Reconstruction following lateral skull base surgery with introduction of facial incisionless reanimation surgery

The large ablations needed to remove some lateral skull base pathologic conditions remain a challenge to the reconstructive surgeon. Major shortcomings abound despite significant development of surgical techniques and advances in the understanding of healing. The tremendous advances of the past 30 years with the dawn of major tissue transfer techniques, new biomaterials, and the use of surgical teams with enormous combined clinical knowledge bases have catapulted surgical reconstruction efforts. Progress has been tempered by the realization that normal tissue functions are still incompletely rebuilt. As work on tissue culture, genomic understanding, biomechanics, blood oxygenation substituted, and other research fronts progress and converge, newer and better ways of addressing lateral skull base reconstruction will arise.     

A pneumatosis cystoides coli revealed by a pseudo-obstruction

Pneumatosis Intestinalis is a rare benign and often asymptomatic disease; we report the case of a 74 year-old woman with a pneumatosis coli revealed by a pseudo-obstruction; the diagnosis was suspected at radiology. The course under medical treatment was uneventfull.     

Growth factor regulation of PC4/TIS7, an immediate early gene expressed during gut adaptation after resection

BACKGROUND: To define the molecular mechanisms underlying the intestinal adaptive response after partial small bowel resection, we previously identified a cohort of genes regulated in the remnant adaptive ileum. One is PC4/TIS7, an immediate early gene preferentially up-regulated during the first 48 hours after resection. To further the mechanisms that regulate gut adaptation, we sought to identify upstream regulators of PC4/TIS7 expression. METHODS: PC4/TIS7 expression in adaptive versus transection control mouse gut was examined at 48 hours after 50% intestinal resection, and its cellular localization was determined by immunohistochemistry. The effects of intestinotrophic peptides and growth factors on PC4/TIS7 expression were examined in vitro in the crypt epithelial cell line IEC 18 and in vivo in the mouse. RESULTS: PC4/TIS7 was expressed in the cytoplasm of IEC 18 cells and in adaptive mouse ileal crypt and villus enterocytes. Epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) increased PC4/TIS7 mRNA levels in postconfluent, quiescent IEC 18 cells, but insulin-like growth factor 1 (IGF-1) and nerve growth factor (NGF) had no effect. A stable derivative of glucagon-like peptide 2 (GLP-2), r(gly2)GLP-2, was most potent in increasing PC4/TIS7 expression; however, stimulation of proliferation and differentiation were not observed. To determine the effect of GLP-2 on PC4/TIS7 expression in vivo, r(gly2)GLP-2 was administered intraperitoneally to mice. PC4/TIS7 mRNA expression was increased in small bowel in response to GLP-2 compared with vehicle control. CONCLUSIONS: These results suggest that PC4/TIS7 plays a role in intracellular signaling in the intestinal epithelium during the adaptive response, possibly as a common downstream effector for several intestinotrophic growth factors.     

Longitudinal and thickness measurement of the normal distal and intravesical ureter in human fetuses

PURPOSE: We define reference data concerning the development of the ureterovesical junction in fetuses and newborns by measuring the diameters of the distal mesenchymal and muscular ureteral walls as well as intravesical ureteral length. MATERIALS AND METHODS: A total of 90 normal fetal and newborn ureters were investigated. Our histological studies were based on "plastinated" sections of whole pelves which allow study of the sectional anatomy of the distal and intravesical ureter. The development of the mesenchymal and smooth muscle growth of the distal and intravesical ureter was examined. The ureteral measurements were correlated with age of gestation. RESULTS: The length of the intravesical ureter and mesenchymal as well as smooth muscle walls increased in a linear mode. Significant correlations (p <0.0001) were found between gestational age and the growth of the mesenchymal as well as smooth muscle walls in the distal intravesical ureter as well as the length of the intravesical ureter. CONCLUSIONS: Significant positive linear relationships exist between gestational week, and distal and intravesical ureteral wall thickness of the mesenchymal and smooth muscle growth to the length of the intravesical ureter in fetuses and newborns. The ratio of the intravesical ureteral length-to-ureteral diameter is obviously lower than assumed previously. Data from this study can be used for a more accurate assessment of cases with abnormal lower urinary tract development.     

