Association of trochlear dysplasia with knee meniscal-cartilage damage and anterior cruciate ligament mucoid degeneration.

AIM: The purpose of this study was to evaluate meniscal and tibiofemoral cartilage injury in patients with trochlear dysplasia (TD) and investigate whether there were correlations between TD grade and meniscal and cartilage injury. In addition, the relationship between TD and mucoid degeneration of the anterior cruciate ligament (ACL-MD) was investigated. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) examinations of 133 patients with TD were included in the study. TD was graded (types A, B, C, D). The tibial tuberosity (TT)-TG distance was also measured. The ACL was assessed for ACL-MD. Both menisci were evaluated for the degeneration and tears. Medial-lateral tibial plateau (MTP-LTP), medial-lateral femoral condyles (MFC-LFC), and trochlear cartilage were examined for focal cartilage defect (FCD). RESULTS: ACL-MD was present in 42 of the patients with TD (31.6%). There was a significant positive relationship between ACL-MD and TT-TG distance. Meniscal tear was detected in 40 (30.1%) of all patients. FCD were detected in the tibiofemoral compartments in 41 (30.8%) of 133 patients. There was a significant positive relationship between the presence of FCD in the LFC and the type of TD (p<0.01). FCD was present in the LFC of all cases in the type D. A significant positive relationship was found between the TT-TG distance and the presence of FCD, especially in the anterior part of LFC (p<0.01). There was a significant relationship between the lateral trochlear cartilage defect and the type of dysplasia (p=0.037). CONCLUSION: TD is a significant risk factor for ACL-MD, meniscal, and tibiofemoral cartilage injury.

Zinc affects nuclear factor kappa b and DNA methyltransferase activity in C3H cancer fibroblast cells induced by a 2100 MHz electromagnetic field.

The use of mobile phones is becoming widespread with the development of technology, and as a result, its effects on human health are becoming more and more important every day. Studies have reported that the electromagnetic field (EMF) emitted by mobile phones may have adverse effects on the biological systems. In order to evaluate the effect of zinc (Zn) on C3H cancer fibroblast cells exposed to 2100 MHz EMF, we analyzed cell viability%, nuclear factor kappa b (NF-κB) and DNA methyltransferase (DNMT) activities. Cells were divided to following groups: Control, sham control, 2100 MHz EMF, 50 µM Zn + 2100 MHz EMF, 100 µM Zn + 2100 MHz EMF, and 200 µM Zn + 2100 MHz EMF for 2 h. We measurement cell viability, NF-κB and DNMT activities. There was increased cell viability % in the 2100 MHz EMF group compared to the control group, while the cell viability % was decreased in the 50, 100 and 200 µM Zn + 2100 MHz EMF groups compared to 2100 MHz EMF. NF-κB and DNMT activities were a significant increase in the 2100 MHz EMF group compared to the control group, although were statistically decreased in the 50, 100 and 200 µM Zn + 2100 MHz EMF groups compared to the 2100 MHz EMF group. Our results demonstrate that 2100 MHz EMF exposure in cancer fibroblast cells induce NF-κB and DNMT activities, whereas zinc supplementation reduce NF-κB and DNMT activities-induced 2100 MHz EMF.

Surgical management of sporadic hemangioblastomas located in the posterior fossa of brain.

PURPOSE: Hemangioblastomas (HBs) are highly vascular tumors, constituting 2%-3% of central nervous system (CNS) tumors. Surgery is a treatment option for HBs. The purpose of this study was to evaluate the demographic, clinical, and radiological findings of patients with HBs who were operated on via microsurgical technique at our clinic and to determine the findings specific to HBs and evaluate their pathological findings and confirmation. METHODS: We evaluated age, gender, initial complaints and duration of 100 patients (50 female and 50 male patients), presence of cranial nerve deficits, magnetic resonance imaging, data (localization, presence of hydrocephalus, tumor size, enhancement pattern, and cystic and solid component features), resection rates, pathological findings (grade, Ki-67 ratio, and staining results), recurrence, special conditions of patients, and the final status of patients in this study. RESULTS: Mean age was 39.08 ± 14.77 years and 66.7% of the patients presented with cerebellar findings. Five of the cases were located in the brainstem, five were located in the cerebellopontine angle, and two were in the cerebellar cortex. In all patients, gross total resection was performed using arteriovenous malformation repair. CONCLUSIONS: Surgical intervention of small and cystic tumors can be performed safely with en bloc resection along with preoperative detailed imaging, improved microsurgical techniques, and an extensive understanding of anatomical and vascular structures. On the contrary, patients with a brainstem invasion and solid structure present surgical difficulties due to arteriovenous malformation-like vascularizations; therefore, gross total resection is the optimal treatment in HBs.

