Surgical complications of 844 consecutive cochlear implantations and observations on large versus small incisions

Abstract

Objectives To list the complications encountered in a series of 844 consecutive patients and to evaluate the long-term difference in wound and flap problems between large and small incisions.

Patients 844 consecutive patients underwent cochlear implantation at the Sydney Cochlear Implant Centre. 212 cases were operated on prior to October 1994 using the retroauricular 'C'-shaped incision or a postauricular incision with a horizontal posterior limb. After October 1994 a new, small vertical postaural incision was used in all patients. Postoperative problems were analysed.

Study design Prospective longitudinal study of cochlear implant recipients from1984 to 2003.

Setting Tertiary care referral centre.

Intervention Change in incision for cochlear implantation.

Main outcome measure Causes of postoperative problems, need for reimplatation, and wound and flap problems.

Results 80 out of the total 844 patients underwent revision procedures for various reasons. The commonest cause of reimplantation was device failure (2.01%) or suboptimum performance of the device (2.37%). Wound and flap problems were encountered by 5 patients out of 212 (2.3%) in the first group. In comparison, 7 out of 632 patients (1.10%) from the later group experienced wound and flap problems using the new incision.

Conclusion There is a reduced incidence of wound and flap problems with small skin incisions and minimal scalp mobilization. Device failure, wound and flap problems are still the commonest causes of explantation. Performance of the replacement device usually was similar to the original device and was not related to the aetiology of deafness or to the cause of explantation. These data will be useful in counselling patients for reimplantation/revision surgery.     

Angiogenesis with biomaterial-based drug- and cell-delivery systems

Angiogenesis, the formation of new blood vessels from existing ones, is an important event in several biological processes, including wound healing. It plays a key role in determining the final functionality and integration of any implanted medical device. In addition, angiogenesis is a required event for organ development and has been accepted as a rate-limiting step in engineering tissue replacements. Besides these regenerative processes, uncontrolled angiogenesis is also involved in a number of pathologies, including tumor growth and metastases. Like angiogenesis, biomaterials also play a role in wound healing after medical device implantation and in tissue engineering. Interactions between the device biomaterials and host tissue will factor into the final device integration. Additionally, tissue-engineering strategies utilize biomaterials to a great extent because the paradigm of tissue engineering involves the use of cells, growth factors and scaffolding matrices in order to regenerate or replace tissue. Since almost all tissues are three-dimensional, the biomaterial scaffold plays an integral role in the paradigm. This review will emphasize the influence of biomaterials on angiogenesis as it applies to medical device implantation, tissue engineering and therapies for pathological angiogenesis.     

Foscarnet therapy for congenital cytomegalovirus liver fibrosis following prenatal ascites

We report on an infant with multi-system disease including liver fibrosis, right microphthalmia with cataract, interstitial pneumonitis, and hyperechoic lesions in the basal ganglia and in the periventricular and thalamic regions. Prenatal ascites with hepatomegaly concomitantly with detection of cytomegalovirus (CMV) DNA in the amniotic fluid, following recurrent maternal CMV infection, had been shown. Although CMV culture and DNA detection were negative in the urine, the infant was given foscarnet because CMV infection was demonstrated in the liver by DNA detection and immunohistochemical staining. Favorable clinical outcome and absence of CMV in the liver were subsequently shown. Our case suggests that congenital CMV disease following maternal recurrence may not be associated with disseminated infection but only with intracellular infection. The diagnosis should therefore be based on CMV detection in the involved organs. Moreover, this is the first report on the possible efficacy and safety of foscarnet for therapy of immunocompetent infants with congenital CMV disease.     

芪众颗粒预防老年人上呼吸道感染的临床研究

【目的】观察芪众颗粒对老年人上呼吸道感染的预防作用：【方法】将149例老年病人随机分为芪众颗粒组（A组）50例、玉屏风颗粒组（B组）49例、空白对照组（C组）50例。A、B2组连续服药7d,C组不采用任何干预方法。观察时间为2周,主要观察上呼吸道感染发生率以及不同时间点症状体征积分变化,同时采用二项分类Logistic回归法分析与发病的相关性。【结果】（1）A、B、C3组发生上呼吸道感染例数分别为1例（2．00％）、2例（4．08％）、11例（22．00％）,AC、BC2组间比较差异有显著性意义（P〈0．01）。（2）A、B2组症状体征积分呈下降趋势,在第7天、第14天,A组积分均数均较B组低,B组积分均数均较C组低：A组症状体征积分的改善优于B组,B组症状体征积分的改善优于C组。（3）对上呼吸道感染发病有显著性意义的变量是：畏寒怕冷,自汗。而啰音、腰酸、纳差OR值均大于1,可看作危险因素、芪众颗粒、玉屏风颗粒2种药物均为保护因素,玉屏风颗粒的发病危险是芪众颗粒的4．33倍。【结论】芪众颗粒能有效预防老年病人上呼吸道感染且用药安全。     