Evaluation of risk factors for lung tumour induction in rats exposed to either NpO(2) or PuO(2) aerosols

PURPOSE: To compare the incidence of each lung tumour type after inhalation exposure of rats to either NpO(2) or industrial PuO(2) aerosols, which have a similar size. MATERIALS AND METHODS: Male Sprague-Dawley rats were exposed once and followed during their whole life span. At the end of their life, the whole lungs were fixed, embedded and cut into thin sections for histological analysis. The presence of tumours was evaluated on three distinct levels of the lobes for phenotype determination to establish dose-effect relationships. RESULTS: In the range of lung doses studied (0.05 to more than 50 Gy), the general trend was an increased frequency of all types of tumours after inhalation exposure to neptunium compared with plutonium. The linearity of the lower part of the dose-effect relationships for all malignant lung tumours leads to the conclusion that NpO(2) is 3.3-fold more carcinogenic than PuO(2). CONCLUSIONS: According to a linear extrapolation of the data on malignant lung tumour incidence collected among all studies reported on actinide oxide carcinogenesis, the risk of lung tumour appears to vary over a factor of about 10 depending on the nature and/or size of the aerosol. This variation has to be taken into account for a realistic assessment of tumour risk.     

Characteristics of burn patients developing pressure ulcers

In 1997 a prospective study to identify pressure ulcer development and identify risk factors was conducted on 217 consecutive patients in the burn center. Weekly rounds were conducted, and the specifics of pressure ulcer development, demographics, concurrent injuries, comorbid conditions, risk factors, and patient outcomes were identified. An incidence of 4.1% was identified, with the most common locations being the sacrum, occipital area, and heel. All patients with pressure ulcers met criteria for a major burn injury. The patients had concurrent injuries or an infectious process, had more surgical procedures, and were older than the group that did not develop pressure ulcers. A lower Braden Scale for risk assessment and a later onset of ulceration was noted in this population compared with previous studies of nonburn patients. The results of this study have led to changes in our burn clinical pathways that target preventive strategies in high-risk patients.     

Development of a scale to predict decline in patients with mild Alzheimer's disease

OBJECTIVES: To develop a scale that can assist in predicting likelihood of decline from mild dementia over 1 year in patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: University Memory and Aging Center. PARTICIPANTS: Patients with probable or possible AD and Clinical Dementia Rating (CDR) of 1 at baseline, divided into development and validation cohorts (n = 118 each). MEASUREMENTS: The CDR and neurological and neuropsychological assessments were given at baseline and 1 year later. RESULTS: In the development cohort, high education, low Mini-Mental State Examination score, poor insight, psychotic symptoms, and greater activity of daily living impairment predicted decline in CDR from 1 to 2 or 3. Receiver operating characteristics (ROC) curve analysis identified cutoff scores that maximized sensitivity and specificity for each significant predictor of decline. Based on the cutoff, raw scores were recoded to reflect risk for decline, weighted, and summed to create a final scale score. ROC curve analysis established a cutoff to indicate risk for decline on the final scale score. Sensitivity, specificity, and area under the ROC were 0.76, 0.74, and 0.83 in the development cohort and 0.77, 0.69, and 0.80 in the validation cohort, respectively. Positive and negative predictive values were 0.71 and 0.78 in the development cohort and 0.68 and 0.78 in the validation cohort, respectively. CONCLUSIONS: Decline from mild to moderate or severe impairment represents significant clinical change, with implications for patient and caregiver quality of life and treatment options. The clinical scale developed uses data to enhance prediction about change from mild to moderate or severe stages of AD.     

Salivary stones: innovative techniques in diagnosis and treatment

During the last decade, minimally invasive and nonsurgical techniques of diagnosing and treating salivary gland duct stones have rapidly evolved. Physicians have developed alternative treatments beyond the sole use of invasive conventional surgery. Techniques and equipment have been specifically developed to deal with ductal lithiasis. Salivary duct endoscopy, endoscopic instrumentation, and intra- or extracorporeal lithotripsy have proven themselves to be efficacious in most cases involving ductal stones. Current algorithms for treatment combine conventional surgical, minimally invasive, and nonsurgical strategies to produce the least invasive and best-tolerated outcomes for each individual patient.