Development of a plasma-polymerized surface suitable for the transplantation of keratinocyte-melanocyte cocultures for patients with vitiligo

The purpose of this study was to develop a convenient methodology for the coculture of autologous melanocytes and keratinocytes for grafting of patients with vitiligo. While grafting of pure melanocytes may achieve repigmentation, the inclusion of keratinocytes ensures rapid reepithelialization. Previously we have used confluent sheets of keratinocytes (with melanocytes present) to transfer cells. However, we found that as the keratinocyte density increased, melanocyte number and function were downregulated. Accordingly in this study we explored combinations of three culture surfaces and three media, seeking to achieve subconfluent culture of primary keratinocytes with a reasonable density of melanocytes, using cells immediately after isolation from skin. For this in vitro study, the surfaces studied were uncoated glass coverslips, and glass coverslips coated with collagen I or a nitrogen-containing plasma polymer. The results show that both the substrate surface and the medium composition influence the proliferation and survival of melanocytes. Keratinocytes and melanocytes could be successfully cocultured on a chemically defined plasma polymer substrate using a serum-free medium.     

Limitation of shoulder mobility due to ankylosis of the sternoclavicular joint in SAPHO syndrome

The rare case of limited range of motion of the shoulder due to ankylosis of the sternoclavicular joint in SAPHO syndrome is presented. The symptoms and the resection arthroplasty of the sternoclavicular joint are discussed.     

Emergency hospital admissions and three-year survival of adults with and without cardiovascular surgery for congenital cardiac disease

OBJECTIVE: This study determined the quantity and nature of emergencies leading to unscheduled hospital admissions of adults with congenital cardiac disease and their mid-term survival. RESULTS: During 1 year, 429 adults with congenital cardiac diseases were admitted 571 times, and 124 admissions (22%) of 95 patients (22%) were emergency admissions. Fifteen of the 95 patients were seen for the first time in 1 of the participating centers. The underlying anomalies were Fallot's tetralogy and pulmonary atresia (n = 26/7), univentricular heart after Fontan procedure (n = 25), atrial septal defect (n = 18), Eisenmenger syndrome (n = 12), complete transposition (n = 11), and others (n = 25). Indications for admission were cardiovascular complications (n = 103; 83%) (arrhythmia, cardiac failure, syncope, pacemaker problems, pericardial tamponade, and sudden death), infections (n = 8, 6%) (endocarditis, pacemaker infection, pneumonia, and cerebral abscess), acute chest pain (n = 7; 6%), and acute abdominal pain (n = 4; 3%). All patients required immediate emergency care, and 16 patients (17%) required urgent cardiovascular or abdominal surgery. Six patients died during the hospital stay. During a follow-up of 2.9 years (SD 0.8), 16 (18%) of the discharged patients died, and 2 additional patients underwent heart or heart-lung transplantation. CONCLUSION: Adults with congenital cardiac disease often experience serious emergency situations with a high in-hospital and mid-term post-hospital mortality. Care given by physicians with special expertise is important in this specific group of patients.     

Insulin inhibits rat hippocampal neurones via activation of ATP-sensitive K+ and large conductance Ca2+-activated K+ channels

In this study, we have used a combination of immunocytochemical and Ca(2+) imaging techniques to determine the functional localisation of insulin receptors as well as the potential role for insulin in modulating hippocampal synaptic activity. Comparison of insulin receptor and MAP2 labelling demonstrated extensive insulin receptor immunoreactivity on the soma and dendrites of cultured hippocampal neurones. Dual labelling with synapsin 1 also showed punctate insulin receptor labelling associated with synapses. In functional studies, insulin inhibited spontaneous Ca(2+) oscillations evoked in cultured hippocampal neurones following Mg(2+) removal. This action of insulin was mimicked by the ATP-sensitive K(+) (K(ATP)) channel opener diazoxide or the large conductance Ca(2+)-activated K(+) (BK) channel activator NS-1619. Furthermore, application of the K(ATP) channel blocker glybenclamide or the BK channel inhibitors iberiotoxin or charybdotoxin attenuated the actions of insulin, whereas prior incubation with a combination of glybenclamide and iberiotoxin completely blocked insulin action. The ability of insulin to modulate the Ca(2+) oscillations was reduced by the inhibitors of MAPK activation PD 98059 and U0126, but not by the PI 3-kinase inhibitors LY 294002 or wortmannin, indicating that a MAPK-driven process underlies insulin action. In conclusion, insulin inhibits spontaneous Ca(2+) oscillations via a process involving MAPK-driven activation of BK and K(ATP) channels. This process may be a useful therapeutic target for the treatment of epilepsy and certain neurodegenerative diseases.     

