Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis: report of 11 cases

Pyloromyotomy remains the standard of care for the treatment of infantile hypertrophic pyloric stenosis. Open pyloromyotomy is effective and is the gold-standard technique. The authors report on the techniques of laparoscopic pyloromyotomy. The clinical courses of the first 11 infants treated with laparoscopic pyloromyotomy we with the courses of 14 infants treated recently with open pyloromyotomy. The average surgical time for the laparoscopic group was 25.4 minutes. The average time (postoperatively) until full feedings was 19.0 hours. In the open pyloromyotomy group the average surgical time was 26.1 minutes, and the time until full feedings was 23.2 hours. These results are not significantly different. When compared with open pyloromyotomy, the laparoscopic approach appears to be equally safe and effective, with superior cosmetic results. The authors believe that laparoscopic pyloromyotomy is an excellent alternative procedure for the management of hypertrophic pyloric stenosis.     

Treatment options in Western hepatocellular carcinoma: a prospective study of 224 patients

BACKGROUND/AIMS: Though hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors in the world, the optimal therapeutic strategy is still poorly defined. This is mainly due to geographic differences in HCC which may affect the validity of treatment regimens in differents areas of the world. The aim of the present study was to analyze the natural course of the disease as well as to assess the efficacy of different therapeutical schemes in HCC observed in Ljubljana (Slovenia) and Trieste (Italy), two cities in Western Europe situated close to each other. METHODS: During the period from January 1988 to December 1993, 224 consecutive patients (132 in Trieste and 92 in Ljubljana) with HCC were enrolled in the study. Patients were treated with the following 3 schemes: surgery 39 (17.4%), transcatheter chemoembolization (TACE) 116 (51.8%), and no treatment 69 (30.8%). The tumor was classified by Okuda staging and the liver disease by Child-Pugh score. Patients were followed up for 12-60 months, with an average of 40 months. The response rate to TACE and recurrence following surgery were evaluated. Comparative analysis of survival between different treatment groups was performed. RESULTS: The natural course of the disease, and other characteristics of the HCC, showed a typical Western type of tumor. Liver disease was scored as Child A in 58%, Child B in 30% and Child C in 12%, and the tumor was staged as Okuda I in 52%, Okuda II in 37% and Okuda III in 11%, respectively. Treatment with TACE was followed by an objective response in 27%, with a median survival of 31 months. Surgery was followed by a recurrence rate of 77% within 19.5 months and median survival of 49 months. The overall median survival of nontreated patients was 8 months. Survival in each group of patients differed significantly between all three consecutive stages of Okuda (p<0.001). In contrast, the differences in survival were significant only between Child A and B (p<0.02). The differences between Child B and C were not significant. CONCLUSIONS: This study emphasizes the importance of staging in the choice of treatment modality and diffusion of HCC in affecting an overall response to treatment and survival. Surgery is highly effective in monofocal HCC of Okuda I and II without cirrhosis. TACE is effective in Okuda I and II and Child A cirrhosis only. The treatment of HCC in Child B cirrhosis needs further studies. In Child C and/or Okuda stage III of HCC, any treatment except pure symptomatic relief is detrimental and should not be used.     

Epidermal cells on stubs used for detection of GSR with SEM-EDX: analysis of DNA polymorphisms

DNA from epidermal cells attached to the adhesive tape of stubs employed to collect and identify gunshot residue (GSR) with scanning electron microscope (SEM) was extracted, amplified with PCR and typed. The method allowed identification of specimens when attribution to a definite person was uncertain. These results also suggest that adhesive tape could be used as a non invasive method for obtaining biological material suitable for DNA analysis from the skin surface.     

Platelet concentrate effects on thromboelastography

OBJECTIVE: This study evaluated platelet effects on thromboelastography to determine how morphologically abnormal platelets affected native whole blood analysis. DESIGN: Prospective, controlled comparison. SETTING: Tertiary care university hospital. PARTICIPANTS: Volunteer cardiac surgery patients. INTERVENTIONS: Fresh platelets were obtained from volunteers and were either treated normally or cryodisrupted with liquid nitrogen. Fresh platelets, liquid nitrogen-treated platelets, or an equivalent quantity of the patient's blood were added to whole blood samples obtained from cardiac surgery patients before heparinization. Thromboelastographic parameters sensitive to platelet effects were measured in each of the three groups. MEASUREMENTS AND MAIN RESULTS: Maximum amplitude and alpha-angle significantly increased in the two groups receiving added platelets. There were no differences between the fresh platelet and the liquid nitrogen-treated platelet groups (Student's paired t-test). The R-time decreased significantly in both platelet-treated groups compared with the group that did not receive additional platelets. CONCLUSIONS: Viscoelastic changes in whole blood coagulation after the addition of platelet concentrates are not dependent on morphologically intact or functionally normal platelets. This in vitro study predicts that transfusion of poorly preserved platelet concentrates as well as fresh platelets would increase clot strength on thromboelastography if the recipient's blood were tested immediately after administration.     

The λ-scheme

A scheme for integrating the Euler equations of compressible flow in any hyperbolic case is presented. The scheme relies on the concept of characteristics but is strictly a finite difference scheme. Improvements is accuracy and physical consistence due to the scheme are discussed and results of its application to complex flows are shown.     

Singular value decomposition-based wave extraction in axial transmission: application to cortical bone ultrasonic characterization

A singular value decomposition-based extraction algorithm is designed in order to recover the group velocity of an energetic contribution measured with an axial transmission device developed previously for cortical bone assessment. Its performance is evaluated on synthetic data mimicking in vivo signals, and it is compared with classical methods.     

Influence of light curing units and fluoride mouthrinse on morphological surface and color stability of a nanofilled composite resin

Composite resin is a dental material susceptible to color change over time which limits the longevity of restorations made with this material. The influence of light curing units and different fluoride mouthrinses on superficial morphology and color stability of a nanofilled composite resin was evaluated. Specimens (N = 150) were prepared and polished. The experimental groups were divided according to the type of light source (halogen and LED) and immersion media (artificial saliva, 0.05% sodium fluoride solution‐manipulated, Fluordent Reach, Oral B, Fluorgard). Specimens remained in artificial saliva for 24‐h baseline. For 60 days, they were immersed in solutions for 1 min. Color readout was taken at baseline and after 60 days of immersion. Surface morphology was analyzed by Scanning Electron Microscopy (SEM) after 60 days of immersion. Color change data were submitted to two‐way Analysis of Variance and Tukey tests (α = 0.05). Surface morphology was qualitatively analyzed. The factor light source presented no significant variability (P = 0.281), the immersion media, significant variability (P < 0.001) and interaction between factors, no significant variability (P = 0.050). According to SEM observations, no difference was noted in the surface of the specimens polymerized by different light sources, irrespective of the immersion medium. It was concluded that the light source did not influence the color stability of composite, irrespective of the immersion media, and among the fluoride solutions analyzed, Fluorgard was the one that promoted the greatest color change, however, this was not clinically perceptible. The immersion media did not influence the morphology of the studied resin. Microsc. Res. Tech. 77:941–946, 2014. © 2014 Wiley Periodicals, Inc.