Biocompatibility of Antifogging SiO-doped Diamond-Like Carbon Laparoscope Coatings.

Laparoscopes can suffer from fogging and contamination difficulties, resulting in a reduced field of view during surgery. A series of diamond-like carbon films, doped with SiO, were produced by pulsed laser deposition for evaluation as biocompatible, antifogging coatings. DLC films doped with SiO demonstrated hydrophilic properties with water contact angles under 40°. Samples subjected to plasma cleaning had improved contact angle results, with values under 5°. Doping the DLC films with SiO led to an average 40% decrease in modulus and 60% decrease in hardness. Hardness of the doped films, 12.0 - 13.2 GPa, was greater than that of the uncoated fused silica substrate, 9.2 GPa. The biocompatibility was assessed through CellTiter-Glo assays, with the films demonstrating statistically similar levels of cell viability when compared to the control media. The absence of ATP released by blood platelets in contact with the DLC coatings suggests in vivo hemocompatibility. The SiO doped films displayed improved transparency levels in comparison to undoped films, achieving up to an average of 80% transmission over the visible spectrum and an attenuation coefficient of 1.1 × 104 cm-1 at the 450 nm wavelength. The SiO doped DLC films show promise as a method of fog prevention for laparoscopes.

Peritoneal loose bodies and the differentiation of fatty abdominal and pelvic lesions.

Peritoneal loose bodies (PLBs) have been sparingly documented within the surgical and radiologic literature, with 38 cases reported to date. A 67-year-old male presented to urology for the management of an asymmetric prostatic nodule. Imaging incidentally identified a well-circumscribed mass of low T2 signal intensity with a small fatty core in the left lower quadrant close to the sigmoid colon; malignancy was in the differential. The mass grew slightly over the next year. A diagnostic laparoscopy retrieved a free floating 4 × 4 cm benign mass from the pelvis, identified as necrotic fat with areas of dystrophic calcifications. PLBs are often a diagnostic dilemma without surgical intervention. Here we present a diagnostic algorithm based on a comprehensive literature review and our case to help better identify unknown abdominal and pelvic fatty masses and to avoid surgery strictly for diagnosis, especially for patients that are not ideal surgical candidates. Using this algorithm, the mass in the patient presented here could have been accurately characterized without invasive diagnostic measures.

Pseudoangiomatous stromal hyperplasia of the breast in two adolescent females.

The majority of breast lesions that present in adolescent girls are benign, with most being fibroadenomas. Rarely, a large and rapidly growing breast mass may be found to be the more recently described entity named pseudoangiomatous stromal hyperplasia (PASH). The pathogenesis of this lesion is attributed to hyperplasia of stromal myofibroblasts in response to hormonal stimuli. To date, PASH has rarely been described in adolescence. We describe the presentation of PASH in two adolescent patients. The first is a 12-year-old girl who found a mass in her left breast 3 months prior to presentation. An excision of an 11.5 x 10 x 3.5 cm lesion weighing 347 g was performed via breast-conserving incisions. The second patient is a 16-year-old girl who also had a rapidly enlarging left breast mass removed in a similar fashion. This mass measured 12 x 11 x 6 cm and weighed 460 g. Both tumors were noted to have a smooth capsule. Histologic appearance consisted of the typical features of PASH; fibrous stroma containing numerous anastomosing slit-like spaces; some compressed and others with discernible lumina. Both patients had complete excisions and have since not experienced recurrence. Each has had excellent cosmetic results with symmetrical breast development since their resection. Pseudoangiomatous stromal hyperplasia is a rare tumor that arises in the breast. These tumors may grow quickly and often are mistaken for fibroadenomas, phylloides tumor, or angiosarcoma. They must be resected with careful attention to resection around the capsule of the tumor with breast conservation as a goal. Long-term follow-up is necessary, as some have been reported to recur.

Arthroscopic shoulder reconstruction: fast-track recovery and outpatient treatment.

Arthroscopic shoulder reconstructive surgery has been handled in many different ways. However, there currently is significant evidence and experience to show that doing this surgery on an outpatient basis is not only cost-effective and efficient, but safe and beneficial to patients. New arthroscopic surgical techniques and the use of regional interscalene anesthesia have been shown to provide effective and comfortable intraoperative conditions, while allowing for prolonged analgesia and quicker recovery with minimal side effects. The authors will discuss their approach to surgery, anesthesia, and recovery for outpatient shoulder reconstruction.

Trends in peripheral vascular procedures in the Veterans Health Administration, 1989-1998.

