Free fibula flap for humerus segmental reconstruction: report on 13 cases

In the period between 1994 and 2004, 13 patients (10 male, 3 female) presenting with post-traumatic defects to the humerus were treated with vascularised fibula graft. Age ranged from 21 to 62 (mean 37) years. Length of the bony defect ranged from 6 to 16 cm. Graft fixation was performed with plates in 12 cases, and in one case only screws were used. All patients were clinically reviewed between 120 days and 14 months after surgery. In one patient the flap was lost and a second free fibula flap was performed to achieve the reconstructive goal. Mean time for segmental bony union was 6 months (range from 3 to 13 months). Vascularised fibula graft allows for a successful humerus reconstruction when traditional techniques provide unsatisfactory results.     

Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study

Musculoskeletal pain affects a significant proportion of the general population. The myofascial trigger point is recognized as a key factor in the pathophysiology of musculoskeletal pain. Ultrasound is commonly employed in the treatment and management of soft tissue pain and, in this study, we set out to investigate the segmental antinociceptive effect of ultrasound. Subjects (n=50) with identifiable myofascial trigger points in the supraspinatus, infraspinatus and gluteus medius muscles were selected from an outpatient rehabilitation clinic and randomly assigned to test or control groups. Test subjects received a therapeutic dose of ultrasound to the right supraspinatus trigger point while control groups received a sham (null) exposure. Baseline pain pressure threshold (PPT) readings were recorded at the ipsilateral infraspinatus and gluteus medius trigger-point sites prior to ultrasound exposure. The infraspinatus point was chosen due to its segmental neurologic link with the supraspinatus point; the gluteus medius acted as a segmental control point. Following the ultrasound intervention, PPT readings were recorded at 1, 3, 5, 10 and 15 min intervals at both infraspinatus and gluteus medius trigger points; the difference between infraspinatus and gluteus medius PPT values, PPT seg, represents the segmental influence on the PPT. The ultrasound test group demonstrated statistically significant increases in PPT seg (decreased infraspinatus sensitivity) at 1, 3 and 5 min, when compared with PPT seg in the sham ultrasound group. These results establish that low-dose ultrasound evokes short-term segmental antinociceptive effects on trigger points which may have applications in the management of musculoskeletal pain.     

Robotic treatment of bowel endometriosis

Endometriosis describes a condition with the presence of ectopic endometrial glands and stroma outside the endometrial cavity that affects up to 15% of reproductive-aged women. Of women affected with endometriosis, 3.8–37% will have endometriosis involving the bowel, primarily the rectosigmoid colon. While medical management is often recommended as a first-line therapy, it is not curative, and surgery is often required as an adjunct for the management of symptoms. Minimally invasive surgery has become the standard of care for managing these patients. The use of robotic-assisted laparoscopy offers benefits that may allow surgeons to perform these challenging surgical cases using a minimally invasive technique. For lesions that affect the colon, there are three primary techniques used for removal which include: 1) rectal shaving, 2) discoid excision and 3) segmental resection. The decision to pursue one approach over another is largely dependent on the number of lesions present, a lesion's size and depth of invasion as well as the involved circumference of the bowel. The available evidence of using robotic-assisted laparoscopy in cases of bowel endometriosis is limited in the literature. In this review, we will summarize the role of robotic-assisted laparoscopy in the management of bowel endometriosis.     

Indirect decompression in spinal surgery

Indirect decompression in spinal surgery means decompression of spinal nerve tissues, such as spinal cord and nerve, without resecting the compressing tissue. Indirect spinal decompression procedures largely can be divided into segmental procedures and global spinal alignment procedures. Segmental procedures are mainly performed by the distraction between two vertebrae, which lead to the opening of the neural foramen and increases the epidural space. Such distraction can be performed through the disc space or using posterior instrumentation. Global spinal alignment procedures allow the spinal cord to migrate dorsally away from areas of anterior compression. Understanding the indirect spinal decompression procedures may broaden the options for surgical treatment and decrease the risk of spinal nerve tissue injury.     

