Use of middle hepatic vein in right lobe living donor liver transplantation

The harvesting of the middle hepatic vein (MHV) with the right lobe graft for living‐donor liver transplantation allows an optimal venous drainage for the recipient; however, it is an extensive operation for the donor. This is a prospective, nonrandomized study evaluating liver functions and early clinical outcome in donors undergoing right hepatectomy with or without MHV harvesting. From August 2005 to July 2007, a total of 100 donor right hepatectomies were performed with (n = 49) or without (n = 51) the inclusion of the MHV. The decision to take MHV was based on an algorithm that considers various donor and recipient factors. There was no donor mortality in donors in either group. Overall complication rate was higher in MHV (+) donor group, however when remnant liver volume was kept above 30%, complication rates were similar between the groups. The results of this study show that right hepatectomy including the MHV neither affects morbidity nor impairs early liver function in donors when remnant volume is kept above 30%. The decision, therefore, of the extent of right lobe donor hepatectomy should be tailored to the particular conditions considering the graft quality and metabolic demand of the recipient.     

First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer

OBJECTIVE: To evaluate the long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for patients with localised prostate cancer. MATERIAL AND METHODS: Patients included in this multicentre analysis had T1-T2 NxM0 prostate cancer, a PSA<15 ng/ml, and a Gleason score (GS) < or = 7, and were treated with prototypes or first-generation Ablatherm HIFU devices between October 1997 and August 2001. The Phoenix definition of biochemical failure was used (PSA nadir+2). Treatment failure was defined as: biochemical failure or positive biopsy. RESULTS: A total of 140 patients with a mean (SD) age 69.1 yr (6.6) were included. Mean (SD) follow-up was 6.4 yr (1.1). Control prostate biopsies were negative in 86.4% of patients. Median PSA nadir of 0.16 ng/ml (range, 0.0-9.1) was achieved at a mean (SD) of 4.9 mo (5.2). A PSA nadir < or = 0.5 ng/ml was recorded in 68.4% of patients. The actuarial biochemical failure-free survival rates (SR) at 5 and 7 yr were 77% and 69%, respectively. The actuarial disease-free SR at 5 and 7 yr were 66% and 59%, respectively. CONCLUSIONS: This study demonstrates the effective long-term cancer control achieved with HIFU in patients with low- or intermediate-risk localised prostate cancer.     

Laparoscopic visualization and dissection of retroperitoneal lymph nodes after patent blue dye injection: a pilot study

PURPOSE: Retroperitoneal lymph node dissection (RPLND) for testicular cancer is an important treatment modality for patients with stage I or IIA disease. Several urologists have previously reported the feasibility and usefulness of laparoscopic RPLND for such patients. The aim of this experimental pilot-feasibility study was to investigate whether visualization of retroperitoneal lymph nodes with patent blue violet (PBV) dye application is a feasible and an effective method during laparoscopic RPLND in a pig model. MATERIALS AND METHODS: Four 12-month-old white male pigs were included in the study. After PBV dye injection into the spermatic funicular and intratesticular parenchyma, the color changes in the retroperitoneal region were examined during transperitoneal laparoscopic visualization of the retroperitoneum. The time interval between the injection and the staining of lymphatic structures was measured for each intervention. Blue-stained retroperitoneal nodal tissues were dissected and removed by the laparoscopic approach and histologic examination was performed. RESULTS: After PBV dye injection, intense staining of the ipsilateral retroperitoneal lymphatic vessels and nodes was seen. Distribution of the PBV and the color changes of the retroperitoneal lymphatic structures were examined under laparoscopic vision in all pigs. All blue-stained retroperitoneal nodular tissues were removed laparoscopically and examined histologically. Histopathologic examination noted all specimens as lymph nodes with no toxic effects of PBV dye. CONCLUSION: We demonstrated that spermatic funicular injection of PVB dye is an effective and accurate method for retroperitoneal lymph node visualization in pigs. The use of this technique in combination with a laparoscopic approach makes RPLND easier and more effective.     