OBJECTIVE: To assess trends in peripheral vascular procedures performed in Veterans Health Administration (VHA) facilities. METHODS: All discharges with peripheral vascular procedures recorded for 1989-1998 were analyzed. The VHA user population was used to calculate age-specific rates. Trends were evaluated using frequency tables and Poisson regression. RESULTS: The VHA had 55,916 discharges with peripheral vascular procedures performed almost exclusively in men. Indications included peripheral vascular disease (53.7%), gangrene (19.3%), surgical complications (13.3%), and ulcers and infection (9.6%). The VHA age-specific rates were higher than US population rates for persons 45 to 64 years, similar for those 65 to 74 years, and lower for those 75 years and older. The age-specific rates declined slightly over the 10 years of observation, with the greatest decline noted in men age 45 to 65. CONCLUSION: The VHA provides almost 8% of all US peripheral vascular procedures in males. The VHA age-specific rates differ from the US rates with a shift to younger patients. The rates decreased for all age groups between 1989-1998.

Environmental control to reduce transmission of Clostridium difficile.

Restrictive antibiotic policies and infection control measures have been shown to reduce the incidence of Clostridium difficile-associated diarrhea (CDAD) among hospitalized patients. To date, the role of environmental disinfectants in reducing nosocomial CDAD rates has not been well studied. In a before-and-after intervention study, patients in 3 units were evaluated to determine if unbuffered 1:10 hypochlorite solution is effective as an environmental disinfectant in reducing the incidence of CDAD. Among 4252 patients, the incidence rate of CDAD for bone marrow transplant patients decreased significantly, from 8.6 to 3.3 cases per 1000 patient-days (hazard ratio, 0.37; 95% confidence interval, 0.19-0.74), after the environmental disinfectant was switched from quaternary ammonium to 1:10 hypochlorite solution in the rooms of patients with CDAD. Reverting later to quaternary ammonium solution increased the CDAD rate to 8.1 cases per 1000 patient-days. No reduction in CDAD rates was seen among neurosurgical intensive care unit and general medicine patients, for whom baseline rates were 3.0 and 1.3 cases per 1000 patient-days, respectively. Unbuffered 1:10 hypochlorite solution is effective in decreasing patients' risk of developing CDAD in areas where CDAD is highly endemic. Presumed mechanisms include reducing the environmental burden and the potential for C. difficile transmission among susceptible patients.

Diagnosis and classification of diabetes mellitus: new criteria.

New recommendations for the classification and diagnosis of diabetes mellitus include the preferred use of the terms "type 1" and "type 2" instead of "IDDM" and "NIDDM" to designate the two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These changes provide an easier and more reliable means of diagnosing persons at risk of complications from hyperglycemia. Currently, only one half of the people who have diabetes mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors, and should begin earlier and be repeated more often in those with risk factors. Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of blood glucose levels and a reduction in the severity of complications associated with this disease.

A call for specific codes for diabetes foot and eye care.

In this report, we propose new International Classification of Diseases (ICD) codes that could be incorporated into computer-based patient records or administrative data to monitor and improve diabetes care. Neither the ICD, 9th Revision, nor its imminent replacement, the ICD, 10th Revision, has specific codes for foot examinations and funduscopic examinations in the asymptomatic person, high-risk diabetic foot status, or clinically significant macular edema. Adoption of official codes for these procedures and conditions implemented in conjunction with computerized databases could be used for surveillance, program planning, and quality of care assessment. Computerized medical records could use the codes to monitor care and issue reminders to patients and providers. Payors could offer reimbursement incentives to encourage compliance with standard recommendations. These codes for care procedures could be linked to outcomes, such as amputations and blindness, to improve our understanding of the etiology of blindness and the relationship between process and outcome. The uniform adoption of these codes would facilitate comparison between health care systems, geographic regions, and nations. The diabetes community should encourage the National Center for Health Statistics to adopt new codes that could be used to monitor diabetes preventive care practices.

Recovery of mitochondrial DNA from blood leukocytes using detergent lysis.

Mitochondrial DNA (mtDNA) was isolated from leukocytes contained in whole blood of cattle. Leukocyte membranes except the nuclear envelope were solubilized in a buffer that contained 1% Triton X-100. After sedimentation of cell nuclei, mtDNA was purified from the cell lysate by organic solvent extraction and ethanol precipitation. Approximately 5 micrograms of mtDNA was recovered from 400 ml of whole blood, a quantity sufficient for routine DNA cloning procedures or for detailed restriction mapping studies. mtDNA isolated with this method is a suitable substrate for several DNA-modifying enzymes. Thus, preparation of mtDNA from blood by detergent lysis provides a noninvasive alternative to tissue biopsy for characterization of mitochondrial genotypes in studies of evolutionary genetics and population dynamics.

