Evaluation of BioCorkscrew and Bioknotless RC suture anchor rotator cuff repair fixation: an in vitro biomechanical study

This in vitro biomechanical study used cadaveric specimens to compare the rotator cuff repair fixation provided by BioCorkscrew and Bioknotless RC suture anchors. Three cm wide by 1-cm long full-thickness supraspinatus defects were repaired using either two BioCorkscrew suture anchors with combined vertical and horizontal mattress sutures (n = 7) or three Bioknotless RC suture anchors with simple sutures (n = 7). Therefore, the BioCorkscrew suture anchor group had two sutures per anchor (four total sutures), while the Bioknotless RC suture anchor group had one suture per anchor (three total sutures). Two-phase cyclic (5–100 N, 1,000 cycles and 5–180 N, 2,000 cycles) and load to failure tests (31 mm/s) were performed. Non-parametric statistics were used to compare group differences (P < 0.05). All of the BioCorkscrew group specimens (seven of seven) completed the two phase cyclic test regimen without failure or gapping ≥ 5 mm, compared to only three of seven of the Bioknotless RC group (Fisher’s Exact test = 0.03). Groups did not differ for repair site gapping during the 5–100 N cyclic test phase (Fisher’s Exact test = 0.77), however more of the Bioknotless RC group displayed gapping ≥ 5 mm during the 5–180 N cyclic test phase than the BioCorkscrew group (P = 0.02). The BioCorkscrew group also displayed greater yield load during load to failure testing (492.2 ± 204 N vs. 296.4 ± 155 N, P = 0.03). In this in vitro biomechanical study, the BioCorkscrew group with combined vertical and horizontal mattress sutures displayed greater cyclic test survival, less repair site gapping, and superior yield load compared to the Bioknotless RC group with simple sutures. These results in human cadaveric rotator cuff-humerus specimens suggest better immediate post-operative repair site strength and a reduced need for post-operative restrictions. Clinical studies are needed to determine how these rotator cuff repair modes withstand the forces of early rehabilitation and activities of daily living that potentially influence patient outcomes.     

Large optical ablation zone using the VISX S2 smoothscan excimer laser

PURPOSE: To prospectively evaluate the safety and efficacy of the new large-zone (6.5 mm) photoablation technology using the VISX S2 Smoothscan excimer laser. SETTING: University-based hospital, Stanford, California, USA. METHODS: Forty-two eyes of 21 patients with a mean preoperative spherical equivalent (SE) of-5.55 diopters (D)+/- 2.24 (SD) (range-2.13 to-10.75 D) had laser in situ keratomileusis (LASIK) using the VISX Smoothscan S2 excimer laser for simple myopia or compound myopic astigmatism. A 6.5 mm optical zone was used in all eyes. Patients were prospectively followed 1 day and 1 and 3 months postoperatively. RESULTS: At 3 months, the mean SE was reduced 94% to-0. 31+/- 0.55 D. Ninety-one percent of eyes had an uncorrected visual acuity of 20/40 or better. Eighty-eight percent were within+/-1.00 D of attempted correction and 84%, within +/-0.50 D. Stability within+/-0.50 D occurred after the first postoperative month. Vector analysis of eyes that had toric ablations demonstrated a difference vector within+/-1.00 D in 100% of eyes. The mean angle of error was-0.04+/- 6.37 degrees. Visually significant steep central islands associated with loss of best spectacle-corrected visual acuity was observed in 7.5% of eyes at 1 month. No eyes experienced significant glare or halos. CONCLUSIONS: The new large-zone (6.5 mm) photoablation technology with the VISX S2 Smoothscan resulted in effective reduction of simple myopia and compound myopic astigmatism. However, with the 6.5 mm zone, there may be an increased risk of developing symptomatic steep central islands in the early post-LASIK period compared with the standard 6.0 mm treatment zone.     

A review of medication administration errors reported in a large psychiatric hospital in the United kingdom

A retrospective analysis of reports of medication administration errors over a period of three and a half years was carried out in a UK psychiatric hospital. A total of 112 errors and "near misses" were studied. The reporting rate increased over time. Psychotropic, intramuscular, and as-needed medications were overrepresented in the error reports. Fifteen percent of the errors had the potential to cause moderate or severe harm to patients. The two most common factors cited by nurses as contributing to error causation were a busy, noisy environment and personal factors, such as feeling tired or unsupported. Physicians were cited as having contributed to some errors.     

Lethal ventricular arrhythmias following one-step pacemaker reprogramming for rapid tracking of atrial tachyarrhythmias

An abrupt decrease in the pacing rate in patients with dual-chamber pacemakers tracking atrial tachyarrhythmias carries a high risk of malignant ventricular arrhythmia. The pacing rate should be reduced by multistep programming over several days.     

