Unit approach for vermilion repair in unilateral cleft surgery

In conventional unilateral cleft lip surgery the suture line proceeds from the philtral ridge to the vermilion in succession. However, when observed carefully, in a noncleft upper lip the existence of a whitish vertical line in the midline of the vermilion can be seen. Therefore we consider that the vermilion can be separated by the midline into two subunits. On the basis of this unit principle we placed the suture line in the vermilion at the midline in the repair of the unilateral cleft lip. This method has been performed in 14 cases of unilateral cleft lip since February 1994. The postoperative follow-up period ranges from 4 months to 7 years and 2 months. The suture line appears to almost correspond to the vertical line at the midline of the noncleft vermilion, thus resulting in a natural contour. Although the number of cases is still small, and the follow-up period is not long enough to draw positive conclusions, unilateral cleft lip surgery according to the unit principle is considered useful in making the scarring less conspicuous.     

The relationships among filling,voiding subscores from International Prostate Symptom Score and quality of life in Japanese elderly men and women

OBJECTIVES: Lower urinary tract symptoms (LUTS) are reported to influence the quality of life (QoL) of the elderly. The aim of this study was to elucidate the relationships among filling problems, voiding problems and QoL in elderly men and women. METHODS: A total of 450 males and 228 females, aged 50 years or older responded to a questionnaire, which included seven questions from the International Prostate Symptom Score (I-PSS) and 16 questions from the King's Health Questionnaire (KHQ). The relations among the filling, voiding subscores deliverable from I-PSS, and KHQ-QoL were investigated. RESULTS: The voiding subscore significantly correlated with the filling subscore with a considerably large standard deviation, and the filling subscore also significantly correlated with I-PSS in both genders. KHQ-QoL was significantly associated with the filling and voiding subscores in almost all domains of the KHQ. Multiple regression analyses demonstrated the filling, voiding subscores, and I-PSS explained the 55% or greater reduction in the QoL in six, four, six domains in men and four, three, four domains in women, respectively. CONCLUSIONS: The filling problems are slightly more associated with KHQ-QoL than voiding problems but filling problems did not appear to predominantly affect QoL as expected in both genders. We believe it valid to use I-PSS to evaluate voiding problems as well as filling problems in the elderly women.     

Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias

Background  

Superficial esophageal neoplasias resected in piecemeal manner with endoscopic mucosal resection (EMR) sometimes recur locally, and additional treatments need to be developed. Efficacy and safety of endoscopic submucosal dissection (ESD) for esophageal neoplasias are not sufficiently demonstrated, so we conducted a retrospective study to evaluate the efficacy and safety of ESD for superficial esophageal neoplasias.     

An optimized fast protocol for magnetic resonance imaging of the temporomandibular joint

OBJECTIVES: To provide a fast protocol for MR imaging of the TMJ with high contrast resolution of both soft tissue and joint fluid. METHODS: A fast turbo-spin echo (TSE) pulse sequence was developed. The new technique was compared with T1W conventional spin echo (CSE) and T2W TSE sequences in imaging 57 TMJs in 50 patients. Disc location and contour and bone delineation were assessed on three images of each TMJ by one observer. Presence and location of intra-articular fluid were evaluated on both standard T2W and new TSE images. Image quality was scored on a 3 point-scale by one observer. RESULTS: The net image acquisition time for one plane was 2 min with the new TSE sequence compared with approximately 5-10 min for T1W and 4 min for T2W. The new sequence provided equivalent diagnostic information to a combination of T1W CSE for disc position and contour and bone contour and T2W TSE sequence for joint fluid. CONCLUSIONS: The examination time for MRI of the TMJ can be considerably reduced with the new fast TSE pulse sequence without compromising image quality.     

Prognosis of Japanese Metastatic Renal Cell Carcinoma Patients in the Cytokine Era: A Cooperative Group Report of 1463 Patients

Background

Incidence rate of renal cell carcinoma (RCC) differs among countries. The rates of Asian countries are lower than those of countries in North America or Europe but are exceptionally high in Japanese males. Approximately 30% of patients with RCC have metastasis at initial diagnosis, and another 30% have metastasis after nephrectomy. Clinical studies of risk factors in patients with metastatic RCC (mRCC) are mainly based on data from non-Asian patients.

Objectives

We aimed to investigate the prognosis of Japanese patients and their prognostic factors.

Design, setting, and participants

The subjects of this study were 1463 patients who were clinically diagnosed with RCC with metastasis in 40 Japanese hospitals between January 1988 and November 2002.

Measurements

The primary end point was overall survival calculated from first diagnosis of mRCC to death or last follow-up. We also investigated the relationship between survival and clinical features.

Results and limitations

The median overall survival time was 21.4 mo. The estimated survival rates at 1, 3, 5, and 10 yr were 64.2%, 35.2%, 22.5%, and 9.1%, respectively; they contrasted with data from the United States of 54%, 19%, 10%, and 6%, respectively for the same periods. A high percentage of patients had undergone nephrectomy (80.5%) and metastasectomy (20.8%), both of which were shown to prolong survival.

