Post‒cataract surgery endophthalmitis outbreak caused by multidrug-resistant Pseudomonas aeruginosa

In June 2010, a severe outbreak of 13 cases of post-cataract surgery endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95% genetic similarity; however, extensive environmental and carriage investigation revealed no source of infection.     

Safety and efficacy of off-pump coronary artery bypass grafting in chronic dialysis patients

Off-pump coronary artery bypass grafting (CABG) has been recently revived, because cardiopulmonary bypass (CPB) appears to worsen the multiple organ dysfunction after conventional CABG. To evaluate the safety and efficacy of the off-pump CABG in chronic dialysis patients, we compared the perioperative morbidity and mortality between 15 dialysis patients who underwent off-pump CABG at our center over the past 8 years with that of a concurrent group of 19 patients who underwent conventional CABG. Patients were selected for off-pump CABG only when complete revascularization was technically feasible. We found that off-pump CABG is as safe and effective as conventional CABG in selected dialysis patients. It might even be beneficial, because it is associated with less hematocrit drop and blood product use, a lower catabolic rate, and fewer dialysis requirements after surgery. However, the impact of off-pump technique on the long-term clinical outcome and resource utilization in renal patients requires further investigation.     

Surgery for Inguinal Hernia in Byzantine Times (A.D. 324–1453): First Scientific Descriptions

The aim of this article is to present the techniques applied by Byzantine physicians for inguinal hernia repair and to note their influence on the development of surgery after that time. A study and analysis of the original texts of the Byzantine medical writers, written in Greek, and containing the now mostly lost knowledge of the ancient Hellenistic and Roman periods, was undertaken. Two Byzantine physicians, Aetius of Amida (6th century A.D.) and Paul of Aegina (7th century A.D.), described two techniques for confrontation of inguinal hernia, namely the surgical removal of the prolapsed peritoneum and the cauterization of the groin. These methods were probably derived from the texts of earlier Greek surgeons to which they added their own keen observations. The study of Byzantine medical and literary texts proves that the surgical techniques for inguinal hernia were practiced in Byzantine times and influenced later Arabian and European surgery, thus constituting significant roots of surgery.     

Trimed fixation system for displaced fractures of the distal radius

OBJECTIVE: To study the functional outcome of displaced distal radius fractures treated by open reduction and internal fixation with the use of fragment-specific fixation. METHODS: Fifteen consecutive displaced distal radius fractures (5 extra-articular and 10 intra-articular) were treated using the Trimed distal radius fixation system (Trimed, Valencia, CA). Radiographic assessment and range of motion of the affected wrist were evaluated postoperatively. Functional outcomes were evaluated with use of the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. RESULTS: The mean follow-up was 11 months. The patients initiated controlled passive and active motion exercises during the first week. The mean score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 16 points. The mean return to work was 12 weeks. The functional outcome was 80% excellent or good by the Gartland and Werley scoring system for intra-articular fractures and 80% excellent for extra-articular fractures. Range of active motion in intra-articular fractures was measured 60 degrees wrist extension, 64 degrees flexion, 65 degrees pronation, and 70 degrees supination, and for extra-articular fractures, 75 degrees extension, 70 degrees flexion, 80 degrees pronation, and 75 degrees supination. There was failure of fixation with loss of the reduction that was achieved at the time of operation in one patient. CONCLUSIONS: Fragment-specific fixation of unstable distal radius fractures using the Trimed system appears to be effective. Anatomic reduction, earlier range of motion, and improved functional results can be achieved using low-profile implants.     

