Microwave technique in hepatic surgery: report of 70 cases]

70 hepatic resections were performed using 2450 MHz microwave scalpel. Primary diseased included hepatocellular carcinoma (46 cases), hemangioma (18), hepatobiliary tract stone (2), biliary cystadenoma (1), inflammatory pseudotumor of the live (1), metastatic liver cancer (2). Hemostasis was excellent despite liver cirrhosis in all cases. The average amount of blood loss and blood transfusion was 249 ml and 294 ml respectively. Blood transfusion was not necessary in 30 patients. All cases were free from postoperative bleeding from the liver stump and abdominal infection. No complications attributable to microwave coagulation were noted. We conclude that this new operative technique can be used safely and easily in the field of hepatic surgery.     

Fetal dexamethasone exposure affects basal ornithine decarboxylase activity in developing rat brain regions and alters acute responses to hypoxia and maternal separation

Although glucocorticoids are widely used to stimulate fetal/neonatal lung function, they also interfere with cellular development in the central nervous system. Dexamethasone was administered to pregnant rats in late gestation at a dose (0.8 mg/kg) that lies just above the threshold for stimulation of lung surfactant synthesis, and the impact on ornithine decarboxylase (ODC) was evaluated in three brain regions. Dexamethasone treatment produced an initial inhibition of basal ODC activity followed by postnatal elevations, a pattern known to be associated with delays in cell replication and differentiation. Dexamethasone also interfered with the ability of the 1-day-old neonate to turn off ODC acutely in response to a 2-h period of maternal separation; as this response conserves energy in the absence of the dam, the effect of dexamethasone is maladaptive. Additionally, dexamethasone sensitized the neonatal brain to hypoxia: the acute increase of ODC associated with a 2-h exposure to 7% O2 was exacerbated in 8-day-old rats exposed to dexamethasone prenatally. These results suggest that administration of dexamethasone, in doses that promote respiratory competence, delays cell development in the central nervous system and renders the brain more vulnerable to adverse neonatal conditions, such as maternal separation or hypoxia.     

Stable Transfection of Nonosteogenic Cell Lines with Tissue Nonspecific Alkaline Phosphatase Enhances Mineral Deposition Both in the Presence and Absence of β-Glycerophosphate: Possible Role for Alkaline Phosphatase in Pathological Mineralization

It is documented that alkaline phosphatase (AP) plays an important role in bone mineralization. Considering that TN-AP is expressed in periodontal ligament fibroblasts, renal epithelial cells, and vascular endothelial cells, and that TN-AP is both a calcium-/phosphate-binding protein and a phosphohydrolytic enzyme, we hypothesize that membrane-bound AP also plays an important role in the initiation of physiological and pathological mineralizations in tissues other than bone and cartilage. To test this hypothesis, nonosteoblast cell lines, including a fibroblast line, a renal epithelial line, and a capillary endothelial line, were stably transfected to express high levels of rat bone AP on their cell surfaces. These rat bone AP-expressing cells were then cultured on filter membranes in the presence or absence of β-glycerol phosphate. von Kossa staining for calcium phosphate and transmission electron microscopy with electron diffraction analysis for minerals were employed to investigate the effect of membrane AP on extracellular calcium phosphate mineralization. Our results indicated that AP expression on these nonosteoblast-like cell surfaces have induced extracellular hydroxyapatite (HAP) mineralization. Our findings support the concept that membrane-bound AP contributes to extracellular apatitic mineralization by mechanisms that do not necessarily involve its hydrolase activity. They also suggest that AP might be important for the initiation of pathological mineralization in nonosteogenic tissues. Received: 11 January 1996 / Accepted: 31 October 1996     

Soda pop vending machine injuries: an update.

Soda pop vending machine tipping continues to be a dangerous behavior that can result in lethal or crippling injuries. This study analyzes 64 cases of injuries secondary to crushing by a soda machine. All were male victims except one. The average age was 19.8 years with a range of 5-39 years. Thirteen victims sustained multiple trauma. Fifteen victims were killed. Increased public awareness coupled with support by the government and private industry has contributed to a sharp reduction in incidence of accidents and improved public safety.     

Benefits and limitations of burn wound excision

This review is intended to provide a balanced view of the role of surgical burn wound excision and closure within the larger context of the total care and rehabilitation of patients with burn injury. The historical background leading to present practice is outlined. The salient technical and logistical problems associated with the performance of wound excision are discussed, with emphasis on the necessity for expeditiously completing these procedures which are associated with major blood loss. A realistic analysis of the results of excisional therapy in patients with burns of varying severity is presented. Benefits attributable to the surgical phase of therapy become progressively more difficult to identify as the size of deep burns increases beyond 20% of total body surface area.

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Resumen La presente revisión propone proveer una visión equilibrada del papel de la resección tangencial quirúrgica de la quemadura y su cierre en el contexto más amplio del cuidado total y la rehabilitación de pacientes con lesiones térmicas. Se hace un recuento de los antecedentes históricos y se discuten los más prominentes problemas técnicos y logísticos relacionados con la resección tangencial de la quemadura con énfasis en la necesidad de implementar en forma expedita estos procedimientos, los cuales se asocian con pérdidas mayores de sangre. Se presenta el análisis realista de los resultados de la resección tangencial en pacientes con quemaduras de gravedad variable. Los beneficios atribuibles a la fase quirúrgica de la terapia se hacen progresivamente más difíciles de identificar en cuanto la extensión y profundidad sobrepasan el 20% de la superficie corporal.

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Résumé Cette article fait le point sur les avantages et inconvénients respectifs de l'excision et la suture dans le cadre du traitement et la rééducation des grands brûlés. L'historique de cette technique est résumée. Les principaux problèmes de technique et de logistique de l'excision des brûlures sont discutés, en soulignant la nécessité d'assurer un geste rapide enfin de réduire les pertes sanguines. Une analyse réaliste des résultats de la technique excisionnelle des brûlures de sévérité variable est présentée. Les bénéfices directement en rapport avec la chirurgie deviennent plus difficiles à apprécier lorsque la surface brûlée dépasse 20 % de la surface corporéelle.

     

Chest wall and mediastinum invasion by lung cancer--a CT and MRI evaluation]

CT and MRI manifestations of 52 peripheral lung cancers located close to the pleural surface or mediastinal structures were studied correlating with the surgical and pathologic findings. Rib destruction as shown by CT and T2 weighted MRI showing the encroachment of tumor upon the chest wall were crucial in demonstrating chest wall invasion. An obtuse chest wall intersecting angle and the length of the neighboring borders of the tumor and chest wall were of limited value. Local pleural thickening was observed near the tumor in 54% of cases, over half of them showed obtuse angle between the tumor and the chest wall but without tumor invasion. T2 weighted MRI was more reliable than CT by showing different signal intensities for pleural thickening, inflammation, localized pleural effusion or tumor invasion to chest wall soft tissue.