¿Cuándo se debe realizar la fijación testicular contralateral en pacientes pospuberales con torsión testicular? Estudio comparativo / When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study

Objetivo En este estudio nos propusimos averiguar cuál es el momento óptimo para realizar la fijación testicular contralateral evaluando nuestros resultados de diez años en pacientes pospuberales con torsión testicular bajo un enfoque centrado en el paciente. Métodos Los pacientes pospuberales con diagnóstico de torsión testicular en un hospital terciario entre enero de 2012 y septiembre de 2022 se dividieron en dos grupos según los criterios del «enfoque centrado en el paciente» que adoptamos en nuestro centro. En el grupo1 se fijó el testículo contralateral en el mismo acto quirúrgico y en el grupo2 la fijación se realizó de forma diferida. Ambos grupos fueron examinados retrospectivamente, analizados estadísticamente y comparados. Resultados Un total de 41 pacientes se incluyeron en el estudio. En 19 (46,3%) de ellos se realizó fijación en el mismo acto, y en 22 (53,7%) se efectuó la fijación testicular contralateral de forma electiva. Se observó dehiscencia precoz de la herida en un paciente de cada grupo (4,5% grupo1 frente al 5,3% grupo2). En el periodo postoperatorio no se detectó atrofia ni torsión testicular contralateral en ningún grupo del estudio durante el seguimiento de 1año. Conclusión No existe ningún algoritmo para determinar el momento óptimo en que debe realizarse la fijación testicular contralateral en pacientes pospuberales con torsión testicular. Mediante enfoques centrados en el paciente, en los que se da prioridad a las características clínicas del paciente para determinar cuándo realizar la fijación testicular contralateral, se pueden obtener resultados que demuestran su eficacia y su seguridad (AU)

Objective In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. Methods Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into two groups according to the «patient-based approach» criteria we adopted in our clinic. Group1 in whom the contralateral teste was fixed in the same surgical act and group2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. Results A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% group1 vs. 5.3% group2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. Conclusion There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results (AU)

When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study.

OBJECTIVE: In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. METHODS: Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. RESULTS: A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. CONCLUSION: There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

Biofilm formation, antibiotic resistance and genotyping of Shiga toxin-producing Escherichia coli isolated from retail chicken meats.

1. The Shiga toxin-producing Escherichia coli (STEC) is a hazardous zoonotic agent for chicken meat consumers. This study determined the serogroups and evaluated the virulence genes, antibiotic resistance, biofilm-forming profiles and genetic relationships of STEC isolates in chicken meat.2. A total of 100 samples belonging to dressed-whole chicken and different parts of the chicken (wing, breast, thigh, drumstick) were collected between September and November 2019 from different retail markets in Kayseri, Türkiye.3. Phenotypic (identification, disc diffusion test, Congo red agar and microtitre plate tests) and molecular tests (identification, serogrouping, virulence factors, biofilm, antibiotic susceptibility, 16S rRNA sequencing and enterobacterial repetitive intergenic consensus-PCR for typing of the isolates) were carried out.4. E. coli was isolated from 35% of the samples and 35% of the samples harboured at least one STEC. Among 35 STEC isolates, 3 (8.5%), 6 (17.1%), 2 (5.7%) and 3 (8.5%) were found to be positive for fliCH2, fliCH8, fliCH11, fliCH19 genes, respectively. Out of 35 STEC positive isolates, 4 (11.4%) were identified as E. coli O157, from which 2 (5.7%) were E. coli O157:H7. E. coli O157 was detected in two (10%), one (5%), one (5%) of the thigh, drumstick and whole chicken samples, respectively.5. Biofilm-forming ability was reported in 33 (94.2%) of 35 E. coli isolates, whilst the biofilm-associated genes detected among 35 STEC isolates included csgA (88.5%), fimH (88.5%), bcsA (85.7%), agn43 (14.2%) and papC (8.5%). The STEC strains showed resistance against ampicillin (88.5%) and erythromycin (88.5%), followed by tetracycline (74.2%) and gentamicin (25.7%). However, the distribution of isolates harbouring blaCMY, ere(A), tet(A) and aac(3)-IV antibiotic resistance genes was found to be 17.1%, 11.4%, 85.7% and 5.7%, respectively.6. ERIC-PCR showed that E. coli strains obtained from different parts and whole of chicken samples had genetic diversities. ERIC-PCR patterns grouped strains of 35 STEC into eight clusters designated A-H, with 73% similarity. Proper hygiene measures and staff training are essential for public health during poultry processing and in retail stores to control STEC.