Multidetector CT findings in gastrointestinal tract perforation that can help prediction of perforation site accurately.

AIM: To assess the accuracy, sensitivity, and specificity of multidetector computed tomography (MDCT) findings by comparing the locations of free air in the abdomen and imaging findings with the site of gastrointestinal perforation. MATERIALS AND METHODS: Ninety-three patients with acute abdominal pain who visited the emergency department between January 2015 and October 2018 were included in the study. There were 59 male and 34 female patients with a mean age of 50.5 years. The site of perforation was based on surgical findings in all cases. RESULTS: Among specific air distributions, periportal free air and subphrenic free air were statistically significant in differentiating upper gastrointestinal tract perforation. Whereas free air in the minor pelvis, right lower quadrant free air, left lower quadrant free air, and air in the mesentery were statistically significant in differentiation of lower gastrointestinal tract perforation. CONCLUSION: Multidetector findings may help to predict the site of gastrointestinal perforation, which would change the treatment plan.

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study.

OBJECTIVE: To investigate outpatient follow-up after mild traumatic brain injury (mTBI) by various medical specialists, for both hospitalized and non-hospitalized patients, and to study guideline adherence regarding hospital admission. METHODS: Patients (n = 1151) with mTBI recruited from the emergency department received questionnaires 2 weeks (n = 879), 3 months (n = 780) and 6 months (n = 668) after injury comprising outpatient follow-up by various health care providers, and outcome defined by the Glasgow Outcome Scale Extended (GOS-E) after 6 months. RESULTS: Hospitalized patients (60%) were older (46.6 ± 19.9 vs. 40.6 ± 18.5 years), more severely injured (GCS <15, 50% vs. 13%) with more Computed Tomography (CT) abnormalities on admission (21% vs. 2%) compared to non-hospitalized patients (p < 0.01) . Almost half of the patients visited a neurologist at the outpatient clinic within six months (60% of the hospitalized and 25% of the non-hospitalized patients (χ2 = 67.10, p < 0.01)), and approximately ten per cent consulted a psychiatrist/psychologist. Outcome was unfavourable (GOS-E <7) in 34% of hospitalized and 21% of non-hospitalized patients (χ2 = 11.89, p < 0.01). CONCLUSION: Two-thirds of all mTBI patients consult one or more specialists within six months after injury, with 30% having an unfavourable outcome. A quarter of non-hospitalized patients was seen at the outpatient neurology clinic, underling the importance of regular follow-up of mTBI patients irrespective of hospital admittance.

Absence of a proximity effect for a thin-films of a Bi2Se3 topological insulator grown on top of a Bi2Sr2CaCu2O(8+δ) cuprate superconductor.

Proximity-induced superconductivity in a 3D topological insulator represents a new avenue for observing zero-energy Majorana fermions inside vortex cores. Relatively small gaps and low transition temperatures of conventional s-wave superconductors put hard constraints on these experiments. Significantly larger gaps and higher transition temperatures in cuprate superconductors might be an attractive alternative to considerably relax these constraints, but it is not clear whether the proximity effect would be effective in heterostructures involving cuprates and topological insulators. Here, we present angle-resolved photoemission studies of thin Bi(2)Se(3) films grown in situ on optimally doped Bi(2)Sr(2)CaCu(2)O(8+δ) substrates that show the absence of proximity-induced gaps on the surfaces of Bi(2)Se(3) films as thin as a 1.5 quintuple layer. These results suggest that the superconducting proximity effect between a cuprate superconductor and a topological insulator is strongly suppressed, likely due to a very short coherence length along the c axis, incompatible crystal and pairing symmetries at the interface, small size of the topological surface state's Fermi surface, and adverse effects of a strong spin-orbit coupling in the topological material.

