The use of cortical heterologous sheets for sinus lift bone grafting: a modification of Tulasne's technique with 7-year follow-up.

In this article, the authors describe their experience with using cortical deantigenated equine bone sheets in sinus lift grafting procedures performed on 23 patients. The technique employed resembles that described by Tulasne but avoids the need for using harvested calvaria bone and introduces some additional operating variants. The use of heterologous cortical bone sheets effectively managed even large lacerations of the Schneiderian membrane and allowed for immediate stabilization of the heterologous bone granules. Average histomorphometric values for bone cores collected six months after grafting, at the time of implant placement, were: newly formed bone tissue, residual bone substitute, medullary spaces. At seven year follow-up, clinical and radiographic examination indicated that the use of the bone sheets preserved the regenerated bone volume. In conclusion, the use of heterologous cortical bone sheets in association with granular bone graft material enabled long-term stabilization of the graft material and effective management of intra-surgical complications.

Kinetics of moisture loss applied to the baking of snacks with pregelatinized cassava starch.

Moisture loss kinetics is a complex process defined as the liquid removal from a solid by thermal application. The purposes of the study were to obtain kinetic curves of moisture loss during the baking of cassava snacks and establish which processes govern the moisture loss, recognize which mathematical models describe the moisture loss curves more precisely, and determine activation energy (Ea) and effective diffusivity (Deff ). Experimental data were obtained through baking at four temperatures formulations for snacks with different dehydrated cassava puree (DCP) proportions. Page's and Chávez Méndez's models showed the best fits. We calculated Deff and Ea employing the analytical solution of Fick's Second Law for the geometry of plane plates. Deff values increase with DCP but did not show a trend. The range found was from 5.22E-06 to 2.93E-05 m2 /s. The results of Ea showed that the mixture of flours produced an increase in the energy necessary to initiate the effective diffusion (24.84 kJ/mol) compared to the samples without mixing (15.54 kJ/mol). Moisture loss curves show that the diffusion process governs a large part of the process. PRACTICAL APPLICATION: Given the need to increase research for the development of the cassava industry, which currently has low competitiveness compared to less expensive products such as corn, various efforts are being made to generate new products that can replace wheat flour, at least in part. However, it is necessary to research how this substitution affects the various steps of the production system, including baking. During baking, one of the most significant processes is moisture loss. In this sense, the kinetic modeling of the moisture loss process parameters is mainly helpful in the food industry. The mathematical models of moisture loss processes are used to design new or improved baking systems or even control the process.

TRPM7 and MagT1 regulate the proliferation of osteoblast-like SaOS-2 cells through different mechanisms.

A correct magnesium (Mg2+) intake is essential for bone health. In particular, Mg2+ deficiency inhibits the proliferation of osteoblast-like SaOS-2 cells by increasing nitric oxide (NO) production through the upregulation of inducible NO synthase. At the moment, little is known about the expression and the role of TRPM7, a channel/enzyme involved in Mg2+ uptake, and MagT1, a Mg2+ selective transporter, in SaOS-2 cells. Here, we demonstrate that TRPM7 is not modulated by different extracellular concentrations of Mg2+ and its silencing exacerbates growth inhibition exerted by low Mg2+ through the activation of inducible NO synthase and consequent accumulation of NO. Moreover, MagT1 is upregulated in SaOS-2 cultured in high Mg2+ and its silencing inhibits the growth of SaOS-2 cultured in media containing physiological or high Mg2+, without any modulation of NO production. We propose that TRPM7 and MagT1 are both involved in regulating SaOS-2 proliferation through different mechanisms.

Ontogenesis of alpha- and beta-receptors located on cerebral microvessels.

Adrenergic receptors in rat brain microvessels were studied during ontogenesis. Microvessels were prepared by albumin floatation and glass bead filtration techniques from cortices of 10, 20- and 90-day-old rats. The lower level of alpha 1- alpha 2- and beta-receptor sites observed in early life may correlate with the lower capacity of cerebral vascular regulatory mechanism in this period.

Diabetes and complications after cardiac surgery: comparison with a non-diabetic population.

