Results of modified Dufourmentel rhomboid flap in patients with extensive Sacrococcygeal pilonidal disease

PURPOSE

The aim of our study was to assess our modified Dufourmentel flap outcomes in a standardized patient group (a symptom duration of equal to or greater than 60 months, presence of equal to or more than 3 sinus ostia or presence of sinus ostia fistulized equal to or greater than 2 cm laterally, and a normal body mass index) with extensive pilonidal sinus.

METHODS

Patients who were diagnosed with chronic pilonidal sinus disease and gave consent to surgical repair with modified Dufourmentel flap were enrolled. Patients were assessed with respect to age, sex, body mass index, presenting symptom, symptom duration, number of previous operations, number of sinus ostia, length of flap rims, depth of intergluteal sulcus, distance of sinus from anus, duration of operation, time of drain removal, length of hospital stay, early postoperative complications, postoperative pain, loss of labor, length of follow-up, and recurrences.

RESULTS

A total of 42 patients were enrolled. Average duration of presenting symptoms was 64.4 +/- 4.7 months and average length of follow-up was 29.4 +/- 3.6 months. Average length of hospital stay was 4.2 +/- 0.8 days, and time to return to work was 16.3 +/- 2.1 days. Two patients (4.7%) developed postoperative wound infection, one patient (2.4%) developed seroma, and three patients (7.1%) had wound dehiscence. There was no recurrence.

CONCLUSION

Modified Dufourmentel flap application can be safely used in the treatment of extensive pilonidal sinus disease.

Fibroblast growth factor 21 mediates specific glucagon actions

Glucagon, an essential regulator of glucose homeostasis, also modulates lipid metabolism and promotes weight loss, as reflected by the wasting observed in glucagonoma patients. Recently, coagonist peptides that include glucagon agonism have emerged as promising therapeutic candidates for the treatment of obesity and diabetes. We developed a novel stable and soluble glucagon receptor (GcgR) agonist, which allowed for in vivo dissection of glucagon action. As expected, chronic GcgR agonism in mice resulted in hyperglycemia and lower body fat and plasma cholesterol. Notably, GcgR activation also raised hepatic expression and circulating levels of fibroblast growth factor 21 (FGF21). This effect was retained in isolated primary hepatocytes from wild-type (WT) mice, but not GcgR knockout mice. We confirmed this link in healthy human volunteers, where injection of natural glucagon increased plasma FGF21 within hours. Functional relevance was evidenced in mice with genetic deletion of FGF21, where GcgR activation failed to induce the body weight loss and lipid metabolism changes observed in WT mice. Taken together, these data reveal for the first time that glucagon controls glucose, energy, and lipid metabolism at least in part via FGF21-dependent pathways.

Psychopathology and psychiatric co-morbidities in patients seeking rhinoplasty for cosmetic reasons

AIM

The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty.

SUBJECTS AND METHODS

Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist-90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/CV, SCID-II).

RESULTS

Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality.

CONCLUSION

Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.

Depletion-induced biaxial nematic states of boardlike particles

With the aim of investigating the stability conditions of biaxial nematic liquid crystals, we study the effect of adding a non-adsorbing ideal depletant on the phase behavior of colloidal hard boardlike particles. We take into account the presence of the depletant by introducing an effective depletion attraction between a pair of boardlike particles. At fixed depletant fugacity, the stable liquid-crystal phase is determined through a mean-field theory with restricted orientations. Interestingly, we predict that for slightly elongated boardlike particles a critical depletant density exists, where the system undergoes a direct transition from an isotropic liquid to a biaxial nematic phase. As a consequence, by tuning the depletant density, an easy experimental control parameter, one can stabilize states of high biaxial nematic order even when these states are unstable for pure systems of boardlike particles.

