Henrik Christensen

Perineal repair after extralevator abdominoperineal excision for low rectal cancer.

BACKGROUND: Extralevator abdominoperineal excision for low rectal cancer includes resection of the pelvic floor as a part of the operative technique to reduce the risk of tumor-involved section margins. OBJECTIVE: This study aimed to compare perineal defect reconstruction with a fasciocutaneous gluteal flap vs biological mesh regarding healing and occurrence of perineal hernia. DESIGN: Retrospective review of medical records comparing surgical methods during 2 consecutive periods. SETTINGS: Tertiary care university medical center (Colorectal Section, Surgical Department P, Aarhus University Hospital, Denmark). PATIENTS: Patients with low rectal cancer who underwent extralevator abdominoperineal excision from December 2005 through October 2008 were included. INTERVENTION: The perineum was reconstructed with a fasciocutaneous gluteal flap in the first period and with a biological mesh in the second period. MAIN OUTCOME MEASURES: We assessed rates of perineal wound infection requiring surgical intervention and perineal hernia diagnosed by clinical examination. RESULTS: The study comprised 57 patients: 33 patients with gluteal flap and 24 with biological mesh reconstruction. Perineal hernia developed in 7 (21%) patients in the gluteal flap group and in none (0%) of the patients in the mesh group (P < .01). Median follow-up was 3.2 (1.7–4.3) years for gluteal flap and 1.7 (0.4–2.2) years for biologic mesh. All hernias occurred within the first postoperative year (median, 6 months; range, 1–12 months). Infectious complications were seen in 2 patients (6%) with a gluteal flap and in 4 patients (17%) with mesh repair (P = .26). After 3 months, all patients were completely healed except for 1 patient in each group with a persistent perineal sinus. The median (range) hospital stay was 14 (8–23) days in the flap group and 9 days (6–35) in the mesh group (P < .05). LIMITATIONS: This was a nonrandomized retrospective observational study comparing 2 methods used in different time periods. CONCLUSION: We recommend biological mesh reconstruction of the pelvic floor after extralevator abdominoperineal resection because this method can achieve a high healing rate with an acceptable risk of infection, a low hernia rate, and a shorter hospital stay without donor-site morbidity.

Perovskites as Cathodes for Nitric Oxide Reduction

Using cone shaped electrodes, the electrochemical reduction of nitric oxide and oxygen has been investigated by cyclic voltammetry on an oxygen overstoichiometric (La{sub 0.85}Sr{sub 0.15}MnO{sub 3+{delta}}), and an oxygen stoichiometric (La{sub 0.85}Sr{sub 0.15}CoO{sub 3{minus}{delta}}) perovskite over the temperature range 300--500 C. An oxygen ion-conducting 10% gadolinium-doped cerium oxide is used as electrolyte. It is shown that the reduction of nitric oxide proceeds rapidly on La{sub 0.85}Sr{sub 0.15}MnO{sub 3+{delta}} compared to the oxygen reduction while the oxygen reduction on La{sub 0.85}Sr{sub 0.15}CoO{sub 3{minus}{delta}} is faster than the nitric oxide reduction.

Image and laparoscopic guided interstitial brachytherapy for locally advanced primary or recurrent gynaecological cancer using the adaptive GEC ESTRO target concept