Diabetes is a well-recognized independent risk factor for mortality due to coronary artery disease. When diabetic patients need cardiac surgery, either coronary-aortic by-pass (CABP) or valve operations (VO), the presence of diabetes represents an additional risk factor for these major surgical procedures. Because of controversial data on mortality rates and post-operative complications in diabetic patients, probably due to not exactly comparable groups of patients, this retrospective study aimed to compare two homogeneous populations, which were different only for the presence or absence of diabetes. We studied 700 patients undergoing cardiac surgery: 350 with and 350 without diabetes, mean age 62 +/- 9 years (67% males); 441 underwent CABP and 259 VO. Apart from the diabetes, the two groups were strictly matched for age, body mass index, concomitant pathologies and smoking habits, except for previous neurological injuries (more frequent in diabetic patients), and for a slightly lower ejection fraction in the diabetic group. Intra- and post-operative complications or events were evaluated carefully: death, number staying in post-operative intensive care unit (ICU), renal, hepatic and respiratory complications, necessity for reoperation and hemotransfusions. Anesthesia and surgical procedures (including extra-corporeal circulation techniques) remained substantially unchanged over the period of recruitment of patients (1996-1998) and applied equally to both groups of patients. All diabetic patients were treated with insulin by using standard procedures in order to optimize metabolic control. Diabetic patients in our study, did not show higher rates of mortality in comparison with non-diabetic patients, but had more total neurological complications, more renal complications, a higher re-opening rate, more prolonged ICU stay, and they needed more blood transfusions. Diabetes remains an independent risk factor for these events even in a multivariate logistic regression model analysis. In the subgroup of diabetic patients who underwent CABP a higher rate of renal dysfunction, re-opening, need for hemotransfusions and prolonged ICU stay were confirmed. In the subgroup of diabetic patients undergoing VO we found a higher rate of renal dysfunction, reopening, prolonged ICU stay and major lung complications. In conclusion, diabetes does not seem to increase the mortality rates of cardiac surgery, but diabetic patients undergoing CABP have, on the basis of the relative risk evaluation, a 5-fold risk for renal complications, a 3.5-fold risk for neurological dysfunction, a double risk of being hemotransfused, reoperated or being kept 3 or more days in the ICU in comparison with non-diabetic patients. Moreover, diabetic patients undergoing VO have a 5-fold risk of being affected by major lung complications.

Trillium biopassive surface: a new biocompatible treatment for extracorporeal circulation circuits.

139 patients undergoing cardiac surgery were included in a prospective, randomized trial. Patients were randomly allocated to receive cardiopulmonary bypass (CPB) with Trillium Biopassive Surface (TBS Group) coated oxygenators or conventional circuits (control group). 112 patients were studied with respect to postoperative biochemical profile; a subgroup of 27 patients was studied with respect to perioperative complement (C3a) activation. Patients in the TBS group demonstrated a significantly lower white blood cell count at the end of the operation (p=0.036) and a significantly higher platelet count the day after the operation (p=0.023) when compared to the control group. C3a was significantly higher (p=0.02) in the TBS group after 30 minutes of CPB, but the C3a increase after protamine administration was significantly less pronounced in the TBS group vs. the control group. Further studies involving platelet and leukocyte activation are required to better elucidate the action of this new coating in the setting of routine CPB.

Closed, phosphorylcholine-coated circuit and reduction of systemic heparinization for cardiopulmonary bypass: the intraoperative ECMO concept.

Cardiopulmonary bypass with heparin-bonded circuits reduces systemic heparinization which is associated to a better clinical outcome in cardiac operations. In the present study, a novel biocompatible treatment, based on a phosphorylcholine coating without heparin, has been used to reduce systemic heparinization during cardiopulmonary bypass. Sixty patients underwent coronary revascularization with a fully phosphorylcholine-coated circuit. The circuit was entirely closed; suctions from the field were separated during the cardiopulmonary bypass time. A low systemic heparinization protocol based on half the loading dose of heparin (150 IU/kg) and a target activated clotting time of 320 seconds was applied. No thrombus formation inside the extracorporeal circulation circuit occurred; in-hospital mortality was absent. One patient (1.6%) had a postoperative myocardial infarction and 2 (3.3%) were surgically revised due to bleeding. Homologous blood transfusion rate was 11.6%, postoperative bleeding was 310 +/- 136 ml. If compared to patients treated with heparin-coated circuits and low systemic heparinization, these patients have better platelet count preservation and lower postoperative bleeding. The low thrombogenicity of phosphorylcholine-treated surfaces, despite the absence of surface-immobilized heparin, allows a safe reduction of systemic heparinization in the setting of an ECMO-like intraoperative cardiopulmonary - bypass. This intraoperative ECMO approach offers promising results in terms of clinical outcome after coronary revascularization operations.

