Effective Management of Pelvic Lymphocysts by Laparoscopic Marsupialfeation

Background and Objectives:

To evaluate laparoscopic transperitoneal marsupialization of pelvic lymphocysts at the time of laparoscopically directed assessment of response to first-line therapy in a population of patients treated for International Federation of Gynecologists and Obstetricians (FIGO) stage IC-IIC epithelial ovarian cancer.

Methods:

Between March 1995 and March 1998, eight patients with FIGO stage IC-IIC serous epithelial ovarian tumors who developed pelvic lymphocysts after primary surgical staging underwent transperitoneal laparoscopically directed marsupialization of lymphocysts at the time of second-look laparoscopy.

Results:

The mean age of the patient population was 50 years (range 23-65 years). The mean length of time required for marsupialization was 30 minutes (range 25-35 minutes). No patient required inpatient postoperative care. No intraoperative complications were observed. Computerized axial tomography (CT) scan of the abdomen and pelvis obtained 12 weeks following surgery failed to demonstrate re-accumulation of lymphocysts among any patient in the study population. With a median follow-up of 20 months (range 3-39 months), no patients have demonstrated pelvic lymphocyst recurrence.

Conclusions and Discussion:

Laparoscopically directed marsupialization of pelvic lymphocysts is technically feasible, safe and effective. Further study of this technique appears to be warranted.     

Revision Total Hip Arthroplasty Using Imageless Navigation With the Concept of Combined Anteversion

Background

The purpose of the study was to evaluate the implant positions and clinical results of revision total hip arthroplasty (THA) using an imageless navigation with the concept of combined anteversion.

Predicting ideal outcome after pediatric liver transplantation: An exploratory study using machine learning analyses to leverage Studies of Pediatric Liver Transplantation Data

Machine learning analyses allow for the consideration of numerous variables in order to accommodate complex relationships that would not otherwise be apparent in traditional statistical methods to better classify patient risk. The SPLIT registry data were analyzed to determine whether baseline demographic factors and clinical/biochemical factors in the first‐year post–transplant could predict ideal outcome at 3 years (IO‐3) after LT. Participants who received their first, isolated LT between 2002 and 2006 and had follow‐up data 3 years post–LT were included. IO‐3 was defined as alive at 3 years, normal ALT (<50) or GGT (<50), normal GFR, no non‐liver transplants, no cytopenias, and no PTLD. Heat map analysis and RFA were used to characterize the impact of baseline and 1‐year factors on IO‐3. 887/1482 SPLIT participants met inclusion criteria; 334 had IO‐3. Demographic, biochemical, and clinical variables did not elucidate a visual signal on heat map analysis. RFA identified non‐white race (vs white race), increased length of operation, vascular and biliary complications within 30 days, and duct‐to‐duct biliary anastomosis to be negatively associated with IO‐3. UNOS regions 2 and 5 were also identified as important factors. RFA had an accuracy rate of 0.71 (95% CI: 0.68‐0.74), PPV = 0.83, and NPV = 0.70. RFA identified participant variables that predicted IO‐3. These findings may allow for better risk stratification and personalization of care following pediatric liver transplantation.     

Bilateral Traumatic Intracranial Hematomas and its Outcome: a Retrospective Study

The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88.29 % (n?=?83) were males and 11.70 % (n?=?11) were females. Commonest mode of injury was road traffic accident in 56.38 % (n?=?53) followed by fall from height in 29.78 % (n?=?28). In our study, 25.53 % patients had epidural hematoma (EDH) with intracerebral hematoma (ICH) or contusion (n?=?24), followed by EDH with subarachnoid hemorrhage (SAH) in 18.08 % (n?=?17). At the time of discharge, all those patients managed conservatively had good Glasgow outcome scale (GOS) while with surgical intervention 58 % patients had good GOS, 19 % had moderate disability, and 9 % remained with severe disability. In cases of bilateral hematomas, EDH is most common and should be managed in neurosurgical emergency. Other combinations of bilateral intracranial hematomas should be managed according to the surgical indication and serial CT imaging.     

