The endocycle restores tissue tension in the Drosophila abdomen post wound repair.

Polyploidy frequently arises in response to injury, aging, and disease. Despite its prevalence, major gaps exist in our understanding of how polyploid cells alter tissue function. In the adult Drosophila epithelium, wound healing is dependent on the generation of multinucleated polyploid cells resulting in a permanent change in the epithelial architecture. Here, we study how the wound-induced polyploid cells affect tissue function by altering epithelial mechanics. The mechanosensor nonmuscle myosin II is activated and upregulated in wound-induced polyploid cells and persists after healing completes. Polyploidy enhances relative epithelial tension, which is dependent on the endocycle and not cell fusion post injury. Remarkably, the enhanced epithelial tension mimics the relative tension of the lateral muscle fibers, which are permanently severed by the injury. As a result, we found that the wound-induced polyploid cells remodel the epithelium to maintain fly abdominal movements, which may help compensate for lost tissue tension.

Fabricated or induced illness in twins associated with insertion of trocar needles into their bodies.

Fabricated and/or induced illness (previously known as Munchausen syndrome by proxy) is a form of child abuse in which the perpetrator induces, exaggerates or fabricates illness in his/her child. Two-month-old twins were referred to the paediatric surgery centre with trocar needles lodged in different organs. A radiograph undertaken in one of them because of acute respiratory distress demonstrated needles in the heart and diaphragm which were removed surgically. The second twin, referred one week after his brother, had a needle deep in his liver and it was decided not to operate owing to the possibility of haemorrhage but, sadly, he died unexpectedly and the autopsy concluded that it was owing to sudden infant death syndrome. Because of a number of admissions to different units in the same hospital, there was a delay in the eventual diagnosis. Recurrent admissions to different hospital units should raise the suspicion of fabricated and/or induced illness.

Prevalence of occupational injuries and knowledge of availability and utilization of post exposure prophylaxis among health care workers in Singida District Council, Singida Region, Tanzania.

BACKGROUND: Infection with Human Immunodeficiency Virus is a serious public health problem that threatens the lives of many people including health care workers. Health care workers are frequently exposed to occupational hazards throughout their careers. Health care workers are at risk of being infected by the virus when caring for patients in health care facilities. Utilization of HIV Post-exposure Prophylaxis (HIV PEP) is very vital once an individual is exposed. AIM: The aim of this study is to determine the prevalence of occupational exposure, knowledge of, availability and utilization of post exposure prophylaxis among health care workers in Singida District Council, Tanzania. METHODS: A descriptive cross sectional study was conducted from April to May 2013. Health care workers actively treating patients were enrolled from 18 heath facilities in Singida District Council. Data were collected using a self-administered questionnaire, and analysed using Stata version 12. RESULTS: Out of 239 participants, slightly more than half, 124 (52%) had inadequate overall knowledge of HIV PEP. Of the 239, 121(50.6%) participants experienced occupational exposure. Two leading types of exposure were blood splash 57(47.1%) and needle stick injuries 45 (37.2%),respectively. Among the 121 exposed participants, 83(68.6%) reported the exposure incident, 91(75.2%) had an HIV test, 32 (26.4%), started HIV PEP after testing, 28 (23.1%), completed HIV PEP, and 65 (53.7%) had a follow-up HIV test. About two thirds (159/239), of participants reported that HIV PEP services were available at the time the study was conducted, and 49 (20.5%), reported daily access to HIV PEP service. CONCLUSION: The prevalence of occupational exposure among health care workers is high with low utilization of HIV PEP. The majority of healthcare workers had inadequate knowledge of HIV PEP. The findings highlight the need to improve the level of knowledge of HIV PEP and utilization of PEP among this at-high-risk-group in Singida.

[Catch me if you can: endoscopic remove of a needle from the jejunum]. / Catch me if you can: Endoskopische Bergung einer Sicherheitsnadel aus dem tiefen Dünndarm.

