Extra Surgery Research Articles

P.142 The use of intraoperative magnetic resonance imaging for endoscopic transnasal transsphenoid surgery in children

Background: Sellar and suprasellar pediatric lesions are uncommon. Endoscopic transnasal transphenoidal surgery (ETTS) is the preferred treatment, but early post-op MRI is hindered by sphenoidal packing. This study aims to assess iMRI safety and efficacy in pediatric ETTS cases. Methods: We performed a retrospective review from Jan 01, 2015 to Dec 31, 2022, evaluating use of iMRI. We determined if the goals of the surgery (biopsy, cyst decompression, subtotal resection, gross total resection) were met, and iMRI’s influence on surgery outcomes. We examined patient age, surgery duration, length of stay, histopathology results, surgical complications, post-op MRIs within 1 month, and tumor progression/recurrence. Results: Over eight years, 20 pediatric ETTS procedures, 14 with iMRI, were conducted. Achieving goals in 13 cases, iMRI prompted extra surgery once. Two adenomas progressed, requiring a second surgery, and craniopharyngioma cases had complications, needing further interventions. Hospital stays varied (1-9 days), with a mean surgery duration of 6 hours and 47 minutes. The study underscores iMRI’s potential impact, stressing the necessity for more research in pediatric transsphenoidal surgeries. Conclusions: While intraoperative MRI in pediatric transsphenoidal surgeries may aid goal verification, this small study doesn’t conclusively demonstrate improved outcomes. Complication rates align with non-IMRI procedures, highlighting the need for further research.

Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker V and VI.

Complex bicondylar tibial plateau fracture (TPF) has always been a tricky problem for surgeons. We created a novel external device used intraoperatively consisting of Kirschner wires, and combined with minimally invasive plate oseoynthesis (MIPO) technique to treat complex bicondylar TPFs, and the clinical effect and feasibility were further evaluated. From March 2016 to February 2021, 49 cases (29 males and 20 females) were identified as bicondylar TPF, the mean age 47.2 (27-69). All patients adopted the device and MIPO technique. A series of score, complications, and radiographs in the follow-up period, from threemonths, sixmonths, oneyear, and twoyears and the last follow-up, were recorded, from visual analogue score (VAS), hospital for special surgery (HSS), and Short-Form 36 (SF-36), containing physical (PCS) and mental (MCS), and Rasmussen score. Forty-seven patients showed good functional recovery. No patients were lost, mean follow-up time was 28.17 ± 2.81 (24.2-35.4) months. Operation time was 89.80 ± 13.46 (58-110) min. At the last follow-up, VAS was 1.3 ± 0.92 (0-4), HHS was 93.10 ± 2.63 (89-99), PCS was 49.20 ± 7.40 (38-65), and MCS was 50.08 ± 4.77 (43-62). Complications were as follows: cutaneous necrosis (3, 6%), asymptomatic arthritis (3, 6%), symptomatic arthritis (1, 2%), and deep venous thrombosis (1, 2%). Mean fracture healing time was 11.82 ± 1.5 (10-15.4) weeks. All patients got recovery without extra surgery and removed the implants at 12.85 ± 0.76 (11.2-15.4) months. Temporary traction device of bilateral external fixator combined with MIPO technique was simple and convenient, with a smaller soft-tissue damage, an easier operational approach, and its worth being promoted.

1486-PUB: Single-Toe Necrosis over Diabetic Foot Ulcer (DFU) : Amputation Surgery at Bedside by a Diabetologist or in the Operating Room by a Surgeon

