Minor complications after mandibular third molar surgery: type, incidence, and possible prevention.

PURPOSE: The aim of this prospective study was to ascertain the incidence of minor complications after mandibular third molar surgery and to predict the risk of skin ecchymosis or mucosa petechiae related to the usage of an absorbable gelatin sponge. PATIENTS AND METHODS: One hundred and four patients subjected to surgical extraction of horizontally impacted lower third molars were selected and investigated by means of questionnaires and clinical examinations. The independent sample t test was used for numeric variables. The chi-square test was used for logistic variables to determine the association between variables, and thereafter stepwise logistical regression was used. RESULTS: The older group (> or = 30 years old), with deeply impacted teeth, and long operation times (> or = 10 minutes) were shown to have significantly higher swelling than the other groups (P < .05). The patients who had deeply impacted teeth or long operation times were shown to have significantly higher VAS scores compared to short operation times (P < .05). The use of an absorbable gelatin sponge in the extraction socket significantly decreased postoperative swelling, mucosal petechiae, and skin ecchymosis (P < .05). CONCLUSION: The clinical variables related to postoperative bleeding disorder, pain, and trismus were identified. The insertion of an absorbable gelatin sponge into the extraction socket was found to be a very useful method to prevent postoperative bleeding problems.     

Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients

Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.     

Estrogen receptor alpha pathway is involved in the regulation of Calbindin-D9k in the uterus of immature rats.

It has been demonstrated in our previous studies that Calbindin-D9k (CaBP-9k) is a potent biomarker for screening estrogen-like chemicals in the rat model. Although treatments with 17beta-estradiol (E2) and endocrine disrupting compounds resulted in the up-regulation of uterine CaBP-9k, the mechanism of CaBP-9k induction by these compounds through two subtypes of estrogen receptors (ERalpha and ERbeta) is unclear. Thus, in the present study, immature rats were treated with propyl pyrazole triol (PPT, an ERalpha-selective ligand), diarylpropionitrile (DPN, an ERbeta-selective ligand), E2, or dimethyl sulfoxide (DMSO, a vehicle control) for three days in order to clarify which subtype of ER is involved in the uterine CaBP-9k induction. Following injection with these ER ligands, uterine CaBP-9k expression was analyzed by Northern blot and immunoblot assays. Uterine CaBP-9k expression is mainly mediated by PPT in a dose- and time-dependent manner in immature rats, whereas no significant alteration of the uterine CaBP-9k gene was observed after DPN treatment. In addition, an estrogenicity of PPT in inducing CaBP-9k expression was completely blocked by the anti-estrogen ICI 182,780, implying that uterine CaBP-9k is solely induced by ERalpha. A single treatment with PPT rapidly increased the protein levels of ERalpha and PR, an E2-mediated gene, in these tissues. Taken together, these results indicate that uterine CaBP-9k is induced by E2 and endocrine disrupting chemicals via the ERalpha pathway, but not ERbeta, in the uterus of immature rats.     

Localization of dystonic muscles with 18F-FDG PET/CT in idiopathic cervical dystonia.

The purpose of this study was to investigate whether (18)F-FDG PET/CT is useful for localizing dystonic cervical muscles in patients with idiopathic cervical dystonia (ICD) by comparing disease severity before and disease severity after botulinum toxin (BT) injection into hypermetabolic muscles. METHODS: Six patients with ICD underwent (18)F-FDG PET/CT. Dystonic muscles suitable for BT injection therapy were defined as those showing diffusely increased (18)F-FDG uptake. RESULTS: Hypermetabolic cervical muscles were identified in all 6 patients. In 2 patients who underwent PET/CT both in a supine position and in a sitting position during (18)F-FDG uptake, abnormal hypermetabolic muscles were observed by PET/CT only when patients were in the sitting position with their heads and necks in the adopted abnormal involuntary posture. Symptoms were significantly improved in 4 patients who underwent BT injection therapy guided by PET/CT and who were clinically monitored. CONCLUSION: (18)F-FDG PET/CT is potentially useful for identifying dystonic cervical muscles for BT therapy in patients with ICD.     

外科手术中产生的烟气:仅仅是大量的热空气吗?

外科医生和手术室人员经常接触手术设备产生的烟气,病人也会暴露于烟气中,特别是腹腔镜手术中产生的烟气滞留于腹腔内这一密闭空间并被吸收.这些烟气是一种与香烟烟气相似的毒性物质,然而对这种毒性物质的影响还未引起足够重视.应该采取必要措施尽可能减少手术中烟气的不良影响.     

Laparoscopic surgery for rectal cancer]

For more than a decade, laparoscopic surgery has been adopted as a treatment of colorectal cancer. With promising evidences from multi-center prospective randomized studies, laparoscopic approach is accepted as an alternative for the management of colon cancer. However, laparoscopic surgery is still technically demanding and has little evidence to convince most surgeons of its usefulness for rectal cancer. Laparoscopic surgery for malignant diseases must stress on oncologic safety as well as its functional excellence. Oncologic principles in surgery for rectal cancer are complete resection of the tumor with safe margins, en-bloc resection of regional lymph nodes and appropriate treatment for metastatic lesion. Despite the lack of results in prospective randomized comparative trials, many studies have been investigating whether laparoscopic resection for rectal cancer can follow these principles. In this review, we analyze early outcomes, long-term result of oncologic adequacy in laparoscopic surgery for rectal cancer, and discuss its potential advantages.