Objective We sought to evaluate the effects of graft type, site of implantation, and ovariectomy on the long-term histologic response to graft materials used in pelvic reconstructive surgery. Study ...Design In all, 45 rabbits underwent ovariectomy or sham laparotomy and were implanted with polypropylene (PP) mesh (n = 23) or cross-linked porcine dermis (PS) (n = 22) in the vagina and abdomen. Grafts were harvested 9 months later and were processed for histology to evaluate the host inflammatory response and degree of tissue incorporation within the grafts. Results Polypropylene induced a milder ( P < .007), more uniform response than PS, whereas PS elicited a more variable response and degraded by 9 months. Vaginal grafts had higher scores for inflammation ( P = .005) and neovascularization ( P < .001), and had lower scores for fibroblastic proliferation ( P < .001) than abdominal grafts. Ovariectomy had no effect ( P > .05). Conclusion Synthetic and biologic grafts evoke different foreign body responses, which may have implications for surgical outcomes in women.
A Decade of Advances in Military Trauma Care Glassberg, E.; Nadler, R.; Erlich, T. ...
Scandinavian Journal of Surgery,
06/2014, Letnik:
103, Številka:
2
Book Review, Journal Article
Recenzirano
Background:
While combat casualty care shares many key concepts with civilian trauma systems, its unique features mandate certain practices that are distinct from the civilian ones.
Methods:
This is ...a review of the most current literature on combat casualty care, based on computer database searches for studies on combat casualty care and military medicine. Studies were selected for inclusion in this review based on their relevance and contribution.
Results:
Over the last decade, meticulous, international data collection and research efforts have led to significant improvements in military trauma care. Combat medicine has focused on the causes of preventable deaths and targeted on bleeding control and resuscitation strategies, as well as improved evacuation. En route care and forward surgical interventions have resulted in unprecedented low fatality rates and the saving of more lives.
Conclusion:
This overview of the developments in combat casualty care in recent years emphasizes medical practices that are characteristic of combat medicine, yet with the potential to save lives in other scenarios, as well.
Enrolling critically ill patients in clinical trials is challenging. We observed that eligible patients at San Francisco General Hospital (SFGH), a public hospital that cares largely for indigent ...patients, were less likely to be enrolled in a clinical trial of acute lung injury (ALI) than eligible patients at the University of California, San Francisco (UCSF), a university referral center. We examined the reasons for nonenrollment and the impact of the availability of a surrogate decision maker on critical care clinical trials enrollment.
Data collected from the ARDS Network trial of lower vs traditional tidal volume ventilation for patients with ALI was analyzed. Patient demographics and reasons for nonenrollment were analyzed among 531 consecutively screened patients at the two hospitals: UCSF and SFGH.
At UCSF, 1% of screened patients were not enrolled because they lacked surrogates, whereas 18% of screened patients were not enrolled at SFGH because they lacked surrogates. Lack of surrogate was the most common reason for nonenrollment among eligible patients at SFGH.
Critically ill patients with ALI at a public hospital were less likely to be enrolled in a clinical trial than patients at a university hospital primarily because they lacked surrogates. Lack of a surrogate also was a major factor in nonenrollment in other ARDS Network hospitals. In order to provide all affected patients an opportunity to participate in research, innovative strategies for increasing enrollment in critical care research without compromising protection from research risks are needed.
Background
Inappropriate distribution of casualties in mass casualty incidents (MCIs) may result in patient overload in primary medical facilities.
Objective
The aim of this study was to review the ...consequences of evacuating casualties from a bus accident to a single rural hospital and lessons learned regarding policy of casualty evacuation.
Methods
Hospital medical records of all casualties from primary and tertiary hospitals were independently reviewed by two senior trauma surgeons. In addition four senior trauma surgeons reviewed the impact of treatment provided in the primary hospital on patient outcomes.
Results
31 survivors from the accident were transferred to the closest local hospital; 4 died en route to the hospital or within 30 minutes of arrival. 27 casualties were air evacuated from the local hospital within 2.5 to 6.15 hours to level I and II hospitals. Under-triage of 15% and over-triage of 7% were noted. 4 casualties did not receive treatment at the local hospital that might have improved their condition.
Discussion
Over and under-triage might have been due to minimal trauma related experience of primary hospital personnel. Evacuation of casualties from an MCI to a limited capacity hospital may overwhelm the facility and affect its ability to provide appropriate medical care.
Conclusions
In MCIs occurring in rural areas, only immediate unstable casualties should be transferred to the closest primary hospital. On-site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
We describe a case of peripheral intravenous catheter fracture occurring during a routine training exercise. The supervising instructor immediately placed a venous tourniquet proximal to the ...insertion site and urgently transported the patient to the hospital. The missing catheter segment was identified within the median cubital vein under ultrasonography and was removed by venous cutdown under local anesthesia. An investigation determined that reinsertion of the needle into the advanced catheter likely caused the fracture and that application of a tourniquet may have prevented embolism of the fractured segment. Our literature review suggested that peripheral intravenous catheter fracture is likely vastly underreported, with only one prior case identified in the English literature. Action was taken following the event to educate all Israeli Defense Force medical providers regarding both proper preventive measures and recognition and treatment of catheter fracture should it occur. This case highlights the importance of health care providers being aware of the possibility of catheter fracture, as well as steps to take to prevent and mitigate its occurrence.