Chemotherapy extravasation injuries beyond the immediate stage: A series of 15 cases treated according to a preset surgical algorithm based on time of presentation.

Chemotherapy extravasation can cause severe harm. There is a lack of evidence-based standardization on the surgical management of such injuries beyond the immediate stage. In an algorithm connecting presentation time post-injury with surgical treatment could help standardize future treatment. This study prospectively validated a preset standardized surgical algorithm based on presentation time in a consecutive series between October 2017 and October 2020. Chemotherapeutic agent, site and extent of injury, type of surgery and outcome at a minimum of 6 months' follow-up were collected. Seven thousand six hundred twelve individuals received chemotherapy during that period; 15 patients suffered extravasation injuries, 2 of whom were referred from outside our hospital. This algorithm distinguished: A) beyond the immediate stage and up to 2 days, treated with saline subcutaneous washout (SCWO) and vacuum-assisted closure (VAC) dressing; B) 2 to 5 days, open surgical decompression and VAC dressing; C) 5 to 10 days, non-operative management with surveillance; and D) more than 10 days, radical necrotic excision with or without VAC dressing and tissue reconstruction. In 2 patients in Group A and 3 patients in Group B, all vesicant symptoms resolved. Five of the 6 patients in Group C (3 vesicant, 3 non-vesicant) did not progress into necrosis or infection, and 1 case of vesicant extravasation progressed to a localized ulcer beyond this period and, as surgery was refused, led to a chronic ulcer with stiffness; 2 cases of non-vesicant extravasation developed a recall phenomenon but resolved after the third cycle. Of the 4 patients in Group D, all vesicant, 2 were treated with no complications, 1 had complex regional pain syndrome (CRPS) due to late presentation, and 1, referred with necrotizing fasciitis, underwent above-elbow amputation but died due to septic shock. This study demonstrated a uniform surgical approach in a series of 15 cases; larger studies are still needed to validate the efficacy of this protocol in reducing morbidity. LEVEL OF EVIDENCE: IV.

A molecular explanation of cardiovascular protection through abnormal cannabidiol: Involving the dysfunctional ß-adrenergic and ATP-sensitive K+ channel activity in cardiovascular compromised preterm infants.

Growing cannabis efficacy, usage frequency, legal supply, and declining awareness of danger recently led to expanded United States cannabis exposure. In turn, cannabis use among elderly people over 50 has more than tripled in a decade and has contributed toward a positive association of cannabis use with pathological conditions, which include type II diabetes, metabolic syndrome, neurovascular and cardiovascular disease. Remarkably, all these outcome results are mediated by the involvement of the ATP-sensitive K+ channel. Cardiovascular compromise is a common syndrome in preterm infants that leads to incidence and death and has been distinguished by poor systemic flow or hypotension. Conditions of cardiovascular compromise include vasodysregulation and myocardial malfunction through dysfunctional ß-adrenergic activity. To avoid organ hypoperfusion progressing to tissue hypoxia-ischemia, inotropic drugs are used. Many premature children, however, respond insufficiently to inotropic activity with adrenergic agonists. The clinical disturbance including myocardial dysfunction through the activation of the ATP-sensitive K+ channel is often involved and the comparative efficacy of the nonpsychotropic cannabinoid, abnormal cannabidiol (Abn-CBD) is not yet known. Therefore, our primary aim was to investigate the molecular exploration of the cannabinoid system specifically Abn-CBD in cardiovascular protection involving dysregulated KATP.

The emerging potential of SIRT-3 in oxidative stress-inflammatory axis associated increased neuroinflammatory component for metabolically impaired neural cell.

