GASTRIC RESECTION—Preoperative and Postoperative Care

Perhaps in no other field of surgery does attention to minute detail play so important a role in determining success as it does in gastric operations.As surgery of the stomach develops toward even greater security and favorable results can be expected with greater confidence, the several aspects of preoperative and postoperative care hitherto regarded as secondary demand closer consideration.     

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 76 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference in the retroauricular angle between the surgical group and controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.     

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.     

Factor XI deficiency: implications for management of patients undergoing aesthetic surgery.

We report our experience in patients with an abnormal partial thromboplastin time elevation due to factor XI deficiency (Rosenthal syndrome) who presented for aesthetic surgery consideration. Preoperative evaluation included a thorough history, physical examination, coagulation profile, and hematological consultation. Nine of 10 patients underwent 12 elective aesthetic procedures without undue intraoperative or postoperative bleeding. Based on these findings, we stratified patients as low risk or high risk. Low-risk patients were those with greater than 15 percent factor XI levels, or those with 5 to 14 percent factor XI levels but a history of multiple major surgical procedures without bleeding complications. High-risk patients were those with factor XI levels less than 15 percent, history of bleeding either spontaneously or with surgery, and a family history of bleeding diathesis from factor XI deficiency. Low-risk patients had fresh frozen plasma available for the procedure, whereas high-risk patients received fresh frozen plasma 2 hours before surgery. We conclude that (1) in these patients with abnormally high partial thromboplastin time values and no prior known bleeding disorder, we have identified factor XI deficiency as the prevalent coagulopathy; (2) partial thromboplastin time does not necessarily correlate with factor XI levels; (3) patients can be classified as high or low risk for elective surgery based on factor XI levels and prior surgical or family history; (4) recommendations for perioperative management can be made based on this risk profile; and (5) aesthetic surgery can be performed successfully and safely on patients with factor XI deficiency on a case-by-case basis when appropriate guidelines are enforced.     

Body condition is associated with a shorter breeding season and reduced ovulation rate in subtropical goats

To determine the effect of body condition on the characteristics of the breeding season in female goats from subtropical Mexico, does in either greater- or lesser-body condition (n=20/group) were monitored for the expression of estrous behavior, ovulation and ovulation rate between June and April. The commencement of estrus and ovulation occurred earlier (P<0.05) in does in greater than lesser body condition. The cessation of estrus and ovulation was later (P<0.05) in female goats with greater than those with lesser body condition. Does in greater body condition had more (P<0.001) normal estrous cycles than those in lesser body condition. As consequence, does from the greater body condition group had fewer short (P<0.001) or long (P<0.05) estrous cycles than those of in the lesser body condition group. The ovulation rate was greater (P<0.01) in the greater (1.9+/-0.1) than lesser body condition does (1.6+/-0.1). In conclusion, female goats in lesser body condition have a shorter breeding season, more abnormal estrous cycles, and fewer ovulations than does in greater body condition.     

Sagittal craniosynostosis outcome assessment for two methods and timings of intervention.

A retrospective quantitative analysis of 40 infants who underwent surgery for sagittal craniosynostosis was conducted to determine whether any difference in outcome, with respect to cranial index (cranial width/cranial length x 100), could be associated with either the age at surgery or the extent of the operation. Children < or = 13 months old at surgery and for whom there were archived computed tomography digital data preoperatively, perioperatively, and 1 year postoperatively were studied. For statistical analysis, the operation was classified as either extended strip craniectomy or subtotal calvarectomy, and the age at operation was either < or = 4 months or > 4 months. Twenty-eight patients underwent extended strip craniectomy at a mean age of 5.1 months. Their mean cranial index preoperatively was 67 versus 71 at 1 year postoperatively (p < 0.0001). Of extended strip craniectomy patients, 15 were operated on at age < or = 4 months (mean = 2.9 months) and 13 at age > 4 months (mean = 7.6 months). Mean cranial indices for age at operation groups did not achieve age-appropriate normal range values 1 year postoperatively for either group, and there was no significant difference between the mean percentages of improvement achieved (p = 0.143). Twelve patients underwent subtotal calvarectomy at a mean age of 5.2 months. Their mean cranial index preoperatively was 66 versus 74 at 1 year postoperatively (p < 0.0001). The mean cranial index in this group reached age-appropriate normal range values 1 year postoperatively. The percentage improvement in cranial index 1 year after subtotal calvarectomy was greater than after extended strip craniectomy (p = 0.003). Extended strip craniectomy for sagittal craniosynostosis does not achieve normal cranial width:length proportions, even when performed before 4 months of age. Subtotal calvarectomy for sagittal craniosynostosis does achieve normal cranial width:length proportions in the majority of the children, at least when performed within the first 13 months of life.     