Photodynamic therapy (PDT) involves the use of laser or noncoherent light energy with photosensitizing dyes to induce a cytotoxic reaction in the target cells, resulting in cell injury and/or death. ...In this study, we have examined laser-induced phototoxicity in normal human skin fibroblasts and HT-1080 fibrosarcoma cells incubated with aluminum phthalocyanine tetrasulfonate (AlPcS) in vitro. The culture, laser, and photosensitizer parameters were varied in attempts to establish the conditions for differential cytotoxicity between normal and malignant human fibroblasts. Biochemical assays, as a measure of cytotoxicity, included 3Hthymidine incorporation (an index of DNA replication), 35Smethionine incorporation (a measure of protein synthetic activity), and the MTT assay (an indirect index of mitochondrial activity). In the absence of laser irradiation, AIPcS was non-toxic to both cell lines in concentrations up to 25 μg/ml. Laser light alone at 675nm (the absorption maxi- mum of A1PcS) had no effect on the cells at energy densities up to 16 J/cm2. In the presence of 3 or 10 μg/ml of AlPcS, both cell lines demonstrated marked energy-dependent toxicity. If an 8-h or a 24-h “efflux” period in AlPcS-free medium was allowed to take place prior to laser irradiation, normal fibroblasts were much less sensitive to PDT, whereas fibrosarcoma cells still exhibited a marked degree of toxicity. The results indicate that, under appropriate treatment conditions, AlPcS is capable of preferentially sensitizing a malignant mesenchymal cell line, while sparing its non-malignant normal cell counterpart.
Non-freezing cold injury (NFCI) is an injury of the hands or feet resulting from exposure to wet conditions and temperatures just above freezing, typically found in soldiers. NFCI is due to ...microvascular endothelial damage, stasis and vascular occlusion. At first, the tissue is cold and anesthetic, progressing to hyperemia in 24-48 hours. Hyperemia is accompanied by an intense painful burning sensation as well as blisters, redness, and possibly, ulcerations. NFCI management raises frustration in both medical officers and commanders. Most authorities are not aware of or remain unimpressed with the severity of NFCI, nor do they realize that it produces lifelong symptomatology. The following review of the available literature attempts to clear up some issues regarding the definition, pathogenesis, symptoms and preventative measures available in NFCI, including our own experience.
The 577-nm flashlamp-pumped tunable dye laser pulsed at 450 microseconds is rapidly becoming the treatment of choice for removal of portwine stains and other vascular ectasias. In this study, we ...examined the mechanisms of vessel destruction by determining the effects of laser irradiation on three types of primary target cells--erythrocytes, endothelial cells, and fibroblasts. Human endothelial cells and fibroblasts in microwell plates were irradiated at various energy densities with the laser, after which several aspects of cellular biology were determined, including 1) viability of cells by trypan blue exclusion test; 2) cell proliferation by 3Hthymidine incorporation; and 3) rate of protein synthesis using 3Hleucine incorporation as a marker. In endothelial cell cultures, both 3Hthymidine and 3Hleucine incorporations were inhibited at energy levels of 5-12 J/cm2 (P less than 0.01). In fibroblast cultures, cell proliferation was similarly inhibited, while supratherapeutic energy density (greater than or equal to 12 J/cm2) was required for inhibition of protein synthesis. The laser energy in the range of 5-8.5 J/cm2 had no effect on cell viability. Erythrocytes as target cells for laser energy demonstrated rapid, dose-dependent lysis, as determined by release of free hemoglobin into culture medium. Addition of erythrocytes into a coculture with endothelial cells abolished the direct inhibitory effect noted in cultures when endothelial cells were present alone. The results of the latter experiment imply that erythrocytes are the primary target cell absorbing the laser energy at 577 nm. However, direct laser effects on endothelial cells may also contribute to the mechanisms of ablation of the vascular ectasias by the tunable dye laser at 577 nm.
The use of lasers in cosmetic surgery has been expanded fairly recently to include blepharoplasties. Controversy exists as to the efficacy of this procedure. This survey is designed to gain an ...understanding of the efficacy of blepharoplasty performed by laser versus conventional scalpel techniques.
A group of surgeons who perform the procedure were questioned. Over 4,000 cases of upper and lower lid laser blepharoplasty were reported by the responding physicians.
The results of this survey indicate that carbon dioxide is by far the most common laser used in laser blepharoplasty (96%). A laser is used as a sole cutting tool by 70% of the responders and as a sole hemostasis tool by 88% of surgeons. Overall, both the intraoperative time and postoperative recovery period were reported as significantly reduced when blepharoplasty is performed by laser as compared with scalpel. In general, the incidences of edema, ecchymosis, and postoperative pain were reported as less severe with laser. No serious complications related to the laser were documented by the survey responders.
This study confirms that laser blepharoplasty techniques can be safe and effective in skilled hands and may even have some potential advantages over conventional blepharoplasty.
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