"Portal double ductopathy sign" in patients with portal vein cavernous transformation

BACKGROUND/AIMS: The aim of this study was to determine to what extent portal vein cavernous transformation affects the biliary tract and pancreatic duct system concurrently. METHODOLOGY: Patients who had liver cirrhosis, liver malignancy, history of chronic alcohol use, chronic pancreatitis, pancreatic cancer, or surgery of upper abdomen were excluded. Endoscopic retrograde cholangiopancreatography was performed on all patients. The radiographic images from the biliary and pancreatic systems obtained at the same session were evaluated. RESULTS: In 36 patients, both systems were evaluated. In 2 out of 36 patients, the biliary system was normal, while in 5 patients (13.9%) the pancreatic duct was found to be normal. Thus, 31 patients (12 men, 19 women) had successful visualization. Additionally, 31 out of 36 patients had luminal narrowing throughout the pancreatic duct, local atrophy at head of the pancreas with moderate dilatation behind the narrowed segment. These findings were not found in control patients. In 4 patients who underwent splenectomy for severe hypersplenism, radiological findings were consistent with surgical findings. CONCLUSIONS: The above mentioned morphological findings which are demonstrated in biliary and pancreatic duct are novel findings which the authors propose to call "portal double ductopathy sign" when both ducts are affected concurrently.     

Navigated scaphoid screw placement using customized scaphoid splint: an anatomical study

Introduction  

Accuracy in navigated surgery depends on placement and registration of stable reference markers close to the anatomic region of interest. Navigation in small and complex anatomic regions, such as the scaphoid, is challenging due to difficulties in placing a stable reference marker. In the current paper, we describe the use of a customized wrist-positioning device “Scaph-splint” with a built-in reference marker that facilitates navigated scaphoid screw insertion in combination with a 3D imaging device.     

In-vitro antiproliferative activity of benzopyranone derivatives in comparison with standard chemotherapeutic drugs

The cytotoxic activities of five new benzopyranone derivatives containing basic amino side chain are described. Their cytotoxicities against ER(+) MCF‐7 and ER(–) MDA‐MB‐231 human breast cancer cell lines, and Ishikawa human endometrial cell line were determined after 72 h drug exposure employing CellTiter‐Glo assay at concentrations ranging from 0.01–1.0 × 10⁵ nM. The antiproliferative activities of these compounds were compared to tamoxifen (TAM), 4‐hydroxytamoxifen (4‐OHT, active metabolite of tamoxifen), and raloxifene (RAL). In‐vitro results indicated that compounds 9 , 10 , 12 , and 13 were more potent than TAM against the human breast cancer cell lines with IC₅₀ < 20 µM. The in‐silico structure–activity relationships of these compounds and their binding mode within the estrogen receptor (ER) binding site using AutoDock vina are discussed.     

Comparison of survival between diabetic and non-diabetic patients on maintenance hemodialysis: a single-centre experience

We analyzed survival rates of 144 prevalent patients on maintenance hemodialysis from 1998 to 2003 at the Department of Nephrology and Dialysis, Rijeka University Hospital, Rijeka, Croatia, and evaluated risk factors predicting their survival. Included were only end-stage renal disease (ESRD) patients on maintenance hemodialysis treatment dialysed more than 6 months before entering the study and who were clinically stable. The patients were randomised in two groups according to the presence or absence of diabetic nephropathy as the cause of ESRD and followed-up. The patient's death as outcome measure was recorded. The survival rates were estimated by the Kaplan-Meier method. The major causes of death were cardiovascular disease in 40 (60.6%) patients. An acute myocardial infarction in 15 (22.7%) patients was the major single cause of death. We found a significantly lower survival of diabetic patients than non-diabetic patients (P=0.0013). The most important predictors of death among diabetic patients on maintenance hemodialysis were hyperglycaemia (P<0.001), ischemic heart disease (P=0.004), hypercholesterolemia (P=0.013), and low delivered dialysis dose (P=0.013). The survival of diabetic patients undergoing hemodialysis was much worse than survival of non-diabetic patients. The cardiovascular disease remained the major cause of death in both groups. Early detection of pre-existing cardiovascular risk factors and diseases, and treatment of infections leading to sepsis, are of great importance, as they may influence the survival rates. Intensive management of diabetic patients is essential.     

