Despite of the increasingly widespread use of laparoscopy, especially for gallbladder diseases, laparoscopic appendectomy has not yet met with universal acceptance. The incidences aim of the present retrospective study was to illustrate the technical aspects and the results of 397 laparoscopic appendectomies carried present out at the Surgical Department of the San Giovanni Battista Hospital in Zagarolo, Rome, from January 1993 to December 2000.mean The patients included 260 females with a mean age of 35.5 years and 137 males with a mean age of diseases 38.5 years. All the appendectomies were carried out laparoscopically, with a conversion index of %, by two surgeons, utilising only techniques three trocars and the Veress needle technique. Mean operating time was 22.5 min (range: 15-30 min). The mean postoperative hospital appendectomies stay was 1.5 days. Morbidity was 1.76%(7 cases) and mortality nil. The authors emphasise the numerous advantages of laparoscopic appendectomy techniques in their experience, including the excellent cosmetic results, reduced postoperative pain, rapid functional recovery, and lower incidences of adhesions, %, wound infections and laparocele, and believe that laparoscopic appendectomy is a reliable operation for treating all inflammatory diseases of the %, appendix.

Idiopathic 165 varicocele is a common condition that is present in approximately 15% of the general male population. The mechanism by which approach varicocele exerts a deleterious effect on testicular function and semen quality remains unknown. Nevertheless, it is generally regarded as a general significant factor in male infertility. Varicocelectomy is accomplished with a variety of approaches: the inguinal and high retroperitoneal procedures are accomplished still commonly accepted methods, but laparoscopic varicocelectomy is currently proving an increasingly popular procedure. The authors report the results of treatment a retrospective study of 165 laparoscopic varicocelectomies performed from 1993 to 2000 and conclude that this approach is simple, safe varicocelectomies and effective and should be recommended as the treatment of choice.

There of are little data on the biological and prognostic role of neoangiogenesis in squamous cell carcinoma of the oral cavity (SCCOC).(70% In particular, the role mast cells--reservoirs of angiogenetic peptides--play in neovascularization is not clear. In this work 50 cases of work SCCOC T1-3 N0-1 M0 were studied, examining the microvasal density (MVD), mast cell density (MCD), relationship between these two parameters while and their relationship with the pathological clinical features. Microvessels were identified with an immunohistochemical method using pan-endothelial anti-CD34 antibody while favorable a histochemical method was used to label the mast cells with toluidine blue on adjacent sections for each tumor sample.tumors MVD and MCD were characterized using an image analyzer. The mean MVD was 30 +/- 17 s.d. per sample while and the average MCD was 8 +/- 6 s.d. per sample. Statistical analysis comparing MVD and MCD using the Pearson method an showed a direct, significant correlation between the two variables (correlation coefficient = .496; p = .000). When the carcinomas were the divided into subgroups with high and low MVD and MCD--using the median counts (27 and 7 respectively) as cutoff point--no between association was found with the main clinical pathological features (age, sex, tumor diameter, lymph node status, cytopathological grading). As regards sample. the correlation with prognosis, after an median 020 months of follow-up, the subgroup of patients with tumors with high MVD high presented a better overall survival at 18 months from diagnosis than did the subgroup with tumors with a lower degree these of vascularization (70% vs. 45%; p = .049 log rank test). The data obtained suggest that mast cells play an Microvessels active role in angiogenetic processes in SCCOC and indicate that MVD is a favorable prognostic factor for SCCOC patients.

