Boris Silberberg

Tissue ferritin concentration in carcinoma of the breast

Ferritin concentration was measured in cytosol extracts of 44 mammary carcinomas and 14 benign breast tissues. A six‐fold difference was observed (mean, 364.6 ± 223.3 ng/mcp in malignant tissue versus mean, 60.2 ± 42.1 ng/mcp in benign tissue P < 0.001). Thirty‐five malignant tissue specimens were reviewed independently by a pathologist without knowledge of their ferritin contents. Higher concentrations of ferritin were present in malignancies with greater degrees of epithelial proliferation and plemorphism suggesting the malignant epithelium as the major site of the increased ferritin. There was no correlation between desmoplastic reaction within the tumors or inflammation within or adjacent to the tumors and ferritin concentration. Ferritin in breast tissue may be important as a marker of neoplasia, a source of elevated serum ferritin, an indicator of clinical prognosis or an immunosuppressive substance.

The use of polyacrylamide gel in soft-tissue augmentation: an experimental assessment.

Background: An increasing number of soft-tissue filler substances that lack experimental and clinical data have been introduced into plastic surgery practice outside the United States. One of these substances is polyacrylamide gel. It contains 2.5% polyacrylamide and 97.5% water. It is homogenous and stable, and has optimum viscosity and elasticity. Methods: One milliliter of polyacrylamide gel was injected into the subcutaneous layer of the right ear in 28 rabbits. The rabbits were divided into two groups, according to when the material was harvested and evaluated. Material was harvested at 4 months in 15 rabbits and 7 months in 13 rabbits. Each group underwent volumetric ultrasound evaluation, magnetic resonance imaging, and histological evaluation with hematoxylin and eosin and CD68 staining. Results: Results were easily observed because of the superficial position of the injected material. There were no systemic or local complications. The samples harvested showed a clear and jelly-like consistency similar to that of the initially injected material. The volume was constant after 6 weeks, after an initial period of acute stretching. Ultrasound volumetric analysis was also constant in all groups. At 7 months, a stable volume of 1.0 ± 0.2 ml was observed. Magnetic resonance imaging scanning showed that the material was stable and that there was no inflammatory reaction. Histological analysis revealed a minimal foreign-body reaction, and the injected material was occasionally surrounded by a thin collagen membrane. The material remained in place. Conclusions: Polyacrylamide gel has a long-lasting effect, with minimal volume variation. It remains soft to the touch and in place.

Tissue ferritin concentration and prognosis in carcinoma of the breast

SummarySeven year follow-up data were available on 36 of 40 breast carcinoma patients in whom breast tissue ferritin concentrations at the time of surgery were known. 18 patients were alive and free of recurrence or second tumor (Group 1) and 11 died with breast cancer (Group 2). Patients with lower tissue ferritin concentrations defined as < 319 ng/mcp (nanograms of ferritin/milligram of cytosol protein) were at reduced risk: 86% of patients with low tissue ferritin concentration survived free of recurrence or second tumor vs. 40% of patients with high tissue ferritin concentration (P = 0.0056). Mean breast carcinoma tissue ferritin concentration was 295 ± 52 ng/mcp in Group 1 and 444 ± 55 ng/mcp in Group 2 (P = 0.036).Lymph node involvement was predictive of mortality from breast carcinoma (P = 0.0003), but did not correlate with mean tissue ferritin concentration (P = 0.082). 10/10 (100%) patients who had both low tissue ferritin concentration and absence of lymph node involvement were in Group 1.The correlation of breast tissue ferritin concentration with histopathologic dedifferentiation and with prognosis suggests tumor tissue ferritin as a marker of malignant potential.

Gangliocytic paraganglioma arising from mature cystic teratoma of the ovary

BACKGROUND Gangliocytic paraganglioma is a rare neoplasm involving the small intestine, stomach, and spinal cord. Ovarian gangliocytic paraganglioma has not been reported in the medical literature. CASE A 55-year-old caucasian woman underwent exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy for evaluation of a persistent right adnexal mass. Microscopic examination of the right ovary revealed a mature cystic teratoma with a mural nodule consistent with gangliocytic paraganglioma. As there was no evidence of significant pleomorphism or neoplastic infiltration, surgical staging was not performed. CONCLUSION Gangliocytic paraganglioma may arise from ovarian cystic teratoma. Although most cases of gangliocytic paragangliomas are benign, surgical staging and retroperitoneal lymphadenectomy may be required if histopathology is suggestive of invasive disease or if enlarged lymph nodes are noted.

Topical gentamicin does not provide any additional anastomotic strength when combined with fibrin glue

BACKGROUND We evaluated the effect of a combination of fibrin sealant and topical gentamicin on a colonic anastomosis in a rat model. METHODS Partial anastomosis in the transverse colon was performed in 70 male Sprague-Dawley rats aged 6 to 10 weeks using 5 interrupted sutures. The rats were divided into 4 groups (control, gentamicin, fibrin glue, and combination). On postoperative days 3 and 5, the rats in each group were killed, anastomotic bursting pressures scores and bowel loop adhesions were determined, and histologic examination was performed. RESULTS No significant difference was noted in the bursting pressures, adhesions, inflammatory infiltrates, fibroblasts, or neoangiogenesis between the fibrin-glue only and the combination groups for both the day 3 and day 5 subgroups. CONCLUSIONS The combination of topical gentamicin and fibrin glue had little effect because the combination did not provide additional anastomotic strength or decrease the number of adhesions when compared with fibrin glue alone.

