Meniscal repair using the inside-to-outside technique

The frequent occurrence of degenerative joint disease following complete or partial meniscectomy is well recognized. Meniscal repair has been shown to lead to a lower prevalence of degenerative changes in the knee. Arthroscopically assisted inside-to-outside meniscal repair is a safe, reproducible technique for for salvaging the torn meniscus.     

Inside-out meniscal repair using zone-specific instruments

The geographic distribution of health services in Australia means that rural people may need to travel long distances from their homes to obtain specialist services. Because sophisticated and expensive medical technologies are centralised, it is not uncommon for rural people to need to access metropolitan health services for many forms of treatment. This study sought to investigate the experiences of central Victorian people for whom illness or injury necessitated their admission to metropolitan hospitals. Because of distance from both metropolitan hospitals and social support structures, these people were likely to have differing experiences from city people admitted to hospital. However, it was found that not only were variables of rurality and social support significant, but socio-economic status and family structure were also found to be important. Even though respondents identified distress and other problems associated with the metropolitan admission, they rationalised the whole experience in terms of the specialised treatment they received; treatment that was not available in country hospitals.     

Thoracoabdominal aortic repair without using assisted bypass

A 41-year-old man, who had undergone descending aortic repair following rupture of the DeBakey type III aortic dissection, underwent thoracoabdominal aneurysm repair 1 year after the first surgery. The operation was performed by partial-clamping and single crossclamping without using assisted bypass or shunt, in order to minimize bleeding ensuing the re-thoracotomy and dissection between lung and the graft.     

Coronary artery perforation repair using microcoil embolization

An 82-year-old woman undergoing percutaneous transluminal coronary angioplasty experienced perforation of the terminal portion of the left anterior descending coronary artery caused by guidewire trauma. The coronary artery perforation was successfully closed using a vascular occlusion system consisting of individual thrombogenic coils delivered to the site. Coronary artery perforation (CAP) during percutaneous transluminal coronary angioplasty (PTCA) has been reported to occur in less than 1% of cases. The incidence seems to be higher with the new interventional devices, e.g., DCA, TEC, and laser CAP may result in pericardial hemorrhage and cardiac tamponade or a coronary artery fistula to either the left or right ventricle. The management of CAP may include prolonged balloon inflations, reversal of anticoagulation, pericardiocentesis, and emergency surgery. Proximal perforations sometimes can be managed with vein covered stents. We describe another option in the treatment of distal CAP using a vascular occlusion system.     

四物汤治验二则

四物汤是补血养血的经典方剂,中医界人对此可以用耳熟能详,如雷贯耳来形容.最早借于晚唐蔺道人著<仙授理续段秘方>,东汉名医张仲景又进行了改进,变成<金贵要略>中胶艾四物汤,后来被尊为补血调经主方,专门用来治疗妇科血症,被后世医家成为妇科第一方笔者临症中采用本方治疗营血亏虚,血行不畅所致的血尿,血精,便秘,常获良效.滋举验案供同道交流.     

Fibrous skeleton endocarditis: repair using Konno procedure

Information about the surgical management of fibrous skeleton endocarditis is incomplete, as the vast majority of current literature describes the isolated repair of either the aortic or the mitral annulus, the combination rarely being addressed. Annular destruction, in the presence of endocarditis, demands extreme ingenuity for surgical treatment and cure. We describe and illustrate the Konno procedure for replacement of both infected mitral and aortic valves and repair of mycotic ventricular septal defects.     

Minimally invasive mitral valve repair using transthoracic aortic occlusion

This report describes a minimally invasive mitral valve repair done through a limited (6-cm) thoracic incision. The patient was supported by peripheral extracorporeal perfusion with cardiac arrest established using a new transthoracic aortic cross-clamp and antegrade blood cardioplegia. The patient was discharged on postoperative day 3 with minimal pain. This less invasive approach to mitral valve surgery may offer combined advantages to patients by increasing comfort, expediting recovery, and decreasing surgical costs by using modified traditional methods compared with specialized intraaortic occlusive balloons.     

Targeted recombination at the Chinese hamster APRT locus using insertion versus replacement vectors

In this study, we have examined the effects of targeting vector configuration and site of vector linearization on the frequency of targeted recombination at the endogenous CHO APRT locus, and have analyzed the types and class distributions of APRT+ recombinants obtained in APRT targeting experiments employing uncut circular, insertion-type (ends-in), and replacement-type (ends-out) configurations of the same pAG7 targeting vector, including configurations produced by introduction of a double-strand break (DSB) at sites either within, or at the 5' or 3' boundaries of APRT targeting homology. Our results suggest that: 1) plasmid-chromosome targeted recombination in mammalian cells may not be stimulated to the same degree by a DSB in the targeting vector as by a DSB in the chromosomal target; 2) recombinant class distributions are highly dependent upon targeting vector configuration; and 3) one-sided invasion mechanisms may play a significant role in homologous recombination in mammalian cells.     