People suffering from conditions like epilepsy, where there is an excess of neuron excitement, stroke, and cardiac arrest, where there are oxygen and glucose deprivation, Alzheimer, Parkinson, and Huntington's disease that causes metabolic and also oxidative stress-inflammatory axis; are known to be more vulnerable to disturbances in the metabolism, and there is a lot of inadequacy in defining the inflammation's mechanistic connections, as well as neurodegeneration and the bioenergetic deficiencies in the CNS. We retrieved relevant studies from PubMed/ScienceDirect/Medline/Public library of science/Mendeley/Springer link as well as Google Scholar. We used various keywords both individually and in combination with the literature search. 'Epidemiology of neurodegenerative disorders', 'neurodegenerative diseases associated hyper inflammation', 'Mechanism of inflammation in neuronal cell', 'Involvement of SIRTin inflammation', 'Pathogenesis of mitochondrial associated metabolic impairment in neurons', 'Reactive oxygen species-mediated mitochondrial dysfunction' were a few of the keywords used for the search. PINCH, which is a chronic neuro-inflammatory component that cannot be detected in matured neurons which are healthy, though expressed in oxidative stress inflammatory axis related tauopathy and diseases that cause neurodegeneration. We attempted to study the regulatory mechanisms that cause changes in the bioenergetics and its neuronal defects and mitochondrial subcellular localization that are PINCH protein-mediated on the other handSIRT1, the most intensively studied sirtuin, in oxidative stress-mediated inflammatory consequence for many diseases but very few research data explore the role of SIRT-3 for correction of the chronic neuroinflammatory component. Thus, in this review, we investigate the very recently identified molecules involving in the pathogenesis during stimulated oxidative stress-inflammatory axis in the excitatory neuronal cell which changes brain metabolism. Simultaneously, in CNS neurons of diseases with a component of chronic neuroinflammation which exhibit neuroprotective response, the consequences (mechanistic and biological) of SIRT-3, could be emerging future targets for neurodegenerative disorder treatment with impaired metabolisms.

Atopy patch test in children with cow's milk and hen's egg allergy: Do clinical symptoms matter?

INTRODUCTION AND OBJECTIVES: Since early 2000s, atopy patch test (APT) has been used to determine non-IgE and mixed-type food allergies. Previous studies have reported conflicting results about the diagnostic value of APT in food allergies, due to non-standardized methods. We aimed to determine the diagnostic efficacy of APT compared to open oral food challenge (OFC) in patients diagnosed with cow's milk allergy (CMA) and hen's egg allergy (HEA) manifesting as atopic dermatitis (AD) and gastrointestinal system symptoms. MATERIALS AND METHODS: In patients with suspected AD and/or gastrointestinal manifestations due to CMA and HEA, the results of OFC, APT, skin prick test (SPT) and specific IgE (sIgE) were reviewed. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sIgE, SPT, APT and SPT+APT were calculated. RESULTS: In total 133 patients with suspected CMA (80) and HEA (53) were included in the study. In patients with CMA presenting with gastrointestinal symptoms, APT had sensitivity of 9.1%, specificity of 100%, PPV of 100% and NPV of 48.7%. In atopic dermatitis patients, sensitivity of APT was 71.4%, specificity 90.6%, PPV 62.5% and NPV 93.6%. In patients diagnosed with HEA, the sensitivity, specificity, PPV and NPV values of APT were 72.0%, 78.6%, 47.2% and 75.0%, respectively. In patients diagnosed with HEA presenting with AD, sensitivity of APT was 87.5%, specificity 70.6%, PPV 73.7% and NPV 85.7%. Atopy patch test had lower sensitivity (44.4%) and higher specificity (90.9%) in patients diagnosed with HEA presenting with gastrointestinal symptoms than those presenting with AD. CONCLUSION: Our study showed that APT provided reliable diagnostic accuracy in atopic dermatitis patients. However, APT had low sensitivity in patients with gastrointestinal symptoms

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Atopy patch test in children with cow's milk and hen's egg allergy: Do clinical symptoms matter?

INTRODUCTION AND OBJECTIVES: Since early 2000s, atopy patch test (APT) has been used to determine non-IgE and mixed-type food allergies. Previous studies have reported conflicting results about the diagnostic value of APT in food allergies, due to non-standardized methods. We aimed to determine the diagnostic efficacy of APT compared to open oral food challenge (OFC) in patients diagnosed with cow's milk allergy (CMA) and hen's egg allergy (HEA) manifesting as atopic dermatitis (AD) and gastrointestinal system symptoms. MATERIALS AND METHODS: In patients with suspected AD and/or gastrointestinal manifestations due to CMA and HEA, the results of OFC, APT, skin prick test (SPT) and specific IgE (sIgE) were reviewed. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sIgE, SPT, APT and SPT+APT were calculated. RESULTS: In total 133 patients with suspected CMA (80) and HEA (53) were included in the study. In patients with CMA presenting with gastrointestinal symptoms, APT had sensitivity of 9.1%, specificity of 100%, PPV of 100% and NPV of 48.7%. In atopic dermatitis patients, sensitivity of APT was 71.4%, specificity 90.6%, PPV 62.5% and NPV 93.6%. In patients diagnosed with HEA, the sensitivity, specificity, PPV and NPV values of APT were 72.0%, 78.6%, 47.2% and 75.0%, respectively. In patients diagnosed with HEA presenting with AD, sensitivity of APT was 87.5%, specificity 70.6%, PPV 73.7% and NPV 85.7%. Atopy patch test had lower sensitivity (44.4%) and higher specificity (90.9%) in patients diagnosed with HEA presenting with gastrointestinal symptoms than those presenting with AD. CONCLUSION: Our study showed that APT provided reliable diagnostic accuracy in atopic dermatitis patients. However, APT had low sensitivity in patients with gastrointestinal symptoms.

