[Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery].

Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost.

Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical and functional outcomes.

OBJECTIVE: To evaluate the anatomical and functional outcomes following laparoscopic sacrocolpopexy in a local unit. DESIGN: Retrospective case series. SETTING: A regional hospital in Hong Kong. PATIENTS: All women who underwent laparoscopic sacrocolpopexy for symptomatic uterine or post-hysterectomy prolapse from January 2003 to December 2008. MAIN OUTCOME MEASURES: Anatomical outcomes, functional outcomes including complications. RESULTS: A total of 31 patients were recruited. The success rate in treating apical vaginal wall prolapse was 100%. There were no recurrences of vault prolapse (defined as stage II or higher). Approximately 19% of women had anterior vaginal wall prolapse and 23% had urinary stress incontinence postoperatively; 6% had a second operation because of anterior vaginal wall prolapse. The rates of dyspareunia and constipation were low. The mean hospital stay was 4 (range, 2-11) days. Two patients sustained bladder injuries and one rectal injury resulting in a rectovaginal fistula. For three patients the procedure was converted to a laparotomy. CONCLUSIONS: Laparoscopic sacrocolpopexy is feasible in our population and has a high success rate for treating apical vaginal wall prolapse. The incidence of complications was acceptable.

Migration of ventriculoperitoneal shunt into the stomach, presenting with gastric bleeding.

We present an extremely rare complication after ventriculoperitoneal shunting. The peritoneal tube migrated into the stomach 8 months after the operation and patient presented with gastric bleeding.

Intermittent on/off prostaglandin E2 and risedronate are equally anabolic as daily PGE2 alone treatment in cortical bone of ovariectomized rats.

In this study, we evaluated the rat cortical bone changes after a two-cycle, 60-day each (ON/OFF/ON/OFF) treatment with either prostaglandin E2 (OVX/c-PGE2) alone or in combination with risedronate (OVX/c-PGE2+Ris), in comparison with daily treatment with PGE2 for 240 days (OVX/PGE2-240d) in ovariectomized (OVX) rats. At the end of the study, we found that: (1) the overall effectiveness of the treatment on bone mass in the tibial shaft indicates the following ranking: OVX/PGE2-240d = OVX/c-PGE2+Ris > OVX/c-PGE2 > OVX/c-Ris > or = OVX = aging; (2) the same bone mass and architecture were produced in the OVX/PGE2-240d and the OVX/c-PGE2+Ris groups, but the histomorphometric profiles differed in that the former exhibited a higher bone turnover and index of resorption; (3) OVX/c-PGE2+Ris treatment prevented endocortical bone loss and minimized trabecular bone loss during the OFF periods; and (4) the OVX/c-PGE2 alone treatment resulted in the accumulation of less total bone than OVX/PGE2-240d and OVX/c-PGE2+Ris because it could not maintain most of the new subendocortical and marrow trabecular bone generated earlier. In summary, both continuous daily PGE2 and two cycles ON/OFF combined PGE2 and Ris treatments result in more bone mass than two cycles ON/OFF PGE2 alone and Ris alone in estrogen-deficient rats. This study showed that the anabolic effects of PGE2 can be induced and maintained either by continuous administration or by cyclical PGE2+Ris.

Risedronate plus prostaglandin E2 is superior to prostaglandin E2 alone in maintaining the added bone after withdrawal in a non-growing bone site in ovariectomized rats.

Effects of risedronate and prostaglandin E2 (PGE2) alone or in combination on the distal tibia, a non-growing bone site with closed epiphysis at 3 months of age, were studied in ovariectomized (ovx) rats. Six-month-old Sprague-Dawley female rats were either ovx or sham-ovx. Rats were treated immediately after operation either with risedronate (5 micrograms/kg/2x/wk), PGE2 (6 mg/kg/d), or risedronate+PGE2 for 60 days (on-groups) and followed by 60 days without treatment (off-groups). Trabecular area, width and numbers were determined in metaphyseal cancellous bone of the distal tibia. No significant bone loss or structural changes were observed in the distal tibial metaphysis after 120 days of ovx. Risedronate alone did not produce any effect on bone mass during the treatment and the withdrawal periods. PGE2 alone increased the trabecular bone mass associated with thickened trabeculae and increased trabecular numbers. However, some of the newly formed bone was lost at the end of 60 days withdrawal. Combination of risedronate and PGE2 treatment added the same amount of bone mass as PGE2 alone, and the added new bone was maintained during the 60 days withdrawal. These results indicate that treatment with risedronate and PGE2 can preserve the anabolic effect of PGE2 on bone mass for at least 60 days after treatment.

Neural activity in the midbrain correlated with hindlimb extension initiated by locomotor stimulation of the hypothalamus of the anesthetized rat.

