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PubMed2005

Genome-scale reconstruction of the metabolic network in Staphylococcus aureus N315: an initial draft to the two-dimensional annotation.

BACKGROUND: Several strains of bacteria have sequenced and annotated genomes, which have been used in conjunction with biochemical and physiological data to reconstruct genome-scale metabolic networks. Such reconstruction amounts to a two-dimensional annotation of the genome. These networks have been analyzed with a constraint-based formalism and a variety of biologically meaningful results have emerged. Staphylococcus aureus is a pathogenic bacterium that has evolved resistance to many antibiotics, representing a significant health care concern. We present the first manually curated elementally and charge balanced genome-scale reconstruction and model of S. aureus' metabolic networks and compute some of its properties. RESULTS: We reconstructed a genome-scale metabolic network of S. aureus strain N315. This reconstruction, termed iSB619, consists of 619 genes that catalyze 640 metabolic reactions. For 91% of the reactions, open reading frames are explicitly linked to proteins and to the reaction. All but three of the metabolic reactions are both charge and elementally balanced. The reaction list is the most complete to date for this pathogen. When the capabilities of the reconstructed network were analyzed in the context of maximal growth, we formed hypotheses regarding growth requirements, the efficiency of growth on different carbon sources, and potential drug targets. These hypotheses can be tested experimentally and the data gathered can be used to improve subsequent versions of the reconstruction. CONCLUSION: iSB619 represents comprehensive biochemically and genetically structured information about the metabolism of S. aureus to date. The reconstructed metabolic network can be used to predict cellular phenotypes and thus advance our understanding of a troublesome pathogen.

Bacterial Proteins↗

PubMed1992

Reconstruction of the anterior cruciate ligament.

Ligaments are strong collagenous structures that act as constraints on joint motion, thus confining the articular surfaces to more or less the same paths. In so doing they prevent arbitrary apposition of these surfaces from occurring and resulting in abnormal stresses which may damage the joint surfaces. Ligaments rupture due to excessive loads, particularly those resulting from trauma occurring during sporting events or motor vehicle accidents. Knee and ankle joints have the highest frequency of ligamentous injuries. This paper is a brief review of the current approaches to the reconstruction of the knee ligaments with specific reference to the anterior cruciate ligament (ACL) being the most frequently reconstructed. This is not only because it is frequently injured but also because of the debilitating consequences of such an injury. Approaches ranging from the conservative to those that advocate the use of frank prosthetic replacement have been adopted by surgeons at both ends of the spectrum. Following a discussion of the rationale for reconstruction of the ACL, the mechanical and biological considerations of the reconstructive procedure are discussed. The different methods of ACL reconstruction are reviewed. These include: (a) primary repair, (b) reconstruction with different tissues, including autogenous allografts and xenografts, (c) reconstruction employing different synthetic devices. A brief discussion of the procedures used for reconstruction with different types of tissue and of the surviving examples of the synthetic devices will follow.

Animals↗

PubMed1998

CT scanning of the paranasal sinuses: axial helical CT with reconstruction in the coronal direction versus coronal helical CT.

Paranasal sinuses of 52 patients with sinusitis, tumours or fibrous dysplasia were scanned. Axially acquired spiral data were obtained and reconstructed coronally. Four radiologists compared the two sets of images. They evaluated the diagnostic quality for visualization of the ostiomeatal unit, infundibulum, infraorbital canal, inflammatory disease, fine osseous lamellae and presence of amalgam or step artefacts. Two test phantoms were scanned for both techniques and lens dose was measured. Statistical significant differences in the diagnostic quality of the representation of the fine osseous structures in the paranasal sinuses, attributable to step artefacts were found in the coronally reconstructed images (p < 0.001). However, there was no amalgam and almost no motion artefacts in the reconstructed images. Interobserver correlation was r = 0.953 versus 0.956 for inflammatory disease, r = 0.816 versus 0.852 for artefacts, and r = 0.596 versus 0.547 for fine osseous lamellae in coronally acquired or axially acquired and reconstructed images, respectively. Lens dose was measured between 11.8 mGy and 13.8 mGy for axially acquired and reconstructed images. The advantage of axially acquired, coronally reconstructed images is the absence of artefacts attributable to amalgam and fewer motion artefacts. Axially acquired, coronally reconstructed images are inferior to coronal helical CT images, because of step artefacts, when it comes to evaluating the resolution of fine osseous structures. Nevertheless, reconstructed images are suitable as a investigatory procedure for patients with inflammatory disease who cannot maintain the prone position.