The angiogenic effects of ischemic conditioning in experimental critical limb ischemia.

OBJECTIVES: Ischemic conditioning (IC) is a method of angiogenic stimulus for limb ischemia. Here, we aimed to investigate the effects of short-term repeated ischemic stimulus on critical lower limb ischemic injury. METHODS: Rats were divided into four groups consisting of 40 animals in each group: sham, ischemia, local IC, and remote IC groups. Right-leg critical limb ischemia was achieved through ligation of the iliac artery and vein in male Sprague-Dawley rats except the sham group. Repeated transient ischemia using the tourniquet method was used for IC of lower extremities in the local and remote groups. IC was performed on the right leg for the local group and on the left leg for the remote group. Ten rats in each group were sacrificed for evaluation on days 1, 7, 14, and 30. Endothelial progenitor cell (EPC) counts were measured. Gastrocnemius muscles were evaluated for the degree of ischemia. Laser Doppler blood flow measurements were performed in order to make comparison between the blood flows of the limbs of the groups. RESULTS: The blood flow in the right limb of rats in the sham (1.65 perfusion units [PU]) and local IC (1.67 PU) groups was significantly higher than the ischemic group (1.17 PU) (p = .001 and p = .022 respectively). The levels of EPCs in the ischemia (1.09 ± 0.5) and remote IC groups (1.36 ± 0.8) were significantly higher than the sham (0.38 ± 0.2) group on day 7 (p = .026 and p = .002 respectively). Remote IC and local IC groups exhibited increased histopathological ischemia on day 7 when compared with sham group (p = .001, p = .01 respectively). The angiogenic scores on the 7th, 14th and 30th days for local IC and remote IC groups were significantly higher than sham and ischemia groups. CONCLUSIONS: IC seems to be the potent activator of angiogenesis in ischemic tissue. This study provides preliminary data showing that repeated short ischemic stimuli may reduce critical ischemic injury by promoting angiogenesis.

The effects of Hypericum perforatum on hepatic ischemia- -reperfusion injury in rats.

BACKGROUND: Ischemia-reperfusion injury (IR) is associated with a high morbidity and mortality. Several agents have been used to protect the liver after IR. We aimed to investigated the effects of the Hypericum perforatum on IR of the liver. METHODS: A total of 62 wistar-albino male rats in 4 groups were used. Sham group (n: 8). Control group (IR, n: 18) was underwent partially liver ischemia and reperfusion (IR). Carboxymethyl cellulose group (CMC n: 18) was given 0.5 % carboxymethyl cellulose before IR for a week. Hypericum perforatum group (HP, n:18) was given 0.5 % carboxymethyl cellulose supplemental the extract of Hypericum perforatum before IR for a week. Blood and liver samples were obtained before ischemia, and 1, 2, 4 hours after the reperfusion. AST, ALT, LDH, TNF-α, IL-6, MDA and advanced oxidation protein products(AOPP) levels were determined in blood samples. Histological evaluation and tissue MDA, AOPP levels were determined. RESULTS: Blood levels of ALT, TNF-α, IL-6 and MDA were significantly low in HP group compared with IR and CMC groups (p < 0.05). There was no difference between the liver injury scrores of IR and CMC groups (p > 0.05). CONCLUSION: [corrected] These results indicate that H. perforatum can protect the liver against IR. As antioxidative agent, Hypericum perforatum has both local and systemic protective effects in ischemia reperfusion injury (Tab. 1, Fig. 4, Ref. 31).

The role of NMDA glutamate receptors in lung injury caused by chronic long-term intermittent hypobaric hypoxia.

