Extended nasal skin reconstruction with a retroauricular free flap harvested on the superficial temporal pedicle

The microsurgical coverage of large nasal skin avulsion was performed in a 40 years old patient after a human bite. Widely exposing the columelle, the alar cartilages and the distal part of the septum, the defect was covered with a retroauricular free flap harvested on the superficial temporal pedicle and transferred on the upper labial vessels in the nasogenian area. Thanks to its excellent colour and texture match with the nose integuments, this flap enjoyed of an optimal integration in the centrofacial area. Its potential indications, advantages, drawbacks and technical variants are discussed in the present paper.     

Transient osteoporosis of the knee following trauma

Transient osteoporosis is an uncommon, self-limiting, reversible condition. We report a case involving the knee following trauma. The aetiology is unknown, but the association between transient osteoporosis and trauma has not been documented previously. The clinical presentation represents a degree of overlap among various clinical syndromes, including reflex sympathetic dystrophy and avascular necrosis. The diagnosis was confirmed by bone scan and MRI. The patient, a 47-year-old man, was treated with non-steroidal anti-inflammatory medication, protected weight-bearing and physiotherapy. He made a full clinical recovery and bone quality returned to virtual normality.     

Tunica albuginea overlapping: a novel technique for the treatment of erectile dysfunction

Tunica albuginea (TA) in venogenic erectile dysfunction (VED) was found subluxated and flabby because of degeneration and atrophy of its collagen fibres. This had apparently led to derangement of TA veno-occlusive mechanism. We investigated the hypothesis that overlapping of the subluxated and flabby TA would achieve a competent veno-occlusive mechanism during erection. Tunical overlapping was performed in nine VED patients (age 35.6 +/- 1.6 years). Intracorporal pressure (ICP) was measured pre- and postoperatively. After penile degloving, TA on lateral penile aspect was divided along whole length of corpus cavernosum (CC) and tunical double-breasting for 1-1 1/2 cm was performed. A biopsy was taken from TA and stained with haematoxylin and eosin and Masson's trichrome. Clinical efficiency of the operation was evaluated after 6 months. ICP increased (P < 0.01) postoperatively in the nine patients. The increase was maintained during follow-up period in eight patients and decreased to preoperative level in one. Six months after operation, the eight patients had significantly (P < 0.01) improved scores for the erectile function domain over the preoperative scores. Microscopic examination of TA biopsies showed atrophy of the collagen fibres. Tunical overlapping aims at correction of TA flabbiness, corporal tissue support and improving of veno-occlusive mechanism.     

A prognostic index (bladder prognostic index) for bilharzial-related invasive bladder cancer

PURPOSE: Bladder cancer is still the most common solid tumor among adult males in Egypt because of the prevalence of bilharzial infestation, especially in the countryside. In this prospective study, we have recorded the prognostic factors for 180 patients with invasive bladder cancer for whom standard radical cystectomy had been performed to develop a prognostic index (bladder prognostic index) that defines high risk patients who are more vulnerable to disease relapse after surgery and who may benefit from additional therapy. PATIENTS AND METHODS: The study was performed between January 1997 and December 1999, in which 180 patients with histopathologically proved invasive bladder cancer associated with bilharziasis underwent radical cystectomy or anterior pelvic exenteration. After surgery, patients were regularly followed for a minimum of 2 years. RESULTS: Our patients included 141 males and 39 females. Squamous cell carcinoma was the most common type (53.3%), and most of the tumors were grade II (61.1%). A total of 173 patients had their tumors operable, while 7 were inoperable. We had 5 (2.8%) operative related mortalities. At 5 years postoperatively, free and overall survival rates for the whole group of patients were 31.44%+/-5.9% and 32.5%+/-6.8%, respectively. Tumor pathologic stage, grade, and nodal affection were the only significant factors with impact on survival (P=0.008, 0.051, and 0.004, respectively). These 3 prognostic indexes were used to design a model to predict an individual patient's risk factor for recurrence. Patients were then assigned to one of the 4 risk groups according to the score achieved in this prognostic index (0=low risk, 1=intermediate risk, and 2 or 3=higher risk). These 4 risk groups had distinctly different rates of disease-free survival, i.e., 91.7%, 53%, 13%, and 7% for low, intermediate, and higher risk groups, respectively. CONCLUSION: Although this prognostic index appears to be of a significant clinical relevance, it needs to be more validated on a larger number of patients, and it could be a surrogate variable for biologic factors responsible for the heterogeneity of bladder cancer.     