Adult↗

PubMed1988

Bioactive glass ceramic in ossicular reconstruction: a preliminary report.

Current techniques for ossicular reconstruction include ossicular autografts and homografts, and plastic and ceramic prostheses. Experimental testing of ceramic materials has led to the development of a nonporous, bioactive form of glass ceramic (Ceravital) for tympanoplastic reconstruction. To determine the clinical usefulness of these implants, Ceravital ossicular reconstructions were evaluated in 37 patients treated at the University of Michigan Medical Center during an 18-month period. Thirty-two patients (86%) with chronic ear disease underwent Ceravital ossicular reconstruction with tympanoplasty with or without mastoidectomy. Five other patients (14%) underwent ossicular reconstruction--2 for congenital anomalies, 2 for temporal bone trauma, and 1 patient for glomus tympanicum removal. Patient follow-up ranged from 2.2 to 3.8 years, with a mean follow-up period of 2.9 years. Prosthesis extrusion occurred in one case (3%). Mean preoperative and postoperative (2-year) pure tone air-bone gaps were 41.6 dB and 21.3 dB, respectively. Hearing was improved in 35 of 37 patients (95%). Postoperative pure tone air-bone gap was closed to 20 dB or less in 23 patients (62%). Hearing gains were greater with partial rather than total reconstructions (p = 0.14) and significantly greater with intact canal wall rather than canal wall down tympanoplasties (p less than 0.05). Initial results obtained with the Ceravital ossicular prosthesis compare favorably with those obtained using other methods of alloplastic reconstruction. These preliminary data suggest that Ceravital is an effective alternative prosthetic material for ossicular reconstruction.

Biocompatible Materials↗

PubMed1999

Dynamic three-dimensional reconstruction of the heart by transesophageal echocardiography.

OBJECTIVE: To evaluate echocardiography accuracy in performing and obtaining images for dynamical three-dimensional (3D) reconstruction. METHODS: Three-dimensional (3D) image reconstruction was obtained in 20 consecutive patients who underwent transesophageal echocardiography. A multiplanar 5 MHz transducer was used for 3D reconstruction. RESULTS: Twenty patients were studied consecutively. The following cardiac diseases were present: valvar prostheses--6 (2 mitral, 2 aortic and 2 mitral and aortic); mitral valve prolapse--3; mitral and aortic disease--2; aortic valve disease--5; congenital heart disease--3 (2 atrial septal defect--ASD- and 1 transposition of the great arteries-TGA); arteriovenous fistula--1. In 7 patients, color Doppler was also obtained and used for 3D flow reconstruction. Twenty five cardiac structures were acquired and 60 reconstructions generated (28 of mitral valves, 14 of aortic valves, 4 of mitral prostheses, 7 of aortic prostheses and 7 of the ASD). Fifty five of 60 (91.6%) reconstructions were considered of good quality by 2 independent observers. The 11 reconstructed mitral valves/prostheses and the 2 reconstructed ASDs provided more anatomical information than two dimensional echocardiography (2DE) alone. CONCLUSION: 3D echocardiography using a transesophageal transducer is a feasible technique, which improves detection of anatomical details of cardiac structures, particularly of the mitral valve and atrial septum.

Adult↗

PubMed2004

The effect of reconstruction algorithm on conspicuity of polyps in CT colonography.

