Comparison of laser power output from the fiber tip during endovenous laser ablation against displayed power and the "first treatment" effect.

OBJECTIVE: International guidelines recommend endovenous laser ablation as one of the first-line treatments for truncal venous reflux associated with varicose veins. Clinicians use linear endovenous energy density to measure the energy used during treatment. The aim of this study was to investigate the power output from the fiber tip and to see if this changed with use. METHODS: We placed 15 mL of water in a thermally insulated 25-mL beaker. Two thermocouples were placed equidistantly adjacent to the laser fiber tip. A 1470-nm laser was fired at 5W for 2 minutes and the temperature change was measured. Three fibers were used on different days to allow the laser to cool for 24 hours between fibers. Each fiber was tested three times in a row. We also tested the "first treatment" effect by comparing the power output when the fiber was fired immediately after the laser was switched on, compared with treatments when the laser had been switched on for 1 hour. To assess whether this was due to the console being "cold" on the first firing of the day, we repeated the experiment having switched on the laser console 1 hour before firing to "prewarm" the console. However, the diode was not fired during this hour. To measure fiber degradation, three runs of the experiment were performed successively before firing the laser continuously for 20 minutes, then three more runs were conducted, resulting in delivery of approximately 10,000 J. RESULTS: The actual power output seemed to be lower than the console suggested. The power output from the first fiber used in a succession of three with the same laser had a significantly lower power output than the following two runs (P = .0004 and P < .0001, respectively). When the laser was prewarmed for 1 hour without firing, no change in this output pattern was noted (P = .293). Fiber degradation was not found in any of the fibers that were tested within the maximum recommended for the fiber (10,000 J). CONCLUSIONS: The first use of a fiber in a treatment session has a significantly lower power output from the treatment tip than subsequent uses, even if the machine is prewarmed and the console displays the same power for each. The authors believe that this phenomenon is due to the diode being less efficient when first used after switching it on. Clinicians need to be aware that the true power output at the fiber tip may not be as indicated by the console display and may be variable during a treatment session.

Spatial and temporal disease dynamics of the parasite Hematodinium sp. in shore crabs, Carcinus maenas.

BACKGROUND: The parasitic dinoflagellates of the genus Hematodinium represent the causative agent of so-called bitter or pink crab disease in a broad range of shellfish taxa. Outbreaks of Hematodinium-associated disease can devastate local fishing and aquaculture efforts. The goal of our study was to examine the potential role of the common shore (green) crab Carcinus maenas as a reservoir for Hematodinium. Carcinus maenas is native to all shores of the UK and Ireland and the North East Atlantic but has been introduced to, and subsequently invaded waters of, the USA, South Africa and Australia. This species is notable for its capacity to harbour a range of micro- and macro-parasites, and therefore may act as a vector for disease transfer. METHODS: Over a 12-month period, we interrogated 1191 crabs across two distinct locations (intertidal pier, semi-closed dock) in Swansea Bay (Wales, UK) for the presence and severity of Hematodinium in the haemolymph, gills, hepatopancreas and surrounding waters (eDNA) using PCR-based methods, haemolymph preparations and histopathology. RESULTS: Overall, 13.6% were Hematodinium-positive via PCR and confirmed via tissue examination. Only a small difference was observed between locations with 14.4% and 12.8% infected crabs in the Dock and Pier, respectively. Binomial logistic regression models revealed seasonality (P < 0.002) and sex (P < 0.001) to be significant factors in Hematodinium detection with peak infection recorded in spring (March to May). Male crabs overall were more likely to be infected. Phylogenetic analyses of the partial ITS and 18S rRNA gene regions of Hematodinium amplified from crabs determined the causative agent to be the host generalist Hematodinium sp., which blights several valuable crustaceans in the UK alone, including edible crabs (Cancer pagurus) and langoustines (Nephrops norvegicus). CONCLUSIONS: Shore crabs were infected with the host generalist parasite Hematodinium sp. in each location tested, thereby enabling the parasite to persist in an environment shared with commercially important shellfish.

Are European lobsters (Homarus gammarus) susceptible to infection by a temperate Hematodinium sp.?

