Early Surgical Repair of Acute Complete Rupture of the Proximal Hamstring Tendons

Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed.     

Whole-body (67)Ga scintigraphy in a patient with thymus carcinoma

We report a case of a 50 year old man referred to our department with a history of mild cough, dyspnea and dysphagia. The thoracic CT scan showed a large solid mass in the anterior mediastinum, corresponding to the findings in the chest radiographs.A 67Ga scintigraphy was performed and showed high pathological accumulation in the anterior mediastinum. A subsequent fine needle aspiration biopsy (FNAB) showed the presence of malignant cells, suggesting thymic carcinoma. Although this type of tumour is uncommon, it should be taken into account in order to establish the differential diagnosis of gallium-avid mediastinal masses.     

Effect of epigallocatechin gallate on renal function in cyclosporine-induced nephrotoxicity

INTRODUCTION: Nephrotoxicity is a clinically important side effect of cyclosporine (CsA). CsA-induced nephrotoxicity results from increased production of free radical species in the kidney. Epigallocatechin gallate (EGCG) acts as an antioxidant, thus, EGCG may have a protective effect on the alteration of renal function resultant from oxygen free radicals. The purpose of the present study was to investigate the protective effect of EGCG in a rodent model. METHODS: Experiments were performed on 3 groups. The normal control group (group 1) received normal saline solution. The CsA-treated group (group 2; 15 mg/kg body weight/d for 14 days) received subcutaneous injections. The EGCG-treated group (group 3) in addition received 25 mg of EGCG/kg body weight by intraperitoneal injection. RESULTS: There were significant increases in levels of blood urea nitrogen (BUN)(42.8 +/- 8.2 mg/dL; P < .001), serum creatinine (1.18 +/- 0.60 mg/dL; P < .05), and serum malondialdehyde (3.09 +/- 0.20 nmol/mL; P < .001), and a significant decrease in CCr(0.07 +/- 0.02 mL/min; P < .001) in group 2 compared with group 1. Levels of BUN (30.2 +/- 0.7 mg/dL; P < .01)and CCr (0.12 +/- 0.08 mL/min) were lower in group 3 than in group 2. Serum creatinine (0.71 +/- 0.04 mg/dL) and serum malondialdehyde level (2.13 +/- 0.15; P < .001 nmol/mL) were lower in group 3 than in group 2. There was no significant difference in CsA levels between group 2 (6.86 +/- 1.48 mug/mL) and group 3 (6.69 +/- 0.62 mug/mL). CONCLUSIONS: EGCG treatment significantly protected renal function and free radical-mediated injury in the kidney from CsA-induced changes.     

Effects of cyclosporine on oxidative stress in human bronchial epithelial cells

Objectives

Some of the airway complications relate to the use of cyclosporine (CsA), a potent agent widely used after organ transplantations. Several recent studies have demonstrated CsA treatment to induce reactive oxygen species (ROS). The present study was undertaken to investigate effects of CsA on production of ROS and antoxidant defense of airway cells using the human bronchial epithelial cell line BEAS-2B.

Methods

We measured biological antioxidant potential (BAP), as well as ROS and malondialdehyde levels in BEAS-2B cells after CsA treatment, using Free Radical Analytical System 4 kits (Diacron, Grosseto, Italy). ROS production was expressed as Carr Units as established by the manufacturer and BAP as μmol/2 × 10⁵ cells; malondialdehyde, by the thiobarbituric acid assay.

Results

ROS production was increased in the BEAS-2B cells after CsA treatment: 73.5 at 0 (controls); 82.5 at 10; 84.0 at 30; 86.0 at 50; and 93.0 Carr Unit/2 × 10⁵ cells at 100 μg/mL of CsA. The levels of BAP were 1821 at 0 (controls), 1698 at 10; 1653 at 30; 1366 at 50 μg/mL; and 1391 at 100 μg/mL. The levels of malondialdehyde were increased: 3.8 at 0 (controls); 3.4 at 10; 4.4 at 30; 4.2 at 50: and 5.0 nmol/10⁶ cells at 100 μg/mL.

Conclusions

Increased production of ROS and decreased BAP by CsA in BEAS-2B cells may increase malondialdehyde levels by radical-induced damage.     

Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation

BACKGROUND: Although much is known about the long-term outcome of patients undergoing left (distal) pancreatectomy for malignancy, comparatively little is known about the optimal management strategy for the residual transected pancreatic parenchyma and the divided pancreatic duct. Clinicopathological and operative factors that may contribute to postoperative pancreatic leak were evaluated. METHODS: A retrospective review of the medical records of 126 patients who underwent left pancreatectomy between June 1990 and December 1999 at the University of Texas M. D. Anderson Cancer Center was performed. RESULTS: Indications for left pancreatectomy included pancreatic neoplasms (n = 42; 33.3 per cent), en bloc resection for management of retroperitoneal sarcoma (n = 21; 16.7 per cent), gastric adenocarcinoma (n = 14; 11.1 per cent), renal cell carcinoma (n = 11; 8.7 per cent) and other tumours or benign conditions (n = 38; 30.2 per cent). Pancreatic parenchymal closure was accomplished by a hand-sewn technique, mechanical stapling, or a combination of the two in 83, 20 and 15 patients respectively. No form of parenchymal closure was used in eight patients. Identification of the pancreatic duct and suture ligation was performed in 73 patients (57.9 per cent). Twenty-five patients (19.8 per cent) developed a pancreatic leak. For subgroups having duct ligation or no duct ligation, pancreatic leak rates were 9.6 per cent (seven of 73 patients) and 34.0 per cent (18 of 53 patients) respectively (P < 0.001). Multivariate analysis including clinicopathological and operative factors indicated that failure to ligate the pancreatic duct was the only feature associated with an increased risk for pancreatic leak (odds ratio 5.0 (95 per cent confidence interval 2.0 to 10.0); P = 0.001). CONCLUSION: Pancreatic leak remains a common complication after left pancreatectomy. The incidence of leak is reduced significantly when the pancreatic duct is identified and directly ligated during left pancreatectomy.     

Role of diagnostic laparoscopy in managing acute mesenteric venous thrombosis

We describe two cases with acute mesenteric venous thrombosis in which diagnostic laparoscopy helped to diagnose the possible bowel infarction. These patients presented with abdominal pain out of proportion to physical findings, and computed tomography demonstrated thrombus in the superior mesenteric vein. Anticoagulation with heparin followed by diagnostic laparoscopy was done immediately after the diagnosis was established. According to the laparoscopic findings, one was managed with full anticoagulation without laparotomy and the other was managed with full anticoagulation and surgical resection. Considering that delay in diagnosis and surgical exploration is still frequent and is a significant contributory factor to the reported high mortality rate, diagnostic laparoscopy in an early position in the management algorithm for acute mesenteric venous thrombosis can furnish a rapid precise diagnosis of bowel infarction. It can also reduce the unnecessary laparotomies in these difficult cases.     

Endoscopically assisted transconjunctival approach in orbital medial wall fractures

Full exposure of the medial orbital wall for fracture repair poses difficulty with traditional approaches except coronal incision, especially in cases of wide fracture. The endoscopic-assisted approach with limited incision has been introduced. The authors used the endoscopically assisted transconjunctival approach in 21 cases: 15 isolated medial orbital wall fractures and 6 cases of concomitant floor fractures. Through the medial transconjunctival slit incision, repair of the fracture using calvarial bone graft was undertaken with the aid of an endoscope. All patients recovered without any eye symptoms including clinically notable enophthalmos, but one immediate revisional operation was needed because of a displaced bone graft. Otherwise, the desired position of the graft was confirmed via computed tomography. The endoscopically assisted transconjunctival approach to the orbital medial wall provides improved surgical exposure of the most posterior and superior aspects of the fracture site, enabling more accurate reduction of orbital soft tissue and placement of bone grafts.     

Is neck tilt and shoulder imbalance the same phenomenon? A prospective analysis of 89 adolescent idiopathic scoliosis patients (Lenke type 1 and 2)

Purpose

To introduce a new clinical neck tilt grading and to investigate clinically and radiologically whether neck tilt and shoulder imbalance is the same phenomenon in AIS patients.

Methods

89 AIS Lenke 1 and 2 cases were assessed prospectively using the new clinical neck tilt grading. Shoulder imbalance and neck tilt were correlated with coracoid height difference (CHD), clavicle\rib intersection distance (CRID), clavicle angle (CA), radiographic shoulder height (RSH), T1 tilt and cervical axis.

