Results in brachial plexus palsy after biceps neuro-muscular neurotization associated with neuro-neural neurotization and teno-muscular transfer.

None of the currently used techniques for elbow flexion recovery in brachial plexus recovery offers enough strength for normal life activities. The association between several methods grants a better result by a summarizing effect compared to each method used separately. The paper reveals the improvement of the functional results in brachial plexus reconstruction by combining the techniques of nerve repair (nerve grafts, nerve transfers or direct muscular neurotization) with palliative muscular transfers. Of the 54 cases of microsurgical reconstruction of brachial plexus palsy, in 20 cases we associated a muscular transposition: 7 latissimus dorsi transfers (5 monopolar and 2 bipolar), 5 pectoralis major and 8 triceps transfers. The direct neuro-muscular neurotization of the biceps-EMG efficient - was associated with a muscular transfer in 8 cases: in 4 of the 7 latissimus dorsi transfers, in 3 cases of triceps transfer and in 2 case of pectoralis major transfer. The association of the 3 methods - direct neuromuscular neurotization, neuro-neuronal neurotization and muscular transfer - has a summarizing effect in the flexion restoration of the elbow flexion, which represents a major problem in the brachial plexus palsy.

[Open-heart surgery in Jehovah's witnesses]. / Szívmútétek jehova tanúinál.

The religious community Jehovah's Witnesses was founded in 1870. They hold that blood transfusion is against God's law. Surgical treatment of a Jehova witness is a great challenge for every surgeon, especially for cardiac surgeons because blood transfusion is frequently needed during such operations. Authors have been trying to reduce the utilization of preserved blood for ten years. This study is about the experience with Jehovah's Witnesses who have undergone open heart surgery in Debrecen. Twenty-four patients underwent open heart surgery from 1989 till May 1999. 7 of them were males and 17 were females. The mean age was 53 years (40-70 yrs). Three patients had congenital heart disease, 11 had acquired valve disease and 7 had coronary stenosis. In 3 cases the patients had combined coronary and valve disease. Authors used a complete procedure for reducing blood loss during the operations. Two patients (8.3%) died during the early postoperative period. Preoperative mean haemoglobin level was 134.2 g/l (112-166) and haematocrit value varied between 36-50% (mean 38%). On the first postoperative day significant decrease was registrated in these values. From the second day a slow but significant increase of haemoglobin and haematocrit levels were detected. The mean follow up time was 37.6 months (2-144), and the NYHA classification of 21 longtime survivors improved from 3.06 to 1.62. At the Department of Cardiac Surgery in Debrecen as well as worldwide more and more operations are done without blood or preserved blood products, so it could be said that nowadays surgical treatment of Jehovah's Witnesses has lower risk than before.

Reoperation for secondary uremic hyperparathyroidism: are technical difficulties influenced by initial surgical procedure?

BACKGROUND: Parathyroid surgery in patients with uremia and secondary hyperparathyroidism is performed either by subtotal parathyroidectomy or total parathyroidectomy with immediate reimplantation. The aim of this study was to compare the results of reoperation for persistent or recurrent hyperparathyroidism after parathyroidectomy according to which initial operative procedure was used. PATIENTS AND METHODS: Eighty-nine patients had reoperation for persistent (28 patients) or recurrent (61 patients) hyperparathyroidism after 53 subtotal parathyroidectomies and 36 total parathyroidectomies with immediate reimplantation. Results of the reoperation were assessed in terms of success rate, morbidity, and operative findings. RESULTS: The success rate of reoperation in patients with persistent hyperparathyroidism was 89% and was independent of the initial type of surgery. Success rates of reoperation for recurrent hyperparathyroidism after initial subtotal parathyroidectomy and total parathyroidectomy with immediate reimplantation were 87% and 70%, respectively (P = .02). Hypertrophy of the parathyroid remnant was the main cause of recurrence after subtotal parathyroidectomy. After total parathyroidectomy with immediate reimplantation, recurrence was located in the graft in half the patients, while hyperplastic tissue was found in the neck or the mediastinum in the other half. CONCLUSIONS: Subtotal parathyroidectomy provides the best conditions for successful reoperation in case of recurrent hyperparathyroidism and should become the surgical treatment of choice for secondary hyperparathyroidism.

