A study for evaluating the effect of the deltoid-flap repair in massive rotator cuff defects

The repair of massive cuff defects by direct suture often is impossible. In these cases, a repair by musculo–tendineous flaps (latissimus-dorsi, pectoralis or deltoideus) is required. It was the goal of this study to evaluate the result of delta-flap repair in case of massive cuff defects with a diameter of 5 cm or more. Between 1998 and 2000 for all patients who were suffering from a massive rotator cuff tear more than 5 cm a deltoid transfer was performed. A total of 20 patients (14 male, 6 female; age: 60.9 ± 8.7 years) were available for a follow-up after 47.2 ± 8.0 (range, 36 to 60) month. The operation included an arthroscopic evaluation, acromioplasty with resection of the lateral clavicular end, and biceps tenodesis. The cuff defect was repaired by transfer a muscular flap from the anterior part of the deltoid (about 2×6 cm) into the defect. The patients subjectively rated their result—10 excellent, 9 good, and 1 poor. Preoperatively, the Constant amounted 26.3 ± 5.1 points. At follow-up, the score significantly increased to 74.5 ± 8.5 points. The acromiohumeral distance increased from 4.9 ± 1.1 to 9.2 ± 1.7 mm. In MRI examination of 11 patients all had an intact flap. Two complications (a wound hematoma and a deep infection) did not influence the result. The repair of massive rotator cuff tears by a deltoid transfer produces acceptable clinical and radiological results.     

Group B streptococcus: the effectiveness of screening and chemoprophylaxis

Although antepartum screening for Group B Streptococcus is not ideal, it may be the most practical approach until rapid tests are proven to be useful in this clinical setting. The efficacy has been established for intrapartum chemoprophylaxis with a penicillin antibiotic of patients with a positive antepartum culture. There is evidence that supports the concept for selective intrapartum chemoprophylaxis in some populations. Intrapartum chemoprophylaxis prevents maternal morbidity. Rapid tests for intrapartum diagnosis of Group B streptococcus colonization appear promising, providing results are available in time for therapy to be administered before delivery.     

The Decline in Serum Albumin after Conversion to High Flux, High Efficiency Dialysis

Abstract: Hypoalbuminemia among chronic hemodialysis patients is recognized as a poor prognostic sign. We observed that many of our chronic patients had a progressive decrease in their plasma albumin concentrations after they were converted to high flux, high efficiency dialysis from conventional dialysis mode. This change occurred in the absence of changes in the KTIV and protein catabolic rate (per) normalized to body mass. When nitrogen losses were measured, we found no difference in the dialysate concentrations of urea, alpha amino nitrogen, uric acid, or total nitrogen when high flux polysulfone was compared with high efficiency Cuprophan. While urea was the predominant nitrogen solute in all dialysate samples, there were some with a large gap between total and urea nitrogen. Alpha amino nitrogen losses, expressed as leucine equivalents, were substantial, ranging from 8. 4 to 9. 8 g/3. 5 h dialysis treatment. We believe that the increased losses of nitrogen experienced by patients after their conversion to a more efficient method of dialysis and not compensated for by a spontaneous increased intake of protein led to the observed fall in plasma albumin. Both urea and amino acid nitrogen losses need to be accounted for when achievement of higher KTIV dialysis is pursued.     

Inter-laboratory transfer of HPLC methods: problems and solutions

As high-performance liquid chromatography (HPLC), the premier analytical technique in the pharmaceutical industry, becomes more ubiquitous, methods are more frequently being transferred from one laboratory to another. This review will discuss sources of failures to reproduce HPLC procedures, ranging from sample handling and preparation, through mobile phase, injector, column, detector and data manipulation problems. Also to be considered will be the precautions that should be taken, when initially developing a method, to obviate future problems. These precautions include using stable, well-defined analytical columns, buffered mobile phases, low wavelengths (or a mass-sensitive detector) and internal tests for accuracy; based on the author's experiences. Since the laboratory that originally developed the procedure has the moral obligation and, perhaps, the regulatory responsibility to "guarantee" that the method will perform successfully elsewhere, a series of increasingly comprehensive steps will be given, based on practice, to be followed by the laboratory that could not reproduce the procedure. Also to be discussed are approaches for treating methods that were initially successful but have slowly deteriorated and now fail, and several examples of procedures that were not reproducible in some other laboratories.