Although the topography of the isthmus of parotid gland and facial nerve is of greatimportance in surgery, yet there is a lot of disagreements among its descriptions in thetextbooks and literatures. In order to clarify this discrepancy, 100 sides of the parotidgland of adult cadavers were dissected and studied. The isthmus of parotid gland was present in all of our specimens, but its shape,number and location were subjected to a number of variations. Its number varied 1--7.the common one being 3 or 4. The most common location of the isthmus was in thegap between the temporo-facial and cervico-facial divisions of the facial nerve (94.6%).The less frequent occurrences were: in the gaps of the branches of the temporo-facialdivision (58.1%), both above and below the trunk of the nerve (43%), in the gapsof the branches of the cervico-facial division (27.9%), at the posterior border of thedeep lobe, immediately below the trunk of the nerve(16.1%) and the least common onewas above the trunk of the nerve (only 5.4%). According to the numbers of division of the nerve, we classified the facial nerve into4 types. Type Ⅰ is the normal pattern (93%) in which the facial nerve, as soon asit emerges between the superficial and deep part of the parotid gland, divides into 2divisions and then is further divided into 5 branches. Type Ⅱ consists of 4% in theseries in which the primary division of the facial nerve is 3 in number. In the type Ⅲ(2 cases only), the facial nerve after piercing into the parotid gland continues to runforward as a single trunk for a short distance. Type Ⅳ is the only case in which theprimary division of the facial nerve is 4 in number. In 41 out of 93 sides, there are a few branches piercing the substance of theisthmus. In our specimen, the majority of posterior facial vein are lying between the super-ficial and deep lobes of the parotid gland.

Hepatoblastoma (HB) is a rare pediatric malignant tumor of the liver. Most of these tumors arise in the embryo and this is usually discernible in the first 3 years of life; thus, its occurrence in the adult population seems to be unusual. We present this case due to its rarity and its potential to mimic other primary liver tumors in adults such as HCC. To the best of our knowledge with literature review, there are only 40 cases of adult HB reported worldwide. In this paper, we report a case of a 49-year-old female, diagnosed with Chronic Hepatitis B, admitted due to abdominal pain. Physical examination revealed hepatomegaly. Liver function test was unremarkable. AFP was elevated at >50,000ng/mI. Triphasic CT scan revealed a hypodense mass in the right lobe of the liver measuring approximately 11 × 11 × 13cm suggestive of HCC. Subsequently, patient underwent right hepatectomy. Pathological examination, however, demonstrated that the tumor showed a malignant neoplasm with epithelial and mesenchymal components consistent with adult HB, mixed type. Since treatment of adult HB is not yet established, studies have suggested that it is logical to follow the treatment protocol for childhood HB. Hence, this patient underwent chemotherapy with Cisplatin, Vincristine and 5-Fluorouracil. The low incidence of HB in adults presents a diagnostic challenge, requiring a high index of suspicion and a thorough evaluation. Since prognosis could be improved with early detection and treatment, it is important for clinicians not to overlook HB.
Hepatoblastoma ; Hepatomegaly

Adult ; Dioxins ; Glutathione Peroxidase ; blood ; Humans ; Lipid Peroxidation ; drug effects ; Male ; Malondialdehyde ; blood ; Middle Aged ; Occupational Exposure ; Oxidative Stress ; drug effects ; Superoxide Dismutase ; blood

The originally published version of this Article contained an error in the author list: the last and first names of all authors are inverted.

OBJECTIVETo prepare morphine-loaded chitosan microspheres by emulsion ionic cross-linking and investigate the effect of initial morphine quantity and different cross-linking degrees on drug loading, encapsulation efficiency and in vitro drug release.

METHODSChitosan (with a relative molecular mass of 50,000 and deacetylation degree no less than 90%) at 100 mg and morphine at 20, 30, 40, or 50 mg were dissolved by 2% acetate and dripped slowly into 15 ml soy-bean oil containing 0.75 ml Span80. After full emulsification at 35 degrees C; for 1.5 h, the mixture was dripped slowly into sodium tripolyphosphate (10 mg/ml) at the mass ratio of 5:1, 7:1, or 9:1 to allow cross-linking for 2 h. The drug loading, encapsulation efficiency and in vitro drug release of the preparations were measured.

RESULTSThe drug loading in the microsphere increased while the encapsulation efficiency reduced with the increment of the initial morphine quantity. High cross-linking degree resulted in prolonged release time of the drug loaded in the preparations.

CONCLUSIONThe microspheres loaded with morphine allows sustained release of morphine.

Chitosan ; administration & dosage ; Delayed-Action Preparations ; chemical synthesis ; Drug Carriers ; administration & dosage ; Microspheres ; Morphine ; administration & dosage

OBJECTIVETo report the clinical application results of free deep inferior epigastric perforator flap in the repair of soft tissue defect.

