[A comparative study of transperitoneal transmesenteric approach versus paracolic sulci approach laparoscopic adrenal tumorectomy for treatment of primary hyperaldosteronism on left side].

Objective: To compare the therapeutic effect of transperitoneal transmesenteric approach versus paracolic sulci approach laparoscopic adrenal tumorectomy for treatment of left-sided primary hyperaldosteronism. Methods: From January 2017 to July 2019, the clinical data of 70 patients with left-sided primary hyperaldosteronism (PHA) who underwent surgery in the First Hospital of Lanzhou University and five other hospitals in Gansu Province were retrospectively analyzed. There are 43 male and 27 female patients. Among them,28 patients were performed transperitoneal transmesenteric approach laparoscopic adrenal tumorectomy and 42 patients were performed transperitoneal paracolic sulci approach laparoscopic adrenal tumorectomy. The general information and perioperative data of the two groups were compared. Results: All 70 cases of surgery were successfully completed. As compared with the paracolic sulci approach group, the operation time was significantly shorter in the transmesenteric approach group[(26.7±8.8)vs (38.9±7.1)min,P<0.001)], and the estimated blood loss was less in the transmesenteric approach group[45(30,50) vs 50(40,60)ml,P=0.042]. There was no statistically significant difference in the postoperative hospitalization days between the two groups[(4.4±1.0)vs(4.5±1.0)d, P=0.669)]. The electrolytes and aldosterone to renin ratio returned to a healthy level in the postoperative one month, and the blood pressure also returned to a healthy level in 53 (75.7%) patients. Conclusion: Transperitoneal transmesenteric approach laparoscopic adrenal tumorectomy is safe and feasible, with a short operation time and relatively less estimated blood loss.

Standing on the shoulder of giants: Tubed pedicle radial forearm flap reconstruction for cutis aplasia.

INTRODUCTION: Aplasia cutis congenita presents a reconstructive challenge. We report the use of a tube pedicle radial forearm flap for scalp resurfacing in a patient who previously had two failed free flaps. CASE REPORT: A young male patient with cutis aplasia presented with a large full thickness defect of his occiput. He had multiple episodes of recurrent infections and a history of numerous surgeries as a child including tissue expansions. As a young adult he had two failed free flap reconstructions. A CT angiogram failed to demonstrate any adequate bloody supply to the scalp that would be suitable for another free tissue transfer. We successfully performed a tube pedicled flap from his forearm achieving good functional and aesthetic results. CONCLUSION: Originally descried by Filatov, the tube pedicle flaps remains a useful salvage option in the armamentarium of modern-day reconstruction.

Transcutaneous Peripheral Nerve Stimulation for the Treatment of Neuropathic Pain in the Upper Limb.

BACKGROUND: A small number of patients develop intractable peripheral nerve pain following injury or surgery to the upper limb that is refractory to pharmacological treatment. This study reports our results of using transcutaneous peripheral nerve stimulation (TPNS), a non-invasive form of neuromodulation, to treat this difficult problem. METHODS: Seventy-two patients were treated for intractable pain in the upper limb using this technique. Electrical current was delivered transcutaneously through a handheld probe, placed on the skin overlying the affected peripheral nerve proximal to the site of pain. Pain severity was determined before and immediately after treatment by subjective patient self-assessment using a visual analogue pain scale. Pre-post treatment changes in pain severity were analysed by Student's test for paired data. Outcome in respect of overall effectiveness of this treatment, was graded according to the maximum duration of pain relief achieved. RESULTS: Overall, TPNS reduced pain intensity from 8.4 (SD 1.6) before treatment to 4.2 (SD 3.5) immediately after treatment, a highly significant effect ([Formula: see text]). The treatment achieved cure in 8/72 (11%) of our patients and a useful therapeutic outcome (pain relief ≥ 1 day) in 27/72 (38%). The treatment failed in 37/72 (51%). CONCLUSIONS: TPNS warrants consideration as a therapy for neuropathic pain in the upper limb after drug treatment has failed and before offering surgery or spinal root stimulation.

A new technique for closed management of displaced intra-articular fractures of metacarpal and phalangeal head delayed on presentation: report of eight cases.

We present the outcomes of the delayed management of eight displaced intra-articular fractures of the metacarpal and phalangeal heads treated with capsuloligamentotaxis using the Penning mini-external fixator. Closed anatomical reduction with a 2 mm over-distraction was achieved at the time of operation at an average of 20 days after the initial injury. Excellent outcomes in terms of function and pain were obtained at 6 month's follow-up in all cases. This technique is simple, minimally invasive, and effective, with minimal complications.

Mycobacterium kanasii flexor tenosynovitis of the finger.

We report an extreme case of Mycobacterium kanasii flexor tenosynovitis with flexor tendon rupture in a healthy 65-year-old left-hand dominant Caucasian housewife. This case highlights the diagnostic conundrum of atypical mycobacteria infections due to their insidious presentation, the need for a high index of suspicion to prevent worsening or delaying the diagnosis from inappropriate steroid use and that these infections can occur in otherwise healthy individuals.

A rare report of foetal lingual cyst excised with harmonic scalpel.

Diagnosis of foetal lingual cysts is extremely rare. If large enough, it can compromise the upper oropharyngeal airway. A case of a large ventral lingual thyroglossal duct cyst mimicking a ranula was identified at 20 weeks of gestation and excised 11 weeks postnatally using the harmonic scalpel. The diagnosis and the benefit of ultrasonic dissection in the treatment of glossal lesions are reviewed.