Aortopexy for tracheomalacia via a suprasternal incision

Aim

Tracheomalacia is flaccidity of the tracheal wall leading to tracheal collapse, particularly on expiration. When severe it can warrant surgical intervention. Aortopexy is one surgical option and has been described using a variety of approaches. We report outcomes of aortopexy performed via a suprasternal incision in a single centre by a single surgeon.

Short-acting beta-adrenergic blockade and the fetus. A case report.

An infant was born to a woman who received intravenous esmolol for intrapartum supraventricular tachyarrhythmia. Despite the very short acting and cardio-selective beta-1 adrenergic blockade induced by that agent, neonatal effects can occur up to 48 hours after delivery.     

Osteonecrosis of the jaws associated with use of risedronate: report of 2 new cases.

Use of various bisphosphonates has been associated with the development of osteonecrosis of the jaws (ONJ). At least 865 cases of ONJ attributed to these agents have been reported in the English-language literature. Approximately 96% of these published cases were seen with administration of the intravenous agents pamidronate and zoledronate, whereas only 26 cases have been associated with oral bisphosphonates, 25 of them with alendronate. Only a single case of ONJ associated with the oral bisphosphonate risedronate has been previously cited. We report 2 cases of ONJ attributed to risedronate administration. The patients developed osteonecrosis 15 and 24 months after treatment for osteopenia. A regimen of antibiotics and chlorhexidine mouthrinse resolved the osseous defect in the mandible caused by complete exfoliation of a lingual torus in 1 patient. The other patient required sequestrectomy, repeated courses of antibiotics, surgical debridement, and steroids to promote closure of an oroantral fistula and management of sinusitis after bone grafting and implant placement in the posterior maxilla. A demographic profile of reported oral bisphosphonate users affected by ONJ is also provided. With the millions of patients receiving various oral bisphosphonates for osteopenia and osteoporosis, health care practitioners should be aware of the potential for the onset of osteonecrosis and familiar with its management.     

Epidemic outbreaks control involving Staphylococcus aureus with reduced sensitivity to glycopeptides

This study describes two epidemic outbreaks involving Staphylococcus aureus with reduced sensitivity to glycopeptides, one in 2000 involving eight patients and the other in 2001-2002 involving 16 patients. These strains were detected rapidly, thanks to routine screening for the offending organisms in the bacteriology laboratory of our hospital. The clonal character of these strains was confirmed by pulsed field electrophoresis. The management of these epidemic outbreaks confirmed (i) the need for systematic adoption of standard precautions, (ii) the importance of circulating information in combating multi-resistant bacteria, as well as the difficulties in transferring colonised patients to different hospital wards, and (iii) the intermittent nature of S. aureus carriage, resulting in a need for prolonged surveillance of colonised and/or infected patients. In addition, our study underlines the value of a multi-disciplinary approach to the management of diffusion of multi-resistant bacteria.     

Does the amount of exercising muscle alter the aerobic demand of dynamic exercise?

The primary purpose of this study was to determine if the aerobic demand for production of specified power outputs is altered by distribution of work between the arms and legs compared with when all the work is performed by the legs. Because of the important exercise training implications, a secondary purpose of this study was to determine if the exercising muscle mass affects the cardiorespiratory demands at specified rating of perceived exertion (RPE) levels and blood lactate concentrations. Nine healthy adults completed leg cycling and combined arm and leg exercise on an Airdyne using a discontinuous protocol. Repeated measures ANOVA revealed that oxygen uptake for the combined arm and leg exercise averaged 0.04 l·min⁻¹ greater (p<0.05) than for leg cycling at the same external power outputs. However, RPE levels at specified power outputs were lower (p<0.05) with combined arm and leg exercise than leg cycling. At specified RPE levels and blood lactate concentrations, oxygen uptake and heart rate values were higher (p<0.05) for combined arm and leg exercise than leg cycling. From these findings we conclude that: (1) the addition of arm exercise to leg cycling results in a reduction in RPE, but a minimal increase in oxygen consumption to perform a given power output, and (2) if training intensity is established by RPE or blood lactate concentration, use of a muscle mass larger than that used in leg cycling should allow a greater cardiorespiratory training effect.     

Differential expression of stem cell mobilization-associated molecules on multi-lineage cells from adipose tissue and bone marrow

Our laboratory has characterized a population of stromal cells obtained from adipose tissue termed processed lipoaspirate cells (PLAs). PLAs, like bone-marrow derived mesenchymal stem cells (BM-MSCs), have the capacity to differentiate along the adipogenic, osteogenic, chondrogenic, and myogenic lineages, In order to better characterize these two multi-lineage populations, we examined the surface phenotype of both bone marrow and adipose tissue-derived cells from five patients undergoing surgery. PLA and BM-MSC cells were isolated, subcultivated, and evaluated for cell surface marker expression using flow cytometry. PLA and BM-MSC cells both expressed CD13, CD29, CD44, CD90, CD105, SH-3, and STRO-1. Differences in expression were noted for cell adhesion molecules CD49d (Integrin alpha4), CD54 (ICAM-1), CD34, and CD106 (VCAM-1). While markedly similar, the surface phenotypes of PLA and BM-MSC cells are distinct for several cell adhesion molecules implicated in hematopoietic stem cell homing, mobilization, and proliferation.     

Synthesis and characterization of polyanhydride for local BCNU delivery carriers

p-Carboxyphenoxy propane (CPP) prepolymer consisting of 4 units and sebacic acid (SA) prepolymer consisting of about 10 units were synthesized by reacting CPP and SA in the presence of excess acetic anhydride, respectively. Polyanhydride, poly(CPP-SA) copolymers were copolymerized by a melt polycondensation process with a mixture of CPP and SA prepolymer. Copolymers of average molecular weight up to 110,000 g/mol were achieved. The crystallinity of poly(CPP-SA) copolymers was decreased by the addition of the CPP homopolymer segment to SA homopolymer. Poly(CPP-SA) copolymers gradually degraded for period of 10 days. No large difference of weight loss observed according to molecular weight variation of poly(CPP-SA) copolymers. BCNU release from wafers fabricated by poly(CPP-SA) showed a sustained release pattern with no initial burst and delay of drug release.     

Characterization of degradation behavior for PLGA in various pH condition by simple liquid chromatography method

The aim of this study was to detect the amount of lactic acid (LA) and glycolic acid (GA) in poly(D,L-lactide-co-glycolide) (PLGA) by development a simple HPLC method and to determine the pH of media, which can influence on degradation of PLGA and drug release. Analysis of in vitro degradation behavior of PLGA with two different molecular weights as 8000 and 33,000 g/mol were performed in various media conditions (pH 3.0, 5.0, 7.0, and 9.0 of PBS and distilled water (approx. pH 5.8)). Also, effect of some additives on PLGA degradation was also investigated in pH 7.0 of PBS. GA and LA were easily detected by a simple HPLC method (retention time: 6.5 min and 10.2 min, respectively). The result showed that GA was released larger amount than that of LA considering the initial sample weight of polymers, due to the higher hydrophilic property. In the lower pH of media conditions, the PLGA was faster degraded generally. The presence of various additives, moreover, affected decrease of pH and slight acceleration of LA and GA detection.