Single toe necrosis complicating DFU requires an amputation performed in the operating room by a surgeon (ORAS) . Bedside amputation by a diabetologist (BAD) complying with the surgical rules might be an option in case of disagreement with the surgeon about the amputation level (major favored by the surgeon) and/or an anesthetic contraindication. In our monocentric, retrospective study, we assessed the one year prognosis (healing rate without extra surgery) of a single toe necrosis amputation over DFU performed by a diabetologist or a surgeon. Amputation levels (transphalangeal, TPA, metatarsophalangeal disarticulation, MPD, single transmetatarsal, TMA) were decided by our multidisciplinary team. Out of 7patients admitted with DFU (05.2016-10.2020) , 57 (8%) were included because of single toe necrosis (BAD n=33, 58%; ORAS n=24, 42%) . Amputation levels TPA, MPD, TMA were respectively 26, 47, 27%. The median duration of follow-up was 28 months. Patients characteristics were non statistically different between groups except for the dorsal arch permeability: males 74%; median age 64y; Type 2 Diabetes Mellitus (DM) 97%; median DM duration 17y. The rate of permeable dorsal arch was significantly lower in the BAD group (45% vs. 75%, p=0.03) . Single TMA rate was significantly higher in the ORAS group (50% vs. 9%, p=0.001) . The one year healing rate without extra surgery was statistically different between the two groups (BAD 58% vs. ORAS 83%, p=0.05) . The need for extra surgery was significantly higher in the BAD group (42% vs. ORAS 13%, p=0.02) . The overall mortality was non significantly different between groups (BAD 21% vs. ORAS 4%, p=0.12) . For a single toe necrosis over DFU, in patients with a high risk for a circumscribed toe amputation failure as stated by the surgeon, the results of bedside amputation performed by a diabetologist invalidated this unfavorable prognosis in most cases. Disclosure F.Féron: None. J.Riveline: None. J.Gautier: Other Relationship; Novo Nordisk, Sanofi, Speaker's Bureau; Eli Lilly and Company. J.Kevorkian: None.

MP03-15 THE CHALLENGES AND ANXIETIES OF PREGNANCY IN CYSTINURIA

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (MP03)1 Apr 2020MP03-15 THE CHALLENGES AND ANXIETIES OF PREGNANCY IN CYSTINURIA Robert Ashe, David Game, Giles Rottenberg, Kay Thomas, and Matthew Bultitude* Robert AsheRobert Ashe More articles by this author , David GameDavid Game More articles by this author , Giles RottenbergGiles Rottenberg More articles by this author , Kay ThomasKay Thomas More articles by this author , and Matthew Bultitude*Matthew Bultitude* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000817.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystinuria is recognised to cause concern about children inheriting the disease, however the impact of pregnancy in cystinuria has not been well studied. Management in pregnant women is challenging due to regular stone formation, difficulty in imaging as well as contraindication of thiol binding medication. METHODS: From a prospective database in a single center, we identified female patients known to have children. With the help of our patients we constructed a questionnaire to evaluate the experiences and challenges of pregnancy in cystinurics. RESULTS: Questionnaire sent to 37 patients; 23 responses received. Mean age 39; Median age of diagnosis 22. Median no.of children was 2 (range 1-4); age range of children was 4 months to 22 yrs. 74% and 50% were taking/ had taken alkalinisation or thiol binding medication respectively. We identified 3 major issues. Firstly, patients were under supported: 37% were anxious about getting pregnant because of cystinuria; only 23% were given specific advice about getting pregnant; 36% had to cease cystinuria medication. Only 27% were offered increased checks during pregnancy. Most reported increasing fluids during pregnancy. 68% found the OBGYN team did not know about cystinuria. Secondly symptoms and new stone formation was a problem. 32% passed stones and 23% reported needing surgery during pregnancy. 54% felt they formed stones during pregnancy that subsequently needed treating. Lastly, the ability to breastfeed was negatively impacted. 59% reported having to stop breastfeeding or discontinued medications to be able to breastfeed. Overall, whilst 64% do not think cystinuria is a barrier to pregnancy, 23% do still think it is. 91% report being concerned their children could have cystinuria; 77% have actually sought advice for them and 50% have actually been tested. Of those with genetic testing, 11 had SLC3A1 mutation; 8 SLC 7A9 and 3 had both. There was no clinical differences experienced in pregnancy between the groups. CONCLUSIONS: Cystinuria causes significant anxiety to female patients considering pregnancy as well as challenges during and afterwards due to cessation of medication, frequent stone episodes and extra surgery. Female patients should be counselled by urologists to ease the anxiety and offered extra ultrasound screening and easy access back to urological services if stone episodes occur. Liaising directly with the OBGYN will help to improve their knowledge as well as patient experience. With appropriate support women should not see cystinuria as a barrier to childbirth. In future work, it would be interesting to explore the concerns for nulliparous women. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e27-e28 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Ashe More articles by this author David Game More articles by this author Giles Rottenberg More articles by this author Kay Thomas More articles by this author Matthew Bultitude* More articles by this author Expand All Advertisement PDF downloadLoading ...

