Horizontal advancement flap for lateral dorsal nasal defects

BACKGROUND: Repairing dorsal nasal defects is a frequent challenge for dermatologic surgeons, mainly due to the high frequency of basal cell carcinomas on this site. Obvious scars, mismatched skin and distortion of the nasal contour are the surgical hazards that must be avoided in these cases. AIM: Our aim was to perform surgery involving a simple flap in order to repair medium to large defects on the dorsal side of the nose. METHODS: The dorsal horizontal advancement flap was studied in 12 patients, in order to evaluate the benefits and limits of this surgical procedure. RESULTS: The resulting scars on most of our patients were well-camouflaged among their natural skin lines, and there was neither distortion of the alar contour nor the nostril. CONCLUSIONS: This flap is easy to perform and, in selected cases, provides an outstanding alternative to second-intention healing, full-thickness skin grafts, transposition, rotation and pedicle flaps.     

Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system

Our objective was to determine the inter-examiner agreement of a simplified pelvic organ prolapse quantification (POPQ) exam and to assess its correlation with the standard POPQ exam. This study consists of two parts; both were preformed in a prospective, randomized, blinded fashion on women presenting with complaints attributed to pelvic organ support defects. The first study was done to determine the inter-examiner reliability of a simplified POPQ exam. The simplified POPQ exam is based on the POPQ with similar ordinal staging but with only four points measured instead of nine. Forty-eight women underwent exams by five different investigators. The order of exams was randomized and the examiners were blinded to the results of each other’s findings. The results of these two exams were compared using weighted kappa statistics. The second part of the study was done to determine the inter-system agreement between the simplified vs standard POPQ exam. A group of 49 women were examined by four different investigators: one using the simplified and the other using standard POPQ exams. The order of the exams was randomized and the examiners were blinded to the results of each other’s exam. Kendall’s tau-b statistics were used to determine the inter-system agreement. For the inter-examiner reliability of the POPQ exam, the average age was 60±13 years. The weighted kappa statistics for the inter-examiner reliability of the simplified prolapse classification system were 0.86 for the overall stage, 0.89 and 0.86 for the anterior and posterior vaginal walls, respectively, 0.82 for the apex/cuff, and 0.72 for the cervix. All demonstrate significant agreement. For the inter-system association between the simplified POPQ and standard POPQ, the average age was 61±15 year. The Kendall’s tau-b value for overall stage was 0.90, 0.83, and 0.87 for the anterior and posterior walls respectively, and 0.78 for the cuff/apex and 0.98 for the cervix. There is good inter-examiner agreement of a simplified POPQ classification system and it appears to have good inter-system association with the POPQ.IUGA Standardization of Terminology Committee members: Robert Freeman MD (chairman), Steven Swift, Eckhard Petri MD, Richard J. Scotti MD, and Peter Dwyer MD.     

Breast pump adverse events: reports to the food and drug administration.

Breast pumps are medical devices used to express milk and maintain the milk supply. The purpose of this study was to characterize adverse events reported to the United States Food and Drug Administration (FDA) on breast pumps. Thirty-seven adverse event reports on breast pumps were identified from the Manufacturer and User Facility Device Experience database between 1992 and 2003. Four additional reports were found in the Device Experience Network database from 1992 to 1996. The most commonly reported adverse events for electric breast pumps were pain, soreness, or discomfort; the need for medical intervention; and breast tissue damage. Most frequently reported problems for manual breast pumps were breast tissue damage and infection. Contamination of breast milk during pumping was also reported. Breast pump adverse events are likely underreported to the FDA. Reporting adverse events is important for improving the design and manufacture of breast pumps and subsequently decreasing adverse events.     

Aspiration drainage of splenic abscesses

The successful use of guided percutaneous needle aspiration in the management of four patients with solitary splenic abscess is described. Two patients had needle aspiration alone and two patients, with large splenic abscesses, had drainage tubes inserted. The procedures were well tolerated and allowed rapid microbiological diagnosis with selection of appropriate antibiotic therapy. The techniques were useful in patients felt to be poor anaesthetic risks, and the complications of splenectomy were avoided.     

APPROACHES TO PROMOTING MORE WIDESPREAD PARTICIPATION IN PHYSICAL ACTIVITY

Exercise is associated with a reduced risk of coronary heart disease, has beneficial effects on cardiovascular risk factors, and has other health benefits. No more than 10 per cent to 20 per cent of adults in Australia and other developed countries participate in regular vigorous physical activity, while over 65 per cent of Australian adults are almost totally sedentary. Survey data from the U.S.A. suggest that levels of participation in jogging and walking have increased in the past 10 years but that the proportion of people who take no deliberate exercise has also increased. Large-scale community interventions to promote exercising have not been subject to rigorous evaluation and it is difficult to reach any firm conclusions about the effects of exercise promotion. However, it is possible to identify some of the factors which may influence exercise participation, and there is information from trials of large-scale, multifactorial interventions to reduce cardiovascular risk which provides some helpful guidelines about how it may be useful to proceed. Approaches to increasing levels of exercise participation should emphasise community-based efforts which provide appropriate settings and social support for exercising, making exercise a more appealing and accessible option for large numbers of people; the use of mass media for community education about exercising should be co-ordinated carefully with specific community activities. Personalized fitness instruction, groups and classes should place more emphasis on exercise as a pattern of behaviour to be integrated into a person's way of life and maintained over time; and there is the potential for more widespread and systematic use of self-instructional exercise materials to assist people who wish to exercise independently. Because there exist only limited local research findings and work in other countries does not yet provide conclusive information, research and development priorities for these areas are suggested.     

