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PubMed2002

Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing.

BACKGROUND: In the case of pilonidus sinus treated with primary intention surgery the uneventful healing is still difficult to obtain, as indirectly proven by the number of different procedures that have been suggested, such as cyst excision with or without primary closure, excision followed by marsupialisation, and excision followed by skin flap transposition. The procedure described here involves excision and primary closure, with a drain being used to flush the operative cavity with an antiseptic solution. METHODS: Two hundred and forty-three patients (173 men and 70 women) were treated by excising the pilonidal sinus and placing a 12F suction drain at the base of the wound, with its tip being brought out in the left gluteal region at least 5 cm laterally to the lower end of the suture. Suction was stopped on the first postoperative day and the drain was cut just above the skin. On day 2, a 5F catheter was inserted through the drain and the cavity was flushed with an antiseptic solution followed by sterile saline solution; the same treatment was repeated on days 4 and 6. The drain was removed on day 8 or 9, some of the stitches on day 8 or 9 and the rest on day 9 or 10. The surgery was performed on a day hospital basis in 207 cases; the remaining 36 were hospitalized overnight and discharged on the following day. RESULTS: Healing was always by first intention, with none of the 243 patients experiencing any complications. The postoperative follow-up now ranges from 5 to 15 years, and there have not been any recurrences. CONCLUSIONS: The drainage of blood from the bottom of the wound and the use of antiseptic/saline flushing are essential for primary intention healing and the avoidance of recurrences.

Adolescent↗

PubMed1979

Correlation among the rates of dimer excision, DNA repair replication, and recovery of human cells from potentially lethal damage induced by ultraviolet radiation.

The kinetics of excision repair in confluent cultures of diploid human fibroblasts after ultraviolet irradiation at varying doses was measured by three different methods: (a) removal of thymine-containing dimers, (b) DNA excision repair synthesis, and (c) biological recovery of cells from the potentially lethal effects of the irradiation. Each method gave similar results and indicated that the excision rate was dependent upon the number of thymine-containing dimers induced (substrate concentration). For example, at a dose of 40 J/m2 (0.2% dimerization), the repair rate was 1.6 J/m2 per h as determined by a modified method to measure the number of thymine-containing dimers remaining in DNA and 1.65 J/m2 as measured by excision repair synthesis. At a dose of 7.5 J/m2, the repair rate was 0.5 J/m2 per h as measured by biological recovery, and at a dose of 7 J/m2, the repair rate was 0.46 J/m2 per h as measured by excision repair synthesis.

Cell Cycle↗

PubMed1996

Does large loop excision of the transformation zone of the cervix predispose to the development of antisperm antibodies in women?

OBJECTIVE: To determine whether large loop excision of the transformation zone of the uterine cervix for cervical intraepithelial neoplasia predisposes to the development of female isoimmunity to human spermatozoa. DESIGN: A prospective, controlled study. SETTING: Colposcopy and Andrology units at the John Radclife and Churchill Hospitals, Oxford, United Kingdom. INTERVENTIONS: Serum samples were collected from 33 women before large loop excision of the transformation zone of the cervix and repeated at a minimum time interval of 4 months after the procedure. Women were questioned regarding the procedure and subsequent reproductive function. A control population of 30 women not undergoing cervical surgery also underwent serial serum screening for antisperm antibodies. MAIN OUTCOME MEASURE(S): The detection of serum antisperm antibodies by flow cytometry. RESULTS: None of the serum samples before large loop excision of the cervical transformation zone had clinically significant levels of antisperm antibodies. There was, however, a significant rise in antisperm antibody levels in women following large loop excision of the transformation zone. Apparent risk factors for the development of antisperm antibodies included a short duration of sexual abstinence and the use of nonbarrier contraception after surgery. There was no rise in antisperm antibody levels in the control population. CONCLUSION: Large loop excision of the transformation zone of the cervix is a risk factor for the development of antisperm antibodies in women. Women should be advised to use barrier contraception or avoid sexual intercourse until complete healing of the cervix has occurred.

Adult↗

PubMed2003

Characterization of Campoletis sonorensis ichnovirus unique segment B and excision locus structure.