Results

Mean age was 17.2 ± 3.8 years old. 66.3 % were Lenke type 1 and 33.7 % were type 2 curves. Strong intraobserver (0.79) and interobserver (0.75) agreement of the clinical neck tilt grading was noted. No significant correlation was observed between clinical neck tilt and shoulder imbalance (0.936). 56.3 % of grade 3 neck tilt, 50.0 % grade 2 neck tilt patients had grade 0 shoulder imbalance. In patients with grade 2 shoulder imbalance, 42.9 % had grade 0, 35.7 % grade 1, 14.3 % grade 2 and only 7.1 % had grade 3 neck tilt. CHD, CRID, CA and RSH correlated with shoulder imbalance. T1 tilt and cervical axis measurements correlated with neck tilt.

Conclusions

In conclusion, neck tilt is distinct from shoulder imbalance. Clinical neck tilt has poor correlation with clinical shoulder imbalance. Clinical neck tilt grading correlated with cervical axis and T1 tilt whereas clinical shoulder grading correlated with CHD, RSH CRID and CA.

     

A comparison of feasibility and safety of percutaneous fluoroscopic guided thoracic pedicle screws between Europeans and Asians: is there any difference?

Purpose

To directly compare the safety of fluoroscopic guided percutaneous thoracic pedicle screw placement between Caucasians and Asians.

Methods

This was a retrospective computerized tomography (CT) evaluation study of 880 fluoroscopic guided percutaneous pedicle screws. 440 screws were inserted in 73 European patients and 440 screws were inserted in 75 Asian patients. Screw perforations were classified into Grade 0: no violation; Grade 1: <2 mm perforation; Grade 2: 2–4 mm perforation; and Grade 3: >4 mm perforation. For anterior perforations, the pedicle perforations were classified into Grade 0: no violation, Grade 1: <4 mm perforation; Grade 2: 4–6 mm perforation; and Grade 3: >6 mm perforation.

Results

The inter-rater reliability was adequate with a kappa value of 0.83. The mean age of the study group was 58.3 ± 15.6 years. The indications for surgery were tumor (70.3 %), infection (18.2 %), trauma (6.8 %), osteoporotic fracture (2.7 %) and degenerative diseases (2.0 %). The overall screw perforation rate was 9.7 %, in Europeans 9.1 % and in Asians 10.2 % (p > 0.05). Grade 1 perforation rate was 8.4 %, Grade 2 was 1.2 % and Grade 3 was 0.1 % with no difference in the grade of perforations between Europeans and Asians (p > 0.05). The perforation rate was the highest in T1 (33.3 %), followed by T6 (14.5 %) and T4 (14.0 %). Majority of perforations occurred medially (43.5 %), followed by laterally (25.9 %), and anteriorly (23.5 %). There was no statistical significant difference (p > 0.05) in the perforation rates between right-sided pedicle screws and left-sided pedicle screws (R: 10.0 %, L: 9.3 %).

Conclusions

There were no statistical significant differences in the overall perforation rates, grades of perforations, direction of perforations for implantation of percutaneous thoracic pedicle screws insertion using fluoroscopic guidance between Europeans and Asians. The safety profile for this technique was comparable to the current reported perforation rates for conventional open pedicle screw technique.

     

Thoracoscopic resection for Mycobacterium avium complex

We report 2 cases of thoracoscopic resection for patients with Mycobacterium avium complex (MAC). A 25-year-old female was referred to our hospital because of abnormal shadows in the right lower lung field on chest X-ray. Her chest computed tomography (CT) showed that the lesion was localized in the right lower lobe. She was given a diagnosis of MAC by polymerase chain reaction (PCR) of sputum. Thoracoscopic lobectomy was performed after chemotherapy for 10 months. A 64-year-old female was referred to our hospital because of hemoptysis. Bronchiectasis had been diagnosed in her since the age of 35 years, and then she was given a diagnosis of secondary MAC. Her chest CT showed bronchiectasis, and consolidations were localized in the superior segment of the right lower lobe. Then superior segmentectomy of the right lower lobe under video-assisted thoracoscopic surgery (VATS) was performed. It was reported that surgical intervention is indicated in patients with MAC, when persistent hemoptysis is seen or chemotherapy is ineffective. If the lesion is localized, lung resection under VATS may be a good option in selected patients.