Excision Of Segment Research Articles

Retrocaval Ureter- A Rare Cause Of Hydronephrosis In Children

Retrocaval ureter is a rare congenital anomaly, with the ureter passing posterior to the inferior vena cava. Its rarity and non-specific presentation poses a challenge to surgeons & radiologists in making the correct diagnosis. Though congenital,it commonly manifests in the third to fourth decade of life and very rarely in children. Symptomatic patients need surgical intervention. We present a child who presented with flank pain and diagnosed to have right hydronephroureterosis on radio imaging. During surgery, retrocaval anomaly was noticed. It was successfully treated by ureteral dissection, excision of the retrocaval segment and uretero-ureteral anastomosis.

Segmental portal/superior mesenteric vein resection and reconstruction with the iliac vein after pancreatoduodenectomy.

ObjectiveThe results of segmental venous resection (VR) combined with pancreatoduodenectomy (PD) are controversial but may be promising. Few studies have described reconstruction of the portal/superior mesenteric vein (PV/SMV) with the iliac vein harvested from donation after cardiac death (DCD).MethodsFrom January 2014 to April 2016, PD combined with segmental excision of the PV/SMV (VR group) was performed in 21 patients with adenocarcinoma of the head of the pancreas (ADHP). The authors established a new technique of venous reconstruction using the iliac vein from DCD and analysed patients’ long-term survival.ResultsThe tumour dimensions and tumour staging were greater and the operation time was longer in the VR than PD group; however, no differences in the resection degree, blood loss, complications, reoperation rate, or mortality rate were found. The median survival was similar between the VR and PD groups. The long-term patency of the donor iliac vein was 90%. The degree of resection was a strong predictor of long-term survival.ConclusionSegmental PV/SMV resection combined with PD is applicable to selective patients with venous invasion by ADHP if R0 resection has probably been achieved. An iliac vein obtained by DCD provides an effective graft for venous reconstruction.

Intestinal Atresia: Experience at a Busy Center of North-West India.

Objective: To evaluate the presentation, management, complications and outcome of intestinal atresia (IA) managed at our center over a period of 1 year. Materials and methods: Records of patients of IA admitted in our center from January 2015 to December 2015 were retrospectively analyzed. Demographic data, antenatal history, presenting complaints, location (duodenal, jejunoileal, colonic) of atresia, surgery performed and peri-operative complications were noted. Results: Total 78 cases of IA were included in the analyses. Mean age and weight at the time of presentation was 5.8 days (range 0-50), and 1.9 kg (range 1.1-3.2), respectively. IA included duodenal atresia [DA (32)], jejuno-ileal atresia [JIA (40)], colonic atresia [CA (3)] and atresia at multiple-location (sites) in 3 cases. Ninety percent of patients underwent surgery within 5 to 20 hours of admission. All cases of DA except one underwent Kimura's diamond shaped duodeno-duodenostomy. One case with perforated duodenal web underwent duodenotomy with excision of web. Seven patients with JIA and CA required primary stoma, while rest were managed by excision of dilated proximal segment and primary anastomosis. Complications included anastomotic leak in 5, proximal perforation in 2, functional obstruction in 7, aspiration pneumonitis in 3, and wound infection in 6 patients. Mean hospital stay for survivors was 11 days. Overall survival was 63%. Conclusion: Late presentation, overcrowding in intensive care unit, septicemia, functional obstruction and anastomotic leak are the causes of poor outcome in our series. Early diagnosis, some modification in surgical technique, use of total parenteral nutrition and adequate investigations for other congenital anomalies may improve the outcome.

