Retrorectal tumors: A challenge for the surgeons

Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.     

Reproductive Health,Sexual Function and Satisfaction Levels in Women with Physical,Hearing, and Visual Disabilities

Sexuality and Disability - This study was carried out to determine the reproductive health, sexual function and sexual satisfaction levels of women with disabilities. The sample of the study was...     

Hemorrhage in cataract extraction

The paper presents the evolution at ten eyes (nine patients) that presented expulsive hemorrhage during surgical act of extracapsular extraction with implant of crystalline lens. There are several cases of extracapsular extraction than intracapsular extraction which were more short like duration. The frequency of female was 90% from cases. The good results show the efficiency of associated treatment: closing of the eyeball with scleral punctura and internal tamponing. Only one eye was lost functionally.     

Belt-Fuqua operation for penile hypospadias repair

Between 1983 and 1993, 41 patients underwent a first-stage Belt-Fuqua operation for penile hypospadias repair and 39 completed the second stage. Minor complications were observed after the first stage. The primary success rate following the second stage was 82%. Major complications noted after the second stage consisted mainly of fistula formation. The surgical technique is described and alternative methods are discussed.     

Facial Nerve Monitoring under Neuromuscular Blockade

The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.We studied the influence of various levels of neuromuscular blockade on facial nerve stimulation in the New Zealand white rabbit. The facial nerve was exposed in the middle ear of six rabbits. Using electromyographic-type facial nerve monitor, we recorded the facial electromyography signals in these rabbits at increasing levels of vecuronium-induced neuromuscular blockade. All animals demonstrated reliable facial electromyography response at all levels of partial neuromuscular blockade (P < .02). Five of the six animals could be monitored throughout complete blockade. These results clearly demonstrate that rabbit facial electromyography monitoring is possible under neuromuscular blockade. The effect of neuromuscular blockers on facial electromyography monitoring deserves further study, as partial blockade would greatly facilitate the management of anesthesia in otologic, neurotologic, and skull base surgery.     

Age-Related Alterations in Antioxidant Enzymes, Lipid Peroxide Levels, and Somatosensory-Evoked Potentials: Effect of Sulfur Dioxide

The effect of sulfur dioxide (SO₂) on somatosensory-evoked potentials (SEPs), thiobarbituric acid reactive substances (TBARS), and the activities of Cu,Zn-superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) were investigated in young (3 months), middle-age (12 months), and old (24 months) Swiss male albino rats. Ten ppm SO₂ was administrated to the animals of SO₂ groups in an exposure chamber for 1 h/day × 7 days/week × 6 while control groups were exposed to filtered air in the same condition. SO₂ exposure caused increased levels of brain Cu,Zn-SOD activity and decreased levels of brain GSH-Px activity in all experimental groups with respect to their corresponding control groups. Brain CAT activities were unaltered. Brain TBARS levels of all SO₂-exposed groups were significantly increased in comparison with their respective control groups. The mean latencies of P₁, P₂, and N₂ components in the older group were either significantly different from the young or from the middle-age groups. The mean latency of the N₁ component in the older group and that of P₁ and N₁ in the middle-age group were significantly increased compared with the young group. SO₂ exposure caused the prolongation of all components in the young group, whereas it affected only the P₂ component in the middle-age group, but it did not result in any latency change in the older group in comparison with their corresponding control groups. Received: 22 December 1998/Accepted: 7 April 1999     

Evidence that the nitrergic neurotransmitter and endothelium-derived relaxing factor might be S-nitrosothiols in the mouse corpus cavernosum

The effects of thimerosal, a sulfhydryl oxidizing agent on nitrergic, endothelium-dependent and -independent relaxations were investigated to examine the possibility that the nitrergic neurotransmitter and endothelium-derived relaxing factor (EDRF) could be S-nitrosothiol or free nitric oxide (NO) in the isolated mouse corpus cavernosum. Thimerosal (5 x 10(-6)-2 x 10(-5) M) inhibited or almost abolished electrical field stimulation--(EFS, 30V, 0.5 ms, 15 sec, 1, 2, 4, 8, 16 Hz), acetylcholine--(ACh, 5 x 10(-8)-1.25 x 10(-6) M), glyceryl trinitrate--(GTN, 3 x 10(-7)-3 x 10(-6) M), and S-nitrosoglutathione--(GSNO, 5 x 10(-6)-1.25 x 10(-4) M) induced relaxations. Thiomerosal inhibition seems to be specific to L-arginine NO pathways since it had no effect on acidified sodium nitrite--(10(-4)-5 x 10(-4) M), photoactivated sodium nitrite--(2 x 10(-4) M), isoprenaline--(10(-6) M), or papaverine--(10(-4) M) elicited relaxations. Moreover, the inhibitory effect of thimerosal on the nitrergic, ACh- or GTN-induced relaxations were partly reversed by sulfhydryl-containing compounds, L-cysteine (10(-3) M), dithiothreitol (10(-3) M), or glutathione (10(-3) M). However L-methionine (10(-3) M), which contains a methyl group on the sulphur atom, failed to restore the thimerosal inhibition. Thimerosal did not change the contraction produced by 10(-4) M NG-nitro-L-arginine methyl ester. These findings indicate that the nitrergic neurotransmitter as well as EDRF may not be free NO but NO-transferring molecules, probably S-nitrosothiols, in the mouse corpus cavernosum.     

A study on impact and tensile strength of acrylic resin filled with short ultra-high molecular weight polyethylene fibers

In dentistry, acrylates have been used for preparing denture bases for 50 years. Although polymethylmethacrylates (PMMA) are known to be an ideal base material, they possess some undesirable mechanical properties, especially their impact strength and tensile strength, which appear to be unsatisfactory for some applications. Additives and fibers have therefore been used to enhance and improve these properties over the last two decades. The present article describes the mechanical properties, impact and tensile strength of PMMA reinforced with chopped ultra-high molecular weight polyethylene fiber (6 mm long). It was found that, although the processing involved for high loading of fibers into the PMMA was difficult, the resulting improvement of impact strength was substantial.     

CT findings of pulmonary artery aneurysms during treatment for Behçet's disease

OBJECTIVE: The purpose of this study was to evaluate the CT findings of pulmonary artery aneurysms in patients being treated for Beh?et's disease. MATERIALS AND METHODS: Thirteen patients with Beh?et's disease who had a total of 46 aneurysms were included in the study. All patients underwent helical CT before and after treatment. Both initial and follow-up CT scans were evaluated for location, number, and size of aneurysms and for thrombosis and pulmonary parenchyma changes. RESULTS: Thirty-five (76%) of the 46 aneurysms completely disappeared during the 3-42 months of treatment (mean, 21 months), and the remaining 11 aneurysms (24%) became smaller. Both disappearance and regression of aneurysms were preceded by thrombus formation. In 15 initially thrombosed aneurysms (33%), the thrombus increased in size during treatment. After treatment, the thrombus regressed and the pulmonary artery aneurysms disappeared. Thirty-one initially nonthrombosed aneurysms (67%) first became thrombosed during treatment; later, the thrombus regressed and the aneurysm decreased in size. Perianeurysmal consolidation and air-space nodules detected in seven patients disappeared in the early stages of treatment. Mosaic attenuation areas were seen in eight patients and disappeared in seven (88%) after treatment. CONCLUSION: Pulmonary artery aneurysms in Beh?et's disease may become smaller or disappear with medical treatment. Mural thrombotic changes may be observed during the regression of pulmonary artery aneurysms. Helical CT is helpful in the diagnosis and follow-up of aneurysms and thrombosis in Beh?et's disease.