Extended vomer flap in the early repair of a cleft palate

The author's original approach to the early repair of cleft palate which consists in the use of the extended vomer flap is presented. The evolution of primary procedure under the influence of the philosophy of Malek and Psaume and all additional improvements of the author are described and illustrated. The early results (up to 6 years) of 40 palatoplasties performed at the ages of 3-6 months are roughly evaluated and discussed.     

In vitro andin vivo inhibition of virus multiplication by microwave hyperthermia

Summary The effects of microwave hyperthermia (41° and 43° C) on virus multiplication have been exploredin vitro (HSV-1 infected primary rabbit kidney cultures) andin vivo (mice infected with HSV-1 or vaccinia). In vitro the cells were inoculated with HSV-1 and heated to 41° or 43° C either before or after infection. Virus yields were significantly decreased when the cells were exposed to hyperthermia within the first few hours after infection, while hyperthermia was without effect when applied before infection or with several hours delay after infection.In mice inoculated intranasally with HSV-1, mortality due to herpes encephalitis was significantly reduced upon daily exposure to microwave hyperthermia from the day of infection onward.In mice inoculated intravenously with vaccinia, a significant decrease in the number of specific tail lesions was observed if the animals were exposed to microwave hyperthermia within the first three days after infection, while irradiation prior to infection or delayed until several days after infection did not exhibit an appreciable effect.Our data suggest that microwave hyperthermia interferes directly with the virus multiplication cycle bothin vitro andin vivo.With 3 Figures     

Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa

Background  

To present and compare population-based and antenatal-care (ANC) sentinel surveillance HIV prevalence estimates among women in a rural South African population where both provision of ANC services and family planning is prevalent and fertility is declining. With a need, in such settings, to understand how to appropriately adjust ANC sentinel surveillance estimates to represent HIV prevalence in general populations, and with evidence of possible biases inherent to both surveillance systems, we explore differences between the two systems. There is particular emphasis on unrepresentative selection of ANC clinics and unrepresentative testing in the population.     

Hepatocyte function in a radial-flow bioreactor using a perfluorocarbon oxygen carrier

The aims of this study were, first, to indicate the metabolic activity of hepatocytes in a radial-flow polyurethane foam matrix bioreactor relative to monocultures, and second, to evaluate the effect on the hepatocytes of including a synthetic perfluorocarbon (PFC) oxygen carrier to the recirculating medium. The efficient O2-carrying ability of PFCs may be beneficial to bioreactors employed in stressed cellular environments. Thus, they may also be useful in the treatment of an acute liver failure patient with a bioartificial liver support system (BALSS). Data on the function of three-dimensional (3-D) hepatocyte cultures exposed to emulsified PFCs are lacking. RESULTS: the metabolic functions of the 3-D hepatocyte cultures were improved relative to monocultures. Three-dimensional cultures with and without PFC behaved similarly, and no adverse effects could be detected when PFC was included in the recirculating medium. The addition of PFC significantly improved lidocaine clearance possibly due to the presence of higher O2 tension in the medium. Imaging indicated that large aggregates formed and that seeding had followed flow through the matrix. Simulations indicated first, that the cell numbers used in this study had been insufficient to challenge the bioreactor O2 supply explaining the similarity in performance of the 3-D cultures, and second, that the benefit of adding PFC would be more pronounced at the cell densities likely to be used in a BALSS bioreactor.     

Depot local anesthetic in polymethylmethacrylate bone cement: a preliminary study

Acrylic bone cement has been used successfully as a slow-release depot for antibiotics after orthopaedic surgery. The feasibility of administering local anesthetics in this way was examined in this preliminary in vitro study. Discs weighing approximately 4 g were prepared from five brands of acrylic cement (40 g) containing as much as 2 g of anesthetic base. Elution of the anesthetics into saline was measured during 72 hours. Prilocaine eluted the fastest and bupivacaine the slowest, with lidocaine between them. The elution rates were greatest in the first hour, declining thereafter. Rates also depended on the brand of cement with the quickest elution from CMW3 and the slowest from Surgical Simplex P. Using cement as a depot, therapeutic levels of a drug should be achievable in vivo at a negligible risk of toxicity. Before in vivo trials it is necessary to optimize elution of drugs in relation to the cement (brand, microstructure, method of preparation) and the concentration of a drug in the cement above which the cements' mechanical and adhesive properties are compromised.     

Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus

Background Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a mirror image of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis.Methods We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition.Results A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass.Conclusion The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.     