Large fragment deletion using a CRISPR/Cas9 system in Saccharomyces cerevisiae

Large chromosomal modifications have been performed in natural and laboratory evolution studies and hold tremendous potential for use in foundational research, medicine, and biotechnology applications. Recently, the type II bacterial Clustered Regularly Interspaced Short Palindromic Repeat and CRISPR-associated (CRISPR/Cas9) system has emerged as a powerful tool for genome editing in various organisms. In this study, we applied the CRISPR/Cas9 system to preform large fragment deletions in Saccharomyces cerevisiae and compared the performance activity to that of a traditional method that uses the Latour system. Here we report in S. Cerevisiae the CRIPR/Cas9 system has been used to delete fragments exceeding 30 kb. The use of the CRISPR/Cas9 system for generating chromosomal segment excision showed some potential advantages over the Latour system. All the results indicated that CRISPR/Cas9 system was a rapid, efficient, low-cost, and versatile method for genome editing and that it can be applied in further studies in the fields of biology, agriculture, and medicine.

The IntXO-PSL Recombination System Is a Key Component of the Second Maintenance System for Bacillus anthracis Plasmid pXO1.

We previously identified three noncontiguous regions on Bacillus anthracis plasmid pXO1 that comprise a system for accurate plasmid partitioning and maintenance. However, deletion of these regions did not decrease retention of certain shortened pXO1 plasmids during vegetative growth. Using two genetic tools developed for DNA manipulation in B. anthracis (the Cre-loxP and Flp-FRT systems), we found two other noncontiguous pXO1 regions that together are sufficient for plasmid stability. This second pXO1 maintenance system includes the tubZ and tubR genes, characteristic of a type III partitioning system, and the IntXO recombinase gene (GBAA_RS29165), encoding a tyrosine recombinase, along with its adjacent 37-bp perfect stem-loop (PSL) target. Insertion of either the tubZ and tubR genes or the IntXO-PSL system into an unstable mini-pXO1 plasmid did not restore plasmid stability. The need for the two components of the second pXO1 maintenance system follows from the sequential roles of IntXO-PSL in generating monomeric circular daughter pXO1 molecules (thereby presumably preventing dimer catastrophe) and of TubZ/TubR in partitioning the monomers during cell division. We show that the IntXO recombinase deletes DNA regions located between two PSL sites in a manner similar to the actions of the Cre-loxP and Flp-FRT systems. Tyrosine recombinases catalyze cutting and joining reactions between short specific DNA sequences. Three types of reactions occur: integration and excision of DNA segments, inversion of DNA segments, and separation of monomeric forms from replicating circular DNA molecules. Here we show that the newly discovered site-specific IntXO-PSL recombinase system that contributes to the maintenance of the B. anthracis plasmid pXO1 can be used for genome engineering in a manner similar to that of the Cre-loxP or Flp-FRT system.

External radiopaque marking of Gillies posterior zygomatic arch osteotomy in reduction malarplasty

Although the Gillies (temporal) approach to reduction malarplasty helps preserve supportive soft tissue and avoid facial scars, the osteotomy site is difficult to gauge when using this blind technique. Our experience with external radiopaque marking of the zygomatic arch to guide this process is presented herein. This retrospective review included all patients who underwent reduction malarplasty (as above) at our clinic between August 2013 and September 2015. Procedures entailed L-shaped osteotomy only (no segmental excision) of the zygomatic body by the intraoral route, and posterior zygomatic arch osteotomy by the Gillies approach, guided by external radiopaque markings. Patient characteristics, surgical outcomes, and complications were analyzed to assess the merits of this strategy. Postoperative results were evaluated by both the patients and the surgeon. Most patients expressed satisfaction during the follow-up period (range, 3-27 months). Posterior osteotomies were properly performed as planned, with no major complications (i.e., malunion or nonunion, cheek drooping, or facial nerve injury), although minor complications were recorded in three instances. Use of external radiopaque markings provides guidance during malarplasty by the Gillies approach and may help avoid procedural complications.

