Intestinal enterolithiasis

We present a case report of a patient affected by chronic ileitis re-made acute and in which we found some entheroliths; they wern't not bezoars. We remarked the importance in bowel diseases in which are stasis or ipomotility like the Crohns disease. Sometimes they are responsible of subsequent complications like obstructions, hemorrages, perforations and so their presence must be considered by important diagnostic implications.     

Peripheral detection of S100β during cardiothoracic surgery: what are we really measuring?

Background

S100β has been used in cardiac surgery to identify patients with postoperative neurologic complications. However, extracranial proteins may falsely elevate measurements of serum S100β;. Objectives of this study were (1) to quantify S100β levels in serum and pericardial cavity during coronary artery bypass grafting (CABG), and (2) to identify proteins recognized by standard immunodetection as S100β.

Methods

Systemic and pericardial cavity blood from 5 patients undergoing CABG were sampled before, during, and after cardiopulmonary bypass (CPB). A commercially available enzyme-linked immunosorbent assay (ELISA) kit was used to quantify S100β. Two-dimensional gel electrophoresis, Western blot, and mass spectroscopy were also performed to identify S100â and other proteins.

Results

Mean S100β levels measured by ELISA, systemic and pericardial cavity blood were (in ng · mL⁻¹) 1.0 ± 0.46 and 111 ± 71 before CPB, 0.6 ± 0.11 and 113 ± 54 during CPB, and 1.7 ± 0.64 and 101 ± 42 after CPB, respectively. However, gel electrophoresis and Western blot analysis revealed proteins other than S100β to be present in the pericardial cavity giving a falsely elevated serum S100â levels measured by immunoassay. Mass spectroscopy of identified potential candidates revealed contaminants including haptoglobin I precursor, apolipoprotein A-1 precursor, complement factor B precursor, and complement C3 precursor.

Conclusions

S100β immunoassays are not specific for S100â and give a falsely elevated reading due to contaminants from the surgical field that cross react with the assay's antibody. This does not appear to be an issue in nonsurgical patients. Caution must be exerted when evaluating immunodetection results for low-abundance proteins under conditions where contamination of the sample is likely.     

Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications

HYPOTHESIS: Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications. DESIGN: Prospective case series. SETTING: Major academic medical and surgical center. PATIENTS: From January 1996 to July 2003, 47 patients who had undergone laparoscopic adjustable gastric banding were operated on again. Considering the causes for reoperation, the patients were divided into 4 groups: group A had major complications (n = 26); group B, minor complications (n= 11); group C, psychological problems (n=6); and group D, insufficient weight loss (n=4). INTERVENTIONS: Forty-three procedures, 38 using general anesthesia (groups A, C, and D) and 5 using local anesthesia (group B), were performed. MAIN OUTCOME MEASURES: Feasibility, safety, and effectiveness of a minimally invasive approach in the treatment of laparoscopic adjustable gastric banding complications. RESULTS: In group A, 9 of 10 patients with irreversible gastric pouch dilatation and 15 of 16 with intragastric band migrations were treated laparoscopically. In group B, 5 ports were substituted and 2 reconnections of the catheter-port system were performed. In group C, 6 laparoscopic band removals were carried out. In group D, 4 laparoscopic revision procedures for insufficient weight loss were performed. The operative mortality was nil. The most frequent cause of reoperation was intragastric migration (37.2%). A minimally invasive approach was adopted in 94.7% of cases. CONCLUSION: Laparoscopy is safe and effective, even as a second operative procedure.     

Usefulness of the ultrasonically activated shears in total thyroidectomy

Surgical technique of total thyroidectomy is nowadays well known. Technology could determine some improvement of this kind of surgery. Two groups of patients that underwent total thyroidectomy were compared retrospectively. In group 1 we described 105 total thyroidectomies performed with ultrasonically activated shears; in group 2, 76 performed with conventional methods of haemostasis. Comparing the two groups for several parameters, it results that in the total thyroidectomies performed with ultrasonically actived shears, operative time is shorter of 24 minutes compared with conventional method (81 vs 105 minutes), the mean amount of intraoperative blood loss is smaller (70 ml vs 125 ml), the postoperative pain is less, the cosmetic result is better (length of incision 6 cm vs 10 cm) and the costs is not more expensive. Complications of thyroid surgery are similar between the two methods. The use of ultrasonically actived shears in total thyroidectomy is safe (no increase of complications) and useful because it reduces operative time, improves the recovery of the patient (less pain, better cosmetic results) and, finally, is not more expensive than conventional method of haemostasis.     

Percutaneous plating of distal tibial fractures

We studied 20 patients (mean age 47.9±3.9, range 25–85 years) undergoing percutaneous plating of the distal tibia for 43A or 43C fractures in the period 1999–2002. Bony and functional results were classified into four categories ranging from excellent to poor. Union was achieved in all but one patient. Seven patients had angular deformities between 7 and 10°, but none of these patients required further operations. No patient had a leg-length discrepancy greater than 1 cm. Thirteen patients had excellent and good bone results, and none used walking aids. Seven patients reported stiffness of the operated ankle. This reported use of percutaneous techniques in the management of fractures of the distal tibial metaphysis is preliminary. However, the functional results and the lack of soft tissue complications are encouraging.

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Résumé Nous avons étudié 20 malades (âge moyen de 47.9±3.9 ans, gamme 25 à 85) qui dans la période 1999–2002 ont eu une ostéosynthèse du tibia distal par plaque percutanée pour des fractures de type 43A ou 43C. Les résultats osseux et les résultats fonctionnels ont été classés dans quatre catégories, dexcellent à mauvais. La consolidation a été obtenue dans tous les cas sauf un. Sept malades avaient une désaxation angulaire entre 7° et 10° mais aucun na du être réopéré. Aucun malade navait une inégalité de longueur de plus dun centimètre. 13 malades avaient des résultants osseux excellents et bons, et aucun nutilise daide à la marche. Sept malades ont une raideur de la cheville opérée. Lusage de techniques percutanées dans la gestion de fractures de la métaphyse tibiale distale est préliminaire. Cependant, les résultats fonctionnels et labsence de complication au niveau des parties molles sont favorables à cette technique.