Polydnaviruses (PDVs) are segmented, symbiotic, double-stranded DNA viruses that are vertically transmitted as proviruses within the genomes of some parasitoid Hymenoptera. The PDV associated with the ichneumonid wasp Campoletis sonorensis (CsIV) consists of 24 non-redundant DNA segments varying in size from approximately 6 to 20 kbp. CsIV segment B, one of the smallest genome segments, was sequenced and the excision sites of the proviral segment were characterized. The segment B sequence was 83.2% non-coding with only two open reading frames (ORFs). Some non-coding sequences have similarities to database sequences and were likely pseudogenic, but most were unrelated to known nucleic acid or predicted protein sequences. One ORF, BHv0.9, encodes a member of the rep gene family and was expressed only in parasitized insects while transcription of the other ORF could not be detected. Previously, a third region of the segment was shown to hybridize to 0.6 and 1.2 kb poly A+ RNAs from female wasps during virus replication (Theilmann and Summers, 1988) but this region did not have an identifiable ORF in the determined sequence. In contrast to CsIV segment W, segment B had little repetitive sequence. The segment B proviral integration locus contains a 59 bp direct imperfect repeat. Further analyses of this integration locus demonstrated that segment B was excised from wasp genomic DNA with flanking sequences at the integration site rejoined after segment excision. The segment B "excision locus" retained one of the two copies of the 59 bp repeat sequence with the other repeat present in the excised segment. The data indicate that Ichnovirus segments have distinctive characteristics possibly reflecting functional co-evolution between the wasp and individual types of polydnavirus segments.

Animals↗

PubMed1985

Early excision of major burns in children: effect on morbidity and mortality.

The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). Of these, 20 had burn wound excision within 7 days (Early) and 33 had delayed excision and grafting (Late). The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.

Adult↗

PubMed1988

Simple cysts of the testis in children: preoperative diagnosis by ultrasound and excision with testicular preservation.

We report on 2 children with simple cysts of the testis who were treated with excision and testicular preservation. To our knowledge both cases represent the first report of conservative surgery for these lesions in children. In 1 case the diagnosis of a simple intratesticular cyst was made by ultrasound. This patient was followed conservatively until enlargement resulted in excision of the cyst with preservation of the gonad. In the other case the diagnosis was made intraoperatively and simple excision of the lesion with testicular sparing was performed. High resolution real-time ultrasound should be performed routinely for all suspected testicular masses in children. Benign testicular tumors are more common than in adults and ultrasound may permit identification of lesions that can be excised locally with testicular preservation. Should the diagnosis of a simple, small intratesticular cyst be made by ultrasound regular followup may be appropriate. Should enlargement occur surgical excision can be done with the possibility of gonadal preservation.

Cysts↗

PubMed1998

Antimutagenic role of base-excision repair enzymes upon free radical-induced DNA damage.

As a consequence of oxidative stress, reactive oxygen species are generated in the cells. They interact with DNA and induce various modifications. Among them, oxidised purines (such as C8-oxoguanine and purines whose imidazole ring is opened), oxidised pyrimidines (such as thymine and cytosine glycols, ring saturated and fragmented pyrimidines), ethenobases and hypoxanthine. These various lesions have either miscoding properties or are blocks for DNA and RNA polymerases during replication and transcription, respectively. Most of these lesions are repaired by the base excision pathway in which the first step is mediated by specific DNA glycosylases. We review the various glycosylases involved in the repair of oxidised bases in Escherichia coli. The Fpg protein (formamidopyrimidine-DNA glycosylase) contains a zinc finger and excises oxidised purines whereas the Nth protein excises oxidised pyrimidines. The Nei protein excises a comparable spectra of pyrimidines and is believed to act as a back up enzyme to the Nth protein. The hypoxanthine-DNA glycosylase excises hypoxanthine residue and is one of the various activities of the AlkA protein (including formyluracil and ethenopurines residues). The Nfo protein was shown to have a novel activity that incises 5' to an alpha-deoxyadenosine residue (the anomer of deoxyadenosine formed by gamma-irradiation). The mechanism of action of the Fpg and Nth proteins are discussed. The properties of the human counterpart of the Fpg and Nth proteins the hNth and OGG1 proteins, respectively are also reviewed.

Antimutagenic Agents↗

PubMed2003

Selecting suspension points and excising the vagina during Michigan four-wall sacrospinous suspension.