Intraoperative transesophageal echocardiography in pediatric congenital cardiac surgery: a two-center observational study

Transesophageal echocardiography (TEE) is a monitoring and diagnostic tool for the care of children undergoing cardiac surgery. We analyzed reports from 865 routine TEE examinations performed between January 1994 and March 2002 in patients younger than 17-yr-old who were undergoing surgery for congenital heart disease. Patients' median age was 36 mo (range, 1 day-16 yr). The primary end-point of the study was the incidence of surgical and medical management decisions changed as a result of TEE findings; secondary end-points were diagnostic impact (diagnostic exclusions and new diagnoses) and surgical outcome. Fifty percent of the examinations were performed by anesthesiologists with an advanced level of training in perioperative TEE; all of the examiners had an experience of >or=>500 TEE examinations. Supervision by an anesthesiologist with an advanced level of training was requested in 36.7% of cases; supervision by a cardiologist was requested in 3.8%. Surgical alterations of management were reported in 12.7% of cases and included the need for a repeat bypass run in 7.3%; medical alterations of management were required in 19.4% of cases. We observed a diagnostic impact of TEE in 18.5% of cases and a suboptimal but acceptable surgical outcome in 27.6%; TEE findings predicted postoperative difficulties in 4.0%. Our results confirm the utility of routine TEE to assess repair of congenital heart defects. Furthermore, this service was competently performed by a regular team of cardiac anesthesiologists appropriately trained in TEE. IMPLICATIONS: Transesophageal echocardiography (TEE) is an essential monitoring and diagnostic device for the care of children undergoing cardiac surgery. The surgical and medical impact of TEE is demonstrated in a large series of patients. This service can be performed by appropriately trained cardiac anesthesiologists.     

An intrapericardial bronchogenic cyst

Bronchogenic cysts arise from an abnormal budding of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Rarely they develop within the pericardium. Symptoms of intrapericardial bronchogenic cysts such as chest pain, shortness of breath and arrhythmias can vary according to the location of the cyst, its size and compression of heart and vessels. In this case report we present a young women in whom the diagnosis of an intrapericardial bronchogenic cyst was made by echocardiography and later was approved intraoperatively.     

Transoesophageal echocardiography in cardiac and vascular surgery: implications and observer variability

Transoesophageal echocardiography (TOE) has gained widespreadacceptance among cardiac anaesthetists as a tool to facilitateperi-operative decision-making. This observational study analysesthe impact of TOE and its inter-observer variability on intra-operativepatient management during cardiac and major vascular surgery.From June 1996 to December 1998, standardized reports were obtainedfrom 11 anaesthetists in 1891 adult cardiac and vascular surgerypatients undergoing routine biplane or multiplane TOE. Inter-observervariability and the difference between variables of interestwere tested using the chi-squared test or factorial analysisof variance as appropriate. TOE examinations were performedbefore and after the operation; 1673 (88.5%) patients underwentcardiopulmonary bypass (CPB), and 218 (11.5%) patients had surgerywithout CPB, including 42 (2.2%) coronary revascularizations.In 923 patients (49%), TOE provided additional information thatinfluenced the patient’s therapy. In 968 patients (51%),TOE had only minor or no impact on clinical decision-making.In two patients (0.10%) the scheduled operation was not performed,and in another two patients the TOE examination led to majorcomplications. Observer-dependent variables were: implicationsof TOE for intra-operative decision-making (P<0.0001), estimationof image quality (P<0.0001), pre-operative left ventricularfractional area change (FAC) (P=0.0026), difference betweenpre-operative FAC and post-operative FAC (P=0.033), and requestsfor supervision (P<0.0001). There was no significant differencein the case mix between observers. TOE had an important impacton intra-operative patient management. Inter-observer variabilitywas significant for several variables but not for the frequencyof additional surgical procedures. Br J Anaesth 2001; 86: 497–505     

The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis

Background and Purpose. Rheumatoid arthritis frequently results in functional impairment. This study investigated the effect of a specific exercise regimen on function. Method. A randomized controlled assessor-blinded (N = 36) compared the effect of knee extensor and f lexor muscle training on pain, the timed up and go (TUG) test and the Health Assessment Questionnaire in subjects with non-acute rheumatoid arthritis. Results. Knee extensor and flexor muscle training increased isokinetic torques at speeds of 60°/sec^?1 and 120°/sec^?1 as measured by an isokinetic dynamometer (p = 0.02–0.003). The experimental group experienced a reduction in pain (p = 0.03), an improvement in TUG time (p = 0.01) and in function as measured by the Health Assessment Questionnaire (p = 0.04). Conclusions. Specific knee muscle training can be administered safely in people with non-acute rheumatoid arthritis, and may produce functional benefits.     

A prospective study of psychosocial adaptation following subarachnoid haemorrhage

Abstract

In this prospective study a series of 89 patients with subarachnoid haemorrhage (SAH), most of whom had a “good” neurological outcome, were interviewed 10 weeks and 12 monts following their SAH about changes in psychosocial functioning since their SAH, and the presence of symptoms, such as excessive fatigue, that can influence psychosocial functioning. Information was also gathered from close relatives whenever possible. Data about a range of “SAH factors”, including site of aneurysm, patient clinical grade, and vasospasm, were also gathered at the time of hospitalisation, and subjects were graded according to the Glasgow Outcome Scale (GOS) at each follow-up assessment. Statistical analyses to see whether these factors were predictive of later psychosocial impairment were carried out. A high proportion of subjects demonstrated some mild to moderate psychosocial impairments at 10 weeks and, although recovery occurred in some areas over the next 8 months, 86% of subjects still suffered from excessive fatigue and 55% from hypersensitivity to noise at the 12-month assessment. Of the subjects who were employed at the time of their SAH and had a good neurological outcome, 59% were either unemployed or were working reduced hours at the 12-month follow-up. Overall the GOS was not sensitive to psychosocial impairment, as 87% of the subjects had a GOS of “1” at both 10 weeks and 12 months. The small number of subjects who demonstrated vasospasm or had a poor neurological grade on discharge from hospital and at follow-up were more likely to report changes in temperament, leisure activities, and social behaviour at follow-up.