OBJECTIVE: CT colonography studies to date have used a standard CT algorithm. To determine whether nonstandard algorithms may result in better performance of CT colonography, we conducted a prospective, blinded-observer study of the effect of the reconstruction algorithm on the conspicuity of colonic polyps and folds. SUBJECTS AND METHODS: CT colonography of patients with proven polyps, masses, or polypoid folds was performed on an MDCT scanner, and the images were reconstructed using the standard, soft, lung, and detail algorithms. Two experiments were performed. The first used four patient data sets of a short segment of colon (30-60 images), each reconstructed using all four algorithms and then viewed on a workstation in a four-on-one format that allowed all four reconstructions to be viewed simultaneously. The second used six sets of cut-film images (four or eight images each); images within each set differed only in the reconstruction algorithm used to generate them (eight-image sets were prepared with two different level settings). Twenty-one reviewers with varying levels of experience who were unaware of the purpose of the study were asked to rank the images within each set according to their value in the detection of either polyps or masses. RESULTS: Reviewers showed statistically significant differences in preference for the four algorithms (p = 0.037 in the computer-based experiment; for the cut-film experiment, p = 0.029 for the four-image sets and p = 0.041 for the eight-image sets). In the computer-based experiment, reviewers preferred the detail algorithm to the standard algorithm with an estimated probability of 0.67 (95% confidence interval [CI], 0.57-0.75) and the soft algorithm over the standard algorithm with an estimated probability of 0.59 (95% CI, 0.51-0.66). However, reviewers with the most experience (having interpreted at least 250 cases) preferred the soft algorithm over the standard algorithm by the same two-to-one margin as observed for the detail algorithm. In contrast, the standard and detail algorithms were ranked similarly in the cut-film experiment, with the soft and lung algorithms ranked worst. CONCLUSION: To our knowledge, ours is the first observer study on the effect of the reconstruction algorithm on conspicuity of folds and polyps in CT colonography. Our results indicate significant differences in the reconstruction algorithms, with the soft and detail algorithms being preferred over the standard algorithm by experienced reviewers when interpreting images on a workstation. These results indicate the need for further research into the effect of reconstruction algorithms on CT colonography.

Algorithms↗

PubMed1995

Breast reconstruction.

Breast reconstruction after mastectomy for breast cancer has usually been performed as a delayed procedure, often not less than one year after completion of postoperative radiation therapy and cytotoxic chemotherapy. The reason for delaying the procedure has been the increased risk of wound complications after the adjuvant therapy. The reconstruction has been even further delayed for patients with increased risk of recurrence in order to avoid a reconstruction 'in vain' for a patient, who will succumb to the disease within a couple of years after the reconstruction. The breast reconstruction can also be performed immediately in conjunction with the mastectomy. The rather slow acceptance of this procedure has mainly been for practical reasons. The mastectomies are usually performed by general surgeons. The operation has not been centralized to larger hospitals, and the patients usually want to have the operation performed as soon as possible. It is therefore often difficult to arrange a joint operation by the general and the plastic surgeons. In addition, suspicions have been raised that enlargement of the dissection area could spread cancer and increase the risk of local metastases. The same types of operation can be used for delayed and immediate breast reconstruction. There are basically two possible ways of creating a new breast mound. One entails transferring muscle, subcutaneous fat and skin into the area of reconstruction in sufficient quantity to shape a breast mound. The other possibility is to shape the breast mound mainly by inserting a prosthesis, similar in consistency to breast tissue into the area of reconstruction. For practical reasons the implant has to be covered by a sufficient amount of soft tissue, and for this purpose a number of pedicled flaps can be used. The implant most commonly used is made of silicone gel and covered by a membrane to prevent the gel from oozing into the surrounding tissues. A recent innovation is an implant with textured surface in order to diminish capsule formation around the prosthesis.

Breast Implants↗

PubMed1976

Tracheal reconstruction with perichondrial grafts.

