Lutzomyia longipalpis (Diptera: Psychodidae: Phlebotominae): a review

Lutzomyia longipalpis is the most important vector of AmericanVisceral Leishmaniasis (AVL) due to Leishmania chagasi in the New World. Despite its importance, AVL, a disease primarily of rural areas, has increased its prevalence and became urbanized in some large cities in Brazil and other countries in Latin America. Although the disease is treatable, other control measures include elimination of infected dogs and the use of insecticides to kill the sand flies. A better understanding of vector biology could also account as one more tool for AVL control. A wide variety of papers about L. longipalpis have been published in the recent past years. This review summarizes our current information of this particular sand fly regarding its importance, biology, morphology, pheromones genetics, saliva, gut physiology and parasite interactions.     

Holmium:YAG- und erbium :YAG-infrarotlaser-osteotomie

Zusammenfassung Die knochenablative Wirksamkeit der gepulsten Festkörperlaser Holmium:YAG ( = 2120 nm) and Erbium:YAG ( = 2940 nm) wurde im Tierversuch vergleichend untersucht. Als Modell für eine klinische Anwendung wurden partielle Oberkiefer-, Unterkiefer-und Nasenbeinosteotomien an der Ratte durchgeführt. In einer ersten Versuchsreihe wurden die unmittelbare klinische Wirkung und das histologische Wirkungsprofil dieser Infrarotlaser am Hartgewebe erforscht und die Temperaturgradienten im Knochen während der Laseranwendung gemessen. Die geringe Ausdehnung der Schädigungszone im Randbereich der Laserinzisionen und das für den Erbium:YAG-Laser praktisch atraumatische, athermische Knochenabtragungsvermögen läßt die neuen Infrarotlaser als ideale Schneidegeräte für Osteotomien erscheinen.

---

Holmium:YAG laser and erbium:YAG laser infrared laser osteotomy

Summary The in-vivo bone ablation characteristics of a pulsed solid-state erbium:YAG laser were compared to those of a pulsed solid-state holmium:YAG laser. Partial osteotomies in the maxillary, the mandibulary, and the nasal bones of white rats were performed. The tissue response was examined by light microscopy. Thermal gradients following the laser application were also measured. Over all energy levels tested the erbium:YAG laser produced ablation of bone with minimal thermal damage to the adjacent tissue. The results of this study are promising for future application of the infrared holmium-and erbium:YAG lasers in otorhinolaryngology.

     

Clinical audit: introduction: getting started

Clinical audit can benefit your practice and your patients. It is one of the pillars of clinical governance that will ensure that SAAD members deliver the best quality dental care. If you have experience of clinical audit that you would like to share with members, we would like to hear about it, so other members can learn from your experience.     

Reprint of: Parastomal hernia: Surgical management

Parastomal hernia is a common clinical problem that is difficult to manage. Although surgical repair is recommended for the majority of other incisional hernias to prevent the complications of incarceration, obstruction, or strangulation, most authors recommend nonoperative management of parastomal hernias. Surgical management is usually reserved for those patients whose parastomal hernia results in intractable difficulty maintaining an effective stoma appliance or who develop a severe complication. This article reviews the nonoperative and operative management of parastomal hernias by fascial repair and stomal relocation. Unfortunately, no randomized trials exist to guide the surgeon in the choice between the accepted nonoperative and surgical management options. Fascial repair without a prosthetic should probably be used only in the rarest of circumstances. If stoma relocation is selected, the stoma should be relocated to the opposite side of the abdominal wall and reconstructed using techniques associated with the lowest risk of stoma-related complications and parastomal hernia. However, the best outcomes may require the use of a prosthetic either to either repair or prevent a parastomal hernia.     