A clinical and radiographical comparison of buccolingual crestal bone changes after immediate and delayed implant placement.

AimThe study aims to clinically and radiographically compare the bucco-lingual crestal bone changes after immediate and delayed placement of implants.MethodsTwo groups that consisted of fifty implants were considered for this study. In group A the implants were placed immediately post extraction, whereas, in group B implants placement were delayed by four to six weeks. All the implants were submerged within the alveoli confines. Bone grafts were only placed if the jumping distance was more than 1.5 mm. Barrier membrane was not placed in any of the cases. Bucco-lingual width was measured at the time of implant placement and during abutment placement after four to six weeks. Primary flap closure was ensured in all the cases.ResultsThirty-one implants were placed in the mandible and nineteen were placed in the maxilla. All the implants achieved osseointegration. Immediate implant group showed a mean width of 8.80 mm (SD2.280) at the time of implant placement whereas, 7.60 mm (SD 1.871) after six months. Delayed implant group showed a mean width of 8.40 mm (SD1.673) at the time of implant placement, and 7.40 mm (SD 1.658) after six months. Intragroup showed statistically significant data (P<0.05). When the intergroup comparison of group 1 and group 2 was made at implant placement day and abutment placement day, it was found to be statistically non-significant.ConclusionThis study suggests that circumferential defect heals on itself without any guided bone regeneration in both the groups. The data suggests that the healing in both the group were equally good. The equally good results suggest placing the implant immediately post extraction. This saves the cost, time and most importantly the need for an extra surgery.

In Situ Magnetic Alignment and Cross-Linking of Injectable Microparticles into Centimeter-Scale Fibers for Efficient Myoblast Alignment and in Vivo Fiber Formation

Muscle cell alignment plays an essential key role in the development of parallelly organized myotubes and the exertion of mechanical functions. Despite remarkable advances in cell alignment, there is still a need for a simpler and more efficient method of stably aligning and supporting cells. Here, we propose magnetic assembly of alginate-coated magnetic microparticles for myoblast alignment. Applying an external magnetic field in a controlled manner followed by ionic cross-linking of adjacent alginate chains led to the formation of stable linear alignment of particles in centimeter-scale even after the removal of the magnetic field. Based on this anisotropic alignment of bundles consisting of magnetic particles with further modification of alginate with arginine–glycine–aspartic acid, myoblast alignment was successfully demonstrated in vitro. Moreover, these particles can be simply injected through a needle without extra surgery and magnetically assembled to maintain the aligned structure in vivo. This i...

The compression of L5 nerve root, single or double sites?-radiographic graded signs, intra-operative detect technique and clinical outcomes.

The L5 nerve root could be compressed at both L4-5 and L5-S1 regions. If L5 nerve root has confirmed compression at L4-5 level and questionable compression at L5-S1 foramina, performing both surgeries at L4-5 and L5-S1 levels may induce unnecessary extra surgery on L5-S1; however, ignoring foraminal stenosis of L5/S1 may require re-exploration. Two hundred seventeen patients with L5 nerve root compressed at L4-5 lateral access were performed with L4-5 decompression and interbody fusion. Lee et al. grade classification was used to assess the foraminal stenosis of L5-S1 preoperatively. Nerve root probe was designed and used to detect if there were foraminal stenosis at L5-S1 level that compressing the exiting L5 nerve root. Visual analog scale (VAS) of low back pain, leg pain and Oswestry Disability Index (ODI) were used to assess clinical outcomes. For all of 217 patients who underwent L4-5 surgery, L5-S1 foramina were preoperatively assessed as: grade 0: 125 cases, grade 1: 58 cases, grade 2: 23 cases, and grade 3: 11 cases. After intra-operative L5 nerve root detection, 11/11 patients with grade 3 radiographic foraminal stenosis, 6/23 (26.1%) with grade 2 and 2/58 (3.4%) who had grade 1 underwent L4-5 and L5-S1 transforaminal lumbar interbody fusion (TLIF), the others received only L4-5 TLIF. Compared to pre-operative baseline data, both L4-5 TLIF and L4-5 and L5-S1 TLIF groups had significant decreased VAS of low back pain and leg pain, and ODI at 3 and 24 months after operation. We suggested that our novel nerve root probe combined with pre-operative radiographic grade may be helpful to surgeons to identify the single or double compression of L5 nerve root and make a more precise surgical strategy to improve surgical outcome than the method depended on pre-operative radiographic grade alone.