Chronic intermittent hypoxia (CIH), a component of sleep apnea-hypopnea syndrome, is suggested to cause damage to lung tissue, and the role of glutamate is not well studied. We used a chronic long-term intermittent hypobaric hypoxia (CLTIHH) model of rats to find out if such procedure causes lung injury and the potential effect of N-methyl-D-aspartate receptors (NMDARs) by using receptor antagonist MK-801 (dizocilpine). Thirty-two rats were placed into four groups; a control and three CLTIHH groups where rats were placed into a low-pressure chamber set to 430 mmHg for 5 h/day, 5 days/week, for 5 weeks. Only one group received MK-801 (0.3 mg/kg, ip) daily. We evaluated tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and nuclear factor (NF)-kB for the inflammatory process, superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), total antioxidant status (TAS), and total oxidant status (TOS) for oxidative stress, and caspase-9 levels. Blood plasma, bronchoalveolar fluid (BALF), and lung tissue extracts were evaluated. Both oxidant and inflammatory parameters were significantly increased in all the mediums of the CLTIHH groups except the group that received MK-801. Significant evidence was collected on MK-801 alleviating the effect of CLTIHH. Histological evaluations revealed lung damage and fibrotic changes in the CLTIHH groups. It was first shown that the CLTIHH procedure caused chronic lung injury, and that inflammation and oxidant stress were influential in the formation of lung injury. Secondly, NMDAR antagonist MK-801 effectively inhibited the development of lung injury and fibrosis.

Signature of spin-phonon coupling driven charge density wave in a kagome magnet.

The intertwining between spin, charge, and lattice degrees of freedom can give rise to unusual macroscopic quantum states, including high-temperature superconductivity and quantum anomalous Hall effects. Recently, a charge density wave (CDW) has been observed in the kagome antiferromagnet FeGe, indicative of possible intertwining physics. An outstanding question is that whether magnetic correlation is fundamental for the spontaneous spatial symmetry breaking orders. Here, utilizing elastic and high-resolution inelastic x-ray scattering, we observe a c-axis superlattice vector that coexists with the 2[Formula: see text]2[Formula: see text]1 CDW vectors in the kagome plane. Most interestingly, between the magnetic and CDW transition temperatures, the phonon dynamical structure factor shows a giant phonon-energy hardening and a substantial phonon linewidth broadening near the c-axis wavevectors, both signaling the spin-phonon coupling. By first principles and model calculations, we show that both the static spin polarization and dynamic spin excitations intertwine with the phonon to drive the spatial symmetry breaking in FeGe.

[Temporary treatment of uncontrolled intrathoracic hemorrhaging with abdominal towels in combination with a rescue procedure. Damage control procedure of the chest]. / Temporäre Versorgung einer unstillbaren intrathorakalen Blutung mit Bauchtüchern in Kombination mit einer Rettungsprozedur. Ein Damage-control-Verfahren des Thorax.

Case report of a 27-year-old patient who presented with a stab wound in the posterior aspect of the right chest. The patient was physiologically unstable and not responding to fluid resuscitation. A right intercostal drainage was inserted which immediately drained 1100 ml of blood. Thoracotomy was performed where a large clot was removed from the pleural cavity and followed by massive bleeding from the hilum of the lung as well as an intercostal artery posteriorly. Control of the hilar hemorrhaging necessitated right middle lobe resection. Attempts to control the bleeding from the intercostal artery were futile becoming technically more difficult due to a comminuted fracture of the ribs at the site of entry of the knife. During these attempts the patient became moribund. As a last resort the pleural cavity was packed with abdominal towels and the patient was transferred to the intensive care unit (ICU). The patient was returned to surgery after 48 h at which time the packing was removed with no further bleeding. On day 11 postoperatively drainage of the pleural collection was carried out and decortication of the right lower lobe. The patient was discharged 23 days after admission in a good general condition. This case report demonstrates that in exceptional circumstances packing of the pleural cavity to control bleeding can be considered as a method of damage control in penetrating chest trauma.

Chiari Type 1 malformation: CSF flow dynamics and morphology in the posterior fossa and craniocervical junction and correlation of these findings with syrinx formation.

