Estrogen receptors in skeletal metabolism: lessons from genetically modified models of receptor function

Estrogens have long been known to be important for skeletal homeostasis, but their precise mechanisms of action in bone are still unclear. Mice with targeted deletions of the estrogen receptors alpha (ERalpha) and beta (ERbeta) have been generated by two research groups and several studies performed characterizing the phenotype of ERalpha knockout (ERKOalpha), ERbeta knockout (ERKObeta), or double deletion of ERalpha and ERbeta (DERKO) mice. Initial studies reported a reduction in bone mineral density in male ERKOalpha mice. More extensive analyses have been puzzling, likely because of compensatory mechanisms in ERKO mice. Furthermore, the existence of a third ER continues to be a potential explanation for some actions of estrogen in bone. Other rodent models, including the testicular feminized mouse and rat, the aromatase knockout mouse, and a rat with a dominant negative ER mutation, have added information regarding estrogen's actions in bone. This review summarizes many reports characterizing available rodent models with genetic alterations relevant to estrogen action. The sum of these reports suggests that the ERbeta is not highly protective in bone because loss of its function results in minimal alterations in the skeleton. Furthermore, loss of both the ERalpha and the ERbeta does not account for loss of estrogen action in bone, because the impact of DERKO is seemingly not as great as the impact of gonadectomy on the skeleton. Finally, through studies of ERKO mice and other rodent models of altered sex steroid action, it appears that estrogen may be more protective in the skeleton than androgens.     

Anaphylactic reaction to polyethylene‐glycol conjugated‐asparaginase: Premedication and desensitization may not be sufficient

In hypersensitive reactions to native L‐asparaginase, either premedication and desensitization or substitution with polyethylene glycol conjugated asparaginase (PEG‐ASP) is preferred. Anaphylaxis with PEG‐ASP is rare. An 8‐year‐old girl and a 2.5‐year‐old boy, both diagnosed as having acute lymphoblastic leukemia, presented with native L‐asparaginase hypersensitivity and substitution with PEG‐ASP was preferred. They received a premedication (methylprednisolone, hydroxyzine and ranitidine) followed by desensitization with PEG‐ASP infusion. Both patients developed anaphylaxis with peg‐asparaginase. These are the first reported cases of anaphylactic reaction to PEG‐ASP, despite the application of both premedication and desensitization. Anaphylaxis with PEG‐ASP is very rare and premedication and desensitization protocols may not prevent these hypersensitive reactions.     

A reliable option for wrist soft tissue defects: adipofascial flaps for immediate and late reconstruction

Extensive volar injuries are common and devastating because of the long‐term adhesion potency. The gliding effect of the adipose tissue is essential in preventing tendon adhesions after injury. In this study, we present the results of performing adipofascial flaps for the reconstruction of soft tissue defects following wrist trauma. The study included 15 patients. Adipofascial flaps were performed for immediate coverage of the tissue defect in 2 patients and for late adhesion‐related problems in 13 patients. Flap dimensions varied from 8 × 14 to 8 × 20 cm. All but one of the flaps and skin grafts survived uneventfully. None of the patients, whether immediate or late, required another operation to address further adhesion problems. Since adipofascial flaps provide a gliding surface, they are a good choice for immediate coverage of soft tissue defects in the wrist that are not suitable for skin grafting alone as well as for late adhesion‐related problems.     

Chest wall deformity after tissue expansion

There have been few reports about skeletal changes beneath a tissue expander in breast reconstruction. We present one, and surgeons should be cautious about the possibility of skeletal deformities in patients who are osteoporotic and postmenopausal who require prolonged tissue expansion.     

The role of omentoplasty in the surgical management of remnant cavity in hepatic hydatid cyst

Background. Cyst hydatid disease of the liver is still endemic in certain regions of the world. Currently, surgical operation remains the treatment of choice in hydatidosis. The cyst cavity can be managed by using capitonnage, external drainage, introflexion or omentoplasty. Methods. Two hundred and thirty-five patients operated for hydatid cyst between January 1990 and February 2001 were analysed retrospectively. Either omentoplasty, external drainage, capitonnage or introflexion were used to treat residual cyst cavity. Results. Patients were categorised into three groups to evaluate complications: omentoplasty alone (group A), omentoplasty combined with other techniques (group B) and other techniques (group C). The overall mortality rates were <1%. Overall morbidity rates were 8.8% for group A, 19% for group B and 25% for group C, respectively. Mean hospital stay was 7.6 days for group A, 11.9 days for group B and 15.8 days for group C. Discussion. Postoperative surgical site infection, bile fistula, recurrence rate and overall morbidity were seen less frequently in patients who underwent omentoplasty in our series. Mean duration of hospital stay was significantly shorter in patients who underwent omentoplasty operations. Because omentum has a high absorptive capacity and the capability to fill the residual cavity, we recommend omentoplasty to manage patients with hydatid cyst of the liver, whether complicated or uncomplicated.     

Multiple Perforations along the Entire Colon as a Complication of Intestinal Behcet's Disease: A Rare Case

Colonic complications of Behcet''s disease due to intestinal involvement are rarely reported in the literature. Ulcers are the most frequently seen intestinal complications that cause bleeding and perforation predominantly in the ileocecal region. In this article, we report a patient with Behcet''s disease who presented with multiple perforations along the entire colon. Postoperative histopathological examination revealed multiple ulcers containing lymphocytic infiltrations in the small peripheral and submucosal venules. Intimal thickening and fresh intraluminal fibrin thrombosis were also seen in these venules.