Microbiological quality of pastrami and associated surfaces at the point of sale in Kayseri, Turkey.

OBJECTIVE: The aim of this study is to trace the possible relations between the hygienic status of slicing utensils and the microbiological quality of pastrami. STUDY DESIGN: A total of 75 pastrami retail markets were visited in Kayseri, Turkey, where the pastrami (a ready-to-eat meat product) is commonly produced and consumed. Sliced pastrami, the cutting board and knife surface swabs were collected from each pastrami retail point to trace possible sources of contamination. METHODS: Samples were analysed for the presence of total viable counts (TVC), total coliforms, Escherichia coli, members of Enterobacteriaceae, Staphylococcus aureus and Listeria spp. In addition, pastrami samples were analysed for sulphite-reducing Clostridium spp. and Toxoplasma gondii. RESULTS: When compared with the target values of related literatures, a total of 6 (8%) pastrami samples were found unsatisfactory as a result of TVC (5.3%), Enterobacteriaceae (5.3%), E. coli (2.6%), S. aureus (2.6%), Listeria spp. (2.6%) and Listeria monocytogenes (1.3%) contaminations. No T. gondii positivity was observed among the pastrami samples. None of the cutting board and knife surface swabs were found to harbour TVC level >103 cfu/cm2, E. coli and L. monocytogenes. For the total coliforms, 7 (9.3%) and 5 (6.6%) of cutting board and knife surface swabs were found to exceed the target value (<2.5 cfu/cm2), respectively. No statistically significant correlation was detected between the organisms on pastrami and slicing utensils indicating that pastrami were not cross-contaminated by the contact surfaces. CONCLUSION: More emphasis needs to be placed for training of food handlers and to apply good hygienic practices at the point of pastrami sale. The conditions at retail points must be monitored and inspections should be tightened to protect public health.

AIDS Awareness: Indispensible Prerequisite Among Fishermen Population.

OBJECTIVES: Fishermen are among the most vulnerable groups for human immunodeficiency virus (HIV)/AIDS with reported high prevalence. Poor knowledge base has been evidenced by a few studies. The present study was conducted to assess the knowledge regarding HIV/AIDS among fishermen of the Kutch coast, Gujarat, India. METHODS: A descriptive cross-sectional study was conducted among 950 fishermen of the Kutch coast, in the months of January-February 2015. Knowledge of HIV/AIDS of fishermen was assessed using structured interview schedules with 12 questions. The information on socio-demographic characteristics was also obtained. Chi-square test and multivariate logistic regression analysis were used for statistical analysis. The confidence level and level of significance were fixed at 95% and 5%, respectively. RESULTS: A major proportion of participants (57.2%) had no access to any potential source of information and had never heard about HIV/AIDS (65.1%). Some of them were aware of modes of transmission of AIDS but only a few of them knew about the methods of prevention. Only 23.1% of participants were observed with appropriate knowledge regarding HIV/AIDS. Bivariate and multivariate analysis revealed significant variation in the proportion of participants with appropriate knowledge with age and educational status. CONCLUSION: Overall, the knowledge of the fishermen community in the present study was evidenced to be poor creating an alarming situation demanding educative interventions as a part of AIDS control programs.

Detection of Escherichia coli O157:H7 using immunomagnetic separation and mPCR in Turkish foods of animal origin.

