Mycobacterium ulcerans, the organism which causes Buruli
or
Bairnsdale ulcer, has never been
isolated in culture from an environmental sample. Most foci of infection
are in tropical
regions. The ...authors describe the first 29 cases of M. ulcerans
infection from a new focus on
an island in temperate southern Australia, 1992–5. Cases were
mostly elderly, had
predominantly distal limb lesions and were clustered in a small region
in
the eastern half of the
main town on the island. The authors suspected that an irrigation system
which lay in the
midst of the cluster was a source of infection. Limitation of irrigation
was associated with a
dramatic reduction in the number of new cases. These findings
support the hypothesis that
M. ulcerans has an aquatic reservoir and that persons may be
infected directly or indirectly
by mycobacteria disseminated locally by spray irrigation.
We compare the survival outcomes of patients with clear cell renal cell carcinoma (RCC) treated with adrenal sparing radical nephrectomy (ASRN) and non-adrenal sparing radical nephrectomy (NASRN).
We ...conducted an observational study based on a composite patient population from two university teaching hospitals who underwent RN for RCC between January 2000 and December 2012. Only patients with pathologically confirmed RCC were included. We excluded patients undergoing cytoreductive nephrectomy, with loco-regional lymph node involvement. In total, 579 patients (ASRN = 380 and NASRN = 199) met our study criteria. Patients were categorized by risk groups (all stage, early stage and locally advanced RCC). Overall survival (OS) and cancer-specific survival (CSS) were analyzed for risk groups. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression.
The median follow-up was 41 months (range: 12-157). There were significant benefits in OS (ASRN 79.5% vs. NASRN 63.3%; p = 0.001) and CSS (84.3% vs. 74.9%; p = 0.001), with any differences favouring ASRN in all stage. On multivariate analysis, there was a trend towards worse OS (hazard ratio HR 1.759, 95% confidence interval CI 0.943-2.309, p = 0.089) and CSS (HR 1.797, 95% CI 0.967-3.337, p = 0.064) in patients with NASRN (although not statistically significant). Of these patients, only 11 (1.9%) had adrenal involvement.
The inherent limitations in our study include the impracticality of conducting a prospective randomized trial in this scenario. Our observational study with a 13-year follow-up suggests ASRN leads to better survival than NASRN. ASRN should be considered the gold standard in treating patients with RCC, unless it is contraindicated.
The anticonvulsant drug gabapentin has been demonstrated to alleviate symptoms of painful diabetic neuropathy as well as other types of neuropathic pain. The aim of the present study was to ...investigate the effect of gabapentin in a recently developed mouse model of peripheral neuropathy. This model is based on a photochemical ischemic lesion of the sciatic nerve generated by laser-induced activation of the photosensitizing dye erythrosin B. Following laser irradiation of the sciatic nerve for 2, 5, or 10 min, tactile allodynia was observed during at least 3 weeks. The degree of allodynia was most marked following 10 min of irradiation. Subcutaneous administration of gabapentin 175–300 μmol/kg (∼30–51 mg/kg), cumulative doses, at 1-h intervals significantly reversed tactile allodynia induced by 10-min laser irradiation. The maximal dose of gabapentin increased the withdrawal threshold from ∼0.55 to ∼1.85 g (i.e., about 77% of the threshold in normal animals, ∼2.4 g). Gabapentin did not affect the tactile withdrawal threshold in intact animals. A dose of gabapentin (100 μmol/kg, sc) that had no effect on allodynia was found to significantly reduce the pain behavior during phase 2 of the formalin test. The present study demonstrates that systemic administration of gabapentin suppresses both allodynia induced by an ischemic lesion of the sciatic nerve and pain behavior in the formalin test.
Objectives: To determine whether FloSeal as a haemostatic agent in tonsillectomy is associated with less postoperative pain than conventional haemostasis with ligatures.
Design: Randomised, ...controlled, single‐blinded pilot study.