Immunoglobulin G binding activity of Brucella abortus.

A Brucella abortus protein with a molecular weight of 50 kDa has been shown to bind bovine immunoglobulin G from healthy, brucellosis-free animals. The Brucella immunoglobulin G binding molecule appears to be a protein, since it is susceptible to proteolysis. The protein is presumed to be located on the cell surface, since intact cells precipitate bovine immunoglobulin G. Examination of other species of Brucella shows that all Brucella species and strains tested express the protein. B. abortus cells also bound immunoglobulin G from other animal species. These included cat, chicken, dog, guinea pig, horse, human, mouse, rat, sheep, swine, and turkey but not immunoglobulin G from goat or rabbit.

A protein isolated from Brucella abortus is a Cu-Zn superoxide dismutase.

Brucella abortus contains a protein that elicits an antigenic response in cattle previously exposed to the organism. The amino acid sequence of the recombinant form of this antigenic protein was determined by gas-phase sequencing of the pyridylethylated protein and its peptides obtained by digestion with cyanogen bromide (CNBr), clostripain, and Staphylococcus aureus V8 protease. The Brucella protein demonstrated 53.6% identity with the Cu-Zn superoxide dismutase (SOD) from Photobacterium leiognathi. Residues essential for metal coordination and enzymatic activity and cysteines required for the formation of the intrasubunit disulfide bridge of Cu-Zn SOD were conserved in the Brucella protein. also exhibited SOD activity that was inhibited by cyanide, which is characteristic of a Cu-Zn SOD. Brucella abortus Cu-Zn SOD is the second prokaryotic Cu-Zn SOD to be sequenced, and the fifth found in prokaryotes. The high degree of conservation between Photobacterium and Brucella Cu-Zn SOD supports the hypothesis of a separately evolved prokaryotic and eukaryotic Cu-Zn SOD gene.

Characteristics of mammary mitochondria in lines of mice genetically divergent for milk production.

The purpose of this study was to determine the relationship of mitochondrial proliferation and ATP production to milk production in two lines of mice that were genetically divergent for milk production. Milk production differed between high production and low production lines by .8 phenotypic standard deviations as determined by cross-fostered litter weight gain from 1 to 12 d postpartum. Mammary weight, mammary total DNA, and RNA:DNA ratio were greater in glands of high line mice. Mammary DNA and protein, expressed per gram mammary tissue, were similar between lines. Mammary mitochondrial mass per gland differed after six generations of divergent selection. Rates of succinate-supported ATP production and ADP:O of isolated mitochondria differed, but the rate of pyruvate-supported ATP production did not differ between lines. Differences between selection lines in mitochondrial mass and in the efficiency of succinate use for support of ATP production were probable consequences of selection for divergent milk production.

Total blood loss in major joint arthroplasty. A comparison of cemented and noncemented hip and knee operations.

Blood loss is an important aspect of any major surgery. With increased experience and increasing use of noncemented prostheses, there are indications that the total blood loss is higher in noncemented than in similar cemented arthroplasties. This report is a retrospective study of blood loss comparing cemented and non-cemented cases. In a total of 30 total hip and 37 total knee arthroplasties that were reviewed in detail, the difference in blood loss between the two groups was statistically significant. The authors give suggestions on how to reduce blood loss in noncemented knee procedures.

Surgical treatment of paralytic scoliosis associated with myelomeningocele.

The spines of forty patients with myelomeningocele and paralytic scoliosis were surgically stabilized at the Twin Cities Scoliosis Center between 1960 and 1979. Treatment with posterior spine fusion and Harrington instrumentation extending to the sacrum, combined with anterior fusion using either Dwyer or Zielke instrumentation, gave the best results, correcting scoliosis by an average of 45 degrees (comparing preoperative values with those at the last visit), lordosis by an average of 20 degrees, torso decompensation by an average of 5.7 centimeters, and pelvic obliquity by an average of 7 degrees. This combined fusion method reduced the rate of pseudarthrosis to 23 per cent (compared with 46 per cent when only posterior fusion and instrumentation were used). Prophylactic antibodies (selected on the basis of preoperative cultures of urine) reduced the infection rate to 8 per cent. Posterior fusion or anterior fusion alone was inadequate, even with instrumentation. Early mobilization wearing a bivalved polypropylene body jacket minimized osteoporosis, pressure sores, and social isolation. Unsolved technical problems remain, however, especially in relation to obtaining fusion across the lumbosacral joint.

Spine deformity subsequent to acquired childhood spinal cord injury.