The Classic: Symposium on Arthroplasty: Arthroplasty: Experimental and Clinical Methods

This Classic article is a reprint of the original work by Nathaniel Allison and Barney Brooks, Symposium on Arthroplasty: Arthroplasty: Experimental and Clinical Methods. An accompanying biographical sketch of Nathaniel Allison, MD, is available at DOI  10.1007/s11999-009-1121-2. The Classic Article is © 1918 by the Journal of Bone and Joint Surgery, Inc. and is reprinted with permission from Allison N, Brooks B. Symposium on arthroplasty: arthroplasty: experimental and clinical methods. J Bone Joint Surg Am. 1918;s2–16:83–93.     

Holmium: YAG lithotripsy: optimal power settings

PURPOSE: We tested the hypothesis that holmium:YAG laser lithotripsy speed is best maximized by using low pulse energy at high pulse frequency. MATERIALS AND METHODS: To demonstrate that optical fiber damage increases with pulse energy and irradiation, the 365-microm optical fiber irradiated calcium hydrogen phosphate dihydrate (CHPD), calcium oxalate monohydrate (COM), cystine, magnesium ammonium phosphate hexahydrate (MAPH), and uric acid calculi at pulse energies of 0.5 to 2.0 J. Optical energy output was measured with an energy detector after 10 J to 200 J of total energy. To demonstrate that lithotripsy efficiency varies with power, fragmentation was measured at constant power settings at total energies of 200 J and 1 kJ with the 365-microm optical fiber. Fragmentation was measured for the 272-microm optical fiber at pulse energies of 0.5 J to 1.5 J at 10 Hz. To demonstrate that low pulse energy produces smaller fragments than high pulse energy, fragment size was characterized for COM and uric acid calculi after 0.25 kJ of irradiation using the 272-microm to 940-microm optical fibers at 0.5 J to 1.5 J. RESULTS: Damage to the 365-microm optical fiber was greatest for irradiation of CHPD, followed by MAPH, and COM (P<0.001). There was no significant optical fiber damage after cystine and uric acid lithotripsy. For the 365-microm optical fiber and CHPD, fragmentation after 200 J was greatest for pulse energies < or =1.0 J (P< 0.001). For other compositions, fragmentation was not statistically different among the power settings for constant irradiation. No significant difference was noted in fragmentation for any composition at different pulse energies (1.0 v. 2.0 J) for 1-kJ irradiation. However, for all compositions, the calculated lithotripsy speed was greatest at high power settings (P<0.001). For the 272-microm optical fiber, CHPD fragmentation was greatest for the 1.0-J pulse energy. The mean fragment size and relative quantity of fragments > or =2 mm both increased as pulse energy increased. CONCLUSIONS: Optical fiber degradation varies with stone composition, irradiation, and pulse energy. Holmium:YAG lithotripsy speed is maximized with higher power (either increased pulse energy or higher pulse frequency). Because low pulse energy may be safer and yields smaller fragments than high pulse energy, holmium:YAG lithotripsy speed is best increased by using pulse energies < or =1.0 J at a high repetition rate.     

Peyronie's disease: surgical management: autologous materials

Peyronie's disease in men with satisfactory erectile function but with significant penile curvature is often treated with plaque incision or excision and grafting. The advantages and disadvantages of various grafting materials have long been debated. While artificial materials have been used, the inflammatory reaction from these grafts has produced poor results. Dermal, venous and tunica vaginalis grafts require additional operative time to harvest and their quality varies. Packaged grafts of autologous materials provide a readily available, reliable and well-tolerated choice for penile reconstruction for Peyronie's disease. These grafting materials including cadavaric pericardium, mammalian intestinal serosal products and others are easily obtained and provide a resilient yet compliant graft choice that is easy to tailor and suture in place. Host reaction is minimal and the infection risk small.Results of Peyronie's plaque incision/excision and autologous grafting are presented and the surgical procedures employed are outlined. Excellent results can be expected in the hands of the experienced reconstructive surgeon.     

Holmium: YAG lithotripsy: photothermal mechanism.