OBJECTIVE: To describe the variations in the location of the vaginal apex and the length of vagina excised in women undergoing the Michigan four-wall sacrospinous suspension for posthysterectomy vaginal vault prolapse. METHODS: A prospective observational study of 76 women who had the Michigan modification sacrospinous suspension performed between 1998 and 2001 for posthysterectomy vaginal vault prolapse was carried out. Demographics and preoperative, operative, and postoperative findings were noted, including the pelvic organ prolapse quantification score. The locations of the suspension points relative to the hysterectomy scar were recorded. The amount of vagina excised at surgery and the pre- and postoperative vaginal lengths are reported. RESULTS: The mean length and standard deviation of vagina excised was 4.6 +/- 2.5 cm. The apex created at sacrospinous fixation was at the hysterectomy scar in only seven women (9%). It was most often situated behind the hysterectomy scar, in 58 cases (76%); it was situated in front of it in 11 (14%). In seven women no vagina was excised, and in the remaining 69 women a mean length of 5.1 +/- 2.2 cm was removed. The mean vaginal lengths were 9.7 +/- 1.7 cm preoperatively and 9.4 cm +/- 0.8 postoperatively, a 0.3-cm difference. CONCLUSION: When one performs the Michigan modification sacrospinous suspension, the chosen suspension points are often not at the hysterectomy scar, and in women with large prolapses excess vagina frequently is excised without compromising postoperative vaginal length.

Aged↗

PubMed2001

Structure of fructans from excised leaves of New Zealand flax.

The accumulation of total water-soluble carbohydrate, and specifically sucrose and fructan, by excised leaves of Phormium tenax and P. cookianum (family Phormiaceae J. G. Agardh, order Asparagales) was investigated. Total water-soluble carbohydrate content of excised leaves of P. tenax and P. cookianum increased during 48 h of continuous illumination at an average rate of 1.3 and 0.9 mg g(-1) fresh weight leaf per hour, respectively. The sucrose content of excised leaves increased throughout the experimental period. The fructan content of excised leaves of P. tenax increased slightly throughout the experimental period, whilst that of P. cookianum was variable and showed no overall change. Chemical and spectroscopic analysis of the fructans obtained from the two Phormium species showed that they were similar to each other and contained mostly 1-linked and terminal fructofuranosyl (Fruf) residues, together with smaller amounts of 6-linked Fruf, 1,6-branched Fruf, terminal and 6-linked glucopyranosyl residues. Separation of the fructans by thin-layer and high-performance anion-exchange chromatography revealed the presence of a complex mixture of fructo-oligosaccharides and higher molecular weight fructan. The branched structure of the fructans isolated from excised leaves of Phormium resembles that of fructans and fructo-oligosaccharides isolated from some related species within the order Asparagales (Agave vera cruz, Cordyline australis and Urginea maritima), but is distinct from the linear structure of fructans from others (Allium cepa and Asparagus officinalis). The structural heterogeniety of fructans within both the order Asparagales and superorder Liliiflorae may be a useful chemotaxonomic aid.

Carbohydrate Conformation↗

PubMed2003

Cavoatrial tumor thrombus excision without circulatory arrest.

INTRODUCTION: Traditional methods of cavoatrial thrombus excision use deep hypothermic circulatory arrest with significant associated morbidity and mortality. We describe a novel technique that avoids circulatory arrest, yet provides a bloodless field for tumor excision. TECHNICAL CONSIDERATIONS: A 59-year-old woman presented with a left renal mass and tumor thrombus with extension into the right atrium. After left radical nephrectomy, an aortic occlusion balloon was placed in the abdominal aorta at the level of the diaphragm, limiting flow in the inferior vena cava for tumor excision and maintaining both cerebral and spinal cord perfusion during cardiopulmonary bypass. Tumor excision was successfully performed using this technique with minimal postoperative morbidity in the patient described. She remained free of recurrence at 9 months of follow-up. CONCLUSIONS: Cavoatrial tumor thrombus excision can be successfully performed without deep hypothermic circulatory arrest.

Aorta, Abdominal↗

PubMed1999

Excision of the neurovascular bundle at radical prostatectomy in cases with perineural invasion on needle biopsy.