The relation of prostate biopsy results and ratio of free to total PSA in patients with a total PSA between 4–20 ng/mL

Objective: In this study our aim was to investigate the efficacy of free tototal PSA ratio in discrimination of benign prostate hyperplasia andprostate cancer.Materials and methods: A total of 194 patients, 52 to 82 years old (mean66.06 ± 0.47 years) with PSA levels between 4 to 20 ng/mL wereincluded into this study. Each patient underwent sextant prostate biopsyunder transrectal ultrasound guidance. The patients were divided into twogroups as PSA 4–10 and 10–20 ng/mL. Patients with benign and malignresults were compared with respect to age, total PSA level, free PSA leveland free/total (f/t) PSA ratio.Results: Biopsies revealed prostate cancer in 16 of 130 patients (12.3%)with serum PSA 4–10 ng/mL and in 10 of 64 patients (15.6%) with serumPSA 10–20 ng/ml. In both PSA groups free PSA and f/t PSA levels werestatistically significant, where total PSA levels were not. In patients with4–20 ng/mL total PSA levels and a cut off level of < 0.18 for f/t PSA, thesensitivity, specificity and positive predictive value for prostate cancerwere 88.5%, 53.6% and 20.4% respectively.Conclusion: Higher levels of PSA suggest prostate cancer, but stilladditional parameters are needed for patients with PSA 4–20 ng/mL, suchas free PSA and f/t PSA. Although a cut off level of < 0.18 for f/t PSA seemsto be the most accurate one to discriminate benign and malign diseasesfurther studies on larger groups of patients are needed.     

Extraskeletal soft tissue chondroma of the cheek

Extraskeletal soft tissue chondroma is a rare, benign, slow-growing cartilaginous tumor. Its pathological diagnosis is based on radiological and histopathological examination. There are a few reports of soft tissue chondroma in this region. We present a 57-year-old man with a painless mass measuring $ {6}.{7} \times {6}.0 \times {4}.0{\hbox{cm}} $ in the left cheek.     

Transosseous capsuloplasty improves the outcomes of Lindgren–Turan distal metatarsal osteotomy in moderate to severe hallux valgus deformity

Introduction

Lindgren–Turan osteotomy used in hallux valgus deformity is a subcapital, transverse displacement osteotomy of the first metatarsal without any additional capsular repair. The aims of this study are to describe a transosseous capsuloplasty technique in this procedure and evaluate whether capsuloplasty would improve the clinical and radiological outcomes in patients with moderate to severe hallux valgus deformity.

Methods

Twenty-three feet operated by Lindgren–Turan osteotomy (Group B) and 25 feet operated by the same osteotomy combined with transosseous capsuloplasty (Group A) were evaluated retrospectively for the correction of the hallux valgus, intermetatarsal and distal metatarsal articular angles, sesamoid reduction, American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Scale as well as patient satisfaction. The mean postoperative follow-up was 14 (range 12–28) months.

Results

All radiological parameters improved considerably as a result of both groups. However, postoperative improvements in intermetatarsal and distal metatarsal articular angles were greater in Group A. Complete reduction of medial sesamoid was achieved in 52% of patients in Group A, whereas 17.4% of patients in Group B had complete reduction. AOFAS scores and number of patients with complete satisfaction in Group A were significantly greater than that in Group B.

Conclusion

Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy, when it combines with transosseous capsuloplasty.     

Treatment with Ultrasound-Assisted Liposuction of Accessory Axillary Breast Tissues

Supernumerary nipples and breast tissue often are dismissed as cosmetic curiosities. These structures have the potential for pathologic degeneration and may be associated with significant congenital abnormalities. In a prospective comparison of 100 Native American women with 100 non-Native American women, these accessory organs were found much more commonly among Native American women. Careful attention should be given to thorough evaluation and long-term follow-up evaluation of any patient with this anomaly. This study investigated a patient who underwent surgical removal of her axillary breast tissue with ultrasound-assisted liposuction. The advantages of this method include a minimal incision scar from the liposuction cannula and the ability to detect residual axillary breast by ultrasound.     

