Possibilities and limitations of fibrin glue usage in nephron-sparing surgery: experimental study

INTRODUCTION: The possibilities and limitations of fibrin glue (FG) usage in nephron-sparing surgery were studied. MATERIALS AND METHODS: A prospective experimental study was carried out in 50 pigs: 30 with polar resection, and 20 with mediorenal wedge resection of the kidney. Hemostatic sutures, FG, and FG with a muscle 'cup' in animals with polar resection of the kidney were compared. FG and sutures in animals with the wedge resection of the kidney were studied as well. Bleeding, hot ischemia time, complication rate, and additional scarring were also analyzed. RESULTS: Suture hemostasis is safe but with significant adverse effects in both polar and wedge resection of kidney. FG was not efficient as a sole hemostatic agent for polar resection. It was as efficient as hemostatic suture for wedge resection of the kidney. FG with a muscle 'cup' on a pole of the kidney achieved good results in animals with polar resection of the kidney. Histological analysis confirmed better results with FG because of both the less intense and smaller area of additional scarring. CONCLUSION: FG is a reliable and efficient hemostatic agent for nephron-sparing surgery whenever both sided gluing is possible.     

Assessment of hemodialysis adequacy by ionic dialysance: comparison to standard method of urea removal

BACKGROUND: The hemodialysis adequacy is one of the most important issues influencing the survival of patients on maintenance hemodialysis (HD). Assessment of measuring the delivered dialysis dose using clearance x time/volume (Kt/V) index requires multiple blood sampling. New methods for assessment of dialysis dose based on ionic dialysance (ID) have been suggested. Online conductivity monitoring (using sodium flux as a surrogate for urea) allows the repeated noninvasive measurement of Kt/V on each HD treatment. In this study we have compared this method with the standard method of estimating Kt/V. METHODS: We studied 24 established HD patients over a 4 week time period. Patients were dialyzed using Fresenius 4008S dialysis monitors, equipped with modules to measure ID. Data were manually collected and analyzed using the appropriate statistical software. Urea removal (UR) was measured once a week by a two-pool calculation, estimating an eKt/V. RESULTS: The Kt/V measured by ID highly correlated with the one derived from the measurement of the UR (r=0.8959, p< 0.0001). The ID underestimated UR by the mean of 6%. The ID varied greatly within individual patients with a median of 1.29 +/- 0.22. If the eKt/V > or = 1.2 is considered adequate, 33% of the patients would have been inadequately dialyzed. The mean HD duration to achieve an adequate dialysis was 4 hours and 47 minutes with high interpatient variability. CONCLUSION: The ID seems to be an easily obtained measure of the delivered dialysis dose, correlating well with standard UR method. Substantial individual variations imply that repeated measures (ideally for all treatments) are necessary to obtain a real answer to the mean treatment dose being delivered to the patients.     

Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis

BACKGROUND: The purpose of this study is to examine the effect of various risk factors on complications in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. METHODS: A retrospective review of 224 pedicled TRAMs in 200 patients over a 10-year period was carried out. Patients were divided into subgroups based on smoking history, weight, radiation status, and pedicle type. Complication rates were calculated and logistic regression analysis was used to identify risk factors. RESULTS: Logistic regression identified active smoking as a statistically significant risk factor for developing multiple (2 or more) flap complications (P = 0.0061) and TRAM infection (P = 0.0255), while former smoking was a risk factor for multiple flap complications (P = 0.01) and TRAM-delayed wound healing (P = 0.0433). Obesity (body mass index > or =30) was found to be a statistically significant risk factor for overall (1 or more) donor-site complications (P = 0.0281), overall flap complications (P = 0.0375), multiple flap complications (P = 0.0002), TRAM-delayed wound healing (P = 0.0334), and minor flap necrosis (P = 0.0075). CONCLUSIONS: This study identified that active or former smoking and obesity contribute to a significant complication rate, while overweight body habitus, use of double-pedicled flaps, and pre-TRAM radiation do not. This second decade "look-back" on pedicled TRAM flap breast reconstruction emphasizes the need for appropriate patient selection to achieve successful results with pedicled TRAM breast reconstruction.     

Mycophenolate mofetil and neurological diseases

We describe experience with the use of mycophenolate mofetil (MMF) in neurological diseases. Although only small series of patients or case reports were described, MMF is promising in immune-mediated neuromuscular disorders. MMF has been used for the treatment of polymyositis, chronic inflammatory demyelinating polyradiculoneuropathy, and multifocal motor neuropathy. These studies showed that MMF is well tolerated and may be useful in some patients. MMF can be effective alone but mainly as an adjuvant therapy by reducing steroid requirements or the frequency of infusions of IVIg. MMF has also been tested alone as a single drug treatment or in combination with immunomodulatory drugs in multiple sclerosis in open surveillance trials or in phase II studies. None of these studies have been designed to demonstrate a clinical efficacy but preliminary results are very promising.     

Viral hepatitis: Croatian consensus statement

There has been a dramatic improvement in diagnostic procedures and therapy of viral hepatitis in the last 20 years. Improvements in therapy caused an increase in actual cost, however, with significant long-term savings through a decreased cost of treatment of advanced liver disease including liver transplantation. The Croatian National Board for Viral Hepatitis has decided to initiate the organization of consensus conference on viral hepatitis enabling the leading experts in the country to give the best possible recommendations for the diagnosis, prophylaxis and therapy in our circumstances. The Consensus Conference took place in Zagreb in June 2004, with update in March 2005, organized by the Croatian National Board for Viral Hepatitis, Reference Centers of the Ministry of Health for Chronic Liver Diseases, Infectious Diseases and AIDS, Croatian Society of Gastroenterology--Hepatology Section, Croatian Society for Nephrology, Dialysis and Transplantation, and Croatian Institute for Health Insurance. Invited experts provided written reports on the respective subjects that appear in this issue and their recommendations resulting in this consensus statement.     

