Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws?

We hypothesised that the anterior and posterior walls of the body of the first sacral vertebra could be visualised with two different angles of inlet view, owing to the conical shape of the sacrum. Six dry male cadavers with complete pelvic rings and eight dry sacrums with K-wires were used to study the effect of canting (angling the C-arm) the fluoroscope towards the head in 5° increments from 10° to 55°. Fluoroscopic images were taken in each position. Anterior and posterior angles of inclination were measured between the upper sacrum and the vertical line on the lateral view. Three authors separately selected the clearest image for overlapping anterior cortices and the upper sacral canal in the cadaveric models. The dry bone and K-wire models were scored by the authors, being sure to check whether the K-wire was in or out. In the dry bone models the mean score of the relevant inlet position of the anterior or posterior inclination was 8.875 (standard deviation (sd) 0.35), compared with the inlet position of the opposite inclination of -5.75 (sd 4.59). We found that two different inlet views should be used separately to evaluate the borders of the body of the sacrum using anterior and posterior inclination angles of the sacrum, during placement of iliosacral screws.

The value of the three-point index in predicting redisplacement of diaphyseal fractures of the forearm in children.

Redisplacement is the most common complication of immobilisation in a cast for the treatment of diaphyseal fractures of the forearm in children. We have previously shown that the three-point index (TPI) can accurately predict redisplacement of fractures of the distal radius. In this prospective study we applied this index to assessment of diaphyseal fractures of the forearm in children and compared it with other cast-related indices that might predict redisplacement. A total of 76 children were included. Their ages, initial displacement, quality of reduction, site and level of the fractures and quality of the casting according to the TPI, Canterbury index and padding index were analysed. Logistic regression analysis was used to investigate risk factors for redisplacement. A total of 18 fractures (24%) redisplaced in the cast. A TPI value of > 0.8 was the only significant risk factor for redisplacement (odds ratio 238.5 (95% confidence interval 7.063 to 8054.86); p < 0.001). The TPI was far superior to other radiological indices, with a sensitivity of 84% and a specificity of 97% in successfully predicting redisplacement. We recommend it for routine use in the management of these fractures in children.

Effect of hydroxyethyl starch 130/0.4 on ischaemia/reperfusion in rabbit skeletal muscle.

BACKGROUND AND OBJECTIVE: Tourniquet use is a common tool in surgical procedures of the limbs. Hydroxyethyl starch (HES) 130/0.4 not only has a role in replacement of the liquid deficits due to trauma, bleeding or shock, but it is also effective in enhancing tissue oxygen tension and regulation of microcirculation. The aim of this study was to investigate how 6% HES 130/0.4 affects ischaemia and reperfusion in skeletal muscle. METHODS: An ischaemia/reperfusion model (3 and 2 h, respectively) was applied in 14 rabbits. Group S (n = 7) was infused with 0.9% NaCl (0.2 ml kg(-1) min(-1)) and group HES was infused with 6% HES 130/0.4 (0.2 ml kg(-1) min(-1)). The total liquid was divided into equal one-thirds and given in the preischaemia, ischaemia and reperfusion phases. Ketamine HCl (30 mg kg(-1)) was used for anaesthesia, and blood pressure, pulse and blood gases were monitored. Muscle biopsies were taken in the preischaemic (A), ischaemic (B) and reperfusion (C) phases. In these samples, nitrite, nitrate, reduced glutathione (GSH) and myeloperoxidase (MPO) were measured to assess oxidative stress elements, and malondialdehyde (MDA) was measured to assess lipid peroxidation. Repeated variance analysis, Mann-Whitney U test and Student's t test were used for statistical analysis of these parameters. RESULTS: In group S, the MPO levels were significantly increased in the reperfusion phase compared with baseline, whereas there was a decrease in MPO levels in the reperfusion period in the HES group. This difference between groups was statistically significant (P = 0.011). CONCLUSION: The results of this study showed that 6% HES 130/0.4 solution is more effective in the prevention of ischaemia/reperfusion injury than saline when given in the same volume.

Are clips useful in the surgical repair of colonic perforations?

PURPOSE: The objective of this study was to assess the effecacy of clip application in the surgical repair of iatrogenic colonic perforations. MATERIAL AND METHODS: Twenty adult male Wistar-Albino rats were divided into two equal groups of ten. In both of the groups an iatrogenic perforation was made in the anti-mesenteric border of the left colon. The defect was closed with interrupted 6/0 polypropylene sutures in group 1 and extraluminal application of vascular clips (VCS--vascular clip system) in group 2. All animals were killed on postoperative Day 4. Wound healing was evaluated with both in situ bursting pressure and hydroxyproline levels. RESULTS: There was no statistically significant difference between the two groups in respect of bursting pressure levels (p = 0.063) whereas hydroxyproline levels were higher in group 2 (p = 0.0021). CONCLUSIONS: Surgical repair of iatrogenic colonic perforations by extraluminal clips gives comparable results according to wound healing parameters. This approach may be a rational alternative to suture or endoscopic repair methods.