Anatomy of the sural nerve in a computer-assisted model: implications for surgical minimal-invasive Achilles tendon repair

Background

Sural nerve injuries are an evident risk especially of minimal‐invasive surgical Achilles tendon repair. However, detailed anatomical studies focusing on the relationship of the sural nerve with the Achilles tendon at various levels are scarce, even pending in two planes.

Aim

To determine the position and course of the sural nerve in relation to the Achilles tendon in two planes after trans‐section and computer‐assisted determination.

Methods

The exact course of the sural nerve was determined in 10 cadavers (55.3 years, 19–89 years), using a computer‐assisted method in two planes (transversal/sagittal).

Results

The sural nerve crossed the Achilles tendon at 11 (8.7–12.4) cm proximal to the tuber calcanei. The distance between the lateral crossing and the proximal musculotendineus junction was 35 (20–58) mm. Starting from the tuber calcanei, the distance was 2/2 mm (transversal/sagittal plane) at 11 cm proximal to the tuber calcanei, 4/4 mm at 10 cm proximal, 5/6 mm at 9 cm, 8/10 mm at 5 cm and 11/18 mm at the tuber calcanei.

Conclusion

In the lateral crossing region of the sural nerve and the lateral proximal Achilles tendon 9–12 cm proximal to the tuber calcanei, a close relationship of both anatomical structures can be visualised using computer‐assisted measurements; caution is suggested to prevent sural nerve entrapment in either open or percutaneous Achilles tendon repair.A number of surgical studies are focusing on the value of open versus percutaneous surgical repair of the Achilles tendon, which was first described by Ma and Griffith¹ among 18 patients. A recent comparative study enrolled 132 consecutive patients treated percutaneously versus 105 patients with conventional open repair at the same institute without randomisation.² They reported significantly fewer major complications (4.5% vs 12.4%, p = 0.03) in the percutaneous group. However, a slightly higher rate of re‐ruptures (3.7% vs 2.8%, p = 0.680) and more sural nerve disturbances (4.5% vs 2.8%, p = 0.487) were noted. In a report by Sutherland and Maffulli,³ 31 patients who had undergone repair of an acute rupture through a “modified” percutaneous technique had a total of five (16%) sural nerve injuries, three of which were resolved in 6–9 months. One patient underwent exploration, and the sural nerve was found to be transfixed by a suture. But even open surgical repair may be associated with sural nerve palsy, as described before by Cretnik et al² and Winter et al.⁴However, the exact anatomical course of the sural nerve in relation to the Achilles tendon is camouflaged. The aim of this study was to more exactly determine the position and course of the sural nerve in relation to the Achilles tendon in two planes after trans‐section and computer‐assisted determination.     

Ergogenic effect of varied doses of coffee-caffeine on maximal aerobic power of young African subjects

Background

Caffeine one of the readily available stimulants consumed daily by more than 80% of the world''s population, making it the most widely consumed drug in history. The objective of this study was to determine the effects of different doses (5, 10 &15 mg.kg⁻¹) of caffeine per kilogram body weight on maximal aerobic power of normal young black African (Nigerian) male adults.

Method

Twenty apparently healthy young male adults volunteers, participated. A repeated measure four randomized crossover (counter balanced) double blind design was used in data collection. Subjects engaged in 20 meter shuttle run test (20 MST) one hour post caffeine (5, 10 & 15 mg.kg⁻¹) and placebo doses ingestion. Endurance performance index (VO₂ max, run time & number of exercise laps) were measured and recorded.

Result

Repeated measures ANOVA was used to assess the level of significant difference between caffeine doses and placebo dose in VO₂ max, run time and number of exercise laps. The result showed no significant effect of caffeine doses over placebo dose.

Conclusion

It was concluded that caffeine dose of up to 15mg/kg seems not to have any ergogenic effect on maximum aerobic power of young black African male adults.