MR imaging as the sole preoperative imaging modality for right hepatectomy: a prospective study of living adult-to-adult liver donor candidates

OBJECTIVE: Our aim was to investigate the feasibility of MR imaging as a comprehensive preoperative imaging test for examination of liver donor candidates for adult-to-adult right lobe transplantation. SUBJECTS AND METHODS: Twenty-five consecutive donor candidates were examined at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weighted imaging of the abdomen, MR cholangiography using T2-weighted turbo spin-echo imaging, and MR angiography and venography of the liver using two interpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right and left lobe liver volumes; definition of hepatic arterial, portal venous, and hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patients, 11 of whom also had surgical findings for comparison. RESULTS: Nine patients were excluded as candidates for donation on the basis of MR imaging findings that included parenchymal or extrahepatic abnormalities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional angiography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients who underwent successful right hepatectomy, all MR imaging findings were corroborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging. CONCLUSION: A comprehensive MR imaging examination has the potential to serve as the sole preoperative imaging modality for living adult-to-adult liver donor candidates provided improvements in definition of intrahepatic biliary anatomy can be achieved.     

Free deep inferior epigastric artery perforator flap for reconstruction of soft‐tissue defects in extremities of children

The deep inferior epigastric artery perforator (DIEP) flap has been a valuable tool in breast reconstruction, but seldom in extremity reconstruction. The aim of this report is to present our experience on the use of the DIEP flap for reconstruction of soft‐tissue defects in the extremities of pediatric patients. From January 2007 to February 2011, 22 consecutive free DIEP flap transfers were performed for reconstruction of complex soft‐tissue defects in the extremities of children with a mean age of 5.7 years old (ranging 2–10 years old). The flap design included transverse, oblique, and irregular DIEP flaps, containing one to three perforators in the flap. The flap size ranged from 7 × 4 cm to 18 × 17 cm. Primary donor‐site closure was accomplished in all of patients. The postoperative course was uneventfully in most of cases. The venous congestion was observed in two cases. One case of venous congestion was caused by flap inset with tension. The other case with venous thrombosis ended with partial loss of the flap after salvage procedure. There was one total flap loss due to the arterial thrombosis. The flap survival rate was 95.5%. The mean follow‐up was 12 months (ranging 6–36 months). All reconstructed extremities had satisfactory aesthetic and functional outcomes except two cases undergoing the secondary debulking procedures. The donor sites healed well in all cases without complications. Our experience showed that the free DIEP flap could be an alternative for reconstruction of soft‐tissue defects in the extremities of children. © 2013 Wiley Periodicals, Inc. Microsurgery 33:612–619, 2013.     

Vacuum assisted closure therapy for treatment of complex wounds in replanted extremities

The object of this study was to compare the outcomes of the vacuum assisted closure (VAC) therapy and conventional wound care with dressing change for treatment of complex wounds in patients with replantation of amputated upper and lower extremities. Data of 43 patients with replantation of amputated extremities from May 2004 to December 2011 were reviewed. There were 18 wounds of 18 patients with replantation, which were treated by dressing change and 26 wounds of 25 patients by VAC therapy. The outcomes were evaluated by the survival rate of replanted extremities, growth of granulation tissue, interval between wound treatment and secondary procedure and eventual secondary wound coverage methods. Vascular thromboses were found in 3 patients with wound treatment by dressing change and 5 by VAC. All replants of two groups of patients survived after salvage procedures. The wound score was 3.6 ± 0.7 in the conventional dressing change group and 5.8 ± 0.7 in the VAC group at the sixth day after treatment, respectively. The intervals between wound treatment and secondary wound coverage procedure were 12.0 ± 1.7 days in the dressing change group and 6.1 ± 0.7 days in the VAC group. Flaps were applied for wound coverage in 9 out of 18 (50.0%) wounds in the dressing change group and 5 out of 26 (19.2%) in the VAC group (P < 0.05), when the wounds of rest of patients were covered by the skin graft. The results showed that VAC could promote the growth of granulation tissue of wound, decrease the need of flap for wound coverage, and did not change the survival of replantation. © 2013 Wiley Periodicals, Inc. Microsurgery 33:620–624, 2013.     

SQUAMOUS CELL CARCINOMA IN SOUTHERN AND NORTHERN AUSTRALIA

Squamous cell carcinoma (scc) of the skin was studied in two similar populations, one living in the temperate zone of Australia, the other living in the tropics. In the tropics, the patients were significantly younger, the man to woman ratio approached unity, and women had significantly more sccs on the legs. In the temperate zone, men had significantly more on the head and neck, but women had significantly more on the upper and lower limbs.     

Effects of UV-A radiation on lens epithelial NaK-ATPase in organ culture.

