Laparoscopic management of acute torsion of the omentum in adults.

BACKGROUND: Acute torsion of the greater omentum is a rare cause of acute abdomen in adults. We report our experience on the clinical presentation, diagnosis, treatment, and outcome of this condition. METHOD: This is a retrospective review of 9 patients who had a clinicopathologic diagnosis of acute torsion of the greater omentum and were treated at the Department of Surgery, Pamela Youde Nethersole Eastern Hospital from January 1994 to March 2004. Eight patients were male and 1 was female with a median age of 43 years (range, 24 to 65). Median body mass index was 24 kg/m(2) (range, 22 to 24). All presented with acute abdominal pain with a median temperature of 36.8 degrees C (range, 36.5 to 37.2) and a median white cell count of 9.5 x 10(9)/L (range, 7.4 to 15.1 x 10(9)). Preoperative ultrasound was done in 5 patients. RESULTS: All diagnoses were made during surgery. Resection of the infarcted omentum was performed for all patients (5 laparoscopic resections and 4 open resections). No postoperative complications occurred. The overall median time from admission to operation was 23 hours (range, 2 to 98). The overall median operating time and postoperative stay were 70 minutes (range, 38 to 105) and 3 days (range, 1 to 6), respectively. The median oral and parenteral analgesic requirement for postoperative pain control was less and the median hospital stay was shorter in patients who underwent laparoscopic resection. CONCLUSION: Acute torsion of the greater omentum is an uncommon cause of acute abdomen in adults, and preoperative diagnosis is usually difficult. Laparoscopy seems a safe and minimally invasive technique for both diagnosis and treatment of this rare disease entity.     

Studies on the effect of liver cytosol on experimental acute hepatic failure in the rat

This paper reports that dog regenerating liver cytosol (DRLC) and human fetal liver cytosol were found capable of increasing the survival rate of rats with liver failure induced by D-galactosamine (Ga1N). It was noted that the potential substances for hepatic failure are not species specific. Nevertheless this is a characteristic of the growing liver. The experimental results suggested that the effects of growing liver cytosol on liver regeneration were through three ways: 1. Hepatocytes DNA synthesis was increased. 2. Phagocytosis function of Kupffer cells was elevated which might prevent damage of liver cells by intestinal endotoxin. 3. Insulin secretion and its combination with hepatocytes were increased.     

A normative study of the CERAD neuropsychological assessment battery in the Korean elderly.

This study aimed to explore the effects of age, education and gender on the performance of eight tests in the Korean version of the CERAD neuropsychological assessment battery and to provide normative information on the tests in the Korean elderly. The battery was administered to 618 healthy volunteers aged from 60 to 90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded. Multiple linear regression analyses were performed to assess the relative contribution of the demographic factors on the score of each cognitive test. Age, education, and gender were found to have significant effects on the performance of many tests in the battery. Based on these results, 4 overlapping age normative tables (60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata (0 to 3 years, 4 to 6 years, and 7 years and more) for both genders are presented. The normative information will be useful for a clinical interpretation of the CERAD neuropsychological battery in Korean elderly as well as for comparing the performance of the battery across countries.     

Head position dependency of induced nystagmus to ice-water irrigation in peripheral vestibulopathy.

OBJECTIVE: Evaluation of head-position dependency during the ice-water test is essential when the test is indicated. Because ice-water irrigation (IWI) in the prone position is frequently skipped in many laboratories, we investigated the importance of evaluating position dependency in an ice-water test. DESIGN AND SETTING: Twenty-five unilateral peripheral vestibulopathy patients showing no nystagmus during warm irrigation were included. IWI was performed in supine and prone positions, and maximum slow-phase velocity and direction of nystagmus were assessed by using video nystagmography. RESULTS: Eleven cases showed head-position dependency and were interpreted as hypofunctional. Fourteen cases showed no dependency, suggesting the absence of end organ function. In the latter group, 6 patients showing definite nystagmus in supine position could have been misinterpreted as hypofunctional, had it not been for prone-position results. CONCLUSIONS: Evaluation of head position dependency by using IWI is important in the determination of lateral semicircular canal function.     

吸入液氧对海拔3700m高原人体力竭运动后自由基代谢的影响

目的　观察吸入液氧对高原人体力竭运动自由基代谢的影响。方法　对进驻海拔 3 70 0m高原 3个月的 1 0名健康青年在吸入液氧 (吸氧组 ,4L/min)和不吸液氧 (对照组 )的条件下 ,采用功率自行车进行递增负荷运动 ,并在安静时 ,运动后测定血中超氧化物歧化酶 (SOD)、总抗氧化能力 (T ACO)、活性氧 (ROS)和丙二醛 (MDA)含量。结果　与安静时比较 ,对照组和吸氧组T ACO ,ROS,MDA均增高 ,SOD吸氧组增高 ,有非常显著差异 (P <0 0 1 ) ,对照组无统计学差异 (P >0 .0 5 )。运动后吸氧组较对照组SOD ,T ACO增高 ,ROS ,MDA降低 (P <0 0 1 )。结论　液态氧能延长供氧时间 ,并能对高原运动造成的自由基损伤有明显抑制作用 ,可加速运动后体内代谢产物自由基的清除及加快疲劳消除     

Successful Treatment of Bone Marrow Failure in Gaucher's Disease with Low-dose Modified Glucocerebrosidase

We report the beneficial effects of enzyme replacement therapywith mannose-terminated human glucocerebrosidase (‘Ceredase’)in a patient suffering from transfusion-dependent bone marrowfailure due to Gaucher's disease. Treatment with low-dose enzymeinfusions, given twice weekly, rapidly reversed the haematopoieticfailure and incapacitating skeletal disease. It appears likelythat prior splenectomy favourably influenced the response tothis therapy.     