Role of the intestinal peptide transporter PEPT1 in oseltamivir absorption: in vitro and in vivo studies

It was reported that oseltamivir (Tamiflu) absorption was mediated by human peptide transporter (hPEPT) 1. Understanding the exact mechanism(s) of absorption is important in the context of drug-drug and diet-drug interactions. Hence, we investigated the mechanism governing the intestinal absorption of oseltamivir and its active metabolite (oseltamivir carboxylate) in wild-type [Chinese hamster ovary (CHO)-K1] and hPEPT1-transfected cells (CHO-PEPT1), in pharmacokinetic studies in juvenile and adult rats, and in healthy volunteers. In vitro cell culture studies showed that the intracellular accumulation of oseltamivir and its carboxylate into CHO-PEPT1 and CHO-K1 was always similar under a variety of experimental conditions, demonstrating that these compounds are not substrates of hPEPT1. Furthermore, neither oseltamivir nor its active metabolite was capable of inhibiting Gly-Sar uptake in CHO-PEPT1 cells. In vivo pharmacokinetic studies in juvenile and adult rats showed that the disposition of oseltamivir and oseltamivir carboxylate, after oral administration of oseltamivir, was sensitive to the feed status but insensitive to the presence of milk and Gly-Sar. Moreover, oseltamivir and oseltamivir carboxylate exhibited significantly higher exposure in rats under fasted conditions than under fed conditions. In humans, oral dosing after a high-fat meal resulted in a statistically significant but moderate lower exposure than after an overnight fasting. This change has no clinical implications. Taken together, the results do not implicate either rat Pept1 or hPEPT1 in the oral absorption of oseltamivir.

Psychopathological evaluation of patients requesting cosmetic rhinoplasty: a review

OBJECTIVE

The goal of this review is to discuss possible underlying psychopathological situations in patients requesting surgical cosmetic rhinoplasty operation and to examine potential problems that might arise.

SUBJECTS AND METHODS

An extensive search was conducted through PubMed, Ambase and Psychlnfo by using related keywords in English, like "rhinoplasty and psychiatric comorbidities", "rhinoplasty and psychopathology".

RESULTS

Patients who demand cosmetic rhinoplasty operation appealed to the surgeon since they wanted to feel better about themselves after the surgery. Indeed, some long-term studies determined that such a situation can take place at high rates. However, some studies reported the possibility of serious psychological disorders after such surgical operations. Studies relating to the analysis of psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD).

CONCLUSIONS

Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.

Polydispersity stabilizes biaxial nematic liquid crystals

Inspired by the observations of a remarkably stable biaxial nematic phase [van den Pol et al., Phys. Rev. Lett. 103, 258301 (2009)], we investigate the effect of size polydispersity on the phase behavior of a suspension of boardlike particles. By means of Onsager theory within the restricted orientation (Zwanzig) model we show that polydispersity induces a novel topology in the phase diagram, with two Landau tetracritical points in between which oblate uniaxial nematic order is favored over the expected prolate order. Additionally, this phenomenon causes the opening of a huge stable biaxiality regime in between uniaxial nematic and smectic states.

Monoblocks in root canals: a finite elemental stress analysis study

AIM

To investigate using finite element stress analysis (FEA) primary, secondary and tertiary monoblocks created either by adhesive resin sealers or by different adhesive posts and to evaluate the effect of interfaces on stress distribution in incisor models.

METHODOLOGY

Seven maxillary incisor FEA models representing different monoblocks using several materials were created as follows: (a) primary monoblock with Mineral Trioxide Aggregate; (b) secondary monoblock with sealer (MetaSEAL) and Resilon; (c) tertiary monoblock with EndoREZ; (d) primary monoblock with polyethylene fibre post-core (Ribbond); (e) secondary monoblock with glass-fibre post and resin cement; (f) tertiary monoblock with bondable glass-fibre post; (g) tertiary monoblock with silane-coated ceramic post. A 300 N load was applied from the palatal surface of the crown with a 135° angle to the tooth long axis. Materials used in the study were assumed to be homogenous and isotropic except the glass-fibre post; the results are expressed in terms of von Mises criteria.

