Factors associated with trigger digit following carpal tunnel release

BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome.Carpal tunnel release(CTR) surgery may be a risk factor for trigger digit development;however,the association between surgical approach to CTR and postoperative trigger digit is equivocal.AIM To investigate patient risk factors for trigger digit development following either open carpal tunnel release(OCTR) or endoscopic carpal tunnel release(ECTR).METHODS This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit.Patients were stratified according to the technique utilized for their CTR,either open or endoscopic.The development of postoperative trigger digit was evaluated at three time points:within 6 mo following CTR,between 6 mo and 12 mo following CTR,and after 12 mo following CTR.Firth's penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit.Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit.RESULTS A total of 47 hands developed postoperative trigger digit following 967 CTR procedures(4.9%).In total,64 digits experienced postoperative triggering.The long finger was most commonly affected.There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR.Furthermore,there were no significant independent risk factors for postoperative trigger digit;however,within group analysis revealed a significant interaction effect between gender and surgical approach(P=0.008).Females were more likely to develop postoperative trigger digit than males after OCTR(OR=3.992),but were less likely to develop postoperative trigger digit than males after ECTR(OR=0.489).CONCLUSION Patient comorbidities do not influence the development of trigger digit following CTR.Markedly,gender differences for postoperative trigger digit may depend on surgical approach to CTR.     

Die Indikation zur Appendektomie nach einer sogenannten „3-Tages-Regel“Erfahrungen aus 10 jähriger Anwendung

Zusammenfassung. Seit 1981 findet bei Appendicitisverdacht zur Pr?zisierung der Operationsindikation eine sog. „3-Tages-Regel“ Anwendung. Die retrospektive Analyse von 1877 Appendektomien der Jahre 1/1981 bis 12/1990 ergab, da? die Mehrzahl histologisch eindeutig akuter Appendicitiden am Aufnahmetag operiert wurde. Darüber hinaus fand sich ein zweiter Gipfel histologisch akuter Appendicitiden mit uncharakteristischer Symptomatik am 3. bzw. 4. Tag. Ein weiteres Untersuchungsergebnis, nach dem 38,0 % (!) aller intraoperativ als „Unschuldswurm“ deklarierten Appendices histologisch eindeutig entzündliche Ver?nderungen aufwiesen, verdient Aufmerksamkeit. Die „3-Tages-Regel“ k?nnte in Zukunft auch im Rahmen pr?station?rer Diagnostik sinnvolle Anwendung finden.

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Summary. Since January 1981, the so-called “3-day principle” in cases of suspected appendicitis has been applied in order to render the indications for surgery more precise. The retrospective analysis of a total of 1877 appendectomies performed between 1981 and 1990 demonstrated that the majority of histologically definite cases of acute appendicitis had been surgically treated on the day of admission to hospital. Furthermore, a second peak of histologically evident cases of acute appendicitis was seen with non-characteristic symptoms on the 3rd day. An additional remarkable finding was that 38.0 % (!) of all appendices intraoperatively declared to be “innocent” showed histologically definite inflammatory alterations.

     

Admissions for antibiotic‐resistant infections in cancer patients during first year of cancer diagnosis: a cross‐sectional study

In this study, linked Western Australian health data were used to determine presence of an antibiotic‐resistant infection (ABRI) for all people diagnosed with a primary invasive cancer in 2009. Of 10 858 cancer cases, 154 (1.42%) had an ABRI. Patients with an ABRI were older (71.5 vs 66 years), and more had died in the year following diagnosis (37.7 vs 20.2%, P < 0.001). The ABRI cohort had a higher proportion of colorectal, genitourinary and haematological cancers (19.5 vs 11.9%; 14.3 vs 9.7% and 16.9 vs 5.8%, respectively). Hospital admissions with an ABRI were longer (22.3 vs 2.9 days, P < 0.001) and had a higher proportion of unplanned admissions (60.3 vs 15.2%), admissions through emergency department (36.8 vs 8.3%) and intensive care admissions (14.9 vs 1.7%, P < 0.001). Patients with solid tumours who developed an ABRI were more likely to have received chemotherapy (35.9 vs 27.8%, P = 0.04). In haematological cancer patients, a greater proportion of the admissions with an ABRI occurred after radiation therapy or chemotherapy (P = 0.01 and P = 0.005, respectively). This study is the first to report population‐level data on ABRI in cancer patients. Patients with an ABRI had more hospital admissions and poorer outcomes.     