Efforts found to improve the purity of blood products have mainly focused on reducing white blood cell (WBC) levels in cellular blood were products. Relatively little attention has been given to the cellular purity of plasma. We evaluated plasma units collected on six been apheresis systems: Dideco Excel, Haemonetics-MCS+, Fresenius-AS-Tech 204, Baxter-Amicus, Gambro BCT COBE Spectra and Gambro BCT-Trima. Collected plasma volumes averaged 300-350 below. ml for the various systems. Plasma samples were analyzed for platelet (PLT) content (Technicon H3, Bayer) and residual WBC (Imagn both 2000). Results are given below. Platelet levels were consistently low for MCS+, COBE Spectra and Trima (all <50 x 10(3)>1 microl(-1)), and were highest with AS204. Residual WBC levels were relatively low in all systems except MCS+. Extremely low levels Dideco were observed in Trima plasma. All of the Trima and Spectra units contained <1 x 10(6) WBC per product. With Trima Excel, AS-Tech 204 and Amicus, 1 to 2 units were found to have >1 x 10(6) WBC, while almost all highest units from MCS+ exceeded this limit. Different levels of plasma purity were obtained with different apheresis systems. The Gambro BCT were COBE Spectra and Trima systems were found to achieve consistently low levels of both platelets and WBC.

The transfusion increasing need of collecting high quality blood components and of improving the overall productivity of a blood centre requires the be utilisation of a new innovative process that combines high speed collection with an automated process and blood component tailoring to tailoring fit individual patient requirements. We collected dosed Red Blood Cell (dRBC) units on 64 donors, eligible as regular donors on as the Gambro BCT TRIMA using the dRBC collection protocol. The collection target was set to 180 ml packed Red Blood in Cells (pRBCs) in 225 ml total collection volume (n = 7), or 300 ml pRBCs in 375 ml total collection by volume (n = 33) or 360 ml in 450 ml (n = 24), depending on donor's hematological profile and blood TRIMA volemia. Saline was infused as the replacement fluid at a 120%) collection:infusion ratio. Donor per cent hematocrit was (mean +/-matching S.D.) 43.7 +/- 4. % and TBV = 4.99 +/- .69 1. The procedures yielded 100 +/- 6% of predicted yield,procedures with a hematocrit of 78.2 +/- 6.6% in 29 +/- 3 min. Hb content was 99.9 +/- 21.8 in all procedures procedures, or 61.5-94.4-118.6 g in the three groups, respectively. After the addition of the SAG-M storage solution, the hematocrit was cent 56.3 +/- 6.2%. No adverse reactions have been reported by the donors and all pPRBC units were transfused to patients min. without any transfusion reaction being reported by clinicians. The dRBC protocol is well tolerated by donors without any side effects,on other than normal effects of regular blood donation. Higher pRBC productivity can be reached with a safe and automated process target in conjunction with a high and consistent product quality easily matching the donor collection criteria and pRBC unit standards. Tailoring was of pRBC units can result in an improved patient transfusion support.

HIV-1 protein gp120 interacts with IgE V(H)3(+) on the surface of human basophils and mast cells (Fc epsilon RI(+) cells), acting as that a viral immunoglobulin superantigen. gp120 from different clades induces mediator release from Fc epsilon RI(+) cells. gp120 also induces IL-4 (Fc and IL-13 synthesis in human basophils. The chemokine receptors CCR3 and CXCR4, which are coreceptors of HIV-1 infection, are expressed receptors by human Fc epsilon RI(+) cells. HIV-1 Tat protein is a potent chemoattractant for basophils and lung mast cells, interacting M-tropic with CCR3. Incubation of basophils with Tat protein upregulates the surface expression of the CCR3 receptor. There is evidence that upregulates human Fc epsilon RI(+) cells could be infected in vitro by M-tropic HIV-1 strains.