Since 1972 a series of experiments (Skoog, Ohlsén & Sohn, 1972; 1975; Ohlsén, 1976) has been performed to elucidate the potential of perichondrial grafts to generate cartilage. In 1974 Sohn & Ohlsén demonstrated in rabbits that tracheal cartilage could be reconstructed from free perichondrial grafts. As these studies were carried out with an intact tracheal mucosa a series of experiments was conducted in rabbits, and reported in this paper, in which a tracheal section containing two cartiliages and the covering mucous membrane was removed and replaced with a free perichondrial graft taken from the ear. New cartilege formed in all animals. The reconstructed portion of trachea was partly covered by ciliated cells of normal appearance, partly by low epithelium with microvilli. These latter areas were mainly within the central parts of the regenerated mucosa. The use of perichondrial grafts for tracheal reconstruction was also studied in two series of dogs. In four dogs a tracheal section, consisting of two comlete cartilages with the covering mucosa, was completely removed. The circumferential defect was reconstructed by free perichondrial grafats from rib cartilage. They were placed on two fascial flaps which had been raised from the adjacent muscles, rotated into the defect and sutured for complete coverage. Regeneration of cartilage occurred in all dogs, producing a biologic framework. The lining of the reconstructed tracheal section was completely restored by epithelialization from the surrounding mucosa. Low epithelial cells were successively replaced by columnar ciliated cells typical of the respiratory tract. The morphological development of the regenerated epithelium was demonstrated by electron microscopy. The regenerated mucosa exhibited normal function by passing mucus across the reconstructed area. This was recorded by filming at low speed using Cardio-green as indicator. All the animals of this series developed tracheal stenosis within the reconstructed portion. Another experiment was therefore carried out in which four dogs were subjected to the same operative procedure. Postoperatively, however, during the phase of healing, a silicon tube was inserted and left in situ to maintain expansion of the reconstructed portion. By this means stenosis could be prevented with good regeneration of the mucosal lining.

Animals↗

PubMed1995

Immediate breast reconstruction: short-term experience in 75 consecutive cases.

Immediate breast reconstructions are being done more often nowadays to avoid the stress that the patient experiences while living without a breast. In this paper, the procedure and short term outcome of 75 patients who underwent immediate breast reconstructions at the Karolinska Hospital are reported. The median age of the patients was 48 years, and most of the tumours were stage O to 2 at the time of the operation, though reconstructions were also done for patients with more advanced cancer, for psychological reasons. The approach was multidisciplinary with oncologists, general surgeons, and plastic surgeons involved. Different reconstructive methods were used, and the operations were tailor-made for each patient. Twenty one permanent prostheses, 11 expanders, 33 expander prostheses, and eight pedicled and two free transverse rectus abdominis musculocutaneous (TRAM) flaps were used for reconstruction. The opposite breast was adjusted in 43 (57%) of the patients. There were 11 postoperative complications (15%), and in only one patient (1%), could the reconstruction not be completed. There was a tendency towards more complicated reconstructive procedures over time. The demand for immediate breast reconstruction is steadily increasing from both patients and doctors.

Adult↗

PubMed2002

Implant-based breast reconstruction following mastectomy.

Post-mastectomy breast reconstruction with prostheses can be performed immediately at the time of mastectomy or delayed for several months or years. It falls into three main categories namely implant-only, expander-implant and expandable implant reconstruction. Sometimes it is combined with the latissimus dorsi myocutaneous flap. Logistically prosthetic reconstruction can be single-stage (with implant-only or expandable implants) or two-stage (traditional expander-implant technique). Over the last decade a wide variety of prostheses has become available which materially vary in shape, surface and consistency. Prosthetic breast reconstruction provides satisfactory results in properly selected patients and has the advantages of simplicity, shorter operating time, hospital stay and recuperation. Additionally there are no extra scars or distant donor site morbidity. It is, however, more prone to additional unplanned revisional surgical procedures than autogenous tissue reconstruction. In general two-stage reconstruction gives more predictable results as it gives the surgeon the opportunity to adjust the reconstruction at the planned 2nd stage, while in practice, single stage reconstruction may be more prone to unplanned revisional surgery. The best results are obtained in patients with small minimally ptotic breasts while those with larger and/or more ptotic breasts often require a contralateral balancing procedure to achieve symmetry. This paper outlines the surgical options and the prosthetic range available at present.

Journal Article↗

PubMedDate not supplied

Breast reconstruction after mastectomy in young women.