Hematodinium spp. infect over 40 species of crustaceans worldwide, but have not been reported to infect the European lobster, Homarus gammarus. In this study, Hematodinium parasites (a mixture of uni- and multinucleate trophont-like stages) were taken from donor crabs (Cancer pagurus) and injected into juvenile H. gammarus. Juvenile C. pagurus were also injected with the same inoculum. Haemolymph was taken at regular intervals and examined for the presence of Hematodinium using light microscopy and PCR, in two separate experiments of duration 4 and 8months. All lobsters were negative for Hematodinium whilst the C. pagurus challenged became infected. It is concluded that European lobsters are not susceptible to infection with a clade of Hematodinium that infects C. pagurus.

Soft tissue tumors with muscle differentiation.

The working group of the World Health Organization (WHO) updated its classification of soft tissue and bone tumors in 2002, and modifications were made primarily to the nomenclature for soft tissue neoplasms. This review presents the imaging features, patient demographics, and clinicopathological findings for benign and malignant skeletal and smooth muscle tumors using the current WHO classification system.

A prospective study of the microbiology of chronic venous leg ulcers to reevaluate the clinical predictive value of tissue biopsies and swabs.

This study determined whether comprehensive microbiological analysis offered real predictive value in terms of healing outcome, and assessed the clinical usefulness of surface swabs vs. tissue biopsies for clinically noninfected leg wounds. The wound microflora of 70 patients with chronic venous leg ulcers was quantified after sampling by swabbing and biopsy. A highly significant association between wound surface area at 4 weeks and eventual healing at 6 months was found (p<0.001), although initial wound size, sex, height, and weight were not significant predictors of outcome (p>0.1). A significant association between healing and bacterial diversity in the wound as assessed by swab (p=0.023) was demonstrated. Furthermore, the bacterial density of wound surface area by swab (CFU/mL; p=0.018) or biopsy (CFU/g tissue; p=0.038) were shown to be independent predictors of nonhealing. Logistic regression showed that microbiological analysis of biopsies provided no additional prognostic information when compared with analysis of the surface microflora (p=0.27). Hence, if biopsies do not contribute significantly to patient management, their use should be discouraged in clinically noninfected wounds. Furthermore, independent predictors of healing, such as wound surface microbial diversity and density, could identify patients likely to have an unfavorable outcome and to whom resources should be targeted.

Use of 16S ribosomal DNA PCR and denaturing gradient gel electrophoresis for analysis of the microfloras of healing and nonhealing chronic venous leg ulcers.

The bacterial microfloras of 8 healing and 10 nonhealing chronic venous leg ulcers were compared by using a combination of cultural analysis and denaturing gradient gel electrophoresis (DGGE) of PCR-amplified 16S rRNA gene products. Cultural analysis of the microflora revealed that the majority of both wound types carried the aerobes Staphylococcus and Pseudomonas spp. (89 and 80%, respectively). Sequencing of 16S ribosomal DNAs selected on the basis of DGGE profiling allowed the identification of strains not detected by cultural means. Of considerable interest was the finding that more than 40% of the sequences represented organisms not cultured from the wound from which they were amplified. DGGE profiles also revealed that all of the wounds possessed one apparently common band, identified by sequencing as Pseudomonas sp. The intensity of this PCR signal suggested that the bacterial load of nonhealing wounds was much higher for pseudomonads compared to healing wounds and that it may have been significantly underestimated by cultural analysis. Hence, the present study shows that DGGE could give valuable additional information about chronic wound microflora that is not apparent from cultural analysis alone.

Occult brain tumour presenting with burns.

An elderly male patient sustained mixed depth burns of 5% total body surface area. The incident was associated with inappropriate behaviour and subsequent clinical examination confirmed the presence of confusion and a hemiparesis. A CT scan revealed an intracranial tumour. Despite early suspicions that tumour excision would be delayed, wound healing was achieved quickly following tangential burn wound excision and skin grafting, and prompt transfer to a neurosurgical unit was expedited. Cases of burns and concomitant intracranial tumours with deteriorating neurological signs may present clinicians with a dilemma in deciding whether or not to await burn wound healing before carrying out tumour excision.