Sjogren's syndrome: concomitant H. pylori infection and possible correlation with clinical parameters

OBJECTIVE: To identify whether or not there are clinical markers that correlate with Helicobacter pylori (H. pylori) infection in patients with Sjogren's syndrome (SS) and its implication to handling this group of patients. METHODS: Four groups of patients were studied. Group 1, 36 patients with primary SS; group 2, 31 patients with secondary SS; group 3, 46 patients with various connective tissue diseases not suffering from sicca symptoms, and group 4, 64 healthy controls. Clinical assessment was done and a score for disease manifestation was given for every SS patient. Serum IgG and IgM antibodies to H. pylori were assessed by ELISA. RESULTS: The prevalence and mean titer of H. pylori infection in patients with SS in group 1 (80.6%) and 2 (71%) were significantly higher than in group 3 (60.9%) and 4 (56.3%) (P < 0.01). There was significant correlation between H. pylori infection and age, disease duration, global score for disease status and C-reactive protein (CRP) in SS patients. On the other hand, there was no significant correlation with body mass index, and erythrocyte sedimentation rate (ESR). CONCLUSION: Patients with SS are more prone to have H. pylori infection in comparison to other connective tissue diseases. Serum antibody titer to H. pylori correlated with index for clinical disease manifestations, age, disease duration and CRP. Assessment of H. pylori infection in older patients suffering from active SS for a relatively long duration is recommended, especially those suffering form primary SS for more than 3 years.     

Spinal cord compression due to vertebral osteochondroma: report of two cases

Osteochondroma, or exostosis, is the most common of all benign bone tumors. Spinal osteochondromas are uncommon but may cause neurological compromise. We report two cases of spinal cord compression by osteochondromas. One patient was a 17-year-old man with hereditary multiple exostoses who was presented with spastic paraparesis, a sensory level at T3-T4, and a pyramidal syndrome. Vertebral exostosis was suspected by magnetic resonance imaging and confirmed by histological examination. Surgical decompression was followed by complete resolution of the neurological impairments. The other patient was a 19-year-old man with spastic paralysis of the right lower limb and a pyramidal syndrome. Whereas magnetic resonance imaging suggested a neurofibroma, histological features were those of osteochondroma. Nine months elapsed from symptom onset to surgery. This delay led to residual neurological impairments, which resolved almost completely after rehabilitation therapy. Vertebral osteochondromas contribute only 1.3-4.1% of all osteochondromas. The lesion may be solitary or a manifestation of hereditary multiple exostosis. Magnetic resonance imaging shows the exact location of the lesion, most notably with relation to neighboring neurological structures. Spinal cord compression is uncommon and usually has a favorable outcome provided surgical decompression is performed before major neurological damage develops.     

Plasma levels of endothelin-1, angiotensin II, nitric oxide and prostaglandin E in the venous and cavernosal blood of patients with erectile dysfunction

OBJECTIVES: To determine the alterations in the plasma levels of endothelin-1, angiotensin II, nitric oxide (NO) and prostaglandin E(2) (PGE(2)) in the venous and cavernosal blood of patients with organic and psychogenic erectile dysfunction (ED). PATIENTS, SUBJECTS AND METHODS: The study included 32 patients complaining of ED; they were subdivided into two equal groups with either organic or psychogenic ED. Fifteen healthy potent age-matched male volunteers were enrolled as a control group. For each patient, venous and cavernosal blood samples were obtained, while venous blood was obtained from the controls. RESULTS: There were significantly greater mean plasma levels of endothelin-1 and angiotensin II, and significantly lower mean plasma levels of NO and PGE(2), in the venous blood of patients with ED than in the controls. Patients with organic ED had significantly higher levels of endothelin-1 and significantly lower levels of NO in both venous and cavernosal blood than had those with psychogenic ED. There were significant positive correlations in both venous and cavernosal blood between endothelin-1 and angiotensin II, and between NO and PGE(2) in all patients with ED and the two subgroups. There were significant negative correlations between venous and cavernosal endothelin-1 and NO, endothelin-1 and PGE(2), angiotensin II and NO, and between angiotensin II and PGE(2). CONCLUSION: The present results suggest that endothelin-1 could be a clinical marker of diffuse endothelial disease manifested by ED. As angiotensin-converting enzyme (ACE) activity controls angiotensin II there might be a rationale for the use of ACE inhibitors to prevent or treat ED. NO and PGE(2) may provide new strategies for the pharmacological treatment of ED.     

Endoscopic confocal fluorescence microscopy of normal and tumor bearing rat bladder

PURPOSE: We evaluated the possibility of performing endoscopic fiber-optic confocal microscopy in a rat bladder model and we distinguished different cell types. MATERIAL AND METHODS: Rhodamine 123 (Molecular Probes, Eugene, Oregon) (100 microM) was instilled for 30 minutes in 5 tumor bearing rat bladders (AY27). Five normal rats served as controls. A Cell-viziotrade mark confocal microscopy fiber was placed transurethrally in contact with normal or transformed bladder wall. Frozen sections were obtained from the same spots and subjected to conventional fluorescence microscopy and anatomical-pathological analysis. RESULTS: The different cells types present in rat epithelium (umbrella, intermediate and basal cells) could easily be identified with the Cell-viziotrade mark device due to their differences in morphology and fluorescence intensity. Individual AY-27 cells could not be demarcated due to the strong fluorescence signal but the entire tumor appeared as a brightly homogenous fluorescent blot surrounded by small inflammatory cells. CONCLUSIONS: We report the feasibility of endoscopic, in vivo, fiber-optic confocal microscopy in the rat bladder. We distinguished tumors from normal epithelium and visualized the different epithelial cell types in nontransformed rat bladder epithelium.