Feasibility of using computer simulation to predict the postoperative outcome of the minimally invasive Nuss procedure: Simulation prediction vs. postoperative clinical observation

The Nuss procedure is the most minimally invasive and commonly used surgical correction for pectus excavatum (PE) by using a prebent pectus bar to elevate the deformed chest wall. However, there are some complications associated with this procedure such as postoperative pain as well as surgical uncertainties because of human judgment. It is therefore important to understand the biomechanical effect of the pectus bar on PE thoraces undergoing an operation to alleviate the postoperative pain as well as to improve surgical outcome. The current study incorporated the finite element method (FEM) to simulate the entire Nuss procedure including the flipping process of the pectus bar on a preoperative PE patient-specific thorax model, in conjunction with comparison against the postoperative CT scans. The mid-sagittal sternovertebral elevation was found to be within 5.32?mm, whereas the transverse sternal deviations ranged from 1.59 to 3.02?mm. The average discrepancy between the predicted contour and postoperative CT contour was approximately 3%. On a different note, the stress and strain distributions largely concurred with reported findings. High bilateral stress was seen to occur at the back of ribs near the vertebral column, and particularly over the second to fifth ribs, whereas the greatest strain was found to be confined to the regions of costal cartilages. It is evident that the FEM is a feasible and robust approach in predicting the outcome of the mechanical surgical procedure. This contributes to the future development of a predictive tool incorporated in surgical planning to enhance surgical management of PE.     

Evaluation for <Emphasis Type="Italic">Helicobacter pylori</Emphasis> in Meckel’s Diverticulum by Using Real-Time PCR

Background  

Although Helicobacter pylori (H. pylori) has been identified in heterotopic gastric mucosa of Meckel’s diverticulum, controversial results are reported in the pertinent literature.     

The genotoxic effects in lymphocyte cultures of children treated with radiosynovectomy by using yttrium-90 citrate colloid

The aim of this study was to investigate the genotoxic effect on the peripheral blood lymphocytes potentially induced by yttrium-90 citrate colloid (Y-90) in children who were undergoing radiosynovectomy for hemophilic synovitis, using chromosomal aberration analysis (CA) and the micronuclei (MN) assay for detecting chromosomal aberrations, as well as the sister chromatid exchanges (SCE) technique for assessed DNA damage. MATERIALS AND METHODS: Cytogenetic analyses were undertaken in 18 boys (mean age, 14.5 +/- 2.1 years) with hemophilic synovitis who underwent radiosynovectomy with Y-90. CA, MN, and SCE were evaluated just prior to, then at 2 and 90 days following radiosynovectomy from the peripheral lymphocytes of the children. An activity of 185 MBq of Y-90 was injected into the 18 knee joints under aseptic conditions. To check the possibility of leakage from the joint and its migration within the body, the patients underwent scanning under a dual-headed gamma camera at the hours 2 and 48 following the procedure. RESULTS: The procedure was well tolerated in all the children, and there was no extra-articular activity owing to extra-articular leakage of radioactive material in whole-body imaging. The mean frequency of CA in lymphocytes determined prior to the onset of therapy (0.31 +/- 0.48/900 cells) was not significantly increased, in comparison to the control values obtained 2 (0.30 +/- 0.48/900 cells) and 90 days (0.15 +/- 0.37/900 cells) after radiosynovectomy (p = 1.0 and 0.625, respectively). We observed that MN frequency was mildly increased in lymphocytes 2 days after therapy (8.30 +/- 1.89 MN/1000 binucleated cells vs. 9.23 +/- 1.79 MN/1000 binucleated cells; p = 0.013). But there was no significant difference between the baseline and the day 90 control levels of MN (p = 0.196). In the analysis of SCE frequency, there were no significant differences between the baseline (8.11 +/- 0.77) and the control analysis performed 2 and 90 days following radiosynovectomy (8.18 +/- 0.77 and 8.07 +/- 0.74; p = 0.710 and 0.662, respectively). CONCLUSIONS: The results of this study indicated that high radiation doses are not obtained by peripheral lymphocytes of children who undergo Y-90 radiosynovectomy and, therefore, they contradict a high cancer risk.     

Signet-ring cell carcinoma of the gallbladder: a case report

Gallbladder cancers are recognised common tumours of the gastrointestinal system. Histologically, almost all of them are adenocarcinomas. Previously, only two cases of signet-ring cell carcinoma of the gallbladder have been published, and little is known about the disease. Here, we present the case of a 76-year-old man with signet cell carcinoma of the gallbladder. Despite radical surgery, followed by 5-fluorouracil infusion chemotherapy, our patient died within 3 months. Advanced information may help to improve the prognosis of this tumour.     

Repair of ectopia cordis using a resorbable poly-L-lactic-polyglycolic acid plate in a patient with pentalogy of Cantrell

We present a case of a 10-month-old male infant with thoracoabdominal ectopia cordis, as part of Cantrell pentad, repaired using a poly-L-lactic-polyglycolic acid plate, a resorbable plating system widely used in craniomaxillofacial reconstruction. This is the first reported case of sternal reconstruction using a poly-L-lactic-polyglycolic acid plate. The repair was successfully carried out without cardiopulmonary compromise and good aesthetic outcome was achieved.