OBJECTIVE: A series of experiments were conducted to test the hypothesis that the mechanism of holmium:YAG lithotripsy is photothermal. METHODS AND RESULTS: To show that holmium:YAG lithotripsy requires direct absorption of optical energy, stone loss was compared for 150 J Ho:YAG lithotripsy of calcium oxalate monohydrate (COM) stones for hydrated stones irradiated in water (17+/-3 mg) and hydrated stones irradiated in air (25+/-9 mg) v dehydrated stones irradiated in air (40+/-12 mg) (P < 0.001). To show that Ho:YAG lithotripsy occurs prior to vapor bubble collapse, the dynamics of lithotripsy in water and vapor bubble formation were documented with video flash photography. Holmium:YAG lithotripsy began at 60 microsec, prior to vapor bubble collapse. To show that Ho:YAG lithotripsy is fundamentally related to stone temperature, cystine, and COM mass loss was compared for stones initially at room temperature (approximately 23 degrees C) v frozen stones ablated within 2 minutes after removal from the freezer. Cystine and COM mass losses were greater for stones starting at room temperature than cold (P < or = 0.05). To show that Ho:YAG lithotripsy involves a thermochemical reaction, composition analysis was done before and after lithotripsy. Postlithotripsy, COM yielded calcium carbonate; cystine yielded cysteine and free sulfur; calcium hydrogen phosphate dihydrate yielded calcium pyrophosphate; magnesium ammonium phosphate yielded ammonium carbonate and magnesium carbonate; and uric acid yielded cyanide. To show that Ho:YAG lithotripsy does not create significant shockwaves, pressure transients were measured during lithotripsy using needle hydrophones. Peak pressures were <2 bars. CONCLUSION: The primary mechanism of Ho:YAG lithotripsy is photothermal. There are no significant photoacoustic effects.     

Breast: Sezary Syndrome: A Unique Presentation

Sezary syndrome is a subtype of cutaneous T cell lymphoma which usually presents as generalized skin disease with erytheroderma. Distal organ involvement is rare and is usually a late finding in the course of the disease. Breast involvement is extremely rare. Herein, we present a case report of a patient whose initial presentation involved an intramammary lymph node prior to the onset of more characteristic skin disease. Sezary syndrome was confirmed by cythopathologic findings.     

The Classic: Review Article: Traffic Accidents

This Classic Article is a translation of the original work by Prof. Harald Tscherne, Der Straßenunfall [Traffic Accidents]. An accompanying biographical sketch of Prof. Tscherne is available at DOI 10.1007/s11999-013-3011-x. An online version of the original German article is available as supplemental material. The Classic Article is reproduced with permission from Brüder Hollinek & Co. GesmbH, Purkersdorf, Austria. The original article was published in Wien Med Wochenschr. 1966;116:105–108. (Translated by Dr. Roman Pfeifer.)     

Choledochal cysts: Part 3 of 3: Management

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review.     

Editorial Commentary: SCR: Substantial Confusion Remains

Superior capsular reconstruction is gaining acceptance as a procedure to treat massive and irreparable superior and posterosuperior rotator cuff tears. With a paucity of clinical and no long-term data, early results suggest that superior capsular reconstruction may offer improvements in pain, range of motion, function, and validated outcome measurements.     

Choledochal cysts: Part 2 of 3: Diagnosis

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 2, we explore the details surrounding diagnosis, describing the presentation and imaging of the disease.     

