A study of the effect of sartorius transposition on lymph flow after ilioinguinal node dissection

Ilioinguinal dissection is associated with a high rate of lymphatic complications. Prolonged lymph flow causes greatest concern and preventive strategies are needed. A retrospective study of 28 consecutive patients undergoing groin dissection for melanoma metastases was performed to evaluate the influence of sartorius muscle transposition on lymph flow. Modification of the surgical technique with transposition of the sartorius muscle was not associated with reduced drainage time (P = 0.66). A 2-staged approach, with initial sentinel lymph node resection and lymph node dissection in a second operation, however, lead to shortened duration of the lymph flow (P = 0.01). Prolonged lymphorrhea was more frequent in older (P = 0.03), obese (P = 0.02) patients affected by diabetes mellitus (P = 0.03) and hypertension (P = 0.04).     

Genotypic and phenotypic characterization of Trypanosoma brucei gambiense isolates from Ibba, South Sudan, an area of high melarsoprol treatment failure rate

Resistance of trypanosomes to melarsoprol is ascribed to reduced uptake of the drug via the P2 nucleoside transporter. The aim of this study was to look for evidence of drug resistance in Trypanosoma brucei gambiense isolates from sleeping sickness patients in Ibba, South Sudan, an area of high melarsoprol failure rate. Eighteen T. b. gambiense stocks were phenotypically and only 10 strains genotypically characterized. In vitro, all isolates were sensitive to melarsoprol, melarsen oxide, and diminazene. Infected mice were cured with a 4 day treatment of 2.5mg/kg bwt melarsoprol, confirming that the isolates were sensitive. The gene that codes for the P2 transporter, TbATI, was amplified by PCR and sequenced. The sequences were almost identical to the TbAT1(sensitive) reference, except for one point mutation, C1384T resulting in the amino acid change proline-462 to serine. None of the described TbAT1(resistant)-type mutations were detected. In a T. b. gambiense sleeping sickness focus where melarsoprol had to be abandoned due to the high incidence of treatment failures, no evidence for drug resistant trypanosomes or for TbAT1(resistant)-type alleles of the P2 transporter could be found. These findings indicate that factors other than drug resistance contribute to melarsoprol treatment failures.     

'Faster counting while walking' as a predictor of falls in older adults

OBJECTIVE: To establish whether changes in a spoken verbal task performance while walking compared with being at rest could predict falls among older adults. DESIGN: Prospective cohort study of 12 months' duration. SETTING: Twenty-seven senior housing facilities. PARTICIPANTS: Sample of 187 subjects aged 75-100 (mean age 84.8 +/- 5.2). During enrollment, participants were asked to count aloud backward from 50, both at rest and while walking and were divided into two groups according to their counting performance. Information on incident falls during the follow-up year was monthly collected. MEASUREMENTS: The number of enumerated figures while sitting on a chair and while walking, and the first fall that occurred during the follow up year. RESULTS: The number of enumerated figures under dual-task as compared to single task increased among 31.5% of the tested subjects (n = 59) and was associated with lower scores in MMSE (P = 0.034), and higher scores in Geriatric Depression Scale (P = 0.007) and Timed Up & Go (P = 0.005). During the 12 months follow-up, 54 subjects (28.9%) fell. After adjusting for these variables, the increase in counting performance was significantly associated with falls (adjusted OR = 53.3, P < 0.0001). Kaplan-Meier distributions of falls differed significantly between subjects who either increased or decreased their counting performance (P < 0.0001). CONCLUSIONS: Faster counting while walking was strongly associated with falls, suggesting that better performance in an additional verbal counting task while walking might represent a new way to predict falls among older adults.     

Behandlung distaler artikulärer Oberschenkelfrakturen

The treatment of distal femur fractures is challenging because the knee is so near. A high incidence of such complications as infection and deficient bony healing has been reported. Problematic biomechanical aspects of lateral plate fixation, disturbance of the vascularisation as the result of extensive bony exposure, and the frequently osteoporotic bone quality, which makes adequate fixation of implants in the distal femur impossible, are some reasons for the high complication rate. Retrograge medullary nailing is a procedure that might offer a solution to some of the problems as the technique is minimally invasive. We report our experience of treating 21 fractures with retrograde nailing.     

Acute Normovolemic Hemodilution Improves Oxygenation in Ischemic Flap Tissue

Background: The flaps used in reconstructive surgery are prone to ischemia and hypoxia, which imply a considerable risk of wound-healing complications. During normovolemic hemodilution, the oxygenation may further deteriorate because of the lack of erythrocytes or improve because of increased microcirculatory blood flow. The aim of this study was to investigate the net effect of normovolemic hemodilution of various degrees on the microcirculation and oxygenation in ischemic flap tissue in adult minipigs.

