Reduction malarplasty through an intraoral incision: a new method

Until recently, osteotomies and surgeries to reposition prominent zygoma have been performed by means of a coronal incision or intraoral and preauricular incisions. Such incisions have penalties such as scars, the possibility of facial nerve injury, and long operative times. After reflecting on their past experiences with facial bone surgery, the authors developed an alternative approach. In this method, the cheekbone protrusion is corrected by performing an osteotomy and repositioning through an intraoral incision only. During the past 3 years, the authors have operated on 23 patients with malar prominences. The amount of bone to be removed is determined by preoperative interviews, physical examinations, and x-rays. Intraoral incisions provide access to the zygomatic body and lateral orbital rim. After L-shaped osteotomies (two parallel vertical and one transverse osteotomy at the medial part of the zygomatic body), the midsegment is removed. The posterior portion of the zygomatic arch was approached through the medial aspect and was outfractured using a curved osteotome. After completing the triple osteotomy, the movable zygomatic complex was reduced medially and fixed with miniplates and screws on the zygomaticomaxillary buttress. The patients were followed for 9.5 months, with acceptable results and few complications. The authors conclude that this technique is an effective and safe method of reduction malarplasty.     

Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients

The advantages of endoscopic carpal tunnel release, compared with traditional open techniques, include smaller incisions, less scar tenderness, and faster recoveries. However, endoscopic carpal tunnel release has also been associated with higher complication rates. The goal of this study was to evaluate the safety and functional outcomes of minimal-incision open carpal tunnel release. In this prospective study involving a 2-year period, 104 patients (149 hands) underwent open carpal tunnel release with a 1-cm incision. Prospective data on complications among 104 patients were recorded, and functional outcomes among 20 patients were assessed by using the Michigan Hand Outcomes Questionnaire, the Jebsen-Taylor Hand Function Test, and pinch/grip strength testing. Data were collected before the operation and 3 weeks and 6 months after the operation. Complications included three wound infections and one carpal tunnel syndrome recurrence, 18 months after the initial release procedure. Michigan Hand Outcomes Questionnaire scores improved significantly between the preoperative and postoperative periods. There were no significant changes in Jebsen-Taylor Hand Function Test results or pinch/grip strength. Minimal-incision open carpal tunnel release can be performed safely and is associated with good functional outcomes.     

Mitochondrial ROS-induced ROS release: an update and review

Unstable mitochondrial membrane potential and redox transitions can occur following insults including ischemia/reperfusion injury and toxin exposure, with negative consequences for mitochondrial integrity and cellular survival. These transitions can involve mechanisms such as the recently described process, "Reactive Oxygen Species (ROS)-induced ROS-release" (RIRR), and be generated by circuits where the mitochondrial permeability transition (MPT) pore and the inner membrane anion channel (IMAC) are involved. The exposure to excessive oxidative stress results in an increase in ROS reaching a threshold level that triggers the opening of one of the requisite mitochondrial channels. In turn, this leads to the simultaneous collapse of the mitochondrial membrane potential and a transient increased ROS generation by the electron transfer chain. Generated ROS can be released into cytosol and trigger RIRR in neighboring mitochondria. This mitochondrion-to-mitochondrion ROS-signaling constitutes a positive feedback mechanism for enhanced ROS production leading to potentially significant mitochondrial and cellular injury. This review and update considers a variety of RIRR mechanisms (involving MPT, IMAC and episodes of mitochondrial transient hyperpolarization). RIRR could be a general cell biology phenomenon relevant to the processes of programmed mitochondrial destruction and cell death, and may contribute to other mechanisms of post-ischemic pathologies, including arrhythmias.     

Carpal tunnel release in the United States and Sweden: reimbursement patterns, cost for treatment, and return to work

Cost containment plays an increasingly important role in health care, affecting providers and recipients. The present investigation addressed a limited number of factors that relate to the total cost for surgical treatment of carpal tunnel syndrome. The purpose of this study was to compare socioeconomic factors in two different societies and how worker's compensation plays a role in the cost, rehabilitation, and operative practices. To that purpose, the authors studied hospital and insurance records from a total of 123 female patients treated in two tertiary referral centers (University of Pittsburgh, Pa., and University of Umea, Sweden). The 123 patients were referred to three subgroups. Group A comprised patients from the University of Pittsburgh with worker's compensation (n = 34), group B comprised patients from the University of Pittsburgh without worker's compensation (n = 47), and group C comprised patients from the University of Umea (n = 42). The analyzed data showed a tendency toward longer duration of postoperative sick leave for those with worker's compensation than those without worker's compensation for patients from the University of Pittsburgh. However, operating room times and operating times, operative cost, use of postoperative therapy, and duration for sick leave were substantially less for patients treated at the University of Umea. There was no statistically significant difference in time off work between group A and group B. The results may indicate that the effect of compensation on a patient's ability or willingness to recover after treatment for carpal tunnel syndrome may be less important than factors that do not primarily relate to the patient or the surgical procedure.     

Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

Background

Eccrine carcinoma is a quite rare malignant tumor that typically arises from a normal sweat gland and that features a rather high recurrence rate subsequent to simple excision. Given its rather poor response to adjuvant therapy, wide excision of the lesion with tumor-free margins may offer a reasonable chance for long-term control of this neoplasm.

Case presentation

Herein, we report on an unusual case of perianal eccrine carcinoma, initially presenting as a perianal abscess.

Conclusion

Even though eccrine carcinomas would appear to be rare, when dealing with recurrent skin tumors or recurrent perianal fistulas, the possibility of eccrine carcinoma should be considered by consulting clinicians.     

