In this study, NIR laparoscopy with ICG mapping allowed ready and rapid confirmation of mesocolic lymphatic drainage patterns and sentinel node identification. With further validation, this technology and technique promises precise, tailored resection surgery by indicating basin pattern and status in advance of radical lymphadenectomy.

Of 16 postpubertal patients evaluated following testicular torsion 9 were treated with detorsion and bilateral orchiopexy (detorsion group), and 7 were treated with ipsilateral orchiectomy and contralateral orchiopexy (orchiectomy group). Each patient was evaluated with regard to semen quality, endocrine parameters (follicle-stimulating hormone, luteinizing hormone and testosterone) and the presence or absence of semen antisperm antibodies. These data were compared to similar data from a group of proved fertile semen donors. The semen quality in the detorsion group did not differ significantly from that of controls (p = 0.25) but follicle-stimulating hormone was significantly elevated compared with that of controls before and after stimulation with gonadotropin-releasing hormone. The orchiectomy group, which had been subjected to prolonged torsion (mean 69 hours), demonstrated a significant decrease in semen quality compared with semen quality in controls (p = 0.001), with average sperm density of only 29.0 million per ml. Baseline and post-stimulation levels of follicle-stimulating hormone in the orchiectomy group were also significantly abnormal when compared with those in controls and in the detorsion group. Our study demonstrates that testicular damage (changes in semen quality and/or endocrine parameters) occurs in the ipsilateral and contralateral testis following torsion, regardless of treatment modality. However, with early intervention by detorsion and testicular salvage, subsequent semen quality is likely to remain within normal limits. Late surgical intervention, even with removal of the nonviable testes, may result in significant impairment of semen quality.

BackgroundBileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients.MethodsWe included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B).ResultsIn the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04).ConclusionsMV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

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Anderson and Johnson 241 1 443. Preparation and Reuctions of Xome Derivatives of Axepine By M. ANDERSON and A. W. JOHNSONThe solvolysis of the esters of 4-chloromethyl-1,4-dihydro-2,6-dimethylpyridine-3,5-dicarboxylic acid with sodium ethoxide causes ring expansion with the formation of the 4-ethoxy-4,5-dihydro-2,7-dimethylazepine-3,6-dicarboxylic esters (11; R' = OEt). These compounds lose ethanol readily and form derivatives of the 4H-azepine ring system (V) which, on heating, tautomerise to the 3H-azepine esters (VIII). Several reactions of these compounds are described including their reconversion to the original dihydropyridines, and base-catalysed ring opening reactions to give pyrrolic derivatives. Hydrogenation of the 4H-azepines yields the 4,5-dihydro-1H-azepines in the first place and then the perhydroazepines. The dihydroazepines also undergo ring-opening reactions to give a series of open-chain compounds and finally, by cyclisation, l-acetyl-2-methylcyclopent-1-ene.

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