Total and free PSA kinetics in patients without prostate cancer undergoing radical cystoprostatectomy

BACKGROUND: Radical cystoprostatectomy and radical prostatectomy are the two major operations where prostate is totally and radically removed. Radical cystoprostatectomy is usually performed in patients with invasive bladder cancer. The aim of the study was to examine Total PSA, Free PSA, and Free/Total Ratio elimination kinetics after radical cystoprostatectomy. METHODS: Serum PSA, Free PSA, and Free/Total Ratio were determined preoperatively, at the time of cystoprostatectomy specimen removal and then at 3, 6, 12, 24, 48, 72, and 168 hr, from seven patients with muscle invasive bladder cancer, who underwent radical cystoprostatectomy. Free and Total PSA concentrations were measured with non-competitive immunological procedures. The elimination rates and half-lives of Total, Free PSA and Free/Total Ratio were studied using a nonlinear regression analysis. RESULTS: Surgical manipulations caused about 1.5-fold increase of PSA, 5-fold increase in Free PSA and 3-fold increase in Free/Total Ratio. PSA and Free PSA followed a biphasic elimination pattern of a rapid exponential (a) phase with a half-life of 4.27 and 2.14 hr and a terminal, nonexponential (b) phase with a half-life of 63 and 173.2 hr, respectively. Free/Total PSA Ratio followed, also, a biphasic kinetic pattern of a rapid exponential decline with a half-life of 3.34 and a terminal non-exponential increase with a doubling time of 43 hr. CONCLUSIONS: Comparing PSA kinetics after radical cystoprostatectomy with those of radical prostatectomy, it appears that PSA follows the same elimination pattern in both models. In contrast, Free PSA and Free/Total Ratio elimination kinetics' patterns differ between the two surgical models.     

Deferoxamine infusion during coronary artery bypass grafting ameliorates lipid peroxidation and protects the myocardium against reperfusion injury: immediate and long-term significance.

AIMS: Previous reports have demonstrated enhanced myocardial protection and better post-ischaemic recovery using the oxygen free radical scavenger deferoxamine (DEF) during cardioplegia. The aim of this study was to test whether, in patients undergoing coronary artery bypass grafting (CABG), DEF i.v. infusion can reduce reperfusion injury on a short- and long-term basis. METHODS AND RESULTS: Forty-five consecutive male patients were randomly allocated to two groups: in group D (n=25, age 60.8+/-8.6 years), 4 g of DEF were infused for 8 h starting immediately after the induction of anaesthesia; in group C (n=20, age 62.2+/-6.4 years) dextrose solution was given for the same time as placebo. Haemodynamic monitoring and measurement of oxygen free radical production [by measuring thiobarbituric acid reactive substances (TBARS)] were carried out before and after CABG. Left ventricular ejection fraction (EF) and wall motion score index (WMSI) were measured before and after CABG and 12 months later. Haemodynamic measurements were similar in both groups before and after CABG. TBARS peaked at 4.8+/-1.1 nmol/mL in group C, but remained unchanged (2.4+/-0.9 nmol/mL) in group D (P=0.01). At baseline, both the EF and WMSI were similar between the groups. Following CABG, EF increased more in group D (8.8+/-8.4%) than in group C (1.3+/-6.7%), P=0.008, while WMSI decreased more in group D (-0.7+/-0.3) than in group C (-0.2+/-0.2), P=0.0001. Dividing group D according to the pre-operative median EF value (38%), we observed that after 1 year follow-up, DEF infusion conferred more protection in patients with a lower EF (EF increased by 19.3+/-6.2%, WMSI decreased by -1.1+/-0.2) than in those with a higher EF (EF increased by 7.7+/-4.5%, WMSI decreased by -0.8+/-0.2), P=0.001, respectively. CONCLUSION: In patients undergoing CABG, DEF i.v. infusion ameliorates oxygen free radical production and protects the myocardium against reperfusion injury. Patients with a lower EF seem to benefit more by DEF i.v. infusion.     

Alternative bi-pectoral muscle flaps for postoperative sternotomy mediastinitis

Suppuration, mediastinitis, and disruption of median sternotomy are all rare, but nevertheless severe complications. We propose a simple mobilization of the two pectoralis major muscles for use as flaps to fill the sternal defect without the need for humeral detachment or a second cutaneous incision. These will be supplied from both the thoracoacromial vessels and the perforating arteries of the nongrafted internal mammary artery (IMA). Our technique is quick and easy, giving excellent results. Furthermore, by maintaining the perforating branches, we also preserve the nongrafted IMA.