Down-regulation of muscarinic receptors in the striatum of organophosphate-treated swine

Subacute (daily) administration of diisopropylfluorophosphate (DFP) to male swine (Yorkshire white) resulted in a 97% inhibition of cholinesterase and a decrease of [3H]quinuclidinyl benzilate [( 3H]QNB) binding sites in homogenates of striata by approximately 50% after 14 days. The maximal density of receptors (Bmax) decreased from 2.1 +/- 0.3 to 1.0 +/- 0.2 pmole/mg protein. There was no significant change in the dissociation constant (Kd) for [3H]QNB binding (control: 52.6 +/- 10.7 pM; 7-day: 57 +/- 2.8 pM). Carbachol displacement of [3H]QNB binding yielded data best fit by a two-binding site model. The dissociation constants were KiL = 115 +/- 62 microM (55 +/- 3%) and KiH = 1.8 +/- 0.7 microM (45 +/- 3%), respectively, for the low- and high-affinity states. Seven-Day treatment with DFP reduced the percentage of high-affinity receptors to 22 +/- 8.6%, but affected neither the low- nor the high-affinity Kd (100 +/- 20 and 2 +/- 0.6 microM). With the addition of Mg2+, striatal homogenates had low- and high-affinity receptors in the proportion of approximately 1 to 1. In the presence of Gpp(NH)p + Mg2+ the ratio of high- to low-affinity receptors was 3:1 in homogenates of control tissue (to 26 +/- 5%). This treatment had no effect on this ratio in homogenates of tissue from 7-day DFP-treated swine (3:1) since it was already 3:1. Pirenzepine displacement of [3H]QNB binding was best described by a two-binding site model, with Ki values of 38 +/- 14 and 201 +/- 78 nM, which represent 74 and 26% of the binding sites, respectively. The high affinity Kd value was unchanged following 7 days of DFP treatment (24 +/- 5 nM). There appears to be little change in the displacement curves for pirenzepine inhibition of [3H]QNB binding. This suggests that about 75% of the receptors are of the M1 subtype. Thus, subacute administration of DFP causes not only a decrease in the number of receptors, but also a change in the proportion of agonist affinity states which is related to the interaction of the guanine nucleotide binding protein and the muscarinic receptor.     

Surgeon perspectives on options for ventral abdominal wall hernia repair: results of a postal questionnaire

Background: Ventral abdominal wall hernias are a common cause of morbidity and mortality. Opinion varies as to appropriate management. A recent consensus meeting on incisional hernia identified the need to standardise repair. On this background, a survey of current practice was performed. Method: A questionnaire was sent to 101 practicing general surgeons within the West of Scotland. Incisional, epigastric and para-umbilical defects were subdivided into defect size <2, 2–5 and >5 cm. The surgeons were asked to indicate the most appropriate repair (suture, mayo or mesh) for each. The influence of reducibility on the decision to repair was also assessed. Results: Sixty-one of 101 questionnaires were returned valid giving a response rate of 60%. Suture repair was significantly more likely to be used in all defects <2 cm (P<0.001). Mesh repair was significantly more likely to be recommended in all defects >5 cm (P<0.001). Of defects >5-cm, mesh was recommended for 90% of incisional hernia compared with 81% of epigastric and 76% of para-umbilical hernia (P<0.001). There was no significant difference in choice of repair for defect size 2–5 cm with opinion divided between suture and mesh. Irreducibility increased the likelihood of recommendation for repair. Conclusion: This survey shows a lack of consensus on the appropriate repair of ventral abdominal wall hernia amonge practicing consultant general surgeons. This reflects the contrasting views within the current literature.     

S-nitrosoglutathione-containing hydrogel accelerates rat cutaneous wound repair

BACKGROUND: Nitric oxide (NO) plays a key role in wound repair and S-nitrosothiols like S-nitrosoglutathione (GSNO) are well known NO donors. METHODS: Animals were separated in two groups and submitted to excisional wounds on the dorsal surface at the first day. GSNO (100 microm)-containing hydrogels were topically applied on the wound bed in the GSNO group, daily, during the first 4 days. Control group was topically treated with hydrogel without GSNO for the same period. Wound contraction and re-epithelialization were measured. Animals were sacrificed 21 days after wounding. Samples of lesion and normal tissue were formalin-fixed, paraffin embedded for histological analysis. RESULTS: Wound contraction, measured 14 and 21 days after wounding, was greater in the GSNO group than in the control group (P<0.05 for both). The re-epithelialized wound area, measured 14 days after wounding, was higher in the GSNO group than in the control group (P<0.05). A higher amount of inflammatory cells was observed in superficial and deep areas of the granulation tissue of the control group compared to the GSNO group. Twenty-one days after wounding, thin red-yellow collagen fibers arranged perpendicularly to the surface were found in the granulation tissue of the control group, whereas in the GSNO-treated group collagen fibers were thicker and arranged parallel to the surface. Increased number of mast cells was observed in the GSNO group compared with that in the control group. Vascularization and myofibroblast distribution were similar in both groups. CONCLUSION: Topical application of GSNO-containing hydrogel during the early phases of rat cutaneous wound repair accelerates wound closure and re-epithelialization and affects granulation tissue organization.     

Unproven Nutritional Remedies and Cancer

Questionable dietary remedies for cancer decreased quality of life and did nothing to improve cancer outcomes in patients with extensive disease.