In vitro leakage susceptibility of tracheoesophageal shunt prostheses in the absence and presence of a biofilm

Although leakage through a tracheoesophageal shunt prosthesis is the main cause of prosthesis failure in a laryngectomy patient, this has never been the subject of in vitro evaluation. The aim of this study was to compare three commercially available voice prostheses by comparison of their in vitro leakage patterns, in absence or presence of a biofilm. To compare in vitro leakage patterns, a model comprised of an artificial throat equipped with a single prosthesis coupled to a water reservoir was developed. By varying the height of the water reservoir, different pressures on the voice prosthesis can be obtained. Both in absence and presence of a biofilm, the Blom Singer voice prosthesis demonstrated the lowest leakage, followed by Groningen Low Resistance. The Provox2 showed significantly the most leakage, however, in presence of a biofilm the leakage of the Provox2 significantly decreased. Regular airflow during biofilm formation significantly increased leakage through the Provox2. Out of 746 clinical replacements, Provox2 showed 76% and Groningen Low Resistance 57% replacements due to leakage. The model used in this study showed significant differences in leakage of the three types of voice prostheses used. Leakage occurred more readily through Provox2 than through Groningen Low Resistance and Blom Singer prostheses, which is in line with clinical observations and enforces the model.     

Primary intratesticular sarcoma of the testis: a rare manifestation of testicular cancer

A 57-year-old white male presented with a 5-month history of a painless right testicular mass. Physical examination revealed a right testicular tumor. The patient underwent a right inguinal orchiectomy. Histopathologic evaluation showed a primary spindle-cell sarcoma of the testis. A retroperitoneal lymph node dissection was performed and revealed no lymphatic metastases. There was no recurrence of the disease over a 2-year follow-up period.     

Meta-analysis of alternate autologous vein bypass grafts to infrapopliteal arteries

BACKGROUND: Several studies have described acceptable results for infrapopliteal bypass surgery that uses an autogenous vein other than the greater saphenous vein but is still no reliable prediction of outcomes. The objective of this study was to use meta-analysis to assess the long-term outcomes after infrapopliteal bypass grafting done with alternate autologous veins. METHODS: Studies published from 1982 through 2004 were identified from electronic databases and pertinent original articles. Thirty-two series were selected, all of which had used survival analysis and had reported a 1-year graft patency rate, with at least 15 bypasses. An interval success rate was calculated for each month in each series of grafts by using data from life tables, survival curves, and texts. Monthly success rates were combined across series to obtain a pooled estimate of success for each month. Pooled survival curves were then constructed for graft patency and foot preservation. RESULTS: The 5-year pooled estimates were 46.9% (95% confidence interval [CI] = 35.5%-58.3%) for primary patency, 66.5% (95% CI = 54.9%-78.2%) for secondary patency, and 76.4% (95% CI = 68.0%-84.8%) for foot preservation. These results were far superior to those reported for nonautologous grafts. Intensive duplex surveillance had a favorable impact on graft patency and foot preservation. No publication bias was detected. CONCLUSIONS: When the greater saphenous vein is unavailable, alternate autologous veins are preferable to other graft materials in bypass surgery to infrapopliteal arteries.     

Heterotopic Pancreatic Tissue Presenting As a Solid and Cystic Lung Lesion: A Very Unusual Bronchopulmonary Foregut Malformation

We describe the history and lung pathology of a premature female infant, who presented with respiratory distress immediately after birth. A thoracic computerized tomography scan showed abnormalities suggestive of congenital cystic adenomatoid malformation of the left lung. In addition, echocardiography revealed a tetralogy of Fallot. A left thoracotomy was performed and the lower lobe of the left lung was removed. Despite intensive supportive therapy, pulmonary hypoperfusion resulted in severe hypoxemia and death. Gross and microscopic analysis of the resected lobe revealed a partly cystic and solid lesion with multiple bronchus-derived cysts and an exuberant multifocal proliferation of glandular tissue, resembling bronchial glands, mixed with heterotopic cartilage surrounding ducts. Immunohistochemical analysis showed the presence of chromogranin A-reactive islet-like structures amidst exocrine tissue showing trypsin and chymotrypsin immunoreactivity, establishing the diagnosis of pulmonary pancreatic heterotopy. In the remaining pulmonary parenchyma, there were secondary changes consistent with partial obstruction and lymphangiectasis which was attributed to the presence of the cardiac malformation. To our knowledge, this is only the fourth reported case of heterotopic pancreatic tissue in the lung, and the first case where this bronchopulmonary foregut anomaly is not associated with a enteric duplication.     

