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First Surgery (first + surgery)
Selected AbstractsJoint capsule mast cells and neuropeptides are increased within four weeks of injury and remain elevated in chronic stages of posttraumatic contracturesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 10 2008Kevin A. Hildebrand Abstract The purpose of this article was to determine mast cell and neuropeptide nerve fiber numbers in joint capsules in posttraumatic contractures, as elevated numbers have been implicated in other fibrotic and contracture conditions. Twelve skeletally mature rabbits had intraarticular cortical windows removed from the medial and lateral femoral condyles and the knee joint immobilized. The contralateral unoperated limb served as a control. Equal numbers of rabbits were sacrificed 4 weeks after surgery or 40 weeks after the first surgery that included 32 weeks of remobilization. Six patients with chronic posttraumatic elbow joint contractures and six age-matched organ donor controls free of elbow contractures were also studied. Joint capsule myofibroblast, mast cell, and neuropeptide containing nerve fiber numbers were assessed with immunohistochemistry. The numbers of myofibroblasts, mast cells, and neuropeptide containing nerve fibers expressed as a percentage of total cells were significantly greater in the contracture capsules when compared to the control capsules at all time points (p,<,0.0001). The range of percentages for the three components in the contracture capsules versus the controls were 41,48% versus 9,10%, 44,50% versus 11,13%, and 45,50% versus 10,12% for the acute and chronic stages of the rabbit model and the chronic stages in the human elbows, respectively. These data support the hypothesis that a myofibroblast,mast cell,neuropeptide fibrosis axis may underlie some of the pathologic changes in the joint capsule in posttraumatic contractures. Approaches designed to manipulate this axis, such as preventing degranulation of mast cells, warrant further investigation. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1313,1319, 2008 [source] Primary sarcoma of the breastJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2004Manoj Pandey Abstract Background and Objectives Primary sarcoma occurring in breast is rare and comprises 0.5,1% of all breast neoplasm. Majority of the series include both stromal and cystosarcoma phyllodes, only a few hundred cases of sarcomas other then cystosarcoma are reported. Patients and Methods We carried out a retrospective analysis of 19 patients with primary sarcoma of the breast treated between 1982 and 2002. Results Mean age of the patients was 38.6 years (12,70 years). Gradually progressive swelling was the commonest presenting feature. There were eight cases of angiosarcoma, four cases of spindle cell sarcoma, two each of pleomorphic sarcoma and stromal sarcoma, and one each of malignant fibrous histiocytoma, embryonal rhabdomyosarcoma, and sarcoma (NOS). Eight of these were high-grade (42%). Eight patients underwent either radical or modified mastectomy, three underwent wide excisions, and one underwent quadrantectomy. Ten (52.6%) patients received postoperative adjuvant radiation. Two patients received chemotherapy. After a mean follow-up time of 34.5 months (median 25 months), eight patients failed. Failure was local in five, opposite breast in one, and both local and distant in two. The disease free survival at 3-year was 39%. In univariate analysis only the margin of first surgery was found to be a significant predictor of survival (P,=,0.05). Conclusions Primary sarcomas of the breast are aggressive tumors. Surgical treatment should consist of at least simple mastectomy. All attempts should be made to achieve a negative margin as this appears to be the only factor influencing survival in these patients. J. Surg. Oncol. 