A randomised trial of ultrasonic dissection versus electrocoagulation to reduce lymphatic complications after surgery for recurrent sapheno-femoral incompetence.

OBJECTIVE: Prospectively to compare lymphatic drainage after ultrasonic dissection, an electrocoagulation technique and sharp dissection in the groin during surgery for recurrent sapheno-femoral incompetence. DESIGN: Prospective, randomised study comparing three surgical techniques. METHODS: Thirty-six consecutive patients undergoing surgery for recurrent sapheno-femoral incompetence were randomised. Twelve patients underwent dissection with ultrasound, 12 with electrocoagulation and 12 controls had sharp dissection with ligation of scar and lymphatic tissue using absorbable suture material. RESULTS: The mean drain output per patient was 13.5 ml in the ultrasonic group, 15.4 ml in the electrocoagulation group and 8.3 ml in the suture ligation group. Six minor cases of lymphatic leakage occurred in the ultrasonic group. This resulted in no clinical problem. There were no other significant differences between the three groups. CONCLUSIONS: There is no detectable advantage for the use of ultrasound or electrocoagulation in recurrent saphenous high ligation compared to sharp dissection.     

Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population

BACKGROUND: There is no consensus regarding the optimal rate of follow-up in the post-bariatric surgery patient population. METHODS: The records of all patients who underwent laparoscopic Roux-en-Y gastric bypass from 2001 to 2003 were reviewed. Using patient zip codes, travel distances were calculated between the patients' places of residence and our clinic. Patients were then assigned to 1 of 3 cohorts according to the following distances: (1) < 50 miles, (2) 50 to 100 miles, and (3) > 100 miles. Patient compliance with follow-up appointments at 3 weeks, 3 months, 6 months, 9 months, and 12 months was analyzed. Linear trends were identified using the Mantel-Haenszel test. Age and sex were analyzed as possible predictors of compliance using the chi(2) test. P values < .05 were considered statistically significant. RESULTS: The study group comprised 150 patients (127 females and 23 males). The 3 cohorts contained 115, 21, and 14 patients, respectively. All patients in each cohort were compliant with the 3-week follow-up appointment. Although there were differences in compliance between cohorts at each of the remaining appointments, only the 9-month (70.3% vs 61.9% vs 35.7%) visit showed statistical significance (P = .035). The 6-month visit trended toward significance (85.2% vs 76.2% vs 64.3%; P = .088). Males were more likely to be compliant with the 12-month follow-up (P = .040). When controlling for sex, travel distance was also a predictor of compliance at this follow-up visit (P = .024). Age was not predictive of compliance (P = .827). CONCLUSION: Based on our findings, we conclude that travel distance from the clinic does not significantly affect compliance at the initial follow-up, 3-month, and 12-month appointments. However, distance does tend to affect compliance at the 6-month appointment and significantly affects compliance at the 9-month appointment. Males are more likely to be compliant at the 12 month follow-up visit. We must continue to strive for 100% follow-up in our post-bariatric surgery patients.     

Composite prostheses for the repair of abdominal wall defects: effect of the structure of the adhesion barrier component

The component of a composite prosthesis, which makes contact with the visceral peritoneum, can be reabsorbable or non-reabsorbable, and laminar or reticular. This study was designed to determine whether the composition of this second, barrier component could improve its behavior at this interface. Abdominal wall defects in rabbits were repaired using a polypropylene prosthesis (PP), or the composites Sepramesh (PP+h) or Vicryl (PP+v). Fourteen days after surgery, the implants were evaluated by light and scanning electron microscopy, and immunohistochemistry. Prosthetic areas occupied by adhesions (PP: 71.08±5.09, PP+h: 18.55±4.96, P+v: 69.69±16.81%), neoperitoneal thickness (PP: 256.17±21.68, PP+h: 83.11±19.63, PP+v:213.72±35.90 μm) and macrophage counts (PP: 8.73±1.16, PP+h: 27.33±4.13, PP+v: 31.24±3.08%) showed significant differences (P<0.05). The tested biomaterials induced an optimal recipient tissue infiltration. Least adhesion formation was observed on the PP+h implants. This suggests that the second component, although reabsorbable, should be smooth in structure.     

P31 The relationship between the relative amount of Porphyromonas gingivalis in saliva and halitosis

Objectives  Porphyromonas gingivalis is one of the microorganisms that most actively produce CH₃SH and we have reported that subjects with P . gingivalis have higher CH₃SH levels than subjects without P .  gingivalis . However, little is known about the relationship between P . gingivalis levels in saliva and the condition of oral malodor. In this study, we evaluated the association between the relative amount of P . gingivalis in saliva and halitosis in mouth air.
Methods  All of the subjects were patients at the Preventive Dentistry and Breath Odor Clinic of Kyushu Dental College, where they received a periodontal examination. Volatile sulfur compounds (VSC: hydrogen sulfide and methyl mercaptan) were measured using gas chromatography. Saliva samples were collected in a sterile plastic tube over a period of 5 min while the subject chewed on paraffin wax, and were then immediately stored at –80°C until use. Template DNA was obtained from the stored saliva using an Easy-DNA Kit (Invitrogen, CA, USA) according to the manufacturer's instructions. Conventional PCR assays were used to confirm the presence of P . gingivalis . A 5' nuclease TaqMan PCR was used to quantify P . gingivalis in saliva. The relative numbers of bacteria were measured using the comparative threshold cycle method.
Results  We found a quantitative relationship between the P . gingivalis levels in saliva and the condition of halitosis in mouth air.
Conclusion  We analyzed the relationship between the relative amount of P . gingivalis in saliva and oral malodor.     

Demographic variables of gestational trophoblastic disease in KwaZulu-Natal, South Africa.

The aim of the study was to map out the pattern of referral of patients with gestational trophoblastic disease (GTD) presenting to a large tertiary referral centre, from the health districts of KwaZulu Natal province, South Africa, and to determine the demographic variables in the presentation of the disease. This retrospective study reviewed the clinical charts of 98 patients managed at the combined gynaecology/oncology clinic over a 5-year period. The types of GTD included molar pregnancy 50 (51%), choriocarcinoma 46 (46%) and placental site trophoblastic tumour 2 (2%). The majority of patients were referred by the district or regional hospitals (63.3%), followed by self-referrals (23.5%). There were 51 (52%) patients from eThekwini health district and only 25 patients (25.4%) from the Northern health districts. With regard to previous pregnancy state, 63.3% (n = 62) had term pregnancy, 13.3% (n = 13) had previous miscarriage and 2% (n = 2) had previous ectopic pregnancy. Five patients (5.1%) had previous molar pregnancy. We did not find a trend of referral of patients being predominantly from the Northern regions of KwaZulu Natal.     

The Fagerström Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire

We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).