Interleukin-1β Inhibits Growth Factor-Stimulated Restoration of Wounded Rat Gastric Epithelial Cell Monolayers

We examined the effect of interleukin-1(IL-1) on spontaneous and enhanced restoration(cell migration and proliferation) using an in vitrowound model comprising a confluent monolayer of ratgastric epithelial RGM1 cells. Repair of an artificialwound in a cell monolayer was found to be time- andconcentration-dependent when the cells were incubatedwith epidermal growth factor (EGF) or transforming growth factor (TGF)- alone for up to 24hr. The growth factors also stimulated DNA synthesissignificantly for 24 hr in a concentration-relatedmanner. IL-1 had no effect on wound restoration in the absence of the growth factors. However, itmarkedly inhibited the restoration enhanced by EGF andTGF-, the inhibition being about 60% and 70%,respectively. In addition, IL-1 significantly reduced the DNA synthesis stimulated by thegrowth factors. The EGF- and TGF--enhancedrestoration was reduced by about 30% by mitomycin C,which potently inhibited the stimulated DNA synthesis.Mitomycin C had no effect on the spontaneous restoration.Even when treated with mitomycin C, the inhibitoryeffect of IL-1 on the enhanced wound repair wasstill observed; however, the extent of the inhibition was decreased. These results indicate thatIL-1 inhibits the migration as well as theproliferation of gastric epithelial cells enhanced byEGF and TGF-, resulting in a failure of woundhealing.     

Comparison of HCV RNA Levels by Branched DNA Probe Assay and by Competitive Polymerase Chain Reaction to Predict Effectiveness of Interferon Treatment for Patients with Chronic Hepatitis C Virus

To compare hepatitis C virus (HCV) RNA levelsdetermined by branched DNA probe assay and bycompetitive polymerase chain reaction (PCR) aspredictive markers of the response to interferon fortreatment of patients with chronic HCV infection, westudied data on 140 patients treated for six months withnatural interferon-alpha. Serum samples were tested forHCV RNA by PCR. HCV RNA was grouped into four genotypes by PCR with type-specific primers,and HCV RNA level was measured by branched DNA probeassay and by competitive PCR. HCV RNA was detected inall patients prior to initiation of the treatment. A complete response, sustained elimination ofHCV RNA, occurred in 51 patients (36.4%). With multiplelogistic regression analysis assessment, when usingcompetitive PCR, a low level of HCV RNA (P < 0.0001), younger age (P = 0.0054) and genotype 2a and 2b(P < 0.0158) were significant predictive markers fora complete response to interferon treatment. When usingbranched DNA probe assay, a low level of HCV RNA (P < 0.0001) and age (P = 0.0089) werepredictive markers, but genotype was not. The branchedDNA probe assay had a narrower linear range forquantitation of HCV RNA level than competitive PCR. In conclusion, HCV RNA level determined bybranched DNA probe assay proved to be useful forprediction of effects of interferon and it is costeffective as a marker of complete response to interferontreatment for patients with chronic HCVinfection.     

The diagnostic value of erythrocyte sedimentation rate in management of brain tumors

Abstract

Objective: Erythrocyte sedimentation rate (ESR) is considered as an indicator of inflammatory processes, and it has a prognostic value in the management of specific neoplastic diseases. It also responds to surgical intervention. There is very little data about the alteration of ESR in patients with brain tumors and information on its course after intracranial tumor surgery is completely lacking.

Methods: ESR was measured for 10 days in 46 patients (19 women and 27 men; mean age: 49.7 years; range: 13–70 years) who underwent elective craniotomy for tumor microsurgery (70–425 minutes with a mean of 230 minutes) under general anaesthesia. Blood samples were taken on the day before surgery and on each consecutive day after surgery for 10 days. The standard method of measuring ESR was based on the technique first described by Westergren.