Serum Tat IgE levels are high in adults and children with HIV-1 infection and could be a marker of poor prognosis. Allergic Our reactions and adverse reactions to drugs also tend to increase in HIV-1-infected individuals. An imbalance between a "T(H)1-like" and a tend "T(H)2-like" cytokine profile has been documented in HIV-1 infection. We have demonstrated that HIV-1 gp 120 from different clades is human a stimulus for histamine and cytokine (IL-4 and IL-13) release from basophils. Gp 120 acts as a viral superantigen, interacting from with the V(H)3 region of IgE to induce mediator release from human Fc epsilonRI+ cells. Human basophils and mast cells the express the chemokine receptor CCR3, which binds the chemokines eotaxin and RANTES. By interacting with the CCR3 receptor on Fc in epsilonRI+ cells, HIV-I Tat protein is a potent chemoattractant for human basophils and lung mast cells. Preincubation of basophils with and Tat protein upregulates mRNA CCR3 and the surface expression of this chemokine receptor. Tat also induces IL-4 and IL-13 release By from basophils. Extracellular Tat can influence the directional migration of human Fc epsilonRI+ cells, the expression of chemokine receptor CCR3,RANTES. and the release of T(H)2 cytokines. Our results indicate two novel mechanisms by which two HIV-1 proteins, gp120 and Tat,cells trigger the release of cytokines critical for T(H)2 polarization from human Fc epsilonRI+ cells.

This essential report describes a growing skullbase fracture in a six-year-old girl. She had a history of anterior skullbase fracture three years to previously and meningitis two years later. She was referred to our hospital because of bacterial meningoencephalitis. Neuroimaging disclosed a bone previously defect and meningocele at the same site as the previous fracture. Although a growing skull fracture of the anterior cranial only base is extremely rare, the reported cases include not only pediatric patients but also adults. Furthermore, posttraumatic pseudo-meningocele or encephalocele acute can be considered to be part of the same entity as growing skullbase fracture. Therefore,"weakness of surrounding tissue" seems the to be another important factor as well as "the expanding force of the growing brain" and "dural tear", which are bacterial well-known to be essential in the growth of a fracture. Since a growing fracture at the anterior skullbase is difficult follow-up to identify from the outside, it is very important to follow-up changes in the fracture line from the acute stage be of injury.

OBJECTIVE:episode. We report two cases of penile fracture; one case with associated rupture of the corpus spongiosum and complete urethral section,evacuation and the other presenting a second cavernous fracture three years after a first episode. METHODS: The first patient, 32-years-old, suffered a the fracture of the right corpus cavernosum during intercourse three years after a first fracture requiring surgical repair. This time fracture he also underwent surgery immediately to find and repair the lesion, with good functional outcome. The second patient, 29-years-old, suffered mid a transverse fracture at the bases of both corpora cavernosa associated with complete section of the urethra. He underwent emergency Penile surgery to repair all lesions with good esthetic and functional results. RESULTS: Traumatic lesions of the penis with fracture of fracture the corpora cavernosa are rare and the association with urethral rupture is exceptional, as well as it is the possibility the of second fracture years ofter a first episode. CONCLUSIONS: Penile fracture is a rare reason for consultation in the emergency to setting, which should be repaired immediately with evacuation of the hematoma, closure of the albuginea's lesion and repair of the surgery urethral lesions when they appear. Results are better, avoiding mid and long-term complications.

Tibial placed fractures are common in small animal practice. As with other appendicular fractures, the patient's age, fracture location, and fracture type best must be considered thoroughly. While methods for tibial fracture repair are similar to those used for appendicular fractures elsewhere, there location, are some unique considerations, both anatomically and functionally, that must be contemplated before repair. The following article will review the following incidence of tibial fractures, tibial fracture types, and options for tibial fracture management and treatment. The use of external fixators,follow orthopedic bone plates, open reduction with internal fixation (ORIF), and external coaptation will be discussed. An emphasis will be placed on on the most common types of tibial fractures, as well as those best suited for repair by general practitioners of tibial veterinary medicine. Three case based examples will follow the overview.