Experience with repair of 120 hypospadias using Mathieu''s procedure

Between 1985 and 1993 120 boys with distal hypospadias (from distal penile shaft to glandular position) were treated using Mathieu's procedure at the department of pediatric surgery, Hannover Medical School, Germany. The outcome of these cases has been analysed. Fistula-rate was 12.5%. Results are compared with published reports, recent developments and changes in treatment are discussed.     

Development of a new easy complementation assay for DNA repair deficient human syndromes using cloned repair genes

Nucleotide excision repair (NER)-deficient human cells have been assigned so far to a genetic complementation group by a somatic cell fusion assay and, more recently, by microinjection of cloned DNA repair genes. We describe a new technique, based on the host cell reactivation assay, for the rapid determination of the complementation group of NER-deficient xeroderma pigmentosum (XP), Cockayne's syndrome (CS) and photosensitive trichothiodystrophy (TTD) human cells by cotransfection of a UV-irradiated reporter plasmid with a second vector containing a cloned repair gene. Expression of the reporter gene, either chloramphenicol acetyltransferase (CAT) or luciferase, reflects the DNA repair ability restored by the introduction of the appropriate repair gene. All genetically characterized XP, CS and TTD/XP-D cells tested failed to express the UV-irradiated reporter gene, this reflecting their NER deficiency whereas cotransfection with the repair plasmid expressing a gene specific for the given complementation group increased the enzyme activity to the level reached by normal cells. Selective recovery of both reporter enzyme activities was observed after cotransfection with the XPC gene for the XP17VI cells and with the XPA gene for both XP18VI and XP19VI cells. Using this method, we assigned three new NER-deficient human cells obtained from patients presenting clinical symptoms described as classical XP to either XP group A (XP18VI and XP19VI) and XP group C (XP17VI). Therefore, this technique increases the range of methods now available to determine the complementation group of new NER deficient patients with the advantage, unlike the somatic cell fusion assay or the microinjection procedure, of being simple, rapid, and inexpensive.     

Urinary fistulas: vaginal repair using a labial fat pad

A technique is recommended to repair urinary fistulas vaginally using a pedicle of labial fat to separate the urothelial and vaginal layers. The technique was used in 6 patients with vesicovaginal and 4 patients with urethrovaginal fistulas. Anatomic results were successful in all cases and stress incontinence was cured in all patients who had this coexistent condition.     

Emergency department repair of hand lacerations using absorbable vicryl sutures

The use of absorbable suture material has a number of potential advantages when compared to nonabsorbable suture. We conducted a 5-year retrospective study of 102 patients with hand lacerations and compared the quality of scar formation and healing in these patients. Those patients who did not have tendon, nerve, or bone injury were included in the study. Lacerations were repaired with either 5-0 Vicryl or nylon. There were no reported complications or infections in any study group patient. The quality of scar, when compared visually and by palpation, was the same at the end of 6 months. In addition, there was no difference in the incidence of scar retraction. We conclude that the use of absorbable suture material is an acceptable alternative in the repair of hand lacerations.     

Brain damage after aortic arch repair using selective cerebral perfusion

BACKGROUND: Selective cerebral perfusion is one of the most popular methods for cerebral protection during aortic arch repair. However, causes of postoperative brain damage are not fully understood. We analyzed brain damage after aortic arch repair using selective cerebral perfusion for true aortic arch aneurysm in regard to preoperative cerebral infarction and intracranial and extracranial occlusive arterial disease. METHODS: Over a 9-year period, 60 patients with true aortic arch aneurysm underwent aortic arch repair using selective cerebral perfusion. Postoperative brain damage was evaluated in regard to preoperative cerebral infarction detected by computed tomography, magnetic resonance imaging, or both in 50 patients and intracranial and extracranial occlusive arterial disease detected by digital subtraction angiography, magnetic resonance angiography, or both in 35 patients. RESULTS: Seven (12%) of the 60 patients died within 30 days of operation. Postoperative brain damage occurred in 6 (10.5%) (3, coma, and 3, hemiplegia) of 57 patients; 3 patients who died without awakening were excluded. Preoperatively, old cerebral infarction was detected in 9 patients (18%), and silent cerebral infarction (lacunar infarction and leukoaraiosis) was diagnosed in 26 patients (52%). Postoperative brain damage occurred in 3 (33%) of the 9 patients with preoperative cerebral infarction and in 3 (23%) of 13 patients with negative preoperative brain findings; this excludes 2 patients who died without awakening. No patient with silent cerebral infarction had postoperative brain damage. Occlusive arterial disease was detected in 7 patients (20%). The incidence of brain damage in these patients was 71% (5/7), which was significantly greater than that of 4% (1/28) in patients without occlusive arterial disease (p < 0.001). CONCLUSIONS: Silent cerebral infarction may not be a risk factor for postoperative brain damage. Preoperative evaluation of intracranial and extracranial occlusive arterial disease provides important information as to whether a patient might sustain brain damage after aortic arch repair using selective cerebral perfusion.