Reply to “Ultrasonographic evaluation of costal cartilage for microtia reconstruction surgery"

Men’s circumcision is in many countries considered as a hygienic-cosmetic or aesthetic treatment. However, it still remains in close connection with religious rites (Judaism, Islam) and is still practiced all over the world. During the Second World War the visible effects of circumcision became an indisputable evidence of being a Jew and were often used especially by the so-called szmalcownicy (blackmailers). Fear of the possibility of discovering as non-Aryan prompted many Jews hiding on the so-called Aryan side of Warsaw to seek medical practitioners who would restore the condition as it was before the circumcision. The reconstruction surgery was called in surgical jargon “knife baptizing”. Almost all of the procedures were performed by Aryan doctors although four cases of hiding Jewish doctors participating in such procedures are known. Surgical technique consisted of the surgical formation of a new foreskin after tissue preparation and stretching it by manual treatment. The success of the repair operation depended on the patient’s cooperation with the doctor, the worst result was in children. The physicians described in the article and the operating technique are probably only a fragment of a broader activity, described meticulously by only one of the doctors – Dr. Janusz Skórski. This work is an attempt to describe the phenomenon based on the very scanty source material, but it seems to be the first such attempt for several decades.

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GROWTH HORMONE AND RADIO-SULFATE INCORPORATION IN COSTAL CARTILAGE

Acta Endocrinologica ◽

10.1530/acta.0.0370176 ◽

1961 ◽

Vol 37 (2) ◽

pp. 176-182 ◽

Cited By ~ 4

Author(s):

Elliott J. Collins ◽

Vernon F. Baker

Keyword(s):

Growth Hormone ◽

Costal Cartilage ◽

Time Response ◽

Hormone Activity ◽

Reliable Estimation ◽

Hypophysectomized Rats ◽

Related Response ◽

Sulfate Incorporation

ABSTRACT The characteristics and nature of the effect of growth hormone on the incorporation of radio-sulfate into the costal cartilage of hypophysectomized rats has been studied. The time-response studies indicate that a reliable estimation of growth hormone activity can be ascertained within a 24 hour period, and a reproducible dose-related response can be obtained at dosage levels ranging from 12-48 μg. Growth hormone stimulates the synthesis of organic sulfates and accumulation of inorganic sulfates within 48 hours.

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Decreases in ovine fetal cartilage sulfate uptake and serum sulfate during gestation

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1985.249.1.e115 ◽

1985 ◽

Vol 249 (1) ◽

pp. E115-E120

Author(s):

F. H. Morriss ◽

R. N. Marshall ◽

S. S. Crandell ◽

B. J. Fitzgerald ◽

L. Riddle

Keyword(s):

Human Serum ◽

Costal Cartilage ◽

Full Term ◽

Late Gestation ◽

In Vitro Assays ◽

Sulfate Uptake ◽

Fetal Sheep ◽

Ovine Fetal ◽

Serum Sulfate

In vitro assays for [35S]sulfate uptake by ovine fetal costal cartilage were used to assess gestational changes in cartilage metabolism. Addition of 20% normal human serum to the incubation medium increased fetal cartilage [35S]sulfate incorporation into glycosaminoglycans. Both basal and human serum-stimulated uptakes of [35S]sulfate by fetal sheep cartilage decreased from midgestation to full term. The incremental response in [35S]sulfate uptake that was stimulated by human serum decreased as gestation proceeded to full-term. Fetal serum sulfate concentration decreased logarithmically during gestation, raising the possibility that cartilage sulfate uptake might become substrate limited as full term is approached. Perfusion of seven late gestation sheep fetuses for 7 days with Na2SO4 to achieve serum sulfate concentrations similar to those observed earlier in gestation resulted in a 33% increase in mean cartilage [35S]sulfate uptake compared with that of control twin fetuses, but uptake was not increased to values that occurred spontaneously earlier in gestation. These results suggest that the decreasing rate of [35S]sulfate uptake by fetal cartilage during the last half of gestation is associated only minimally with decreasing serum sulfate levels and is most consistent with intrinsic change in resting chondrocyte metabolism during gestation.