Young women with breast cancer differ from older women in a number of ways that may affect their experience with breast reconstruction after mastectomy. Parenting, work, or recreational activities may influence a young woman's decisions about whether or not to have reconstruction, timing of reconstruction, and type of reconstruction. Young women with breast cancer are known to experience greater psychological morbidity and poorer quality of life than older women. A young woman's breast anatomy and physiology and overall medical condition generally allow more reconstructive options. Young women can often tolerate autologous reconstruction well, and more young women are expressing interest in perforator-based free tissue transfer to reduce donor site morbidity. Although the reconstructive issues are different for younger women, outcomes of breast reconstruction appear to be the same for women of all ages.

Adult↗

PubMed2003

Standardization of flap design for oropharyngeal reconstruction after cancer ablation surgery.

A variety of residual defects containing many sulci and fossae in the oropharyngeal cavity make it extremely difficult to achieve an adequate flap design as well as the functional reconstruction of the complex defects after ablation surgery for oropharyngeal tumors. This study attempted to standardize flap design for the different types of defects in order to produce a better functional reconstruction of intra-oral defects. The oropharyngeal defects were classified into 6 Zones. When the defect involves only the mouth floor, it was classified as Zone 1. A hemi tongue was classified as Zone 2. A defect involving the mouth floor and a part of the tongue was classified as Zone 3. A defect involving the mouth floor, a part of the tongue and the tonsil was classified as Zone 4. A defect involving the mouth floor, a part of the tongue, tonsil and soft palate was classified as Zone 5. A defect involving the pharyngeal wall was classified as Zone 6. The following four types of forearm free flap designs were applied to each defective Zone accordingly: Type I flap design - an unilobed design for reconstructing Zone 1, 2 and 6 defects, Type II design - bilobed design for reconstructing Zone 3 defects, Type III design - trilobed design for reconstructing Zone 4 defects and Type IV design for reconstructing Zone 5 defects. During 1999 to 2002, 91 patients with oropharyngeal defects underwent a reconstruction using these standardized forearm free flap designs. The Type I design was used in 41 cases, the Type II design in 18 cases, the Type III design in 10 cases and the Type IV design in 22 cases. In all patients, the decannulation was successful, and the swallowing and deglutination functions were within the normal parameters. There was less nasal escape of the voice and the regurgitation of food than that observed using the conventional flap design method. Effective and functional reconstructions with minimal morbidities are possible with the application of the standardized forearm free flap design in oropharyngeal defects.

Humans↗

PubMed2004

Comparison of perioperative complications between reconstructive pelvic surgery and general gynecologic surgery.

The purpose of this study was to compare the perioperative complication rates of reconstructive pelvic surgery and general gynecologic surgery, and to identify the predictive risk factors for perioperative complications in reconstructive pelvic surgery. The medical records of 148 reconstructive pelvic surgery patients and 146 general gynecologic surgery patients were reviewed, and the types of complications, along with their rates and predictive risk factors were examined. The statistical analysis included descriptive statistics and logistic regression. There was no difference in the type of complications between reconstructive pelvic surgery and general gynecologic surgery. The prevalences of perioperative complications were 34.4% in the reconstructive pelvic surgery group and 26.7% in the general gynecologic surgery group. Intraoperative blood loss (p= 0.006) and the duration of surgery (p=0.014) were independent risk factors for perioperative complications in the reconstructive pelvic surgery group. The perioperative complication rates for the patients undergoing reconstructive pelvic surgery were not higher than those of the patients undergoing general gynecologic surgery, even though more procedures were performed and a longer duration of surgery was needed in the former cases. Since the duration of surgery and the amount of blood loss are the major factors affecting the complication rate, decreasing these two factors would be the key to improving the outcomes of patients undergoing reconstructive pelvic surgery

Adult↗

PubMed2001

[Evaluation of canal wall down tympanoplasty with canal reconstruction for draining ear with middle ear cholesteatoma].