BACKGROUND: Chiari type 1 malformation (CMI) is a disorder in which cerebellar tonsils descend below the foramen magnum. Although syringomyelia associated with CMI thought to be caused by hypoplastic posterior fossa and stenosis at the craniocervical junction; it has characteristic neurological and radiological features and the exact mechanism of syringomyelia remains unknown. PURPOSE: The purposes of this study were to gain insight into morphological changes in posterior fossa and to find whether there is a difference in aqueductal stroke volume (ASV) between CMI with syrinx and without syrinx which may be an underlying mechanism of syrinx development. MATERIALS AND METHODS: We consecutively evaluated 85 patients with Chiari malformation between January 2017 and December 2019 who had undergone phase-contrast MRI examination for CSF flow and between 18-60-years-old. We divided patients into two groups as subjects with syrinx (n=19) and without syrinx (n=66). After evaluating morphological changes, peak and average velocity (cm/s), forward and reverse flow volume (µl), net forward flow volume (µl), ASV (aqueductal stroke volume) (µl), aqueductus Sylvi (AS) area (mm2), and prepontine cistern diameter to AS diameter ratio (PPC/AS) were calculated. Distribution of variables from two groups was evaluated by using Shapiro-Wilk normality test. Independent t test was used for groups comparison. RESULTS: The forward and reverse volumes were statistically significantly higher in patients with syrinx (P=0.021, P=0.005 respectively). ASV was significantly increased in patients with syringomyelia (P=0.014). The PPC/AS was significantly lower in patients with syrinx compared to those without (P <0.001). AS area was significantly larger in those with syrinx. (P=0.022). The diameter of foramen magnum was significantly lower in patients with syrinx than those without (P <0.0001). The diameter of the herniated tonsilla at the foramen magnum level was found to be significantly lower in those with syrinx (P=0.011). CONCLUSION: Foramen magnum diameter, ASV, diameter of herniated tonsil, and PPC/AS ratio are important factors in syrinx development.

Gap-like feature observed in the non-magnetic topological insulators.

Non-magnetic gap at the Dirac point of topological insulators remains an open question in the field. Here, we present angle-resolved photoemission spectroscopy experiments performed on Cr-doped Bi2Se3 and showed that the Dirac point is progressively buried by the bulk bands and a low spectral weight region in the vicinity of the Dirac point appears. These two mechanisms lead to spectral weight suppression region being mistakenly identified as an energy gap in earlier studies. We further calculated the band structure and found that the original Dirac point splits into two nodes due to the impurity resonant states and the energy separation between the nodes is the low density of state region which appears to be like an energy gap in potoemission experiments. We supported our arguments by presenting photoemission experiments carried out with on- and off- resonant photon energies. Our observation resolves the widely debated questions of apparent energy gap opening at the Dirac point without long range ferromagnetic order in topological insulators.

A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study.

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the utility of a laparoscopic approach in the management of patients with right lower abdominal pain and in the quality of life after the operation. METHODS: Patients with suspected appendicitis were included in the study. They were randomly assigned either to treatment with a traditional open approach or with a laparoscopic approach. The patients' data, including demographic data, complications and gastro-intestinal quality of life index scores, were collected at the 6th week and 6th month and compared between the groups. RESULTS: Overall, 83 appendectomies were performed. Other pathologies were ovulation bleeding, ovarian cyst, Meckel's diverticulum, ectopic pregnancy and leiomyoma of the uterus. Negative appendectomy rate was 7%. Severe infection occurred in five of the open group. The advantages of the laparoscopy also showed significantly in hospital stay (55.80 +/- 20.97 hours vs. 75.06 +/- 35.14 hours), the need for narcotics and in visual analog score, as well as in the gastrointestinal quality of life index (85.88 +/- 9.73 vs 101.30 +/- 9.31). The quality of life is still better in the long-term (95.14 +/- 8.45 vs 120.36 +/- 10.25). When the groups were compared according to the subgroups of gastro-intestinal quality of life index, except for disease-specific items, in all categories a significant improvement was seen in the laparoscopically treated patients. This improvement was observed in the follow-up period also. However, the hospital costs (987.50 +/- 77.25 USD vs. 406.27 +/- 100.59 USD) and operative time (56.25 +/- 10.9 vs. 49.41 +/- 11.76 minutes) still continued to be a problem for the laparoscopic group. CONCLUSION: Laparoscopic appendectomy is a safe method, which also has advantages of diagnostic procedure for other pathologies, a better quality of life both in the early and late period, and a short hospital stay. The important advantage is also seen in the late period with better quality of life.

