An Antireflux Anastomosis Following Esophagectomy: A Randomized Controlled Trial

Background  

Reflux of duodeno-gastric fluid is a significant problem after esophagectomy with gastric conduit reconstruction. Symptoms may be severe and impact considerably upon the quality of life. Previous studies have suggested that a fundoplication type anastomosis may limit post-esophagectomy reflux.     

Involvement of nitric oxide pathway in the acute anticonvulsant effect of melatonin in mice

Melatonin, the major hormone produced by the pineal gland, is shown to have anticonvulsant effects. Nitric oxide (NO) is a known mediator in seizure susceptibility modulation. In the present study, the involvement of NO pathway in the anticonvulsant effect of melatonin in pentylenetetrazole (PTZ)-induced clonic seizures was investigated in mice. Acute intraperitoneal administration of melatonin (40 and 80 mg/kg) significantly increased the clonic seizure threshold induced by intravenous administration of PTZ. This effect was observed as soon as 1 min after injection and lasted for 30 min with a peak effect at 3 min after melatonin administration. Combination of per se non-effective doses of melatonin (10 and 20 mg/kg) and nitric oxide synthase (NOS) substrate L-arginine (30, 60 mg/kg) showed a significant anticonvulsant activity. This effect was reversed by NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME, 30 mg/kg), implying an NO-dependent mechanism for melatonin effect. Pretreatment with L-NAME (30 mg/kg) and N(G)-nitro-L-arginine (L-NNA, 10 mg/kg) inhibited the anticonvulsant property of melatonin (40 and 80 mg/kg) and melatonin 40 mg/kg, respectively. Specific inducible NOS (iNOS) inhibitor aminoguanidine (100 and 300 mg/kg) did not affect the anticonvulsant effect of melatonin, excluding the role of iNOS in this phenomenon, while pretreatment of with 7-NI (50 mg/kg), a preferential neuronal NOS inhibitor, reversed this effect. The present data show an anticonvulsant effect for melatonin in i.v. PTZ seizure paradigm, which may be mediated via NO/L-arginine pathway by constitutively expressed NOS.     

Flexion contracture following primary total knee arthroplasty: risk factors and outcomes

Function and satisfaction after total knee arthroplasty (TKA) are partially linked to postoperative range of motion (ROM). Fixed flexion contracture is a recognized complication of TKA that reduces ROM and is a source of morbidity for patients. This study aimed to identify preoperative risk factors for developing fixed flexion contracture following TKA and to quantify the effect of fixed flexion contracture on outcomes (Oxford knee score 12-60 and patient satisfaction) at 2 years. Pre-, intra-, and postoperative data for 811 TKAs were retrospectively reviewed. At 2 years postoperatively, the incidence of fixed flexion contracture was 3.6%. Men were 2.6 times more likely than women to have fixed flexion contracture (P=.012), and patients with preimplant fixed flexion contracture were 2.3 times more likely than those without to have fixed flexion contracture (P=.028). Increasing age was associated with an increased rate of fixed flexion contracture (P=.02). Body mass index was not a risk factor (P=.968). Incidence of fixed flexion contracture for those undergoing computer navigated TKA was 3.9% compared with 3.4% for those having conventional surgery (P=.711). Patients with fixed flexion contracture had poorer outcomes with a median [interquartile range] Oxford Knee Score of 25 [15] compared with 20 [11] for those without (P=.003) and lower patient satisfaction (P=.036). These results support existing literature for incidence of fixed flexion contracture after TKA, risk factors, and outcomes, indicating that these figures can be extrapolated to a wide population. They also clarify a previously contentious point by excluding body mass index as a risk factor.     

Why large-head metal-on-metal hip replacements are painful: the anatomical basis of psoas impingement on the femoral head-neck junction

Large-head metal-on-metal total hip replacement has a failure rate of almost 8% at five years, three times the revision rate of conventional hip replacement. Unexplained pain remains a feature of this type of arthroplasty. All designs of the femoral component of large-head metal-on-metal total hip replacements share a unique characteristic: a subtended angle of 120° defining the proportion of a sphere that the head represents. Using MRI, we measured the contact area of the iliopsoas tendon on the femoral head in sagittal reconstruction of 20 hips of patients with symptomatic femoroacetabular impingement. We also measured the articular extent of the femoral head on 40 normal hips and ten with cam-type deformities. Finally, we performed virtual hip resurfacing on normal and cam-type hips, avoiding overhang of the metal rim inferomedially. The articular surface of the femoral head has a subtended angle of 120° anteriorly and posteriorly, but only 100° medially. Virtual surgery in a normally shaped femoral head showed a 20° skirt of metal protruding medially where iliopsoas articulates. The excessive extent of the large-diameter femoral components may cause iliopsoas impingement independently of the acetabular component. This may be the cause of postoperative pain with these implants.     