OBJECTIVES: We studied the postoperative stability of canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma with preoperative otorrhea. SUBJECTS AND METHODS: 155 ears with middle ear cholesteatoma treated with canal wall down tympanoplasty with canal reconstruction were evaluated retrospectively. A comparison was made between the group of 80 ears which showed otorrhea, preoperatively, and the group of 75 without preoperative otorrhea. Problems observed in the tympanic membrane or reconstructed external auditory canal were evaluated both at the postoperative initial stage and more than 1 year after surgery. Postoperative hearing prognosis was also studied. RESULTS: 1) In the postoperative initial stage, local infection and necrosis of materials for canal reconstruction were significantly more likely to be observed in ears with preoperative otorrhea. 2) In ears with postoperative local infection, necrosis of materials for canal reconstruction occurred more frequently, and the period until drying of the reconstructed external auditory canal was significantly extended. 3) No significant difference was seen in postoperative status of the tympanic membrane and reconstructed ear canal at least 1 year after surgery. 4) The presence of preoperative otorrhea had no influence on hearing prognosis. CONCLUSIONS: When canal wall down tympanoplasty with canal reconstruction is used for ears with preoperative otorrhea, careful attention should be paid to local treatment at the postoperative initial stage. However, no significant problem occurred in the outcome of preoperative ear draining at least 1 year after surgery.

Adolescent↗

PubMed1998

[Reconstructive strategies in head and neck cancer: case history review from 1992 to 1997 (154 cases)].

Technological progress in reconstructive surgery, in particular the use of pedunculated or free flaps, has given new impetus to head and neck dissection. This stems from the fact that such techniques provide greater oncological radicality, reduce the number of severe post-operative complications and give better quality of life. The present study examines 154 patients suffering from upper aero-digestive tract neoplasms (131 males and 23 females; age range 23-82 years) who had undergone radical surgery. Reconstruction was performed with flaps in 154 cases: 119 pedunculated flaps (102 large myocutaneous pectoral and 17 temporal muscle flaps) and 35 free flaps (18 radial osteofasciocutaneous, 13 radial fasciocutaneous and 4 omentum flaps). Analysis of the individual districts showed that the flap of choice was the temporal muscle flap when surgery involved the soft parts of the orbital-maxilly-zigomatic area and the rhinopharynx. This is because it is highly moldable and reliable. In surgery of the oral cavity and oropharynx the grand pectoral flap is most frequently used as it provides enough tissue for the reconstruction, adequately protects the vascular-nerve axis in the neck and it is quick and easy. However, the functional results are not the best and there is some alteration in the initial phases of deglutition. To reduce these problems, the authors encourage the use of free flaps which provide good results from both the functional and esthetic points of view. They are, however, more difficult to perform and this leads the authors to conclude that they should only be selected for certain patients (long life expectancy, female, young, etc.). In the center where the authors work the flap of choice is the radial fasciocutaneous or osteofasciocutaneous flap. In surgery of the hypopharynx and larynx reconstruction is normally performed with a grand pectoral myocutaneous flap, sculpted as needed for the individual case. In this region, reconstruction proves functionally satisfactory even when there is a minimum of residual mucosa. Finally, for reconstructive surgery of the apex, the omentum free flap was used as it is malleable and can be used to reconstruct broad areas of dissection. The esthetic and functional results, the low incidence of complications and the greater quality of life suggest that this type of flap be extended to the surgery of locally advanced tumors in combination with an accurate, valid reconstructive solution.

Adult↗

PubMedDate not supplied

Covalently bound lipids in reconstructed human epithelia.