RESULTS

Maximum stresses were concentrated on force application areas (18-22.1 MPa). The stresses within the models increased with the number of interfaces both for the monoblocks created by the sealers (1.67-8.33 MPa) and for the monoblocks created by post-core systems (1.67-11.7 MPa).

CONCLUSIONS

Stresses within roots increased with an increase in the number of the adhesive interfaces. Creation of a primary monoblock within the root canal either by an endodontic sealer or with an adhesive post-core system can reduce the stresses that occur inside the tooth structure.

Influence of several fibre-reinforced composite restoration techniques on cusp movement and fracture strength of molar teeth

AIM

To compare mean cusp movement in molar teeth with endodontic access and mesial-occlusal-distal (MOD) cavities before and after restoration with several fibre-reinforced composite restoration techniques under loading and to evaluate the effect of restoration technique on fracture strength.

METHODOLOGY

Reference points were marked at the mesial cusp ridges of extracted human mandibular molar teeth. Digital images were taken under loading (300 N) using a stereomicroscope (Leica MZ16A; Wetzlar, Germany). Three-dimensional (3D) distances between the reference points were recorded (Leica, Stereo-Explorer, 2.1) as controls. Standard MOD cavities were prepared and restored as follows (n = 10), group 1: composite restoration (Clearfil AP-X; Kuraray, Tokyo, Japan); group 2: cavity lined with polyethylene fibre (Ribbond, Ribbond Inc., Seattle, WA, USA) in combination with flowable resin (Protect-Liner F; Kuraray, Tokyo, Japan) before composite restoration; group 3: polyethylene fibre inserted on occlusal surface of the tooth from buccal to lingual after finishing the composite restoration; group 4: missing walls were restored with composite resin and inner surfaces of the axial walls were then reinforced with polyethylene fibre placed circumferentially before the composite restoration. The restored teeth were re-loaded, digital images were re-taken and the 3D distance between the reference points was recorded in μm. Comparisons of the restoration techniques, the effectiveness of restoration for each group were analysed statistically (Kruskall-Wallis, paired-samples t-test). The teeth were then loaded until failure (5 mm min(-1) ), the data were recorded (N) and analysed statistically (Kruskall-Wallis test).

RESULTS

A significant difference occurred amongst the groups in terms of cusp movement (P = 0.018). All the groups revealed a decrease in inter-cuspal width when compared to their initial records. The mean values of these decreases were as follows: group 1 17.6 (P = 0.003), group 2 6.7 (not sig), group 3 6.6 (not sig) and group 4 0.85 (not sig) μm. No significant difference was found amongst the fracture strength values (P = 0.22). In group 1, 90% of the fractures were non-restorable, whereas in group 3 100% of the fractures were restorable.

CONCLUSIONS

Regardless of restoration technique, fibre reinforcement of composite restorations decreased cusp movement in molar teeth with MOD and endodontic access cavities but did not affect fracture strength.

Emergent surgical treatment of radiation-induced enteropathies for patients with urogynecological and colorectal carcinomas

AIM

The aim of this study is to describe our 10-year experience in patients with urogynecological and colorectal carcinomas with radiation enteropathy treated surgically as an emergency, and to reassess symptoms and mortality.

PATIENTS AND METHODS

The study included 17 patients receiving emergency surgery for complications of radiotherapy. Data about the patients and outcomes of the treatment alternatives used were retrospectively analyzed.

RESULTS

Of 17 patients, nine had colorectal cancer, six had gynecological cancer, and two had cancer of the urinary system. As an emergency, 12 patients had ileus only, one patient had intestinal fistulae and ileus, two patients had bleeding and ileus and two patients had perforation on admission. Seven patients underwent resection and anastomosis, two patients intestinal by-pass, four patients resection and ostomy and four patients bridectomy. Morbidity (75% for early complications and 100% for late complications) and mortality in the early postoperative period (25%) were higher in the patients undergoing bridectomy than in the patients undergoing other surgical methods. The rate of early and late complications (71.4% and 66.6%, respectively) was lower in the patients undergoing resection-anastomosis with a higher of quality life. Only 11 patients survived during a long follow-up period (64.7%).

