Anatomical assessment of bile ducts of Luschka in human fetuses

Bile ducts of Luschka (also called subvesical or supravesicular ducts) can cause bile leakage during laparoscopic cholecystectomy, especially if surgery is carried out in ignorance of such variations. The aim of this study was to clarify the clinical anatomy of these ducts in human fetuses and frequency of the ducts locating near gallbladder fossa. Thirty-two fetal cadaver livers were dissected and the gallbladders were separated from the livers and ducts were investigated under a surgical microscope. All observed ducts were examined microscopically and connective tissue cords were excluded. Bile ducts of Luschka locating near cystic fossa were found in 7 of 32 fetuses (21.9%). Three of the seven ducts ran towards to liver segment 5 (S5); three ducts were found in the gallbladder fossa; and one duct ran towards to liver segment 4 (S4). Also it was found that three of the seven ducts drained into the subsegmental duct of S5, two ducts drained into the right hepatic duct, one duct drained into the right anterior branch bile duct, and one duct drained into the subsegmental duct of S4. Subvesical ducts running along the gallbladder fossa between the gallbladder and the liver parenchyma were found in a relatively high incidence in fetuses than adults. Awareness and knowledge about incidence of such ducts alerts the surgeon during laparoscopic cholecystectomy. Therefore morbidity due to bile leaks can be reduced.     

Bladder metastasis of malignant melanoma: a case report and review of literature

Metastatic malignant melanoma of the bladder is extremely rare in clinical practice with less than 10 cases reported in the last 30 years in the English literature. We report a case of malignant melanoma metastasis into the bladder, and review of the pertinent literature. A 60-year-old woman with a history of malignant melanoma in the distal phalanx on the right middle finger, excised 8 years ago presented with gross hematuria and weight loss. She underwent cystoscopy and complete transurethral resection of the bladder tumor. Pathological examination showed metastatic malignant melanoma of the bladder mucosa. The patient eventually died 7 months after transurethral resection.     

In vivo linear microcracks of human femoral cortical bone remain parallel to osteons during aging

Previous studies have examined the density of microdamage within the cortex of long bones mostly from the viewpoint that is perpendicular to the long axis of the bone. The goal of the present work is to conduct a systematic characterization of the microcracks from a viewpoint that is parallel to the long axis of a load-bearing bone, the femur, so as to gain a better understanding of the size, shape and orientation of the microdamage. Longitudinal cross sections were taken at the mid-diaphysis of femurs from 13 male donors (23-85 years old) after being stained with basic fuchsin. The number of cracks, their lengths and orientation with respect to osteons were characterized using brightfield and UV-epifluorescent imaging. The mean crack density was 0.1118+/-0.0417 mm(-2) in the longitudinal plane and it significantly increased with age. The median crack length along the longitudinal plane did not change with age. The crack length in the posterior quadrant was significantly lower than anterior, medial and lateral quadrants. Less than 3% of the cracks were longer than 1 mm, indicating the presence of 'in vivo macroscopic' cracks in bone tissue. It was observed that the 99% of the cracks had angles that were less than 25 degrees with the osteons (median angle of 4.2 degrees with an interquartile range of 5.8 degrees ), indicating that the majority in vivo linear microcracks are parallel to osteons. This parallelism did not differ between quadrants nor changed with age. The remarkably stagnant crack length and crack orientation across decades of aging suggest that either physiological loading profile leading to these in vivo microcracks are not changing notably with age, or, microcrack and osteonal orientations may be relatively insensitive to age-related changes in locomotion. In conclusion, in vivo linear microcracks of the femoral mid-shaft grow in planes parallel to osteons and their lengths do not increase with age.     

Peritoneal hydatid cyst perforation: a rare cause of emergency abdominal surgeries

Introduction  In hydatid cyst disease, perforation and spontaneous fistula formation are rare, yet very serious, complications. In this study we describe five cases of hydatid cyst disease in which the cysts perforated. Methods  In this retrospective study we evaluated five patients who were surgically treated for perforated hydatid cysts between 2002 and 2006. All patients were admitted to a local hospital with acute abdominal symptoms. Results  The mean age of the patients (four males and one female) was 39 years. The perforations occurred spontaneously in four patients, and were the result of trauma in one. Three of the hydatid cysts were located in the liver and two in the spleen. Only one patient had a recurrent hydatid cyst. Diagnostic tools included ultrasonography (n=5), computerized tomography (n=1), and diagnostic peritoneal lavage (n=1). The cysts were treated by radical (n=2) or conservative (n=3) methods. There was no postoperative morbidity or mortality, and no recurrences of hydatid disease after follow-up (mean: 14 months). Conclusion  Cyst perforation in the peritoneal cavity is a serious complication of hydatid disease and should be treated immediately. The literature suggests that recurrences may be related to the operative technique, the location of the cyst, and inadequate irrigation of the peritoneal cavity with scolicidal agents. The findings of this study suggest that if treated promptly, cyst perforation can be successfully treated.     

Carbamazepine poisoning managed with haemodialysis and haemoperfusion in three adolescents

Carbamazepine is a widely used antiepileptic agent. Accidental or suicidal overdose in children is not uncommon. Acute toxicity is associated with seizures, coma, arrhythmias and death in severe cases. Here we report three adolescents with carbamzepine overdose, two managed with standard low-flux haemodialysis and one with charcoal haemoperfusion. Our report emphasizes that haemodialysis might be a cheaper and easier alternative for carbamazepine overdose in milder cases, with fewer side-effects than haemoperfusion.