OBJECTIVES: To assess, in a group of patients who had undergone radical prostatectomy and who were likely to have extraprostatic extension of their tumors based on the previous finding of perineural invasion on needle biopsy, how effective excision of the neurovascular bundle was in reducing the number of positive margins and increasing the potential cure rate. METHODS: Eighty radical prostatectomy cases from our institution that had perineural invasion on prostate needle biopsy were retrospectively studied to determine the presence and location of extraprostatic extension, positive margins, and seminal vesicle or lymph node involvement, whether the neurovascular bundle had been excised, and whether tumor was present in the bundle region. RESULTS: In 14 (17.5%) of 80 cases, excising the neurovascular bundle led to a situation in which there was tumor in the neurovascular bundle, all the surgical margins of resection were negative for tumor, and there was no seminal vesicle or lymph node involvement. The remaining cases were equally divided between (a) less aggressive tumors that were organ-confined or had only focal extraprostatic extension with no tumor in the neurovascular bundle and (b) more aggressive tumors that had positive margins or involvement of the seminal vesicles or lymph nodes. Within the latter group, however, there were 9 patients (11.3% of all 80 cases) with negative seminal vesicles and lymph nodes in whom excision of the neurovascular bundle at least reduced the extent of positive margins. Most of the positive margins in patients with tumor in the neurovascular bundle occurred outside the bundle region, and in this study, none of the cases with positive surgical margins were the sole result of failure to excise the neurovascular bundle. CONCLUSIONS: When perineural invasion is seen on needle biopsy, the morbidity of resecting one or both neurovascular bundles, which in some cases could turn out to be unnecessary, must be weighed against the benefit of reducing the incidence of positive margins (17.5% of our cases) or decreasing the extent of positive margins (11.3% of our cases).

Biopsy, Needle↗

PubMed1985

Metastasis and the excision of irradiated LMCI tumours in the rat.

Lymph node metastases occurring within 150 days of local non-curative irradiation and excision of a transplantable mammary adenocarcinoma (LMCI) have been scored and their growth measured in isogeneic rats. Single doses (5-40 Gy) of 60Co gamma-rays were given to the primary at 8-10 mm diameter and these were excised either immediately or up to 30 days later. From the results it is concluded that approximately half of all rats have occult dissemination at the time of irradiation. Only these form metastases after the early excision of 10-40 Gy treated tumours but the number of positive sites per animal is significantly reduced. Delayed excision of the irradiated primary permits the further seeding of metastases and, with its regrowth, the incidence of positive rats and the mean number of metastases per animal is restored to that observed after control surgery. This process was dependent on the radiation-induced delay in growth of the primary tumour. However, all metastases, irrespective of site, radiation dose, and time of primary tumour excision showed a growth rate characteristic of the untreated LMCI tumour. No evidence was obtained for an enhancement in the dissemination of metastatic cells from the irradiated but regrowing primary tumour. However, an alteration in the pathways of lymphatic dissemination leading to an increased number of metastases seeding the mediastinum and abdominal lymph nodes may have occurred.

Adenocarcinoma↗

PubMed1997

Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections.

BACKGROUND: Keloids that are surgically removed commonly recur within the excision sites. OBJECTIVE: Our purpose was to determine whether postsurgical adjunctive therapy reduces such recurrences. METHODS: We determined the rate of recurrence after excision alone (n = 43) and postoperative injection with triamcinolone acetonide (TAC; n = 65) or interferon alfa-2b (IFN-alpha 2b; n = 16). RESULTS: Of lesions excised without postoperative injections, 51.1% (22 of 43) recurred; 58.4% of TAC-treated lesions (38 of 65) recurred and 18.7% of IFN-alpha 2b-treated lesions (3 of 16) recurred (p = 0.025). CONCLUSION: Postoperative TAC injections do not reduce the number of keloid recurrences. However, injection of keloid excision sites with IFN-alpha 2b offers a therapeutic advantage over keloid excision.

Adolescent↗

PubMedDate not supplied

Developmentally programmed excision of internal DNA sequences in Paramecium aurelia.

The development of a new somatic nucleus (macronucleus) during sexual reproduction of the ciliate Paramecium aurelia involves reproducible chromosomal rearrangements that affect the entire germline genome. Macronuclear development can be induced experimentally, which makes P. aurelia an attractive model for the study of the mechanism and the regulation of DNA rearrangements. Two major types of rearrangements have been identified: the fragmentation of the germline chromosomes, followed by the formation of the new macronuclear chromosome ends in association with imprecise DNA elimination, and the precise excision of internal eliminated sequences (IESs). All IESs identified so far are short, A/T rich and non-coding elements. They are flanked by a direct repeat of a 5'-TA-3' dinucleotide, a single copy of which remains at the macronuclear junction after excision. The number of these single-copy sequences has been estimated to be around 60,000 per haploid genome. This review focuses on the current knowledge about the genetic and epigenetic determinants of IES elimination in P. aurelia, the analysis of excision products, and the tightly regulated timing of excision throughout macronuclear development. Several models for the molecular mechanism of IES excision will be discussed in relation to those proposed for DNA elimination in other ciliates.

Animals↗

PubMedDate not supplied

Nucleotide excision repair: from E. coli to man.

