[Laparoendoscopic single site cholecystectomy (LESS) in a 16-year-old girl: the way to go even in pediatric surgery?]. / Laparoendoskopische Single-Site-Cholezystektomie (LESS) bei einem 16-jährigen Mädchen: Ein Weg auch für die Kinderchirurgie?

The laparoscopic paradigm to place different ports according to ergonomic principles is presently challenged by laparoendoscopic single site surgery (LESS). Its objective is to perform a complex task with several instruments using only one access. However, this approach introduces distinct ergonomic problems and requires innovative technical solutions to allow for more complex surgical tasks. In paediatric surgery, this development has just begun. A 16-year-old girl presented with a symptomatic cholecystolithiasis. A multi-channel TriPort (Advanced Surgical Concepts) was introduced through a 20 mm umbilical incision for LESS cholecystectomy. Retraction of the gallbladder was facilitated by a straight grasper, which was inserted transabdominally. For exposition and triangulation a pre-bend dissector (5 mm, Olympus) was employed. Thus, the cystic duct and artery could be exposed, clipped (5mm) and divided. Finally, the gallbladder was dissected from its bed and extracted into a specimen bag. Operating time was 90 minutes and no intra- or postoperative complications occurred. In conclusion, a multi-channel port and angulated instruments during LESS cholecystectomy provided ergonomics close to conventional laparoscopic surgery. For smaller children though, this technology will have to be adapted to their geometry. Finally, even though LESS seems attractive, the present euphoria should not turn into scientific acceptance, until more experience is available and valid data have proven a benefit for patients of any age.

Completely isolated enteric duplications cysts: a survey of four cases.

Enteric duplication cysts are uncommon congenital abnormalities with epithelial lining. They are cystic or tubular structures intimately attached to a portion of the gastrointestinal tract; they are usually located on the mesenteric site of the digestive tract sharing common blood supply. Isolated cystic duplications are an extremely rare variant with their own blood supply: in literature only five cases have been reported. We present our four cases series of this uncommon anomaly.

Lymphatic preservation using methylene blue dye during varicocele surgery: a single-center retrospective study.

OBJECTIVE: Hydrocele and testicular edema caused by division of lymphatic vessels during varicocelectomy could lead to decrease in testicular function. In-vivo methylene blue mapping of testicular lymphatic vessels should prevent damage to the lymphatic system. MATERIALS AND METHODS: We retrospectively compared outcomes for 46 patients who received an intraparenchymal injection of 0.25 ml of vital dye (isosulphan blue) before a laparoscopic or an inguinal/subinguinal spermatic vein ligation with 93 controls in whom no mapping technique was adopted. RESULTS: Methylene blue mapping of testicular lymphatics reduced the incidence of postvaricocelectomy hydrocele from 6.4% (6/93) to 2.1% (1/46); the incidence of hydrocele was 0% in all cases of successful lymphatic mapping. CONCLUSION: Mapping of testicular lymphatic drainage with intraparenchymal vital dye is an easy, safe, rapid and cost-free technique. We stress the importance of sparing the lymphatic system to ensure the best andrological outcome.

Cell cycle- and cell growth-regulated proteolysis of mammalian CDC6 is dependent on APC-CDH1.

CDC6 is conserved during evolution and is essential and limiting for the initiation of eukaryotic DNA replication. Human CDC6 activity is regulated by periodic transcription and CDK-regulated subcellular localization. Here, we show that, in addition to being absent from nonproliferating cells, CDC6 is targeted for ubiquitin-mediated proteolysis by the anaphase promoting complex (APC)/cyclosome in G(1). A combination of point mutations in the destruction box and KEN-box motifs in CDC6 stabilizes the protein in G(1) and in quiescent cells. Furthermore, APC, in association with CDH1, ubiquitinates CDC6 in vitro, and both APC and CDH1 are required and limiting for CDC6 proteolysis in vivo. Although a stable mutant of CDC6 is biologically active, overexpression of this mutant or wild-type CDC6 is not sufficient to induce multiple rounds of DNA replication in the same cell cycle. The APC-CDH1-dependent proteolysis of CDC6 in early G(1) and in quiescent cells suggests that this process is part of a mechanism that ensures the timely licensing of replication origins during G(1).

Genetic aspects of the worldwide colonization process of Ceratitis capitata.

Multilocus enzyme electrophoresis data from 26 polymorphic loci (124 alleles) were used to analyze the genetic aspects of the worldwide colonization of Ceratitis capitata (medfly). Eighty-two samples of 17 populations were collected from six regions throughout the species range: Africa, extra-Mediterranean islands (Madeira and Gran Canaria), Mediterranean region, Latin America (Guatemala), Pacific (Hawaii), and Australia. The variability parameters (H, P, A) reveal that the geographical dispersal of medfly from its ancestral source area (East Africa) is associated with a great reduction in variability. The pattern of decreasing variability occurs at two regional levels: in the African-Mediterranean region where the differentiation is gradual, and in the Latin American-Pacific region where some ancestral variability is still present as a consequence of recent colonization. The UPGMA phylogenetic tree, derived from Nei's genetic distances, shows the presence of intraspecific differentiative processes affecting mainly the two island populations, Réunion and Hawaii. The population genetic changes observed in the species range are consistent with both the chronology and the historical circuitous course of the medfly colonization process.