Early debridement of second-degree burn wounds enhances the rate of epithelization--an animal model to evaluate burn wound therapies.

The purpose of this study was to examine the rate of epithelization of second-degree burn wounds with use of two debridement times (early versus late). Burn wounds were randomly assigned to one of the following treatment groups: (1) control, no debridement, (2) early debridement at 24 hours after burning, or (3) late debridement at 96 hours after burning. Wounds from each treatment group were harvested, incubated to allow separation of the dermis and epidermis, and then examined macroscopically for complete epithelization. On day 7 after burning, the percentage of burn wounds completely epithelized was as follows: nondebrided, 41%, 24-hour early debridement, 75%, and 96-hour late debridement, 22%. Burn wounds that were excised 24 hours after burning enhanced the rate of healing as compared to 96 hour and nondebrided burn wounds.

[Lipoma of the anal canal]. / Lipoma del canale anale.

Lipoma of the colon is a rare tumour that is often asymptomatic, and frequently discovered casually. Most examples are isolated and submucosal. An unusual case in a site not hitherto reported in the literature is described. Its clinical and radiological picture is explained and the more significant features are examined.

[Alveolar carcinoma of the lung. Anatomo-clinical considerations and presentation of 4 cases]. / Il carcinoma alveolare del polmone. Considerazioni anatomo-cliniche e presentazione di 4 casi.

Alveolar carcinoma of the lung is a rare form that is often discovered casually, and may well be asymptomatic. Four personal cases are presented. The view is advanced that this is a distinct form that is clearly distinguishable from bronchogenic adenocarcinoma. It has a single site and is derived from the type II pneumocyte. Particular attention is given to the clinical and diagnostic features of alveolar carcinoma. It is felt that early diagnosis followed by radical surgery leads to a marked improvement in prognosis.

Ureteral obstruction associated with prostate cancer: the outcome after ultrasonographic percutaneous nephrostomy.

We retrospectively reviewed the outcome of 28 prostate cancer patients with ureteral obstruction treated by percutaneous nephrostomy. The over-all survival was 60% at 1 year and 32% at 2 years. The 1 and 2 years survival rates of 13 patients with no prior hormonal therapy were 70 and 45%, respectively, while those of patients who had previously received hormonal therapy were 46 and 17% respectively. Of 10 patients who had severe renal failure before percutaneous nephrostomy (serum creatinine greater than or equal to 7 mg per dl), 8 had an adequate return of renal function (serum creatinine less than 3 mg pe dl) after drainage and 55% survived more than 1 year, cutaneous nephrostomy is safe and effective in relieving ureteral obstruction and reasonable survival can be achieved even in patient with renal failure. Percutaneous nephrostomy should be considered strongly in these patients.

[Varicocele and its repercussion on infertility. Indications and limitations of surgical intervention]. / Varicocele e sue ripercussioni sulla sterilità. Indicazioni e limiti dell'intervento chirurgico.

According to different Authors, varicocele incidence in unselected population fluctuates from 8 to 22% but in selected population affected by sterility incidence ranges from 21 to 39%. However other Authors have demonstrated that about 50% of patients suffering from varicocele have semen alterations. Various mechanisms have been suggested for testicular dysfunction associated with varicocele: intrascrotal hyperthermia, reflux of renal and adrenal metabolites from the renal vein and hypoxia. The most important semen alterations are observed in patients suffering from grade 2 and 3 varicocele and especially these patients must undergo surgical operation. According to recent findings, better results about the improvement of semen quality are obtained by operating children in puberal age. This clinical approach allows a prevention of testicular hypotrophy or, when this is already present, its reversibility. Varicocele surgical treatment makes use of traditional techniques microsurgical or not and mininvasive techniques. After renouncing of intrascrotal varicocelectomy, traditional techniques provide ligature and section of ectasic spermatic veins, after a surgical high (at level of the internal inguinal ring) or low (over inguinal canal) skin incision. Microsurgery allows recognition and protection of lymphatic and arterial vessels and execution of microsurgical anastomosis between venous spermatic and ileo-femoral circle vessels, when this is necessary. Internal spermatic vessels and vas deferens can be visualized through the laparoscope and so laparoscopic varicocele treatment was suggested. These new techniques and traditional operation are burdened with the same percentage of relapses but in laparoscopic procedure complications are more important. Recently radiographic occlusion techniques are also utilized (internal spermatic vein retrograde scleroembolization); the percentage of relapses is between 4 and 11%, with no risk of postvaricocelectomy hydrocele but with risk of loss of kidney (migration of the ballon or coil into the renal vein). Surgical treatment of varicocele produces a significant improvement in semen analysis in 60 to 80 per cent of patients affected by testicular dysfunction. Pregnancy rates after varicocelectomy are including from 20 to 60 per cent with most series averaging about 35 per cent.

