Two-centre experience in the treatment of thyroglossal duct remnants using the modified muscle-sparing Sistrunk technique.

The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate. A total of 110 consecutive patients (62 (56.4%) male, 48 (43.6%) female) who underwent a modified muscle-sparing Sistrunk procedure were included in the study. Their mean age at presentation was 26.9 ± 18.9 years. A modified muscle-sparing Sistrunk procedure using cold instruments, electrocautery, and a harmonic scalpel was performed in all patients. Recurrence was recorded in six (5.5%) patients. The median hospital stay was 2 days (range 1-7 days), and the median follow-up duration was 7 years (range 2-13 years). There was no significant difference in recurrence rate between the conventional and modified muscle-sparing Sistrunk procedure in primary TDRs. The study findings showed that the modified muscle-sparing Sistrunk procedure had low recurrence and complication rates in the context of primary TDR.

Isolated bilateral macrostomia: literature review and case report.

AIM: Macrostomia, or lateral cleft lip, which is known as Tessier cleft type 7, is one of the rarest facial anomalies. The purpose of this review is to describe the main characteristics, epidemiology, aetiology and treatment of this anomaly. METHODS: We present an overview of surgical techniques as well as a review of all 36 cases of bilateral asyndromic macrostomia reported to this da in the literature. Furthermore, we report the case of a 4-month male infant with bilateral transverse cleft lip and analyse the treatment decision and the procedure itself. CONCLUSION: Early diagnosis and surgical intervention are crucial in treating children with these malformations. Adequate timely reconstruction plays a main role in both physical and psychological rehabilitation.

Development of a valid and reliable instrument for the assessment of quality of life in parents of children with clefts.

PURPOSE: Orofacial clefts are the most common congenital malformations that affect craniofacial structures. Studies show that they have a major influence on psychological development of the patient, and on their families. A review of the literature showed a lack of specific questionnaires for children and their parents. This study investigated the impact of orofacial clefts in children on the quality of life of their parents. In addition, the results of the treatment and the quality of work of the health team members involved in this process were evaluated. MATERIALS AND METHODS: For the purpose of this study, an original questionnaire was made to analyse the effect of orofacial clefts in children who had undergone surgery on the quality of life of 73 of their parents. The questionnaire consisted of 28 simple statements, which were evaluated with a 5-degree Likert scale (from 1-fully disagree to 5-fully agree), did not require any specific additional clarification, and were easy to complete. RESULTS: Analysis of areas of the questionnaire that applied to the parents, resulted in two subscales, parental social health and child social health, which had satisfactory Cronbach's coefficients (0.907 and 0.897, respectively). However, some issues had a relatively poor coefficient of internal consistency, which justified their expulsion from the final model of the parent questionnaire. CONCLUSION: The questionnaire developed for this study comprised two subscales concerned with the social health of parents/respondents and the social health of adolescents, as perceived by the parents. It was a valid and reliable instrument, and it showed satisfactory quality of life for parents of adolescents with clefts.

The CD34-microvascular density in colorectal cancer patients.

PURPOSE: To investigate the influence of the angiogenesis parameter CD34 microvascular density (MVD) on overall survival of colorectal cancer (CRC) patients. METHODS: Thirty-one CRC patients were followed-up for 72 months after curative colorectal operation. Blood vessels measurement was done using the CD34-MVD immunochemistry method, and light microscopy. RESULTS: MVD was inversely correlated with patients' survival. MVD value < 35 proved as independent good prognostic factor, and patients with this value lived during the 72-month follow up after surgery, while a MVD value > 65 was an independent poor prognostic factor and such patients died within 11 months after radical surgery for CRC (p<0.01). CONCLUSION: According to these results, the CD34-MVD seems to be a significant prognosticator of overall survival in CRC patients.

Phages of Pseudomonas aeruginosa: response to environmental factors and in vitro ability to inhibit bacterial growth and biofilm formation.

AIMS: To examine effects of various environmental factors on adsorption and inactivation of Pseudomonas aeruginosa-specific phages: δ (family Podoviridae), J-1, σ-1 and 001A (family Siphoviridae) and their ability to inhibit bacterial growth and biofilm formation. METHODS AND RESULTS: The phages examined in the study were clonally different, as revealed by RFLP. The temperature in the range 7-44°C had no influence on the adsorption of Podoviridae, but did affect Siphoviridae adsorption, particularly 001A. All phages were significantly stable at pH 5-9, and phages δ and 001A even at pH 3. Most of the examined carbohydrates and exopolysaccharides of the original host efficiently inactivated phage δ, while phages σ-1 and J-1 were inactivated considerably only by the amino acid alanine. Silver nitrate efficiently inactivated all the phages, while Siphoviridae were more resistant to povidone-iodine. Serum of nonimmunized rats had no influence on phage inactivation and adsorption. Only phage δ showed ability to effectively inhibit in vitro bacterial growth and biofilm formation. CONCLUSIONS: The examined environmental parameters can significantly influence the adsorption and viability of Ps. aeruginosa-specific phages. The phage δ is a good candidate for biocontrol of Ps. aeruginosa. SIGNIFICANCE AND IMPACT OF THE STUDY: The study provides important data on Ps. aeruginosa-specific phage adsorption, inactivation and in vitro lytic efficacy.

Complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study.

Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam-fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane-fentanyl anesthesia was induced and maintained with sevoflurane (5-8 vol% and 0.8-1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam-fentanyl group) and 4 of 64 children (sevoflurane-fentanyl group) (P=0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane-fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane-fentanyl group (17 cases; P<0.001); postoperative nausea and vomiting occurred in 2 children (midazolam-fentanyl group) and 3 children (sevoflurane-fentanyl group) (P=0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.

Preoperative antiseptics in clean/contaminated maxillofacial and oral surgery: prospective randomized study.

In order to show the effectiveness of preoperative antiseptic mouthwash the authors undertook a prospective study in 120 patients who underwent elective surgery under general or local anesthesia. Patients were allocated toone of 4 groups, depending on whether the oral cavity was washed preoperatively with 1% cetrimide, chlorhexidine, povidon-iodine or sterilized normal saline solution (control group). Aerobic and anaerobic bacterial samples were taken from the inferior vestibulum mucosa before surgery, 5 min after the start of the operation and at the end of the procedure. The results show a statistically significant reduction in bacterial counts during procedures in which antiseptics are used to wash the oral cavity preoperatively. 1% cetrimide solution was the most successful in reducing intra-oral bacterial counts and produced the longest lasting antiseptic effect. Chlorhexidine is a good option for procedures longer than 1 hour, while povidon-iodine is recommended for procedures lasting up to 1 hour. Normal saline reduced bacterial counts in the specimen taken 5 min after washing but this short-lasting effect is due to mechanical cleansing rather than the antiseptic effect.

[Risk factors in chronic ischemic pancolitis].

Ischaemia of the colon wall leads to lesions that are gathered under entity of ischaemic colitis. Acute or chronic tissue hypoxia is caused by various vascular disorders which could be divided into two large groups: occlusive or non-occlusive. Chronic ischaemic colitis is manifested with necrosis of colon wall, with consequent stenosis of the affected area. Clinically, it is manifested with increased number of bloody stools and abdominal pain. Treatment of choice is surgery, and resection of the affected segment is often life saving. We present a case of a patient with chronic ischaemic pancolitis, due to atheromathosis of upper and lower mesenterial arthery branches, corelated with age, cardiovascular diseases, chronic opstipation and drug-intake.

Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects.

OBJECTIVE: To evaluate and discuss the free flap reconstructive options for patients with partial and total maxillectomy defects. DESIGN: Retrospective review of cases. SETTING: Two tertiary referral centers. PATIENTS: Fifty-one patients had partial or total maxillectomy defects resulting from oncologic surgical resection, and 7 had partial maxillectomy defects resulting from trauma. Inferior or partial maxillectomy defects included 10 anterior arch and hemipalate defects and 12 subtotal or total palate defects. Total maxillectomy defects with and without orbital exenteration included 36 maxilla defects with hemipalate and malar eminence. INTERVENTION: There were 11 fibula, 14 rectus abdominis, 9 scapular, 10 radial forearm, 5 latissimus dorsi, and 13 combination latissimus dorsi and scapular flaps. MAIN OUTCOME MEASURES: Separation of the oral cavity from the sinonasal cavities, diet, type of dental restoration, type of orbital restoration, speech intelligibility, and complications. RESULTS: Only 1 flap failure was reported. There was loss of bone in 2 flaps and loss of the skin paddle in 1 flap. All palatal defects were sealed by the separation of the oral and sinonasal cavities. Thirty-eight patients were able to eat a regular diet while the remaining patients maintained a soft diet. All patients conversed on the telephone without difficulty in intelligibility. Eight patients had an implant-borne dental prosthetic, and 30 patients had a conventional partial prosthetic. Orbit restoration was achieved in 2 patients with an implant-borne prosthetic, and 6 patients retained a standard orbit prosthetic. CONCLUSIONS: Free flap reconstruction of the maxilla creates reproducible permanent separation of the oral and sinonasal cavities in a single-stage procedure. In addition, there exists the potential for dental rehabilitation with restoration of masticatory and phonatory function. Free flap reconstruction also provides a good cosmetic result, which improves patients' outlook and contributes to their overall well-being. Reconstructive flaps are designed to fit specific maxillary defects and patient needs to provide optimally functional and cosmetic results.

Reconstruction following radical maxillectomy with flaps supplied by the subscapular artery.