Laparoscopic giant parastomal hernia repair with prosthetic mesh.

Laparoscopy is being increasingly used in colorectal surgery interventions. Herein, we present a patient with giant parastomal hernia who underwent laparoscopic repair. A70-year-old man who had undergone abdominoperineal resection and end colostomy for carcinoma of rectum was admitted to our clinic with a giant parastomal hernia. The parastomal hernia was repaired by laparoscopic approach using prosthetic material. The patient was discharged uneventfully on postoperative day 4. Laparoscopic approach is a rational alternative to conventional repair techniques of parastomal hernia and may be a reliable and easily applicable method with the classic benefits of laparoscopic surgery.

Laparoscopic approach to hepatic hydatid disease.

BACKGROUND: The aim of this paper is to present our brief experience on laparoscopic hydatid cyst surgery; we estimated the reproducibility of used techniques in conventional surgery with this relatively recent and attractive method. METHODS: Fifteen cysts in 12 selected hydatid disease patients were treated laparoscopically. Cystotomy, partial cystectomy and drainage were performed in 9 patients. Omentoplasty was added to the procedure in the remaining 3 cases. RESULTS: The mean postoperative hospital stay was 4.9 days. There was no mortality, and 1 patient developed bile leakage. Mean follow-up is 18 months. No recurrence was observed during this period. CONCLUSION: We suggest that laparoscopic treatment of hydatid disease is feasible in selected patients respecting the principles of open surgery and seems beneficial concerning postoperative comfort, hospital stay and return to daily activities.

Effect of growth hormone treatment on the healing of left colonic anastomoses in protein-malnourished rats.

BACKGROUND: Malnutrition is known to affect wound healing but it is not known with certainty whether or not postoperative hyperalimentation can reverse this defect. The present study was designed to examine the effects of recombinant human growth hormone (hGH) on left colonic anastomoses in malnourished rats. METHODS: Experimental animals were allocated randomly into four groups. In groups 1 and 2 animals were fed with normal diet for 10 days before surgery. In groups 3 and 4 animals were fed with a low-protein diet. Left colonic anastomoses were performed in all animals. Following surgery, rats in groups 1 and 3 received hGH whereas rats in groups 2 and 4 were injected with saline as control. Bursting pressure and hydroxyproline levels on day 4 after operation were used to determine anastomotic healing. RESULTS: Bursting pressure was lower in the malnourished rats than those fed with normal diet (P< 0.05). Bursting pressure was higher in normally fed rats which were given hGH. No significant differences could be noted between malnourished control rats and those receiving hGH. CONCLUSION: These results suggest that hGH strengthened the left colonic anastomoses in rats fed a normal diet, but could not reverse the negative effects of malnutrition on colonic anastomoses.

The effects of hyperbaric oxygen on normal and ischemic colon anastomoses.

BACKGROUND: Leakage from colonic anastomoses is a major complication causing increased mortality and morbidity, and ischemia is a well-known cause of this event. Inadequate tissue oxygenation could be reversed by using hyperbaric oxygen. This study was designed to investigate the effects of hyperbaric oxygen on the healing of ischemic and normal colon anastomoses in the rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats divided into four groups. The control group (I) received no further treatment. To mimic ischemia, 2 cm mesocolon was ligated on either site of the anastomosis in group II and IV rats. Hyperbaric oxygen therapy was started immediately after surgery in group III and IV rats (therapeutic groups). All animals were sacrificed on the fourth postoperative day. After careful relaparotomy, in situ bursting pressure was measured. The hydroxyproline contents of the anastomotic segments in equal length were determined. RESULTS: The hydroxyproline assay revealed that rats in group II with ischemic colonic anastomosis have significantly lower levels (P <0.05). The highest levels are in the group III rats with normal colonic anastomosis treated by hyperbaric oxygen (P <0.05). There was no significant difference in hydroxyproline levels between group II and group IV animals (P >0.05). Group III animals had significantly higher bursting pressures than any other group (P <0.05). Group II rats had lowest bursting pressures (P <0.05). Group IV animals had significantly higher levels than group II (P <0.05). Mean bursting pressure values both in groups III and IV and hydroxyproline levels in group III were significantly increased by hyperbaric oxygen therapy (P <0.05). CONCLUSIONS: Ischemia impairs anastomotic healing. Hyperbaric oxygen increases anastomotic healing of both normal and ischemic colonic anastomosis and reverses ischemic damage. This study demonstrated that hyperbaric oxygen improves anastomotic healing.

Single session ligation treatment of bleeding hemorrhoids.

Rubber band ligation (RBL) was prospectively used in 49 consecutive patients with bleeding internal hemorrhoids between 1987 and 1990. All patients underwent a two year follow-up period. Ten patients experienced complications consisting of pain, bleeding, mild discomfort and dissatisfaction. Hemorrhoidectomy was required in three patients. Long term results were satisfactory in 93.9 percent of the patients. The results of this study confirm that single session RBL is a valuable alternative to hemorrhoidectomy in selected patients.