Platelet-rich plasma for zone II flexor tendon repair.

BACKGROUND: Platelet-rich plasma (PRP) has shown promise in the treatment of tendinopathy, including rotator cuff and lateral epicondylitis. Here, we evaluate the effect of PRP on healing in a rabbit zone II flexor tendon model. METHODS: Thirty New Zealand white rabbits underwent transection and repair of the second and fourth flexor digitorum profundus. Half of the rabbits received autologous PRP intraoperatively, while the other half underwent standard four-strand tendon repair. Tendons were examined at 2, 4, and 8 weeks postoperatively. Range of motion and ultimate tensile strength were assessed on the fourth toes, while second toes underwent histologic analysis with hematoxylin and eosin, Masson Trichrome, and Picrosirius Red, for assessment of cell count, collagen content, and collagen maturity. RESULTS: There were no significant differences in ultimate tensile strength between treatments at 2, 4, or 8 weeks. There was a trend towards lower tensile strength in the PRP group at 2 weeks. There was no statistically significant difference in excursion or range of motion between PRP and control tendons. Cell counts at 4 weeks were statistically significantly reduced in the PRP tendons as compared to controls. No difference in collagen content or maturity was detected. CONCLUSIONS: In contrast to previous studies, PRP did not significantly improve ultimate tensile strength. PRP-treated tendons exhibited trends towards reduced healing, including a significant reduction in cell counts as well as a smaller increase in collagen deposition over time as compared to controls. Further study is needed to determine the precise effect of PRP on intrasynovial flexor tendon repairs.

Postprocedural hypotension after carotid artery stent placement: predictors and short- and long-term clinical outcomes.

PURPOSE: To describe the predictors of persistent hypotension after carotid artery stent (CAS) placement and define the clinical outcome of patients with this hemodynamic disturbance. MATERIALS AND METHODS: One hundred forty CAS procedures were performed in 133 consecutive patients. Post-CAS hypotension-defined as a greater than 40 mm Hg decrease in arterial pressure without evidence of hypovolemia, with a systolic pressure lower than 90 mm Hg at the end of CAS and lasting at least 1 hour-was observed in 25 patients (group 1); 108 patients did not have hypotension (group 2). RESULTS: Post-CAS hypotension developed in 33.9% of cases after balloon-expandable stent placement versus in 13.6% of cases after self-expanding stent placement (P =.04). In-hospital minor ipsilateral strokes occurred in 16% of cases in group 1 versus in 3% of cases in group 2 (P =.03). There was one (0.9%) major stroke (transient) and three (2.6%) transient ischemic attacks, all of which occurred in group 2 (not significant vs group 1 for both conditions). At 10 months +/- 4 (SD) of follow-up, there was greater total mortality in group 1 than in group 2 (20% vs 4%, P =.02), whereas neurologic events did not differ significantly between the groups. CONCLUSION: Hypotension due to carotid sinus stimulation is frequent after CAS with balloon-expandable stents. This phenomenon correlates with increased in-hospital complications and long-term risk of death.

Injury to a patent left internal thoracic artery graft at coronary reoperation.

BACKGROUND: The purpose of this study was to determine the prevalence, outcome, and operative strategies for patients having injury to a patent left internal thoracic artery (LITA) graft to the left anterior descending coronary artery (LAD) at coronary reoperation. METHODS: Of 655 patients with a patent LITA graft to the LAD undergoing coronary reoperation from 1986 to 1997, 35 (5.3%) sustained intraoperative injury to the LITA graft. RESULTS: Strategies to restore flow to the LAD included new saphenous vein graft to the LAD in 15 patients, saphenous vein graft to the LITA stump in 7, saphenous vein graft to the LAD and repair of the LITA graft in 6, and other strategies in 7. All or part of the LITA graft to the LAD was salvaged in 20 patients (57%). Fourteen patients (40%) sustained perioperative myocardial infarction, and 3 patients died (8.6%). The 3 patients who died all had stenosis or thrombosis of the graft to the LAD documented at autopsy. CONCLUSIONS: We conclude that (1) the prevalence of injury to a patent LITA graft is 5.3%; (2) a variety of techniques can be used to restore blood flow to the LAD; and (3) ineffective revascularization of the LAD in this situation is associated with operative mortality. At primary coronary artery bypass grafting, the LITA pedicle should be positioned in the left chest away from the posterior sternal table; this strategy may minimize the risk of LITA graft injury at coronary reoperation.

The geography of fundholding in southwest England: implications for the evolution of primary care groups.

Using postcode-ED linkage to calculate patient-weighted deprivation indices for 330 general practices in southwest England, this study examines whether the populations served by fundholding and non-fundholding practices varied with respect to socio-economic status. Little evidence is found of systematic socio-economic bias in the uptake of fundholding. However, a distinct spatial pattern to the distribution of fundholding is revealed in this article, urban practices having adopted the scheme more readily than their rural and mixed rural/urban counterparts. As practice-level fundholding is replaced by commissioning at the locality level, such geographical variation is likely to be expressed in the way in which primary care groups evolve.

Comparison of two progestogens during out-of-season breeding in a commercial ewe flock.

A comparison was made of the relative effectiveness of subcutaneous ear implants containing 2 mg Norgestomet or vaginal pessaries containing 60 mg medroxyprogesterone acetate (MAP) to induce estrus and conception in dry anestrous ewes. Groups of ewes were treated with one of the two progestogens for 14 d, and 500 IU pregnant mare serum gonadotropin (PMSG) was administered intramuscularly at the time of progestogen withdrawal. No significant differences in estrus induction, pregnancy rate or number of lambs born per ewe lambing were observed. Ewes treated with Norgestomet had 96% estrus, 60% pregnancy rate and 1.4 lambs per ewe lambing. Comparably, ewes treated with MAP had 94% estrus, 65% pregnancy rate and 1.7 lambs per ewe lambing. Norgestomet implants compared favorably with MAP pessaries for estrus induction and breeding of commercial, dry anestrous ewes.

Ideological goals of different health insurance plans.

Questionnaires sent to and interviews with managerial personnel in two types of health insurance organizations revealed substantial differences in their goals. Top policy makers, executive managers, and lower level management personnel (in all 165 people from four entities) were questioned. Although differences occurred among the various administrative levels, the commercial companies were more strongly oriented toward profit and growth and the prepaid group practice plans more strongly oriented toward service and community relations. These findings were confirmed by a study of the public statements of these organizations. The findings would seem to have relevance to the use of insurance companies by the government in implementation of any national health insurance program.

Quality of medical care: a factor analysis approach using medical records.

A relatively inexpensive, reliable, and unobtrusive method is described for measuring the content of medical care. Factor analysis of the content of the records of more than 11,000 physician-patient encounters from six different health insurance plans extracted four main factors or dimensions that together explained 42 percent of the variance in record content. Appropriate names for these dimensions appear to be: "prevention," "rationality," "verification," and "continuity." The method is tested by scoring the six insurance plans on the four factors.