A computerized medical incident reporting system for errors in the intensive care unit: initial evaluation of interrater agreement

Errors resulting in adverse events in the medical care system are ubiquitous and underreported. Critical incident techniques that have been used to reduce errors in aviation have recently been applied to evaluate adverse events in the critical care arena. We report an evaluation of interrater agreement on responses to questions concerning adverse event reporting using a computer-based medical incident reporting system (MIRS). Thirty-four intensive care unit staff volunteers reviewed five fabricated test cases containing iatrogenic factors, then completed an incident report for each case using the MIRS. Interrater agreement was significant for all five cases (p < 0.01). The time required to complete a report decreased significantly from the first case to the last (p < 0.01). Overall, the MIRS was perceived as a relatively quick (< 6 minutes) and comprehensive reporting tool. The results indicate that health care providers report adverse events similarly, suggesting that the MIRS would be a useful tool in the reduction of errors (as a process improvement program) and to facilitate the continuing process of health care improvement.     

Evaluation of treatment results of patients with Dupuytren's contracture--our clinical experience

Dupuytren's contracture is a common condition leading to impairment of the function of the hand which affects from 2 to 12 % of the population, mainly males, and presents as progressive contracture of fingers caused by shortening of the palmar aponeurosis. The objective of the work was to present our own approach to managing Dupuytren's disease and evaluate treatment results in patients with hypertrophy of the palmar aponeurosis. Material and method 288 patients with Dupuytren's disease were treated at the Plastic Surgery Hospital in Polanica Zdroj over a period of 25 years (1977-2002). The present paper is a retrospective analysis of treatment results in 253 patients for whom complete medical documentation was available. All patients were operated in local anaesthesia in ischemia. A Bunnell flap skin incision was followed by a fasciectomy of the hypertrophied segment of the palmar aponeurosis. The skin wound was closed using V-Y plasty. Postoperative management involved hand elevation and early rehabilitation. Results Restoration of the full range of motion and total extension in the MP joint and the interphalangeal joints were achieved in 70% and 68% of patients, respectively. Of 145 patients who were professionally active, 132 were able to return to work. Finger amputation was necessary in 2 patients, one patient suffered from arthrodesis and two other developed skin necrosis which was removed with the wound closed by skin grafts. A follow-up examination 6 months after the operation revealed a recurrence in 8 patients and deterioration of hand dexterity with finger stiffness in 4. Conclusions A low complication rate and good treatment results are arguments in favour of the approach adopted at our hospital, i.e. surgery in local anaesthesia in ischemia with compressive bandaging, using a Bunnell flap skin incision followed by radical fasciectomy and V-Y plasty.     

In vivo 31P MR spectroscopic imaging of the human prostate at 7 T: Safety and feasibility

³¹P MR spectroscopic imaging of the human prostate provides information about phosphorylated metabolites that could be used for prostate cancer characterization. The sensitivity of a magnetic field strength of 7 T might enable 3D ³¹P MR spectroscopic imaging with relevant spatial resolution in a clinically acceptable measurement time. To this end, a ³¹P endorectal coil was developed and combined with an eight‐channel ¹H body‐array coil to relate metabolic information to anatomical location. An extensive safety validation was performed to evaluate the specific absorption rate, the radiofrequency field distribution, and the temperature distribution of both coils. This validation consisted of detailed Finite Integration Technique simulations, confirmed by MR thermometry and B measurements in a phantom and in vivo temperature measurements. The safety studies demonstrated that the presence of the ³¹P endorectal coil had no influence on the specific absorption rate levels and temperature distribution of the external eight‐channel ¹H array coil. To stay within a 10 g averaged local specific absorption rate of 10 W/kg, a maximum time‐averaged input power of 33 W for the ¹H array coil was allowed. For transmitting with the ³¹P endorectal coil, our safety limit of less than 1°C temperature increase in vivo during a 15‐min MR spectroscopic imaging experiment was reached at a time‐averaged input power of 1.9 W. With this power setting, a second in vivo measurement was performed on a healthy volunteer. Using adiabatic excitation, 3D ³¹P MR spectroscopic imaging produced spectra from the entire prostate in 18 min with a spatial resolution of 4 cm³. The spectral resolution enabled the separate detection of phosphocholine, phosphoethanolamine, inorganic phosphate, and other metabolites that could play an important role in the characterization of prostate cancer. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

The A to Z of healthcare data breaches

There currently exists a myriad of privacy laws that impact a healthcare entity, including more than 47 notification laws that require notification when a data breach occurs, as well as the breach notification requirements of the Health Information Technology for Economic and Clinical Health Act. Given the plethora of issues a healthcare entity faces, there are certain principles that can be built into an organization's philosophy that will comply with the law and help protect it from reputational harm.