2004;87:121,125. © 2004 Wiley-Liss, Inc. [source] Penile Enhancement Using Autologous Tissue Engineering with Biodegradable Scaffold: A Clinical and Histomorphometric StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 9 2010Sava V. Perovic PhD ABSTRACT Introduction., Autologous tissue engineering with biodegradable scaffolds is a new treatment option for real penile girth enhancement. Aim., The aim of this article is to evaluate tissue remodeling after penile girth enhancement using this technique. Methods., Between June 2005 and May 2007, a group of 12 patients underwent repeated penile widening using biodegradable scaffolds enriched with expanded autologous scrotal dartos cells. Clinical monitoring was parallel to histological investigation of tissue remodeling. During second surgical procedure, biopsies were obtained 10,14 months after first surgery (mean 12 months, N = 6) and compared with those obtained after 22,24 months (mean 23 months, N = 6), and control biopsies from patients who underwent circumcision (N = 5). Blind evaluation of histomorphometrical and immunohistochemical finding was performed in paraffin sections. Main Outcome Measurements., Penile girth gain in a flaccid state ranged between 1.5 and 3.8 cm (mean 2.1 ± 0.28 cm) and in full erection between 1.2 and 4 cm (mean 1.9 ± 0.28 cm). Patients' satisfaction, defined by a questionnaire, was good (25%) and very good (75%). Results., In biopsies obtained 10,14 months after first surgery, highly vascularized loose tissue with collagen deposition associated with small foci of mild chronic and granulomatous inflammation surrounding residual amorphous material was observed. Fibroblast-like hyperplasia and small vessel neoangiogenesis occurred intimately associated with the progressive growth of vascular-like structures from accumulation of CD34 and alpha-smooth muscle actin-positive cells surrounding residual scaffold-like amorphous material. Capillary neoangiogenesis occurred inside residual amorphous material. In biopsies obtained after 22,24 months, inflammation almost disappeared and tissue closely resembled that of the dartos fascia of control group. Conclusions., Autologous tissue engineering using expanded scrotal dartos cells with biodegradable scaffolds is a new and promising method for penile widening that generates progressive accumulation of stable collagen-rich, highly vascularized tissue matrix that closely resemble deep dartos fascia. Perovic SV, Sansalone S, Djinovic R, Ferlosio A, Vespasiani G, and Orlandi A. Penile enhancement using autologous tissue engineering with biodegradable scaffold: A clinical and histomorphometric study. J Sex Med 2010;7:3206,3215. [source] Analysis of the Long-Term Hearing Results after the Surgical Repair of Aural AtresiaTHE LARYNGOSCOPE, Issue 10 2006Sun O. Chang MD Abstract Objectives: Careful surgical candidate selection guarantees a high probability of serviceable hearing postoperatively in congenital aural atresia (CAA) patients. The authors analyzed hearing results after CAA surgery with long-term follow-up (F/U) with respect to several clinical factors. Study Design: This was a retrospective study. Methods: The medical records of 93 CAA patients (100 ears) who underwent operations from January 1987 through December 2002 at Seoul National University Hospital were reviewed. Mean duration was 56.9 months. The authors evaluated the results of hearing after surgery over 3 year F/U with a view to clarifying the factors accounting for unsuccessful results. Results: Approximately 64% of patients treated surgically achieved a considerable hearing gain over long-term F/U. Postoperative hearing remained relatively stable over the period from 6 months to 3 years postoperatively, yielding only 2.75 dB of aggravation. However, hearing results in revision cases deteriorated with time, which led to statistically higher air-conduction thresholds than those of primary cases at the 1 and 3 year F/Us. Resultantly, only 26.6% of patients having achieved a poor hearing gain post first surgery benefited from revision audiologically. The severity of microtia was found to help predict poor long-term hearing outcomes after CAA surgery. Conclusions: Nonrevision cases and cases with mild microtia appear to have acceptable and stable long-term hearing results. Disappointing long-term hearing results in revision, and severe microtia cases should lead to considerations of alternative options in these cases, such as bone-anchored hearing aids, which offer reliable and stable results. [source] Dimensional Stability of the Free Fascia Grafts: An Animal Experiment,THE LARYNGOSCOPE, Issue 4 2002Shabbir Indorewala MS (ENT) Abstract Objectives/Hypothesis It appears that autologous free fascia grafts (fascia lata and temporal fascia) change their dimensions during the vital first 5 days of healing. Poor dimensional stability of these grafts can be an important reason for failure of complete closure of tympanic membrane perforations in tympanoplasty operations. There has been no study regarding this dimensional instability. Study Design Prospectively dimensional instability