The influence of diabetes on short-term outcome following a prosthetic above-the-knee femoro-popliteal bypass

Objectives

To assess the influence of diabetes mellitus on early morbidity and mortality following a femoro-popliteal bypass.

Methods

Clinical data on patients subjected to a prosthetic above-the-knee femoro-popliteal bypass for atherothrombotic disease over a four-year period in the Durban Metropolitan Vascular Service were culled from a prospectively maintained computerised database. The patients were divided into two groups, diabetic and non-diabetic.

Results

Two hundred and seventeen patient records were analysed; 102 (47%) patients were diabetic and 115 (53%) non-diabetic. The mean age in the two groups was almost similar. Differences noted between the two groups were that there was a higher prevalence of males and cigarette smokers in the non-diabetic group and hypertension among the diabetics. The prevalence of ischaemic heart disease in the two groups was not statistically significant. The majority of patients in both groups presented with critical limb ischaemia.Overall, 208 (96%) of the patients had their procedures performed using loco regional anaesthesia. The incidence of superficial wound infection between the two groups was not statistically significant. Deep infection, which necessitated removal of the graft, and cardiovascular complications were significantly higher in the diabetics. Four patients (3.9%) in the diabetic group and only one (0.9%) in the non-diabetic group died.

Conclusion

Diabetes mellitus significantly increases the incidence of graft sepsis and cardiovascular morbidity in patients undergoing above-the-knee femoro-popliteal bypass.     

Antidepressant-like effects of cannabidiol in mice: possible involvement of 5-HT1A receptors

Background and purpose:

Cannabidiol (CBD) is a non-psychotomimetic compound from Cannabis sativa that induces anxiolytic- and antipsychotic-like effects in animal models. Effects of CBD may be mediated by the activation of 5-HT_1A receptors. As 5-HT_1A receptor activation may induce antidepressant-like effects, the aim of this work was to test the hypothesis that CBD would have antidepressant-like activity in mice as assessed by the forced swimming test. We also investigated if these responses depended on the activation of 5-HT_1A receptors and on hippocampal expression of brain-derived neurotrophic factor (BDNF).

Experimental approach:

Male Swiss mice were given (i.p.) CBD (3, 10, 30, 100 mg·kg⁻¹), imipramine (30 mg·kg⁻¹) or vehicle and were submitted to the forced swimming test or to an open field arena, 30 min later. An additional group received WAY100635 (0.1 mg·kg⁻¹, i.p.), a 5-HT_1A receptor antagonist, before CBD (30 mg·kg⁻¹) and assessment by the forced swimming test. BDNF protein levels were measured in the hippocampus of another group of mice treated with CBD (30 mg·kg⁻¹) and submitted to the forced swimming test.

Key results:

CBD (30 mg·kg⁻¹) treatment reduced immobility time in the forced swimming test, as did the prototype antidepressant imipramine, without changing exploratory behaviour in the open field arena. WAY100635 pretreatment blocked CBD-induced effect in the forced swimming test. CBD (30 mg·kg⁻¹) treatment did not change hippocampal BDNF levels.

Conclusion and implications:

CBD induces antidepressant-like effects comparable to those of imipramine. These effects of CBD were probably mediated by activation of 5-HT_1A receptors.     

Extraluminal colonic arteriovenous haemangioma: an unusual cause of chronic lower gastrointestinal bleeding

Lower gastrointestinal bleeding is a common general surgical presentation in acute and chronic settings. Vascular anomalies account for 2% of such cases and can therefore be missed. We discuss a rare vascular anomaly in one of our patients where the diagnosis was not established for a ten-year period. We describe the subsequent management and a brief review of the literature of this uncommon condition.     

Working toward reducing postoperative fracture radiographs: a survey of Canadian surgeons

BackgroundWhen fracture management includes operative fixation with a load-sharing construct in good-quality bone, screening for healing problems or hardware failure with radiographs in the first 6 postoperative weeks may be unnecessary. I sought to determine Canadian orthopedic surgeons’ current protocol for early postoperative radiographs of stable, internally fixed fractures as well as their willingness to adopt a simplified protocol.MethodsMembers of the Canadian Orthopaedic Association were surveyed electronically. Five examples of surgically treated fractures were chosen to represent the spectrum of load-sharing constructs. The survey collected demographic data and inquired about current postoperative radiograph protocols and consideration of a simplified protocol.ResultsOf the 822 emailed invitations to complete the survey, 400 were opened and 243 surveys were completed. Most participants (91%) practised in Canada and managed some trauma (91%), but were not trauma specialists (82%). Surgeon experience was equally distributed. Sixty-six percent of respondents acquire immediate postoperative radiographs after femur and tibia intramedullary nails, and 62% repeat radiographs at 2-week follow-up. Fifty-one percent of respondents acquire immediate postoperative radiographs after forearm, humerus and ankle internal fixation, and 69% repeat radiographs at 2-week follow-up. Of the respondents who currently acquire radiographs, 33% would consider foregoing immediate postoperative radiographs after intramedullary nailing of femur and tibia fractures, while 25% would forego them at 2-week follow-up. Similarly, 58% would consider foregoing radiographs immediately after internal fixation of forearm, humerus and ankle fractures, while 24% would forego them at 2-week follow-up.ConclusionMany Canadian orthopedic surgeons do not acquire screening postoperative radiographs after stable fracture fixation, and many more are willing to adopt this practice. These findings support investigating the safety and cost-effectiveness of a simplified postoperative radiographic protocol.     