Y-type congenital urethral duplication with normal dorsal urethra and small ventral fistula to perineal skin – 28th reported case

Abstract There are numerous types of urethral duplication previously described in the literature including a Type IIA2Y where a large ventral channel branches from the hypoplastic, dorsal, orthotopic urethra. There have been 27 previously reported cases of a similar defect, called “congenital posterior urethrocutaneous fistula” (CUPF) with the only difference being that the ventral urethra is hypoplastic and the dorsal, orthotopic one normal. The difference in treatment for these 2 entities is markedly different, and preoperative identification of the appropriate abnormality is essential. Treatment of CUPF requires only safe excision of the ventral segment, but treatment for a Type IIA2Y duplication requires resection of the hypoplastic, orthotopic urethra and transposition of the larger ventral segment into the dorsal orthotopic position. The outcome for treatment of CUPF is much better than for treatment of Type IIA2Y entities. We herein present the 28th case of CUPF in the English literature with discussion of the anatomy, appropriate diagnostic criteria, and safe method of treatment for these entities.

Endocervical metastasis of pancreatic cancer: A rare case report of long-term survival

Most uterine cervix adenocarcinomas are primary tumors. Here, we report a case of pancreatic cancer that metastasized to the uterine cervix. The patient was a 77-year-old Jehovah's Witness whose pancreatic cancer had been diagnosed 10years previously. As she had refused blood transfusion on religious grounds, the tumor only underwent segmental excision, followed by radiofrequency wave therapy and chemotherapy. During a routine health examination 6years after her pancreatic tumor resection, a tumor in the left lower lobe of her lung was found, and then removed. Three years after the lung surgery, her serum CA19-9 increased. A detailed examination found tumors in the ascending colon and uterine cervix. She underwent chemotherapy and radiotherapy after a right hemicolectomy, endocervical biopsy, and endocervical cytology. At present, about 10years after her initial diagnosis, she is alive with no recurrence or metastatic findings. Morphologically, well-differentiated pancreatic adenocarcinoma is similar to endocervical type adenocarcinoma and adenocarcinoma in situ of the uterine cervix. Therefore, careful immunohistochemical examination and clear understanding of the patient's clinical information are needed in diagnosing adenocarcinoma in the uterine cervix.

Isolated Metastasis of Uterine Leiomyosarcoma to the Small Bowel Diagnosed Initially as Uterine Leiomyoma: A Case Report and Review of the Literature

Introduction: Uterine sarcoma is rare, Leiomyosarcoma is the main type of sarcoma that may resemble to leiomyoma. Metastasis to small bowel is extremely rare, treatment is chemotherapy and the prognosis is unfavorable. Case presentation: A 41-year-old Moroccan women, with no significant past medical history, was diagnosed with intracavitary myoma. The patient underwent subtotal hysterectomy with bilateral salpingectomy. Pathology findings indicated high grade leiomyosarcoma. The patient was re-operated, she underwent bilateral oophorectomy, omentectomy, segmental small bowel resection and excision of uterine cervix. Histopathology revealed a metastatic lesion of the primary uterine leiomyosarcoma of the small bowel. The patient was treated by chemotherapy: Doxorubicin 75 mg/m2 every 3 weeks for 6 cycles. The follow-up of this patient is 10 months and her ECOG is 0. Conclusion: Leiomyosarcoma is the main type of sarcoma that may resemble to leiomyoma. Metastatis to small bowel is rare, treatment is chemotherapy and the prognosis is poor.

Capsule Endoscopy for Crohn's Disease: Current Status of Diagnosis and Management.

Crohn's disease (CD) is an idiopathic inflammatory bowel disease involving the small and/or large intestine. More than 50% of Western CD patients and up to 88% of Asian CD patients may have small intestinal involvement. Video capsule endoscopy (VCE) has a higher diagnostic yield than small bowel barium radiography and computed tomography enterography for the detection of small intestinal involvement of CD. VCE also provides diagnostic yields comparable to magnetic resonance- (MR-) based enterography or enteroclysis and may have several advantages over MR-based tests for the detection of early small intestinal lesions. Several studies have suggested the use of VCE-based disease activity scoring systems to evaluate small intestinal mucosal disease activity, although their clinical relevance needs to be further studied. A possible indication for VCE is recurrence monitoring after complete surgical excision of CD-involved segments but its usefulness and efficacy compared with conventional endoscopy should be evaluated. The capsule retention rate ranges from 0 to 5.4% in suspected CD patients and from 0 to 13.2% in established CD patients. If VCE is necessary, significant small bowel stricture should be ruled out before VCE by performing a patency capsule study and/or small bowel radiological study in suspected or established CD patients.

