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Abstract Background Both in vitro and epidemiological studies indicate that dietary polyunsaturated fatty acids may play a protective role against peptic ulcer in humans. Adipose tissue fatty acid composition is thought to reflect dietary fatty acid intake. The aim of the present study is to investigate adipose and gastric mucosa fatty acid levels in relation to gastric ulceration status. Methods Fifty two adult outpatients undergoing upper gastrointestinal tract endoscopy participated in the study. Adipose tissue samples were taken from the abdomen and buttock during the endoscopy procedure and samples from gastric tissue were taken from a subsample of 30 subjects. The presence of Helicobacter pylori was determined using the CLO test. Capillary gas chromatography was used for the extraction of 36 and 42 adipose tissue and gastric mucosa lipids respectively. Results The monounsaturated fatty acids (MUFAs) C18:1n-12c, C16:1n-5, C16:4n-1 and the polyunsaturated fatty acids (PUFAs) C16:3n-4, C20:3n-3, C20:4n-6, C21:5n-3 and C18:2n-9c,12t of the gastric mucosa were present in higher proportions in ulcer negative patients. These unsaturated fatty acids, however, each contributed less than 1% on average to total fatty acid content. In addition, higher average levels of eicosapentaenoic acid (EPA) C20:5n-3 and docosahexaenoic acid (DHA) C22:6n-3 were detected in abdominal and buttock samples in CLO negative controls, compared to CLO positive controls. Adipose tissue and gastric mucosa n-6 and trans fatty acid levels were positively linearly correlated (r = 0.37 and 0.41 for n-6 and trans fatty acids respectively). Conclusion Certain minor MUFAs and PUFAs of the gastric mucosa appear to be present in higher proportions in ulcer negative patients. Overall, the findings provide only weak evidence of an association between the gastric mucosal fatty acids and the presence of gastric ulceration. The higher average levels of EPA and DHA in abdominal and buttock adipose tissue in CLO negative controls could be an indicator that dietary FAs inhibit Helicobacter pylori growth. Larger studies are necessary to provide evidence of a biologically relevant effect.

Background. Being predictive of the entire nodal bed, sentinel lymph node biopsy (SLNB) is invaluable in the surgical management of melanoma. Although the concept is simple, sentinel lymph node (SLN) identification and removal can be technically challenging. Methods. A total of 102 consecutive patients have undergone SLNB in the Division of Plastic and Reconstructive Surgery of Soroka University Medical Center from 2009 to 2012. Patients have undergone SLNB using a radioactive tracer and blue stain in order to identify the SLN. Although SLNB usually precedes the wide excision of melanoma, primary lesions in close proximity (<10 cm) to the lymph basin require wide excision before beginning the SLN quest. Results. All pathology reports confirmed the excision of lymph nodes. Conclusions. When treating MM in close proximity to the lymph basin, changing the sequence of the SLNB procedure seems to increase the efficacy of the method. [ABSTRACT FROM AUTHOR]

AIM: Pelvic injuries range from benign to life threatening. The majority of pelvic injuries are due to high-energy blunt trauma, often caused by car accidents or explosions. Pelvic injuries can present complex diagnostic and management dilemmas. We present a case of severe pelvic trauma that was admitted to our hospital and treated by a multidisciplinary medical team. MATERIAL - METHOD: A 50-years-old offi cer was admitted to the 401 General Army Hospital of Athens for pelvic injury. Clinical examination and radiographic studies revealed a pelvic ring fracture associated with rectus, perineal, prostate, urethral and urinary bladder traumas. The patient underwent multiple operations including open reduction of pelvic ring fracture with plate, colostomy formation, urethral and urinary bladder reconstruction. Having a substantial tissue defect, the urethral injury was reconstructed using epiploon and gracilis muscle. The restoration of intestinal continuity was reserved for a subsequent operation. RESULTS: The function of all affected organs was successfully restored and the patient fully recovered. CONCLUSIONS: All surgical centers, especially military hospitals, will be confronted some day with patients with pelvic trauma and for this reason all surgeons should maintain a high degree of suspicion in order to avoid missing these injuries. Severe traumas are complex, multidisciplinary and often require several re-interventions. However, successful reconstruction is feasible and patients can fully recover. [ABSTRACT FROM AUTHOR]