Erbium: YAG versus holmium:YAG lithotripsy

PURPOSE: We test the hypothesis that erbium:YAG (Er:YAG) lithotripsy is more efficient than holmium:YAG (Ho:YAG) lithotripsy. MATERIALS AND METHODS: Human calculi composed of greater than 97% calcium oxalate monohydrate and cystine were studied. Calculi were irradiated in water using Er:YAG or Ho:YAG lasers. Er:YAG lithotripsy was done with a 425 microm sapphire optical fiber at a pulse energy of 50 mJ at 10 Hz. Ho:YAG lithotripsy was performed with a 365 microm low hydroxy optical fiber at a pulse energy of 500 mJ at 10 Hz or a 425 microm sapphire optical fiber at a pulse energy of 50 mJ at 10 Hz. Fragmentation was defined as the initial stone mass minus the final dominant fragment mass and normalized for incident laser fluence (energy per unit area of fiber tip). RESULTS: Mean fragmentation plus or minus standard deviation for calcium oxalate monohydrate was 38 +/- 27 mg for Er:YAG and 22 +/- 6 for Ho:YAG (low hydroxy silica fiber) versus 5 +/- 1 for Ho:YAG (sapphire fiber, p = 0.001). When fragmentation was normalized for incident laser fluence given different optical fiber sizes, mean fragmentation efficiency was 53.6 +/- 38.7 g-microm2/J for Er:YAG lithotripsy compared with 22.6 +/- 6.4 for Ho:YAG (low hydroxy silica fiber) lithotripsy (p = 0.04). Mean cystine fragmentation was 15 +/- 3 mg for Er:YAG versus 9 +/- 1 for Ho:YAG (sapphire fiber, p = 0.0005). CONCLUSIONS: Er:YAG lithotripsy is more efficient than Ho:YAG lithotripsy.     

Skin Cancer in Asians: Part 2: Melanoma

The Asian population in the United States is expected to increase in the next 50 years. Concurrently, there is an overall rise in the incidence of melanoma. It is therefore crucial to obtain a better understanding of this deadly skin cancer in this minority population, as little information is currently available and prognosis remains poor. Through a review of the literature, this paper explores melanoma in the Asian population, including the most common subtype encountered, prognosis, theories on pathogenesis, and molecular biology.The National Cancer Institute estimates that 39,080 men and 29,640 women will be diagnosed with cutaneous melanoma (CM) in 2009.1 It is further estimated that of those diagnosed with melanoma, 8,650 men and women will die in the United States.1 The US census bureau projects that the Asian population will triple in the next 50 years.2 With an overall rise in melanoma and anticipated increases in the Asian population, clinicians and patients alike must be aware of the potential for skin cancer in this minority population. Currently, there is limited available data on skin cancer in Asians, including melanoma.CM is predominantly an ultraviolet (UV) light-induced skin cancer more commonly associated with light-skinned Caucasians than in individuals with darker skin.³ Traditionally, clinical features associated with CM included Fitzpatrick skin types I to III with lighter color hair and eyes, an increased tendency to burn, history of multiple nevi, and strong family history of CM.⁴ Therefore, it is generally recognized that CM rarely affects individuals of ethnic backgrounds other than Caucasians, including those of Asian, Indian, Hispanic, or African descent. It is believed that greater concentrations of melanin in these darker skin populations provides photoprotective activity against the carcinogenic effects of UV radiation.³ More specifically, increased levels of melanin in darker skin tones are thought to allow less damage to deoxyribonucleic acid (DNA) in the lower epidermis, and more effectively prevents proliferation of UV-damaged cells via apoptosis.³ Consequently, CM in these individuals tends to occur at anatomic locations that are not continually sun-exposed, such as the feet.     

Resolved: being fat is good for dialysis patients: the Godzilla effect: pro

Obesity is the epidemic of the 21st century. Despite the fact that obesity is known to have major health consequences in the general population, an increasing number of large-scale epidemiological studies indicate an inverse association between increasing body mass index and mortality in dialysis patients. Here it is argued pro and con that epidemiological data derived from the healthy general population may or may be not applicable to conditions such as end-stage renal disease.     

Nd: YAG laser iridectomies: 100 consecutive cases

We reviewed the patient charts of our first 100 consecutive Nd:YAG laser iridectomies. Our success rate (99%) is the same as that reported by others. Iris bleeding was not problematic. We did find that relative pupillary block may still be present with a patent but very small Nd:YAG iridectomy; that transillumination is not an adequate criterion for assessing patency; and that a Nd:YAG laser iridectomy, probably in part because of its small size, frequently closes with chronic inflammation.