UNLABELLED: The present study was conducted to investigate the presence of Escherichia coli O157:H7 in food samples of animal origin and to detect its virulence genes by immunomagnetic separation technique and multiplex PCR (mPCR). A total of 500 samples (consisting of diced meat, minced meat, burger, raw cow's milk and raw cow's milk cheese) were analysed. Escherichia coli O157:H7 was detected in 5 (1%) of 500 analysed samples including two diced meat, one minced meat and two raw-milk cheese. None of the burger samples tested contained E. coli O157:H7. Three isolates obtained from minced and diced meat were found to carry stx1 , stx2 , hlyA and eaeA genes whereas two isolates from raw-milk cheese were found to harbour the stx1 , eaeA and hlyA genes. The results of this study suggest that raw meat and raw-milk cheese tested could pose public health problems in consumers with regard to their virulence factors. SIGNIFICANCE AND IMPACT OF THE STUDY: Escherichia coli (E. coli) O157:H7 is an important human pathogen. Escherichia coli 0157:H7 infections have been associated with consumption of uncooked meat and meat products, as well as unpasteurized dairy products. This study demonstrated that without specific tests for E. coli virulence factors raw meat and raw-milk cheese could pose public health problems to Turkish consumers.

Deaths due to differentiated thyroid cancer: a South Island, New Zealand experience: 1984-2009.

AIM: To assess differentiated thyroid cancer (DTC) deaths from the northern half of New Zealand's South Island. METHODS: Retrospective review of Christchurch Hospital Thyroid Clinic and Oncology Department clinical records of resident patients who died of differentiated thyroid cancer of follicular cell origin over the 25-year period 1984-2009. RESULTS: During the 25-year study period 25 patients died from differentiated thyroid cancer. All patients (17 female, 8 male) were Caucasian, with median age 65 years (47-86 years) at presentation. Most (24/25) patients presented with advanced (15 Stage IV, 9 Stage III) disease. Three patients initially presented with cervical lymphadenopathy and four patients with distant metastases--three patients with bone metastases, and one with a pleural effusion. The pathological classification of the tumours included 14 papillary cancers (four were follicular variants), six follicular cancers and five Hurthle cell cancers. The majority of primary tumours were large (>4 cm) and 11 were locally invasive. However one patient had a small (1.3 cm) papillary cancer and presented with a pleural effusion. Surgical removal of the primary tumour was attempted in 24 of the 25 patients, 18 received postoperative radioiodine 131I therapy, and three had external beam radiation therapy. The median survival from diagnosis was 5.5 years (0.2-22 years) with two Stage IV patients (both with Hurthle cell cancers) dying within 4 months. The majority of patients died of metastatic disease but seven died of local disease. CONCLUSIONS: During the 25-year study period, 25 patients died of differentiated thyroid cancer which approximates to one DTC death per year in our region. The median age at diagnosis was 65 years with no patients <45 years of age, and the female to male ration was 2.1:1. Most patients presented with advanced disease--7 patients (28%) had distant metastases. Hurthle cell cancers were over-represented (20%) in our series.

Body contouring following massive weight loss.

Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them.

What is new in abdominoplasty?

The purpose of this article is to first review the traditional abdominoplasty procedure. Current studies focused upon improvements in abdominoplasty surgery and results of surgery will then be discussed.Abdominoplasty is a familiar procedure in plastic surgery and has increased in numbers performed by more than 300% in the past decade ((Brauman & Capocci, 2009).

Risk of active tuberculosis in adult household contacts of smear-positive pulmonary tuberculosis cases.

SETTING: Seven public tuberculosis (TB) dispensaries in Istanbul, Turkey. OBJECTIVE: To investigate the risk of active TB among adult household contacts (age > or = 15 years) of newly diagnosed sputum smear-positive pulmonary TB (PTB) cases in Istanbul. DESIGN: A retrospective analysis of adult household contacts of 1570 pulmonary TB cases registered at seven TB dispensaries in Istanbul between 1997 and 2000. RESULTS: A total of 6188 household contacts (mean contact/index case: 3.9) were included in the study, of whom 4114 (67%) were aged > or = 15 years (mean contact/index case: 2.6); 3310 (80.5%) of these participated in a contact investigation. The mean duration of follow-up was 2.2 years (range 1-4 years); 222 active TB cases (rate 5.4%, 95%CI 5.2-5.6) were detected, 171 within the first year. The incidence of active TB was 2491/100 000 (3555/100 000 in the 15-34 year age group and 1195/100 000 in the > or = 35 year age group, P < 0.0001). Rates of active TB were highest in the 15-24 year (8.5%) and 25-34 year (6.5%) age groups. CONCLUSION: The incidence of active TB among adult household contacts of sputum smear-positive PTB cases was high. This high incidence justifies the prescription of chemopropylaxis not only for children but also for all contacts, especially those aged between 15 and 34 years.