A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications

ObjectiveTo evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. MethodsA case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan.Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. Results150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population.Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6–26.4). ConclusionsDISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent OSAS.

Centralisation of radical cystectomies for bladder cancer in England, a decade on from the 'Improving Outcomes Guidance': the case for super centralisation.

To analyse the impact of centralisation of radical cystectomy (RC) provision for bladder cancer in England, on postoperative mortality, length of stay (LoS), complications and re-intervention rates, from implementation of centralisation from 2003 until 2014. In 2002, UK policymakers introduced the 'Improving Outcomes Guidance' (IOG) for urological cancers after a global cancer surgery commission identified substantial shortcomings in provision of care of RCs. One key recommendation was centralisation of RCs to high-output centres. No study has yet robustly analysed the changes since the introduction of the IOG, to assess a national healthcare system that has mature data on such institutional transformation. RCs performed for bladder cancer in England between 2003/2004 and 2013/2014 were analysed from Hospital Episode Statistics (HES) data. Outcomes including 30-day, 90-day, and 1-year all-cause postoperative mortality; median LoS; complication and re-intervention rates, were calculated. Multivariable statistical analysis was undertaken to describe the relationship between each surgeon and the providers' annual case volume and mortality. In all, 15292 RCs were identified. The percentage of RCs performed in discordance with the IOG guidelines reduced from 65% to 12.4%, corresponding with an improvement in 30-day mortality from 2.7% to 1.5% (P = 0.024). Procedures adhering to the IOG guidelines had better 30-day mortality (2.1% vs 2.9%; P = 0.003) than those that did not, and better 1-year mortality (21.5% vs 25.6%; P < 0.001), LoS (14 vs 16days; P < 0.001), and re- intervention rates (30.0% vs 33.6%; P < 0.001). Each single extra surgery per centre reduced the odds of death at 30days by 1.5% (odds ratio [OR] 0.985, 95% confidence interval [CI] 0.977-0.992) and 1% at 1year (OR 0.990, 95% CI 0.988-0.993), and significantly reduced rates of re-intervention. Centralisation has been implemented across England since the publication of the IOG guidelines in 2002. The improved outcomes shown, including that a single extra procedure per year per centre can significantly reduce mortality and re-intervention, may serve to offer healthcare planners an evidence base to propose new guidance for further optimisation of surgical provision, and hope for other healthcare systems that such widespread institutional change is achievable and positive.

Association Between Long-term Oral Contraceptive Use and Risk of Crohn’s Disease Complications in a Nationwide Study

Use of exogenous hormones, in the form of oral contraceptives (OCs), has been linked consistently to risk of Crohn's disease (CD). Nonetheless, it is not clear how OCs might contribute to the progression of CD. We conducted a prospective study of female patients with CD (age, 16-51 y), identified from the inpatient and outpatient care components of the Swedish National Patient Register from January 2002 through December 2013. Information on current OC use was obtained from the Prescribed Drug Register starting in July of 2005 and updated until December of 2013. Primary outcomes were defined as first CD-relatedsurgery and first steroid prescription. We used Cox proportional hazard modeling with time-varying covariates to estimate multivariable-adjusted hazard ratios (MV-adjusted HRs). We identified 482 incident cases of surgery among 4036 patients with CD, with a median follow-up period of 58 months. Compared with nonusers, the MV-adjusted HRs for surgery were 1.14 (95% confidence interval [CI], 0.80-1.63) forpast users and 1.30 (95% CI, 0.89-1.92) for current users. The risk of surgery increased with longer duration of use (Ptrend= .036) and higher prescribed daily dose (Ptrend= .016). Specifically, for women with more than3years of OC use, theMV-adjusted HR for surgery was 1.68 (95% CI, 1.06-2.67). The association was confined to the combination type of OC. We estimated that for every 83 patients with CD receiving the combination type of oral contraceptives for at least 1 year, 1 extra surgery is required. The rate of steroid prescriptions did not appear to increase with past or current use of OCs, compared with patients whohave not taken OCs (all Pcomparisons > .20). In a nationwide analysis of patients in Sweden, long-term use of OCs, particularly the combination type, was associated with an increased risk of surgery among women with established CD. Clinicians carefully should evaluate and monitor contraceptive options among women with established CD.