[Primary reconstruction of the common truncus arteriosus in infants, using modified pulmonary homograft]. / Truncus arteriosus communis primer rekonstrukciója csecsemökorban, méretre alakított pulmonalis homograft felhasználásával.

Truncus arteriosus communis (TAC) is a complex heart disease, it presents 1% of the congenital heart defects. A 7 weeks old infant with cardiac failure was operated on with TAC. The bicuspidized (14 mm diameter) pulmonary homograft valved conduit was used to reconstruct the right ventricular outflow tract (RVOT). The sternum closure was delayed. The important points of the indications for the surgical management of TAC: 1. Management or prevention of the pulmonary hypertensive crisis. 2. Patient's age. 3. Reconstruction of the RVOT (choices: homograft, dacron valve conduit, autologous pericardial valve conduit, porcine aortic root, direct anastomosis of the pulmonary trunc to the right ventricle). The surgical management is based on the optimal combination of these three important points. This is the first successfully performed primary surgical repair of an infant with TAC using modified pulmonary homograft in Hungary.

[A free microsurgical transfer of a radial (Chinese) flap in reconstructing the lower limb]. / Transferul liber microchirurgical de lambou radial (chinez) în reconstructia membrului pelvin.

UNLABELLED: The microsurgical transplantation of the radial flap to the hind limb has as main advantages to offer a good quality and sensitive skin cover, the possibility to use the flap's radial artery as a vascular bypass and to raise composite flaps with tendon or bone in case of complex reconstruction. MATERIAL AND METHODS: The authors present 9 free radial flap transfers to the foot. Patients' ages ranged from 22 to 50 years. Flap dimensions varied between 7 x 5 cm and 12 x 9 cm. Two flaps contained the flexor carpi radialis tendon to reconstruct the Achilles' tendon and one flap included a bone graft from the radial shaft to resolve a bone defect in the second metatarsal. All flaps were reinnervated by suturing the antebrachial cutaneous nerve of the flap to a cutaneous nerve in the recipient site. RESULTS: There was only one failure in an extensive crush injury. We recommend the radial flap in reconstructing complex defects for it's versatility and for the fact that it can include all types of tissue that may be necessary.

Tissue-specific effects of aldose reductase inhibition on fluorescence and cross-linking of extracellular matrix in chronic galactosemia. Relationship to pentosidine cross-links.

Chronic experimental hyperglycemia mediated by galactose has been shown to induce browning and cross-linking of rat tail tendon collagen that could be duplicated in vitro by nonenzymatic galactosylation. To investigate the nature of these changes, Sprague-Dawley rats were placed on a 33% galactose diet without and with sorbinil for 6 and 12 mo. Collagen-linked fluorescence and pentosidine cross-links increased with age and galactosemia in tail tendons (P less than 0.001) and skin but were essentially unresponsive to aldose reductase inhibition (ARI). In contrast, tendon breaking time in urea, a likely parameter of cross-linking, was markedly improved (P less than 0.001) by ARI. Fluorescence that was inhibited by sorbinil treatment was increased in pepsin and proteinase K digest of aortic tissue from galactosemic rats (P less than 0.001), but impaired enzymatic digestibility was not observed. Systolic blood pressure as potential consequence of aortic stiffening was not increased in galactosemia. These data suggest that fluorescence in skin and tendon might be in part due to advanced glycosylation and pentosidine formation because these were not decreased by ARI. However, they also suggest that nonfluorescent cross-links may also be forming because, in contrast to fluorescence, tail tendon breaking time was partly corrected by ARI. Thus, it appears that extracellular matrix changes in chronic galactosemia are complex, being partly attributable to advanced glycosylation and partly to polyol-pathway activation.