Breaking through a roadblock in prostate cancer research: an update on human model systems

Prostate cancer is a prevalent disease that affects the aging male population. Whilst there have been significant advances of our biological understanding of the disease, clinical translation of promising agents continues to lag behind. In part, this is due to a paucity of relevant experimental and pre-clinical models required to further develop effective prevention and therapeutic strategies. Genetically modified cell lines fail to entirely represent the genetic and molecular diversity of primary human specimens, particularly from localised disease. Furthermore, primary prostate cancer tissues are extremely difficult to grow in the laboratory and virtually all human models, whether they grow as xenografts in immune-deficient animals or as cell cultures, are genetically modified by the investigator or derived from patients with advanced metastatic disease. In this review, we discuss the latest advances and improvements to current methods of xenografting human primary prostate cancer, and their potential application to translational research.     

Physical activity, cardiorespiratory fitness and insulin resistance: a short update

PURPOSE OF REVIEW: High levels of cardiorespiratory fitness and/or habitual physical activity are associated with reduced risk of cardiovascular disease. The responsible mechanisms are multifarious, but effects on insulin sensitivity are likely to play an important role. The purpose of this review is to highlight some recent evidence on the interrelationships between physical activity, fitness, obesity, genotype and insulin resistance. RECENT FINDINGS: Effects on cardiorespiratory fitness and abdominal obesity are both likely to contribute to the insulin-sensitizing effects of regular physical activity. Recent data suggest that at least in older adults, the intensity of an exercise intervention may influence the magnitude of changes in insulin sensitivity, and emerging data suggest that individual changes in insulin sensitivity following an exercise programme may, in part, be influenced by genotype. SUMMARY: Increasing physical activity reduces insulin resistance. As both intensity of exercise and genetic factors may modulate the magnitude of this effect, current physical activity for health guidelines that emphasize engagement in moderate-intensity physical activity in a 'one-size-fits-all' approach may need revision in the future to optimize the potential benefits accrued from individuals becoming more active.     

Carbamoyl phosphate synthetase: a tunnel runs through it

The direct transfer of metabolites from one protein to another in a biochemical pathway or between one active site and another within a single enzyme has been described as substrate channeling. The first structural visualization of such a phenomenon was provided by the X-ray crystallographic analysis of tryptophan synthase, in which a tunnel of approximately 25 Å in length was observed. The recently determined three-dimensional structure of carbamoyl phosphate synthetase sets a new long distance record in that the three active sites are separated by nearly 100 Å.     

Infracture technique for reduction malarplasty with a short preauricular incision

The infracture technique for reduction malarplasty has been widely used as an aesthetic surgical procedure in northeast Asia. Since 1988, the authors' original method of infracture technique was performed through the combined approach of intraoral and temporopreauricular incision, which may leave a rather long scar on the temporal region. To shorten the external scar, a new technique using a short preauricular incision instead of a long temporopreauricular incision was developed. From September of 2000 to June of 2001, this new approach was applied to 142 patients for correction of prominent zygoma. In this procedure, anteriorly, incomplete fracture of the zygomatic body was performed through an intraoral approach for bending inward. Posteriorly, full-thickness cutting of the zygomatic arch was performed through a preauricular incision. Then, lateral bulging of the zygomatic arch was reduced with infracturing, and the infractured site was fixed in a new position with a microplate and three screws. The advantages of this technique are reduction of the operation time, reduction of the length of the external scar, and reduction of postoperative edema around the operative region. With this combined approach, the authors were able to sufficiently expose the zygomatic arch and body and able to change the lateral convex arch into a concave one. Under direct vision, the authors could effectively and precisely perform the infracture technique through a much shorter preauricular incision that did not result in a long, conspicuous external scar.     

Ivermectin: an update

Ivermecan was introduced as an antiparasitic agent in 1981. It is now registered for animal-health use in 35 countries and is being evaluated for possible use in man. This review summarises its antiparasitic efficacy and apparent mode of action. Additional information is given in previous review articles.     

Yersinia: an update

The 8th International Symposium on Yersinia was held in Turku, Finland, 4–8 September 2002.     

Clonorchiasis: an update

Clonorchis sinensis, the Chinese or oriental liver fluke, is an important human parasite and is widely distributed in southern Korea, China (including Taiwan), Japan, northern Vietnam and the far eastern part of Russia. Clonorchiasis occurs in all parts of the world where there are Asian immigrants from endemic areas. The human and animal reservoir hosts (dogs, pigs, cats and rats) acquire the infection from the ingestion of raw fish containing infectious metacercariae. The first intermediate snail hosts are mainly species of Parafossarulus and Bithynia. Numerous species of freshwater fish serve as the second intermediate hosts of C. sinensis. Extensive studies of clonorchiasis during several decades in Japan, Korea, China and other countries have shown much progress in proving its morphological features including ultrastructure, biology, pathogenesis, epidemiology, clinical manifestations and chemotherapy. The present review deals with mainly current results obtained on the epidemiological, pathological and clinical aspects, as well as control measures in endemic areas. As for the complications of clonorchiasis, formation of calculi in the intrahepatic biliary passages is one of the most characteristic pathological features. It is sometimes accompanied by suppurative cholangitis, cholecystitis, cholangiohepatitis and ultimately can cause cholangiocarcinoma. Experimental results on the relationship to the occurrence of cholangiocarcinoma are presented. Clinical diagnosis by radiological findings including cholangiography, sonography and computerized tomography as well as magnetic resonance imaging for biliary or pancreatic ducts are outlined. Current studies on immunology and molecular biology of C. sinensis were introduced. Praziquantel is the drug of choice for clonorchiasis. The most effective regimen is 25 mg kg(-1) three times daily (total dose, 75 mg kg(-1)) administered orally at 5- to 6-h intervals over a single day. Prevention and control measures are also discussed.     

Letter to Editor: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

A response to Chalidis et al: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement. World J Surg Oncol 2007, 5:92.