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Outside-in TOT procedure: three-years experience with 175 Cases (Dıştan-İçe TOT Operasyonunda 3 Yıllık Deneyim:175 Olgu)

Aim: The aim of this study is to evaluate the surgical outcomes and complications of transobturator tape (TOT) procedure. Material and Methods: In this study, 175 patients who were undergone TOT procedure due to pure stress urinary incontinence (SUI) or mixt urinary incontinence (MUI) from 2011-2014 and examined at st and 3rd postoperative months with physical examination and stress tests were evaluated retrospectively.Results: All of the patients were multiparous and the median age was 50.0±11.3 years. Sixty-eight (38.8%) of the patients were postmenopausal and sixty-two (35%) of the patients who had TOT operation had extra surgery. One patient is complicated with bladder perforation. Only one patient had blood transfusion requirement due to TOT operation. Intraoperative bleeding more than 200 ml. is seen in 6 patients. Four patients had vaginal fornix perforation. Three patients had developed perineal pain. De-novo urge incontinence was seen in 8 patients in the postoperative period and was successfully treated with anticholinergic drugs. Mesh removals and reconstruction of vaginal mucosa were done for 6 patients who had vaginal erosions. The objective and subjective cure rates were found to be 87.4% and 82.8%, respectively.Conclusion: The use of mid-urethral synthetic slingis the first-choice of the surgical treatment of SUI nowadays. The main reasons for this are low complication rates due to surgical technique, the use of good quality materials, short operation time, and short hospital stay.

Investigation of HOXA9 promoter methylation as a biomarker to distinguish oral cancer patients at low risk of neck metastasis.

BackgroundMetastasis to the cervical (neck) lymph nodes is one of the most significant clinical factors responsible for death from oral squamous cell carcinoma (SCC). Therefore, the lymph nodes are frequently removed when the tumor is excised (neck dissection), even though the majority of patients will not benefit from the extra surgery. Two subtypes of oral SCC distinguished by the presence of tumor genomic aberrations +3q, -8p, +8q and/or +20 differ in risk for metastasis – high for the 3q8pq20 subtype, harboring one or more of the aberrations and low for the non-3q8pq20 subtype, lacking these alterations. A prior analysis of the literature suggested genes differentially methylated in the two subtypes. Therefore, the goal of this study was to further investigate the methylation status of candidate biomarkers of the non-3q8pq20 subtype, and evaluate their utility for identifying patients at low risk for metastasis.MethodsMethylation status of genes in a cohort of 52 oral SCC patients with at least five year follow up was determined by pyrosequencing. Gene expression levels were determined by quantitative RT-PCR. Growth following re-expression of HOXA9 in cultured oral SCC cells was assessed by proliferation and colony formation assays.ResultsA pilot study evaluating methylation levels of HOXA9, MT1A and HOXA11 promoters in DNA from 12 tumors (six each of the 3q8pq20 and non-3q8pq20 subtypes) revealed that only HOXA9 was differentially methylated. Significant differences in methylation levels of HOXA9 were observed amongst the 52 oral SCCs with respect to genomic subtype and nodal status (p = 0.014, and p = 0.024, respectively, Wilcoxon rank sum test). High levels of HOXA9 methylation and low levels of expression in oral SCC cell lines were observed compared to HaCaT, a non-tumorigenic keratinocyte cell line. Re-expression of HOXA9 in the SCC4 oral cancer cell line resulted in diminished proliferation and colony formation.ConclusionsHOXA9 methylation is frequent in oral cancers and levels are higher in tumors with greater risk of metastasis. Expression of HOXA9 is low in cells with high levels of methylation and reduced expression appears to confer a growth advantage.

Operating room turnaround time analysis: a case study

Operating rooms in the USA are typically the largest source of revenue for a hospital and correspondingly are also major cost centres. In efforts to cut overall operating costs, hospitals typically reduce budgets (and costs) instead of increasing productivity. Although many operating room 'studies' are conducted, few are documented in the archival literature. The case study presented proposes a standard definition of key parameters including turnaround time. It also presents a replicable methodology for analyses of operating room turnaround times. It can be seen from the case study that careful implementation is a key to successful change that will consequently reduce patient wait times. The results of the case study show that operating room turnaround times can be reduced by as much as a third which in turn can result in one extra surgery per shift.