Nucleotide excision repair is both a 'wide spectrum' DNA repair pathway and the sole system for repairing bulky damages such as UV lesions or benzo[a]pyrene adducts. The mechanisms of nucleotide excision repair are known in considerable detail in Escherichia coli. Similarly, in the past 5 years important advances have been made towards understanding the biochemical mechanisms of excision repair in humans. The overall strategy of the repair is the same in the two species: damage recognition through a multistep mechanism involving a molecular matchmaker and an ATP-dependent unwinding of the damaged duplex; dual incisions at both sides of the lesion by two different nucleases, the 3' incision being followed by the 5'; removal of the damaged oligomer; resynthesis of the repair patch, whose length matches the gap size. Despite these similarities, the two systems are biochemically different and do not even share structural homology. E. coli excinuclease employs three proteins in contrast to 16/17 polypeptides in man; the excised fragment is longer in man: the procaryotic excinuclease is not able by itself to remove the excised oligomer whereas the human enzyme does. Thus, the excinuclease mode of action is well conserved throughout evolution, but not the biochemical tools: this represents a case of evolutionary convergence.

DNA Repair↗

PubMed2002

The use of tourniquets in the excision of unexsanguinated extremity burn wounds.

PURPOSE: Tangential excision of burns is complicated by blood loss. Tourniquet use decreases blood loss, but adequacy of excision has been questioned. An attempt was made to assess the value of not exsanguinating the limb prior to tourniquet inflation to improve visualization of bleeding points and subsequent engraftment. METHODS: Eleven excisions of bilateral extremity wounds were performed. One limb was excised without the benefit of a tourniquet, the other with tourniquet but without exsanguination. Tangential excision was performed, hemostasis achieved, and blood loss quantified. Engraftment of skin was assessed at first dressing change and at initial follow-up after discharge. RESULTS: Area of burn was the same, 4.8% with tourniquet, 5.1% without (P=0.38). Overall blood loss was less with tourniquet control, 100-259 cm(3) (P=0.002); as was blood loss per area, 0.19-0.58 cc/cm(2) (P=0.04). Graft take was similar, 98.2% early and 98.1% later with tourniquet, with 98.2 and 96.8% take without (P>0.1). CONCLUSIONS: Tourniquet use in the unexsanquinated extremity reduced blood loss without affecting engraftment.

Adolescent↗

PubMed1998

Wide excision of the distal ulna: a multicenter case study.

Excision of the distal ulna to treat degenerative disease or instability has fallen into disfavor following reports of radioulnar impingement, carpal instability, and distal ulnar instability. Alternative procedures for reconstruction of the painful distal ulna have been developed to address these problems; the results have been generally favorable. When faced with distal ulnar reconstruction that has failed after multiple surgical procedures, or a distal ulnar neoplasm, the surgeon is left with few treatment options. Creation of a one-bone forearm, free fibular transfer, and allograft replacement have been attempted, with mixed outcomes. We report the results of 5 men and 7 women who underwent wide excision of the distal ulna, defined as surgical excision of 25% to 50% of the ulnar length. The diagnosis was failed distal radioulnar reconstruction or excision in 8 patients, osteomyelitis in 1, congenital pseudoarthrosis of the radius in 1, and neoplasm in 2. No soft tissue reconstruction was performed. Patients were examined at an average of 22 months after surgery for radiocarpal and radioulnar instability, functional outcome, pain relief, grip strength, and range of motion. Nine of the 12 procedures resulted in good or excellent results; 1 patient had a fair result after resection for osteosarcoma, and the procedure in 2 patients failed, requiring conversion to a one-bone forearm. Grip strength was restored to 75% of the normal side and range of motion was restored to 86% of the normal side. Wide excision of the distal ulna without soft tissue reconstruction is a simple and durable treatment of neoplasms of the distal ulna or salvage of the failed reconstruction of the distal radioulnar joint. We do not recommend its use in patients with incompetency or disruption of the interosseous membrane.

Adult↗

PubMed1982

Treatment of 100 burned hands by early excision and skin grafting.

The analysis of 101 cases has shown that early excision and grafting is the choice for hand burns. The indications are deep second degree and third degree burns. The excision is performed before the 4th post burn day, by tangential excision or direct knife dissection according to the site and depth. Immediate covering of all excised areas, usually by split-thickness skin autografts, is essential. The combination of early excision and grafting, active physiotherapy, Jobst compressive gloves and hydrotherapy guarantees the best cosmetic and functional results.

Adolescent↗