Pathophysiology of post-gastrectomy hypoglycaemia

The blood glucose and plasma insulin response to oral glucose and slow intravenous infusion of glucose was determined in seven patients who had undergone partial gastrectomy or gastroenterostomy. Similar studies were conducted in normal subjects; in these experiments oral glucose administration was replaced by infusion of glucose direct into the jejunum in order to simulate the rapid gastric emptying which occurs after gastric surgery.Peak insulin levels were much higher after oral or intrajejunal glucose, though peak blood glucose levels were higher after intravenous glucose. Despite the high insulin levels occurring with oral administration the late fall in blood glucose below fasting levels was not significantly greater after oral or intrajejunal glucose than after intravenous administration of the sugar. This does not support the concept that hyperinsulinaemia alone is responsible for reactive hypoglycaemia.     

An apparatus to retain the spatial orientation of breast biopsies

An apparatus has been designed to retain the spatial orientation of breast biopsies throughout surgery, transport and processing in the pathology laboratory. It does not interfere with regular surgical procedures and simplifies the surgeon's task of marking the orientation of a specimen. As the use of the apparatus does not involve either chemical or physical substances it is an appropriate handling procedure for those specimens requiring sensitive testing procedures such as cell culture.     

Regional Chemotherapy as an Adjunct to Surgery: An Experimental Study

Using the Walker 256 tumour in the hind limb of the rat as an experimental model, regional chemotherapy (isolation perfusion and intra-arterial infusion) was used as a pre-surgical adjunct in order to evaluate further the role of chemotherapy combined with surgery. There was an impressive and significant increase in the number of animals surviving free of tumour for 60 days when regional chemotherapy was carried out with triethylenethiophosphoramide (ThioTEPA). Intra-arterial infusion is a simpler procedure and affords the same improvement as does isolation perfusion.We must continue to assess critically the role of regional chemotherapy combined with surgery in human tumours.     

即时扩展型背阔肌肌皮瓣乳房再造在保留乳头乳晕复合体乳癌术后的运用分析

目的：探讨分析即时扩展型背阔肌肌皮瓣乳房再造在保留乳头乳晕复合体乳癌术后的运用。方法：回顾性分析我院2008年2月-2012年4月收治的乳腺癌术后患者106例,采用乳癌术即时扩展型背阔肌肌皮瓣乳房再造保留乳头乳晕复合体,观察手术效果以及满意度。结果：术后患者乳房美容优良率为88．68％明显大于对照组的47．17％,并且术后6个月治疗组生活质量评价总分明显大于对照组总分术后6个月患者生活质量评价总分明显大于术前评价总分,差异具有条件下意义（P〈0．05）,差异均具有统计学意义（P〈0．05）。结论：即时扩展型背阔肌肌皮瓣乳房再造在保留乳头乳晕复合体乳癌术后患者乳房美容效果较好,提高患者生活质量高,值得在临床上推广,但在手术后需积极处理可能存在的并发症情况。     

Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image

This large, multisite study investigated female college students' experiences with and attitudes about cosmetic surgery. The study also assessed the relationship between several aspects of body image, including appearance satisfaction and investment and symptoms of body dysmorphic disorder, and interest in cosmetic surgery. Thirty (5 percent) of the 559 women surveyed reported that they had undergone cosmetic surgery. Two thirds of respondents reported knowing someone who had received cosmetic surgery, and approximately one third indicated that a family member had undergone surgery. Overall, participants held relatively favorable attitudes about surgery. Regression analysis suggested that a greater psychological investment in physical appearance and greater internalization of mass media images of beauty predicted more favorable attitudes toward cosmetic surgery. Fourteen women (2.5 percent) screened positive for body dysmorphic disorder based on the nature and severity of their self-reported body-image concerns. Results of this study provide new information on young women's experiences and attitudes about cosmetic surgery and how these attitudes relate to body image.     

Pseudoexfoliation syndrome and cataract surgery by phacoemulsification

Pseudoexfoliation syndrome is a systemic age-related disease in which abnormal extracellular material is produced and accumulates in many ocular tissues. Its ocular manifestations involve all of the structures of the anterior segment as well as conjunctiva and orbital structures. The presence of pseudoexfoliation should alert the physicians to the increased risks associated during and after cataract surgery. Increasing awareness of this condition are important in the detection and preoperative determination of patients inclined to be at greater risk for complications during surgery. Data regarding the rate of complications during phacoemulsification suggest a lower complication rate than with exstracapsular extraction but still greater than in eyes without pseudoexfoliation. Despite the existence of a higher number of intraoperative and postoperative complications, experience with the phacoemulsification technique together with the improvement of the apparatus and instruments used enable similar results to obtained in eyes with pseudoexfoliation syndrome as in eyes without this pathology.     

