A double-chamber rotating bioreactor for the development of tissue-engineered hollow organs: From concept to clinical trial

Cell and tissue engineering are now being translated into clinical organ replacement, offering alternatives to fight morbidity, organ shortages and ethico-social problems associated with allotransplantation. Central to the recent first successful use of stem cells to create an organ replacement in man was our development of a bioreactor environment. Critical design features were the abilities to drive the growth of two different cell types, to support 3D maturation, to maintain biomechanical and biological properties and to provide appropriate hydrodynamic stimuli and adequate mass transport. An analytical model was developed and applied to predict oxygen profiles in the bioreactor-cultured organ construct and in the culture media, comparing representative culture configurations and operating conditions. Autologous respiratory epithelial cells and mesenchymal stem cells (BMSCs, then differentiated into chondrocytes) were isolated, characterized and expanded. Both cell types were seeded and cultured onto a decellularized human donor tracheal matrix within the bioreactor. One year post-operatively, graft and patient are healthy, and biopsies confirm angiogenesis, viable epithelial cells and chondrocytes. Our rotating double-chamber bioreactor permits the efficient repopulation of a decellularized human matrix, a concept that can be applied clinically, as demonstrated by the successful tracheal transplantation.     

Helping the soul: the relationship between connectivity and well‐being within a church community

Although previous research attests to the importance of psychological sense of community (PSOC) to individuals' well‐being, little research has examined this relationship for the four proposed dimensions of PSOC: membership, influence, integration and fulfillment of needs, and shared emotional connection (McMillan & Chavis, 1986). Further, little research has explored multiple aspects of community connectivity in the one study. The current research investigated the relationship between participants' (N=127) religiosity, PSOC, social support, and identification within a church community context and their well‐being. Results indicated that the PSOC dimensions of shared emotional connection and influence were particularly important in the prediction of well‐being in this context. Further, individuals' perception of social support mediated the relationship between PSOC and well‐being and the strength of individuals' identification as a church member enhanced the relationships of both PSOC and religiosity with well‐being. © 2009 Wiley Periodicals, Inc.     

Enterolith ileus due to jejunal diverticulosis

Jejunal diverticulosis is a rare malformation that is often asymptomatic. Complications might be similar to those occurring in large-bowel diverticula but also include a much more particular event: intestinal obstruction due to migration and impaction of enterolith formed inside diverticula. This is a very uncommon entity; diagnosis and management are thus often delayed. Mostly surgical exploration is necessary because obstruction symptoms are unresponsive to medical treatment. The authors report a new case of enterolith ileus in a 74-year-old man, due to jejunal diverticulosis, and its successful surgical management in emergency. Only 39 similar cases have ever been reported in the literature.     

Pancreatic duct stents for "obstructive type" pain in pancreatic malignancy

OBJECTIVE: Obstruction of the main pancreatic duct from malignancy with secondary ductal hypertension may be an important contributor to pain. The aim of our study was to determine the efficacy and safety of pancreatic stent placement for patients with "obstructive" pain due to pancreatic malignancy. METHODS: Pancreatic duct stents were placed in 10 consecutive patients with malignant pancreatic duct obstruction and abdominal pain. Seven patients had "obstructive" type pain and three had chronic unremitting pain. Nine had primary pancreatic ductal adenocarcinoma and one had metastatic melanoma. There were eight women and two men. Mean age was 61 yr (range, 47-80 yr). All patients had dominant main pancreatic duct strictures with proximal dilation. Tumors were unresectable. All patients took potent analgesics before endoscopic stent therapy. Polyethylene pancreatic stents, 5- and 7-French, were successfully placed in seven patients, and self-expanding metallic stents were successfully placed in three patients. RESULTS: There were no procedure-related complications. One patient required a single repeat examination to replace a migrated stent. Seven patients (75%) experienced a reduction in pain. Analgesia was no longer required in five (50%). Three patients who did not improve had chronic pain rather than "obstructive" pain. CONCLUSIONS: Pancreatic stent placement for patients with "obstructive" pain secondary to a malignant pancreatic duct stricture appears to be safe and effective. It should be considered as a therapeutic option in these patients. It does not seem to be effective for chronic unremitting pain.     