The effect of time to release of an obstructing synthetic mid‐urethral sling on repeat surgery for stress urinary incontinence

The primary objectives were to describe the rate of repeat surgery for stress urinary incontinence (SUI) after release of an obstructing synthetic mid-urethral sling (MUS) and to evaluate the effect of time from sling placement to sling release on repeat surgery rates. The secondary objective was to assess rates of recurrent and persistent SUI. This is a retrospective review of women who underwent synthetic MUS release (incision or excision of segment of sling) from 2005-2013. SUI rates and repeat surgery were ascertained by patient report and urinary distress inventory (UDI-6) questionnaire responses. Data analysis included descriptive statistics and multivariable logistic regression analysis. 107 patients were included. Median time to sling release was 22 months (IQR 5-49 months). 43.2% were transobturator slings. 15/107 patients (14%) underwent repeat surgery for SUI. On multivariable analysis, women were significantly less likely to undergo repeat surgery for SUI when sling release was performed >24 months after initial sling surgery (OR 0.12, 95% CI 0.02-0.85, P = 0.03) compared to release within 3 months. 49% and 77% reported recurrent and persistent SUI after sling release, of which 83% were significantly bothered. The repeat surgery rate for SUI was 14%. The rate of recurrent SUI was 49%. Most of these women were significantly bothered. On multivariate analysis, longer interval to sling release was associated with decreased likelihood of repeat surgery for SUI. The reason for a low repeat surgery rate for SUI despite a high rate of bothersome SUI should be explored in future studies. Neurourol. Urodynam. 36:349-353, 2017. © 2015 Wiley Periodicals, Inc.

Treatment of atrophic bone nonunion of the elderly humerus shaft fracture with excision of the atrophic segment and locking plate fixation in 8 cases

Treatment of atrophic bone nonunion of the elderly humerus shaft fracture with excision of the atrophic segment and locking plate fixation in 8 cases

Surgical management of damaged inferior alveolar nerve caused by endodontic overfilling of calcium hydroxide paste.

To evaluate the neurosensory outcome of management of damaged inferior alveolar nerves caused by endodontic overfilling and to assess the efficacy of delayed surgical intervention. Nine patients who underwent surgical removal of extruded endodontic material were included. All patients were evaluated for neurosensory function using a set of standardized tests. The outcome of surgical intervention was evaluated through patient interview and quantitative statistical analysis. Surgical procedures included foreign body removal, microsurgical external/internal decompression, excision of neuroma followed by nerve repair, and excision of damaged nerve segment with interpositional nerve graft. Seven of the nine patients had significant improvement according to the follow-up neurosensory assessment. Four patients reported significant improvement, three patients reported mild improvement and two patients reported no appreciable improvement in the Visual Analog Scale (VAS). Two patients who reported no appreciable improvement in VAS also did not achieve FSR. In these patients, calcium hydroxide was spread widely along the IAN and a surgical approach was obtained via sagittal spit osteotomy. The mean time to reach FSR was 222.7 (±41.8)days with a range of 106-397days. In the early repair group who received surgery within 60days, three out of five patients achieved FSR in a mean time of 198.0 (±76.2)days. The mean time to FSR in all four subjects who received surgical attention over 60days after injury was 241.3 (±139.8)days with a range of 106-397days. As all four cases in the late repair group with limited amount of nerve injury achieved FSR, only 3 of 5 early repair cases with wide-spread injury achieved a similar outcome. The results of this case series confirmed the notion that surgical management of the inferior alveolar nerve is effective in the treatment of nerve injuries caused by endodontic extrusion of calcium hydroxide paste. Delayed surgical repair of the inferior alveolar nerve can be indicated and helpful for the neurosensory recovery of damaged IAN, however, the surgical management was less effective in case of widespread nerve injuries.