The cases of forty children who had incurred a spinal cord injury between birth and the age of eighteen years were reviewed at two to 26.8 years (mean, ten years) after injury. In all of the twenty-five patients who were injured prior to the adolescent growth spurt paralytic spinal deformity developed; in twenty-four (96 per cent) of them it was progressive. Scoliosis developed in twenty-three (92 per cent); kyphosis, in sixteen (64 per cent); and excessive lumbar lordosis, in five (20 per cent). Management of the spinal deformities by bracing was difficult, and seventeen patients (68 per cent) required spine fusion, usually to the sacrum. Complications were frequent. All of the fifteen patients who were injured after the onset of the adolescent growth spurt had sustained a spinal fracture or fracture-dislocation. Nine (60 per cent) had an acute angular thoracic or thoracolumbar fracture kyphosis and seven (47 per cent) had progressive fracture kyphosis. A history of a thoracic and thoracolumbar laminectomy always was associated with increased kyphosis progression. Six (40 per cent) of these patients required spinal stabilization, usually for unstable injuries and progressive post-laminectomy deformity. Progressive paralytic spinal deformity was uncommon in the postadolescent patient.

Severe spine deformity in myelodysplasia and sacral agenesis: an aggressive surgical approach.

The results of a prospective study of the surgical treatment of paralytic scoliosis and congenital lumbar kyphosis in 19 children with myelodysplasia and one child with sacral agenesis indicate that improved results can be achieved with the use of staged anterior and posterior fusions, more rigid spinal instrumentation, and bank and autogenous bone graft. No wound infections occurred as a result of preoperative treatment of urinary infection and with the use of prophylactic antibiotics. Improved posterior spinal fixation was accomplished with a double square end sacral hook in paralytic scoliosis and pelvic obliquity and with a cable-hook compression system in congenital lumbar kyphosis. Posterior lumbopelvic fusion with cable-hook compression instrumentation gave acceptable results in lumbopelvic kyphosis from complete sacral agenesis.

Spinal deformity in children treated for neuroblastoma.

Of seventy-four children who were treated at a mean age of seventeen months for neuroblastoma and survived more than five years, fifty-six (76 per cent) had spinal deformity due either to the disease or to the treatment after a mean follow-up of 12.9 years. Of these fifty-six, 50 per cent had post-radiation scoliosis (mean, 18 degrees; range, 5 to 79 degrees), and 16 per cent had post-radiation kyphosis, most frequently at the thoracolumbar junction (mean, 39 degrees; range, 13 to 61 degrees), at the time of follow-up. Two kyphotic thoracolumbar curve patterns were identified: (1) an angular kyphosis with a short radius of curvature and its apex at the twelfth thoracic and first lumbar vertebrae, and (2) a thoracic kyphosis with a long radius of curvature that extended into the lumbar spine. The post-radiation deformity--both the scoliosis and the kyphosis--progressed with growth, the scoliosis at a rate of 1 degree per year and the kyphosis at a rate of 3 degrees per year. Epidural spread of the neuroblastoma was associated with most of the cases of severe scoliosis and kyphosis. The deformity was due either to the laminectomy or to the paraplegia acting in conjunction with the radiation. Eighteen per cent of 419 children with this malignant disease survived more than five years, and of the survivors, 20 per cent had spinal deformity severe enough to warrant treatment. The factors associated with the development of spinal deformity in patient treated for neuroblastoma were: (1) orthovoltage radiation exceeding 3000 rads, (2) asymmetrical radiation of the spine, (3) thoracolumbar kyphosis, and (4) epidural spread of the tumor.

Congenital kyphosis due to defects of anterior segmentation.

Twenty-seven patients with Type-II congenital kyphosis (failure of anterior vertebral segmentation) all had progression of the kyphosis which varied in magnitude. The average rate of progression was 5 degrees per year. Pain due to compensatory lumbar hyperlordosis (eight patients) and objectionable deformity (fifteen patients) were the most frequent complaints. Unlike patients with Type-I kyphosis (failure of vertebral formation), paraplegia did not occur and associated congenital anomalies were infrequent (three of the twenty-seven patients). Spontaneous ossification of the anterior part of seemingly normal intervertebral discs leading to bar formation and progression of deformity occurred in five patients. A Milwaukee brace had little effect on this fixed kyphotic deformity in the six patients in whom the brace was used. Early recognition and spine fusion are the recommended treatment. Posterior fusion is sufficient in young children with progressive deformity, whereas combined two-stage anterior and posterior fusion with osteotomy of the anterior bar is recommended in children with severe deformity.