Results: The mean ESR level on the day before surgery was 8.26 ± 7.27 mm/h after 1 hour and 14.80 ± 10.36 mm/h after 2 hours. After tumor surgery, ESR increased stepwise. The mean peak value of 22.89 ± 13.41 mm/h after the first hour was reached on the third post-operative day. Whereas mean values varied over time, ESR remained increased and did not decline to normal values until the tenth post-operative day. The mean ESR peak value was higher in patients having undergone surgery for intra-axial lesions (31.36 ± 30.43 mm/h on the post-operative day 6) as compared to patients with extra-axial lesions (21.31 ± 12.20 mm/h on the post-operative day 3).

Conclusion: ESR is not relevantly increased in patients harboring brain tumors. Because it remains elevated until the tenth post-operative day after uneventful craniotomy and generally responds more slowly than other indicators like C-reactive protein, it is also not suitable for the detection of post-operative infective complications.     

Serum Pancreatic Enzyme Concentrations in Chronic Viral Liver Diseases

Serum amylase and lipase concentrations weredetermined in 78 patients with chronic liver diseases[26 chronic active hepatitis (CAH) and 52 livercirrhosis] and in 15 healthy subjects. Pancreaticisoamylase concentrations and macroamylase complexes wereassayed in hyperamylasemic sera. Serum amylase levelswere abnormally elevated in 27 patients (35%; 22 livercirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 livercirrhosis, 1 CAH). In 9 of the 27 hyperamylasemicpatients, the hyperamylasemia was of pancreatic type.Macroamylasemic complexes were not detected inhyperamylasemic sera. Patients with liver cirrhosis had serumlevels of amylase and lipase significantly higher thanboth the healthy subjects and the patients with CAH,while no significant differences were found in serum levels of these enzymes in patients with CAH ascompared to the healthy subjects. A decreased livermetabolism of serum amylase and lipase in patients withchronic infective liver disease, especially in those having liver cirrhosis, may lead to anaccumulation of these enzymes in the blood.     

双盲法观察甲氟喹和法西密对恶性疟原虫配子体感染性的影响

18例配子体和无性体均阳性的恶性疟患者,随机双盲分为A、B和C三组,各组均6例。A组顿服甲氟喹750mg,B组顿服甲氟喹750mg+周效磺胺1500mg+乙胺嘧啶75mg,C组顿服甲氟喹750mg+伯喹45mg。以大劣按蚊检测配子体的感染性,以志愿者试验于孢子的感染性。结果全部患者治愈,治疗后7天,A组按蚊涎腺感染率为33.3～87.5％,B组为33.3～85.7％,被叮咬的志愿者全部感染恶性疟;治疗后14天,A组按蚊感染率为0～57.1％,B组为0～60.0％;治疗后21天,A组和B组的感染率均为0。C组仅1例治疗后1天能感染蚊媒,其余各天都未能感染蚊媒。显示甲氟喹和法西嘧对恶性疟配子体感染性无明显抑制作用,可能当地恶性疟原虫对法西达有抗性,当地恶性疟的潜伏期是7～13天。     

Influence of Epstein–Barr virus infection in adult T-cell leukemia

Abstract

The involvement of adult T-cell leukemia (ATL) cells in organs such as the skin and lymph nodes is observed in about 50% of cases of ATL. Epstein–Barr virus (EBV) infection has often been observed in the clinical course of ATL. In this study, we established two B-cell lines from peripheral blood of patients with ATL. EBV DNA, proviral DNA for HTLV-1 and Tax mRNA were detected in both lines. As part of the characterization of these cells, an enhanced expression of intercellular adhesion molecule-1 (ICAM-1) (CD54) or ICAM-3 (ICAM-3) (CD50), lymphocyte function-1 (LFA-1) (CD11a/CD18), and Mac-1 (CD11b/CD18) was observed. To investigate the role of the interaction of these viruses, we transfected EBV and/or HTLV-1 into a healthy donor's lymphocytes, an EBV-infected B cell line, Raji, and a HTLV-1 negative T-cell line, Jurkat. Enhanced expression of adhesion molecules was also observed in double transfectants (EBV and HTLV-1). In the clinical course of ATL, LMP-1, EBNA-2, CD50 and CD54 were detected in lymph nodes and skin specimens by immunohistochemical staining. Furthermore, high levels of interleukin-4 (IL-4) were detected in these cell lines and transfectants. The results indicated that coinfection with HTLV-1 and EBV may induce aggressive organ involvement through the enhanced expression of adhesion molecules via IL-4 signaling. A new mechanism of ATL involvement is discussed.