Reaming debris as a novel source of autologous bone to enhance healing of bone defects

Reaming debris is formed when bone defects are stabilized with an intramedullary nail, and contains viable osteoblast-like cells and growth factors, and might thus act as a natural osteoinductive scaffold. The advantage of using reaming debris over stem cells or autologous bone for healing bone defects is that no extra surgery is needed to obtain the material. To assess the clinical feasibility of using reaming debris to enhance bone healing, we investigated whether reaming debris enhances the healing rate of a bone defect in sheep tibia, compared to an empty gap. As golden standard the defect was filled with iliac crest bone. Bones treated with iliac crest bone and reaming debris showed larger callus volume, increased bone volume, and decreased cartilage volume in the fracture gap, and increased torsional toughness compared to the empty gap group at 3 weeks postoperative. In addition, bones treated with reaming debris showed increased torsional stiffness at 6 weeks postoperatively compared to the empty defect group, while bending stiffness was marginally increased. These results indicate that reaming debris could serve as an excellent alternative to iliac crest bone for speeding up the healing process in bone defects that are treated with an intramedullary nail.

Invasive cholangiocarcinoma identified in congenital biliary dilatation in a 3-year-old boy

We herein report a 3-year-old male demonstrating invasive cholangiocarcinoma (CC) associated with congenital biliary dilatation (CBD). A 3-year-old Japanese boy was admitted to our hospital with abdominal pain and vomiting. Computed tomography and magnetic resonance imaging demonstrated a dilated extrahepatic bile duct. A diagnosis of Todani's type 1a CBD was made. Intraoperative cholangiography demonstrated the presence of pancreaticobiliary maljunction but could not reveal any tumor lesion in the bile duct. The excision of extrahepatic bile duct and gallbladder and Roux-en-Y hepaticojejunostomy were performed. On gross inspection, we could not find any tumor lesion in the resected specimen. However, the postoperative histopathologic examinations confirmed the presence of well-differentiated tubular adenocarcinoma with lymphovascular invasion. Most of the carcinoma remained within the mucosal layer, and the carcinoma was identified at both the distal and proximal surgical margins of the bile duct. We scheduled additional surgery to eradicate the residual carcinoma, but informed consent for the extra surgery could not be obtained. A close follow-up with abdominal computed tomography has been going on without either additional surgery or adjuvant chemotherapy about for 1 year. The patient has so far been clinically doing well without any obvious symptoms of recurrent disease. To our knowledge, this report is the youngest case of CC associated with CBD.

Biodegradable surgical implants based on magnesium alloys – A review of current research

There is considerable interest in the potential of magnesium alloys to be used in place of existing materials for surgical implants. Of particular interest is the possibility of using magnesium implants to act as both scaffolding on which new bone can grow, and as fixtures to hold together bone long enough to allow natural healing to take place.Magnesium is particularly desirable in this type of application as it is bio-compatible, and it has a modulus of elasticity closer to bone than currently used materials. Another major advantage of using magnesium as a surgical implant is in its ability to biodegrade in situ. This in turn means that the implant need not remain in the body without needing extra surgery to remove it.This paper presents a review of current research into magnesium based surgical implants.

Comparative study of knee anterior cruciate ligament reconstruction with or without fluoroscopic assistance: a prospective study of 73 cases

Correct placement of both tibial and femoral tunnels is one of the main factors for a favorable clinical outcome after anterior cruciate ligament (ACL) reconstruction. We used an original system of computer assisted surgery (CAS). The system, based on fluoroscopic guidance combined with special graphical software of image analyzing, showed to the surgeon, before drilling, the recommended placement of tibial and femoral tunnel centers. We compared the first anatomical and clinical results of this procedure to the usual one single incision technique. We conducted a prospective study on 73 patients; 37 patients were operated on with CAS and 36 without CAS, by the same senior surgeon. The mean age was 27 years for both groups. Every patient was reviewed at an average of 2.2 years (range 1-4.5) by an independent observer, using IKDC scoring system, KT-1000, and passive stress radiographs. Time between ACL rupture and reconstruction averaged 30 months for both groups. CAS needed 9.3 min extra surgery time. Clinical evaluation was graded from A to C as per the IKDC scoring system: 67.6% A, 29.7% B, 2.7% C with CAS; and 60% A, 37.1% B, 2.9% C without CAS. IKDC subjective knee evaluation score averaged 89.7 with CAS and 89.5 without CAS. Pre operative KT-1000 maxi manual differential laxity averaged 7. At revision time, all the patients after CAS had a differential laxity less than 2 and 97.7% without CAS. Stress X-rays differential laxity averaged 2.4 mm with CAS and 3 mm without CAS. The area of dispersion of the tunnels' center was smaller on the femoral side using the CAS method. There was no statistically significant difference between both groups using IKDC score, KT-1000 and passive stress radiographs. The CAS method provided a more accurate and reproducible tunnels placement without clinical significant effect.

