Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts.

The viability of cartilage grafts has been well documented; however, controversy still exists about the viability of crushed cartilage. Recently, there has been a tendency to use diced cartilage grafts wrapped with oxidized regenerated cellulose (Surgicel) sheets for improving dorsal contour in rhinoplasty. The viability of diced cartilage grafts and the effect of Surgicel on cartilage grafts are not well known. In this study, we used ear cartilage from 18 New Zealand rabbits. Cartilage grafts were transplanted to surgically created subcutaneous pockets on the back of the rabbits on both the left and right sides. There were three groups: (1) intact cartilage grafts, (2) crushed cartilage grafts, and (3) diced cartilage grafts. The grafts that were transplanted to the right side were wrapped with Surgicel. Cartilage grafts in all groups were viable. In grafts that were wrapped with Surgicel, a marked increase in the collagen content was investigated. Grafts that were wrapped with Surgicel demonstrated no evidence of proliferation, whereas the bare cartilage grafts demonstrated significant amounts of proliferation.

Adenomatoid tumor of the uterus in a patient with chronic renal failure.

A case of adenomatoid tumor of the uterus in a 34-year-old patient, who had received a renal transplant and was undergoing immunosuppresive therapy is presented. At surgery, there were a total of eight nodular intramural and subserous masses thought to be leiomyoma nodules, and tumor excision was unusually, hardly performed because the nodules were strictly adherent to the myometrium. All the specimens yielded the same pathological diagnosis - adenomatoid tumor. This case is unusual because of the multiple nodular pattern and its association with the immunocompromised status of the patient. Although adenomatoid tumors have not been shown to recur, we are in doubt in our case, because the uterus is still intact and the immunocompromised status of the patient might have a role in the extensive growth and also in the possibility of recurrence.

A viable residual spinal hydatid cyst cured with albendazole. Case report.

Spinal hydatid disease is a rare entity that frequently yields to severe, acute-onset neurological deficits. Although the gold standard treatment is total surgical removal of the cysts without inducing any spillage, it may not be possible to perform this in patients with multiple and fragile cysts. In such cases, the neural structures should be adequately decompressed and albendazole should be administered promptly. The authors describe the case of a 13-year-old girl who was admitted with a history of back pain and acute-onset lower-extremity weakness. Magnetic resonance imaging scans demonstrated severe spinal cord compression caused by multiple cysts involving T-4 and the mediastinum. The patient underwent surgery, and the cysts were removed, except for one cyst that was hardly exposed. Following histopathological confirmation of spinal hydatid disease, she was treated with albendazole for 1 year. One year postoperatively, the residual cyst had gradually shrunk and had almost disappeared. Although a single case is not sufficiently promising, we believe that administration of albendazole is efficient to prevent recurrences in cases in which it is not possible to obtain total removal of the cysts without inducing spillage.

The effects of tissue expansion on skin lymph flow and lymphatics: an experimental study in rabbits.

Histomorphological, physiological, and biomechanical changes of the skin and tissue that are being expanded have been extensively studied in the past. The purpose of this study was to investigate whether the skin lymph flow and lymphatics may be influenced during tissue expansion, and also to study different pattern of vascular supply of skin on lymph flow during tissue expansion. The skin lymph flow was quantitatively assessed by 99mTc-dextran lymphoscintigraphy, and the structure of dermal lymphatics was evaluated by histological examination in 12 rabbits. Lymphoscintigraphic results showed that lymph flow is significantly reduced both in expanded and non-expanded (sham-operated) skin. Histologically, we saw widespread lymphatic distension in both expanded and non-expanded skin. There were no quantitative differences in the number of lymphatic vessels compared with control skin. We did not see any lymphatic capillaries in the subdermal capsule of either expanded or non-expanded skin. These results show that lymphostasis has an obstructive (mechanical) aetiology, and the tissue expander itself reduces the lymph flow regardless of expansion, and interferes with the formation of new lymphatic vessels.

Rete testis adenocarcinoma recurring in the inguinal lymph nodes. A case report.

Adenocarcinoma of the rete testis is a rare neoplasm with 41 reported cases in the literature till 1994. In most of the reported cases, the neoplasm presents as a scrotal mass with diffuse enlargement. The aetiology is unknown and the clinical course of the tumour is not very well defined. In six of the reported cases metastatic spread of the tumour to inguinal lymph nodes was demonstrated in the follow-up. We report herein a distinctive case of rete testis adenocarcinoma presenting as an isolated inguinal recurrence one year after radical orchiectomy.

[Treatment of depression with sleep deprivation and sleep phase advancement]. / Behandlung von Depressionen mit Schlafentzug und Schlafphasenvorverlagerung.

Total sleep deprivation (TSD) exerts beneficial but only transient effects on mood in approximately 60% of the patients with a major depressive disorder (MDD). The positive effect of TSD is generally reversed after the next night of sleep. A pilot study of our group indicated that a consecutive one week phase advance of the sleep phase stabilized mood in more than half of the patients who responded to TSD. However, the majority of patients in our pilot study had been treated concomitantly with antidepressive medication. To exclude a possible synergistic effect of simultaneous antidepressive medication and the sleep-wake manipulation in the present study eleven medicated and sixteen drug-free depressed patients were investigated. In two thirds of the patients relapse into depression after successful TSD could be prevented. This effect seemed to be independent of adjunct antidepressant pharmacotherapy. Ten of these patients were studied polysomnographically prior to and during the treatment. Data analysis revealed that during the advance of the sleep phase no prolonged partial sleep deprivation took place. At the end of the study REM % had even increased and REM latency was still short in spite of clinical improvement, thus contradicting the assumption that REM sleep suppression is a necessary prerequisite for antidepressive therapy. The results support the hypothesis of a "critical phase" in the morning hours during which sleep can reinduce depressive mood and, vice versa, prevention of sleep during this time may act antidepressively.

Retroperitoneal malignant teratoma. A case report.

Retroperitoneal teratomas are rare in adults. These tumours may be benign or malignant and are composed of multiple tissues foreign to the part in which they arise. We report a malignant teratoma of retroperitoneal space. In searching the literature, we have been able to find 39 cases reported since 1937. Of the forty cases reported (including this case), only ten (25%) were malignant.

[Chronotherapeutic approaches in depressive disorders]. / Chronotherapeutische Ansätze bei depressiven Erkrankungen.

Sleep deprivation has been regarded as a beneficial treatment modality for about 60% of patients with Major Depressive Disorder. Unfortunately, however, more than 80% of the improved patients relapse into depression after the next night of sleep. In the present study we tried to prevent relapses into depression after successful total sleep deprivation (TSD) by treating 27 patients suffering from a Major Depressive Disorder according to DSM-III-R with a combination of sleep deprivation with consecutive sleep phase advance for 1 week. Advancing the sleep period to 5.00 p.m. until 12.00 p.m. following TSD and then gradually shifting back by 1 h daily the sleep period to the normal phase position (11.00 p.m. until 6.00 a.m.) prevented 61% of these patients from relapsing into depression. Thus, the combination of sleep deprivation with consecutive sleep phase advance has been proven to be an effective antidepressant treatment besides other well established antidepressive treatment modalities.

Reticulate acropigmentation of Kitamura: two case reports.

BACKGROUND: Reticulate acropigmentation of Kitamura (RAK) is an autosomal dominantly inherited dermatosis. CASE REPORTS: Two patients are described with the clinical and histopathologic features of reticulate acropigementation of Kitamura. CONCLUSIONS: We speculate that RAK and the Dowling-Degos disease (DDD) are the same diseases.