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Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987426 ◽

2021 ◽

pp. 000348942098742

Author(s):

Stephen R. Chorney ◽

Joanne Stow ◽

Luv R. Javia ◽

Karen B. Zur ◽

Ian N. Jacobs ◽

...

Keyword(s):

Costal Cartilage ◽

Case Series ◽

Primary Objective ◽

Multivariable Logistic Regression Analysis ◽

Pediatric Airway ◽

Surgical Closure ◽

Laryngotracheal Reconstruction ◽

Airway Reconstruction ◽

Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

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Ossicular chain reconstruction: endoscopic or microscopic?

The Journal of Laryngology & Otology ◽

10.1017/s0022215120002728 ◽

2021 ◽

pp. 1-7

Author(s):

E A Guneri ◽

A Cakir Cetin

Keyword(s):

Word Recognition ◽

Middle Ear ◽

Risk Index ◽

Ossicular Chain ◽

Recognition Score ◽

Reconstruction Surgery ◽

Ossicular Chain Reconstruction ◽

Operation Duration ◽

Air Conduction

Abstract Objective To compare the results of endoscopic and microscopic ossicular chain reconstruction surgery. Methods Patients undergoing ossicular chain reconstruction surgery via an endoscopic (n = 31) or microscopic (n = 34) technique were analysed for age, gender, Middle Ear Risk Index, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air conduction threshold, air–bone gap, air–bone gap gain, word recognition score, mean operation duration and mean post-operative follow up. Results Post-operative air conduction, air–bone gap and word recognition score improved significantly in both groups (within-subject p < 0.001 for air conduction and air–bone gap, and 0.026 for word recognition score); differences between groups were not significant (between-subject p = 0.192 for air conduction, 0.102 for air–bone gap, and 0.709 for word recognition score). Other parameters were similar between groups, except for incision type. However, endoscopic ossicular chain reconstruction surgery was associated with a significantly shorter operation duration (p < 0.001). Conclusion Endoscopic ossicular chain reconstruction surgery can achieve comparable surgical and audiological outcomes to those of microscopic ossicular chain reconstruction surgery in a shorter time.

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Geometric Analysis of the Bilobed Flap for Nasal Reconstruction Surgery

FACE ◽

10.1177/2732501621993908 ◽

2021 ◽

pp. 273250162199390

Author(s):

Daniel Henick ◽

Kelvin K. Ampem-Darko ◽

Farah Sayegh ◽

Paymon Sanati-Mezrahi ◽

Mehul Bhatt ◽

...

Keyword(s):

Geometric Analysis ◽

Nasal Reconstruction ◽

Anatomical Features ◽

Reconstruction Surgery ◽

Repair Technique ◽

Bilobed Flap ◽

Calculated Ratio ◽

Flap Design ◽

Objectively Measured ◽

Angle Of Rotation

Background: Reconstruction of the nose can be difficult due to its complex anatomical features. In 1989, Zitelli described a modified version of the bilobed flap design technique using 45° and 90° angles to improve nasal reconstructions. While the bilobed flap is still frequently referenced in scholarly literature, there seems to be inconsistency in preoperative flap design; these deviations can lead to suboptimal outcomes. The authors aim to illustrate the variability in bilobed flap execution and provide guidelines in preoperative design to improve consistency. Methods: A geometrically-based approach was used to characterize the inconsistency of bilobed repair technique. The pre-operative design images from fifteen scholarly articles were analyzed via a series of measurements and computations to quantify the angle of rotation and dimensions for the primary and secondary lobes. The “Error Quotient” was a calculated ratio that objectively measured the extent to which a bilobed design deviated from Zitelli’s specifications. Results: There was a noticeable variability in the design of both the primary and secondary lobes. Bilobed designs with smaller angles of rotation, particularly of the first lobe, were associated with higher Error Quotients and greater amounts of deviation from Zitelli’s design. Designs with the smallest Error Quotients had a primary lobe rotation that approached 45°. Conclusion: Consistency of application of the bilobed flap should be established to allow for optimal results, particularly with emphasis on design of the primary lobe. This can be accomplished by including a disposable protractor and marker in their sterile kit to measure a 45° rotation.

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