Beyond the BMI: The Search for Better Guidelines for Bariatric Surgery

The application of the BMI of ≥35 as the major prerequisite for access to bariatric surgery is no longer appropriate because the index, now incorporated in the requirements of Medicare, Medicaid and most private carriers, does not reflect the degree or distribution of adiposity, it discriminates unfairly on the basis of gender, race, age, fitness, and body fat composition. Further, with increasing evidence that bariatric surgery can also induce full and durable remission of such comorbidities as type 2 diabetes even in patients with BMIs <30, new guidelines must be pursued.     

Use of fluorogestone acetate after breeding to reduce the effect of premature luteal regression in dairy goats when superovulation is induced with FSH

The aim of the present study was to determine the effect of fluorogestone acetate (FGA) administered after mating, on embryo production in the dairy goat subjected to conventional superovulatory and embryo recovery protocols. Adult does, most of them of the French Alpine breed, were randomly assigned after a FSH-superovulatory estrus and fertile matings to a control group (n=20) or to a treated group (n=20) in which intravaginal sponges impregnated with FGA were inserted after mating and remove before embryo collection (day 6). Blood samples were collected every 12h from days 1 to 7 post-estrus and serum progesterone concentrations were determined. The FGA-group had a lesser percentage of does with normal corpora lutea (CL) and a greater percentage of animals with CL in regression or mixed (normal and in regression) when compared with the control group (13.3 and 64.7%, 53.3 and 23.5%, and 33.3 and 11.8%, respectively; P<0.05). Mean number of normal CL per doe was less and mean number of regressed CL greater in FGA as compared with the control group (4.2 compared with 10.7 and 8.5 compared with 3.6, respectively; P<0.05). There were no differences (P>0.05) in recovery rate, total number of CL, total recovered structures, oocytes and transferable and non-transferable embryos between groups. Serum progesterone concentrations from day 5 to 7 post-estrus were lower (P<0.05) in FGA as compared with the control group. Percentage of does with luteal failure on day 6 post-estrus was greater in FGA as compared with the control group (86.6 compared with 33.3%; P<0.01). When considering only does with luteal failure on day 6 post-estrus, mean total recovered structures, transferable embryos and percentage of does rendering > or =3 transferable embryos were greater in the FGA compared with the control group (6.3 and 1.3 structures, 4.5 and 1.2 embryos, 67 and 17%, respectively; P<0.05). In does not having luteal failure, FGA administration did not appear to affect embryo production or embryo survival. These results indicate that FGA administration after mating improves embryo recovery in dairy goats with luteal failure after superovulatory treatment. However, it also increases the incidence of luteal regression when administered early in the estrous cycle.     

Selected contribution: Effects of gender on reduced-size liver ischemia and reperfusion injury.

Hepatic resection with concomitant periods of ischemia and reperfusion (I/R) is a common occurrence in resectional surgery as well as reduced-size liver transplantation (e.g., split liver or living donor transplantation). However, the I/R induced by these types of surgical manipulations may impair liver regeneration, ultimately leading to liver failure. The objectives of the study were to develop a murine model of reduced-size liver I/R and assess the role of gender in this model of hepatocellular injury. We found that 100% of female mice survived the surgery indefinitely, whereas all male mice had greater initial liver injury and died within 5 days after surgery. The protective effect observed in females appeared to be due to ovarian 17beta-estradiol, as ovariectomy of females or administration of a selective estrogen antagonist to female mice resulted in enhanced liver injury and greater mortality following reduced-size liver I/R. Conversely, 17beta-estradiol-treated male mice exhibited less hepatocellular damage and survived indefinitely. Taken together, these data demonstrate an estrogen-mediated protective pathway(s) that limits or attenuates hepatocellular injury induced by reduced-size liver I/R.     

Measurement of serum amyloid A protein concentrations as test of renal allograft rejection in patients with initially non-functioning grafts.

Serum amyloid A protein concentrations were monitored in 10 renal transplant recipients who required dialysis after transplantation because of an initially non-functioning graft. Fifteen rejection episodes were identified by repeated fine needle aspiration biopsies of the grafts. All rejections were characterised by pronounced increases in serum amyloid A concentrations, the mean peak value being 363 (SE 57) mg/1 as compared with a mean preoperative concentration of 14 (5) mg/1. The rise in concentrations preceded the start of anti-rejection treatment by an average of 2.5 days in eight of the rejection episodes, in five episodes it occurred the same day, and in two episodes it occurred the next day. With exclusion of the predictable surgery induced rise in values, which peaked on the second postoperative day, there were 17 increases in amyloid A concentrations peaking at greater than or equal to 100 mg/1; in two cases they were not related to documented rejection. These findings show that measurements of serum amyloid A concentration provide a valuable non-invasive aid in identifying acute renal allograft rejection, including that in patients whose graft does not function initially.     

