Mastoid pneumatization in children with congenital cholesteatoma: An aspect of the formation of open-type and closed-type cholesteatoma

Objectives: To clarify mastoid pneumatization in children with congenital cholesteatoma and compare their clinical characteristics. Study Design: The mastoid pneumatization of 34 children with congenital middle ear cholesteatoma, of 34 age-matched children with unilateral acquired cholesteatoma, and of 17 age-matched control children without middle ear diseases was studied. Methods: The sizes of the mastoid cells were measured from 1.5-mm sliced semiaxial sections of a temporal bone computed tomography scan. The sum of the two areas from the two images, one showing the lateral semicircular canal and the other, 3 mm below this, was defined as the area of the pneumatized mastoid cells. Results: The mastoid cells in ears of children with congenital cholesteatoma were poorly pneumatized compared with those of control children without middle ear diseases, but were better pneumatized compared with those of children with acquired cholesteatoma. In children with congenital cholesteatoma, the degree of pneumatization in the cholesteatoma side was significantly poorer than that in the opposite side. A well-pneumatized mastoid was seen in ears with no episode of otitis media, in ears with the open-type cholesteatoma, and in ears with ossicular anomalies. Conclusions: The presence of cholesteatoma matrix accelerates the inflammatory response when middle ear infections occur, and this probably leads to the suppression of mastoid pneumatization. The authors also propose the hypothesis that cholesteatoma in most congenital cases is the open type, and that middle ear inflammation may contribute to the formation of cystic and closed-type cholesteatoma.     

Retinal neurodevelopmental assessment with electroretinogram in patients with biliary atresia

BACKGROUND: To evaluate the effect of n-3 polyunsaturated fatty acid (PUFA) deficiency on the development of retinal function in children with biliary atresia (BA), we examined serum fatty acid levels and performed electororetinogram (ERG) in patients with BA. METHODS: The study group was composed of one male and four female BA patients (8-14 years) with serum bilirubin levels ranging from 0.40 to 1.48 mg/dL. All of the subjects were born as full-term infants. The fatty acid composition of total lipids in serum was analyzed by gas chromatography before the Kasai operation, approximately 10 months after the Kasai operation, and at the time of the ERG study. The ERG was recorded using corneal contact lens electrodes. RESULTS: Two of the five patients showed decreased levels of arachidonic acid and docosahexaenoic acid (DHA) before and after the operation, but no abnormal findings on ERG were detected in these patients. The other three patients had decreased levels of alpha-linolenic acid or DHA after the operation, but again, no abnormalities were found on ERG. CONCLUSION: These results suggest that insufficiencies of DHA and other n-3 PUFA in full-term infants might not have an influence on later ERG results.     

Human Papillomavirus DNA in Squamous Cell Carcinomas of the Respiratory and Upper Digestive Tracts

The prevalence of human papillomavirus (HPV) types 16 and 18in clinical samples of squamous cell carcinomas from respiratoryand upper digestive tracts was studied. HPV DNA of types 16and/or 18 was detected using the polymerase chain reaction (PCR)method in 16 out of 121 cases (13.2%). By Southern blot hybridization,however, only the DNA from a laryngeal and a tonsillar carcinomawas found to hybridize with the whole HPV 16 DNA probe (twoout of 16 HPV DNA-positive cases by PCR, 12.5%). None of theDNAs hybridized with the whole HPV 18 DNA probe. The discrepancyin the results of PCR and Southern blot hybridization methodsseemed to reflect their sensitivity. The possible relation betweenprevalence of HPV DNA and carcinogenesis in respiratory andupper digestive tract is discussed.     

A modified maze procedure performed only on the left atrium for chronic atrial fibrillation associated with mitral valve disease: Report of a case

We describe herein the successful treatment of a patient with chronic atrial fibrillation (AF) associated with mitral valve stenosis and regurgitation, achieved by performing a modified maze procedure on the left atrium alone. The patient was a 51-year-old man who had suffered from intractable AF for 17 years, causing multiple cerebral emboli and palpitations. He had undergone open mitral commissurotomy and balloon commissurotomy 15 and 7 years ago, respectively. On admission, an echocardiogram revealed mitral valve restenosis and thrombosis in the left atrial appendage. Prosthetic valvular replacement was performed following isolation of all pulmonary veins with cryoablation to the posterior wall of the left atrium and excision of the left atrial appendage. Postoperatively, the AF disappeared and echocardiogram demonstrated a left atrial kick in the mitral valvular inflow without any evidence of thrombosis in the left atrium. Thus, we believe that our modified left side only maze procedure is a simple and efficient method for the treatment of chronic AF with mitral valve disease.     

Survival and clinical results of a modified &quot;<Emphasis Type="Italic">crosse de hockey</Emphasis>&quot; procedure for chronic isolated patellofemoral joint osteoarthritis: mid-term follow-up

Background

The optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA.

Materials and methods

We assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. The mean age was 57.6 years (range, 46–75 years) and mean follow-up was 90.1 months (range, 24–216 months). We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up.