of the free fascia grafts was studied in 14 mongrel dogs. Methods Fourteen healthy Mongrel dogs were operated on twice. During the first surgery, fascia lata and temporal fascia grafts of measured dimensions (length, breadth, and thickness) were implanted in the subcutaneous pockets on the thoracoabdominal wall of the same dog (autograft). Five dogs were operated on again after 2 days, and 7 dogs were operated on again after 5 days to harvest the implanted grafts. The dimensions of the harvested grafts were noted. Changes with respect to their implant dimensions after 2 days and after 5 days were calculated. Results It was found that free fascia lata exhibits significantly superior dimensional stability when compared with free temporal fascia during the early healing phase, before graft integration has occurred. Shrinking and thickening of temporal fascia are greaterand are also most unpredictable. Conclusions Poor dimensional stability of temporal fascia may compromise a well-sealed perforation at the time of surgery, and it may reopen by the 5th day. This must be one of the causes of failure of tympanoplasty, which needs to be studied further. [source] Acquired arachnoid cyst in a catAUSTRALIAN VETERINARY JOURNAL, Issue 7 2009T Sugiyama A 5-year-old Birman cat presented with paraparesis associated with a fracture of the third thoracic vertebra and was managed conservatively. Voluntary function was regained over the next 6 months, but the cat was referred 4 years after the trauma because of recurrence of hindlimb paresis and ataxia. Magnetic resonance imaging (MRI) showed a spinal arachnoid cyst at the level of the fourth thoracic vertebra, which was treated surgically by dorsal laminectomy and durectomy, and hindlimb function subsequently recovered. The cat re-presented 4 years later for recurrent hindlimb paresis. Myelography and computed tomography,myelography (CT-M) showed dorsolateral pooling of cerebrospinal fluid (CSF) at the previous laminectomy site. The neurological signs after the second surgery improved, but not as much as after the first surgery and the cat remained ataxic with moderate paresis. Seven months later repeat CT-M revealed an atrophic spinal cord, but negligible pooling of CSF at the previous site of the arachnoid cyst. The cat could walk, but was being treated for self-induced trauma of the left hindlimb that was thought to be related to paraesthesia. The neurological signs gradually deteriorated over 3 months and the cat was euthanased. [source] Clinical outcome of submerged vs. non-submerged implants placed in fresh extraction socketsCLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2009Luca Cordaro Abstract Aim: The aim of this study was to compare the clinical outcome of submerged vs. non-submerged tapered implants placed into fresh extraction sockets. Materials and methods: A prospective, controlled, multicenter, randomized, clinical trial has been performed in two centers in Rome and Torino (Italy). Thirty healthy patients were recruited according to the following inclusion criteria: need for an immediate post extraction implant, ages between 18 and 70, horizontal defect depth <2 mm, smokers <10 cigarettes/day and absence of any circumstance or condition that could represent contraindications to implant surgery. The patients were randomly allocated to submerged or non-submerged treatment groups immediately after flap elevation and tooth extraction. Submerged implants were exposed 8 weeks after the first surgery; all implants were loaded with provisional restorations 12 weeks after the first surgery and with definitive restoration 12 weeks thereafter. Clinical and radiographic parameters were evaluated at baseline, at implant loading and at the 1-year follow-up visit. Results: The results showed statistically significant differences between the two groups in the mean value of keratinized tissue (KT) height after surgery that was significantly reduced for submerged implants when compared with transmucosal implants (mean reduction of KT at year follow-up: T group 0.2 mm, S group 1.3 mm; P=0.007). Conclusion: Similar outcomes were found for submerged and non-submerged implants placed in fresh extraction sockets with a horizontal peri-implant defect smaller than 2 mm, except for a reduction of KT in the submerged group. Either with a submerged or a non-submerged procedure, 1 mm of mean soft tissue recession is seen after 1 year when compared with the pre-extraction situation. [source] | ||||||||||