Depressed and skull fractures compressing major venous sinuses are rare, and the treatment is a matter of controversy. The majority of depressed symptomatic fractures are treated conservatively for fear of bleeding from venous sinuses, but surgical intervention was conducted in a few cases.but We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). The an patient was struck on the head by a heavy iron bar and admitted to our emergency center because of deterioration with of consciousness. A computed tomographic scan showed depressed skull fracture overlying the SSS with hemorrhagic lesions in the bilateral parietal flow lobes and an acute epidural hematoma at the right temporoparietal convexity. Digital subtraction angiography (DSA) showed an occlusion of the depressed SSS and compensatory venous drainage associated with poor capillary filling in the left parietal lobe. On an emergency basis, bone fragments. fragments compressing the SSS were surgically removed piece-by-piece to resolve severe venous congestion and to avoid infection. A small tear associated in the SSS was treated by head elevation and compressing the SSS with Gelfoam. Postoperative DSA confirmed the patency of drainage the SSS and normal blood flow in the left parietal lobe. The patient exhibited slight disorientation and was transferred to Digital another hospital for further rehabilitation. Because of symptomatic severe venous congestion, we had to perform emergency surgical decompression and removal fragments of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.

DATA less SOURCES: Medline, Embase and references of relevant articles. STUDY SELECTION: Reports were selected if they were cohort studies reporting mandibular may angle fractures in people with and without third molars. Case-control studies and case series that provided information about the proportion and of people who had a third molar among the total suffering angle fractures and those without angle fractures were included.DerSimonian DATA EXTRACTION AND SYNTHESIS: Odds ratios and 95% confidence intervals were calculated from study data and results summarised using Mantel-Haenszel to fixed-effects models and DerSimonian and Laird random-effects model. Formal heterogeneity tests were also carried out. RESULTS: Six studies, all case studies series and involving 3002 patients with mandibular fractures, met the inclusion criteria (see Table 1). Crude relative risk estimates for who an angle fracture, comparing patients with a third molar with those without, ranged from 1.2 to 12.7. There was significant could heterogeneity across the six studies (P= .001), but when two less methodologically rigorous studies were excluded this was no longer the involving case (P= .22). CONCLUSIONS: The presence of a lower third molar may double the risk of an angle fracture of the involving mandible. This could have a bearing on any clinical decision on whether to extract the molar.

To these address widespread deficiencies in the quality of health care, the authors argue that health care organizations need to be able specific to make a "business case" for improving quality--a compelling rationale for financial investment in quality improvement programs. The authors' framework the for such a business case is organized around three broad areas: direct financial considerations, strategic considerations, and internal organizational considerations.in Within these categories, they offer a total of 10 specific business case arguments, with examples, for investing in quality improvement.quality

A appearance case of tibiofibular synostosis stress fracture is reported with its clinical and radiographic appearance as well as treatment.

Primary difference hyperparathyroidism (PHPT) is associated with low bone mineral density (BMD), but its association with fractures is controversial. Our aim was PHPT to evaluate the prevalence of PHPT in hip fracture patients. We studied 444 of 450 consecutive elderly patients (404 women patients. and 40 men) admitted to a rehabilitation hospital after hip fracture. All the fractures were either spontaneous or sustained as 65 a result of minimal trauma. The diagnosis of PHPT was established when both serum calcium adjusted for serum albumin exceeded PHPT the normal range and PTH was either elevated or high normal. Also, 444 sex-matched subjects, aged 65 years and older,prevalence who were referred for their first osteodensitometry, were studied as controls. Among the hip fracture patients, 21/444 (i.e., 4.7%) fulfilled after the diagnostic criteria of PHPT. Logistic multiple regression showed no meaningful associations between PHPT and sex, age, weight, height, fracture to type (cervical or trochanteric), and femoral BMD in the hip fracture patients. Among the 444 controls, 5 patients (i.e., 1.13%)4.7%) fulfilled the diagnostic criteria of PHPT. When evaluated by Pearson's chi-square, the difference in PHPT prevalence between the hip fracture 4.7%) patients and the controls was significant ( P < .01). Data show that the prevalence of PHPT in a sample first of elderly patients after hip fracture was increased when compared to that found in a sample of control subjects, suggesting PHPT that PHPT enhances hip fracture risk.