Type A aortic dissection model to improve endovascular research and technologies.

OBJECTIVE Type A aortic dissection is a life-threatening disease requiring immediate surgical treatment. With emerging catheter-based technologies, endovascular stent-graft implantation to treat aneurysms and dissections has become a standardized procedure. However, endovascular treatment of the ascending aorta remains challenging. Thus we designed an ascending aortic dissection model to allow simulation of endovascular treatment. METHODS Five formalin-fixed human aortas were prepared. The ascending aorta was opened semicircularly in the middle portion and the medial layer was separated from the intima. The intimal tube was readapted using running monofilament sutures. The preparations were assessed by 128-slice computed tomography. A bare-metal stent was implanted for thoracic endovascular aortic repair in 4 of the aortic dissection models. RESULTS Separation of the intimal and medial layer of the aorta was considered to be sufficient because computed tomography showed a clear image of the dissection membrane in each aorta. The dissection was located 3.9 ± 1.4 cm proximally from the aortic annulus, with a length of 4.6 ± 0.9 cm. Before stent implantation, the mean distance from the intimal flap to the aortic wall was measured as 0.63 ± 0.163 cm in the ascending aorta. After stent implantation, this distance decreased to 0.26 ± 0.12 cm. CONCLUSION This model of aortic dissection of the ascending human aorta was reproducible with a comparable pathological and morphological appearance. The technique and model can be used to evaluate new stent-graft technologies to treat type A dissection and facilitate training for surgeons.

Effect of locally increased zinc contents on zinc transport from the flag leaf lamina to the maturing grains of wheat

From previous experiments, it was evident that the accumulation of zinc in maturing wheat grains is highly regulated, but the regulatory mechanisms involved are not yet identified. In this study, we determined the transfer of radiolabelled zinc (fed directly into a leaf flap) from the flag leaf lamina to the grains. We also determined how this zinc transfer was affected by feeding additional unlabeled zinc (1 μmol per plant) either into the flag leaf sheath or the peduncle. Most of the 65Zn was retained in the feeding flap. A high percentage of the zinc exported from the flap accumulated in the grains with little accumulation of radiolabel in the other parts of the shoot. Unlabeled zinc remained mainly in the feeding flap and in the parts reached by the transpiration stream from the feeding position. The transfer of radiolabelled zinc was essentially not influenced by unlabeled zinc fed into another plant part. Our results suggest that the loading of zinc into the phloem and the mass flow in the sieve tubes might regulate zinc redistribution within the wheat shoot.

No third path /

"Jacket design by Ronald Fratell" -- Rear flap of dust jacket.

[Calligraphic specimen, 1205?, i.e. 1790 or 1791?].

Exquisite album of calligraphy (muraqqaʻ or murakkaa) with design for a monumental inscription to appear in stone on a commemorative range marker (menzil taşı) of Bilâl Ağa (d.1807?), likely executed by Yesari Mehmed Esad Efendi (d.1798), the great Ottoman master of nastaʻlīq (talik).

[Calligraphic specimen, 1206, i.e. 1791 or 1792].

Exquisite album of calligraphy (muraqqaʻ / murakkaa) employing ḥadīth of the Prophet executed by the celebrated Ottoman calligrapher Mahmud Celâleddin Efendi (d.1829) in imitation of a model executed by the master calligrapher Hafız Osman Efendi (d.1698).

[Calligraphic specimen, early to mid 18th century].

Exquisite album of calligraphy (muraqqaʻ or murakkaa) comprising kıt'alar employing ḥadīth of the Prophet executed by the celebrated Ottoman calligrapher Eğrikapılı Mehmet Râsim Efendi (d.1756), renowned student of Seyyid Abdullah of Yedikule (d.1731).

Europe's children, 1939 to 1943 /

"Limited autographed edition"--back flap.

[al-Kawākib al-durrīyah fī madḥ khayr al-barīyah, 16th century?].