Late anaphylactic shock after hysterosalpingography

We observed a patient who had a severe anaphylactic reaction 1 hour after HSG. Allergic symptoms recurred several hours after antiallergic therapy was stopped. The initial complaints of pain and vomiting could have been due to peritoneal irritation or alternatively to an early anaphylactic reaction. Patients who are at risk should be carefully evaluated before performing HSG. These patients and those with complaints after HSG should stay under observation for 1 or 2 hours after HSG.     

Physical effects of reuse and repeated ethylene oxide sterilization on transscleral cyclophotocoagulation laser G-probes

PURPOSE: The authors documented the physical effects of reuse and repeated ethylene oxide sterilization on transscleral cyclophotocoagulation laser G-probes. METHODS: Transscleral cyclophotocoagulation was performed using G-probes on fresh porcine eyes. Each of two G-probes was used for four transscleral cyclophotocoagulation procedures, with three cycles of ethylene oxide sterilization in between. The power output from the G-probes was measured by a laser output meter before and after each transscleral cyclophotocoagulation procedure. The G-probes were also examined under a slit lamp for signs of physical damage. RESULTS: Repeated use of the G-probe in transscleral cyclophotocoagulation, with ethylene oxide sterilization in between, resulted in an average decrease of 3% in laser energy delivered per repeated cycle of use up to the fourth cycle. No signs of physical damage were found. CONCLUSIONS: Laser G-probes remain functional after repeated use and ethylene oxide resterilization for up to four cycles. No visible physical damage to the probes was identified. It is safe and cost-effective to reuse G-probe for transscleral cyclophotocoagulation with ethylene oxide sterilization, provided the surgeon stays alert for signs of probe damage. This alertness should be retained regardless of whether new or old G-probes are used.     

Intracameral lidocaine in trabeculectomy. A preliminary safety and efficacy study

PURPOSE: To study the safety and efficacy of intracameral lidocaine as anaesthesia in trabeculectomy for primary open-angle glaucoma. METHODS: Trabeculectomy under intracameral anaesthesia using 1% preservative-free lidocaine was performed in 10 patients with primary open-angle glaucoma. Intraoperative pain score, postoperative intraocular pressure (IOP) and endothelial cell count at 3 months were recorded. RESULTS: The mean pain score was 1.70 +/- 1.34. The mean IOP was lowered from 24.60 +/- 8.28 mmHg preoperatively to 14.1 +/- 3.11 mm Hg postoperatively. There was no significant decrease in the mean endothelial cell count 3 months after the surgery (P = 0.375). CONCLUSION: Intracameral lidocaine may be a safe and effective alternative anaesthesia method in trabeculectomy for uncomplicated primary open-angle glaucoma.     

Incisional surgery for angle closure glaucoma

Angle closure glaucoma remains a major challenge for ophthalmologists. The three main challenges in the treatment of angle closure glaucoma are, firstly, to achieve rapid reduction of intraocular pressure in acute angle closure glaucoma, secondly, to prevent progression to chronic angle closure glaucoma, and thirdly, to manage established chronic angle closure glaucoma. Incisional surgery for angle closure glaucoma is typically required when laser surgery and/or medical therapy fail to control the intraocular pressure or control progressive synechial closure. The role for surgical iridectomy and emergency trabeculectomy in the modern management of acute angle closure glaucoma is diminishing. Trabeculectomy, goniosynechialysis, cyclodestructive procedures, and glaucoma implant are effective surgical options for chronic angle closure glaucoma, but none of them have been shown to be more effective than the others with proper comparative clinical trials. Trabeculectomy and goniosynechialysis are often combined with cataract extraction, which appears to offer additional pressure-control benefits to patients with chronic angle closure glaucoma.