A rare variant case of pure esophageal atresia with an atretic segment

Pure esophageal atresia is typically characterized by a long gap between the upper and lower pouches, with a gasless abdomen and no fistula. The association of pure esophageal atresia with an atretic segment is extremely rare. We report a rare variant case of pure esophageal atresia in which the two blind esophageal pouches were joined by an atretic segment. Excision of the atretic segment and primary anastomosis were performed successfully.

Management options of congenital pouch colon--a rare variant of anorectal malformation.

Congenital pouch colon (CPC) was analysed for anatomical variations and surgical options. Records of CPC patients managed between 1999 and 2014 were studied. CPC was classified as complete (CCPC) and incomplete (ICPC) pouch. Of 400 cases of high anorectal malformations, 68 cases were CPC (17%). Male:female ratio was 2:1. Fistulous communication was colovesical, colocloacal, colovaginal and absent in 42, 15, 8 and 3 cases. ICPC and CCPC was 48 (70%) and 20 (30%). In neonatal period, proximal/end colostomy (31), ileostomy (6), pouch excision with abdominoperineal pull-through (18 cases) and coloplasty with end colostomy (7) were done. 6 presented as infants including 3 referred cases of CCPC with a window colostomy. Definitive surgery was completed in 56. Severe colonic dilatation after coloplasty was noted in 5, requiring excision of coloplasty segment in 2. Histopathology of excised pouch (45) showed muscle layer disorganization, widened sub mucosa, prominent vasculature and mature and immature ganglion cells, with no hypertrophy of nerve fibres. Diarrhoea and faecal incontinence (soiling) were more frequent in patients with CCPC versus ICPC. Six neonates with CCPC died. Six are awaiting definitive surgery. CPC had 8.8% neonatal mortality. Pouch excision and definitive procedure are feasible in neonates with CPC. Coloplasty in CCPC may result in postoperative colonic dilatation.

PTU-244 A close shave in the management of rectovaginal endometriosis

Introduction Endometriosis affects the bowel in 3–37% of all cases. 1 There is ongoing debate regarding the necessity of either segmental resection or full-thickness disc rectal excision. This study aimed to review the use of the laparoscopic rectal shave technique with respect to outcomes and patient satisfaction. Method Data was collected retrospectively for all patients requiring operative management of rectovaginal endometriosis between 2009 and 2014. Both electronic records and case notes were reviewed and data was collected on pre-operative symptoms, surgical procedure, length of stay, complication and re-admission rates and post-operative symptom recurrence. In addition patients answered a telephone satisfaction questionnaire. Results 52 patients underwent surgery during the study period with 69.2% carried out by a combined colorectal and gynaecological surgical team. Average age was 33.9 (21–43). Out of 52 patients 90% underwent rectal wall shave, 8% had segmental resection and 2% hysterectomy in combination with rectal shave. Surgery was performed laparoscopically in 96% with a 0% conversion rate. Average length of stay was 1.5 days with a re-admission rate of 5.8%. Major complications occurred in 2% with no patients requiring re-operation within the early postoperative period. Overall 17.3% went on to have further surgery for their endometriosis although only 3.8% required bowel resection. Patient satisfaction levels were high with a high proportion of patients having symptom improvement post surgery. Conclusion The laparoscopic rectal shave is a successful technique for the management of rectovaginal endometriosis with low complication rates and high patient satisfaction. Outcomes are improved by using combined colorectal and gynaecological surgical teams. Disclosure of interest None Declared. Reference Revised American Society for Reproductive Medicine classificationof endometriosis: 1996. Fertil Steril. 1997;67:817–821

