Thoracic duct variations may complicate the anterior spine procedures

The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.     

Can mycoplasma contribute to formation of prostate cancer?

Purpose

To reveal the possible role of mycoplasmas in the etiopathogenesis of prostate cancer.

Methods

In the study, prostate biopsy was performed on 62 patients with an abnormal digital rectal examination and/or elevated PSA. The patients’ age was between 62 and 77 (mean 65.4 years) years. Thirty-one patients had adenocarcinoma of the prostate histopathologically (group 1). From these patients, the specimens were divided into two subgroups as specimens with malignant findings (group 1A) and specimens with benign findings (group 1B). The control group consisted of 31 patients with benign prostatic hyperplasia (group 2). In the specimens, the presence of mycoplasma DNA was investigated by the polymerase chain reaction method.

Results

The mycoplasma DNA was found to be positive in 11 (35.4 %) patients in group 1A and in 4 (12.9 %) patients in group 1B. There was no mycoplasma DNA in the patients in group 2. The differences between group 1A and group 1B, and between group 1A and group 2 were statistically significant (p values, respectively, 0.006 and 0.0001).

Conclusions

Our data supported the thesis that mycoplasma infections play a role in the etiopathogenesis of the prostate cancer.     

There are no estrogen and progesterone receptors in cerebral cavernomas: A preliminary immunohistochemical study

Background

Literature consistently mentions that pregnancy and hormonal therapy probably increase the bleeding rate and seizure expression of cerebral cavernomas. Either increased hormonal activity or embryogenesis related abundant expression of some growth factors such as VEGF, bFGF, and placental growth factor during pregnancy were proposed to initiate angiogenic process and vascular proliferation in cavernomas, thereby increasing their bleeding rate and seizure expression.

Methods

To reveal whether estrogen and/or progesterone have direct effect on cerebral cavernomas, their receptor expressions were studied immunohistochemically in recently excised 12 cerebral cavernomas.

Results

Study showed no expression of either estrogen or progesterone receptors in cerebral cavernomas even the staining worked well in positive control tissues of infiltrative ductal carcinoma.

Conclusions

Aggressive behavior of cerebral cavernomas during pregnancy is a commonly proven observation and attributed to some hormonal effects. However, this effect seems not related to effect of estrogen or progesterone on cavernoma tissue via receptor binding.     

Sexual Function and Long-Term Results Following Vaginal Reconstruction with Free Vascular Jejunal Flap

IntroductionSexual adjustment and long-term results following vaginal reconstruction with free vascular jejunal flap are not well known.AimsThe study aims to investigate sexual adjustment and long-term results among patients who underwent vaginal reconstruction with free vascular jejunal flap.MethodsA total of 34 women, aged 16–31 years (mean 23.5), who underwent vaginal reconstruction with a vascular jejunal flap between 2005 and 2011 were evaluated. Indications for reconstruction included the following: Mayer Rokitansky Kuster Hauser syndrome (29 patients), isolated vaginal agenesis (2 patients), androgen insensitivity syndrome (2 patients), and (1) history of gynecologic-oncologic surgery.Main Outcome MeasuresThe study evaluates the perioperative results, complications, satisfaction with sexual function, length and width of the neovagina.ResultsAll of the surgeries were completed without any intraoperative complications. Three patients required reoperation because of postoperative venous compromise in the grafts. The flap success rate was 100%, and no infection was observed for any case. The mean follow-up was 50 months (between 20 and 87 months). The mean vaginal depth and diameter were satisfactory for all cases. Postoperatively, six patients complained of jejunal hypersecretion, one patient complained of mucosal prolapse, and one patient complained of vaginal constriction. The neovaginal prolapse was repaired via minor surgery. Twenty-seven were married and sexually active. Twenty patients completed the questionnaire on sexual function. Sexual function was assessed using the Female Sexual Function Index (FSFI). Eleven patients were satisfied with their sexual lives after surgery (FSFI scores ≥ 25).ConclusionBased on our results, satisfactory sexual function was achieved using the free jejunal vascular flap. Erman Akar M, Özkan Ö, Özkan Ö, Colak T, and Gecici O. Sexual function and long-term results following vaginal reconstruction with free vascular jejunal flap. J Sex Med 2013;10:2849–2854.     

Metrifonate trial in the treatment of various presentations of Schistosoma haematobium and S. mansoni infections in the Sudan.

The effect of metrifonate (Bilarcil Bayer) on Schistosoma haematobium and S. mansoni infections was studied in 174 patients near Khartoum. A high cure rate was obtained in S. haematobium infections, but anthelmintic efficacy was minimal in patients passing S. mansoni eggs in their stools. There was, however, a marked reduction of egg output in patients passing S. mansoni eggs in urine. This suggests that the site of infection in man, rather than the species of parasite, renders the parasite more susceptible to metrifonate. The significance of this and the possibility that these results further clarify the mode of action of metrifonate are discussed.     

Tracheostomy in Pediatric Intensive Care Unit: When and Where?

Background:

Tracheostomy was first observed in Egyptian drawings in 3600 BC and performed frequently during the 1800’s diphtheria epidemic.

Objectives:

The aim of this study was to elucidate the indications, complications, mortality rate, and the effect of pediatric tracheostomy on length of PICU or hospital stay.

Materials and Methods:

Demographic characteristics, diagnosis at admission, duration of ventilation of 152 patients were analyzed retrospectively.

Results:

The most common tracheostomy indication was prolonged intubation. The mean duration of mechanical ventilation before tracheostomy was 23.8 days. Forty five percent of the tracheostomy procedures were performed at bedside. Neither the place nor the age had any effect on the development of complications (P = 0.701, P = 0.622). The procedure enabled 62% of the patients to be discharged from hospital.

Conclusions:

Tracheostomy facilitates discharge and weaning of mechanical ventilation. Although the timing of tracheostomy has to be determined for each individual patient, three weeks of ventilation seems to be a suitable period for tracheostomy. Tracheostomy can be performed at bedside safely but patient selection should be made carefully.     

Single-Dose del Nido Cardioplegia Compared With Standard Cardioplegia During Coronary Artery Bypass Grafting at a Veterans Affairs Hospital

Del Nido cardioplegic solution (DNC), used chiefly in pediatric patients, rapidly induces prolonged cardiac arrest during cardiac surgery. To determine whether surgical outcomes after coronary artery bypass grafting in a United States military veteran population differed when DNC was used instead of our standard Plegisol cardioplegia, we retrospectively reviewed 155 consecutive operations performed from July 2016 through June 2017. Del Nido cardioplegia was used to induce cardiac arrest in 70 patients, and Plegisol in 85.Compared with the Plegisol group, the DNC group had a shorter mean cardiopulmonary bypass time (96.8 vs 117 min; P <0.01) and aortic cross-clamp time (63.9 vs 71.7 min; P=0.02). On multiple linear regression, DNC use and number of bypasses performed were predictors of cardiopulmonary bypass time. The groups were similar in median number of bypasses performed, median time to extubation, intensive care unit stay, and total postoperative stay; however, the DNC group had a shorter mean operating room time (285.8 vs 364.5 min; P <0.01). Del Nido cardioplegia, number of bypasses, cardiopulmonary bypass time, and red blood cell transfusion were predictors of operating room time. Outcomes in the groups were similar for 30- and 180-day death, stroke, renal failure, ventilation time >48 hours, atrial fibrillation, tracheostomy, reintubation, and mechanical circulatory support. We conclude that single-dose DNC is safe, effective, and cost-effective for achieving cardiac arrest in U.S. veteran populations.