Safety and tolerability of simvastatin plus niacin in patients with coronary artery disease and low high-density lipoprotein cholesterol (The HDL Atherosclerosis Treatment Study)

The high-density lipoprotein (HDL)-Atherosclerosis Treatment Study showed that simvastatin plus niacin (mean daily dose 13 mg and 2.4 g, respectively) halt angiographic atherosclerosis progression and reduce major clinical events by 60% in patients with coronary artery disease (CAD) who have low HDL, in comparison with placebos, over 3 years. How safe and well-tolerated is this combination? One hundred sixty patients with CAD, including 25 with diabetes mellitus, with mean low-density lipoprotein cholesterol of 128 mg/dl, HDL cholesterol of < or =35 mg/dl (mean 31), and mean triglycerides of 217 mg/dl were randomized to 4 factorial combinations of antioxidant vitamins or their placebos and simvastatin plus niacin or their placebos. Patients were examined monthly or bimonthly for 38 months; side effects (gastrointestinal upset, nausea, anorexia, vision, skin, and energy problems, or muscle aches) were directly queried and recorded. Aspartate aminotransferase, creatine phosphokinase (CPK), uric acid, homocysteine, and fasting glucose levels were regularly monitored. A safety monitor reviewed all side effects and adjusted drug dosages accordingly. Patients who received simvastatin plus niacin and those on placebo had similar frequencies of clinical or laboratory side effects: any degree of flushing (30% vs 23%, p = NS), symptoms of fatigue, nausea, and/or muscle aches (9% vs 5%, p = NS), aspartate aminotransferase (SGOT) > or =3 times upper limit of normal (3% vs 1%, p = NS), CPK > or =2 times upper limit of normal (3% vs 4%, p = NS), CPK > or =5 times upper limit of normal, new onset of uric acid > or =7.5 mg/dl (18% vs 15%, p = NS), and homocysteine > or =15 micromol/L (9% vs 4%, p = NS). Glycemic control among diabetics declined mildly in the simvastatin-niacin group but returned to pretreatment levels at 8 months and remained stable for rest of the study. This combination regimen was repeatedly described by 91% of treated patients and 86% of placebo subjects as "very easy" or "fairly easy" to take. Thus, the simvastatin plus niacin regimen is effective, safe, and well tolerated in patients with or without diabetes mellitus.     

Prevention of biofilm formation by dairy products and N-acetylcysteine on voice prostheses in an artificial throat

OBJECTIVE: To evaluate the preventive effect of buttermilk, Yakult Light fermented milk drink and N-acetylcysteine on biofilm formation on voice prostheses in vitro. MATERIAL AND METHODS: Groningen button and Provox 2 voice prostheses were inoculated with a mixture of bacteria and yeasts isolated from previously explanted Groningen button voice prostheses. After 5 h, separate throats were flushed with buttermilk, Yakult Light fermented milk drink, N-acetylcysteine or phosphate-buffered saline, which served as a control. After 7 days, the microflora on each voice prosthesis was determined. RESULTS: On Groningen button voice prostheses, buttermilk, Yakult Light fermented milk drink and N-acetylcysteine all reduced the amount of both bacteria and yeasts. On Provox 2 voice prostheses, buttermilk, Yakult Light fermented milk drink and N-acetylcysteine reduced the amount of bacteria but, conversely, increased the amount of yeasts. CONCLUSION: These in vitro experiments demonstrate that biofilm formation on voice prostheses is reduced in an artificial throat by the use of buttermilk, Yakult Light fermented milk drink and N-acetylcysteine. However, the structural differences between the type of voice prostheses may influence the ultimate effects.     

Effect of acute inner ear pressure changes on low-level distortion product otoacoustic emissions in the guinea pig

OBJECTIVE: To determine a relation between acute inner ear pressure changes and cochlear function as measured by low-level 2f(1)-f(2) distortion product otoacoustic emissions (DPOAEs). MATERIAL AND METHODS: During and after a change in inner ear pressure induced by injection or aspiration of perilymph, the 2f(1)-f(2) DPOAE at 4.5 kHz generated by low-level primaries was recorded in the guinea pig. RESULTS: Large changes in overall inner ear pressure produced only small changes in the 2f(1)-f(2) amplitude and phase. During injection of 0.5 microl of artificial perilymph into the scala tympani over a 10-s period, the mean inner ear pressure increased by approximately 500 Pa, with an accompanying mean increase in the 2f(1)-f(2) amplitude of 0.7 dB. During aspiration of 0.5 microl of perilymph over a 10-s period, the mean inner ear pressure decreased by approximately 700 Pa, with an accompanying mean decrease in the 2f(1)-f(2) amplitude of 0.9 dB. Changes in DPOAE amplitude followed inner ear pressure changes with a delay of 1-2 s. The magnitude and sign of the amplitude changes can (partly) be explained by a change in oval window stiffness. No explanation was found for the measured delay. CONCLUSION: Clinically, these experiments can be of value in gaining insight into the pathophysiological mechanisms of pathological pressure changes as seen in Meniere's disease and perilymphatic fistulae.