A novel reconstructive strategy for pancreaticoduodenectomy following Roux-en-Y distal gastrectomy.

The rate of pancreaticoduodenectomy (PD) performed for both benign and malignant periampullary diseases has increased. In addition, Roux-en-Y reconstruction after distal gastrectomy for cancer or ulcer is still widely used. Therefore, a surgeon may be confronted with a partially- gastrectomized patient who needs a PD. This is a very challenging circumstance for surgeons because of adhesions, bloodstream, anatomical changes and length of the remnant intestine. In our experience, we performed two pancreaticoduodenectomies after distal gastrectomy in patients with periampullary tumors. We preserve gastrojejunal anastomosis and perform an end-to-side pancreaticojejunostomy (PJ) on the afferent limb of gastrojejunal anastomosis and a termino-lateral hepaticojejunal anastomosis on an independent transmesocolic Roux-en-Y limb. In literature, few cases of PD after distal gastrectomy are reported and most of them consider only PD after Billroth II reconstruction. Many authors have demonstrated pancreaticogastrostomy (PG) is superior to PJ in terms of lower risk of pancreatic and biliary fistula, but it is not possible to anastomose pancreas stump with gastric wall in patients who have been undergone distal gastrectomy. For this reason, we retrospectively review our experience about PD following distal gastrectomy and suggest a novel standardized technique which allow surgeons to benefit from same advantages of a typical PG also in this group of patients.

Descrição do movimento da articulação metacarpofalangiana de equinos pela metodologia baseada em videogrametria / Equine metacarpophalangeal joint movement using videogrammetry method

Caracterizou-se, mediante análise cinemática tridimensional baseada na videogrametria, o ângulo dorsal da articulação metacarpofalangiana de equinos em sete equinos da raça Puro Sangue Árabe. A análise tridimensional do movimento foi realizada em esteira rolante. O programa Dvideo foi utilizado para a obtenção das coordenadas tridimensionais do sistema de calibração e dos marcadores reflexivos posicionados na extremidade proximal do terceiro osso metacárpico, articulação metacarpofalangiana e extremidade distal da primeira falange. A articulação metacarpofalangiana apresentou extensão máxima durante o momento de apoio, no qual a face lateral do terceiro osso metacarpiano se apresentava de forma perpendicular ao solo. Foram observados dois picos de flexão durante a fase de elevação. Concluiu-se que a instrumentação utilizada para a análise cinemática tridimensional permitiu a investigação quantitativa da variação angular do movimento de extensão e flexão da articulação metacarpofalangiana de equinos por meio de imagens digitalizadas.

The kinematic pattern of the metacarpophalangeal joint of equine using videogrammetry was evaluated. The three dimensional kinematic analysis were performed in a treadmill using seven Arabian horses. The Dvideo program was used to obtain the three dimensional coordinates from a calibration system and three reflective markers placed on the third metacarpus, metacarpophalangeal joint and proximal phalanx of the left forelimb. After the landing of the hoof, the fetlock extends to maximal loading at mid stance. During the swing phase the joint shows two flexion peaks. This method allows the determination of the flexion and extension angle of the metacarpophalangeal joint during locomotion.

Experiences with Bicontact ceramic-ceramic total hip arthroplasty.

AIM: Mid-term result documentation of ceramic-on-ceramic cementless total hip replacement. METHOD: From November 1998 to December 2005, 356 patients were submitted to 419 total hip arthroplasties of the hip with a cementless, ceramic-ceramic Bicontact/Plasmacup type of prosthesis. Patients were controlled in a consecutive prospective study. RESULTS: The average age of the patient group is 47.9 years, with an average follow-up of 48 months. There was no case with release of osteolysis of the acetabular or femoral components. There was one ceramic head fracture in an obese patient. Articular wear was negligible and could not be measured radiographically. CONCLUSION: The ceramic-ceramic Bicontact hip joint replacement presents a low complication rate in young patients, with very low wear.

Polymeric nanoparticles composed of fatty acids and polyvinylalcohol for topical application of sunscreens.

Benzophenone-3 (BZP) or oxybenzone is widely used in many cosmetic formulations, such as sunscreen lotions or emulsions, shampoos and hair sprays. The nature of the vehicle used can enhance or block the percutaneous absorption of UV filter. In this work, we hydrophobically modified polyvinylalcohol 10 000 (PVA) with fatty acids (FAs) to obtain PVA-FA derivatives for the preparation of lipophilic polymeric nanoparticles able to prevent BZP movement towards the skin. Synthesized PVA-FA derivatives were confirmed by H1 NMR. Nanoparticles loaded with BZP were prepared using a solvent extraction method. The particle size was monitored by means of dynamic light scattering measurements. In-vitro skin permeation studies were performed.

[Relation between hypogonadism and malocclusion in beta-thalassemia major patients: analysis of 122 subjects]. / Relazione tra ipogonadismo e malocclusione dentaria in pazienti affetti da beta-talassemia major. Studio su 122 pazienti.