[Andrologic surgery]. / La chirurgia andrologica.

The need of an economic and social low costs drive more and more surgeons towards the day surgery. The always growing diffusion of local anesthetic supports this trend. The drugs used as local anaesthetics are: carbocaine, procaine, lidocaine and bipivacaine. The Day Surgery can be largely employed in the therapy of andrological pathologies. In fact the anatomical placement of male genital apparatus allows easy possibilities of anaesthetical and surgical approach. It is so possible perform the following operations: meatotomy, section and plasty of fraenum, extirpation of Papovavirus lesions, circumcision, paraphymosis setting, corpora cavernosa drainage in priapism, section and ligation of deep dorsal vein, corporopexi, glandulopexi, cavernous crural plication, endocavernous penile prosthesis' implant, congenital or acquired penile recurvatum correction, blandulectomy, hepidydimis' cyst excision, testicle's biopsy, subcapsular orchiectomy sec. Higgins, testicular prosthesis' implant, resection and eversion of vaginal tunic of testicle in hydrocele's therapy, vasotomy and section and ligation of internal spermatic vein in varicocele's surgery. The Authors describe the anaesthetical and surgical techniques for bring forward these operations in Day Surgery.

Cardiac response to robotic assisted locomotion in normal subjects: a preliminary study.

Robotic assisted locomotion systems are recently gaining appreciation and diffusion as useful methods to rehabilitate individuals with lost sensorimotor function. Our aim was to evaluate potential changes in the autonomic nervous system activity (by ECG and spectral analysis), due to the experimental protocol, which include suspension of the subject to be instrumented on the system. A group of 10 normal subjects was studied during the rehabilitation protocol. Results showed a significant tachycardia and a reduced variance, during orthostatic stress induced by the suspension phase in comparison with sitting baseline condition but no significant increase of LF normalized power as it would be expected during a sympathetic activation.

[A case of perirenal myxoid liposarcoma]. / A proposito di un caso di liposarcoma mixoide peri-renale.

Radical operation of a right perirenal myxoid liposarcoma is reported. Retroperitoneal sarcomas, in fact, show little response to antiblastic and radiation management. It is pointed out that angiographic diagnosis is an essential prelmiminary to correct surgical indication, particularly since the clinical picture may well be indistinct and poorly specific.

A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts--three years of experience.

OBJECTIVES: Penile augmentation surgery is a highly controversial issue due to the low level of standardisation of surgical techniques. The aim of the study is to illustrate a new technique to solve the problem of enlarging the penis by means of additive surgery on the albuginea of the corpora cavernosa, guaranteeing a real increase in size of the erect penis. METHODS: Between 1995 and 1997, 39 patients who requested an increase in the diameter of their penises underwent augmentation phalloplasty with bilateral saphena grafts. The patients considered eligible for surgery were patients with either hypoplasia of the penis or functional penile dysmorphophobia. All the patients included in our study presented normal erection at screening. The average penis diameter in a flaccid state and during erection was found to be 2.1cm (1.6-2.7 cm) and 2.9 cm (2.2-3.7 cm), respectively. Before surgery the patients were informed of the experimental nature of the surgical procedure. The increase in volume of the corpora cavernosa was achieved by applying saphena grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penis. RESULTS: No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the post-operative follow-up period. All the patients resumed their sexual activity in 4 months. A measurement of the penile dimensions was carried out 9 months after surgery. No clinical meaningful increases in the diameter of the flaccid penis were documented. The average penis diameter during erection was found to be 4.2 cm (3.4-4.9) with post-surgery increases in diameter varying from 1.1 to 2.1cm (p<0.01). CONCLUSIONS: The penile enlargement phalloplasty technique with albuginea surgery suggested by the authors definitely is indicated for increasing the volume of the corpora cavernosa during erection. Albuginea surgery with saphena grafts has been found to be free from aesthetic and functional complications with excellent patient satisfaction.