POSTOPERATIVE UPPER GASTROINTESTINAL BLEEDING ASSOCIATED WITH ISCHAEMIC ULCERATION OF THE DUODENUM

SUMMARY A rare case is reported of massive postoperative bleeding associated with ischaemic ulceration of the duodenum.     

从《世说新语》看魏晋南北朝志人小说的特点

《世说新语》继承史传文学讲究“实录”的传统 ,崇尚真实。表达方式多为直陈其事 ,较少描写 ,缺乏完整的故事情节。善于即事见人 ,通过典型的细节刻划及对比手法等突现人物性格。人物语言简洁生动 ,较少用典。比喻手法的运用更增添了作品的形象性和艺术感染力。以《世说新语》为代表的魏晋南北朝志人小说的艺术成就对后世小说的影响是深远的。     

Urinary mutagenicity as a biomarker in workers exposed to benzidine: correlation with urinary metabolites and urothelial DNA adducts

Urinary mutagenicity has been used in occupational and epidemiological studies for over two decades as a cost-effective, general biomarker of exposure to genotoxic agents. However, few studies have compared urinary mutagenicity to additional biomarkers determined among low- and high-exposed groups. To address this issue, we evaluated the relationship between urinary mutagenicity and other types of biomarkers in a cross-sectional study involving 15 workers exposed to the urinary bladder carcinogen benzidine (BZ, high exposure), 15 workers exposed to BZ-dyes (low exposure), and 13 unexposed controls in Ahmedabad, India. Urinary organics were extracted by C18/methanol and evaluated for mutagenicity in the presence of S9 in the Salmonella strain YG1024, which is a frameshift strain that overproduces acetyltransferase. The results were compared to biomarker data reported recently from the same urine samples (Rothman et al., Proc. Natl Acad. Sci. USA, 93, 5084- 5089, 1996) that included a metabolite biomarker (the sum of the urinary levels of BZ + N-acetylbenzidine + N,N'-diacetylbenzidine) and a DNA adduct biomarker [a presumptive N-(3'-phosphodeoxyguanosin-8-yl)- N'-acetylbenzidine (C8dG-ABZ) DNA adduct in exfoliated urothelial cells]. The mean +/- SE urinary mutagenicity (revertants/micromol of creatinine) of the low-exposure (BZ-dye) workers was 8.2 +/- 2.4, which was significantly different from the mean of the controls (2.8 +/- 0.7, P = 0.04) as was that of the mean of the high-exposure (BZ) workers (123.2 +/- 26.1, P < 0.0001). Urinary mutagenicity showed strong, positive correlations with urinary metabolites (r = 0.88, P < 0.0001) and the level of the presumptive C8dG-ABZ urothelial DNA adduct (r = 0.59, P = 0.0006). A strong association was found between tobacco use (bidi smoking) and urinary mutagenicity among the controls (r = 0.68, P = 0.01) but not among the exposed workers (r = 0.18, P = 0.11). This study confirms the ability of a biomarker such as urinary mutagenicity to detect low-dose exposures, identify additional genotoxic exposures among the controls, and correlate strongly with urinary metabolites and DNA adducts in the target tissue (urinary bladder epithelia) in humans.      

A case of kernicterus in New Zealand: A predictable tragedy?

Abstract: A case of neonatal kernicterus due to glucose-6-phosphate dehydrogenase deficiency (G6PD) is described. Diagnosis was delayed as the primary healthcare attendant had no knowledge of this condition and its potential to cause rapidly escalating levels of bilirubin and as she was reassured by the lack of signs of systemic illness or anaemia. The baby has been left deaf, blind, intellectually handicapped, epileptic and paralysed due to athetoid cerebral palsy. The re-organization of perinatal care in New Zealand, which has ted to neonates sometimes being managed solely by primary healthcare attendants with minimal training in paediatrics may have increased the risk of a late diagnosis of potentially devastating diseases such as this.