CONCLUSION

As the postoperative complication rate, overall and operative mortality of patients treated for radiation enteropaties as emergent surgery are high, specialists following this group of patients may favor removal of the pathologic tissue to avoid complications in the early and late postoperative period.

The effect of different posts on fracture strength of roots with vertical fracture and re-attached fragments

The aim of this in vitro study was to test the effect of different post systems on fracture strength of roots with re-attached fragments. Root canals of eighty extracted single-rooted human teeth were instrumented (ProFile) and randomly divided into two groups. The roots in the first group were vertically cracked, and the fragments were re-attached using Super Bond C&B (Sun Medical, Tokya, Japan). The roots in the second group were kept sound. Obturation of the roots was performed with MetaSEAL (Sun Medical) and gutta-percha. Post spaces were prepared, and the roots were restored with one of the followings: UniCore (Ultradent), Everstick (Stick Tech), Ribbond (Ribbond), ParaPost (Coltene/Whaledent) (n = 10). Four mm high build-ups were created (Clearfil DC Bond Core; Kuraray, Tokyo, Japan). Compressive loading of the samples was performed after 24 h (1 mm min(-1)). Mean load necessary to fracture each sample was recorded (Newton) and statistically analysed (One-way anova, t-tests). ParaPost showed the highest fracture strength among the roots with re-attached fragments (P < 0.05). UniCore and ParaPost systems showed similar fracture strength in the sound roots (P > 0.05). Re-attached fragments significantly reduced the fracture strength of roots in UniCore group (P = 0.000). Ribbond post showed mostly repairable fractures. Metal post (ParaPost) showed the highest fracture strength in the roots with re-attached fragments; however, fracture pattern was 41% non-repairable. Re-attached fragments significantly reduced the fracture strength of the roots in UniCore group. Prefabricated posts showed similar fracture strength in the sound roots. Customized post systems EverStick and Ribbond showed mostly repairable failure after loading in sound roots or roots with re-attached fragments.

Cholesterol-mediated activation of P-glycoprotein: distinct effects on basal and drug-induced ATPase activities

Cholesterol promotes basal and verapamil-induced ATPase activity of P-glycoprotein (P-gp). We investigated whether these effects are related to each other and to the impact of the sterol on bilayer fluidity and verapamil membrane affinity. P-gp was reconstituted in egg-phosphatidylcholine (PhC) liposomes with or without cholesterol, 1,2-dipalmitoyl-phosphatidylcholine (DPPC), alpha-tocopherol (alpha-Toc) or 2,2,5,7,8-pentamethyl-6-chromanol (PMC). Basal and verapamil-induced ATPase activities were studied with an enzymatic assay. Membrane fluidity was characterized with diphenyl-hexatriene anisotropy measurements and membrane affinity by equilibrium dialysis. DPPC (70% mol/mol) decreased the fluidity of PhC bilayers to the same level as 20% cholesterol. PMC (20%) and alpha-Toc (20%) decreased the fluidity to lesser extents. alpha-Toc and PMC, but not DPPC increased the verapamil membrane affinity. While 20% cholesterol strikingly enhanced the basal ATPase activity, none of the other constituents had a similar effect. In contrast, verapamil stimulation of P-gp ATPase activity was not only enabled by cholesterol but also by alpha-Toc and DPPC. PMC had no effect. In conclusion, cholesterol exerts distinct effects on basal and verapamil-induced ATPase activity. The influence on basal ATPase activity is sterol-specific while its effect on verapamil-induced ATPase activity is unspecific and not related to its influence on membrane fluidity and on verapamil membrane affinity.