GC-MS assay for acetaminophen in human hair segments

A detailed procedure for sensitive analysis of acetaminophen (APAP) in human hair segments by gas chromatography-mass spectrometry is reported. The limit of quantitation was as low as 0.1 ng/mg. The linear concentration range of the assay was 0.1–10 ng/mg. The interday and intraday coefficients of variation were below 10%. The method was successfully applied to hair analysis of APAP in an actual poisoning case.     

肺静脉节段性消融治疗心房颤动40例

目的初步分析肺静脉节段性消融治疗心房颤动。方法心房颤动40例，其中阵发性30例、持续性10例，年龄26～75（60±10）岁，行肺静脉节段性消融。结果达到消融终点（4根肺静脉均完全隔离）27例，完成3根肺静脉隔离9例，完成2根肺静脉隔离4例。手术操作时间（200±37）min；x线曝光时间（55±10）min。手术相关并发症9例（9／40，22．5％），其中急性心包填塞2例（2／40，5．0％）；肺静脉狭窄5例（5／40，12．5％）（其中有症状1例，无症状4例）；严重迷走神经反应2例（2／40，5．0％）。二次消融2例，手术成功，未复发。随访1～4年，总成功率为（30／40，75％）。结论经导管治疗心房颤动有效及相对安全；消融效果与左心房内径，心房颤动发作病史，是否持续性，肺静脉是否被完全隔离有关，术者通过学习曲线将能进一步提高手术成功率及降低并发症。     

Anterior segmental osteotomies without orthodontics: practicability of the correction of dentoalveolar deformities

We designed this study to determine the efficiency and stability of anterior segmental osteotomies (ASO) without orthodontics for various dentofacial deformities. Records of patients treated with maxillary or mandibular ASO, or both, without orthodontics in the past 15 years were analysed. The assessment included postoperative analysis of patients’ aesthetics and functional satisfaction using a questionnaire and grading (score 0 - 4) system, and the amount of relapse calculated from 12-month postoperative cephalograms. A total of 26 ASO subjects (age range 13- 31 years) were studied (14 maxillary, two mandibular, and 10 bimaxillary). Long-term stability was acceptable in all cases with no significant relapse (p>0.05). No major complications were encountered. All patients reported good to excellent (score = 3 to 4) satisfaction following surgery. Using meticulous planning and a careful surgical technique, ASO without orthodontics is a simple, quick, safe, and stable option for the correction of dentofacial deformities.     

The spectrum of segmental colitis associated with diverticulosis

Background Segmental colitis associated with diverticulosis (SCAD) has been defined as chronic colonic inflammation surrounding diverticula with rectal sparing. Distinguishing this condition from inflammatory bowel disease may be difficult. Our aim was to evaluate the epidemiological and clinical characteristics of SCAD in our area.Methods Retrospective case identification with prospective follow-up was done. Patients with endoscopic findings suggestive of SCAD were enrolled. The epidemiological, clinical, and histological characteristics of these patients were analyzed.Results Out of 605 patients with diverticulosis, 23 cases of SCAD were identified (3.8%). Four patients had histological characteristics suggestive of ulcerative colitis, in 1 case the histology was suggestive of ischemic colitis, 6 patients had histology compatible with SCAD, and the remaining patients had either transitional mucosa or minimal lesions. Four cases were refractory to conservative treatment (mesalamine and antibiotics) and surgery was required. No cases of extension of colonic inflammation in diverticula-free areas were found.Conclusions Segmental colitis associated with diverticulosis is not a rare disorder. It may occur with a spectrum of clinical and histologic features and may be confused with ulcerative colitis. The majority of the cases respond to medical therapy with antibiotics and/or mesalamine, whereas few cases are refractory and need surgery. No evolution to inflammatory bowel disease was observed.