Methods: A rectangular flap was raised in the middle of the epigastrium, consisting of an adequately perfused portion and a partly ischemic portion. The animals were randomly assigned to either the control group (n = 10) or the experimental group (n = 10) receiving graded normovolemic hemodilution with 6% hydroxyethyl starch 200-0.5.

Results: Normovolemic hemodilution caused a significant linear increase in total blood flow to the flap (measured by transit time flowmetry). In the ischemic flap tissue, both oxygen tension (measured by polarographic cells) and venous base excess were transiently improved during hemodilution (F = 4.79 and P = 0.019 for the regression of tissue oxygen tension on hemoglobin and hemoglobin squared, and F = 4.18 and P = 0.029 for base excess). The expected values reached a peak at hemoglobin concentrations of 9.1 and 8.5 g/dl, respectively. The measured values at this level of hemodilution were 17 +/- 10.7 mmHg (mean +/- SD) versus 7.6 +/- 1.9 mmHg (baseline) for oxygen tension and -1.7 +/- 3.4 versus -5.6 +/- 4.1 mm for venous base excess.     

Assessment of absolute metabolite concentrations in human tissue by 31P MRS in vivo. Part II: Muscle,liver, kidney

Absolute metabolite concentrations were assessed in the muscle, the liver, and the kidney of healthy human volunteers by ³¹P MRS. Fully relaxed in vivo spectra were acquired with a surface coil and were localized with an adiabatic lSlS pulse sequence. The spectra were quantified with a subsequent measurement of a calibration phantom and were processed iteratively in the time domain. The following mean metabolite concentrations (mmollliter) were measured in the resting male calf muscle (n = 9), in the fasting liver (n = 12), and in the orthiotopic kidney (n= 5): [PME] = 2.0 ± 0.6, 3.8 ± 0.7, and 2.6 ± 0.9, [Pi] = 2.9 ± 0.3, 1.8 ± 0.3, and 1.6 ± 0.4, [PDE] = 3.8 ± 0.8, 9.7 ± 1.5, and 4.9 ± 1.1, [PCr] = 22.0 ± 1.2, 0, and 0, [NTP] = 5.7 ± 0.4, 2.9 ± 0.4, and 2.0 ± 0.3, respectively. Several interesting findings are to be emphasized: The concentrations of Pi, PCr, and NTP were 20% lower in the muscle of women than of men. In addition, the pH, was significantly lower in female muscle (6.99 ± 0.03) than in male muscle (7.05 ± 0.03). The pH, in the liver (7.12 ± 0.09) and in the kidney (7.09 ± 0.08) were higher than in the muscle of both genders. The free magnesium concentration (mmollliter) was higher in the lliver (1.40 ± 0.64) than in the kidney (0.79 ± 0.39) and in the muscle (0.52 ± 0.10).     

Establishment of detailed reference values for luteinizing hormone, follicle stimulating hormone, estradiol, and progesterone during different phases of the menstrual cycle on the Abbott ARCHITECT analyzer.

During a normal menstrual cycle, serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone can vary widely between cycles for the same woman, as well as between different woman. Reliable reference values based on the local population are important for correct interpretation of laboratory results. The purpose of our study was to determine detailed reference values for these hormones throughout the menstrual cycle using the Abbott ARCHITECT system. From 20 volunteers (age 20-36 years) with normal cycles and no use of oral contraceptives, samples were taken every day during their cycle. Volunteers received three vaginal ultrasound examinations (days 10 and 13, and 1 or 2 days after ovulation) to measure follicular and corpus luteum development. Hormone levels were measured using the corresponding ARCHITECT assay and were synchronized to the LH peak. Median, and 5th and 95th percentile values were determined for each day of the cycle, as well as for early follicular (days -15 to -6), late follicular (days -5 to -1), LH peak (day 0), early luteal (+1 to +4), mid-luteal (days +5 to +9), and late luteal (days +10 to +14) phases of the cycle. Based on our data, we were able to establish detailed reference values for LH, FSH, estradiol, and progesterone, which should aid in the interpretation of results for these reproductive hormones in a variety of circumstances.     

Identification and Clinical Significance of Helcococcus kunzii in Human Samples

From 2008 to 2013, 39 Helcococcus kunzii strains were collected from human clinical specimens (79% from foot ulcers), and 85% of the 39 patients were infected. Matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry and molecular methods accurately identified all isolates. This large study of clinical observations confirms the potential pathogenic role of H. kunzii.