Functional sphincter ani externus reconstruction for treatment of fecal stress incontinence using free latissimus dorsi muscle transfer with coaptation to the pudendal nerve: preliminary experimental study in dogs

The external anal sphincter (EAS) is a skeletal muscle capable of voluntary contraction to prevent accidental defecation. Current reconstructive options for a severely damaged EAS using local muscle flaps are not always adequate for functional repair. The present preliminary experimental model was designed to assess the feasibility of a neuromicrovascular latissimus dorsi muscle transfer for functional external spincter muscle reconstruction. In nine mongrel dogs, the anal sphincter muscles were totally resected, leaving a mucosal canal in place. A segmental latissimus dorsi muscle was shaped around the anal canal in a circular fashion, with coaptation to the pudendal nerve, and vessel anastomosis at the ischiorectal fossa. Functional evaluation was performed using electromyogram, sphincter manometry, video documentation, and histologic examination with standard and immunohistochemical staining. After 8 months, the remaining three eligible dogs were continent. Muscle function was verified by means of electromyogram, sphincter manometry, and a video record. Histologic and immunohistochemical examination confirmed the functional results, showing only minor zones of fatty and fibrous degeneration. Transplantation of a segmental latissimus dorsi muscle with vascular anastomosis and coaptation to the pudendal nerve has proved to be successful in restoring (voluntary) anal continence experimentally in dogs. Its feasibility for perfect orientation as a neosphincter seems to be superior to any pedicled muscle flap. However, these preliminary results deserve further investigation prior to considering application in humans.     

Hand-assisted laparoscopic radical nephrectomy in pregnancy

Purpose

To demonstrate the beneficial results of hand-assisted laparoscopic tumor nephrectomy in pregnancy and to emphasize the proper timing of such surgery for its crucial importance attempting to avoid fatal cancer-related outcomes as a result of late interventions of aggressive tumors.

Methods

A report of a 32-year-old woman with a 61 × 41 mm chromophobe renal cell carcinoma (RCC) successfully treated with laparoscopic transperitoneal hand-assisted nephrectomy during the 20th week of gestation is presented.

Results

The fetus was stable during the intervention; the postoperative period was uneventful; she had a normal vaginal delivery at term and gave birth to a healthy female child. The patient remained tumor-free at her 34-month follow-up.

Conclusion

Although the pure laparoscopic interventions have become recognized in the treatment of RCC over the last decade, these methods have their limitations and dangers as well. The hand-assistance method makes the procedure faster and safer which is especially important during second or third trimester. Renal biopsy may play a specifically important role in predicting the malignant potential of a renal tumor, whereas postponement of this surgery until after delivery, may lead to the mother’s death. To our knowledge, this is the first report on hand-assisted laparoscopic nephrectomy in pregnancy.     

Spleen autotransplantation. Morphological and functional follow-up after spleen autotransplantation in mice: a research summary

In 1986, we started the research on spleen surgery aimed at saving the splenic mass after its traumatic injury, with elaboration of special resection and autotransplantation techniques. The researches started on mongrel dogs and were continued on inbred mice and beagle dogs with complex histological, imaging, and laboratory investigations, following-up the function and the regeneration of autotransplanted spleen chips. Performing research on mice provided more immunological methods, such as lymphocyte subsets, immunoglobulin levels, and monitoring the phagocytic functions. Researches showed evidence also on the presence of apoptosis, furthermore, stem cell studies on regeneration and functional restoration of the spleen chips are in progress. Our results contributed to two multidisciplinary guidelines in Hungary: (1) One of them is under preparation and underlines the importance of spleen saving methods after traumatic splenic injury; (2) The second guideline shows that hemorheological changes can be early indicators of the increased sensitivity to postsplenectomy infections.     

Universal occurrence of glomerular abnormalities in patients receiving liver transplants.