Setting: James Cook University Hospital, Middlesbrough, Cleveland, UK.
Participants: Thirty patients over 16 years of age undergoing tonsillectomy for recurrent tonsillitis were recruited for the study. At surgery both tonsils were removed by cold steel dissection. Following randomisation one tonsil fossa had FloSeal applied and the other ligatures for haemostasis.
Main outcome measures: The primary outcome measure was postoperative pain following tonsillectomy measured on a visual analogue scale. Pain was recorded three times a day for the first 10 days following surgery. Haemorrhage rates were also recorded as a secondary outcome.
Results: Complete data was analysed for 26 patients (87%). The data was grouped into distinct time periods: 0–2, 3–6 and 7–10 days. The sum of the visual linear analogue scale over the time periods for each patient was calculated. Using Wilcoxon Signed Ranks Test, the data was analysed and it was found that there was no statistically significant difference in postoperative pain scores between the control and treatment side at any time. There was a postoperative reactionary haemorrhage rate of 6.7% on the FloSeal side.
Conclusion: In our pilot study there was no reduction in pain on the FloSeal side in the first 10 days following tonsillectomy which contrasts with previous findings in the literature.
The value of high resolution computerized tomography (CT) prior to routine mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity and specificity, in detecting the extent ...of underlying pathology and in predicting asymptomatic complications, prevent widespread adoption. This retrospective study looks at the influence of pre-operative scanning on the surgical management of chronic suppurative otitis media over an 18-month period. The radiological findings determined the choice of surgical approach, but contributed less to the decision to operate and the prediction of potential hazards. CT is of most value when the otologist can be flexible in surgical technique, tailoring it to imaging findings.
The resonance Raman and infrared spectra of the bridging ligand 3,6‐bis(2‐pyridyl)‐1,2,4,5‐tetrazine (bptz) have been studied. Ab initio calculations on bptz and the radical anion bptz·− are able to ...predict the frequencies and intensities of the vibrational spectra. This analysis is used to interpret the vibrational spectroscopy of the bridged binuclear complexes (bpy)2Ru(μ‐bptz)Ru(bpy)24+ (1) and (PPh3)2Cu(μ‐bptz)Cu(PPh3)22+ (2) and their redox products. The resonance Raman spectroscopy of 1 reveals the bichromophoric nature of the complex, with bpy and bptz ligand modes being enhanced selectively as a function of excitation wavelength. The UV/Vis spectrum of 1+ reveals a strong IVCT band suggesting the mixed‐valent species is Class III in nature. This is consistent with findings for other metal moieties with the bptz ligand. The resonance Raman spectrum of 1+ is also consistent with a Class III formulation. The resonance Raman spectrum of 2− is used to model bptz·− and the ab initio calculations show some correlation with the observed spectrum. The excited‐state resonance Raman spectra of 1, generated with 532 and 633 nm excitation, show spectral features that are not strongly characteristic of bptz·−. This appears to be a consequence of the delocalised nature of the molecular orbitals involved in the excited‐state of 1.
We have measured the performances of a LYSO crystal matrix prototype tested with electron and photon beams in the energy range 60–450 MeV. Furthermore, this study has been carried out to determine ...the achievable energy and time resolutions for the calorimeter of the Mu2e experiment.
The finding of the vermiform appendix in an inguinal hernia has an incidence of approximately 1%. The condition is given the eponymous name Amyand's hernia. However in just 0.08% the condition is ...complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix and is most often misdiagnosed as an incarcerated inguinal hernia. As such it is rarely recognised prior to surgical exploration. We report a case of Amyand's hernia in an 85 year old woman, which presented as a right groin enterocutaneous fistula. CT scanning illustrated a fistulous tract in the right groin, which communicated with the caecum and the peritoneal cavity. She underwent laparotomy, which revealed that the appendix appeared inflamed, lay in the inguinal canal and was the origin of the enterocutaneous communication.
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