AIM: The type of malocclusion most often seen in beta thalassemic patients is represented by Angle's II class, which however cannot be considered significant in the patients studied in this research. The only causal factor indicated by medical literature for this pathology is medullary hyperplasia due to inefficient erythropoiesis which occurs in patients transfused at low hemoglobin levels. The aim of this research is to evaluate the influence of other factors as well, particularly sexual development, the level of seric ferritin, ALT, and age at first transfusion. METHODS: One-hundred and twenty-two b thalassemic patients and 39 homozygotes, aged between 16 and 27, undergoing treatment at the "Ospedale Regionale per le Microcitemie di Cagliari", have been analysed. RESULTS: The results of the statistic analysis have shown that hypogonadism can play an important role in determining malocclusions in male beta thalassemic patients (Odds ratio 4,5; CI 1,5-13). No other factor has shown any statistically relevant influence on dental occlusion. CONCLUSION: It would therefore be interesting to further investigate the hormonal mechanisms that can alter bone development in thalassemic youngsters: the prevention of such alterations will surely contribute to improving the quality of life in these patients, particularly now that their life expectancy has been significantly extended by the progress made in transfusional therapy and ferrochelation.

Purification and characterization of thermostable xylose(glucose) isomerase from Bacillus thermoantarcticus.

Xylose isomerase produced by Bacillus thermoantarcticus was purified 73-fold to homogeneity and its biochemical properties were determined. It was a homotetramer with a native molecular mass of 200 kDa and a subunit molecular mass of 47 kDa, with an isoelectric point at 4.8. The enzyme had a K(m) of 33 mM for xylose and also accepted D-glucose as substrate. Arrhenius plots of the enzyme activity of xylose isomerase were linear up to a temperature of 85 degrees C. Its optimum pH was around 7.0, and it had 80% of its maximum activity at pH 6.0. This enzyme required divalent cations for its activity and thermal stability. Mn(2+), Co(2+) or Mg(2+) were of comparable efficiency for xylose isomerase reaction, while Mg(2+) was necessary for glucose isomerase reaction.

Fibroblast growth factor receptor mutational screening in newborns affected by metopic synostosis.

A number of craniosynostotic disorders have recently been ascribed to mutations in genes coding for the fibroblast growth factor receptors(FGFRs). The common feature of these FGFR-associated conditions is the unilateral or bilateral premature ossification of the coronal suture. One distinct craniosynostotic condition is trigonocephaly, which results from the premature fusion of the metopic suture. Trigonocephaly mostly occurs as isolated cranial defect; however, the premature closure of the metopic suture may represent a feature of more complex craniosynostotic conditions in which a progressive involvement of other cranial sutures with age is observed. The possible involvement of mutated FGFRs in trigonocephaly was investigated in nine newborns affected by isolated premature synostosis of the metopic suture. All except one of these cases carried no mutations in the FGFR1-3 domains indicated as hot spots for craniosynostosis-associated mutations. A T(978)C transition in the FGFR2 exon IIIa was found in a patient who had a phenotype that apparently fitted the trigonocephalic condition at birth, but showed additional facial anomalies, which worsened progressively with age towards a Crouzon-like profile. The present finding points out the importance, from both diagnostic and prognostic points of view, of early FGFR mutational screening in craniosynostotic conditions, even in forms that apparently do not involve closure of the coronal suture at birth.

Methimazole embryopathy: delineation of the phenotype.

We report on a further case of congenital anomalies in a child exposed to methimazole during the first trimester of pregnancy (from first to seventh gestational week), and define a specific malformation pattern related to prenatal methimazole exposure and consisting of choanal and esophageal atresia, scalp defects, minor facial anomalies and psychomotor delay.

Recurrent RPE microrips in a case of vascularised pigment epithelial detachment.

Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.

Stereotactic core needle biopsy of nonpalpable breast lesions: initial experience with a promising technique.

OBJECTIVES: To evaluate the correlation between the pathological findings of stereotactic core needle biopsy (SCNB) and the prebiopsy mammographic findings, as well as the pathological findings of lesions that were subsequently removed by surgical excision. DESIGN: A retrospective review of 97 consecutive patients who underwent 100 SCNBs of suspicious nonpalpable mammographic lesions. The criterion standard is surgical excisional biopsy with needle localization. Mammographic findings were graded according to the American College of Radiology Breast Imaging Reporting and Data System. The pathological findings of SCNB were categorized into 4 groups: benign and specific, benign and nonspecific, premalignant, and malignant. Surgical excision of the lesion was performed if the pathological finding on SCNB was nonconcordant with the prebiopsy mammogram and when premalignant or malignant lesions were found. The pathological findings of lesions that were subsequently removed by surgical excision were compared with those of SCNB. SETTING: Community-based private multispecialty ambulatory practice. PATIENTS: A population-based sample composed of 97 patients who had grade III, IV, or V lesions on routine screening mammograms. INTERVENTION: Stereotactic core needle biopsy of nonpalpable mammographic lesions. MAIN OUTCOME MEASURES: Percentage of patients whose SCNB results were concordant with the mammographic findings and the pathological findings on subsequent surgical excision. RESULTS: Concordance between SCNB and mammography occurred in 97% of biopsy specimens. Concordance between the pathological findings of SCNB and those of surgically excised lesions occurred in 92.5% of biopsy specimens. We had 1 false-negative result. We had no false-positive diagnosis of cancer with SCNB. CONCLUSION: On the basis of accumulating literature and our own initial experience, SCNB is a promising, safe, and cost-effective procedure.

