Coexistence of a Meckel's diverticulum and a urachal remnant

Meckel's diverticulum, which is a remnant of the omphalomesenteric or vitelline duct, is the most common congenital abnormality of the gastrointestinal system. Urachal abnormalities, resulting from anomalous urogenital development, are not observed frequently and case reports are mainly represented in literature. The presence of these two congenital anomalies together is a very rare pathology. Complications arising from a Meckel's diverticulum or urachal remnant may clinically mimic acute appendicitis and other surgical pathologies. We report on a patient who underwent surgery for acute appendicitis when it was discovered that the symptoms were produced by a perforated Meckel's diverticulitis. In the course of the surgery, a urachal remnant was found to coexist with the diverticulum.     

An anterior approach to the cervicothoracic junction of the spine (modified osteotomy of manubrium sterni and clavicle)

Standard anterior approaches to the cervicothoracic junction of the spine provide inadequate exposure. For this reason, various techniques of exposure are developed. One of these is Sundaresan's technique in which a part of the manubrium sterni and medial clavicle is resected. This technique provides good visibility and working area at the lesion level but causes a significant bony defect. We modified Sundaresan's technique and did not damage the sternoclavicular joint. After decompression and fusion was completed, the osteotomized segment was replanted. We performed this technique in a case of Pott's disease and had no problem with union at the osteotomy sites.     

Videolaparoscopic treatment of liver hydatid cysts with partial cystectomy and omentoplasty

Hydatid disease is one of the world's most important health problems. Although several conservative approaches have been used for the management of this condition, surgery remains the ideal choice in most of the cases. Videolaparoscopic approach can safely be applied for the management of liver hydatid cysts if several precautions are undertaken. In this study, we present two liver hydatid cyst cases successfully treated with partial cystectomy and omentoplasty using videolaparoscopic approach.     

The ethics of extracorporeal membrane oxygenation in brain‐dead potential organ donors

Organ‐preserving extracorporeal membrane oxygenation (OP‐ECMO) is defined as the use of extracorporeal support for the primary purpose of preserving organs for transplantation, rather than to save the patient's life. This paper discusses the ethics of using OP‐ECMO in donation after brain determination of death (DBDD) to avoid the loss of organs for transplantation. We review case reports in the literature and analyze the ethical issues raised. We conclude that there is little additional ethical concern in continuing OP‐ECMO in patients already on ECMO if they become brain dead. The implementation of OP‐ECMO in hemodynamically unstable brain‐dead patients is ethically permissible in certain clinical situations but requires specific consent from relatives if the patient's wish to donate is not clear. If no evidence of a patient's wish to donate is available, OP‐ECMO is not recommended. In countries with presumed consent legislation, failure to opt out should be considered as a positive wish to donate. If a patient is not‐yet brain‐dead or is undergoing testing for brain death, OP‐ECMO is not recommended. Further research on OP‐ECMO is needed to better understand the attitudes of professionals, families, and lay people to ensure agreement on key ethical issues.     

The decline of FANCM immunohistochemical expression in prostate cancer stroma correlates with the grade group

Prostate adenocarcinoma (PCa) stromal markers have recently gained attention as complementary diagnostic tools. The DNA reparation complex protein FANCM has been shown to express in the normal prostate stroma and FANCM gene alterations to be associated with PCa susceptibility; this has led to the hypothesis that an insufficient level of FANCM expression may provide additional information for the evaluation of PCa. The study cohort comprised 60 radical prostatectomy specimens. The controls involved 11 autopsies (CTRL) and non‐cancerous tissue (NCT) areas from the prostatectomy specimen. The samples were stained with the FANCM antibody. The quantification of the stromal staining index (SSI) was made using ImageJ and QuPath. Overall, 655 regions of interest (ROI) were analyzed. FANCM expression appeared equally intense and stroma specific in both CTRL and NCT, indicating the absence of underlying baseline alterations. Within the age span of the cohort 47–89 years, no significant effect of the age of the patients on the FANCM expression was seen. FANCM demonstrated Gleason grade (G) dependent decline in PCa, being statistically significant in controls versus G1 and G2 versus G3. In other adjacent International Society of Urological Pathology (ISUP) groups, it remained insignificant, still being meaningful between high and low‐grade cancers.     

动脉粥样硬化的分子成像:血管细胞黏附分子-1为靶向的磁性微泡和对比增强超声诊断效能

目的评价经血管细胞黏附分子-1(VCAM-1)(CD106)靶向的微泡,在磁性导引系统帮助下,能否提高对比增强分子超声(US)对主动脉粥样硬化的检出效能。材料与方     

The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases

Long periods of immobilization, progressive kyphosis and graft failure are the major postoperative problems encountered after anterior radical surgical treatment for tuberculosis of the spine. Posterior fusion and instrumentation can be an effective solution for these problems. Effectiveness of posterior fusion and instrumentation was investigated in this study on the basis of the cases with anterior procedure only, and with combined anterior-posterior procedures. One hundred twenty-seven cases of tuberculosis of the spine were surgically treated between 1987 and 1995. All had either 1 or more of conditions such as spinal cord compression and neurological deficit, vertebral body collapse and kyphosis, or wide paravertebral abscess unresponsive to medical treatment. Of these, 57 had only anterior radical procedure between the years 1987 and 1993. Seventy cases had posterior instrumentation and fusion after the anterior procedure between the years 1991 and 1995. In about two third of the patients (81) autogenous iliac strut graft and in one third of them (40) autogenous fibular strut graft (cases with more than 2 level involvement) was used along with rib grafts after debridement. Twenty-one of the 57 patients who had only anterior procedure demonstrated a postoperative increase of kyphosis of more than 10 degrees. Increased kyphosis was due to graft slippage in 3, resorption in 2 and subsidence in 16 patients. No such increase or graft failure was noted in cases of combined anterior-posterior procedure. The difference in terms of kyphosis was found to be statistically significant (P=0.047). Anterior radical debridement and strut graft is the golden standard in the surgical treatment of spinal tuberculosis, but it should always be accompanied by posterior instrumentation and fusion to shorten the immobilization period and hospital stay, obtain good and long lasting correction of kyphosis, and prevent further collapse and graft failure.     

CASE STUDIES OF THE TREATMENT OF HYPOTHYROIDISM BY MERIDIAN THEORY OF CHINESE MEDICINE

Some patients with hypothyroidism still remain symptom after prolonged treatment with thyroxine. Alternative treatment needs to be explored. The treatment is described as overlapof acupunture, supplemented with electric acupuncture, magnetic acupuncture, ear acupuncture, herbaltreatment, and acupressure of thyroid. The result of two case studies will be discussed in the presentation.The theoretical basis for the approach will also be explored.In Chinese medicine, hypothyroidismis often defined as spleen deficiency in the early stage and can be treated with ISRQ recipes (Invigorating the Spleen and Replenishing the Qi). In the chronic stage, hypothyroidism can be seen as kidneydeficiency and can be treated with KRR (Kidney Reinforcing Regimen). Hypthyroidism symptoms aresometimes diffcult to treat. However, TCM (Traditional Chinese Medicine) diagnosis and treatmentare based on an overall analysis of the illness according to patients' condition. After successful treamentof TCM, patients can stop taking Thy