The role of nystagmus in silicone oil emulsification after pars plana vitrectomy and silicone oil injection for complex retinal detachment.

PURPOSE: The purpose of this study was to determine whether nystagmus has a role in silicone oil emulsification after pars plana vitrectomy and silicone oil injection for complex retinal detachment. METHODS: A retrospective review was conducted of the clinical and operative records of eight eyes with nystagmus that underwent pars plana vitrectomy and silicone oil injection for repair of retinal detachment associated with proliferative vitreoretinopathy. Three male (37.5%) and 5 female (62.5%) patients were included in this study. The mean age was 36.4 years (range, 19 to 54 years) and the mean follow-up time was 18.3 months (range, 5 to 49 months). RESULTS: Three eyes underwent combined lensectomy and vitrectomy. During the initial postoperative period, retinal attachment was obtained in 6 (75%) patients. Two of eight eyes required further surgery. Silicone oil emulsification occurred in all eyes to different degrees in the 1- to 3-month postoperative period. No inverse hypopyon was observed in any of patients. Three of eight eyes developed open angle glaucoma due to silicone oil emulsification before the silicone oil removal. In these patients, intraocular pressure was controlled successfully by medical therapy. Silicone oil removal was performed before the planned time because of early emulsification. After the removal of silicone oil, two of three eyes had established open angle glaucoma and medical therapy was maintained. After the removal of silicone oil, recurrent retinal detachment developed in two eyes and one of them developed phthisis bulbi. CONCLUSIONS: Silicone oil emulsification may develop earlier than expected in patients with nystagmus who underwent pars plana vitrectomy combined with silicone oil injection.

Primary intraocular lymphoma: another great masquerader.

PURPOSE: To describe diverse and atypical presentations of the most common masquerader in neoplastic masquerade syndromes. METHODS: Retrospective interventional case series. The authors identified three patients who presented with atypical and diagnostically challenging masquerading manifestations. These patients were eventually found to have primary intraocular lymphoma (PIOL). Their case histories, presenting signs and symptoms, diagnostic tests, and treatments are described. RESULTS: Patient 1 masqueraded as viral retinitis and branch retinal vein occlusion but was resistant to 5 weeks of oral and intravenous acyclovir. Patient 2 presented with choroidal infiltrates and vision loss. This patient had had breast carcinoma for the last 25 years and secondary metastasis was suspected. Patient 3 had chronic uveo-retinitis and a chronic Propionibacterium acnes infection was suspected. All three patients were diagnosed with PIOL. CONCLUSIONS: PIOL is an aggressive masquerader and not only presents clinical diagnostic difficulties but also requires expert tissue handling and analysis, so that early diagnosis can be made and therapy can be instituted.

The role of NMDA glutamate receptors in lung injury caused by chronic long-term intermittent hypobaric hypoxia

Chronic intermittent hypoxia (CIH), a component of sleep apnea-hypopnea syndrome, is suggested to cause damage to lung tissue, and the role of glutamate is not well studied. We used a chronic long-term intermittent hypobaric hypoxia (CLTIHH) model of rats to find out if such procedure causes lung injury and the potential effect of N-methyl-D-aspartate receptors (NMDARs) by using receptor antagonist MK-801 (dizocilpine). Thirty-two rats were placed into four groups; a control and three CLTIHH groups where rats were placed into a low-pressure chamber set to 430 mmHg for 5 h/day, 5 days/week, for 5 weeks. Only one group received MK-801 (0.3 mg/kg, ip) daily. We evaluated tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and nuclear factor (NF)-kB for the inflammatory process, superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), total antioxidant status (TAS), and total oxidant status (TOS) for oxidative stress, and caspase-9 levels. Blood plasma, bronchoalveolar fluid (BALF), and lung tissue extracts were evaluated. Both oxidant and inflammatory parameters were significantly increased in all the mediums of the CLTIHH groups except the group that received MK-801. Significant evidence was collected on MK-801 alleviating the effect of CLTIHH. Histological evaluations revealed lung damage and fibrotic changes in the CLTIHH groups. It was first shown that the CLTIHH procedure caused chronic lung injury, and that inflammation and oxidant stress were influential in the formation of lung injury. Secondly, NMDAR antagonist MK-801 effectively inhibited the development of lung injury and fibrosis.

