Arthroscopic rotator cuff repair:Indications and technique

Arthroscopic repair of rotator cuff tears is now possible. By using the biomechanical principles of margin convergenceand the balance of force couples, even large cuff defects can be repaired. Suture anchors are particularly suitable for arthroscopic repairs, and a corkscrew anchor design lends itself to a trans-tendon approach     

Decreased Efficacy of Topical Anesthetic Creams in Presence of Benzoyl Peroxide

Background. Topical anesthetics are widely used to diminish the sensation of pain from various medical cutaneous procedures. Any topical agent that reduces the desired effect has clinical ramifications.
Materials and Methods. Topical 6% benzocaine cream was applied to both inner forearms of five persons and covered with a bandage. One of the arms was additionally treated simultaneously with 5% benzoyl peroxide. The areas were tested with a pinprick examination every 10 minutes for the ensuing hour.
Results. There was an estimated 75% increased perception of pain on the forearm to which benzoyl peroxide was applied in consort with the topical anesthetic at all examination times.
Conclusions. Benzoyl peroxide chemically reacts with topical anesthetics such as tetracaine, procaine, pramoxine, prilocaine, and lidocaine, causing a significant reduction in their numbing effect. Clinically, make sure that the skin area to be topically anesthetized is devoid of any previous treatment with benzoyl peroxide or insist that the skin is thoroughly washed prior to application of the anesthetic.
CRAIG G. BURKHART, MPH, MD, AND CRAIG N. BURKHART, MSBS, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.     

The nurse's role as clinical coordinator for the Center for Cranial Base Surgery

The newly created position of clinical coordinator for the Center for Cranial Base Surgery at Presbyterian-University Hospital is detailed in this article. The position evolved in response to needs of this specialized center, because the complexities of cranial base tumors (CBTs) require optimal patient care be a collaborative effort. The clinical coordinator works with the neurosurgeon in all phases of treatment. From the preoperative visit, through admission and surgery, and then in postoperative care and follow-up, patient care is centered not only on the physical aspects inherent in surgery and recovery, but also on psychological support and attention which must be maintained throughout the patient's treatment course. In addition, the clinical coordinator has important input concerning research activities, particularly in clinical implementation of new therapies, as well as patient data management. Inservice education of other health professionals in their dealings with CBT patients further enhances quality of and continuity in patient care. Patient-care responsibilities as well as related research and training activities are discussed.     

Effect of depressive symptoms on survival after heart transplantation

OBJECTIVE: This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated. METHOD: An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome. RESULTS: Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables. CONCLUSIONS: Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.     

Engulfment of mast cell secretory granules on skin inflammation boosts dendritic cell migration and priming efficiency

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Recruitment of complement factor H-like protein 1 promotes intracellular invasion by group A streptococci

Numerous microbial pathogens exploit complement regulatory proteins such as factor H (FH) and factor H-like protein 1 (FHL-1) for immune evasion. Fba is an FHL-1 and FH binding protein expressed on the surface of the human pathogenic bacterium, Streptococcus pyogenes, a common agent of pharyngeal, skin, and soft-tissue infections. In the present study, we demonstrate that Fba and FHL-1 work in concert to promote invasion of epithelial cells by S. pyogenes. Fba fragments were expressed as recombinant proteins and assayed for binding of FHL-1 and FH by Western blotting, enzyme-linked immunosorbent assay, and surface plasmon resonance. A binding site for FHL-1 and FH was localized to the N-terminal half of Fba, a region predicted to contain a coiled-coil domain. Deletion of this coiled-coil domain greatly reduced FHL-1 and FH binding. PepSpot analyses identified a 16-amino-acid segment of Fba which overlaps the coiled-coil domain that binds both FHL-1 and FH. To localize the Fba binding site in FHL-1 and FH, surface plasmon resonance was used to assess the interactions between the streptococcal protein and a series of recombinant FH deletion constructs. The Fba binding site was localized to short consensus repeat 7 (SCR 7), a domain common to FHL-1 and FH. SCR 7 contains a heparin binding site, and heparin was found to inhibit FHL-1 binding to Fba. FHL-1 promoted entry of Fba(+) group A streptococci into epithelial cells in a dose-dependent manner but did not affect invasion by an isogenic fba mutant. To our knowledge, this is the first report of a bacterial pathogen exploiting a soluble complement regulatory protein for entry into host cells.     

Effect of age on the accumulation of lung protein following unilateral pneumonectomy in rats

The effects of unilateral pneumonectomy (PNX) on the net synthesis of right lung protein were investigated in vivo using three groups of rats with body weights (BW) ranging from 85 to 330 g. These data were compared to those from sham-operated and normal growing control animals. After PNX, both the 2-day lag prior to the compensatory increase in right lung mass (LW) and the subsequent rate of increase in LW and LW/BW ratio were independent of two-fold differences in the basal rate of lung growth. In all PNX groups, both right LW and LW/BW reached control values for both lungs, but in the older rats the time required for complete compensation was extended from 5 days to 12 days. The rate of net accumulation of right lung protein increased two-fold in the youngest PNX rats and 6 to 8-fold in the older animals, but when these changes were normalized to the protein content of the remaining tissue, the older rats appeared to respond to PNX less efficiently. Increased tissue levels of RNA and the resulting increased capacity of the lungs for protein synthesis could account for the accelerated rate of gain in right lung protein following PNX in both adult and young animals.