     

Effect of ski binding parameters on knee biomechanics: a three-dimensional computational study

INTRODUCTION: Downhill skiing is a relatively safe sport, but many potentially avoidable injuries do occur. Whereas tibia and ankle injuries have been declining, severe knee sprains usually involving the anterior cruciate ligament (ACL) have increased from the 1970s to the 1990s. The goal of the present study was to evaluate the effect of the position of the binding pivot point and binding release characteristics on ACL strain during a phantom-foot fall. METHODS: We computed ACL strain using a biomechanical computer knee model to simulate the phantom-foot ACL-injury mechanism. This mechanism, which is one of the most common mechanisms of ACL injury in downhill skiing, occurs when the weight of the skier is on the inner edge of the ski during a backward fall, resulting in a sharp uncontrolled inward turn of the ski. RESULTS: The model predicts, that under simulated phantom-foot conditions, a binding with fast-release characteristics with a pivot positioned in front of the center of the boot produces less strain on the ACL. Current bindings have their pivot point approximately at the center of the heel radius. A pivot positioned at the back of the binding is more effective for sensing loads that occur at the tip of the ski. However, it is less effective for sensing loads that occur at the tail of the ski and, therefore, offers less protection during a phantom-foot fall. CONCLUSION: A binding with two pivot points, one positioned in front and the other at the back, could sense twist loads applied to the ski both at the front and at the back, and might, therefore, be a solution to reduce the occurrence of ACL injuries.     

Biomechanics and pathophysiology of overuse tendon injuries: ideas on insertional tendinopathy

Tendons behave viscoelastically and exhibit adaptive responses to conditions of increased loading and disuse. High-resolution, real-time ultrasound scanning confirms the applicability of these findings in human tendons in vivo. In addition, recent biomechanical studies indicate that strain patterns in tendons may not be uniform, as tendons show stress-shielded areas and areas subjected to compressive loading at the enthesis. These areas correspond to the sites where tendinopathic characteristics are typically seen. This indicates that some tendinopathies may, paradoxically, be considered as 'underuse' lesions despite the common beliefs that they are overuse injuries. Classic inflammatory changes are not frequently seen in chronic athletic tendon conditions and histopathology features in tendinopathic tendons are clearly different from normal tendons, showing an exaggerated dysfunctional repair response. Tendinopathies are traditionally considered overuse injuries, involving excessive tensile loading and subsequent breakdown of the loaded tendon. Biomechanical studies show that the strains within the tendons near their insertion site are not uniform. If the material properties are similar throughout the tendon, forces transferred through the insertion site preferentially load the side of the tendon that is usually not affected initially in tendinopathy. In that case, the side affected by tendinopathy is generally 'stress shielded'. Thus, the presence of differential strains opens the possibility of alternative biomechanical explanations for the pathology found in these regions of the tendon. The traditional concept of tensile failure may not be the essential feature of the pathomechanics of insertional tendinopathy. Certain joint positions are more likely to stress the area of the tendon commonly affected by tendinopathy. Incorporating different joint position exercises may exert more controlled stresses on these affected areas of the tendon, possibly allowing better maintenance of the mechanical strength of that tendon region and, therefore, prevent injury. Such exercises could stress a healing area of the tendon in a controlled manner and thus stimulate healing once an injury has occurred. Additional work is needed to prove whether such principles should be incorporated in current rehabilitation techniques.     

Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography

The purpose of this study was to assess the accuracy of four-row multi-detector CT (MDCT) in the evaluation of coronary artery bypass graft (CABG) in patients with at least a left internal mammary artery (LIMA) grafted to the left anterior descending artery (LAD), because of the conduit of choice in bypass surgery and the greater difficulty of evaluation with non-invasive diagnostic tools. Included in the study were 57 patients with a total of 122 grafts (95 arterial and 27 venous) who underwent MDCT (4×2.5-mm detector-collimation, 3-mm slice width, 1.5-mm reconstruction increment) with retrospective ECG gating. Twelve patients (21%) with high heart rates were given beta-blockers in order to obtain a heart rate 70 bpm in all patients. The ECG-synchronized axial images, reconstructed in the mid-diastole, MPR, MIP and 3D-VR images were independently and blindly assessed by two radiologists for graft patency and presence of high grade stenosis. Conventional angiography was the standard of reference. MDCT correctly classified 92/94 patent grafts and 26/28 occluded grafts (sensitivity/specificity 93%/97.8%); sensitivity and specificity of MDCT for assessment of arterial grafts were 100 and 98.7% (77/78 patent grafts and 17/17 occluded grafts). Image quality was considered adequate for assessment of significant stenoses in 62/92 (67%) patent grafts, with a significant differences between LIMA and non-LIMA conduits (44/57 vs. 18/65; P=0.002), according to the coronary vessel area supplied (anterior>lateral>posterior-inferior wall; P=0.002). In the remaining 30 patent grafts (33%), the assessment of stenoses was hampered by surgical clips, calcifications and motion artifacts. Sensitivity and specificity of MDCT for detection of significant graft stenoses were 80 and 96%, respectively. Inter-observer agreement was good (K=0.73). MDCT seems to be a valuable diagnostic tool for non-invasive assessment of patency of both venous and arterial grafts. An accurate evaluation of distal anastomoses and native coronary arteries may still represent a limitation of four-row MDCT, which will improve with the newest MDCT scanner.