Late infection after cranioplasty--review of 14 cases

The incidence of late infection after cranioplasty was studied in 130 patients with 133 cranioplasties. The materials used were prefabricated resin in 62 cases, autogenic bone in 38, intraoperatively fashioned resin in 25, and vitallium in eight. Six infections were documented, for an infection rate of 4.5%. In addition to these six cases, we studied eight patients with infections who had undergone cranioplasty elsewhere but had the infected plates removed in our hospitals. Among the 14 cases of infection, the intervals between cranioplasty and plate removal were 3 to 43 months (average, 10.5 months). The eight patients referred from other hospitals had a significantly shorter average interval between external decompression and cranioplasty than did patients who did not develop infection (2.6 versus 6.7 months; p less than 0.005). Systemic signs were mild despite obvious local signs of infection. Of the 11 first infections, nine (82%) were associated with discharge of pus from a fistula; in these cases a galeal suture had become infected apparently through scratching by the patients. In contrast, in the three patients who had had a previous infection, the second infection manifested as subgaleal and epidural empyema or meningitis without a fistula or pus discharge. Nine infections (69%) were due to Staphylococcus. All but two patients required removal of the infected plates. One recovered with conservative therapy and one died of meningitis, giving a mortality rate of 0.8%. No matter how mild the systemic signs, late infection warrants surgical debridement and plate removal. The risk factors for late infection of cranioplasty are discussed.     

Pathologic findings after recession and resection of extraocular muscles in rabbits

A study on the pathologic findings after recession and resection of extraocular muscles in rabbits was performed. Fibrosis of the extraocular muscles increased with time, which showed no difference between the recessed and resected muscles. Inflammation and foreign body reaction decreased with time, which showed no difference between the recessed and resected muscles. Adhesions of extraocular muscles to the sclera were observed from one month after the operation. The resected muscles showed milder adhesion to the sclera than the recessed ones. The operated extraocular muscles showed atrophies at one month, which showed no difference between the recessed and resected muscles. According to our results, when reoperation is needed, fibrosis of the extraocular muscles after recession and resection should be considered when making a decision on the amount of muscle to be recessed and resected.     

Effect of a natural flavonoid on gastric mucosal barrier

The effects of 3,5,7-trihydroxy-2-(3,4-dihydroxyphenyl)-1-benzopyrylium chloride (IdB 1027) on the rat gastric mucosa were evaluated. IdB 1027 administered intragastrically at doses ranging from 100 to 400 mg/kg inhibited the fall in transmucosal potential difference and the increase in H+ back-diffusion induced by acetylsalicylic acid. Moreover, IdB 1027 at doses of 50 and 200 mg/kg by intragastric route increased the gastric bicarbonate secretion. These results suggest that the gastroprotective activity of IdB 1027 is mediated by an increase in the efficiency of gastric mucosal barrier.     

Experimental study on the optimal size of the tricuspid valve annular area on annuloplasty

The optimal size of tricuspid valve annular area (TVAA) by annuloplasty for tricuspid regurgitation remains controversial. Recently, we developed a new measuring system which permits to do real-time measurement of tricuspid valve annular area in anesthetized dogs. Using this system, we studied the optimal size of TVAA by annuloplasty. After the right atrial incision, a metal thread which functions as a sense loop of the electromagnetic fields was stitched along the tricuspid valve annulus (visible juncture of the valve leaflets and the cardiac wall). The drive coil assembly was placed perpendicular to the extension of the long axis of the heart and was directed toward the tricuspid valve region. During control conditions, the maximum TVAA appeared at the onset of ventricular systole. The minimum TVAA appeared during the early ventricular diastolic phase which included the ventricular isovolumic relaxation phase. The maximum TVAA varied in five dogs between 2.2 cm2 and 3.1 cm2, the minimum TVAA also varied between 1.8 cm2 and 2.5 cm2: During regular sinus rhythm, a decrease of TVAA during one cardiac cycle ranged between 11.9% and 22.4% of the maximum size. When TVAA was not decreased by annuloplasty to the minimum area which was observed during cardiac cycle in the control state, the cardiac output and the right atrial pressure remained unchanged, because the ventricular filling was not obstructed. On the other hand, when TVAA was decreased smaller than this minimum area, the cardiac output decreased and the right atrial pressure rose.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mycobacterium ulcerans infection in Ashanti region, Ghana

We describe a series of 96 cases of Mycobacterium ulcerans infection (Buruli ulcer) from a new endemic focus in the Afram valley, north of Agogo, in Ghana. 63 cases were children under 13 years old. Active treatment by excision and skin grafting necessitates long stays in hospital and repeated procedures. Scarring and contracture are frequent. Eyes and other vital organs may be destroyed. In its endemic foci Buruli ulcer is a serious health burden on rural populations. Research is urgently needed, especially in prevention and non-surgical management.     

Positive sign of the stenocardia syndrome as a criterion of myocardial ischemia during the treadmill test

Diagnostic validity of the criteria of myocardial ischemia in coronary patients exposed to the treadmill test is assessed. The risk of a false diagnosis of coronary insufficiency on the basis of the pain syndrome was 5 times as high as that of diagnosis based on ischemic electrocardiographic ST depression. In subjective assessment of walking tolerance, patients with severe angina were particularly prone to mistakes. Limitations of angina classifications by severity, based on subjective sensations of coronary patients, are considered.     

Role of immediate versus delayed nephrectomy for failed renal transplants

The role of timing of transplant nephrectomy after renal transplantation has not been well defined. This report compares the morbidity, mortality, and hospitalization costs of 37 patients undergoing transplant nephrectomy within 14 days after graft failure and return to dialysis, with 31 patients undergoing delayed transplant nephrectomy (less than 14 days after graft failure and return to dialysis). This analysis revealed that there were no significant (P greater than .05) differences in patient morbidity and mortality between these groups. There was, however, a substantial increase (P less than .05) in the cost of hospitalization in the delayed nephrectomy group. For this reason, we recommend early nephrectomy after renal transplant failure in order to minimize the cost of health care for these patients undergoing failed cadaver donor transplant nephrectomy.     

Radiological findings in 1135 edentulous patients

A sample consisting of 1135 edentulous patients with clinically healthy denture bearing areas, was examined radiologically. It appears that the diagnostic yield is high whereas the expected radiation induced risk is low. Patients should therefore be examined radiologically prior to full denture construction.