branchial arches. In this report, a case of a male infant, with the features of hemi facial microsomia, anotia, vertebral anomalies, congenital facial nerve palsy and lagophthalmos is described. Although the syndrome itself is not uncommon, the presence of congenital facial nerve palsy, which has been reported in rare cases, prompted this case report.     

A mature cystic teratoma in pineal region mimicking parietal encephalocele in a newborn

Objective Teratoma is the most frequently encountered intracranial tumor at birth and constitutes 18–20% of all germ cell tumors. They are usually located in pineal and suprasellar regions. The authors aim to report an extremely unusual presentation, location, and appearance of a teratoma in a newborn. Case report A soft tissue swelling in the vertex was detected in a 1-month-old girl. Neurological examination was normal. A big, cystic–solid lesion beginning from pineal region and extending to the scalp was detected in magnetic resonance imaging. It is interesting to note that cerebral venous angiography showed that the superior sagittal sinus (SSS) was divided into three branches at the level of the lesion and they joined together distally. The tumor was excised totally. Histopathological examination revealed the diagnosis of a mature cystic teratoma. Conclusion A mature cystic teratoma mimicking parietal encephalocele is extremely rare. Germ cell tumors should be kept in mind in the differential diagnosis of all midline lesions with unusual radiographic appearance. Cerebral venous angiography or MR angiography must be performed for the diagnosis and the surgical planning in lesions located near SSS.     

A neurosurgical view of anatomical evaluation of anterior C1–C2 for safer transoral odontoidectomy

An anatomical study for evaluation of anterior C1–C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approach for odontoidectomy have been described in detail. Anterior arcus of C1 must be drilled out to reach odontoid process for transoral odontoidectomy. The thickness of anterior ring of C1 has not been studied before. Sixty, dried adult atlas and 60 axis vertebrae and ten cadaveric craniocervical specimens were measured for the following: (1) bony drilling depth (BDD), the distance from the anterior wall of anterior ring of C1 to anterior wall of odontoid; (2) minimum drilling diameter (MDD), distance of minimum C1 anterior ring removal for odontoid resection on horizontal plane; (3) maximum bony drilling diameter (MBDD), distance of maximum C1 anterior ring removal for odontoid resection on horizontal plane. Lateral border of this diameter is limited by medial borders of the lateral mass; (4) the widest odontoid diameters (WOD) on coronal sections were measured. On 60 atlas and axis vertebrae, the BDD was 7.0 ± 1.2 mm on dry bones, the distance between the medial borders of the lateral mass (MBDD) was 16.1 ± 1.5 mm, and the WOD on coronal sections (WOD) was 9.8 ± 0.8 mm. On cadavers, the distance between the two edges of C1 anterior ring removal for odontoid resection (MDD) was 10.8 ± 1.1 mm and the WOD on coronal sections (WOD) was 10.1 ± 1.4 mm. An odontoid surgery through transoral approach is safe and feasible. A quantitative understanding of the anterior anatomy of C-1 and C-2 is necessary when considering transoral odontoid resection. In this study the authors define safe zones for anterior atlas and axis.     

CNS involvement in Ewing's sarcoma

Summary Ewing's sarcoma is one of the malignant bone tumours, which occurs in various bones of the body. When the spinal column or skull bones are involved, it may cause spinal cord compression or brain invasion. In this study, 12 cases of Ewing's sarcoma with central nervous system (CNS) involvement are presented. Seven of them were male and five female. In seven of the cases tumoural mass was located in the spinal column, whereas in the others it was found in the cranium. The major complaints were motor weakness in the lower extremities in seven cases, and a mass on the cranial vault in four cases. On neurological examination, eight of the patients had impairment of movements of the extremities (67%), and seven had sensory loss (58%). All except one patient underwent surgery. In seven cases, decompressive laminectomy plus subtotal tumour excision was performed, in three, craniectomy with grossly total tumour excision, and in one, biopsy.In this report, age and sex distribution, complaints, clinical and laboratory findings, neurological examination, and histopathology of our cases are reviewed and surgical results are compared with others reported in the literature.     

Survey of patients' experiences after nail surgery

Nail surgery is performed to aid diagnosis and treatment of nail disease. A survey was conducted to determine whether patients understood the nature and consequences of nail surgery at the time of consent and to ascertain the most important aspects of morbidity after the procedure. The results identified that most patients understood the nature of their surgery and the immediate postoperative limitations they would face. Pain was short-lived, with no patients requiring analgesics after 6 weeks. The most important finding from this survey was that sensory disturbance was recorded by a large proportion (47%; 29/62) of patients. Of these, 35% (22/62) recorded either complete or partial resolution by 6–12 months after surgery, but 11% (7/62) noted no improvement. This is a point that is not made clear in standard surgical texts. The significance of dysaesthesia of a fingertip must be considered when counselling a patient before surgery.