AIM: The large increase of traffi c accidents during the past decade results in an increased incidence of pelvic fractures and urethral injuries with strictures occuring in 60 to 80%. The purpose of our study is to evaluate the use of tubularized penicle circular fasciocutaneous fl ap as a treatment option for the reconstruction of urethral injuries and to describe the main surgical steps of the technique. MATERIAL - METHOD: From 1988 to 2013, twenty-three patients with urethral injuries were referred to our hospital. 16 patients were presented with partial and 7 with complete urethral ruptures. We used tubularized penicle fasciocutaneous fl ap for the urethral reconstruction of 4 patients (group A). Group B consisted of patients treated with repeated urethrography at 2-weekly intervals, endoscopically assisted catheter realignment or end-to-end anastomosis over a stenting catheter. Comparison of the stricture rates between group A and B was made in order to evaluate the use of tubularized penicle fasciocutaneous fl ap. RESULTS: 3 out of 4 patients who underwent urethral recosntruction with tubularized penicle fasciocutaneous fl ap presented without voiding disturbance during a mean follow-up period of 26 months. The group of patients treated with other treatment options had a stricture rate of 84.2% during a mean follow-up period of 4.7 months. CONCLUSIONS:The use of penicle circular fasciocutaneous fl ap can be successfully used for the reconstruction of urethral injuries, providing an ample length of nonhirsute, well-vascularized tissue. [ABSTRACT FROM AUTHOR]

AIM: Hypospadias is one of the most common congenital anormalities in men with prevalence rates varying from 4 to 43 patients per 10,000 births in different countries and studies. Hypospadias repair is regarded as a demanding procedure with many techniques described in the literature. The aim of this study is to present our experience with one-stage hypospadia repair in adults, using tunica vaginalis fl ap in combination with buccal or bladder mucosa graft. MATERIAL - METHOD: From 1991 to 2012, a total of 55 adult patients underwent one-stage hypospadia repair with tunica vaginalis fl ap. Buccal mucosa and bladder mucosa grafts for the neourethra reconstruction were used in 37 and 18 patients respectively. Patients attended routine follow-up visits. RESULTS: Our series of 55 patients resulted in 91% success after a single operation with 9% needing a second repair. All patients had satisfactory results in terms of aesthetics and function. CONCLUSIONS: The goals of hypospadia surgery are the creation of a straight, cosmetically acceptable phallus consisting of an orthotopic, slit-like urethral meautus and conically shaped glans and adequate skin coverage with an appropriate mucosal collar. Tunica vaginalis fl ap brings its vascular supply to the reconstructed area and therefore serves as a tissue layer that provides the buccal or bladder mucosa graft with the essential nutritients in order for the graft to take. Although more technically challenging, this combination seems to minimize surgical complications and result to a high rate of successful outcomes through a one-stage procedure. [ABSTRACT FROM AUTHOR]

Background: Aplasia cutis congenita is a rare, congenital disorder. In its severe phenotype, it is potentially life threatening. Its management and the timing of surgery remain controversial because of the risks involved with both conservative and surgical approaches. Most literature is based on case reports and very small case series because of the rarity of the disorder. The authors present their experience treating newborns with aplasia cutis congenita and its progressive development., Methods: Using a hospital registry, the authors found all cases of newborns diagnosed with aplasia cutis congenita during the years 2000 to 2013. Clinical data were gathered from hospital and clinic records, and photographs were obtained by the plastic surgery team., Results: Twenty-two cases of aplasia cutis congenita were included in this study: 21 on the scalp and one on the foot heel. Eleven patients were male and 11 were female. Defect size ranged from 1 to 150 cm (average, 29 cm). Three patients died as a result of uncontrollable hemorrhage. Six patients underwent emergency coverage, one with allografts later replaced by split-thickness skin grafts and five by immediate split-thickness skin grafting. All of the patients who underwent immediate skin grafting survived and thrived., Conclusions: The authors emphasize the role of emergency split-thickness skin grafting in the treatment of large aplasia cutis congenita or ones with large veins or sagittal sinus exposure. The authors also present a practical, treatment-oriented classification that could assist physicians in estimating the severity and therefore prognosis of the disease and offer a treatment guideline., Clinical Question/level of Evidence: Therapeutic, IV.