Bilateral Poland anomaly

Bilateral absence of the pectoralis major muscle with accompanying abnormalities of shoulder muscles has been reported in patients without Poland anomaly (PA). However, symmetric absence of pectoralis major muscles, hypoplasia of breasts and nipples with symmetric chest wall deformity and bilateral hand anomaly has not previously been reported. A 6-year-old girl with bilateral absence of pectoralis major muscles and hand involvement and symmetric chest wall deformity is, to our knowledge, the first known case of bilateral Poland anomaly. Am. J. Med. Genet. 75:505–507, 1998. © 1998 Wiley-Liss, Inc.     

Functional results of Plastipore prostheses for middle ear ossicular chain reconstruction.

OBJECTIVE: Assessment of plastipore prostheses for middle ear ossicular chain reconstruction. Hearing results with total and partial Plastipore ossicular replacement prostheses (TORP and PORP) were evaluated in open- and closed-cavity operations. STUDY DESIGN: A retrospective review of 237 patients who underwent operation for chronic ear disease as well as ossiculoplasty with plastipore prostheses. In order to assess the functional results, only 156 of 237 patients were included in the study. Follow-up ranged from 6 to 46 months. METHODS: Canal wall up and canal wall down operations were performed. Either TORP or PORP ossiculoplasty was performed in each operation. An airbone gap closure to within 20 dB was considered successful. RESULTS: With TORPs, the airbone gap closure to within 20 dB was achieved in 43.1%, and similar results were obtained with PORPs in 63.3%. In canal wall down and canal wall up operations, the success rates were 55.8% and 55.7%, respectively. The best results were obtained with PORPs in canal wall down operations, with a success rate of 82%. The extrusion rate of the prostheses was 4.2%. CONCLUSION: Hearing results of PORPs are better than TORPs. In canal wall up and canal wall down operations similar hearing results are obtained. PORP ossiculoplasty in a canal wall down operation yields the most favorable hearing result.     

Evaluation of the results of endoscope-assisted acoustic neuroma surgery through posterior fossa approach

The objective of this study was to evaluate the results of endoscope-assisted acoustic neuroma surgery in posterior fossa approach. Between 1996 and 2002, 60 consecutive patients with acoustic neuroma were operated via the retrosigmoid suboccipital approach. Standard 4-mm sinus endoscopes at different angles were used during the surgeries either for inspection or tumor endoscopic dissection. Clinical parameters and treatment outcome were evaluated retrospectively. Tumor sizes were small, medium and large in 46.6, 45 and 8.3% of the patients, respectively. The hearing preservation rate, which did not correlate with tumor size (p > 0.05), was 24.4%. The need for facial reanimation surgery, which was needed in 5% of patients, was significantly higher in the large tumors than in the small and medium tumors (p < 0.001). Cerebrospinal fluid fistula rate, which was not related to tumor size (p > 0.05), was 13.3%. Tumor recurrence or residual tumor was not encountered at all. In conclusion, endoscopes give accurate information about the relationship between the tumor and the adjacent structures and help control the fundus of the internal auditory canal to ensure complete tumor removal. It is also helpful in visually verifying the continuity of the facial and cochlear nerves. The use of endoscopes does not appear to increase the hearing preservation rate, but is very helpful in complete tumor removal in the posterior fossa approach.     

Total calcium content of sacs associated with inguinal hernia,hydrocele or undescended testis reflects differences dictated by programmed cell death

INTRODUCTION: Inguinal hernia and hydrocele are suggested to result from the persistence of smooth muscle (SM) which should undergo programmed cell death (PCD) after presenting transiently to propel the testis. Since Ca(2+) is involved in PCD, the Ca(2+) contents of the peritoneum and sacs associated with undescended testis, inguinal hernia and hydrocele were determined and compared. MATERIALS AND METHODS: Sacs were obtained from boys with undescended testis (n = 11), inguinal hernia (n = 22) and hydrocele (n = 10), and girls with inguinal hernia (n = 7). The calcium content of the sacs and peritoneal samples (n = 6) was determined through atomic absorption spectrophotometry. Calcium contents were compared according to their sources using the Mann-Whitney U test and p values of <0.05 were considered significant. RESULTS: While revealing similar Ca(2+) contents as the peritoneum, sacs associated with undescended testis and hydrocele contained more Ca(2+) contents than the sacs of boys and girls with inguinal hernia (p < 0.05). CONCLUSIONS: Sacs associated with inguinal hernia, which are known to contain SM all around the mesothelial layer, contain the least Ca(2+). Despite the decrease in SM, sacs associated with hydrocele contain more Ca(2+). Since PCD is associated with Ca(2+) overload and inhibition of Ca(2+) load inhibits PCD, differences in Ca(2+) content may reflect the inhibition of PCD at different stages and for different reasons in inguinal hernia or hydrocele of childhood.     

Portal vein thrombosis after splenectomy in pediatric hematologic disease: risk factors, clinical features, and outcome

Background/Purpose

A retrospective study was performed to evaluate risk factors, clinical features, and treatment modalities of portal vein thrombosis (PVT) after splenectomy in pediatric hematologic disease.

Methods

Sixty-eight patients who underwent splenectomy for various hematologic diseases were evaluated with regard to age, sex, blood count, and splenic mass. Patients who developed PVT were also reviewed for clinical features, treatment modalities, and outcome.