Cell-Based Bone Tissue Engineering

To restore skeleton function in the field of orthopaedic and oral-maxillofacial surgery, bone tissue regeneration remains an important challenge. Spinal fusion, augmentation of fracture healing, and reconstruction of bone defects resulting from trauma, tumour, infections, biochemical disorders, or abnormal skeletal development are clinical situations in which surgical intervention is required. The types of graft materials available to treat such problems essentially include autologous bone (from the patient), allogeneic bone (from a donor), and demineralised bone matrices, as well as a wide range of synthetic biomaterials such as metals, ceramics, polymers, and composites. Until recently, the use of autologous bone grafts has been the number one choice for bone repair and regeneration [1–5]. A patient's own bone lacks immunogenicity and provides bone-forming cells, which are directly delivered at the implant site. Moreover, autologous bone grafts recruit mesenchymal cells and induce them to differentiate into osteogenic cells through exposure to osteoinductive growth factors [1,3,6,7]. Although there are many advantages to using autologous bone, there are major drawbacks to the harvesting procedure, and for centuries there has been a search for alternatives. The extra surgery involved in harvesting autologous bone causes morbidity at the donor site [1,3,6,8] and can cause post-operative continuous pain [3,9–11], hypersensitivity [3], pelvic instability [10–12], infection [6,9], and paresthesia [3,6]. These complications affect 10% to 30% of the patients [9]. Moreover, the amount of bone that can be collected is limited. As an alternative, the use of allografts (from human to human) eliminates the harvesting procedure and the quantity of available tissue is no longer an issue. Nevertheless, the quality of allografts is worse than that of autologous grafts. Allografts have a poor degree of cellularity, less revascularisation, and a higher resorption rate compared to autologous grafts [3,6], resulting in a slower rate of new bone tissue formation, as observed in several studies [11,13–15]. In addition, the immunogenic potential of these allografts and the risks of virus transmission to the recipient are serious disadvantages [2,14,16]. Although processing techniques such as demineralisation, freeze-drying, and irradiation have been shown to reduce the patient's immune response, processing also alters the structure of the graft and reduces its potential to induce bone healing (osteoinductivity), while the possibility of disease transmission still remains [3].

DAFE autofluorescence assessment of oral cavity, larynx and bronchus in head and neck cancer patients

Head and neck (H&N) cancer patients have a high incidence of local field change as well as second primary lung tumours. We have applied the Wolf Diagnostic Autofluorescence Endoscopy (DAFE) system in a novel way, combining autofluorescence evaluation of both H&N region and bronchial. New H&N cases as well as "old" cases with symptoms were included. The DAFE procedure was done separate to panendoscopy. The H&N region was examined first; images were recorded of the known primary with reference to subsequent resection margins, as well as of adjacent mucosa inspecting for additional abnormal sites. Then autofluorescence bronchoscopy was performed. Changes in management were only on the basis of histology taken because of abnormal autofluorescence. One hundred and seven cases were referred, including 96 new cases and 11 old cases. Autofluorescence examination of H&N detected sites which led to change of management in 11 patients. This included additional sites in nine patients (which then either had extra surgery or radiotherapy as a result) and wider resection margins were made possible in two patients. In the bronchus there were 21 significant lesions in 16 patients. Immediate management change occurred in one invasive cancer, two microinvasive carcinomas and three carcinomas in situ (in four patients). There were 15 sites of severe and moderate dysplasia in 12 patients. None of these bronchoscopic lesions were detectable on CT chest. Therefore, overall an immediate change in management occurred in 15 of 107 patients (14% of patients). This combined procedure yielded a significant number of lesions particularly as a simple addition to preoperative work-up in new H&N cancer cases.