Conclusions

The median survival time in the present study was approximately twice as long as that of previous studies from North America or Europe. Early diagnosis of metastasis, nephrectomy, metastasectomy, and cytokine-based therapy seemed to improve the prognosis of RCC patients in the present study.     

ASO Visual Abstract: Influence of Damaged Stomach on Anastomotic Leakage After Cervical Esophagogastrostomy for Patients with Esophageal Cancer

Annals of Surgical Oncology -     

Anatomical assessment of the vastus medialis oblique muscle in patients with osteoarthritis of the knee

Minimally invasive total knee arthroplasty requires subluxation of patella laterally without eversion. The anatomy of the vastus medialis oblique muscle (VMO), which affects the surgical exposure of minimally invasive total knee arthroplasty, was investigated. There was no significant difference between men and women with respect to any parameter. The average fiber angle relative to the rectus femoris muscle was 52.9 degrees on anteroposterior view and 49.7 degrees on lateral view. The average insertion height and the distal portion of VMO belly were 17.3% and 38.4% of the patella length from the upper pole of patella, respectively. Female patients had lower VMO attachment and VMO belly, and a significant sex difference was demonstrated. All patients had attachments beneath the upper pole of the patella.     

Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors

Background

Rectal carcinoid tumors 10 mm in diameter or smaller located within the submucosal layer can be cured by local excision including endoscopic treatment. But complete resection of these tumors with endoscopic polypectomy is difficult. This study aimed to evaluate the usefulness of endoscopic submucosal dissection (ESD) and endoscopic ultrasonography (EUS) for the treatment of rectal carcinoid tumors.

Methods

In this study, 22 rectal carcinoid tumors in 21 patients were evaluated with EUS and treated using ESD from January 2004 to December 2008.

Results

The mean size of the resected tumors was 6.1 mm (range, 2.0–10 mm) on histopathologic evaluations. When the sizes of the tumors shown by EUS and histopathologic evaluation were compared, the mean values were not significantly different. All the tumors were located within the submucosal layer, and the accuracy of the preoperative depth determination with EUS was 100% (22/22). The mean duration of the ESD procedure was 37 min (range, 20–71 min). The overall rate of en bloc resection with ESD was 100% (22/22). Although postoperative bleeding occurred in two cases (9%), both cases were successfully managed by endoscopic hemostasis. No perforation or recurrence was observed during the mean follow-up period of 30 months (range, 7–66 months).

Conclusions

Endoscopic submucosal dissection and preoperative assessment with EUS are effective for treating rectal carcinoid tumors and enabling en bloc resection.     

Studies on cytokines related to wound healing in donor site wound fluid

This study was performed to evaluate cytokines in donor-site wound fluids and to determine their effect on wound healing. A film dressing was applied to the donor-site wound of 24 patients immediately after a split-thickness skin graft was taken. On the 5th day after treatment, 2–3 ml of the fluid retained under the film dressing was collected by means of puncture with a syringe. Growth factors and cytokines considered to accelerate wound healing were present in relatively large amounts in the exudate. Very low concentrations of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) were detected by a commercially-available enzyme-linked immunosorbant assay (ELISA) kit. However, the presence of both growth factors in wound fluid could not be confirmed because of the possible cross-reactivity of the antibodies to other EGF and FGF family growth factors. In contrast, platelet derived growth factor (PDGF), interleukin-6 (IL-6), transforming growth factor- (TGF-) and TGF-β were present in relatively large amounts. The finding that certain cytokines coexist in a balanced state under the film dressing suggests that epithelization can proceed, since an adequate balance would insure proper regulation by the cytokine network. Our present study increases the likelihood that film or hydrocolloid dressings will be used more frequently in the future for treatment of burn wounds, ulcers or donor-site wounds since these dressings were shown to be more capable than ointments of retaining cytokines, particularly intrinsic growth factors secreted at the wound site.     

Improvement of the sentinel lymph node detection rate of cervical sentinel lymph node biopsy using real‐time fluorescence navigation with indocyanine green in head and neck skin cancer

The standard technique using lymphoscintigraphy, blue dye and a gamma probe has established a reliable method for sentinel node biopsy for skin cancer. However, the detection rate of cervical sentinel lymph nodes (SLN) is generally lower than that of inguinal or axillary SLN because of the complexity of lymphatic drainage in the head and neck region and the “shine‐through” phenomenon. Recently, indocyanine green fluorescence imaging has been reported as a new method to detect SLN. We hypothesized that fluorescence navigation with indocyanine green in combination with the standard technique would improve the detection rate of cervical sentinel nodes. We performed cervical sentinel node biopsies using the standard technique in 20 basins of 18 patients (group A) and using fluorescence navigation in combination with the standard technique in 12 basins of 16 patients (group B). The mean number of sentinel nodes was two per basin (range, 1–4) in group A and three per basin (range, 1–5) in group B. The detection rate of sentinel nodes was 83% (29/35) in group A and 95% (36/38) in group B. The false‐negative rate was 6% (1/18 patients) in group A and 0% in group B. Fluorescence navigation with indocyanine green may improve the cervical sentinel node detection rate. However, greater collection of data regarding the usefulness of cervical sentinel node biopsy using indocyanine green is necessary.