The wound inflammatory response exacerbates growth of pre‐neoplastic cells and progression to cancer

There is a long‐standing association between wound healing and cancer, with cancer often described as a “wound that does not heal”. However, little is known about how wounding, such as following surgery, biopsy collection or ulceration, might impact on cancer progression. Here, we use a translucent zebrafish larval model of Ras^G12V‐driven neoplasia to image the interactions between inflammatory cells drawn to a wound, and to adjacent pre‐neoplastic cells. We show that neutrophils are rapidly diverted from a wound to pre‐neoplastic cells and these interactions lead to increased proliferation of the pre‐neoplastic cells. One of the wound‐inflammation‐induced trophic signals is prostaglandin E₂ (PGE₂). In an adult model of chronic wounding in zebrafish, we show that repeated wounding with subsequent inflammation leads to a greater incidence of local melanoma formation. Our zebrafish studies led us to investigate the innate immune cell associations in ulcerated melanomas in human patients. We find a strong correlation between neutrophil presence at sites of melanoma ulceration and cell proliferation at these sites, which is associated with poor prognostic outcome.     

Binding of affinity cross-linked oligomers of IgG to cells bearing Fc receptors.

The binding of covalently cross-linked oligomers of rabbit IgG antibodies to tumor cells resembling macrophages and lymphocytes and to normal spleen cells has been measured. With all cells trimeric IgG binds with greater affinity than does the dimer, which in turn binds more tightly than does the monomer. However, as the oligomers increase in size, the individual monomeric subunits bind with decreasing energy. The macrophage tumor line. P388D1, binds oligomers with greater affinity than does the lymphocyte line, AKTB-1, but the differences in affinities are not great, differing by at most a factor of 5 in equilibrium constant. Normal spleen cells bind oligomers in the same concentration range as the tumor cells. The kinetics of binding do not occur as single first or second order reactions and suggest a multistage mechanism for oligomer binding. The presence of large concentrations of monomeric IgG tends to weaken oligomer binding and increases the exchange rate of bound oligomer from the cells. Since plasma and extracellular fluid also contain large concentrations of monomeric IgG, it is suggested that many immune complexes will bind weakly to the types of cells examined here and will rapidly exchange with IgG from the external medium.     

Influence of short-term relocation and male exposure on sexual receptivity and reproduction in artificially inseminated lactating doe rabbits

A study was conducted to evaluate the effect of short-term relocation and male exposure on receptivity rate, kindling rate and total born per litter in lactating does under an artificial insemination (AI) programme. Thirty-two, 2-month-old New Zealand White rabbits were randomly allocated to one of four treatments: (1) relocation and male exposure; (2) relocation without male exposure; (3) no relocation with male exposure; (4) no relocation without male exposure (control). Relocation and male exposure were done 8-10 h before the time of service. First insemination was when does reached 3200 g body weight and does were bred 4-13 days after parturition across parities during a 6 month reproduction period. Of all breeding records, 125 inseminations and 91 kindlings were from nursing does. The mean interval from parturition to insemination for nursing does was 10.3 days. Relocation of lactating does resulted in greater (P<0.01) receptivity rate at service (74.8%) as compared with no relocation (55%). Receptivity rate was not influenced by male exposure. However, the interaction of relocationxmale exposure tended to be significant (P=0.07). Receptivity rate in relocated does exposed to males was 62.8 and 86.7% without exposure while in non-relocated does male exposure showed no effect. Kindling rate was not influenced by relocation or male exposure. The mean total born per litter in relocated and non-relocated does was 8.05 +/- 0.33 and 7.39 +/- 0.36, respectively, but no significant difference was observed. There was no effect of male exposure on total born per litter (7.85 +/- 0.34 versus 7.59 +/- 0.34 without male exposure). However, interaction of relocationxmale exposure on this variable was significant (P=0.009). Male exposure in relocated does decreased the size of the litter (7.52 +/- 0.46 versus 8.58 +/- 0.47 without male exposure) whereas mean values in non-relocated does increased when they were exposed to males (8.18 +/- 0.52 versus 6.60 +/- 0.49). Short-term relocation improved receptivity rate and reproduction in lactating does under an artificial insemination programme. Preliminary results indicated that male exposure in non-relocated does improves the total born per litter at a similar level than relocated does without male exposure. Relocation combined with male exposure decreased receptivity rate and total born per litter as compared with relocated does without male exposure, but the reproductive performance in the former was greater as compared with those does where no relocation occurred without male exposure.