Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases.

OBJECTIVE: To investigate the computed tomography (CT) features of malignant pleural mesothelioma (MPM) cases, comparing them to those in other malignant and benign pleural diseases. MATERIALS AND METHODS: We reviewed the CT findings of 215 patients; 99 with MPM, 39 with metastatic pleural disease (MPD), and 77 with benign pleural disease. The findings were evaluated in univariate and multivariate analysis for differentiation of pleural diseases. RESULTS: In patients with MPM, the most common CT features were circumferential lung encasement by multiple nodules (28%); pleural thickening with irregular pleuropulmonary margins (26%); and pleural thickening with superimposed nodules (20%). In the majority (70%) of cases, there was rind-like extension of tumor on the pleural surfaces. In multivariate analysis, the CT findings of "rind-like pleural involvement", "mediastinal pleural involvement", and "pleural thickness more than 1 cm" were independent findings in differentiating MPM from MPD with the sensitivity/specificity values of 70/85, 85/67, and 59/82, respectively. "Rind-like pleural involvement", "mediastinal pleural involvement", "pleural nodularity" and "pleural thickness more than 1 cm" were independent findings for differentiation of malignant pleural diseases (MPM+MPD) from benign pleural disease with the sensitivity/specificity values of 54/95, 70/83, 38/96, and 47/64, respectively. Invasion of thoracic structures such as pericardium, chest wall, diaphragm, mediastinum, with pleural disease and nodular involvement of fissures, was detected infrequently; however, since these invasions were not seen in benign pleural diseases, it was concluded these invasions, if detected on a CT scan, directly suggested malignancy. CONCLUSION: A patient has extremely high probability of malignant pleural disease if one or more of these CT findings are found and the possibility of MPM is high. These findings may be important for patients in bad state or patients who do not want any invasive biopsy procedures. It is also possible to identify cases with a low probability of malignant disease.     

Hepatic adenomatosis: MRI demonstration with the use of superparamagnetic iron oxide

This case report describes a case of a 38-year-old woman with hepatic adenomatosis. MRI revealed five hyperintense nodular liver lesions on T1-weighted images which were hypo-isointense with the liver parenchyma on T2-weighted images. Serial gadolinium-enhanced images did not reveal distinctive imaging findings. With the use of superparamagnetic iron oxide (SPIO) particles, hyperintense adenomas revealed signal loss on T1-weighted images after SPIO. Two subcapsular adenomas were resected based on MRI findings and histopathology confirmed MRI diagnosis.     

Evaluation of the patellofemoral joint with kinematic MR fluoroscopy

OBJECTIVE: The aim of this study was to evaluate the diagnostic effectiveness of kinematic magnetic resonance fluoroscopy (KMRF) on patients with patellofemoral incongruency. MATERIALA AND METHODS: 17 patients (20 knees) and 10 healthy volunteers (20 knees), all men (mean age 29.4 years, S.D. 9, range 16-50), were included to our study. Only male subjects were studied because of potential biomechanical differences between sexes. KMRF was used to perform kinematic MR imaging of patellar alignment and tracking in 10 healthy subjects and 17 patients with a provisional clinical diagnosis of abnormal patellofemoral joints. The patellofemoral joints were examined with the knee in different angles of active flexion. At each knee position, real time kinematic and axial MRF image was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. Three angles were measured: patellar tilt angle (PTA), sulcus angle (SA) and congruence angle (CA). RESULTS: Five patterns of malalignment were identified and studied. Two patellofemoral joints were normal, 10 had lateralization of the patella, 2 had patellar tilt, 2 had lateralization and patellar tilt (i.e. excessive lateral pressure syndrome) and 4 had medialization of the patella. CONCLUSION: KMRF is an effective method in evaluating patellofemoral incongruency. Short time duration of investigation, ability to get nearly real time images, suitable temporal contrast resolution and investigation from very different angles of knee are important advantages of the method.     

Tramadol and levobupivacaine wound infiltration at Cesarean delivery for postoperative analgesia

Purpose

The aim of the present study was to investigate whether levobupivacaine and tramadol wound infiltration decreases postoperative pain following Cesarean section and reduces the need for analgesics in the immediate post-delivery period.

Methods

Ninety patients (aged 18–40 years) scheduled for elective Cesarean section under general anesthesia were randomly allocated to one of the three groups: the placebo group (group P) received 20 mL local wound infiltration with 0.9 % saline solution; the levobupivacaine group (group L) received 20 mL local wound infiltration with levobupivacaine 0.25 %; and the tramadol group (group T) received 20 mL local wound infiltration with 1.5 mg/kg tramadol within 0.9 % saline solution. Following the closure of the uterine incision and the rectus fascia, 20 mL solution was infiltrated subcutaneously along the skin wound edges. The primary outcome was 24-h tramadol consumption. Secondary outcomes were recorded VAS scores, diclofenac requirement, fever, vomiting, and wound infection.

