Delayed presentation of arteriovenous fistula 20 years after blunt renal trauma

Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual delayed presentation of renal arteriovenous fistula following blunt trauma. A gentleman presented with hematuria and clot colic. Following initial investigations, renal arteriography showed an arteriovenous fistula in the mid-pole of the right kidney. The fistula was successfully occluded by super-selective coil embolization. Although this case is an unusual presentation, AV fistulae must be ruled out in management of patients of hematuria.     

Changes in the Masseter Muscle After Curved Osteotomy of the Prominent Mandibular Angle

Background This study aimed to explore the changes in the masseter muscle after curved osteotomy of the prominent mandibular angle and to supply guidance for resection of the mandibular angle. Methods Ultrasonography was used to assess changes in the thickness of the masseter muscle after curved osteotomy for 10 patients (20 hemimandibles) at the 6-month following-up assessment. The measurements were performed under both relaxing and maximal clenching positions through three cross sections of the masseter muscle (planes A, B, and C). Plane A contains the line from the mouth angle to the ipsilateral ear lobe. Planes B and C are parallel planes above and below plane A with a distance of 1 cm between them. Results No significant difference between the preoperative and postoperative thicknesses of the masseter muscle for planes A and B (p > 0.05) was found, but there was a significant difference (p < 0.05) for plane C. The postoperative thickness of the masseter muscle in plane C was reduced by 0.244 ± 0.121 cm in the relaxing position and by 0.244 ± 0.142 cm in the clenching position, which were respectively 19.22% ± 7.785% and 15.404% ± 7.648% of its original thickness. There was no significant difference in the contraction amplitude of the masseter muscle under maximal clenching (p > 0.05) for any of the three cross sections postoperatively. Conclusions The masseter muscle around the mandibular angle becomes atrophied but without functional defect after curved osteotomy. Patients with prominent mandibular angles can be treated simply with curved osteotomy instead of masseter excision.     

Do hydronephrosis and extracorporeal shock wave lithotripsy affect carbohydrate antigens?

Objectives

To investigate carbohydrate antigen (CA 19-9, CA 15-3, and CA 125) levels in the patients who had hydronephrosis with renal stones and in whom Extracorporeal shock wave lithotripsy (ESWL) was performed.

Materials and Methods

This prospective study included 20 people with no known disease for control group and 30 patients who had hydronephrosis with renal stones and in whom ESWL was performed between January 2005 and January 2006. None of patients had urinary infection and malignancy. The blood for carbohydrate antigens was taken pre-ESWL and 30 min after ESWL in both groups. CA 19-9, CA 15-3, and CA 125 in the serum were tested with the electro-immunoassay method on the Roche^® E-170 apparatus with the original Roche^® kit.

Results

The CA 19-9 and CA 125 values in the patients group were found to be statistically significant when compared with the control group but the CA 15-3 was not found to be significant. However, CA 19-9, CA 15-3, and CA 125 values of post-ESWL were not statistically significant when compared with pre-ESWL group (P > 0.05).

Conclusions

The average serum values of CA 125 and CA 19-9 in patients were found to be significantly high. However, serum values of CA 19-9, CA 15-3, and CA 125 were not affected by ESWL.

     

Prevalence of lower urinary tract symptoms among female elementary school teachers in Taipei

The aim of this study was to estimate the prevalence of lower urinary tract symptoms (LUTS) among female elementary school teachers in Taipei. A total of 520 self-administered surveys were distributed to 26 elementary schools in Taipei City. Data analyses were based on 445 usable surveys. The prevalence rates for different types of LUTS ranged from 9.9 to 44.5%. The prevalence of urinary incontinence (UI; 26.7%) and nocturia (16.0%) fell within the prevalence estimates of these LUTS in North American and European women. Employed women in this study were more likely to experience LUTS than women in previous epidemiological or community studies. This study extended research on UI into other LUTS among employed women in Asia. Study results suggest that the working environment may affect LUTS in female elementary school teachers. This preliminary study is important for developing future behavioral interventions for female LUTS in the workplace.     

Malaria-induced renal damage: facts and myths

Malaria infections repeatedly have been reported to induce nephrotic syndrome and acute renal failure. Questions have been raised whether the association of a nephrotic syndrome with quartan malaria was only coincidental, and whether the acute renal failure was a specific or unspecific consequence of Plasmodium falciparum infection. This review attempts to answer questions about “chronic quartan malaria nephropathy” and “acute falciparum malaria nephropathy”. The literature review was performed on all publications on kidney involvement in human and experimental malarial infections accessible in PubMed or available at the library of the London School of Hygiene and Tropical Medicine. The association of a nephrotic syndrome with quartan malaria was mostly described before 1975 in children and rarely in adult patients living in areas endemic for Plasmodium malariae. The pooled data on malaria-induced acute renal failure included children and adults acquiring falciparum malaria in endemic areas either as natives or as travellers from non-tropical countries. Non-immunes (not living in endemic areas) had a higher risk of developing acute renal failure than semi-immunes (living in endemic areas). Children with cerebral malaria had a higher rate and more severe course of acute renal failure than children with mild malaria. Today, there is no evidence of a dominant role of steroid-resistant and chronic “malarial glomerulopathies” in children with a nephrotic syndrome in Africa. Acute renal failure was a frequent and serious complication of falciparum malaria in non-immune adults. However, recently it has been reported more often in semi-immune African children with associated morbidity and mortality.     

