Free transplantation of lyophilized dura for vestibuloplasty: a clinical and histological study.

Covering epithelial defects in the oral cavity is often neccessary in maxillofacial surgery. Special problems arise in preprosthetic surgery because requisites for function and quality of epithelial grafts must be satisfied. Using free heterologous lyophilized dura grafts for vestibular sulcoplasty in 23 patients, we observed a good clinical and histological healing process. Considering the necessity of a second operation for skin or mucosal grafts (and the limited source of mucosa), we believe that the lyophilized dura can be used successfully in preprosthetic surgery.     

In vivo and in vitro effects of stellate ganglion blockade on radial and internal mammary arteries

OBJECTIVE: To investigate the effects of stellate ganglion blockade (SGB) on the internal mammary (IMA) and radial arteries (RA) in patients undergoing coronary artery bypass graft (CABG) surgery with in vivo and in vitro studies. DESIGN: Prospective, randomized trial. SETTING: University hospital. PARTICIPANTS: Thirty-seven patients undergoing CABG surgery. INTERVENTIONS: SGB was performed on 19 patients before anesthesia induction. Another group of 18 patients underwent surgery without SGB. Diameters of proximal RA, distal RA, and IMA were determined by Doppler ultrasonography before (T1) and after (T2) anesthesia induction. Control or blocked IMA and RA segments were obtained. Norepinephrine (NE) was applied to determine the contractile force of IMA and RA rings in a concentration-dependent manner. The maximal contractile response and the sensitivity of the vessels were compared. MEASUREMENTS AND MAIN RESULTS: The diameters of IMA and distal RA were statistically larger in the SGB group than those in the control group at T2. NE-induced maximum contraction was higher in the blocked RA rings than those in the control RA and blocked IMA rings. The sensitivity of IMA segments to NE was higher than that of RA segments in the SGB group. The control and blocked IMA segments showed similar sensitivity to NE. CONCLUSION: The present results show that SGB not only increases distal RA and IMA diameters but is also associated with in vitro differences, the mechanism of which remains to be elucidated. Therefore, SGB might be considered as an alternative to topical and systemic vasodilators for reducing vasospasm in patients undergoing CABG.     

Total anomalous pulmonary venous drainage with major aorto-pulmonary collaterals - a diagnostic dilemma

A term female newborn presented with right atrial isomerism and infra-diaphragmatic total anomalous pulmonary venous drainage associated with complex cardiac anatomy. The repair was performed utilizing circulatory arrest in deep hypothermia. However, in the post-operative period the patient could not be weaned off mechanical ventilation and underwent cardiac catheterisation. This revealed major aortopulmonary collaterals, which were occluded with coils. We review the literature with specific focus on the occurrence of this unusual combination and its implication in the management during the postoperative period.     

A Perichondrial Flap for Functional Purposes in Rhinoplasty

Recent trends in rhinoplasty techniques have focused on anatomic repair as well as respect and preservation of soft tissue integrity. In this article, the authors describe the use of a perichondrial flap, then discuss technical considerations and clinical perspectives of their advantages. A perichondrial flap helps to restore the stability of the upper lateral cartilage, to achieve extra padding, and to secure osteocartilagenous grafts. The method described has been used for 60 consecutive patients. The majority of these patients were satisfied with the results.To obtain detailed information about the perichondrial flap, the authors performed an anatomic study of 13 cadavers. The average thickness of the perichondrium was 186 ± 146.1 μm (range, 90–596 μm). On the basis of the results, it was concluded that elevation of the perichondrial flap with loupe magnification could improve the outcome of rhinoplasty.     

The role of urtica dioica (urticaceae) in the prevention of oxidative stress caused by tourniquet application in rats

Tourniquets are used in extremity surgery and provide a relatively bloodless field, thereby minimizing blood loss and helping identify the vital structures. However, they may cause an ischemia-reperfusion injury with potentially harmful local and systemic consequences. Many therapeutic effects such as diuretic, natriuretic, hypotensive, anti-rheumatic, anti-prostatic, and in-vitro anti-oxidant effects of the Urtica dioica (UD) have been determined. In the present study, we aimed to investigate the potential role of UD plant for prevention of oxidative stress in muscle tissues generated by tourniquet application in rats. Wistar rats were used in this study. The UD extract or 1.15% KCl aqueous solution, in which UD leaf samples were homogenized, was given to each group of eight rats once a day for 5 days through an intraesophageal canule. No treatment was applied to untreated group. Tourniquets were applied to the left posterior limb of rats for 1 or 2 h followed by a reperfusion period of 1 h. After the ischemia and reperfusion, the rats were killed with a high dose of anesthetic drug, and malonyldialdehyde (MDA) levels were measured in their tibialis anterior muscles. Basal MDA levels were obtained from tibialis anterior muscles of 8 control rats, which were not exposed to ischemia. MDA levels were lower in the UD-treated rats than those in untreated and KCl-treated rats after either 1 or 2 h of ischemia and 1 h reperfusion. These results indicate that UD has a potential antioxidant effect on ischemic muscle tissues.     