A family with a novel frameshift mutation in the PMP22 gene (c.433_434insC) causing a phenotype of hereditary neuropathy with liability to pressure palsies

Hereditary neuropathy with liability to pressure palsies is usually due to PMP22 deletion. Point mutations of PMP22 causing an hereditary neuropathy with liability to pressure palsies phenotype are rare. We describe a clinical and electrodiagnostic phenotype of hereditary neuropathy with liability to pressure palsies in a 21-year-old woman, which led to our detecting a novel frameshift mutation of PMP22. This mutation was also found in her mother and brother and corresponded to an insertion of one cytidine between nucleotides 433 and 434 in the last coding exon (c.433_434insC). The mutated PMP22 protein lacks the last 15 amino acids and has a modified C terminus lengthened to 221 residues instead of 160 (Leu145fsX222). The mother and the proband had a clinical and electrophysiological hereditary neuropathy with liability to pressure palsies phenotype. The brother was asymptomatic, but the results of electrodiagnostic tests were suggestive of hereditary neuropathy with liability to pressure palsies. This observation of a new mutation mostly leading to a PMP22 haploinsufficiency provides further evidence of the diversity of phenotypes associated with frameshift PMP22 mutations.     

Extracellular matrix of Reinke's space in some pathological conditions

OBJECTIVE: Reinke's space (RS) is a highly specific structure in which the majority of vocal fold pathology occurs. The vibratory equivalents of structurally normal RS are regular vocal fold vibrations and normal glottic mucosal waves. Recently, RS has been considered to be composed not only of fibres but also of extracellular matrix (ECM), which is an extremely important component of a normal mucosal wave. As Reinke's oedema (RO) is characterized by excessive ECM in RS, we investigated the cell activity in RO tissue which is possibly responsible for excessive ECM production. MATERIAL AND METHODS: Tissue samples were obtained from 20 RO patients during microlaryngeal surgery. Tissue was analysed histochemically using the AgNOR method and the proliferation activity was assessed immunohistochemically using Ki67 monoclonal antibodies. RESULTS: AgNOR activity was detected in prominent stromal cells in 16 patients. Also, more pronounced activity, compared to the surrounding control tissue, was demonstrated in the epithelial cells of 17 patients using a Ki67 proliferation marker. Electron microscopy showed thickening and decomposition of the basement membrane in all RO tissue samples. CONCLUSIONS: Vocal fold mucosa that has been damaged by smoking and phonotrauma may react by producing excessive ECM, resulting in RO. Both epithelial and stromal cells are in a state of higher metabolic activity, indicating their role in this production.     

Autofluorescent diagnostics in laryngeal pathology

Autofluorescent diagnostics are based on the ability of oxidized flavin mononucleotide (FMN) in normal cells to emit green fluorescence when exposed to blue light. Neoplastic cells have significantly lower concentrations of FMN and do not emit green fluorescence. Autofluorescent endoscopy is designed for early, accurate and minimally invasive diagnostics for laryngeal pathology. This procedure has the ability to give information about the nature of laryngeal lesions without the devastation of tissue and has important advantages over standard biopsy. In our investigation we used the System of AutoFluorescent Endoscopy (SAFE 1000) designed by Pentax. We examined 38 patients using the SAFE 1000 system, and then all of the patients underwent laryngomicroscopy (LMS). In LMS, a biopsy was taken, and the diagnostic sensitivity of these two methods was compared according to the pathohistologic diagnosis. For statistical evaluation we used Fisher's exact test. We found that autofluorescent endoscopy has greater sensitivity in the detection of precancerous and malignant conditions in the larynx than standard laryngomicroscopy. We believe that autofluorescent endoscopy in addition to laryngomicroscopy gives a more accurate diagnosis of laryngeal pathology than laryngomicroscopy alone.     

Fibromyalgia and Tinel's sign in the foot

In the physical examination of the patient suspected of having tarsal tunnel syndrome, the podiatric physician relies on Tinel's sign: tapping the posterior tibial nerve in the tarsal tunnel should produce a distally radiating sensation if the nerve is pathologically compressed at this location. The American College of Rheumatology recognizes fibromyalgia as a condition characterized by multiple "tender points" on physical examination. This report compares the locations of the 18 critical diagnostic fibromyalgia points with known sites of anatomical entrapment of peripheral nerves in the lower extremity. We also describe a patient with both fibromyalgia and tarsal tunnel syndrome. Tinel's sign in the lower extremity is a valid technique for assessing peripheral nerve compression in the patient with fibromyalgia.     

Role of lipid peroxidation in non-alcoholic steatohepatitis

The liver steatosis is a frequent human disease. The most frequent cause of the process is the alcohol consumption. But it also may arise without significant alcohol abuse. This pathogenetic process is called non-alcoholic steatohepatitis (NASH), that is characterized by the same conditions like the alcoholic steatohepatitis. In the pathogenesis of the NASH various factors participate i.e. obesity, diabetes mellitus type II, hyperlipidaemia, pregnancy, variable chemotoxins, parenteral nutrition, jejunoileal bypass, chronic inflammatory diseases, protein deficient nutrition and inborn metabolic diseases. Pathobiochemically the process consists of oxidative stress and lipid peroxidation. This condition comes from the progressive accumulation of the free fatty acids in mitochondria and from the induction of cytochrome P450, CYP 2E1 isoform in hepatocytes and Kupffer cells. The free fatty acids and ketons can cause the induction of CYP 2E1 system, that is why diabetes mellitus and obesity are the two most important factors in the NASH pathogenesis. This article is concerned mainly in the explanation of NASH pathomechanism.