The authors present their experience of 27 cases with repairs of defects following radical maxillectomies with free flaps. A total of 28 flaps were used (five latissimus dorsi, six scapula, 16 combination flaps of scapula and latissimus dorsi and one combination of scapula, latissimus dorsi and serratus anterior flap). Only one scapula flap was completely lost and in three cases where a combination of scapula and latissimus dorsi flap was used, partial necrosis of one component occurred. The authors first choice for reconstruction is a scapula bone flap raised on the angular artery combined with the latissimus dorsi flap. The combination of flaps with a long pedicle and of the bony and muscular components provides the surgeon with the option of customizing the flap to meet individual patient needs. For intraoral closure the authors prefer the latissimus dorsi muscle which rarely requires secondary procedures for prosthesis placement following epithelialization and atrophy. The main disadvantage of the flap is the difficulty of two teams working simultaneously, thus increasing the average operating time. All postoperative corrections and prosthetic rehabilitation should be postponed for at least 2 months following surgery because of postoperative swelling.

Arterial ring encircling the bile duct with coexisting anomalous liver irrigation.

Analysis of the arterial system of the liver in a 64-year-old male cadaver revealed an anomaly of the branching of the proper hepatic artery. The right branch of the hepatic artery was missing, replaced by two segmental arteries, so that a 'trifurcation' occurred, consisting of two segmental arteries, anterior segmental and posterior segmental, and the left branch of the hepatic artery. These segmental arteries formed an arterial ring around the common hepatic duct, completely encircling it. A single cystic artery unusually originated from the posterior segmental artery. An extremely rare anatomical variation of the dorsal liver segment irrigation proves the fact that anatomical anomalies are usually multiple. The arterial blood supply for the dorsal liver segment is through four separate vessels ('quadruple type'), two originating from the left branch of the hepatic artery and two from the posterior segmental artery. These four arteries presented numerous anastomotic bridges among themselves.

[Blood serum and milk serum levels of sodium benzylpenicillin after intravenous regional antibiosis in surgery of the claw area in cattle]. / Blutserum- und Milchserumspiegel nach intravenöser Stauungsantibiose mit Na-Benzylpenicillin bei Eingriffen im Zehenbereich des Rindes.

An intravenous regional antibiosis using 10 Mega I.U. Sodium-Benzylpenicillin was carried out during surgery in 14 dairy cows affected with spontaneous occurring digital diseases. Blood serum and milk serum levels were determined over a period of 48 hours by means of a micro agar diffusion method using Sarcina lutea Stamm BGA Berlin as a test germ. Even before opening of the rubber tourniquet, penicillin traces were detectable in the blood serum of 6 cows. Maximal concentrations ranging from 0.43 mcg/ml to 8.63 mcg/ml were determined after 45 minutes to 4 hours. 24 hours after intravenous regional antibiosis no levels above the limit of detectability were determined. Significant lower maximal concentrations were found in claw amputation cases as compared with claw preserving surgical interventions. Milk serum levels showed delayed and lower maximal concentrations, ranging between 2.09 and 0.09 mcg/ml. In 5 animals no positive levels were detected. After 48 hours, penicillin levels were below the limit of detectability in the milk of all examined animals.

Quantification of hind limb lameness in the horse.

The three-dimensional optoelectronic locomotion analysis system SELSPOT II was used for kinematic studies of hind limb locomotion patterns. Two groups, 11 sound horses and 15 horses suffering from hind limb lameness, were examined at the trot. Both graphical and quantitative analyses were compared in sound and lame horses. The parameter hip acceleration quotient (HAQ), using the different peaks of vertical acceleration of one hip during one stride, proved to be a suitable value for quantitative analysis of hind limb lameness. In sound horses the HAQ ranged from 1.03 to 1.54, lame horses showed values between 1.32 and 2.96. Checking and documentation of diagnostic anesthesias or therapies are possible applications.

Plasma histamine levels in laminitic horses and in horses treated with a corticosteroid.

In seven sound horses histamine plasma levels were evaluated by means of a radioenzymatic method using the enzyme histamine-N-methyltransferase (mean = 4.46 nmol/l, SD = 1.55 nmol/l). Histamine levels of laminitic horses were significantly higher (n = 11; mean = 12.46 nmol/l, SD = 3.24 nmol/l). In three sound horses plasma histamine levels were determined over a two week period following a double administration of 10 mg dexamethasone-21-isonicotinate/100 kg body weight. Histamine levels remained within the range of sound control horses.

[Thrombectomy of the descending aorta in the horse]. / Zur Thrombektomie aus der Aorta descendens des Pferdes.

Thrombosis of the aorta as the cause of intermittent claudication in the horse appears to be rare. Two cases out of about 10 000 horses 1973-1984 are discussed. There are various views on its aetiology, whereby haemodynamic factors and disturbances of coagulation have been mentioned as well as parasites. For treatment surgical methods should be explored in addition to medical procedures. History, diagnosis and the attempt of an aortic thrombectomy in a 12 year old thoroughbred mare are described in this paper. A standardbred stallion was left untreated on owners wish.