Mandibular lateral incisor-canine transposition associated with dental anomalies

Tooth transposition is a rare positional anomaly that may create many orthodontic problems. Its etiology is an enigma. The occurrence of mandibular canine/lateral incisor transposition is a relatively rare anomaly. Two rooted canine/rotated incisor transposition has not been reported previously in the clinical dental literature. We describe a case with transposition of a mandibular two rooted canine and a lateral incisor with 180 degrees rotation. Possible causes such as trauma and tooth agenesis were absent in this case. Due to the root anomaly, we consider that our case may have a genetic etiology. Although the mandibular lateral incisor and canine were not in their normal anatomic positions, there were no functional or esthetic problems.     

Two cases of glycine encephalopathy accompanied by pes equinovarus

Glycine encephalopathy is a rare autosomal recessive metabolic disease characterized by glycine accumulation in body fluids owing to a defect in the glycine cleavage system. There are several forms of glycine encephalopathy. In the classic or neonatal form, symptoms usually develop as neurologic symptoms in the first few days of life. It characteristically presents with hypotonia, lethargy, apnea, and seizures and usually results in death by 1 year of age. In this report, we present two cases of neonatal glycine encephalopathy accompanied by isolated pes equinovarus deformity.     

Deep brain stimulation for refractory obsessive-compulsive disorder.

BACKGROUND: Neurosurgery (anterior capsulotomy) has been beneficial to many patients with debilitating, refractory obsessive-compulsive disorder (OCD), but the irreversibility of the procedure is an important limitation to its use. Nondestructive, electrical stimulation (deep brain stimulation; DBS) has proven an effective alternative to ablative surgery for neurological indications, suggesting potential utility in place of capsulotomy for OCD. METHODS: The effects of DBS for OCD were examined in four patients in a short-term, blinded, on-off design and long-term, open follow-up. The patients had incapacitating illness, refractory to standard treatments. Hardware developed for movement disorder treatment was surgically implanted, with leads placed bilaterally in the anterior limbs of their internal capsules. Patients received stimulation in a randomized "on-off" sequence of four 3-week blocks. Ongoing, open stimulation was continued in consenting patients after the controlled trial. RESULTS: Patients tolerated DBS well. Dramatic benefits to mood, anxiety, and OCD symptoms were seen in one patient during blinded study and open, long-term follow-up. A second patient showed moderate benefit during open follow-up. CONCLUSIONS: It appears that DBS has potential value for treating refractory psychiatric disorders, but additional development work is needed before the procedure is utilized outside of carefully controlled research protocols.     

Effects of diazeniumdiolates (NONOates) and methylene blue on the reduction of postoperative adhesion in rats

We investigated the effects of spermine NONOate (SPER/NO), diethylenetriamine NONOate (DETA/NO) and methylene blue for preventing postoperative adhesion in a rat uterine horn model. Before operations, rats were randomly assigned into 6 groups, each composed of 12 rats. These were the sham, control, normal saline, SPER/NO, DETA/NO and methylene blue groups. Each rat was anesthetized with ketamine hydrochloride (40 mg/kg i.v.). The abdominal wall was shaved; the surgical site was scrubbed with povidone iodine and rinsed with sterile saline 3 times before surgery. Under sterile conditions, a 3-cm vertical midline incision was made in all groups. In the sham group, we closed the abdominal wall without any procedure. In the other groups, a 2-cm segment of each uterine horn was injured in 10 spots on the antimesenteric surface using unipolar cautery. Before the final abdominal closure, no adjuvant therapy was administered intraperitoneally to the rats in the control group; 2 ml of normal saline solution, 1% methylene blue solution, SPER/NO (0.5 mg/ml) and DETA/NO (0.1 mg/ml) were instilled into the uterine horns of the rats in the respective groups. The incision was closed with a running 4-0 monofilament delayed absorbable suture in a single layer of muscle and fascia in a running pattern, excluding the peritoneum, and in the covering layer of skin in an interrupted pattern, in all groups. Two weeks after the surgery, all animals were killed, second laparotomies were performed, and the extent and severity of adhesions were determined by a blinded examiner. The adhesion scores of the sham group were significantly lower than those of the other groups (p < 0.05). In the methylene blue, SPER/NO and DETA/NO groups, adhesion scores were significantly lower than in the normal saline and control groups (p < 0.05). However, there were no significant differences related to the extent and severity scores of adhesions between the methylene blue, SPER/NO and DETA/NO groups (p > 0.05). This study showed that SPER/NO, DETA/NO and methylene blue administered at the end of surgery reduced the adhesion formation in a rat uterine horn model.