Results

The Kujala score (mean improvement of 46.7, P < 0.001) and the Fulkerson score (mean improvement of 19, P = 0.001) were significantly higher compared to preoperative values. Overall clinical results rated excellent in 24.3 %, very good in 21.6 %, good in 35.1 %, fair in 13.5 %, and poor in 5.4 % of knees. Patellar tilting (P = 0.015) and congruence angle (P = 0.018) significantly improved postoperatively. On the other hand, the Insall-Salvati index decreased at the time of follow-up, although it remained in the physiologic range. Postoperatively, consecutive disease progression in the tibiofemoral joint and patellofemoral joint osteoarthritis were 18.9 and 5.4 %, respectively. The operative complication rate was 5.4 % in this case series. These percentages were lower than those of alternative tibial tuberosity osteotomy techniques.

Conclusion

In most patients with chronic isolated PFJ-OA, tibial tuberosity osteotomy by modified crosse de hockey is a reliable procedure that provides good/excellent mid-term clinical results.

Level of evidence

Level IV.

     

Neurologic findings caused by ossification of ligamentum flavum at the thoracolumbar junction

Objective: To evaluate neurologic findings caused by a single ossification of ligamentum fravum (OLF) and identify the level of the lumbar segment of spinal cord.

Design: Retrospective study.

Methods: Subjects were 28 patients with a single OLF at T10-11 level (15 patients), T11-12 (11), and T12-L1 (2). The tip of the conus medullaris was assessed using computed tomographic myelography or magnetic resonance imaging. Neurologic evaluations were performed for patellar tendon reflex (PTR), sensory disturbance, and motor weakness.

Results: The tip of the conus medullaris was located at the L1 vertebral body level. At the T10-11 level, all patients showed hyperreflexia of PTR. Sensory disturbance was observed for L1 dermatome and weakness of the iliopsoas was noted. At the T11-12 level, 8 of 11 patients didn't show hyperreflexia of PTR. Sensory disturbance was observed for L5 dermatome and weakness of the tibialis anterior was noted. At the T12-L1 level, all patients showed normal reflex of PTR, sensory disturbance of L5 dermatome, and weakness of the tibialis anterior.

Conclusion: With regard to the relationship between PTR and OLF level, all patients at the T10-11 level showed involvement of the L3 segment of spinal cord proximally. On the other hand, most patients at the T11-12 level showed involvement of the L4 segment of spinal cord distally. From all neurologic findings, we confirmed the presence of the L4 segment of spinal cord from the lower third of T11 vertebral body to the T11-12 intervertebral disc level.     

Safety and feasibility of laparoscopic gastrectomy for gastric cancer patients with a history of abdominal surgery

Purpose

To assess the safety and feasibility of laparoscopic gastrectomy (LG) for gastric cancer patients with a history of abdominal surgery (HAS).

Methods

This retrospective study analyzed data collected from gastric cancer patients with HAS, who underwent LG between 2004 and 2015. We compared the clinicopathological features that correlated with conversion to open surgery and the development of severe postoperative complications (Clavien–Dindo classification of grade III or higher).

Results

Of the 41 patients identified, 6 (14.6%) required conversion to open surgery. The incidence of conversion to open surgery was associated with a history of lower gastrointestinal tract surgery (p?=?0.009), attempted laparoscopic total gastrectomy (p?=?0.002), and excessive blood loss (p?<?0.001). Severe postoperative complications developed in six patients (14.6%). Although the development of complications was associated with high postoperative serum C-reactive protein, the type of past abdominal surgery was not significantly correlated with severe complications.

Conclusions

LG was feasible for gastric cancer patients with a HAS, but for those with a history of lower abdominal surgery or those who require total gastrectomy, surgeons should carefully consider the indications for LG.

     

Regeneration of peritoneal mesothelial cells after placement of hyaluronate carboxymethyl-cellulose (Seprafilm<Superscript>®</Superscript>)

Purpose

To examine the regeneration of mesothelium under a bioresorbable membrane.

Methods

A 1 cm² piece of peritoneum was resected from both sides of the abdominal wall of retired female mice. A piece of hyaluronate and carboxymethyl-cellulose (Seprafilm^®) was placed over the wound on one side and the other side was left uncovered. We evaluated the degree of adhesion and regeneration of mesothelial cells macroscopically and histologically using immunohistochemistry at different times.

Results

Macroscopically, the degree of postoperative adhesion in the treated site was significantly less than that in the untreated site. The membrane was left in place for 7 postoperative days (PODs). By POD 5, the regenerated peritoneum mesothelial cells covered part of the area and by POD 7, they had regenerated over almost all of that area in the abdominal wall.

Conclusion

The anti-adhesion membrane worked as a physical barrier to prevent postoperative adhesion until the mesothelial cells had regenerated completely. To our knowledge, this is the first study conducted to assess the regeneration of peritoneum mesothelial cells under a bioresorbable membrane using immunohistochemistry.