We conducted a prospective study of renal histology and function in 18 consecutive nonalcoholic patients who underwent orthotopic liver transplantation (OLT). Despite well-preserved renal function, all patients had abnormal renal biopsies. Four patterns of glomerular injury were identified: minor glomerular abnormalities (eight patients), hepatic glomerulosclerosis (seven), membranoproliferative glomerulonephritis (one), and IgA nephropathy (one). In one patient there was insufficient tissue to allow classification. There was a trend toward lower plasma bilirubin and higher plasma albumin in patients with minor glomerular abnormalities than in the group of patients with more severe forms of glomerular injury (29 v 82 mumol/L, 35.5 v 30 g/L; P = 0.1, 0.1 greater than P greater than 0.05, respectively). Glomerular changes persisted in the three patients who died within 7 weeks post-OLT. IgM immunofluorescence was present in all biopsies and IgA in 11. IgM-containing circulating immune complexes occurred in five patients, suggesting a pathogenic role for IgM immune complex deposition. The significance of cirrhosis-associated glomerular abnormalities is not yet known. They may contribute to the hepatorenal syndrome and the renal dysfunction that occurs in up to 94% of patients post-OLT.     

Synthesis and Hypotensive Activity of Some Heterocyclic Analogues of GYKI-12 743

[1,4]Benzodioxanylmethyl-, [1,4]benzodioxanylmethylaminopropyl- and phenoxyethylaminoethyl-substituted lactams were synthesised and their hypotensive activity was investigated. Some of these compounds show moderate to high hypotensive effect, but they had more toxic and/or side effects than GYKI-12 743.     

Unusual case of orthostatic tachycardia

Orthostatic intolerance and postural tachycardia are common complaints, often caused by hypovolemia, antihypertensive medications, diuretics or alcohol. These symptoms could also be related to autonomic failure. Although upright posture renders patients more susceptible to provocation of supraventricular tachyarrhythmias in the electrophysiologic laboratory, orthostasis by itself seldom enough for the induction of such arrhythmias. The authors hereby present a patient, whose AV nodal reentry tachycardia could be provoked by head-upright tilting. Vagal maneuvers could terminate the tachycardia by decreasing the conduction in the slow anterograde pathway, however these maneuvers were successful only after assuming supine posture. The authors' report illustrates the role of autonomic influences, and the mechanism of vagal maneuvers in terminating this common arrhythmia.     

Fetal varicella syndrome

AIM: To attract attention to the increasing number of pregnant women with varicella disease and to the importance of varicella vaccine in the prevention of fetal varicella disease. METHOD: The data sets of the Hungarian Case-Control Surveillance of Congenital Abnormalities, Genetic and Teratologic Counseling Clinic and Periconceptional ("Optimal Family Planning") Clinic were evaluated. RESULTS: There was an increasing reporting rate of pregnant women with varicella disease in the Hungarian Case-Control Surveillance of Congenital Abnormalities and particularly in the Genetic and Teratologic Counseling Clinic. In these cases the risk for fetal varicella disease is low (1%) thus consulting physicians cannot indicate elective termination of these pregnancies without definitive diagnosis of any congenital abnormalities. However, this 1% risk causes an anxiety in pregnant women, and the outcome of a fetal varicella disease could be severe, as it is demonstrated by a case reported here. CONCLUSIONS: It is necessary to clarify previous varicella disease in the history of every woman before their planned pregnancy. In case of negative or unsure history it is necessary to recommend the administration of varicella vaccine available in Hungary before conception.     

The prompt effect of emedastine eye drop and the safety of its permanent use in children suffering from acute seasonal allergic conjunctivitis

INTRODUCTION: In the treatment of any disease, it is advantageous if the concentration of the administered drug is highest in the target organ. It follows that, if possible, diseases of the conjunctiva should primarily be treated with eye drops. AIMS: The author investigated the effect of an eye drop with selective H1-receptor antagonist properties, on children suffering from acute seasonal conjunctivitis. METHOD: During the first experiment 20 children (suffering from acute seasonal allergic conjunctivitis) had received Emadine eye drop (containing emedastine difumarate, an H1 antihistamine agent). The severity of the itching of the eye and the grade of hyperemia of the conjunctiva were scored on scales ranging 0 to 4 (score 4 representing the most severe symptoms). In the second experiment 232 other children had received this eye drop during two pollen seasons and the author investigated its effectiveness and side effects. RESULTS: The conjunctival itching decreased within less than 3 minutes significantly, and the redness was also reduced in an average of 8 minutes. In the second experiment none of the 232 children had to change this drug because of its ineffectiveness or side effects. CONCLUSIONS: Emadine eye drop decreases the itching and the redness of the conjunctiva very quickly and effectively. It is usable even for three-year-old patients, and it keeps its effectiveness during the long-term treatment, too.