Easy tissue expansion of prelaminated mucosa-lined flaps for cheek reconstruction in a canine model

In head and neck reconstruction, there is sometimes the need for a skin flap lined with mucosa. The object of this study was to determine whether small pieces of mucosa grafted onto the undersurface of a skin flap can be expanded in a reasonable time to provide the material required to reconstruct a full-thickness cheek defect as a free flap. The study consisted of two phases: prelamination and expansion of the flap, and vascularized free-tissue transfer of the flap. Six adult mongrel dogs were used. First, a 5 x 10-cm flap based on the saphenous vessels was elevated on the lower leg, and then four 1 x 2-cm pieces of mucosa harvested from the tongue were grafted onto the undersurface of the flap. A tissue expander (5 x 10 cm) was then placed under the flap, and the incision was closed primarily. The expanders were initially filled with just enough normal saline to obliterate dead space immediately after surgery. The expansion was continued twice weekly for 3 weeks until sufficient expansion was obtained. Two of six flaps were followed for an additional 6 weeks after the 3-week expansion period to observe whether additional mucosa could be obtained. After measurement of the mucosal area, each flap was transferred as free flap to reconstruct an iatrogenic cheek defect. The increase of mucosal surface area was compared with the original graft, and differences were analyzed using the paired t test. All flaps were successfully expanded without any complications. Histologic evaluation revealed that grafted mucosa took well without evidence of graft necrosis, and the intergraft area was covered with histiocytes. Angiography revealed well-defined vascular structures covering the entire area of the flap. The new mucosal area (23.5 +/- 2.4 cm2) was significantly larger than the original mucosal graft (8.7 +/- 0.9 cm2) (p < 0.001). The net increase of the mucosal area was 172.9 +/- 32.4 percent. The increase of mucosal area in two flaps, following a 6-week consolidation period after 3 weeks of expansion, was only slightly greater (25.9 +/- 1.3 cm2) than those without the consolidation period (22.3 +/- 1.8 cm2). This increase of the mucosal area appears to be related to the amount of expansion, and not to the length of the consolidation period. The flaps were successfully transferred as free flaps to reconstruct the full-thickness cheek defects without major complications. Although a staged operation to allow flaps to mature is needed, the present procedure has the advantages of providing a mucosa-lined flap and allowing primary closure of the donor site. The authors conclude that expansion of this flap has great potential in reconstructive surgery.

Transvesical NOTES: Survival Study in Porcine Model

BACKGROUND AND OBJECTIVES The optimal access route and method for natural orifice transluminal endoscopic surgery (NOTES) has not been established. A transvesical approach, with its low rate of peritoneal contamination, is an effective clean portal of entry, but a safe urinary bladder closure has been a challenge. We developed a new technique for a safe, pure transvesical NOTES approach. METHODS Four female piglets were used in the study. With the pigs under anesthesia, a flexible cystoscope (15Fr) was used to make an endoscopic cystotomy; diagnostic peritoneoscopy of the abdominal quadrants was done with biopsies and hemostasis. At the end, a Vicryl loop was pushed to close the bladder incision while the incision edges were pulled inwards. The pigs were euthanized after 2 wk, and necropsies were performed. RESULTS No bowel injury was noted in any of the 4 pigs. Satisfactory bladder closure was done in 2 pigs, while a partial closure was achieved in 1 case. In the postoperative period, the pigs showed no signs of pain or distress, voided normally, and had a good appetite. On necropsy, we noted healed cystotomy incisions, no intraabdominal adhesions, and no adhesions at the site. CONCLUSION Our new technique for endoscopic cystotomy overcomes previously reported risks for bowel injuries. Using this route gives good spatial orientation and access to all quadrants, including the pelvis. Biopsies with good hemostasis can be easily achieved. Lack of intraperitoneal changes postoperatively indicate that this procedure may be safe for humans.

Protective effect of methylprednisolone on warm ischemia-reperfusion injury in a cholestatic rat liver.

BACKGROUND Cholestasis has been identified as a risk factor for oxidative stress, and it potentially enhances after ischemic-reperfusion injury. The aim of this study was to evaluate the role of methylprednisolone on warm ischemia-reperfusion injury in the presence of cholestasis. METHODS A reversible cholestatic rat model was created. After 7 days, rats received 30 mg/kg of intravenous methylprednisolone 2 hours before ischemia, followed by 30 minutes of ischemia. Rats were euthanized 24 hours after ischemia. Serum aspartate aminotransferase and interleukin-6 were measured, and the liver was harvested for histology and myeloperoxidase estimation. RESULTS Methylprednisolone had a protective effect, with a statistically significant decrease in aspartate aminotransferase (P=.01) and a trend toward decreased levels of interleukin-6 (P=.07). Histology showed a significant difference in architectural distortion (P=.01), cytoplasmic vacuolation (P=.01), and nodular hepatocellular necrosis (P=.04). CONCLUSIONS Methylprednisolone attenuated the ischemic-reperfusion injury in the presence of cholestasis and can be considered for clinical use in the presence of cholestasis.

Comparison of Autologous Platelet-Rich Plasma With Bone Dust Versus Platelet-Rich Plasma Alone and Bone Dust Alone in a Rabbit Model

Introduction: When reconstructing bony defects created secondary to tumor excision or remodeling, there exists a need to increase the rate of bone graft acceptance and the degree of development. In our study we intend to show that platelet-rich plasma can be used in craniofacial defects to increase graft densities. Methods and Materials: Twenty-seven New Zealand white rabbits were used as specimens in which cranial osteotomies were performed to create a critical size defect that was then repaired with several combinations of substances. Either the bone dust from the defect, bone dust plus autologous platelet-rich plasma, or autologous plateletrich plasma alone was placed into the graft site. Each specimen was evaluated by DEXA Scan as well as histologic examination. Results: All 27 specimens survived and remained infection free. Thus, the results showed that the combination of platelet-rich plasma and bone dust allowed for superior bone mineral density and prevention of bone reabsorption.