METHODSFrom January 2006 to January 2012,13 patients with soft tissue defect (7 cases in leg and 6 cases in forearm) underwent reconstruction with a free deep inferior epigastric perforator flap. There were 9 males and 4 females, aged from 21 to 45 years old with an average of 33 years. Soft tissue defect in the extremities were from 7 cm x 17 cm to 8 cm x 26 cm. The medial branch and lateral brangh flaps were 7 cases and 6 cases respectively. The donor site was closed directly.

RESULTSOne patient developed small wound dehiscence, which spontaneous healed at one month after surgery. All the flaps had survived completely. Follow-up period ranged from 1.8 to 4.0 years with the mean of 2.8 years postoperatively. Satisfactory clinical results were obtained in 12 cases. A good contour was confirmed at the recipient area.

CONCLUSIONThe free deep inferior epigastric perforator flap for the extremities defects of soft tissue is a good option. This technique is safe and reliable, and can decrease the injury of donor site.

Adult ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Perforator Flap ; Soft Tissue Injuries ; surgery

OBJECTIVETo summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle.

METHODSFrom January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot.

RESULTSAll muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair.

CONCLUSIONSWhen the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.

OBJECTIVETo summarize clinical outcomes of using medial transposition of the radial nerve in humeral shaft fracture fixation.

METHODSFrom January 2005 to December 2009, 16 patients with humeral shaft fractures were treated with medial transposition of the radial nerve during open reduction and anterolateral plate fixation, included 12 males and 4 females ranging in age from 26 to 49 years, with a mean of 36 years. There were 7 fractures in the right and 9 in the left. According to AO classification, 6 fractures were type A3.2, 5 fractures were type A2.2, 2 fractures were type A1.2 and 3 fractures were type B2.2. The results were evaluated with DASH (disability of arm-shoulder-hand) Questionnaire by the American Academy of Orthopedic Surgeons (AAOS), where 0 indicates normal upper extremity function, and 1 to 100 indicate varying degrees of damage to the function of the upper extremities.

RESULTSThere was no neurologic complication or postoperative would infection in this series. The followed-up period ranged from 20 to 46 (means 29) months postoperatively. The clinical outcomes were evaluated with DASH Questionnaire, indicating that all patients reached a normal value (value of 0). The function of the upper extremities recovered satisfactorily. There was no surgery-related complication.

CONCLUSIONMedial transposition of the radial nerve is safe and does not cause iatrogenic nerve injury. It protects the radial nerve during open reduction and anterolateral plate fixation of humeral shaft fractures.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Radial Nerve ; surgery

Background: Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitorcells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells.Although liver progenitor cell proliferation during the regenerative process has been observed in animalmodels of severe liver injury, it has never been observed in vivo in humans because it is unethicalto take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitorcells and the roles they play in liver regeneration. Associating liver partition and portal vein ligationfor staged hepatectomy (ALPPS) is a staged procedure for inducing remnant liver hypertrophy sothat major hepatectomy can be performed safely. This staged procedure allows for liver biopsyspecimens to be taken before and after the liver begins to regenerate. Case presentation: The liverprogenitor cell proliferation is observed in a patient undergoing ALPPS for a metastatic hepatictumour. Liver biopsy is acquired before and after ALPPS for the calculation of average number ofliver progenitor cell under high magnification examination by stain of immunomarkers. This is thefirst in vivo evidence of growing liver progenitor cells demonstrated in a regenerating human liver.

PURPOSE: The aim of this study was to evaluate the technical feasibility and rate of mid-term occlusion in aneurysms treated solely with the Pipeline Embolization Device (PED) in a German tertiary care university hospital. MATERIALS AND METHODS: Forty-nine non-consecutive intracranial aneurysms underwent endovascular treatment using the PED exclusively between March 2011 and May 2017 at our institution. Primary endpoint was a favorable aneurysm occlusion defined as OKM C1-3 and D (O'Kelly Marotta Scale). Secondary endpoints were retreatment rate and delayed complications. Median follow-up was 200 days. RESULTS: The mean aneurysm size was 7.1 ± 5.3 mm. Forty-four aneurysms were located in the anterior circulation (90%). Ten aneurysms were ruptured (20%). Branching vessels from the sac were observed in 11 aneurysms (22%). Favorable obliteration immediately after PED placement was seen in 13/49 aneurysms (27%), of those nine aneurysms were completely occluded (18%). Angiographic and clinical follow-up was available for 45 cases (92%); 36/45 aneurysms (80%) were occluded completely and 40/45 aneurysms (89%) showed a favorable occlusion result. A branching vessel arising from the aneurysm sac was associated with incomplete occlusion (P < .05). All electively treated patients had good outcome (mRS 0). Three aneurysms (6%) required additional treatment due to aneurysm recurrence. CONCLUSION: In our series, treatment of intracranial aneurysms with the PED was associated with favorable occlusion rates and low complication rates at mid-term follow-up. The presence of branching vessels arising from the aneurysms sac was predictive for an incomplete occlusion.
Aneurysm ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Recurrence ; Retreatment ; Tertiary Healthcare