An assessment of between-recti distance and divarication in patients with and without abdominal aortic aneurysm

INTRODUCTION

The study assessed whether there is a greater incidence of divarication of the recti and whether between-recti distance is greater in patients with abdominal aortic aneurysm (AAA).

PATIENTS AND METHODS

The study consisted of two parts: a radiological and a clinical assessment. All patients with a confirmed AAA on computerised tomography were included and compared with patients in whom AAA was excluded with imaging. Between-recti distance was measured using a computerised image viewer and clinical divarication was assessed by a surgical registrar or consultant.

RESULTS

In the radiological part of the study, 108 patients with AAA were compared with 84 with colorectal cancer. Median between-recti distance was 38 mm (range, 25–59 mm) in the AAA group and 27 mm (range, 20–44.5 mm) in the non-AAA group (P = 0.006). AAA diameter did not correlate with between-recti distance. The clinical study included 50 patients (25 AAA). The groups were well matched, with only a greater incidence of diabetes in the AAA group (20% vs 0%; P = 0.018). AAA patients were more likely to have clinically detected divarication of the recti (76% vs 36%; P = 0.004).

CONCLUSIONS

Patients with AAA have greater radiological and clinical evidence of divarication. It is suggested that patients with divarication be screened for AAA.     

Radiographic results of combined Salter innominate and femoral osteotomy in Legg–Calvé–Perthes disease in older children

Purpose  Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined innominate and femoral osteotomies are generally performed to better contain and provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and a congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. Methods  We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 17 males and 3 females comprised 11 lateral pillar (LP) group B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Results  Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two hips. One of the two LPC hips became SIII and the other one SIV. The three female patients had one LPB, one LPB/C, and one LPC hip, and surgery resulted in SIII hips in all three cases. Eight of these 20 cases were older than 11 years of age at the time of surgery, and all had fair or poor hips. Conclusions  Simultaneous femoral and Salter innominate osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor results to fair results.     

Cichorin A: a new benzo-isochromene from Cichorium intybus

One new benzo-isochromene, named cichorin A (1), together with three known compounds oleanolic acid, β-sitosterol, and β-sitosterol glucopyranoside, was isolated from Cichorium intybus. The structure of the new compound was elucidated by detailed spectroscopic analysis such as (1)H, (13)C NMR, COSY, HMQC, HMBC, and HR-EI-MS. Relative configuration of asymmetric centers of cichorin A (1) was determined by the analysis of the (1)H NMR coupling constants together with the NOESY experiment.     

Synthesis, in vitro antimicrobial and antioxidant activities of chalcone and flavone derivatives holding allylic substitutions

In a wide search program towards new and efficient biological active agents, a series of chalcone and flavone derivatives holding allylic substitutions have been synthesized and tested for their in vitro antibacterial and antifungal activities. The synthesized compounds were tested in vitro against Gram-positive, Gram-negative bacteria, and the yeast Candidia kefir in comparison with control drugs (Sulfamethoxazole and Fluconazole). The antioxidant activity of the synthesized allylic chalcones and flavones was also assessed using two methods, including, 1,1-biphenyl-2-picrylhydrazyl (DPPH) radical scavenging, and reducing power assays and compared to reference drug Trolox.     

Hepatitis C Prevalence in Patients With Hepatocellular Carcinoma Without Cirrhosis

BackgroundHepatocellular carcinoma (HCC) occurring in “noncirrhotic” hepatitis C virus (HCV)-infected patients has been reported; but the exact prevalence or incidence has not been described before.MethodsWe conducted a systematic review of literature: Ovid was used to search the literature from January 1, 1990, to September 1, 2008. Articles containing “HCC” keywords (hepatocellular carcinoma, hepatoma, liver cancer) were combined with the word “cirrhosis” or “fibrosis” and with “absence” keywords [noncirrhotic, absence, without]. Two hundred articles were selected and screened according to predesigned exclusion and inclusion criteria.ResultsNineteen articles met the inclusion criteria. The estimated prevalence of noncirrhotic HCC ranged from 6.7% to 50.1%. The pooled prevalence estimates for HCV in noncirrhotic HCC ranged from 0% and 68.4% according to the geographic location. Reports from Japan had the highest estimated pooled prevalence of HCV (55.01%) followed by Italy (29.95%).ConclusionsHCV can occur in patients with HCC without cirrhosis, but the true incidence and prevalence are very difficult to ascertain. Further studies are needed to define this group of patients.     

