Postoperative pulmonary function in laparoscopic versus open cholecystectomy: prospective, comparative study.

BACKGROUND: Pulmonary complications remain a leading cause of morbidity after major abdominal operations. OBJECTIVE: To compare pulmonary function and the frequency of pulmonary complications after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). METHODS: Fifty-five patients with symptomatic gallstone disease undergoing elective cholecystectomy (LC 40, OC 15) under general anesthesia were evaluated using pulmonary function tests (forced vital capacity [FVC], forced expiratory volume at 1 second [FEV1], and forced expiratory flow at 25% to 75% [FEF25% -75%], chest X-ray and pulse oximetry before and after surgery. RESULTS: FVC, FEV1 and FEF25% -75% decreased by 21.5%, 21.2% and 30.3%, respectively, on postoperative day 1 following LC, and by 44.3%, 46.2% and 58.3%, respectively, after OC. Chest X-ray showed atelectasis in 15% of patients undergoing LC and 45% of those with OC. CONCLUSION: Impairment in pulmonary function after LC was less marked than after OC.     

Fleischner recommendations for the management of subsolid pulmonary nodules: high awareness but limited conformance – a survey study

Objectives

The aim of this study was to assess awareness and conformance to the Fleischner society recommendations for the management of subsolid pulmonary nodules (SSN) in clinical practice.

Methods

An online questionnaire with four imaging cases was sent to 1579 associates from the European Respiratory Society and 757 from the European Society of Thoracic Imaging. Each respondent was asked to choose from several options which one they thought was the indicated management for the nodule presented. Awareness and conformance to the Fleischner recommendations (FR) were assessed and correlated to respondents characteristics.

Results

In total, 119 radiologists (response rate 16.0 %) and 243 pulmonologists (response rate 16.5 %) were included. Awareness of the FR was higher in radiologists than in pulmonologists (93 % vs. 70 %, p?<?0.001), as was implementation in daily practice (66 % vs. 47 %, p?<?0.001). Radiologists conformed to FR in rates of 31, 69, 68, and 82 %, and pulmonologists in 12, 43, 70, and 75 % for cases 1 to 4, respectively. Overmanagement was common. Conformance in SSN management was associated with awareness, working in an academic practice, larger practice size, teaching residents, and higher SSN exposure.

Conclusions

Although awareness of the Fleischner recommendations for SSN management is widespread, management choices in clinical practice show large heterogeneity.

Key points

? Guideline awareness among clinicians is widespread, but conformance shows large heterogeneity.? Awareness and conformance is significantly higher among radiologists than pulmonologists.? Overmanagement is common, which may lead to avoidable financial and physical burden.

     

Targeted exon skipping in transgenic hDMD mice: A model for direct preclinical screening of human-specific antisense oligonucleotides.

The therapeutic potential of frame-restoring exon skipping by antisense oligonucleotides (AONs) has recently been demonstrated in cultured muscle cells from a series of Duchenne muscular dystrophy (DMD) patients. To facilitate clinical application, in vivo studies in animal models are required to develop safe and efficient AON-delivery methods. However, since exon skipping is a sequence-specific therapy, it is desirable to target the human DMD gene directly. We therefore set up human sequence-specific exon skipping in transgenic mice carrying the full-size human gene (hDMD). We initially compared the efficiency and toxicity of intramuscular AON injections using different delivery reagents in wild-type mice. At a dose of 3.6 nmol AON and using polyethylenimine, the skipping levels accumulated up to 3% in the second week postinjection and lasted for 4 weeks. We observed a correlation of this long-term effect with the intramuscular persistence of the AON. In regenerating myofibers higher efficiencies (up to 9%) could be obtained. Finally, using the optimized protocols in hDMD mice, we were able to induce the specific skipping of human DMD exons without affecting the endogenous mouse gene. These data highlight the high sequence specificity of this therapy and present the hDMD mouse as a unique model to optimize human-specific exon skipping in vivo.     

I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator

BACKGROUND: Iodine 123 metaiodobenzylguanidine (MIBG) imaging and heart rate variability (HRV) analysis were compared in patients with an implantable cardioverter defibrillator (ICD) who did and did not receive defibrillator discharges. Although the ICD has been shown to abort potentially fatal ventricular arrhythmias, identification of patients who most benefit from this device remains difficult. As the autonomic nervous system has been implicated in the genesis of these arrhythmias, we undertook a pilot study to evaluate local myocardial sympathetic innervation with the use of I-123 MIBG myocardial imaging, as well as central autonomic tone with the use of HRV, in patients with implantable defibrillators. Test results were correlated with the occurrence of ICD discharges. METHODS AND RESULTS: Seventeen patients with previously implanted defibrillators were studied. Of these, 10 had at least 1 appropriate device discharge for ventricular tachyarrhythmias, whereas 7 had no discharge. Patients with a discharge had a significantly lower I-123 MIBG heart-mediastinal tracer uptake ratio, higher I-123 MIBG defect scores, more extensive sympathetic denervation, and significantly reduced values for several HRV parameters, particularly those in the frequency domain. When combined, the I-123 MIBG heart-mediastinal ratio and HRV 5-minute low-frequency variables were highly predictive of defibrillator discharges. All patients with a heart-mediastinal ratio lower than 1.54 and 5-minute low frequency lower than 443 ms(2) had an ICD discharge (4/4), whereas no patient with an uptake ratio greater than 1.54 and 5-minute low frequency greater than 443 ms(2) did (0/3, P =.03). CONCLUSIONS: Cardiac autonomic assessment using a combination of myocardial scintigraphic and neurophysiologic techniques may help select patients who would most benefit from an implantable defibrillator by identifying those at increased risk for potentially fatal arrhythmias.     