Results

Patients with PVT (n = 4, 5.88%) and without PVT (n = 64, 94.2%) had a mean age and female/male ratio of 13.2 years (range, 10-16 years) and 4:0, and 10.2 years (range, 1-16 years) and 29:35, respectively. Postoperative thrombocyte levels and splenic mass with and without PVT was 804 × 10³/mm³ and 752.5 g, and 465.2 × 10³/mm³ and 441g, respectively. Three patients with PVT presented with abdominal pain, fever, and vomiting. The diagnosis of PVT was made by Doppler ultrasonography in all patients including the asymptomatic case. Protein C, protein S, and antithrombin III levels were mostly decreased and/or normal and di-dimer levels were increased and/or normal after the development of PVT. Antiplatelet (acetylsalicylic acid) and antithrombotic therapy (low molecular weight heparin) were treatment agents. None of the patients needed surgery. During a mean follow-up period of 55.5 months, by Doppler ultrasonography, 1 patient was found to be free of thrombosis, whereas 1 had partial thrombosis. Two patients developed cavernomatous transformation leading to portal hypertension.

Conclusions

Portal vein thrombosis is a rare but significant complication of splenectomy done for hematologic diseases. According to our results, female gender and decreased levels of coagulation inhibitors seem to be risk factors in addition to previously mentioned thrombocytosis and greater splenic mass. Doppler ultrasonography may be performed in all patients after splenectomy to screen PVT. In the presence of well-known risk factors, prophylactic antiplatelet and antithrombotic therapy should be considered after splenectomy.     

Effects of a static magnetic field on wound healing: results in experimental rat colon anastomoses

BACKGROUND: Research has shown that pulsed electromagnetic fields (EMFs) promote wound healing in experimental colonic anastomosis; however, the effects of static EMFs in this setting have not been investigated to date. METHODS: Fifty male Wistar rats were used. Ten served as controls for mechanical strength testing, and the other 40 underwent descending colon resection and anastomosis. Twenty of these 40 animals (M group) had NeFeB magnets placed in contact with the anastomosis site (magnetic field strength at the site 390 to 420 G). The other 20 animals (sham [S] group) had non-magnetized NeFeB bars of the same dimensions and weight implanted. Half of the animals in each group were killed and assessed for healing parameters on postoperative day 3 (M3 and S3 groups) and the other half on postoperative day 7 (M7 and S7 groups). Four types of assessment were done: gross healing, mechanical strength, hydroxyproline deposition, and histopathology. RESULTS: There were no differences between the M and S animals with respect to gross healing parameters. The mechanical strength was also not different between groups (23.8 +/- 12.7 and 24.7 +/- 9.6 mm Hg for M3 and S3, respectively; P = .863 and 91.3 +/- 65.4 and 94.8 +/- 55.9 mm Hg for M7 and S7, respectively; P = .902). Similarly, hydroxyproline deposition was not different between groups on postoperative day 3 or day 7. On postoperative day 3, the M group had significantly higher scores than the S group for fibroblast infiltration (2.4 +/- 0.7 vs 1.4 +/- 0.7, respectively; P = .008) and capillary formation (2.5 +/- 0.7 vs 0.9 +/- 0.4, respectively; P <.001). However, these effects were reversed and did not endure by day 7. CONCLUSIONS: The study results suggest that static EMF has no effect on experimental colonic wound healing in the rat.     

Surface stimulation single-fiber electromyography in myasthenia gravis.

Surface stimulation for single-fiber electromyography has been proposed previously as a novel technique based on a study performed on healthy subjects. The current study was designed to determine the diagnostic value of surface stimulation single-fiber electromyography in patients with myasthenia gravis. Ten patients with myasthenia gravis were recruited for the study. Surface stimulation of the facial nerve trunk, as well as extramuscular needle stimulation of its zygomatic branch was performed. Twenty single-fiber potentials were recorded from the orbicularis oculi muscle for each stimulation type in each patient. For both stimulation techniques, mean jitter values and the total number of abnormal individual junctions were found to be abnormally high. Jitter values obtained by surface stimulation were comparable with those obtained by needle stimulation.     

Histological response to injected gluteraldehyde cross-linked bovine collagen based implant in a rat model

Background-

Neglected renal stones remain a major cause of morbidity in developing countries. They not only result in functional impairment of affected kidney, but also act as an important predisposing factor for development of urothelial neoplasms. It is not uncommon to miss an associated urothelial tumor in a patient of nephrolithiasis preoperatively.

Case presentation-

In last 3 years, we came across two patients with giant staghorn calculus and poorly functioning kidneys who underwent laparoscopic nephrectomy. In view of significant perirenal adhesions & loss of normal tissue planes both these patients were electively converted to open surgery. The pathological examination of specimen revealed an unsuspected urothelial carcinoma in both these patients. The summary of our cases and review of literature is presented.

Conclusion-

It is important to keep a differential diagnosis of associated urothelial malignancy in mind in patient presenting with long standing renal calculi. The exact role of a computerized tomography and cytology in preoperative workup for detection of possible associated malignancy in such condition is yet to be defined. Similarly if laparoscopic dissection appears difficult during nephrectomy for a renal calculus with non-functional kidney, keeping a possibility of associated urothelial malignancy in mind it is advisable to dissect in a plane outside gerotas fascia as for radical nephrectomy.     

A huge gastric stromal tumor in a 13-year-old girl

A 13-year-old girl presenting with severe anemia was diagnosed to have a large gastric tumor protruding toward the antrum with two central ulcerations. Partial gastrectomy including antrectomy and gastroduodenostomy were performed. Histologic and immunohistochemical studies revealed one of the most uncommon gastric tumors in children; a gastrointestinal stromal tumor. Close follow-up of the patient with endoscopy, abdominal ultrasonography and/or computed tomography in three to six month intervals revealed no recurrences or metastasis of the tumor following its complete excision.