Pilot study of intraoperative digital imaging with the use of a mammograph for assessment of bone surgical margins in the head and neck region.

AIM: To investigate alternative possibilities for the intraoperative evaluation of surgical margins after bone resection utilizing more conventional hospital infrastructure technologies. MATERIALS AND METHODS: A small pilot study was performed using digital mammograph imaging intraoperatively on 16 surgical specimens of bone tumours or malignancies with bone infiltration of the head and neck area, with the aim of evaluating the resection margins. RESULTS: In thirteen cases the intraoperative specimen images indicated clinically complete excision. In two cases incomplete resection or close proximity of margins was detected, which required additional resection. CONCLUSIONS: The results indicated that intraoperative specimen radiography can prove useful in evaluating completeness of excision. The significance of intraoperative assessment of surgical margin is of paramount importance when immediate reconstruction is performed. This proposed method is cheap, easy to perform and fast. Its cost-benefit ratio is superior than that of any other available technique. Intraoperative analysis of specimens with digital mammography imaging can potentially become a useful tool for immediate evaluation of osseous margins after resection.

The stapled hemorrhoidopexy syndrome: a new clinical entity?

PURPOSE: Haemorrhoidal disease is a rather common disease of unknown cause. A new technique for treating prolapsing haemorrhoids known as the stapled hemorrhoidopexy (SH) or the "Longo procedure" is widely used. Serious adverse events were reported in 2000 and some discussion over the syndrome but nothing since. METHODS: Two hundred and five patients underwent SH by our surgical team at the Interbalkan European Medical Center. Modified SH was performed. RESULTS: Despite the low incidence of postoperative complications (11/205), 36.58% of patients developed syndrome comprised of urgency to defecate, sensation of anal foreign body and incomplete defecation and mild cramp like anal discomfort, immediately after surgery or in the following 48 h. There is not statistically significant relationship between the presence of the syndrome and the gender, the presence of muscle fibres in the resected "ring" the degree of haemorrhoidal disease, age and ring length. CONCLUSION: Observations led us to conclude that the stapled hemorrhoidopexy syndrome (SHS) is probably caused by the irritating presence of the titanium staples in the rectal mucosa and by the resection itself.

Immunohistochemical investigation of CD34 antigen in male breast carcinoma.

A total of 30 archival cases of male breast carcinoma were studied immunohistochemically for the expression of CD34 antigen. An obvious CD34 staining was found in three cases. By adding the original CD34-positive case, recently published as unique CD34-stained male breast carcinoma, the number of positive cases comes to four. This case was classified as an invasive papillary carcinoma of solid conformation, whereas the three other cases were invasive ductal carcinomas, not otherwise specified. The aim of this study is to establish whether the CD34 positivity, observed in the case of papillary subtype, was a case-specific finding. CD34 expression in the male breast carcinoma, according to our findings, seems to be neither a feature presented exclusively by a singular case nor a specific immunophenotype characterising a special type. The presence or preservation of CD34 antigen in four totally male breast carcinomas may be considered as a novel finding that supports a relationship between these tumours and the progenitor CD34-positive stem cells, committed to the organogenesis of mammary gland. In this context we hypothesise an origin of male breast carcinoma from the stem cells expressing or not the CD34 antigen according to their stage of differentiation.