Technical aspects and access devices for preperitoneal and retroperitoneal endoscopic surgery

The main advantages of preperitoneal and retroperitoneal endoscopic surgery over conventional laparoscopy or open surgery are the decreased risk of injury to organs and reduced postoperative adhesion formation. Exact knowledge of anatomy, as well as correct positioning of the patient, is essential for its success. While a blunt dissection technique, using either the fingers or an endoscope under pneumodissection, is preferred for preperitoneal surgery, the introduction of a balloon dissection device directly into the retroperitoneal cavity simplifies this procedure for retroperitoneoscopy. Different general surgical procedures are described for preperitoneal (hernia) and retroperitoneal (adrenalectomy, neurectomy/ sympathectomy) surgery. Urological/gynaecological procedures (kidney, tumor biopsy, lymphadenectomy) are excluded from this review. In recent years, the number of possible preperitoneal and retroperitoneal surgical procedures has increased, mainly as a result of the development of commercially-available balloon trocars and balloon-tipped trocars, which create and maintain a working space.     

Sick-listing habits among general practitioners in a Swedish county

Objective - To describe sick-listing habits in general practice, how common it is and for how long and for what diagnoses it is granted. Design - Medical audit study. Setting - Primary health care. Subjects - 53 general practitioners (GPs) registering all cases during a 2-week period when sick-listing was considered. Main outcome measures - Percentage of GP consultations that involved sick-listing, number of days of certified sick-leave, percentage of partial sick-listing, GP sex differences. Results - 9% of all consultations included a consideration about sick-listing, and in only 6% of these instances was a certificate not issued. The median length of the certified sickness period was 14 days. Musculoskeletal problems were by far the most common diagnosis. Female patients were more often partially sick-listed than males. Female GPs sick-listed a larger proportion of their patients than male GPs. Risk factors for long certification periods were in fact associated with long certification periods. Even in cases where the GP would not recommend sick-listing a certificate was issued in 87%. Conclusions - Patients appear to have a strong influence on sick-listing practice, and there are important sex differences among GPs in this practice.     

Intraoperative biologische Augmentation am Knochen und der subchondralen Zone

The treatment of bone defects is always a challenge for orthopedic surgeons. Autologous bone grafting is still regarded as gold standard in the therapy of bone defects. Methods, such as reamer-irrigator-aspirator (RIA) technology were recently developed for biological bone grafting but due to limited availability these methods are restricted. The use of sterilized human cancellous bone offers an alternative in the treatment of small and medium sized bone defects. Microporous beta tricalcium phosphate (β-TCP) is suitable for bone replacement due to its mechanical consistency during healing. The selective use of bone morphogenic protein 2 (BMP-2) and BMP-7 provides a reasonable therapeutic option for complex bone disorders and the treatment of nonunion. Depending on the respective size osteochondral defects can be treated either by osteochondral transplantation or by bone grafting with concomitant cartilage transplantation.     

An analysis of college students' attitudes and beliefs concerning body disposal

Abstract

The purpose of this study was to ascertain the body disposal preferences of college students at The Pennsylvania State University, and to identify factors related to their choice in order to draw implications to strengthen death education programming. In this study, 184 undergraduate students were asked to complete a short questionnaire regarding body disposal preferences and related concerns. A variety of independent variables were identified.

Significant interrelationships were found between the independent variables; primary reason for choice of body disposal, religious affiliations, perceived reasonable costs, desire to utilize the services of a funeral director, and the dependent variable, choice of body disposal. These data also indicate that college age students prefer non-traditional burial modalities. The educational implication of these findings are discussed.     

Programmed cell death: many ways for cells to die decently

Apoptosis, a cell death programme mediated by the caspase family of cysteine proteases, is essential for appropriate removal of excess cells in many developmental and physiological settings. It would, however, be very dangerous for the organism to depend on a single protease family for clearance of unwanted and potentially dangerous cells. Indeed, the exclusive role of caspases in the execution of programmed cell death (PCD) has been challenged recently, and the understanding of the molecular control of alternative death pathways is emerging. Here, I review recently discovered triggers and molecular regulators of caspase-independent cell death programmes and discuss their potential as therapeutic targets for the treatment of cancer.     

Role of angiogenic growth factors in transplant coronary artery disease

Transplant coronary artery disease (TxCAD) as a manifestation of chronic rejection is a major limitation to long‐term survival of heart transplant recipients. Although the exact molecular and cellular mechanisms contributing to neointimal formation are unknown, it has been generally believed that smooth muscle cells (SMC) of donor origin migrate from the media into the subendothelial layer of the vascular wall, where SMC proliferate and synthesize extracellular matrix resulting in intimal thickening. However, recent observations indicate that hematopoietic and vascular progenitor cells derived from recipient bone marrow may contribute to the arteriosclerotic lesion formation in the coronary arteries of the transplant. On the other hand, studies on postnatal hematopoiesis indicate that angiogenic growth factors such as vascular endothelial growth factor (VEGF) and angiopoietin‐1 (Ang1) may regulate the recruitment of these cells into distant organs. Furthermore, embryonic VEGFR‐2 ⁺ /CD34 ⁺ stem cells may serve as vascular progenitor cells and their differentiation into endothelial cells and SMC may be regulated by VEGF and platelet‐derived growth factor (PDGF), respectively. In this review, we discuss the role of angiogenic growth factors such as VEGF, Ang, and PDGF in the recruitment of hematopoietic and vascular progenitor cells in TxCAD and suggest novel therapies targeted at homing, differentiation and proliferation of these cells in the allograft.