Lymphocyte subsets in schizophrenic disorders. Relationship with clinical, neuromorphological and treatment variables.

Peripheral blood lymphocyte subsets and serum immunoglobulin levels were assessed in 42 patients and 37 healthy controls. 24 patients were free from neuroleptic medication and 15 had never been treated with neuroleptics. 31 patients had a diagnosis of schizophrenia (DSM-III criteria) and 11 a diagnosis of a disorder of the schizophrenic spectrum. As compared to healthy subjects, the drug naive schizophrenic patient group showed an increase of T suppressor lymphocytes, while the drug-treated schizophrenic group showed an increase of T helper lymphocytes. The drug-treated schizophrenic group differed from the drug naive one relative to a decrease of T suppressor lymphocytes. As compared to healthy subjects, the drug naive spectrum disorder patients showed an increase of absolute number of lymphocytes, while the drug treated spectrum group showed an increase of B lymphocytes. These findings did not correlate with any clinical or neuromorphological variables taken into account.

[The experience of the corporal self and the Rorschach test in severe obesity under medical-surgical treatment]. / Le vécu du soi corporel et le test de Rorschach dans l'obésité grave en traitement médical-chirurgical.

Purpose of this study is an investigation about the experience on the body Self and many relevant symbolic meanings in the massive obesity before and after the surgical therapy as well as a checking of the former obese patients in order to find out if such a heavy intervention may involve a modification of the body Self Perception in comparison with the former massive obesity situation. The investigation covered a sample group of 82 patients, and 12 of them were submitted again, after one year, to the Rorschach test with relevant evaluation through the Rausch de Trauenberg Self Representation Scale. The data thus obtained were considered again in a later phase by means of a sub-group of 10 obese patients compared with two checking groups consisting of subjects suffering from addiction pathologies (alcohol and opiate dependence) by means of the same method.

Splenosis. A cause of massive gastrointestinal hemorrhage.

Splenosis is the autotransplantation of splenic tissue following surgery or trauma. While it has been reported to cause a number of complications, splenosis is most commonly an incidental finding at laparotomy or on imaging studies. In our study, a case of massive, acute gastrointestinal hemorrhage occurred secondary to splenosis involving the small bowel. While there are several reports of self-limited gastrointestinal hemorrhage secondary to splenosis involving the gastric fundus, we are aware of no reports of massive, acute intestinal bleeding caused by this condition. Splenosis should be considered in the differential diagnosis of gastrointestinal hemorrhage in patients who have experienced prior splenic trauma or splenectomy.

Plasmacytoma of the breast. An unusual case of recurrent myeloma.

An unusual case of multiple myeloma is presented in which recurrence of the disease after a four-year remission was heralded by an infiltrating plasmacytoma of the breast. The clinical and histologic features of this neoplasm are presented and compared with ten previously reported cases of plasmacytoma of the breast.

[Valpromide (Depamide) in the treatment of acute psychotic states. Open clinical study]. / Le valpromide (Dépamide) dans le traitement d'états psychotiques aigus. Une étude clinique ouverte.

In an open clinical study on the effect of Depamide in acute psychosis, 59 schizophrenic and 23 manic hospitalized patients were tested. They were divided in two groups: in group A, Depamide was administered only after an initial period of treatment with haloperidol or chlorpromazine; in group B instead, Depamide was added from the beginning of the neuroleptic treatment. The results show that the association of Depamide with neuroleptics leads to a reduction of agitation and of the hospitalization period, whereas it ameliorates the adaptation of the patients to the therapeutic milieu.

Biohybrid artificial pancreas. Long-term insulin secretion by devices seeded with canine islets.

Long-term insulin secretion was investigated in seven biohybrid capillary devices seeded with canine islets. Approximately 50,000 islets could be isolated from a single canine pancreas using collagenase digestion in conjunction with the recently described Velcro technique. Devices were perfused with tissue culture medium 199 containing 300 mg/dl glucose. Insulin secretion fell during the first 1-2 days of culture from approximately 18 to 6 U/day. After 3-4 wk of perfusion, however, there was a gradual rise in insulin output that reached greater than 15 U/day after 7 wk. Insulin output eventually stabilized at 18-20 U/day. Two of these devices were studied for 80 and 86 days, respectively, and continued to secrete these same amounts of insulin. Glucose-induced insulin release was studied after 1 and 4 wk of culture and was well preserved.