RalA is overactivated in medulloblastoma

Medulloblastoma (MDB) represents a major form of malignant brain tumors in the pediatric population. A vast spectrum of research on MDB has advanced our understanding of the underlying mechanism, however, a significant need still exists to develop novel therapeutics on the basis of gaining new knowledge about the characteristics of cell signaling networks involved. The Ras signaling pathway, one of the most important proto-oncogenic pathways involved in human cancers, has been shown to be involved in the development of neurological malignancies. We have studied an important effector down-stream of Ras, namely RalA (Ras-Like), for the first time and revealed overactivation of RalA in MDB. Affinity precipitation analysis of active RalA (RalA-GTP) in eight MDB cell lines (DAOY, RES256, RES262, UW228-1, UW426, UW473, D283 and D425) revealed that the majority contained elevated levels of active RalA (RalA-GTP) as compared with fetal cerebellar tissue as a normal control. Additionally, total RalA levels were shown to be elevated in 20 MDB patient samples as compared to normal brain tissue. The overall expression of RalA, however, was comparable in cancerous and normal samples. Other important effectors of RalA pathway including RalA binding protein-1 (RalBP1) and protein phosphatase A (PP2A) down-stream of Ral and Aurora kinase A (AKA) as an upstream RalA activator were also investigated in MDB. Considering the lack of specific inhibitors for RalA, we used gene specific silencing in order to inhibit RalA expression. Using a lentivirus expressing anti-RalA shRNA we successfully inhibited RalA expression in MDB and observed a significant reduction in proliferation and invasiveness. Similar results were observed using inhibitors of AKA and geranyl–geranyl transferase (non-specific inhibitors of RalA signaling) in terms of loss of in vivo tumorigenicity in heterotopic nude mouse model. Finally, once tested in cells expressing CD133 (a marker for MDB cancer stem cells), higher levels of RalA activation was observed. These data not only bring RalA to light as an important contributor to the malignant phenotype of MDB but introduces this pathway as a novel target in the treatment of this malignancy.     

Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial

BACKGROUND: A novel narrow band imaging (NBI) system is able to visualize the mucosal and vascular network in the GI tract. OBJECTIVE: The aim of the current study was to test the feasibility of NBI to predict gastric histologic diagnosis. DESIGN: A pilot feasibility study. SETTING: Veterans Affairs Medical Center. PATIENTS: Forty-seven patients undergoing upper endoscopy for various indications were prospectively enrolled. METHODS: The gastric body and antrum were systematically examined by NBI before targeted biopsies. Images were graded according to the mucosal (ridge/villous and circular) and vascular patterns and correlated with histologic findings in a blinded manner. MAIN OUTCOME MEASUREMENTS: Final histologic diagnosis based on updated Sydney classification system. RESULTS: Overall, 25 patients (53.1%) had a normal biopsy specimen, 13 (27.6%) had non-Helicobacter pylori gastritis, 4 (8.5%) had H pylori gastritis, and 5 (10.6%) had intestinal metaplasia. The sensitivity, specificity, and positive predictive value of a regular mucosal and vascular pattern for the diagnosis of normal mucosa/mild gastritis were 89%, 78%, and 94%, respectively. The sensitivity and specificity of an irregular pattern with decreased density of vessels for the diagnosis of H pylori were 75% and 88%, and that of the ridge/villous pattern for the diagnosis of intestinal metaplasia were 80% and 100%, respectively. LIMITATION: The small number of patients with H pylori and intestinal metaplasia was the main limitation. CONCLUSIONS: This is the first U.S. study of NBI for gastric lesions. NBI may help predict in vivo histologic diagnosis of gastric pathologic conditions with a good degree of accuracy. Future larger studies are needed.     

3,4-Disubstituted-1,2,3,4,5,6,7,8-octahydroquinazoline-2-thiones: synthesis, antimicrobial evaluation and QSAR investigations using Hansch analysis

The 3,4-disubstituted-1,2,3,4,5,6,7,8-octahydroquinazoline-2-thione derivatives were synthesized and characterized by physicochemical and spectral means, and the results of antimicrobial study of these compounds against Staphylococcus aureus, Escherichia coli, and Candida albicans by tube dilution method indicated that 4-(4-chlorophenyl)-3-(4-nitrophenylsulfonyl)-1,2,3,4,5,6,7,8-octahydroquinazoline-2-thione 6 and 4-(4-fluorophenyl)-3-(4-nitrophenylsulfonyl)-1,2,3,4,5,6,7,8-octahydroquinazoline-2-thione 12 were the most potential ones. Further, the QSAR studies by Hansch analysis applied to find out the correlation between physicochemical characteristics of synthesized compounds with antimicrobial activity demonstrated the contribution of electronic parameter, total energy (Te) and the topological parameter (valence second order molecular connectivity index (2 chi v). Excellent statistically significant models were developed by Hansch approach (r2 = 0.828-0.898) for the three microorganisms under study. The cross-validated r2 (q2), which is an indication of the predictive capability of the model for all cases was also very good (q2 = 0.776-0.875).     

Surgical Management of Stable Vitiligo: A Review with Personal Experience

BACKGROUND: Various modalities are available for surgical management of stable, localized patches of vitiligo, which are resistant to conventional medical treatment. Cutaneous surgeons often struggle to select among various methods of surgical treatment that include camouflage tattooing, melanocyte transplants, excision, and melanocyte culture. The advantages, disadvantages, and limitations of all the available modalities are reviewed. OBJECTIVE: The purpose of this review is to find out if any guidelines can be drawn regarding the surgical management of stable vitiligo. METHODS: This article is based on a review of the medical literature and the author's personal experience over the last decade. RESULTS: It is difficult to draw any fixed guidelines from this review. Treatment must be individualized depending upon the site and the extent of involvement. CONCLUSION: Although the retrospective nature of this article limits its validity, discussing the various therapeutic options is of value as continuing medical education. Surgical treatment may be individualized to obtain the best possible cosmetic result.