Endonasal endoscopic repair of ethmoid roof cerebrospinal fluid fistula by suturing the dura

Introduction  Over the past 20years, improvement in surgical techniques as well advances in surgical instruments for sinus surgery has led to surgical closure of cerebrospinal fluid (CSF) leak using endoscopic approach. Minimally invasive and having lower post op morbidity, compared to traditional intracranial techniques, repairing CSF leak endoscopically has evolved to become the standard practice for management of CSF leak. Discussion  Widespread use of endoscope in sinus surgery have made us more familiar with the anatomy of the sinuses as well as the skull base. In this paper, we will describe our experience of CSF repair by suturing dura under endoscopic guidance for the repair of small ethmoid roof (<1.2cm) defects.     

Analyses of subjects with hypokalemic metabolic alkolosis, Gitelman's and Bartter's syndrome

The two most common forms of inherited normotensive hypokalemic metabolic alkalosis are Bartter's and Gitelman's syndromes. Bartter's is mostly seen in children, while Gittelman's is mostly seen in adolescents and adults. We analyze three subjects of adult-onset Gitelman's and Bartter's syndrome. The patients applied to our hospital due to severe hypokalemia with little clinical expression (paresthesia, cramp, polyuria, polydipsia, and/or weakness). All had normal blood pressure, hypokalemia, hyperreninemic hyperaldosteronism, and a decrease in the fractional chloride reabsorption. Key elements in differential diagnosis of chronic hypokalemia are blood pressure assessment, acid base equilibrium, serum calcium concentration, and 24-hour urine potassium and calcium excretion.     

Kaposi's Sarcoma After Liver Transplantation from a Donor with a History of Ventriculoperitoneal Shunt and Craniotomy for Primary Central Nervous System Lymphoma: Report of a Case

The transplantation of organs from donors who have undergone shunt surgery or craniotomy for a malignant central nervous system (CNS) tumor is controversial. We report a case of Kaposi's sarcoma (KS) developing as a result of immunosuppression in the recipient of a liver transplant from a donor who underwent craniotomy and ventriculoperitoneal shunt surgery for primary CNS lymphoma. Polymerase chain reaction assay did not isolate human herpes virus-8 in the Kaposi lesions. To our knowledge, this is the only case ever reported of KS developing after liver transplantation from a donor with lymphoma. Thus, with appropriate screening to exclude possible dissemination, patients with a history of high-grade primary CNS lymphoma treated by ventriculoperitoneal shunt and craniotomy may be accepted as donors.     

The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA

OBJECTIVE

To evaluate the effect of prostate weight on perioperative, functional and oncological outcomes after laparoscopic radical prostatectomy (LRP).

PATIENTS AND METHODS

Between January 2003 and January 2006, 327 patients had LRP by one surgeon, 193 of whom were available for analysis. Patients were stratified into three groups on the basis of pathological prostate weight, i.e. ≤30, 30–75 and ≥75 g. Perioperative, oncological and functional (continence and potency at 1 year) outcomes were compared among the three groups.

RESULTS

Of the 193 patients the prostate was ≤30 g in 18 (9%), 30–75 g in 131 (68%) and ≥75 g in 44 (23%); the mean prostate weight was 27, 49 and 98 g in the three subgroups, respectively. At presentation, 144 patients (75%) had T1c disease, 159 (82%) were potent and 187 (97%) were continent. Unilateral nerve‐sparing was done in 37 (19%) and bilateral in 114 (59%) patients. The three subgroups were comparable in age, body mass index, preoperative prostate‐specific antigen level, preoperative Gleason score, clinical stage, operative duration, length of hospital stay, duration of catheterization, biochemical recurrence and continence after LRP. In the patients with a prostate of ≤30 g there was a higher incidence of positive margins (39% vs 16% vs 27%; P = 0.03) and inferior 1‐year potency (47% vs 75% vs 79%; P =0.04), respectively. Estimated blood loss increased with increasing prostate size (204 vs 256 vs 340 mL; P = 0.01).

CONCLUSIONS

Prostate size has no effect on continence or biochemical recurrence at 1 year after LRP, but affects intraoperative blood loss, potency and surgical margins. More patients with a longer follow‐up are needed to confirm these findings.     

Fueling protein DNA interactions inside porous nanocontainers

Vesicle encapsulation offers a biologically relevant environment for many soluble proteins and nucleic acids and an optimal immobilization medium for single-molecule fluorescence assays. Furthermore, the confinement of biomolecules within small volumes opens up new avenues to unique experimental configurations. Nevertheless, the vesicles' impermeability, even toward ions and other small molecules such as ATP, hinders more general applications. We therefore developed methods to induce pores into vesicles. Porous vesicles were then used to modulate the interaction between Escherichia coli RecA proteins and ssDNA by changing the extravesicular nucleotides. Repetitive binding and dissociation of the same RecA filament on the DNA was observed with a rebinding rate two orders of magnitude greater than in the absence of confinement, suggesting a previously unreported nucleation pathway for RecA filament. This method provides a biofriendly and simple alternative to surface tethering that is ideal for the study of transient and weakly interacting biological complexes.