Use of Vicryl (polyglactin 910) mesh to limit epidural scar formation after laminectomy

A variety of substances have been used at laminectomy sites to prevent postoperative epidural scarring. Free grafts of autologous subcutaneous fat are commonly used both clinically and experimentally. The free fat grafts usually survive, but decrease in size by about 50%. Postoperatively, subcutaneous seroma has been observed with the use of fat grafts, as well as recurrent symptoms of neural compression by the graft that required additional operations. When compared to the use of free grafts after laminectomy in dogs, Vicryl mesh produced slightly more scarring, but consistently less than that observed in control animals. The Vicryl mesh was resorbed by a minimal chronic inflammatory response over about 45 days. Seven of 11 fat-grafted zones showed signs of necrosis, at times with a greater collection of inflammatory cells than that associated with the Vicryl mesh. Of the 4 fat-grafted zones that showed good survival, 2 had gross evidence of neural compression. No surgical zone treated with Vicryl mesh exhibited evidence of neural compression. In view of these results, the use of Vicryl mesh at laminectomy sites may be a safer method of limiting postoperative epidural scar formation.     

Radial artery infections and aneurysms after catheterization

Twelve patients in whom radial artery infections developed after catheterization in an intensive care unit over a 2-year period were reviewed. The incidence of local infection was 0.4%. An increased risk of infection was associated with prolonged catheterization (greater than 4 days). Aneurysms developed in five patients. Signs of septic emboli were present in two patients, including Osler's nodes, Janeway's lesions, and fingertip infarcts. In 6 of the 12 patients, the radial artery infection resolved with antibiotic treatment alone. The five patients with infected aneurysms were treated successfully with antibiotics and surgical excision. The radial artery was reconstructed by use of a vein graft in one patient. We believe that patients not responding promptly to antibiotics or patients with infected aneurysms are best treated by surgical excision.     

Glycerol-induced acute renal failure in the rat: the protective effect of unilateral nephrectomy

Studies were performed to evaluate the effect of unilateral nephrectomy on glycerol-induced acute renal failure in the rat. Normal rats were subjected to either sham uninephrectomy (n = 43) or right uninephrectomy (n = 53). The functional compensation of the remaining kidney was followed after 1 and 2 weeks. Fourteen days after the operation, acute renal failure was induced by injection of 50% glycerol solution to both groups. Uninephrectomised rats developed a lesser degree of renal failure compared to sham-operated rats. Forty-eight hours after glycerol injection, PCr of uninephrectomised rats was 260 +/- 22 mumol/l compared with 338 +/- 26 in sham-operated rats (P less than 0.0125) and CCr in uninephrectomised rats was greater (0.10 +/- 0.01 ml/min vs 0.07 +/- 0.01; P less than 0.025) in sham rats. Uninephrectomised rats had significantly greater recovery of CCr compared to sham rats at 24 h (20.1% +/- 2.3 vs 13.1% +/- 2.2, P less than 0.025) and at 48 h (32.1% +/- 3.3 vs 19.2% +/- 3.3, P less than 0.005) after glycerol injection. FENa was significantly less in uninephrectomised rats: 0.96 +/- 0.16% vs 2.25 +/- 0.05% (P less than 0.025) in sham rats 24 h post glycerol. Urinary excretion of K+ was greater in rats following uninephrectomy compared to sham rats both after 24 h and 48 h post glycerol (P less than 0.01), accompanied by lower plasma potassium (P less than 0.05). A correlation coefficient (r) of 0.793 was observed between urinary potassium excretion rate and percentage recovery of CCr.(ABSTRACT TRUNCATED AT 250 WORDS)     

The importance of intraoperative cholangiography during laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) using electrocoagulation was successfully performed in 56 out of 58 selected patients. Cholangiography was performed in 53 patients. Six patients had common duct stones; five were unsuspected preoperatively. After the gallbladder was removed, three patients underwent open common duct exploration. In another five cases, anatomical anomalies were discovered. Cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication--common duct injury. Cholangiography should be attempted on all patients undergoing LC.     

Acute erosions of the gastric mucosa in burned rats: effect of gastric acidity and fluid replacement

Early changes in the morphology of the gastric mucosa after the skin had been burned were studied using a standardised model in rats. A full thickness burn was inflicted by exposing about 20% of the total body surface area to hot water (99 degrees C) for 10 s. Intragastric acidity was kept at pH 1.0 or pH 7.4 in six experimental groups of eight rats. Rats were subjected to burns with the stomach irrigated at pH 1.0 or pH 7.4. Parallel groups received fluid replacement with a solution of human albumin, and two uninjured groups served as controls. Lesions of the gastric mucosa were measured by planimetry of photographs, and light microscopy was used for histological examination. At an intragastric pH of 1.0, the burned rats developed mucosal erosions covering an average of 13% of the total glandular mucosa; the remaining groups had only minimal mucosal lesions. Erosions of the gastric mucosa after the skin had been burned could be prevented in two ways--either by establishing an alkaline (pH 7.4) milieu in the gastric lumen, or by replacing sufficient fluid to maintain aortic blood pressure at the pre-experiment level. Fluid replacement prevented mucosal erosions even if the intragastric pH was kept at 1.0. Thus both luminal acidity and local tissue blood flow are possible mechanisms for gastric epithelial damage following burns of the skin.     

Acute idiopathic scrotal oedema: Rare disorder or difficult diagnosis?

This study reports our experience in 6 cases of acute idiopathic scrotal oedema. Although children were the primary targets, this pathologic condition was also encountered in adults. Specific diagnosis of acute idiopathic scrotal oedema, opposed to other causes of scrotal swelling, is based on history, an objective examination, velocimetric Doppler exam and echography. Correct diagnosis is important in order to avoid unnecessary surgery. We are inclined to consider acute idiopathic scrotal oedema as an allergic disorder and recommend a follow-up within two days.     

Health and social inequities in Switzerland

Despite standards of living and life expectancy amongst the highest in Europe, Switzerland exhibits fairly substantial social inequities in health. As regards male mortality by socio-economic group, these differentials are both marked and independent of cause of death. There is a wealth of information on morbidity and disability supporting the hypothesis that people in lower socio-economic groups tend to age faster and suffer more at younger ages. It is similarly evident that infants of low class mothers, particularly those unwed, underprivileged immigrant, are at excess risk. The Swiss results are of political and scientific interest in that they suggest that the average wealth of a community does not determine health differentials.