Effects of N-acetylcysteine on radiocontrast nephropathy in rats

OBJECTIVE: N-acetylcysteine (NAC) has yielded some promising results recently in the prevention of radiocontrast nephropathy (RCN). In this study, the structural and functional effects of NAC on RCN were analyzed. MATERIAL AND METHODS: Twenty-eight Wistar rats were randomized into four groups, as follows: Group 1, controls; Group 2, contrast; Group 3, contrast+NAC; and Group 4, NAC. All rats were deprived of water for 24 h and then contrast medium (ioxoglate; 10 ml/kg) was administered to Groups 2 and 3. NAC (50 mg/kg) was introduced enterally to Groups 3 and 4 at a dose of 50 mg/kg in 0.5 ml of distilled water, in four sequential doses 12h apart, starting after 12?h of water deprivation. After 4 days, rats were sacrificed. Creatinine clearance was calculated. The malondialdehyde (MDA) level was quantified in tissue samples. Slides stained with hematoxylin-eosin and periodic acid-Schiff were examined by means of light microscopy. Each tubular cross-section from all images was scored as either mild (preserved brush border, no necrosis), moderate (loss of brush border, no necrosis) or severe (loss of brush border accompanied by necrosis) and the frequencies of these lesion severities were compared. RESULTS: Mean baseline serum creatinine levels and creatinine clearances were similar in all groups. Mean serum creatinine level increased significantly only in Group 2 (0.6+/-0.1 vs 0.7+/-0.2 mg/dl; p<0.05). Tissue MDA levels were similar in all groups. Moderate (13.8%+/-1.5% vs 42%+/-1.4%; p<0.05) and severe (0% vs 40%+/-2.1%; p<0.05) lesions were significantly more frequent in Group 2 compared to Group 1. The frequency of severe lesions in Group 3 was found to be halved compared to that in Group 1 (40%+/-2.1% vs 20.2%+/-0.86%; p<0.05). CONCLUSION: NAC protects the kidneys following exposure to contrast medium as it decreased the severity of tubular lesions in rats.     

The effects of N-acetylcysteine on antioxidant enzyme activities in experimental testicular torsion

Testicular torsion is a serious problem in male children and, if not treated at the right time, can lead to subfertility and infertility. The main reason for testicular damage is ischemia-reperfusion injury. A number of chemical substances have been used to protect testes against ischemia-reperfusion injury in experimental animals. The possible protective effect of N-acetylcysteine on testicular tissue after testicular detorsion was examined in the current study. Twenty-four rats were divided into four groups: sham operation, torsion, detorsion, and NAC + detorsion groups (n = 6 for each group). Excluding sham operation group, the rats were subjected to unilateral torsion (720-degree rotation in clockwise direction). After torsion (5 h) and detorsion (2 h), unilateral orchidectomy was performed. Malondialdehyde levels and superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase activities were determined in testicular tissue. Administration of N-acetylcysteine caused a decrease in malondialdehyde levels and an increase in glutathione peroxidase levels compared to detorsion group. The results suggest that N-acetylcysteine may be a potential protective agent for preventing the negative biochemical changes related to oxidative stress in testicular injury caused by testis torsion.     

Effects of fentanyl on baroreceptor reflex control of heart rate in newborn infants

Baroreceptor reflex control of heart rate was studied in ten neonates and young infants before and after intravenous fentanyl (10 micrograms/kg). All infants were in stable condition while being mechanically ventilated. Mean (+/- SD) corrected gestational age was 40.1 +/- 3.7 weeks, mean weight 3120 +/- 700 g. The pressor response was tested using phenylephrine and the depressor response using nitroglycerin. Changes in heart rate (R-R interval) were plotted against changes in systolic arterial pressure, and the slope of the linear portion of this relationship expresses the baroreflex sensitivity. No significant changes in systolic arterial pressure, heart rate, and blood gas values were observed after fentanyl injection when compared to control values. Mean (+/- SEM) control phenylephrine slope was 8.44 +/- 2.05 msec/mmHg, and mean nitroglycerin slope was 2.54 +/- 0.37 msec/mmHg. Both slopes decreased significantly by 48% and 42%, respectively, after fentanyl injection (P less than 0.02). Mean plasma fentanyl concentrations measured at the end of each test were not statistically different (5.11 +/- 0.65 ng/ml and 4.28 +/- 0.58 ng/ml, respectively). This suggests that the baroreflex control of heart rate is present in term neonates and markedly depressed during fentanyl anesthesia. Changes in blood pressure occurring during fentanyl anesthesia have to be carefully considered, because cardiac output is principally rate-dependent in newborns.