Laparoscopic Nephrectomy,Ex Vivo Repair,and Autotransplantation for a Renal Artery Aneurysm: Report of a Case

A 57-year-old woman was hospitalized with a left renal artery aneurysm (RAA). The aneurysm measured 35 mm in diameter and was located at the renal artery bifurcation. We performed a laparoscopic nephrectomy using a retroperitoneal approach and performed an ex vivo repair of the renal artery. The reconstructed kidney was then autotransplanted at the left iliac fossa. The patient's postoperative course was uneventful. A laparoscopic nephrectomy and ex vivo repair are both considered to be effective for treating complex RAA.     

Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus

Purpose In this randomized, double-blind study, we aimed to compare the effectiveness of lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus in patients undergoing cesarean section. Methods One hundred and eight parturients (American Society of Anesthesiologists [ASA] I-II status) requesting neuraxial analgesia by a combined spinal-epidural (CSE) technique were recruited for this study. A CSE technique was performed and anesthesia was achieved with fentanyl 25 μg and hyperbaric bupivacaine 12 mg. Patients were randomly allocated to three groups, each with 36 participants. Immediately following delivery, patients received either lornoxicam 8 mg IV (group L; n = 36), ondansetron 8 mg IV (group O; n = 36), or normal saline 2 ml IV (group P; n = 36). Pruritus, pain, and nausea and vomiting scores were recorded during the initial 24 h postoperatively. Results The incidence of pruritus was significantly lower in group O from 4 to 12 h postoperatively when compared to that in group L and group P. According to the pruritus grading system we used, the number of patients without pruritus was significantly higher in group O when compared to that in group L and group P. The number of patients experiencing moderate pruritus was significantly lower in group O when compared to that in group P. Conclusion We observed that the administration of 8 mg IV lornoxicam failed to prevent intrathecal fentanyl-induced pruritus in parturients. Also, our data confirmed that ondansetron is likely to attenuate intrathecal fentanyl-induced pruritus.     

Stereophotogrammetric measurement of the nasolabial fold in repose: a study of age and posture-related changes

The nasolabial fold is a significant facial landmark. Its size, shape, and symmetry are important in facial reanimation surgery, while effacement is an important goal in rejuvenation surgery. However, quantitative data for the nasolabial fold volume (NLFV) and depth is still unavailable. We present a new method of measurement using 3D color speckle stereophotogrammetry and its application in the assessment of NLFV. The VECTRA-3D system was validated to determine its minimum resolution and accuracy. Normal volunteers aged 13–84 years (n = 87) were imaged in repose. Mother–daughter pairs (n = 15, aged 13–61) were imaged in the upright and supine positions. All data were processed using custom software and analyzed by linear regression and nonparametric tests as appropriate. NLFV varied from 0.0026 to 0.2306 ml. There was significant correlation between NLFV and age (r = 0.7269, p < 0.0001). Men had significantly higher NLFV than women across all ages. There was no significant difference between the left and right NLFV. NLFV altered significantly from upright to supine in all subjects (p = 0.0012). However, the mothers increased their NLFV by 32% from supine to upright postures, which was a greater change than observed in their daughters. We have demonstrated a rapid, objective, and non-invasive assessment tool for facial reanimation and rejuvenation surgery. We have quantified the effects of age and posture on NLFV, and the efficacy and longevity of rejuvenation procedures are currently under investigation.     

Lumbar facet anatomy changes in spondylolysis: a comparative skeletal study

Opinions differ as to the exact mechanism responsible for spondylolysis (SP) and whether individuals with specific morphological characteristics of the lumbar vertebral neural arch are predisposed to SP. The aim of our study was to reveal the association between SP and the architecture of lumbar articular facets and the inter-facet region. Methods: Using a Microscribe three-dimensional apparatus (Immersion Co., San Jose, CA, USA), length, width and depth of all articular facets and all inter-facet distances in the lumbar spine (L1–L5) were measured. From the Hamann-Todd Human Osteological Collection (Cleveland Museum of Natural History, OH, USA) 120 normal male skeletons with lumbar spines in the control group and 115 with bilateral SP at L5 were selected. Analysis of variance was employed to examine the differences between spondylolytic and normal spines. Results: Three profound differences between SP and the norm appeared: (1) in individuals with SP, the size and shape of L4’s neural arch had significantly greater inter-facet widths, significantly shorter inter-facet heights and significantly shorter and narrower articular facets; (2) only in the L4 vertebra in individuals with SP was the inferior inter-facet width greater in size than the superior inter-facet width of the vertebra below (L5) (38.7 mm versus 40 mm); (3) in all lumbar vertebrae, the right inferior articular facets in individuals with SP were flatter compared to the control group. Conclusions: Individuals with L4 “SP” characteristics are at a greater risk of developing fatigue fractures in the form of spondylolysis at L5.     

The laterally extended medial hemisoleus flap for reconstruction of a tibial wound in the distal third of the leg

A soleus flap as a local reconstructive option for soft-tissue coverage of a tibial wound in the distal third of the leg has never been well recognized. In a 2-year period, seven patients underwent reconstruction of a less extensive tibial wound (4 × 3 to 10 × 4 cm) in the distal third of the leg after orthopedic trauma with the laterally extended medial hemisoleus flap. The flap was elevated with emphasis on the preservation of the most distal perforators from the posterior tibial vessels to the flap as possible while allowing adequate rotation of the flap to cover the exposed tibia and/or hardware and on the possible preservation of foot planter flexion by reconstruction of the proximal Achilles’ tendon. In this series, there was no total or partial flap loss. All patients healed their tibial wounds primarily with reliable soft-tissue coverage, evidenced fracture healing, and good cosmetic outcome during follow-up. Thus, the laterally extended medial hemisoleus flap described by the author can be a reliable option for soft-tissue coverage of a less extensive tibial wound in the distal third of the leg. It offers a more cost-effective approach for managing this unique problem and can be performed by most reconstructive surgeons without microsurgical expertise.