The composition of free and covalently bound lipids in reconstructed epithelia generated with normal human keratinocytes, HaCaT cells and squamous carcinoma cells was investigated and compared with native skin. Stratum corneum isolated from native human and reconstructed epidermis was subjected to extensive extraction with chloroform-methanol mixtures followed by alkaline hydrolysis to release covalently bound lipids. High-performance thin layer chromatography was used for analysis of solvent-extractable and non-extractable lipids and gas liquid chromatography was performed to assess the fatty acid profile in extractable lipids. In both native and reconstructed tissue covalently bound lipids consisted of omega-hydroxyceramides, omega-hydroxyacids and free fatty acids. Small amounts of omega-hydroxyacids could already be detected in solvent-extractable fractions. omega-Hydroxyceramides consisted of Ceramide A, Ceramide B and a small fraction of unknown ceramides with intermediate polarity. The relative proportions of individual omega-hydroxyceramides were similar in both native and reconstructed stratum corneum. In contrast, differences were found in profiles of both solvent-extractable and non-extractable lipids isolated from epithelia reconstructed with transformed cell lines (HaCaT, SCC-12F2 and SCC-13 cells). Compared with native or reconstructed epidermis, in epithelia reconstructed with transformed cell lines the ceramide content was low, the most polar ceramides were missing and the content of free fatty acids was low. The same holds true for covalently bound lipids that were virtually absent in these epithelia. Marked similarities were demonstrated in the overall lipid composition of free and bound stratum corneum lipids in native epidermis and in epidermis reconstructed with normal human keratinocytes. The observed imbalance in fatty acid profile may account for differences in phase behaviour of stratum corneum lipids.

Cells, Cultured↗

PubMed1998

Three-dimensional reconstruction of electron beam computed tomography angiography for evaluating coronary artery bypass grafts.

OBJECTIVES: To probe into electron beam computed tomography (EBCT) angiography and 3-D reconstruction of coronary artery bypass grafts (CABG) and to evaluate the clinical application of EBCT angiography and 3-D reconstruction of CABG. METHODS: EBCT angiography with 3-D reconstruction was achieved in 150 patients (142 men and 8 women, mean age, 57 +/- 8 years) with 399 grafts including 100 internal mammary artery grafts (IMG), 296 saphenous vein grafts(SVG) and 3 radial artery grafts (RAG) respectively. The time from bypass surgery to EBCT scanning ranged from 7 days to 120 months, averaging 15 +/- 28 months. Enhanced single slice mode (SSM) and flow studies were performed in all patients. The results of 3-D reconstruction of CABG were compared with bypass operation records and with coronary arteriograms (7 patients). RESULTS: 150 patients underwent successfully EBCT angiography and CABG 3-D reconstruction. According to 3-D reconstruction of the coronary bypass grafts with flow studies, 318 of 399 coronary bypass grafts were patent including IMG patency in 87/100 (87%), SVG in 228/296 (77%) and RAG in 3/3 (100/100). The overall patent rate was 79.7%. In 7 patients with 12 coronary bypass grafts, EBCT studies showed graft patency (7 grafts) and occlusion (5), which were confirmed by conventional graft angiography. CONCLUSIONS: EBCT angiography with 3-D reconstruction is effective in providing the entire anatomic structure of coronary bypass grafts and evaluating coronary bypass graft patency. EBCT flow study can provide quantitative data for evaluating coronary bypass graft patency and for supplemental diagnosis of CABG 3-D reconstruction. EBCT angiography is a noninvasive technique that could replace conventional coronary arteriography for follow-up survey of coronary bypass surgery in future.

Adult↗

PubMed2001

Results of preputial reconstruction in 77 boys with distal hypospadias.

PURPOSE: There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. MATERIALS AND METHODS: We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures. RESULTS: At a mean followup of 2.5 years 52 patients had an anatomically normal penis with a normal retractable foreskin, while 25 (33%) presented with a complication. The most common complications were partial dehiscence, and fistula of the prepuce and urethra. There was a complication of the reconstructed foreskin only in 16 cases (21%), a combined problem with the reconstructed foreskin and reconstructed urethra in 7 (9%), and a problem with the reconstructed urethra in 2 (3%). Of the 25 patients with complications 19 underwent reoperation with closure of the fistula or dehiscence and 5 were circumcised, while in 1 the parents accepted the minor cosmetic problem and refused reoperation. CONCLUSIONS: Preputial repair combined with hypospadias repair may lead to anatomically correct reconstruction of the penis at the cost of a 33% complication rate. Parents are informed about this risk and to date in 15% of all boys with distal hypospadias the parents have elected preputial reconstruction.

Child↗