Quantitative evaluation of interstitial fibrosis with Sirius Red in IgA nephritis

Objective: Tubulointerstitial fibrosis is one of the strongest independent predictive factors in determining the prognosis in IgA nephritis. Recently, software-based quantitative measurement of interstitial fibrosis with Sirius Red staining has entered the practice. The objective of this study was to investigate the prognostic value of measurement of interstitial nephritis with this method in IgA nephritis. Method: Forty-three patients diagnosed with IgA nephritis with renal biopsy between the years 2005 and 2009 were included in this retrospective observational study. The diagnostic biopsies of 37 patients were examined. Basal data included age, gender, creatinine level, glomerular filtration rate (GFR), presence of proteinuria, hypertension, glomerulosclerosis, mesangial proliferation, and interstitial fibrosis and fibrosis index calculated by the measurement of computed images of Sirius Red positive areas. Final visit included evaluation of development of end-stage renal disease (ESRD), and GFR (whether?=?60?mL/min or <60?mL/min). Results: Numbers of patients with hypertension (75% vs. 34.5%; p?=?0.050), ESRD development (62.5% vs. 20.7%, p?=?0.035), GFR?<60?mL/min (87.5% vs. 31%; p?=?0.007) were greater; and basal GFR (34.25?±?25.29 vs. 64.14?±?35.34; p?=?0.048) was lower in high-intensity interstitial fibrosis group (>1000?μm2) compared to low-intensity interstitial fibrosis group (≤1000?μm²). Conclusion: Quantitative analysis of computed imaging of areas of Sirius Red positive tubulointerstitial fibrosis might serve as an effective novel method to determine the prognosis in IgA nephritis.     

Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours

Purpose

We sought to analyse clinical and oncological outcomes of patients after guided resection of periacetabular tumours and endoprosthetic reconstruction of the remaining defect.

Methods

From 1988 to 2008, we treated 56 consecutive patients (mean age 52.5 years, 41.1 % women). Patients were followed up either until death or February 2011 (mean follow up 5.5 years, range 0.1–22.5, standard deviation ± 5.3). Kaplan–Meier analysis was used to estimate survival rates.

Results

Disease-specific survival was 59.9 % at five years and 49.7 % at ten and 20 years, respectively. Wide resection margins were achieved in 38 patients, whereas 11 patients underwent marginal and seven intralesional resection. Survival was significantly better in patients with wide or marginal resection than in patients with intralesional resection (p = 0.022). Survival for patients with secondary tumours was significantly worse than for patients with primary tumours (p = 0.003). In 29 patients (51.8 %), at least one reoperation was necessary, resulting in a revision-free survival of 50.5 % at five years, 41.1 % at ten years and 30.6 % at 20 years. Implant survival was 77.0 % at five years, 68.6 % at ten years and 51.8 % at 20 years. A total of 35 patients (62.5 %) experienced one or more complications after surgery. Ten of 56 patients (17.9 %) experienced local recurrence after a mean of 8.9 months. The mean postoperative Musculoskeletal Tumor Society (MSTS) score was 18.1 (60.1 %).

Conclusion

The surgical approach assessed in this study simplifies the process of tumour resection and prosthesis implantation and leads to acceptable clinical and oncological outcomes.     

The seasonal and monthly distribution of body limbs affected by burns in paediatric patients in southeast Turkey

Studies on the frequency of burned limbs according to season and months are limited. The burning of some body limbs, especially in some months, shows that the causes of burns are different, and knowing the reasons is important for providing preventive measures. The aims of this study were to determine the distribution rate of child burns by months and seasons and to contribute to preventive measures by determining the distribution of the burning of body limbs by months. We retrospectively evaluated 419 paediatric patients (0‐17 years of age) who were hospitalised in the burn unit between 1 May 2017 and 1 November 2018. The demographic characteristics of the patients were recorded according to age, gender, months, and seasons of the patients admitted; cause of burns; degree of burns; total body surface area; and burning regions. The distribution of burns by months was established as being mainly in May to October. As for the distribution of the patients according to the seasons, it was found that it was most common in summer, 122 (29.1%), and in the autumn season as well, it was 122 (29.1%). While body burns increased in the summer‐autumn seasons (P < .023), genital area burns were the lowest in winter and were the highest in summer and autumn seasons. Genital site burns increased statistically in September, October, and November (P < .010). Burn traumas are observed to be more frequent in some seasons and months. The environments where individuals live, forms of life, forms of warming, areas of interest, and sociocultural and economic levels are the causes of this variability.     