Fine copy of al-Būṣīrī's poem in praise of the Prophet accompanied by elucidation in Persian and Turkish.

Naẓm al-Jamīʻ al-ṣaghīr, [late 15th century?].

Fine copy of Abū Naṣr al-Farāḥī's (d.1242) versification of al-Jamīʻ al-ṣaghīr fī al-furūʻ, the well-known legal treatise by Muḥammad ibn al-Ḥasan al-Shaybānī (d.804). Excerpts from Kashf al-ẓunūn addressing these two works appear on leaf affixed to 'title page' (p.5).

Parnassus on wheels /

Mode of access: Internet.

al-Asmāʼ al-ḥusná mustakhrajah min al-Qurʼān al-ʻaẓīm wa-Kitāb al-Ṭibb al-nabawī, [15th century?].

A work on prophetic medicine (or the Prophet's medicine) by al-Maqdisī (d.1245) preceded by a short treatise of uncertain authorship on the beautiful names of God.

Nazm-ı Dilârâ, [1231, i.e. 1815 or 1816].

Elegant autograph copy of the versified Persian-Turkish glossary of the müderris Osman Şakir (whose name appears in Īḍāḥ al-maknūn as ʻUthmān Shukrī, d.1818?). Apparently inspired by the popular Tuhfe-yi Vehbî (used for many years in Ottoman schools) of Sünbülzâde Vehbi Mehmet Efendi (d.1809), see opening matter on p.5-15.

Hāẕā Kitāb-i Khvājah Ḥāfiẓ-i Shīrāzī, [1280, i.e. 1863 or 1864].

Richly elegant copy of the Dīvān of the masterful poet Ḥāfiẓ (Khvājah Shams al-Dīn Muḥammad Shīrāzī, d.1390?).

The treatment of pterygium

The treatment of pterygium is still quite controversial, with various treatments being advocated in the scientific literature. Unfortunately, there are very few well-conducted controlled clinical trials of treatments. However, years of anecdotal and noncontrolled studies have confirmed that some methods, such as bare scleral closure, are no longer acceptable in the treatment of pterygium and that other methods are likely to be more useful. In the future it will be important to develop a grading system, and surgeons will need to be conservative in the treatment of pterygium until such time as a single treatment provides a lower recurrence rate and complication rate.

Parotidectomy: review of treatment and outcomes

Background: Parotidectomy is a common surgical procedure performed for a wide array of benign and malignant tumours. The aim of the present study was to review a single-institution experience with parotidectomy over a 10 year period. Methods: We retrospectively reviewed 170 patients who had parotidectomy performed. The preoperative investigations, clinicopathological parameters, perioperative morbidity and mortality were assessed. Results: One hundred and six (62%) of the patients were men. The mean age was 54 years (range 21-80). Indications for parotidectomy included benign tumour (44%), malignant tumour (42%), inflammatory parotid disease (7%) and miscellaneous (5%). The most common benign tumour was pleomorphic adenoma (25%). The most common malignant tumour was metastatic cutaneous squamous cell carcinoma (SCC) (19%). Fine needle aspiration cytology was performed in 83% patients with a sensitivity and specificity for benign tumours of 76% and 97%, respectively. The sensitivity and specificity for malignant tumours was 90% and 99%, respectively. One (0.6%) patient died in the postoperative period. Postoperative complications included wound infection (2.3%), wound haematoma (3.5%) and seroma (6.6%). Six patients (3.5%) developed temporary complete facial paresis, while 33 patients (20%) developed temporary partial facial palsy in the immediate postoperative period. The 2-year disease-free and disease-specific survival for those patients with metastatic cutaneous SCC were 75% and 76%, respectively. Conclusions: The most common indications for parotidectomy were pleomorphic adenoma and metastatic cutaneous SCC. Our perioperative morbidity and survival for patients with malignant parotid disease compare favourably with other institutional series.