“Hernia-itis”, a case report

We describe a case of an incarcerated hernia in which there was good evidence that infection was the primary aetiology. We propose the term hernia-itis to describe similar cases to facilitate identifying them in the literature.     

Study of the potential of stratum corneum lipids and exogenous molecules interaction by fluorescence spectroscopy for the estimation of percutaneous penetration

Considering that the skin barrier properties are closely linked to the ceramides composition and conformation within the SC, our work focused on developing a new evaluation criterion in complement of the Log Pow and MW: lipids retentive role within the SC. We developed an in vitro model to study exogenous molecules (Mol) and SC lipids interaction by fluorescence spectroscopy. As ceramides do not fluoresce, fluorescence probes that emit a fluorescence signal in contact with lipidic chains were selected for the study. A protocol was developed based on the exogenous molecule (cosmetic actives) affinity for the SC lipids. A fluorescence criterion (ΔI) was calculated from our results and compared to ex vivo skin penetration measurements realized with a Franz cell device. Our results indicated that polarity seems to be very representative of the ceramide and exogenous molecule interaction for most of the molecules tested. However, the ΔI calculated highlighted the particular interaction of some exogenous molecules with ceramides and their skin distribution. This particular behavior was not initially possible to estimate with the Log Pow and MW. This work aimed to develop a new alternative method to enhance the percutaneous penetration estimation of exogenous molecules for the risk analysis.     

Recommendations for hypercholesterolemic children

Some of hypercholesterolemias observed in childhood have a high risk of premature cardiovascular diseases. The monogenic dominantly inherited hypercholesterolemias such as the familial hypercholesterolemia due to mutations on LDL receptor gene corresponds to these diseases. This article, jointly elaborated by the Nouvelle Société Fran?aise d’Athérosclérose together with the Nutrition committee of the Société Fran?aise de Pédiatrie, is to propose recommendations for a screening strategy and for management of hypercholesterolemia in children. The approach of these high-risk inherited hypercholesterolemia is specified and the dietary management, the indications and supervision of lipid lowering drug therapy in children are discussed.     

Using the WHO Surgical Safety Checklist to Direct Perioperative Quality Improvement at a Surgical Hospital in Cambodia: The Importance of Objective Confirmation of Process Completion

Background

The WHO surgical safety checklist (SSC) is known to prevent postoperative complications; however, strategies for effective implementation are unclear. In addition to cultural and organizational barriers faced by high-income countries, resource-constrained settings face scarcity of durable and consumable goods. We used the SSC to better understand barriers to improvement at a trauma hospital in Battambang, Cambodia.

Methods

We introduced the SSC and trained data collectors to observe surgical staff performing the checklist. Members of the research team observed cases and data collection. After 3 months, we modified the data collection tool to focus on infection prevention and elicit more accurate responses.

Results

Over 16 months we recorded data on 695 operations (304 cases using the first tool and 391 cases with the modified tool). The first tool identified five items as being in high compliance, which were then excluded from further assessment. Two items—instrument sterility confirmation and sponge counting—were identified as being misinterpreted by the data collectors’ tool. These items were reworded to capture objective assessment of task completion. Confirmation of instrument sterility was initially never performed but rectified to >95% compliance; sponge counting and prophylactic antibiotic administration were consistently underperformed.

Conclusions

Staff complied with communication elements of the SSC and quickly adopted process improvements. The wording of our data collection tool affected interpretation of compliance with standards. Material resources are not the primary barrier to checklist implementation in this setting, and future work should focus on clarification of protocols and objective confirmation of tasks.

     

Reinforced iliotibial tenodesis for chronic anterolateral instability of the knee: a 6-year follow-up

Reinforced iliotibial tenodesis is an extra-articular procedure to eliminate anterolateral instability of an anterior cruciate ligament-deficient knee. The procedure carries a low complication rate and offers an easy rehabilitation program. This study evaluated the use of reinforced iliotibial tenodesis in a select group of 52 patients with a mean age of 41 years (range: 38-50 years). Obese patients, professional athletes, and patients with more complex injuries (eg, concomitant posterior cruciate or medial collateral ligament injuries) were excluded. Results are encouraging after a mean follow-up of 6 years (range: 2-10 years). Although 24 patients had a positive anterior drawer or Lachman test, none had a positive pivot test. In addition, all patients reported giving way was eliminated after surgery.     

Primary care diabetes in Greece

The role of general practitioners in Greece in the management of diabetes mellitus (DM) is critical as they are responsible for the patients with DM. In this role they can effectively control the disease, manage any other comorbid conditions and risk factors and prevent the development of long-term complications.