Efficacy of right anterior sector drainage reconstruction in right-lobe live-donor transplantation.

BACKGROUND: Without including the middle hepatic vein (MHV) into right-lobe grafts, venous drainage of the anterior segment (AS) has always been a concern. The efficacy and the necessity of additional venous reconstruction in the AS for graft viability and function are still controversial. METHODS: Since February 2002, 57 right-lobe grafts were implanted into adult recipients. The mean graft to ideal recipient weight ratio (GRWR) was 1.3% (minimum: 0.8%, maximum 2.1%). All minor venous tributaries to the MHV less than 5 mm in diameter were ligated. The management of MHV tributaries was categorized into three groups: (A) no major tributaries (n = 33); (B) major tributaries ligated (n = 11); and (C) major tributaries reconstructed (n = 13). Reconstructions were established using vascular grafts (PTF, n = 8; cadaveric, n = 2) or joining with right hepatic vein orifice (n = 6). The groups were homogenous in age, gender, MELD (17 +/- 6, 16 +/- 4, 18 +/- 7), graft weight (817 +/- 181, 838 +/- 152, and 855 +/- 159 g), and graft/ideal liver weight ratio (0.54 +/- 0.12, 0.57 +/- 0.13, and 0.57 +/- 0.1, respectively). We investigated the volume of ascites, serum bilirubin, albumin, and liver enzyme levels and INR on postoperative day 4 (POD4) and POD21. RESULTS: Two patients died of MRSA sepsis on POD18 and POD23 (MELD: 24 and 28) after initial graft function. Their graft weights were 800 g and 980 g, and their volumes were 47% (group B) and 62% (group A) of the ideal liver mass of the recipients, respectively. One PTF and another cadaveric vascular graft were found occluded 4 and 7 days after implantation without any negative consequence. At 6-month follow-up, the remaining 55 patients were alive with primary liver grafts. Vascular reconstructions were patent except for 2 early occlusions. Among the 3 groups, no significant difference was found on POD4. Three weeks after transplantation, the mean AST level in the major ligation group (46.7 +/- 8.14) was significantly higher than in the minor ligatation group (29.6 +/- 8.6) but not in the major reconstruction group (33.7 +/- 3.7; P = .03 and P = .29). The mean albumin level was highest after minor ligation (3.2 +/- 0.18), which was significantly better than the major reconstruction (2.7 +/- 0.1) but not the major ligation (3.1 +/- 0.14) cohorts (P = .02 and P = .13). CONCLUSIONS: In this study of a limited number of cases, right-lobe liver grafts with GRWR of > or =1.1% displayed optimal graft function without additional venous reconstruction to the AS.

Adult ileal intussusception: an unusual emergency condition.

Adult intussusception occurs infrequently and differs from the childhood condition in its presentation, cause, and treatment. Nonspecific symptoms can delay diagnosis; most cases are diagnosed at emergency laparotomy. Increased use of computed tomographic scanning to evaluate patients with abdominal pain can enhance reliable preoperative diagnosis. Treatment entails simple bowel resection in most cases. Reduction is controversial, especially in cases of colonic intussusception. This report describes the diagnosis and management of a case of adult ileal intussusception caused by an inflammatory fibroid polyp-a rare lesion of the gastrointestinal tract.

Spontaneous gastrosplenic fistula in primary gastric lymphoma: Surgical management.

Gastrosplenic fistula formation resulting from primary gastric malignancy is rare and should be managed as a matter of emergency. We report a patient who was diagnosed with primary non-Hodgkin's lymphoma and who underwent surgical treatment for gastrosplenic fistula.