Midbrain neuronal activity that correlated with the initiation of locomotion produced by hypothalamic stimulation was studied. Locomotion was elicited by electrical stimulation in the perifornical hypothalamus of 59 rats anesthetized with Nembutal. The first hindlimb extension indexed stepping onset. Single and multiple neurons were recorded ipsilateral to the stimulation site at 2230 sites in the anterior and posterior midbrain. To classify responses, activity patterns averaged around stimulation onset and around the extension onset were examined. Responses with specific correlations to extension onset were Type I; responses not specifically related to the extension onset were Type II. In the anterior midbrain, 6% of sites were Type I and 8% were Type II. The larger Type I responses were frequent in the anterior tegmentum near the central gray. The relative frequency of Type I patterns in the posterior ventrolateral tegmentum was similar. Other regions showed relatively more Type II responses; they included the ventral tegmental area, and the regions near the superior cerebellar peduncle and the posterior central gray. Regional population profiles showed that during the initiation of locomotion, neurons in the posterior peribrachial region responded early and neurons in the anterior dorsal and the posterior ventrolateral tegmentum responded later. The initiation-related activity of Type I neurons in the anterior and posterior midbrain tegmentum suggest that they warrant further study for a role in locomotor initiation.

Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials.

BACKGROUND: Laparoscopic total extraperitoneal (TEP) inguinal hernioplasty is significantly less painful than open repair, but it is not completely painless. Local anesthetics are thought to decrease postoperative pain when placed at the surgical site. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of extraperitoneal bupivacaine treatment during laparoscopic inguinal hernia repair for the reduction of postoperative pain. METHODS: We conducted a systematic review and meta-analysis of RCTs that investigated the outcomes of extraperitoneal bupivacaine analgesia versus control in laparoscopic TEP hernia repair. Pain was assessed using a visual analog scale at 4-6 h and at 24 h following the surgery. The secondary outcomes included complications and analgesia consumption. RESULTS: We reviewed eight trials that included a total of 373 patients. We found no difference between the groups in postoperative pain reduction following laparoscopic TEP inguinal hernia repair. The intensity of pain was not significantly different between the bupivacaine treatment group and the control group. The pooled mean differences in pain scores were -0.26 (95% CI -0.72 to 0.21) at 4-6 h and -0.47 (95% CI -1.24 to 0.29) at 24 h. No bupivacaine-related complications were reported. CONCLUSION: Extraperitoneal bupivacaine treatment during laparoscopic TEP inguinal hernioplasty is not more efficacious for the reduction of postoperative pain than placebo.

Radiofrequency ablation as first-line treatment for small solitary hepatocellular carcinoma: long-term results.

AIMS: To evaluate long-term results of patients with small solitary hepatocellular carcinoma (HCC) and well-preserved liver function who received radiofrequency ablation (RFA) as first-line treatment. MATERIALS AND METHODS: Between November 1999 and June 2007, 247 patients with solitary HCC ≤5 cm and liver status scored as Child-Pugh class A were enrolled. RFA was performed in 224 patients as first-line treatment; 23 patients excluded from RFA because of unfavorable tumor location or their unwillingness, and all of these patients converted to surgical resection. RESULTS: In the 224 patients treated with RFA, the overall 5-, 7-, 10-year survival rates were 59.8%, 55.2%, 33.9%, respectively, and the median of overall survival was 76.1 months. Complete ablation was achieved in 216 patients (96.4%). Major complications occurred in two patients (0.9%), with no treatment-related death or needle track seeding. Indocyanine green retention rate in 15 min (ICGR15) (P = 0.014) and prothrombin activity (P = 0.004) were associated with overall survival. A subgroup of patients with ICGR15 ≤ 10% and prothrombin activity >75% had 5-, 7-, 10-year survival rates of 67.1%, 64.2%, 57.1%, respectively, with a median survival of 87.7 months. The 10-year recurrence-free, tumor-free survival rates were 17.5%, 28.2%, respectively. Serum albumin was the only factor that significantly impacted recurrence-free and tumor-free survival (P = 0.008, 0.002, respectively). CONCLUSION: RFA is considered to be the treatment of first choice for patients with solitary HCC ≤5 cm and well-preserved liver function. Surgery can be used as second-line therapy for few patients if RFA is unfeasible.

A case-control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinoma.

AIMS: To assess whether combining percutaneous radiofrequency ablation (PRFA) with transcatheter arterial chemoembolization (TACE) was better than PRFA alone for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: One hundered twenty patients (with a solitary HCC5.0 cm (p=.031) and for multiple tumors (p=.032), but not for tumors 5 cm or multiple tumors.

Percutaneous radiofrequency ablation for the treatment of hepatocellular carcinoma in the caudate lobe.

AIMS: This study aimed to evaluate the efficacy and safety of percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) in the caudate lobe. PATIENTS AND METHODS: Between January 2001 and December 2006, 17 patients (twelve males and five females) who were between 33 and 68years old (mean 54.3), with caudate lobe HCC [2.0-6.5cm in diameter (mean 3.1)] were treated with either PRFA alone (n=14), or PRFA with percutaneous ethanol injection (n=3) under ultrasound guidance. The right or the anterior approach was used in 12 and 5 patients, respectively. RESULTS: All procedures were performed successfully. There was no mortality and major morbidity due to PRFA. Fourteen tumors (82%) were completely ablated after one to two sessions of treatment. During follow-up (range 3-60, mean 29.1months), two (14%) developed local recurrence. Intrahepatic metastases developed in 9 of 17 patients (53%). No distant metastasis was found. Four patients died (24%), 3 from tumor progression and 1 from hepatic failure. The 1-, 2-, and 4-year overall survivals were 88%, 80%, and 72%, respectively, and the progress free survivals were 47%, 20%, and 10%, respectively. CONCLUSIONS: PRFA is efficacious and safe for patients with HCC in the caudate lobe.