Listeria monocytogenes peritonitis in a patient on peritoneal dialysis: a case report and review of the literature

Listeria monocytogenes (LM) is one of the rare microorganisms causing peritonitis in peritoneal dialysis (PD) patients. We report a sporadic case of peritonitis caused by LM in a young female PD patient with lupus receiving corticosteroid therapy, who presented with abdominal pain, cloudy PD effluent, nausea, and conjunctivitis. The effluent showed a high PD effluent white cell count and monocytosis, and gram staining showed gram-positive bacilli in single or short chains and PD effluent culture grew LM. She was treated successfully with beta lactum antibiotics. LM peritonitis should be suspected if a patient presents with gram-positive bacilli and monocytosis in dialysis effluent.     

A very rare case of single coronary artery anomaly, with left anterior descending and left circumflex arteries originating separately from proximal right coronary artery

Coronary artery anomalies are rare, with the reported prevalence of 0.2% to 1% in routine angiographic studies. Among them, presence of a single coronary artery is one of the rarest anomalies, comprising less than 3% of all coronary anomalies. In this article we report a case of single coronary artery anomaly with left anterior descending and left circumflex arteries arising separately from proximal right coronary artery, and left anterior descending artery reaching atrioventricular sulcus by passing between aortic and pulmonary artery trunci. The patient underwent off-pump coronary artery bypass grafting and is currently symptom-free.     

Role of Nd:YAG laser for prevention of neuroma formation: an in vivo experimental study

Nerve transection is commonly followed by the development of neuroma at the proximal stump. It can be very painful especially at exposed sites. It may arise spontaneously or after mechanical irritation. Neuroma and its high recurrence rate might be resisting problems to treat. Various treatment modalities for neuroma and its recurrence have been proposed, but none has provided satisfactory results. The present study was conducted to evaluate the neodymium:yttrium aluminum garnet (Nd:YAG) laser (1,064 nm) nerve transection technique for prevention of neuroma formation. There were 48 facial nerves out of 24 Rex rabbits divided into two equal groups. The 24 left-sided facial nerves at group A were subjected to Nd:YAG laser for nerve transection, while the 24 right-sided facial nerves at group B were subjected to scalpel nerve transection. The results were grossly and histopathologically evaluated. Grossly, laser-transected nerves showed an infrequent incidence of neuroma formation. Histopathologically, laser-transected nerves showed photothermal degenerative changes of the axons and myelin sheaths with intact perineurium and endoneurium. No Schwann cell hyperactivity could also be elicited among laser-transected nerves. Nd:YAG laser was found to be an effective tool that could be applied, whenever it is possible, for division of major nerves to prevent the formation of the subsequent stump neuroma. Moreover, this technique should be considered during treatment of well-established neuroma to prevent the challenging reported high incidence of recurrence.     

Bone reinnervation after fracture: a study in the rat.

Reinnervation after tibial fracture in the rat was studied by analyzing the occurrence of growth-associated protein 43 (GAP-43), a marker for regenerating nerve fibers, and protein gene product 9.5 (PGP-9.5), a marker for mature nerve fibers, by immunohistochemistry. At 3 days postfracture, GAP-43--immunoreactive nerve fibers were first observed in the fracture hematoma and periosteum. At 7 days postfracture, abundant sprouting of GAP-43--positive fibers was seen in the callus, hyperplastic periosteum, and edge of fibrocartilage. In the latter region, the nerve fibers were nonvascular, showing dense ramifications and terminal sprouting close to chondroid cells. At 14 days and 21 days postfracture, many GAP-43--positive fibers were still sprouting into the fibrocartilage and new woven bone. Fine varicose GAP-43--positive fibers also were present in the bone marrow. In contrast to GAP-43, PGP-9.5-positive nerve fibers were observed only occasionally at 3 days postfracture but gradually increased in number from day 14 to 21. Our study shows that intense nerve regeneration occurs in early fracture healing partly unrelated to neovascularization. Considering that neuronal mediators have been shown to participate in local bone formation and resorption, the nerve regeneration observed may prove to be essential for delivery of neuronal mediators required for normal callus formation and/or neovascularization.     

Expression of Carbohydrate Antigens in Human Esophageal Squamous Cell Carcinoma: Prognostic Application and Its Diagnostic Implications

Background Tumor markers whose antigenic determinants have been demonstrated to consist of carbohydrates are probably one of the most extensive tools that have been used in routine cancer diagnosis. In this study, the relevance of carbohydrate antigen expression profile was examined in esophageal squamous cell carcinoma together with prognosis in 130 patients. Methods The expression of carbohydrate antigens was estimated immunohistochemically by anti–sialyl Lewis a (sialyl Le^a) and anti–sialyl Lewis x (sialyl Le^x) monoclonal antibodies, and correlation between their staining and clinicopathological status was examined. In addition, the correlation of both carbohydrate antigens expression was evaluated with microvessel density (MVD). Results Expressions of sialyl Lewis antigens and MVD were associated with several clinicopathological features that reflect the tumor aggressiveness in esophageal cancer. The 5-year survival rate of patients was found to be associated with expression of sialyl Le^a and sialyl Le^x antigens and with MVD; thus, all of them were revealed to be independent prognostic factors. Conclusions Combination of these factors offered a better prediction of prognosis of esophageal squamous cell carcinoma. Further, carbohydrate antigens represent a promising target for therapeutic approaches against the disease.