PURPOSE: To investigate the mechanisms involved in the damage caused by UV-A irradiation at 365 nm on the eye lens. METHODS: Bovine lenses obtained from animals 1 to 5 years of age were placed in specially designed organ culture chambers for preincubation. Twenty-four hours later, the lenses were irradiated by 33 J/cm2 UV-A at 365 nm. During irradiation, the lenses were oriented in the culture so that the anterior surface faced the incident UV-A radiation source. After irradiation, lens optical quality was monitored throughout the 8 days of the culture period, and lens samples were taken for analysis of NaK-ATPase activity. RESULTS: Lens optics and NaK-ATPase activity were affected by irradiation of 33 J/cm2. The effects on lens epithelial NaK-ATPase activity were stronger at the equators than at the center. The damage to the activity at the center was reversible, as the lens optically recovered from the LW-A damage. CONCLUSIONS: Lens NaK-ATPase activity can recover from damage caused by UV-A at 365 nm. When the lenses received irradiation of 33 J/cm2, NaK-ATPase activity recovered from the damage during the culture period only at the center and not at the equators of the epithelium.     

Retinotopic organization of primary visual cortex in glaucoma: a method for comparing cortical function with damage to the optic disk

PURPOSE: To demonstrate that the relationship between the functional organization of primary visual cortex (V1) and damage to the optic disc in humans with primary open-angle glaucoma (POAG) can be measured using a novel method for projecting scotomas onto the flattened cortical representation. METHODS: Six subjects participated in this functional magnetic resonance imaging (fMRI) experiment. Structural damage to the optic disc and the retinal nerve fiber layer (RNFL) was measured by three techniques: scanning laser polarimetry (GDx ECC; Carl Zeiss Meditec, Dublin, CA), confocal scanning laser ophthalmoscopy (HRT II; Heidelberg Engineering, Heidelberg, Germany), and optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Inc.). Cortical activity for viewing through the glaucomatous versus fellow eye was compared by alternately presenting each eye with a contrast-reversing checkerboard pattern. The resultant fMRI response was compared to interocular differences in RNFL or mean height contour for analogous regions of the visual field. RESULTS: fMRI responses to visual stimulation were related to differences in RNFL thickness or mean height contour between eyes. The correlation between fMRI responses and measurements of optic disc damage for OCT (RNFL), HRT (mean height contour), and GDx (RNFL) were r = 0.90 (P = 0.02), r = 0.84 (P = 0.04), and r = 0.79 (P = 0.063), respectively. The probability of observing all three correlations by chance was low (P = 0.0003). CONCLUSIONS: Cortical activity in human V1 was altered in these six POAG subjects in a manner consistent with damage to the optic disc. fMRI is a possible means for quantifying cortical neurodegeneration in POAG.     

Oxidative stress is an early event in hydrostatic pressure induced retinal ganglion cell damage

PURPOSE: To determine whether oxidative adduct formation or heme oxygenase-1 (HO-1) expression are altered in retinal ganglion cell (RGC) cultures exposed to elevated hydrostatic pressure and in a mouse model of glaucoma. METHODS: Cultured RGC-5 cells were subjected to 0, 30, 60, or 100 mm Hg hydrostatic pressure for 2 hours, and the cells were harvested. Parallel experiments examined the recovery from this stress, the effect of direct 4-hydroxy-2-nonenal (HNE) treatment, and the effect of pretreatment with resveratrol or quercetin. Mice were anesthetized and intraocular pressure was increased to 30, 60, or 100 mm Hg for 1 hour; then the retinas were harvested. HNE adduct formation and HO-1 expression were assessed by immunocytochemistry and immunoblotting. RESULTS: Increases of HNE-protein adducts (up to 5-fold) and HO-1 expression (up to 2.5 fold) in pressure-treated RGC-5 cells were dose dependent. During recovery experiments, HNE-protein adducts continued to increase for up to 10 hours; in contrast, HO-1 expression decreased immediately. HNE, at a concentration as low as 5 muM, led to neurotoxicity in RGC-5 cells. HNE adducts and HO-1 expression increased in the mouse retina and optic nerve after acute IOP elevation up to 5.5-fold and 2-fold, respectively. Antioxidant treatment reduced the oxidative stress level in pressure-treated RGC-5 cells. CONCLUSIONS: This study demonstrates that oxidative stress is an early event in hydrostatic pressure/IOP-induced neuronal damage. These findings support the view that oxidative damage contributes early to glaucomatous optic neuropathy.     

Leserbrief Zum Beitrag von W. Harth und R. Linse: “Botulinophilie” Der Hautarzt (2001) 52:312–316

Ohne Zusammenfassung     

Pemphigus Therapy with Oral Prednisolone Regimens A 5-Year Study

Twenty-two newly diagnosed patients with pemphigus were randomly divided into two groups of 11 each. One group was placed on a high-dose prednisolone (120 mg/day) therapy and the other group on a low-dose (60 mg/day) therapy. The patients were followed for 5 years. Although a rapid initial control of the pemphigus appeared to be achieved with the high-dose regimen, this regimen did not have any long-term benefit over the low-dose regimen with respect to the frequency of relapse or in the incidence of complications.