Ruptured aneurysms of the sinus of Valsalva.

From 1969 to 1989, 15 patients with an aneurysm of the sinus of Valsalva underwent operative correction. This represents 0.23% of 6515 cardiac operations with cardiopulmonary bypass during that time. There were 8 males and 7 females ranging in age from 15 to 54 years (mean 35.8 years). Symptoms of congestive heart failure, fatigue and palpitation were common. All patients underwent cardiac catheterization including aortography. Associated lesions included aortic valve regurgitation in 6 patients and a ventricular septal defect in 3 patients. The following connections occurred: right coronary sinus to right ventricle (8 patients), right coronary sinus to both right atrium and right ventricle (1 patient), and noncoronary sinus to right atrium (6 patients). The aneurysm was repaired via aortotomy or through the chamber into which it emptied. The aortic valve was replaced in 2 patients. There were no early or late postoperative deaths. Fourteen patients were in NYHA functional class I at late follow-up (range 0.5 to 20.5 years, mean 8.7 years). There have been no recurrences. Our experience supports the concept that early surgical intervention in patients with ruptured aneurysms of the sinus of Valsalva is justified.     

The measurement of I for the cement and the paraffin solidified low and intermediate level wastes (LILWs), spent resin or evaporated bottom from the pressurized water reactor (PWR) nuclear power plants

In this paper a relatively simple and low cost analysis procedure to apply to a routine analysis of ¹²⁹I in low and intermediate level radioactive wastes (LILWs), cement and paraffin solidified evaporated bottom and spent resin, which are produced from nuclear power plants (NPPs), pressurized water reactors (PWR), is presented. The ¹²⁹I is separated from other nuclides in LILWs using an anion exchange adsorption and solvent extraction by controlling the oxidation and reduction state and is then precipitated as silver iodide for counting the beta activity with a low background gas proportional counter (GPC). The counting efficiency of GPC was varied from 4% to 8% and it was reversely proportional to the weight of AgI by a self absorption of the beta activity. Compared to a higher pH, the chemical recovery of iodide as AgI was lowered at pH 4. It was found that the chemical recovery of iodide for the cement powder showed a lower trend by increasing the cement powder weight, but it was not affected for the paraffin sample. In this experiment, the overall chemical recovery yield of the cement and paraffin solidified LILW samples and the average weight of them were 67±3% and 5.43±0.53 g, 70±7% and 10.40±1.60 g, respectively. And the minimum detectable activity (MDA) of ¹²⁹I for the cement and paraffin solidified LILW samples was calculated as 0.070 and 0.036 Bq/g, respectively. Among the analyzed cement solidified LILW samples, ¹²⁹I activity concentration of four samples was slightly higher than the MDA and their ranges were 0.076–0.114 Bq/g. Also of the analyzed paraffin solidified LILW samples, five samples contained a little higher ¹²⁹I activity concentration than the MDA and their ranges were 0.036–0.107 Bq/g.     

Reconstruction of Complex Abdominal Wall Defects

Introduction

Reconstruction of large abdominal wall defects not amenable to primary closure remains a challenging problem. These defects result from trauma, previous surgery, infection and tumour resection. The primary objectives of abdominal wall reconstructions are to protect abdominal contents and provide functional support. The abdominal wall reconstruction aims at providing basic component parts, i.e. skin, soft tissue and fascia. For large soft tissue defects, pedicled or free flap closure can be used. In clean wounds, fascial replacement is accomplished with synthetic mesh provided there is adequate soft tissue coverage.

Methods

We treated a total of 20 consecutive patients with complex abdominal wall defects utilizing various reconstructive procedures. There were 15 males (75%) and 5 females (25%). The aetiology included dehiscence of laparotomy wounds in eight (40%), following ablative surgery for malignant tumours in seven (35%), trauma in three (15%) and congenital defects in two (10%) cases. The reconstructive procedures consisted of onlay prolene mesh in seven (35%), Gore-Tex (PTFE) dual mesh both as inlay and onlay in five (25%), facial partition release technique in three (15%), inlay prolene mesh covered with omentum and split skin graft in two (10%), inlay prolene mesh covered with expanded skin in two (10%), and Gore-Tex dual mesh covered with latissimus dorsi myocutaneous flap in one (5%) case. Postoperatively none developed mesh infection or extrusion. Three patients with malignant aetiology received postoperative radiotherapy. During follow up, one patient developed ventral hernia cephalad to the repair and one died due to recurrence of abdominal wall malignancy.

Conclusion

The reconstruction of an abdominal wall defect requires a comprehensive plan of preoperative and post operative care of the patient and aims toward restoration of abdominal structural integrity by a variety of procedures. The use of new biomaterials and tissue expanders provides reliable and durable abdominal wall closure along with good aesthetic results.Key Words: Abdominal wall defect, Mesh repair, Abdominal wall reconstruction