the place of belsey mark iv fundoplication in the era of laparoscopic surgery

Objectives: Laparoscopic fundoplication to correct or avoid gastroesophageal reflux decreased Belsey Mark IV fundoplication (BMIV) dramatically worldwide. The purpose of this paper was to determine the role of BMIV and its current indications. Methods: We reviewed all patients who underwent fundoplication between April 1997 and December 2001. All patients underwent a complete work-up included barium meal, endoscopy, 24-h pH-metry and manometry preoperatively. Results: Sixty-two consecutive fundoplications were performed. There were 23 males and 39 females. Forty-six patients were treated by laparoscopic approach (37 patients with total and nine patients with partial fundoplication). BMIV was preferred in 16 patients with the following indications: reoperations for failed oesophageal surgery (5), hiatal hernia fixed in the chest (4), epiphrenic oesophageal diverticula (3), diffuse oesophageal spam (2), hiatal hernia associated with bullous emphysema (1), leiomyoma of the oesophago ‐ gastric junction (1). Excellent to good results were reported in 14 patients and poor in two. Follow-up was completed in all patients. Conclusions: BMIV remains a valid fundoplication although the current indications are now limited. The technique is to be considered an additional, but necessary, weapon for thoracic surgeons with interest in oesophageal disease. q 2003 Elsevier B.V. All rights reserved

Sex-based comparison of trunk flexors and extensors functional and contractile characteristics in young gymnasts

Purpose. Gymnastics is a sport characterized by acrobatic and postural strength exercises that require great trunk muscles activation and control. Males and females can be characterized by different morphological and neuromuscular characteristics of such muscles, and this might be of importance for training and injury prevention. The aim of this study was to measure different aspects of trunk flexors and extensors characteristics in a sample of young female and male gymnasts. Methods. Twenty-eight sub-elite adolescent female (n = 14, 16 y, 14-17) and male (n = 14, 17 y, 14-18) gymnasts participated in this cross-sectional study. Tensiomyography was used to assess muscle contractile properties of the rectus abdominis (m.RA) and erector spinae (m.ES), while muscle thickness was assessed for abdominal muscles and lumbar multifidus (m.LM) with ultrasound. Flexors, extensors, and lateral endurance tests were performed. Results. Females presented smaller m.ES radial displacement (p < 0.001, p & eta;(2) = 0.535), smaller internal oblique thickness (p < 0.001, p & eta;(2) = 0.543), and shorter lateral endurance (p = 0.002, p & eta;(2) = 0.302). A significant side x sex interaction was found for the external oblique thickness (p = 0.004, p & eta;(2) = 0.276). Conclusion. Present findings report sex-based differences in abdominal and lumbar muscles characteristics and support the development of different sex-based training and rehabilitation protocols in adolescent gymnasts

Open issues in mucopolysaccharidosis type I-hurler

Mucopolysaccharidosis I-Hurler (MPS I-H) is the most severe form of a metabolic genetic disease caused by mutations of IDUA gene encoding the lysosomal α-L-iduronidase enzyme. MPS I-H is a rare, life-threatening disease, evolving in multisystem morbidity including progressive neurological disease, upper airway obstruction, skeletal deformity and cardiomyopathy. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the gold standard for the treatment of MPS I-H in patients diagnosed and treated before 2-2.5 years of age, having a high rate of success. Beyond the child's age, other factors influence the probability of treatment success, including the selection of patients, of graft source and the donor type employed. Enzyme replacement therapy (ERT) with human recombinant laronidase has also been demonstrated to be effective in ameliorating the clinical conditions of pre-transplant MPS I-H patients and in improving HSCT outcome, by peri-transplant co-administration. Nevertheless the long-term clinical outcome even after successful HSCT varies considerably, with a persisting residual disease burden. Other strategies must then be considered to improve the outcome of these patients: one is to pursue early pre-symptomatic diagnosis through newborn screening and another one is the identification of novel treatments. In this perspective, even though newborn screening can be envisaged as a future attractive perspective, presently the best path to be pursued embraces an improved awareness of signs and symptoms of the disorder by primary care providers and pediatricians, in order for the patients' timely referral to a qualified reference center. Furthermore, sensitive new biochemical markers must be identified to better define the clinical severity of the disease at birth, to support clinical judgement during the follow-up and to compare the effects of the different therapies. A prolonged neuropsychological follow-up of post-transplant cognitive development of children and residual disease burden is needed. In this perspective, the reference center must guarantee a multidisciplinary follow-up with an expert team. Diagnostic and interventional protocols of reference centers should be standardized whenever possible to allow comparison of clinical data and evaluation of results. This review will focus on all these critical issues related to the management of MPS I-H

Adeno-associated viral vector-mediated human vascular endothelial growth factor gene transfer stimulates angiogenesis and wound healing in the genetically diabetic mouse

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EP-1176: Three years of VMAT patient quality assurance with the PTW seven29 ionization chamber array and Octavius phantom

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Discovery of the first potent and selective Mycobacterium tuberculosis Zmp1 inhibitor

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Epid-based in\ua0vivo dose verification for lung stereotactic treatments delivered with multiple breath-hold segmented volumetric modulated arc therapy

We evaluated an EPID-based in-vivo dosimetry (IVD) method for the dose verification and the treatment reproducibility of lung SBRT-VMAT treatments in clinical routine. Ten patients with lung metastases treated with Elekta VMAT technique were enrolled. All patients were irradiated in five consecutive fractions, with total doses of 50 Gy. Set-up was carried out with the Elekta stereotactic body frame. Eight patients were simulated and treated using the Active Breath Control (ABC) system, a spirometer enabling patients to maintain a breath-hold at a predetermined lung volume. Two patients were simulated and treated in free-breathing using an abdominal compressor. IVD was performed using the SOFTDISO software. IVD tests were evaluated by means of (a) ratio R between daily in-vivo isocenter dose and planned dose and (b) gamma-analysis between EPID integral portal images in terms of percentage of points with gamma-value smaller than one (gamma(%)) and mean gamma-values (gamma(mean)) using a 3%(global)/3 mm criteria. Alert criteria of +/- 5% for R ratio, gamma(%) &lt; 90%, and gamma(mean) &gt; 0.67 were chosen. 50 transit EPID images were acquired. For the patients treated with ABC spirometer, the results reported a high level of accuracy in dose delivery with 100% of tests within +/- 5%. The gamma-analysis showed a mean value of gamma(mean) equal to 0.21 (range: 0.04-0.56) and a mean gamma(%) equal to 96.9 (range: 78-100). Relevant discrepancies were observed only for the two patients treated without ABC, mainly due to a blurring dose effect due to residual respiratory motion. Our method provided a fast and accurate procedure in clinical routine for verifying delivered dose as well as for detecting errors