Improving service systems for spinal cord injury patients in British Columbia: a survey of urologists

INTRODUCTION: A previous survey of individuals with spinal cord injury (SCI) in British Columbia (B.C.) reported some dissatisfaction in the services provided to treat this condition. We surveyed Urologists in B.C. to gather information about services provided and suggestions for future service development. MATERIALS AND METHODS: A 14-item questionnaire was developed and sent to all Urologists in B.C. Frequency analyses were done on responses. RESULTS: Fifty-one out of 62 questionnaires (82%) were returned. Seventy-five percent of Urologists saw 0-14 SCI patients per year. Urinalysis, culture, ultrasound, and electrolytes/BUN/creatinine were ordered by >80% of Urologists, and cystoscopy, urodynamic studies, and intravenous pyleogram were ordered by 22-64%. Seventy-five percent were satisfied with urological resources in their area. Regarding the need for development of centralized services 64% agreed. However, 100% indicated that they would use selected services typically provided from a centralized resource centre if available. CONCLUSIONS: Urologists in B.C. are relatively satisfied with their regional urological services but expressed a need for specialized resource development.     

Comorbidity of axis I and axis II disorders in patients who attempted suicide

OBJECTIVE: The authors compared the characteristics of suicide attempters with and without comorbid psychiatric and personality disorders to identify factors that explain the high suicide risk associated with psychiatric comorbidity. METHOD: A representative group of 111 patients who had attempted suicide (72 female and 39 male) was assessed for psychiatric and personality disorders according to ICD-10 criteria. The characteristics of patients with both types of disorder were compared with those of patients without comorbid disorders. A semistructured interview schedule and standardized questionnaires were used to investigate patients' background characteristics, the circumstances of the suicide attempts, psychological characteristics, and outcome after 12-20 months. RESULTS: Comorbidity of psychiatric and personality disorders was present in 49 patients (44%). More patients with comorbid disorders had made previous suicide attempts (N=41 [84%] versus N=28 [45%]) and repeated attempts during the follow-up period (N=25 [51%] versus N=9 [15%]). Differences in precipitants and motives for the index episode were also found: patients with comorbid disorders were more depressed and hopeless, reported more episodes of aggression, were more impulsive, and had lower self-esteem and poorer problem-solving skills. Differences in self-esteem and problem-solving skills distinguished between the groups in a stepwise discriminant function analysis. More of the patients with comorbid disorders reported not being loved by their parents and parental suicidal behavior. CONCLUSIONS: Suicide attempters with comorbid psychiatric and personality disorders show marked differences from those without both of these disorders. Comorbidity may contribute to greater suicide risk. Some of the characteristics of patients with comorbid disorders pose major clinical challenges that should be addressed in an effort to reduce suicide risk.     

Congenital mitral regurgitation due to papillary muscle infarction: a case report and approach to evaluation

Congenital mitral regurgitation is relatively rare. It can be due to congenital malformation of the valve apparatus, associated structural heart defects, or results from myocardial dysfunction leading to deformation of the valve annulus. Hence, careful delineation of the pathologic processes involved in the mechanism is critical when evaluating patients presenting with congenital mitral valve regurgitation. Congenital anomalies of the coronary system are one of the serious associations, which needs prompt recognition and treatment to prevent fatal complications. We report a case of congenital atresia of left main coronary artery in an asymptomatic 8-month-old presenting with an incidental finding of mitral valvar regurgitation. Appropriate investigations and management lead to restoration of normal coronary blood flow and valve function. This particular case illustrates that congenital coronary anomalies may present in an otherwise asymptomatic child. It should be considered as one of the possible differential diagnosis in unexplained mitral regurgitation. Early recognition and prompt surgical treatment can radically modify the prognosis.     

Nutrition, immune function, and inflammation: an overview

The collective evidence suggests that nutritional insult to both cell-mediated and humoral immunity in the presence of protein-energy malnutrition contributes to abnormalities of inflammation. The primary goal of nutritional support in inflammatory disease is to provide adequate energy and protein to meet endogenous requirements for tissue repair, IL-1 production, and restored cellular function, thus preventing secondary infection. Substrate provision should aim at improving the acute phase of injury while avoiding immune dysfunction. This goal may be achieved by altering the eicosanoid pathway toward a more regulated inflammatory state. In the context of allograft response, macrophages are central to the initiation of allosensitization by virtue of their ability to present antigen to T-cells. Activated T-cells may further modulate macrophage function by the secretion of lymphokines. Manipulation of macrophage eicosanoid production by dietary omega-3 PUFA may reduce cellular immune response. (table; see text) Nutritional support should also focus on providing essential micronutrients, with their potentially immunomodulating role, as adjunctive therapy in order to protect the host from toxic effects of free-radicals and chemicals released during inflammatory events. (Feeding regimens currently under investigation and development are presented in Table 4.) By integrating dietary immunotherapy with the use of recombinant hormones, monoclonal antibodies, and various available monokines, an optimal outcome for each patient may be achieved. However, effective application of immunotherapy to nutritional supplementation will require accurate monitoring of immune function in individual patients in order to avoid inappropriate treatment.