Mesenteric lipoblastoma presenting as a segmental volvulus

Mesenteric lipoblastoma is a rare tumor and, its presentation as a bowel obstruction with possible midgut volvulus has only been reported once before. A 7-year-old girl presented with nausea and vomiting but a benign abdominal examination. Upper gastrointestinal contrast study demonstrated possible malrotation with midgut volvulus. During emergency laparotomy, segmental small bowel volvulus secondary to a large mesenteric lipoblastoma was found. The lipoblastoma was resected with a segment of small bowel. Resection margins were negative for tumor, and the patient is doing well with no evidence of recurrence.     

A 1- to 4-year follow-up review of treatment of sciatica using chemonucleolysis or laminectomy.

To help clarify the comparative effects of chemonucleolysis and discectomy, the author studied 178 consecutive patients with sciatica who did not respond to conservative treatment. None had previously undergone laminectomy or chemonucleolysis or had spinal stenosis. All received postmyelography computerized tomography (CT) and, if the radiological interpretation was that of an extruded migrated disc, a laminectomy was performed; otherwise, the patient was given a choice of the two procedures. Of the 178 patients, 106 underwent chemonucleolysis and 72 laminectomy. Workers' compensation was being paid to 21.6% of the chemonucleolysis patients and 20.8% of the laminectomy patients. Postoperatively, substantial improvement was noted in 82.7% of the chemonucleolysis patients and 92.5% of the laminectomy patients at 6 weeks and in 92.8% of the chemonucleolysis patients and 89.7% of the laminectomy patients at 6 months. The majority of patients in both groups had improved neurological signs. Follow-up questionnaires at 1 to 4 years postoperatively revealed an overall success rate of 86.5% for chemonucleolysis patients and 83.8% for laminectomy patients. In patients not receiving workers' compensation, 90.1% of the chemonucleolysis patients and 88.6% of the laminectomy patients had a successful outcome; in those receiving workers' compensation, 69.6% of the chemonucleolysis patients and 60.0% of the laminectomy patients had a successful outcome. No statistically significant differences in improvement rate in neurological symptoms or signs were identified between the two procedures. Overall, 85.1% of the chemonucleolysis patients and 78.5% of the laminectomy patients were employed at follow-up review. To achieve optimum results and eliminate noncandidates for chemonucleolysis, routine use of postmyelography CT is recommended. When properly used, chymopapain chemonucleolysis is an acceptable alternative to surgical discectomy.     

Imaging axillary lymph nodes in patients with newly diagnosed breast cancer

The presence of axillary lymph node metastasis in patients newly diagnosed with breast cancer carries significant prognostic and management implications. As a result, there is increasing interest to stage accurately the axilla with preoperative imaging to facilitate treatment planning. Currently, the most widespread imaging techniques for the evaluation of the axilla include ultrasound and magnetic resonance imaging. In many settings, the ability to detect axillary lymph nodes containing metastases with imaging and image-guided biopsy can allow surgeons to bypass sentinel lymph node dissection and proceed with full axillary lymph node dissection. However, no imaging modality currently has sufficient negative-predictive value to obviate surgical staging of the axilla if no abnormal lymph nodes are detected. Promising advanced imaging technologies, such as diffusion-weighted imaging and magnetic resonance lymphangiography, hold the potential to improve the accuracy of axillary staging and thereby transform management of the axilla in patients newly diagnosed with breast cancer.