An evaluation of epidural analgesia following circumferential belt lipectomy.

BACKGROUND: Belt lipectomy combines traditional abdominoplasty with a circumferential excision of skin and fat, with resultant buttock and lateral thigh lifts. Because of the extensive nature of the procedure, postoperative pain management can be difficult. Epidural analgesia has been shown to be efficacious in treating postoperative pain. This study compares the postoperative use of epidural analgesia with more traditional pain management regimens in a large series of belt lipectomy patients. METHODS: Charts of 62 belt lipectomy patients were examined retrospectively. Postoperative pain control regimen, pain scores, total amount of opioids administered, and side effects encountered were recorded. Twenty-seven patients had traditional pain control regimens, opioids on demand, and pain control pumps. Thirty-five patients received epidural analgesia as their primary mode of postoperative pain control. RESULTS: Pain scores and total nonepidural opioids used were lower in the epidural analgesia group on postoperative days 0 and 1 compared with the nonepidural group. The two groups converged on postoperative days 2 through 5, sharing similar pain scores and opioid use after discontinuation of epidural analgesia. The incidence of side effects was similar in the two groups, with the exception of pruritus, which was much more prominent in the epidural group. Eight of the 35 epidural patients (23 percent) experienced transient and minor complications associated with epidural therapy; several resolved spontaneously, whereas the balance resolved with cessation or modification of the epidural infusion. CONCLUSIONS: Epidural analgesia is more effective than traditional pain control methods in reducing immediate postoperative pain in belt lipectomy patients. On the basis of these findings, epidural analgesia should also be considered for postoperative pain management in other truncal procedures.

Locally produced bovine bone sponge as a haemostatic agent.

The aim of this study was to evaluate the morphological and biological properties of a locally produced "Bovine Bone Sponge" for use in dentistry. Bovine bone sponge was prepared from local calf bone. Endotoxin level and surface properties were investigated. The pore size and water uptake ability were measured and results were compared with the commercial haemostatic agent. The material was tested for its haemostatic property and its inhibition of alveolar bone resorption in a sheep model following dental extraction. Results revealed a significant difference in haemostatic effect, and a shorter bleeding time and a lower rate of alveolar bone resorption in bovine bone sponge compare to a commercial haemostatic agent.

Truncal body contouring surgery in the massive weight loss patient.

Body contouring of massive weight loss patients is the latest frontier in plastic surgery. It is important to become familiar with the presentation of these patients and with the delineation and effective treatment of their deformities. Because they usually present with circumferential excess, circumferential belt lipectomy treats their truncal contour as a unit. This article details the preoperative work-up, intraoperative technique, and postoperative course for the belt-lipectomy patient. Results and how to predict them are discussed. Complications are enumerated and suggestions offered for avoiding them.

Belt lipectomy for circumferential truncal excess: the University of Iowa experience.

When some patients with circumferential truncal excess undergo traditional abdominoplasty, the trunk is not addressed as a unit. Belt lipectomy, a procedure that combines abdominoplasty with circumferential excision of skin and fat, is often more ideal for these patients. In this article, the authors review the literature on belt lipectomy and evaluate their series of 32 patients who underwent belt lipectomy at the University of Iowa. The evolution and current preoperative markings, intraoperative surgical technique, and postoperative care are described. The patients' charts and their preoperative and postoperative photographs were examined retrospectively. It was found that belt lipectomy improved abdominal contour, abdominal wall laxity, mons pubis ptosis, back rolls, waist contour, and buttocks contour. Initially, the procedure was performed on post-weight-reduction patients only, but its indications were extended to three other groups: patients who were 30 to 50 pounds overweight, patients of normal weight who desired a significant overall truncal improvement, and an obese patient with persistent intraabdominal excess. The improvements were significant in all groups of patients except for the latter patient. Complications included a 37.5 percent seroma rate, a 9.3 percent pulmonary embolus rate, and one dehiscence that required reoperation. The authors concluded that belt lipectomy should be seriously considered for patients who present with circumferential truncal excess and for a select group of normal-weight patients. It is not recommended for the obese patient with excessive intraabdominal content. Furthermore, belt lipectomy should be undertaken only in patients who are well informed about the possible risks and complications.