Infection with Kaposi's sarcoma-associated herpesvirus among families of patients with classic Kaposi's sarcoma

BACKGROUND: Classic Kaposi's sarcoma (CKS) primarily affects elderly Mediterranean or Eastern European men. Incidence rates of CKS in Israel are among the world's highest. In practically all cases, antibodies against Kaposi's sarcoma-associated herpesvirus (KSHV) can be detected. A relatively high seroprevalence rate of KSHV in Israel generally correlates with the incidence of CKS. A sexual mode of virus transmission is recognized among homosexual men, whereas the precise transmission routes in the heterosexual population and those with CKS are still unclear. OBJECTIVE: To better assess the transmission routes of KSHV in Israeli patients with CKS and their first-degree relatives as compared with a control group. DESIGN: Serum was collected from all study participants and tested for KSHV antibodies by means of latent and lytic immunofluorescence assays. An open reading frame 65 (ORF65) Western blot assay was applied as a confirmatory tool. SETTING: Three dermatological departments in Israel. PATIENTS: Sixty-four Jewish patients with CKS, 143 of their first-degree relatives, and 186 hospital-based control subjects. RESULTS: Seropositivity to KSHV was detected in 62 (96.9%) of the patients with CKS, in 56 (39.2%) of their first-degree relatives, and in only 21 (11.3%) of the hospital controls (P<.001). The specific relationship with the index patient (spouse, offspring, or sibling) had no significant effect on the prevalence of serpositivity in the family members. CONCLUSION: Our serologic evidence of familial clustering of KSHV infection suggests a predominantly nonsexual horizontal transmission route of the virus.     

Effect of Exchangeable Ions in Natural and Modified Zeolites on Ag Content,Ag Nanoparticle Formation and Their Antibacterial Activity

To broaden the application of silver nanoparticles (AgNPs), which are well-known antibacterial agents, they are supported on different substrates to prevent aggregation, increase their surface area and antibacterial efficiency, and to be separated from the system more effectively at the end of treatment. To produce nanocomposites that consist of silver nanoparticles on natural and modified zeolites, silver ions (Ag⁺) were loaded onto zeolite (natural, Na-modified, H-modified) and then thermally reduced to AgNPs. The effect of the exchangeable cations in zeolite on Ag⁺ uptake, AgNPs formation, size and morphology was investigated by the TEM, SEM, EDX, XPS, UV-vis, XRD and BET methods. The silver amount in the nanocomposites decreased in the following order Na-modified zeolite > natural zeolite > H-modified zeolite. Microscopic techniques showed formation of AgNPs of 1–14 nm on natural and Na-modified zeolite, while the diameter of metal particles on H-modified zeolite was 12–42 nm. Diffuse reflectance UV-vis and XPS methods revealed the presence of both silver ions and AgNPs in the materials indicating that partial reduction of Ag⁺ ions took place upon heating at 400 °C in air. Additionally, antibacterial properties of the nanocomposites were tested against Escherichia coli, and it was found that Ag–containing composites originating from the Na-modified zeolite demonstrated the highest activity.     

Green Synthesis of Stable Spherical Monodisperse Silver Nanoparticles Using a Cell-Free Extract of Trichoderma reesei

In the current study, a green method for the preparation of silver nanoparticles (AgNPs) is presented as an alternative to conventional chemical and physical approaches. A biomass of Trichoderma reesei (T. reesei) fungus was used as a green and renewable source of reductase enzymes and metabolites, which are capable of transforming Ag⁺ ions into AgNPs with a small size (mainly 2–6 nm) and narrow size distribution (2–25 nm). Moreover, extracellular biosynthesis was carried out with a cell-free water extract (CFE) of T. reesei, which allows for facile monitoring of the bioreduction process using UV–Vis spectroscopy and investigation of the effect of experimental conditions on the transformation of Ag⁺ ions into AgNPs, as well as the simple isolation of as-prepared AgNPs for the study of their size, morphology and antibacterial properties. In continuation to our previous results about the influence of media on T. reesei cultivation, the amount of biomass used for CFE preparation and the concentration of Ag⁺ ion solution, herein, we present the impact of temperature (4, 20, 30 and 40 °C), agitation and time duration on the biosynthesis of AgNPs and their properties. A high stability of AgNPs in aqueous colloids was observed and attributed to the capping effect of the biomolecules as shown by the zeta potential (−49.0/−51.4 mV) and confirmed by the hydrodynamic size of 190.8/116.8 nm of AgNPs.     

Autosomal recessive malformation syndrome with minor manifestation in the heterozygotes: A preliminary report of a possible new syndrome

We describe 3 patients with a new malformation syndrome in 2 sibships in a large kindred from Bahia, Brazil. The parents in both sibships are consanguineous. The syndrome is characterized by malformations of the face, ears, hands and feet, plus mixed deafness and pseudopapilledema. Fifty-four relatives were examined clinically and scored by the number of anomalies. A control sample of 54 individuals was equally examined. The distribution of the number of anomalies per individual (score) is bimodal in the relatives of the patients but unimodal in the control individuals. Detection of heterozygotes was based on the score distribution.