Lumbar spinal stenosis in a young individual as a result of ligamantum flavum ossification: A case report

INTRODUCTIONSymtomatic lumbar ligamantum flavum calcification is quite rare in the young age group.PRESENTATION OF CASEThe authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation.DISCUSSIONIt is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis.CONCLUSIONComplete relief can be achieved with early and adequate surgery.     

Pinealectomy Does Not Affect the Healing of Experimental Colonic Anastomoses

Gastrointestinal system anastomoses, especially colonic anastomoses, have significant morbidity and mortality despite recent technical improvements. Besides regulating the circadian rhythm, the pineal gland and its main neurohormone product melatonin have widespread actions in the organism. The purpose of this study was to investigate the effects of pinealectomy on the healing of colonic anastomoses. One hundred male albino Wistar rats were used in this study. The rats were separated into three groups: control, pinealectomy, and sham groups. In the control group, only colonic resection and anastomoses were performed. Following pinealectomy, colonic anastomosis was performed 2 weeks later on one half and 2 months later on the other half of the pinealectomy group. Only craniotomy was performed on the sham group, and the rats were separated and evaluated like the pinealectomy group. Colonic anastomoses were evaluated on postanastomotic day 3 and 7 by measuring the bursting pressure and the hydroxyproline levels in the anastomotic segments. There was no difference in the bursting pressure measurements between the groups on both postoperative day 3 and 7. Although hydroxyproline levels were different between groups on both postanastomotic days 3 and 7, it has been observed that neither normal nor anastomotic hydroxyproline levels influenced the anastomotic bursting pressure measurements. The percent deviation from the normal values was compared in the anastomotic segments, and no differences were found regarding the bursting pressure and hydroxyproline levels. It was concluded that pinealectomy has no effect on the healing of colonic anastomoses.     

Surgical resection and radiation therapy of desmoid tumours of the extremities: results of a supra-regional tumour centre

Purpose

Desmoid tumours of the extremity have a high recurrence rate. The purpose of this study was to analyse the outcome after resection of these tumours with special emphasis on recurrent disease and adjuvant therapeutic strategies.

Methods

In this retrospective study we evaluated prognostic factors for recurrence-free survival after surgical treatment of desmoid tumours of the extremity in 27 patients with an average age of 41 years treated from 1997 to 2009. Adjuvant radiotherapy (50–60 Gy) was given in five cases with primary and in nine patients with recurrent disease. The average follow-up was 64 months.

Results

The five-year recurrence-free survival in patients with primary disease was 33 %. Patients with negative resection margins tended to have a better outcome than patients with positive resection margins, but the difference between both groups was not significant (56 vs 14 %, p = 0.145). In patients with positive margins, adjuvant radiotherapy did not significantly improve recurrence-free survival (40 vs 14 %, p = 0.523). Patients with local recurrence had a five-year further recurrence-free survival of 47 %. In those patients further recurrence-free survival was significantly better after adjuvant radiation (89 vs 25 %, p = 0.015). Two thirds of all patients suffered moderate or severe complications due to the treatment regimen.

Conclusions

Compared to desmoids of the trunk or the head and neck region, desmoids affecting the limbs show by far the worst outcome in terms of relapse or treatment-related morbidity. The importance of negative resection margins is still not clear. Particularly in recurrent desmoids adjuvant radiotherapy appears to reduce the further recurrence rate. Therefore, a general use of radiation should be considered for this high-risk group.     

The reference point to measure the anterior intermeniscal ligament's thickness: an MRI study

The purpose of this study was to identify a reliable reference point for measuring anterior intermeniscal ligament thickness and to investigate the morphological characteristics of the ligament at its attachment site to anterior horns of both menisci by MRI. MRI was performed in 98 knees of randomly chosen patients. The anterior intermeniscal ligament was detected in 61 knees (62.2%). The average ligament length was 29.8 mm. Men had significantly longer anterior intermeniscal ligament than women patients (32.5 vs. 27.8 mm). The thickness of anterior intermeniscal ligaments at their attachment sites to menisci was usually less than 3 mm; a thickness of 3 mm or more at the attachment site to anterior horns of the meniscus was defined as "cordlike." It is suggested that the "cordlike" pattern is a variation of the anterior intermeniscal ligament's attachment characteristics, and that this might have a significant role in meniscal translations during knee motion, and also that the "cordlike" pattern could be clinically important with respect to its relationship to the anterior horn of medial meniscus. The attachment site of the ligament is a reliable reference point for measuring its thickness.     

Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing

Background: Elevated intra‐abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model. Methods: Thirty‐six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared. Results: Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P = 0.0003). Mean tissue hydroxyproline concentrations showed no difference (P > 0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P = 0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P = 0.0009). Conclusion: Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.