Results

At 15 min postoperatively, VAS values were lower in groups T and L than group P (P = 0.0001). The mean 24-h tramadol consumption was lowest in group T (P = 0.0001) and it was lower in the group L compared to group P (P = 0.007) (401.6, 483.3, and 557.5 mg for T, L, and P groups, respectively). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (P > 0.05).

Conclusions

We conclude that wound infiltration with tramadol and levobupivacaine in patients having Cesarean section under general anesthesia may be a good choice for postoperative analgesia.     

Repetitively stretched tendon fibroblasts produce inflammatory mediators

We studied the expression of cytosolic phospholipase-A2 and activity of secretory phospholipase-A2 by human patellar tendon fibroblasts subjected to cyclic mechanical stretching. The effect of different stretching frequencies on the production of prostaglandin-E2 and expression of cyclooxygenase enzyme were also examined. An in vitro system that can control alignment, shape, and mechanical loading conditions of tendon fibroblasts was used for this study. Cyclic stretching of fibroblasts increased the expression level of cytosolic phospholipase-A2 by 88% and activity level of secretory phospholipase-A2 by 190%, compared with those of nonstretched fibroblasts. Cyclic stretching of tendon fibroblasts at 0.1 Hz and 1.0 Hz also increased prostaglandin-E2 production by 40% and 69%, respectively. Furthermore, cyclooxygenase-1 and cyclooxygenase-2 expression levels were increased in a stretching frequency-dependent manner, but cyclooxygenase-2 expression was increased more than that of cyclooxygenase-1. Because cytosolic phospholipase-A2 and secretory phospholipase-A2 are involved in the production of prostaglandin-E2 and other inflammatory mediators, this study suggests that regulation of phospholipase-A2 expression level may be an alternative approach to control in vivo tendon inflammation. The results of this study also may explain in part why activities that involve repetitive motion and high frequency loading of tendons are more likely to result in tendon inflammation.     

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

Background and Objectives:

Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Methods:

Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated.

Results:

In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries.

Conclusion:

Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy.     

松质骨基质复合生物蛋白胶构建组织工程软骨的研究

目的尝试采用松质骨基质与生物蛋白胶复合材料构建组织工程软骨。方法体外培养大鼠软骨细胞,接种于松质骨基质／生物蛋白胶材料上行体外培养。采用HE、甲苯胺蓝染色免疫学检测、扫描电镜观察等方法观察所构建的组织工程软骨的特性。结果松质骨基质／生物蛋白胶组的组织学结构更接近于软骨样组织．其Ⅱ型胶原、蛋白多糖基因表达量及蛋白多糖含量明显高于松质骨基质组。结论松质骨基质／生物蛋白胶复合材料可用于构建组织工程软骨,是一种较理想的支架材料。     

Elective Noncardiac Surgery in Patients with Left Ventricular Assist Devices

Abstract As the number of heart failure patients supported with left ventricular assist devices (LVAD) increases, the frequency of elective, noncardiac surgery in this patient population will similarly rise. We retrospectively analyzed our LVAD patient database and identified six patients who underwent elective, noncardiac surgery while on LVAD support. These cases are discussed, with an emphasis on the anesthetic and perioperative considerations. These patients have an acceptable risk profile for elective surgery and should be treated similarly to their age‐matched counterparts not on LVAD support. (J Card Surg 2012;27:639‐642)     

Minimally Invasive Treatment of Pilonidal Disease: Crystallized Phenol and Laser Depilation

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6–30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.     

Inter- and intraobserver reliability of the Crowe and Hartofilakidis classifications in the assessment of developmental dysplasia of the hip in adult patients

Background

The purpose of this study is to investigate the inter- and intraobserver reliability of Crowe and Hartofilakidis classifications in the assessment of developmental dysplasia of the hip in adult patients.

Materials and methods

Two consultant orthopedic surgeons classified 141 dysplastic hips on 103 standard anterior–posterior pelvis radiographs according to the Crowe and Hartofilakidis classifications. Assessments were performed in random order by each observer on two separate occasions, at least 4?weeks apart. Kappa statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer.

Results

At the first readings, interobserver reliability analysis revealed kappa coefficient of 0.71 for the Crowe classification and 0.54 for the Hartofilakidis classification. At the second reading, the kappa coefficient was 0.72 for the Crowe classification and 0.75 for the Hartofilakidis classification. Intraobserver reliability analysis revealed kappa coefficients of 0.71 for the Crowe and 0.80 for the Hartofilakidis classification for observer A, and 0.76 and 0.70 for observer B.

Conclusions

In conclusion, we have found substantial inter- and intraobserver agreement for Crowe classification and substantial to moderate agreement for Hartofilakidis classification in this study. Both classification systems assess the different aspects of developmental dysplasia of hip in adults. Each system has advantages and disadvantages. We suggest using both of these classifications together to increase the accuracy.