What has changed in malignant mesothelioma between 1990 and 2019? A time- series analyses in Turkey

International Journal of Clinical Oncology - To investigate the changes in epidemiological and survival characteristics of malignant mesothelioma (MM) cases diagnosed in a 30-year period between...     

Soft-tissue reconstruction of the foot with distally based neurocutaneous flaps in diabetic patients

Soft-tissue coverage of the foot in diabetic patients is often a difficult problem to undertake. The aim of this study was to evaluate the efficiency and safety of distally based neurocutaneous flaps for foot reconstruction in diabetic patients. The authors describe their experience with a series of 10 diabetic patients in whom reconstruction of defects of the foot (range, 6 x 11-10 x 12 cm) were performed using distally based sural and saphenous neurocutaneous flaps. In 9 patients the flap survived completely and in only 1 patient was superficial marginal necrosis of the flap observed. Partial skin graft loss at the donor site occurred in 1 patient, but no additional surgical revision was needed and healing occurred by secondary intention. In these diabetic patients, defects were reconstructed successfully using neurocutaneous flaps, and good results were achieved.     

Der postischämische Reperfusionsschaden Biochemische und methodische Grundlagen

The term "ischemic reperfusion injury" encompasses all toxic events in a cell that occur during ischemia and subsequent reoxygenation. These reactions have a significant effect, for example, on the rate of organ survival in kidney transplantation. Reactive oxygen intermediates (ROI) play an important role in the process of postischemic reperfusion. The basic mechanisms of generation and detoxification of ROI as well as the possibilities for their registration and quantification under conditions of ischemic reperfusion injury in the rat kidney are demonstrated in this report. A prerequisite to developing cytoprotective strategies is understanding the precise course of these mechanisms to minimize damage caused by ischemia and the subsequent reperfusion, thus retaining the organ's function to the greatest extent.     

Combination of different techniques for the treatment of earlobe keloids

Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined these techniques to improve therapeutic outcomes for earlobe keloids. Nine patients with earlobe keloids of a total number of 12 with auricular keloids were treated with a combined approach between 1995 and 2001. The keloids varied in size 2 × 1 to 5 × 3 cm and the patient age ranged 15–63 years. The patient group consisted of nine females, three males. Ear piercing was the main etiological factor for females. In the first session, surgical excision of the keloids was performed. It was followed with triamcinolone acetonide injection to the surgical field on the postoperative second week. Slight pressure was applied by silicone gel sheet coated earring for four months. No recurrence was noted in eight patients over longterm followup. One of nine patients had keloid recurrence. The authors found the results promising a combination of four techniques for treatment of ear lobe keloids is recommended even for recurrent lesions.     

Supplemental oxygen reduces the incidence of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) are unpleasent for patients and increase the risk of aspiration pneumonia. PONV is the leading cause of unexpected admission following planned day surgery. Despite new anaesthetic drugs and antiemetics, the incidence of PONV remains high. The incidence of PONV depends numerous factors including age, gender, obesity, anxiety, gastroparesis, history of motion sickness, previous PONV, and the duration and type of surgery. Anaesthesia related factors include premedication, ventilation techniques, and postoperative pain management. Recently, the intraoperative inspired oxygen concentration was identified as a factor that influences PONV. Among the three studies that evaluated intraoperative supplemental O2 for prevention of PONV, two found that it halves PONV while the third failed to identify any benefit. Since supplemental O2 is inexpensive and essentially risk-free, it appears preferable to pharmacologic anti-emetics for prevention of PONV in abdominal surgery.     

In vitro effects of dantrolene sodium and verapamil on noradrenaline-induced contractions of rabbit aorta and their interactions

The effects of dantrolene sodium (0.1 to 10 microM) and verapamil (0.01 to 1 microM) administered alone or together (1 microM verapamil, 0.1 to 10 microM dantrolene sodium) were investigated in isolated rabbit thoracic aorta precontracted with 0.1 microM noradrenaline (NA). Verapamil plus dantrolene sodium produced a dose-dependent inhibition of aortic strips contractions evoked by NA, and all concentrations of dantrolene sodium significantly decreased the inhibitory effect of 1 microM verapamil (p < 0.001, ANOVA). In conclusion, dantrolene sodium and verapamil inhibited 0.1 microM noradrenaline-evoked aorta contractions, and all doses of dantrolene sodium decreased the inhibitory effect of 1 microM verapamil in a dose-dependent manner.     

Initial experience with a novel heat-exchanging catheter in neurosurgical patients

Even mild hypothermia provides marked protection against cerebral ischemia in animal models. Hypothermia may be of therapeutic value during neurosurgical procedures. However, current cooling systems often fail to induce sufficient hypothermia before the dura is opened. Furthermore, they usually fail to restore normothermia by the end of surgery, thus delaying extubation. We evaluated a new internal heat-exchanging catheter. Eight ASA physical status II-IV patients (29-72 yr) undergoing craniotomy were enrolled. After the induction of general anesthesia, we introduced the SetPoint catheter into the inferior vena cava via a femoral vein. The target core body temperature was 34 degrees C-34.5 degrees C. After reaching the target, core temperature was maintained until the dura was closed. Target core temperature was then set to 37.0 degrees C, and the patient was rewarmed as quickly as possible. Seven patients had a tumor resection, and one had an aneurysm clipped. The core-cooling rate was 3.9 degrees C +/- 1.6 degrees C/h, and the rewarming rate was 2.0 degrees C +/- 0.5 degrees C/h; core temperature was 35.9 degrees C +/- 0.2 degrees C by the end of surgery. Patients were subsequently kept normothermic for 3 h before the catheter was removed. No thrombus or other particulate material was identified on the extracted catheters. None of the patients suffered any complications that could be attributed to the SetPoint system or thermal management. IMPLICATIONS: Because current systems for inducing therapeutic hypothermia are too slow, we tested an internal counter-current thermal management system during hypothermic neurosurgery. The SetPoint catheter cooled at 3.9 degrees C +/- 1.6 degrees C/h and rewarmed at 2.0 degrees C +/- 0.5 degrees C/h. Catheter-based internal thermal management thus seems to be rapid and effective.     

Hypercapnia improves tissue oxygenation

BACKGROUND: Wound infections are common, serious, surgical complications. Oxidative killing by neutrophils is the primary defense against surgical pathogens and increasing intraoperative tissue oxygen tension markedly reduces the risk of such infections. Since hypercapnia improves cardiac output and peripheral tissue perfusion, we tested the hypothesis that peripheral tissue oxygenation increases as a function of arterial carbon dioxide tension (PaCO(2)) in anesthetized humans. METHODS: General anesthesia was induced with propofol and maintained with sevoflurane in 30% oxygen in 10 healthy volunteers. Subcutaneous tissue oxygen tension (PsqO(2)) was recorded from a subcutaneous tonometer. An oximeter probe on the upper arm measured muscle oxygen saturation. Cardiac output was monitored noninvasively. PaCO(2) was adjusted to 20, 30, 40, 50, or 60 mmHg in random order with each concentration being maintained for 45 min.(2) (2) RESULTS: Increasing PaCO(2) linearly increased cardiac index and PsqO(2) : PsqO(2) = 35.42 + 0.77 (PaCO(2)), < 0.001. CONCLUSIONS: The observed difference in PsqO(2) is clinically important because previous work suggests that comparable increases in tissue oxygenation reduced the risk of surgical infection from -8% to 2 to 3%. We conclude that mild intraoperative hypercapnia increased peripheral tissue oxygenation in healthy human subjects, which may improve resistance to surgical wound infections.