Heterogeneity of Schistosoma haematobium transmission in irrigated fields

Heterogeneity of Schistosoma haematobium transmission in irrigated fields. Although irrigated areas exist since a long time in the Niger Valley the distribution of the urinary schistosomiasis does not appear homogeneous, testifying to the existence of limiting or favourable factors. The identification of these factors could lead to a better definition of the distribution of the schistosomiasis risks and to optimise control programmes. The population of five villages about 1,900 inhabitants living in the same irrigated area (Sébéri) was examined at the end of 1999 before treatment and surveyed two and ten months after treatment by praziquantel in order to investigate re-infections. In parallel, the transmission sites were subject to a semi-monthly malacological follow-up from 1998 to 2001 and the water contacts were quantified in the sites of the main village during 2000. Before treatment, schistosomiasis risks appeared related to the proximity between habitat and lateral canals: the infections concerning youngers were all the more intense that the dwellings were close to the canal. The parasitological indices were the highest in the village lacking of other water sources. The morbidity indices followed a similar distribution with maximum values in the children of the 3 villages located to less than 1 km from the canal; however, morbidity was mainly observed in the adult population, in particular male, of the 2 villages which were the most distant from the canal. After treatment, the incidence of the re-infection between 2 and 10 months was comparable in the 3 villages close to the canal (28%) but was significantly weaker in the 2 villages far from the transmission sites (5%). In the villages bordering the canal, the incidence in the children was all the more high since the habitat was close to the canal. Between 1999 and 2000, the collected number of Bulinus truncatus decreased from 1.4 to 0.6 individuals per survey; moreover, no mollusc harbouring parasites was found, representing the decrease of the parasite burden. The abnormal weakness of re-infection, regarding this type of focus, could be explained by the repeated stop of water supply inducing a complete drying out of the canal for 2 months during the year preceding the study. These repeated drying out also resulted in a reduction of the exposure. Whereas the average frequentation of the sites of the canal remained rather comparable between January (cold dry season) and May (dry hot season), it decreased dramatically in September (rainy season but canals were not irrigated this year) from 99 to 11 daily contacts. The use of the lateral canal when filled represented 80% of the contacts. In the event of drying out, 80% of the contacts were transferred in the ponds but not in the river (5% of the contacts whatever the season). These results confirmed (1) that the presence of canals reduced the use of natural sites and (2) that the drying out of the canals induced a total reduction of the contacts.     

Lincoff temporary balloon buckle in retinal detachment surgery

PURPOSE: To assess the long-term anatomical and functional results of balloon buckle surgery for rhegmatogenous retinal detachment. PATIENTS AND METHODS: Twenty-five selected detachments with a single break or a group of breaks close together were treated with a temporary parabulbar balloon. Adhesion was obtained with transconjunctival cryopexy and argon laser photocoagulation. Retinal detachment was associated with the following risk factors: myopia (15 eyes), aphakia (2 eyes), blunt trauma (1 eye). Twenty-three eyes had a detached macula. The balloon was withdrawn after one week. The patients were kept under observation for at least six months (mean 44.7 months). RESULTS: Initial retinal attachment was achieved in 29 eyes. After the balloon was removed redetachment occurred in two eyes; thus, complete attachment was attained in 27 eyes. Causes of failure were: undetected break (2 eyes), inadequate buckle (4 eyes), proliferative vitreoretinopathy (2 eyes). Conventional scleral buckling and subretinal fluid drainage was done in all failed cases. Vitrectomy and silicone oil were employed in one patient, and finally retinal attachment was achieved in all patients. CONCLUSIONS: Temporary balloon buckling is a simple and curative technique for a selected group of patients with retinal detachments.     

Primary small bowel melanoma: a case report.

The small intestine is the most common site of gastrointestinal metastasis from cutaneous melanoma. However, the small intestine itself is rarely the site of a primary melanotic tumour. We describe a case of primary small bowel melanoma in a 70-year-old man, and discuss the features of primary and metasttic melanoma.     

Comparing culture, real-time PCR and fluorescence resonance energy transfer technology for detection of Porphyromonas gingivalis in patients with or without peri-implant infections

Galassi F, Kaman WE, Anssari Moin D, van der Horst J, Wismeijer D, Crielaard W, Laine ML, Veerman ECI, Bikker FJ, Loos BG. Comparing culture, real‐time PCR and fluorescence resonance energy transfer technology for detection of Porphyromonas gingivalis in patients with or without peri‐implant infections. J Periodont Res 2012; 47: 616–625. © 2012 John Wiley & Sons A/S Background and Objective: The aim of the study was to compare the detection of Porphyromonas gingivalis using a fluorescence resonance energy transfer (FRET) technology with commonly used diagnostic methods in salivary and subgingival plaque samples from subjects with dental implants. P. gingivalis was considered as a marker for a pathogenic microbiota. Material and Methods: Ninety‐seven adult subjects were recruited, including periodontally healthy controls with no dental implants, implant controls with no peri‐implant disease and patients with peri‐implant disease. Saliva and subgingival/submucosal plaque samples were collected from all subjects and were analyzed using culture, real‐time PCR and FRET technology employing P. gingivalis‐specific substrates. Results: It was found that the P. gingivalis‐specific substrates were highly suitable for detecting the presence of P. gingivalis in saliva and in subgingival plaque samples, showing comparable specificity to culture and real‐time PCR. Conclusion: We applied the FRET technology to detect P. gingivalis in implant patients with or without an implant condition and in controls without implants. The technique seems suitable for detection of P. gingivalis in both plaque and saliva samples. However, with all three techniques, P. gingivalis was not very specific for peri‐implantitis cases. Future work includes fine‐tuning the FRET technology and also includes the development of a chair‐side application.