The use of triamcinolone combined with surgery in major ear keloid treatment: a personal two stages approach

Background Keloid is a fibroproliferative disorder characterized by an abnormal deposition of collagen within a wound. Despite an increased understanding of wound healing and collagen metabolism, the exact cause, the clinical behavior, and gold standard of treatment for keloids remain an enigma. There is no one right way of treatment, the results are variable, and the management of ear keloids can be difficult and frustrating both for patients and physicians. Traditional techniques include intralesional steroids, topical applications of silicone, vitamins, and segmental excision by lasers or surgery. The purposes of this article are to review the literature concerning the current therapies as well as to present the authors’ experience in the treatment of major ear keloids.

Reduction mammoplasty in conservative breast surgery in the early stage of breast cancer

ObjectiveThe aim of this study is to evaluate the application and clinical outcomes (oncological and cosmetic) following oncoplastic conservative surgery using bilateral reduction mammoplasty in conjunction with breast conservation therapy for esthetic purposes.BackgroundBreast cancer is the most common malignancy in women worldwide. Until recently, breast surgery could provide only two options for early-stage breast cancer: either modified radical mastectomy or segmental excision, followed by radiation, but the latter causes breast deformities. Reduction mammoplasty is used as a conservative breast surgery with excision of a large volume of tissue without compromising the cosmetic outcome.Patients and methodsWe studied 17 patients with breast cancer, aged 30-65 years (mean 48.4 years). Patients had been operated on by the reduction mammoplasty technique at Menoufia University Hospital in 2012 and later. Patients were followed up at regular intervals 2 years or more after the operation had been carried out.ResultsReduction mammoplasty is a good technique for conservative breast cancer surgery at its early stage, with fewer complications and better cosmetic results. All specimens showed free resection margins with an average size of 2.4 cm. No recurrence was detected. Postoperative complications were encountered in seven patients in the form of wound infection, seroma, partial skin slough, and asymmetry. Long-term follow-up results are awaited to support the more widespread use of this surgical technique in the definitive treatment of early-stage breast cancer.ConclusionOncoplastic breast surgery is now being used widely as a better substitute for the management of early-stage primary breast cancer with proved safety and efficacy.

Congenital Segmental Giant Megaureter Presenting as Cystic Abdominal Mass in a Child

A six years old male child presented with gradually progressive distension of abdomen since one year of his age. Imaging suggested it as a large mesenteric cyst. Further evaluation and intra-operative findings suggested it to be bilateral congenital megaureter with giant one on the left side which was causing gross abdominal distension. Excision of left megaureteric segment, psoas hitch and ureteroneocystostomy was performed. Excision, tapering and uretereroneocystostomy of right ureter was performed. Congenital giant megaureter should be considered as one of differential diagnosis in children presenting as abdominal mass.

Estabelecimento in vitro de segmentos caulinares de Araucária (Araucaria angustifolia)

Araucaria angustifolia is a species of high economic value, timber, food and to resin but have problems concerning propagation by seed due to the low viability of propagules. The micropropagation may be an alternative for producing seedlings of good quality. The present study evaluated the in vitro establishment of stem segments of A. angustifolia collected in three different positions and in different shifts in culture media and their dilutions. After 60 days of sowing in plastic trays held excision of stem segments of approximately 2-3 cm in length. The experiment was conducted in a completely randomized design, using a 3 x 4 factorial scheme, in which the levels of factor A referred to the different collection positions and levels of the factor B, the nutrient media (MS full, ½ MS, WPM full and ½ WPM. were six replicates of each explant for treatment. After 60 days of culture in vitro was assessed the percentage of establishment, contamination and callus formation, and the number of shoots per explant and shoot length. Callus formation was lower with the use of MS complete nutrient medium and diluted to 50%. Use the position of explants collected and cultured in basal medium MS had the highest training shoots and greater length. Establishing in vitro Araucaria from explants of seminal origin is most successful when it makes use of suitable nutrient media and observing the position of collection.