PURPOSE To retrospectively assess treatment outcome of image and laparoscopic guided interstitial pulsed dose rate brachytherapy (PDR-BT) for locally advanced gynaecological cancer using the adaptive GEC ESTRO target concept. MATERIALS AND METHODS Between June 2005 and December 2010, 28 consecutive patients were treated for locally advanced primary vaginal (nine), recurrent endometrial (12) or recurrent cervical cancer (seven) with combined external beam radiotherapy (EBRT) and interstitial PDR-BT. Treatment was initiated with whole pelvic EBRT to a median dose of 45 Gy followed by PDR-BT using the Martinez Universal Perineal Interstitial Template (MUPIT). All implants were virtually preplanned using MRI of the pelvis with a dummy MUPIT in situ. The GEC ESTRO high risk clinical target volume (HR CTV), intermediate risk clinical target volume (IR CTV) and the organs at risk (OAR) were contoured and a preplan for implantation was generated (BrachyVision, Varian). The subsequent implantation was performed under laparoscopic visualisation. Final contouring and treatment planning were done using a post-implant CT. Planning aim of PDR-BT was to deliver 30 Gy in 50 hourly pulses to HR CTV. Manual dose optimisation was performed with the aim of reaching a D90>80 Gy in the HR CTV calculated as the total biologically equivalent to 2 Gy fractions of EBRT and BT (EQD2). Dose to the OAR were evaluated using dose volume constraints for D(2cc) of 90 Gy for bladder and 70 Gy for rectum and sigmoid. RESULTS For HR CTV the median volume was 26 cm(3) (7-91 cm(3)). Coverage of the HR CTV was 97% (90-100%) and D90 was 82 Gy (77-88 Gy). The D(2cc) for bladder, rectum, and sigmoid were 65 Gy (47-81 Gy), 61 Gy (50-77 Gy), and 52 Gy (44-68 Gy), respectively. Median follow up was 18 months (6-61 months). The actuarial 2 years local control rate was 92% (SE 5), while disease-free survival and overall survival were 59% (SE 11) and 74%, respectively (SE 10). No complications to the laparoscopic guided implantation were encountered. Late grade 2 (CTC v 3.0) complications were recorded in nine (32%) patients. One patient had a grade 3 vaginal complication. No grade 4-5 complications have been recorded so far. CONCLUSION Image and laparoscopic guided interstitial PDR-BT using the GEC ESTRO target concept is applicable for locally advanced primary vaginal or recurrent endometrial and cervical cancer resulting in an excellent local control rate and limited morbidity.

Electrochemical reduction of NO and O2 on Cu/CuO

The electrochemical reduction of NO and O2 on a Cu-point electrode covered with a surface layer of CuO is investigated in an electrochemical cell with a gadolinium doped cerium oxide oxygen ion conducting electrolyte in the temperature interval 300–500 ∘C. It is shown that the reduction of NO on CuO is possible at a lower overvoltage than it is in the case of the reduction of O2. The results indicate that the reduction of NO on CuO is not inhibited in the presence of O2 and that the reduction of NO can be selectively performed on a CuO-electrode.

Sexual Dysfunction After Colpectomy and Vaginal Reconstruction With a Vertical Rectus Abdominis Myocutaneous Flap

BACKGROUND: The use of the vertical rectus abdominis myocutaneous flap in reconstruction after abdominoperineal resection or pelvic exenteration for neoplasia is well documented. However, functional outcomes after vaginal reconstruction, including sexual function, are poorly described. OBJECTIVE: This study aimed to examine sexual function in women following extensive pelvic surgery with colpectomy and vaginal reconstruction with the use of a vertical rectus abdominis myocutaneous flap. DESIGN: This study is a retrospective review of medical records in combination with patient questionnaires. Nonresponders were followed up with a second contact. SETTINGS: This study was performed at a tertiary care university medical center (Colorectal Section, Department of Surgery P, Aarhus University Hospital, Denmark) PATIENTS All women undergoing pelvic surgery and simultaneous vaginal reconstruction with the use of a vertical rectus abdominis myocutaneous flap between 2004 and 2010 at our department were identified from a patient database. Thirty women who were alive at the time of identification were included in the study. MAIN OUTCOME MEASURES: Sexual function before and after surgery was evaluated by the use of the Sexual function Vaginal changes Questionnaire. The main outcome end point was whether the patient was sexually active after vaginal reconstruction. RESULTS: Twenty-six participants (87%) answered the questionnaire. Fifty percent of patients reported an active sex life before surgery. In general, patients reported an unchanged desire for both physical and sexual contact after surgery. However, only 2 patients (14%) reported being sexually active after surgery. LIMITATIONS: This was a retrospective study with a heterogeneous cohort involving several types of cancers and surgical procedures. Factors other than vertical rectus abdominis myocutaneous flap reconstruction itself may interfere with the sexual function. CONCLUSION: Extensive pelvic surgery with colpectomy leads to sexual dysfunction even when the vagina is reconstructed with a vertical rectus abdominis myocutaneous flap. This knowledge may improve the quality of information given to this group of patients before surgery.