Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study

OBJECTIVE: The objectives of this study were the comparison of patients who needed mesh closure of the abdomen with patients who underwent standard abdominal closure after ruptured abdominal aortic aneurysm repair and the determination of the impact of timing of mesh closure on multiple organ failure (MOF) and mortality. METHODS: We performed a case-control study of patients who needed mesh-based abdominal closure (n = 45) as compared with patients who underwent primary closure (n = 90) after ruptured abdominal aortic aneurysm repair. RESULTS: Before surgery, the patients who needed mesh abdominal closure had more blood loss (8 g versus 12 g of hemoglobin; P <.05), had prolonged hypotension (18 minutes versus 3 minutes; P <.01), and more frequently needed cardiopulmonary resuscitation (31% versus 2%; P <.01) than did the patients who underwent primary closure. During surgery, the patients who needed mesh closure also had more severe acidosis (base deficit, 14 versus 7; P <.01), had profound hypothermia (32 degrees C versus 35 degrees C; P <.01), and needed more fluid resuscitation (4.0 L/h versus 2.7 L/h; P <.01). With this adverse clinical profile, the patients who needed mesh closure had a higher mortality rate than did the patients who underwent primary closure (56% versus 9%; P <.01). However, the patients who underwent mesh closure at the initial operation (n = 35) had lower MOF scores (P <.05), a lower mortality rate (51% versus 70%), and were less likely to die from MOF (11% versus 70%; P <.05) than the patients who underwent mesh closure after a second operation in the postoperative period for abdominal compartment syndrome (n = 10). CONCLUSION: This study reports the largest experience of mesh-based abdominal closure after ruptured abdominal aortic aneurysm repair and defines clinical predictors for patients who need to undergo this technique. Recognition of these predictors and initial use of mesh closure minimize abdominal compartment syndrome and reduce the rate of mortality as the result of MOF.     

Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation

Background contextPolyetheretherketone (PEEK) has been increasingly used as a biomaterial for spinal implants. PEEK lumbar fusion rods have recently become available for use in posterior lumbar fusion procedures.PurposeTo compare Polyetheretherketone Rod System to traditional titanium rod fixation in a cadaveric model and provide mechanical test data for the PEEK system.Study designBiomechanical testing.MethodsCadaveric biomechanical testing was conducted to compare Expedium 5.5 mm PEEK rods to titanium rods of equivalent diameter. Biomaterials testing was performed to determine static and dynamic performance of Expedium 5.5 mm PEEK rods with 6% BaSo4 in compressive bending and torsion.ResultsCadaveric testing demonstrated that PEEK rods can significantly reduce the range of motion of a destabilized segment. The testing showed no significant difference in the stability provided by PEEK and titanium rods in posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) constructs. PEEK static compressive bending tests showed 67 degrees displacement without fracture of the rod. Torsion testing showed 30 degrees of rotation without yield or plastic deformation. Dynamic compression testing revealed two fatigue runouts at 23 degrees.ConclusionsPEEK rods provide comparable stability to titanium rods of equivalent diameter in cadaveric testing. Mechanical testing suggests PEEK rods can withstand far beyond the angular displacements suggested by cadaveric testing and that of normal physiologic range of motion. Potential advantages to PEEK rods include better anterior column load sharing, reduced stress at bone-to-screw interface, and reduced computed tomography and magnetic resonance imaging scatter and artifact.     

Further evidence in support of the selective uptake and anterograde transport of [I]wheat germ agglutinin by chick retinal ganglion cells

Following intravitreal injection, affinity purified, iodinated wheat germ agglutinin ([¹²⁵I]WGA) is taken up by chick retinal ganglion cells and transported in an anterograde direction to nerve terminals in the optic tectum. The accumulation of axonally transported label in the tectum may be measured quantitatively. Using such an approach, we find that co-injection of [¹²⁵I]WGA with an excess of unlabeled WGA reduces the amount of axonally transported labeled lectin. Since co-injection of comparable levels of soybean agglutinin or Ulex Europeanus-I fails to reduce tectal labeling to a similar extent, and since native WGA at the same concentration does not appear to be toxic to retinal ganglion cells, these results support the hypothesis that the uptake and subsequent anterograde axonal transport of WGA by these cells is a selective process, dependent on a limited number of extra- or intracellular binding sites.     

Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography

BACKGROUND: Popliteal artery injury is frequently associated with knee dislocation following blunt trauma, an injury that is being seen with increasing frequency. The primary purpose of the present study was to evaluate the use of physical examination to determine the need for arteriography in a large series of patients with knee dislocation. The secondary purpose was to evaluate the correlation between physical examination findings and clinically important vascular injury in the subgroup of patients who underwent arteriography. METHODS: One hundred and thirty consecutive patients (138 knees) who had sustained an acute multiligamentous knee injury were evaluated at our level-1 trauma center between August 1996 and May 2002 and were included in a prospective outcome study. Four patients (four knees) were lost to follow-up, leaving 126 patients (134 knees) available for inclusion in the study. The results of the physical examination of the vascular status of the extremities were used to determine the need for arteriography. The mean duration of follow-up was nineteen months (range, eight to forty-eight months). Physical examination findings, magnetic resonance imaging findings, and surgical findings were combined to determine the extent of ligamentous damage. RESULTS: Nine patients had flow-limiting popliteal artery damage, for an overall prevalence of 7%. Ten patients had abnormal findings on physical examination, with one patient having a false-positive result and nine having a true-positive result. The knee dislocations in the nine patients with popliteal artery damage were classified, according to the Wascher modification of the Schenck system, as KD-III (one knee), KD-IV (seven knees), and KD-V (one knee). CONCLUSIONS: Selective arteriography based on serial physical examinations is a safe and prudent policy following knee dislocation. There is a strong correlation between the results of physical examination and the need for arteriography. Increased vigilance may be justified in the case of a patient with a KD-IV dislocation, for whom serial examinations should continue for at least forty-eight hours.     

Predictive genetic testing in maturity-onset diabetes of the young (MODY).

INTRODUCTION: Maturity-onset diabetes of the young (MODY) is characterized by autosomal dominant inheritance of young-onset non-insulin-dependent diabetes. It accounts for approximately 1% of Type 2 diabetes (approximately 20 000 people in the UK). Diagnostic and predictive genetic tests are now possible for 80% of MODY families. Diagnostic tests can be helpful as the diagnosis can be confirmed and the subtype defined which has implications for treatment and prognosis. However predictive genetic testing, particularly in children, raises many scientific, ethical and practical questions. METHODS: This is a case report of a family with diabetes resulting from an hepatic nuclear factor (HNF)1alpha mutation, who request a predictive test in their 5-year-old daughter. The scientific issues arising from molecular genetic testing in MODY are discussed, along with the process of genetic counselling. The views of the family and the clinical genetics team involved are presented. RESULTS: The implications of positive and negative predictive test results and the possibility of postponing the test were among many issues discussed during genetic counselling. The family remained convinced the test was appropriate for their daughter and the clinical genetics team fully supported this decision. The family, motivated by their family history of diabetes and personal experiences of the disease, wished to reduce uncertainty about their daughter's future irrespective of the result. CONCLUSIONS: This case emphasizes that decisions on predictive testing are very personal and require appropriate counselling.     

Ultrastructural and immunocytochemical study of lamina II islet cells in rat spinal dorsal horn.

In order to compare the ultrastructure of GABA-immunoreactive and nonimmunoreactive islet cells in lamina II of the rat dorsal horn, a combined ultrastructural and immunocytochemical study of nine Golgi-stained neurones was performed. Cell bodies of these neurones were tested with antiserum to GABA, and in most cases with antiserum to glycine, while parts of the cell body and dendritic tree were examined with the electron microscope. Four of the neurones had cell bodies that were immunoreactive with GABA antiserum, and 2 of these were also glycine-immunoreactive, while 2 were not. Cell bodies of the remaining five neurones were not immunoreactive with GABA antiserum, nor, in the 3 cases tested, with glycine antiserum. Three of the GABA-immunoreactive cells possessed vesicle-containing dendrites and were presynaptic at dendrodendritic synapses, whereas no vesicles were observed in the dendrites of any of the neurones that were not GABA-immunoreactive. The axon of one of the nonimmunoreactive cells was found with the electron microscope. It gave rise to boutons that contained round agranular vesicles and a few dense-cored vesicles. Three synapses formed by this axon were identified and all were asymmetric. No obvious differences were detected in the types of profile that were presynaptic to GABA-immunoreactive and nonimmunoreactive cells. These results suggest that GABAergic islet cells are a source of presynaptic dendrites in lamina II of the rat and that some presynaptic dendrites contain GABA and glycine, while others contain GABA without glycine. The nonimmunoreactive islet cells presumably represent a distinct functional class of neurones and some of these may release an excitatory amino acid transmitter, possibly in addition to one or more neuropeptides.     

Diabetes and risk of bladder cancer: evidence from a case-control study in New England

BACKGROUND:

Diabetes is an emerging public health issue in the US, affecting 11% of Americans over the age of 20, with long‐term complications that include cardiovascular disease, retinopathy, neuropathy, and nephropathy . A recent meta‐analysis found that bladder cancer incidence was approximately 40% higher in individuals with diabetes; however, few studies considered duration or type of therapy and had limited adjustment for potentially confounding factors.

METHODS:

To further investigate the potential role of diabetes in risk of bladder cancer, the authors analyzed data from a case‐control study conducted in New Hampshire in which patients with bladder cancer, and controls sampled from the population, completed an interview regarding history of diabetes, cigarette smoking history, height, weight, and history of urinary tract infections.

RESULTS:

The study consisted of 331 cases and 263 controls on whom information regarding diabetes was ascertained. History of diabetes was related to an increased bladder cancer risk (adjusted odds ratio = 2.2, 95% CI, 1.3 to 3.8). The association was strongest in those who had diabetes for the longest duration (OR for 16 or more years = 3.6, 1.1 to 11.2) and in those taking oral hypoglycemic medications (OR = 3.3, 1.5 to 7.1).

CONCLUSIONS:

Our findings support an association between bladder cancer incidence and diabetes, and further suggest that the risk may be greater among patients taking oral hypoglycemics and those with diabetes of longer duration. Cancer 2011. © 2010 American Cancer Society.