INTRODUCTION: The ingestion of foreign bodies is a frequently observed problem in daily clinical practice. In order to avoid complications such as perforation, endoscopic removal of potentially penetrating foreign bodies should be attempted quickly. The use of various endoscopic techniques has been reported for this purpose. However, extraction of foreign bodies from the mid gastrointestinal tract has rarely been reported. CASE REPORT: We present the case of a patient who had swallowed a safety needle which could safely be removed from the jejunum by means of double-balloon enteroscopy (DBE). The combination of a thin p-type enteroscope with a thick t-type overtube was used in order to improve the manoeuvrability of the endoscope. The needle was pulled into the overtube which served as a protective shield during the retrieval of the endoscope. CONCLUSION: Our case report describes the potential of removing foreign bodies from the deep small bowel by pulling them into the overtube of a double-balloon enteroscope. If the suspicion of foreign body impaction in the small bowel is made, it may be advisable to primarily choose a balloon enteroscopy system. Through this, quick and deep insertion can be combined with a safe removal of the foreign body.

Endoneurial pathology of the needlestick-nerve-injury model of Complex Regional Pain Syndrome, including rats with and without pain behaviors.

Current rodent models of neuropathic pain produce pain hypersensitivity in almost all lesioned animals and not all identified experimental effects are pain specific. 18G needlestick-nerve-injury (NNI) to one tibial nerve of outbred Sprague-Dawley rats models the phenotype of Complex Regional Pain Syndrome (CRPS), a post-traumatic neuropathic pain syndrome, leaving roughly half of NNI rats with hyperalgesia. We compared endoneurial data from these divergent endophenotypes searching for pathological changes specifically associated with pain-behaviors. Tibial, sural, and common sciatic nerves from 12 NNI rats plus 10 nerves from sham-operated controls were removed 14 days post-surgery for morphometric analysis. PGP9.5(+) unmyelinated-fibers were quantitated in plantar hindpaw skin. Distal tibial nerves of NNI rats had endoneurial edema, 30% fewer axons, twice as many mast cells, and thicker blood-vessel walls than uninjured tibial nerves. However the only significant difference between nerves from hyperalgesic versus non-hyperalgesic NNI rats was greater endoneurial edema in hyperalgesic rats (p < 0.01). We also discovered significant axonal losses in uninjured ipsilateral sural nerves of NNI rats, demonstrating spread of neuropathy to nearby nerves formerly thought spared. Tibial and sural nerves contralateral to NNI had significant changes in endoneurial blood-vessels. Similar pathological changes have been identified in CRPS-I patients. The current findings suggest that severity of endoneurial vasculopathy and inflammation may correlate better with neuropathic pain behaviors than degree of axonal loss. Spread of pathological changes to nearby ipsilateral and contralateral nerves might potentially contribute to extraterritorial pain in CRPS.

Stem cell renewal and contraction of the tunica media caused by a damaged blood vessel following a thick needle stab.

A marked difference in the healing process of the inferior vena cava in rats following a stab with a 17-G (1.48 mm phi) ultrahard zirconium ceramic (Zr) needle and with a common stainless steel (St) needle (also 1.48 mm phi was observed. This was investigated in vivo by histological imaging and biochemical micro-autoradiographic imaging using [2-(14)C]-thymidine as a biomarker in vivo. On the first day after the stab with either, the Zr or the St injection needle, the tunica adventitia showed the most pronounced damage, as evidenced by a large puncture wound characterized by blood congestion, but with few inflammatory cells being observed. A marked contraction of the tunica media was observed. The depth of the injury reached the tunica layer, but amounted to less than 1/3 of the needle diameter. Loose fragments of the endothelial lining were detected, together with scattered red corpuscles. The survival rate of the experimental animals amounted to less than 40% on the 3rd day after the stab by either the Zr or St needle, due to the large needle diameter. In addition, histological imaging of the wound area in the endothelial layer and tunica media showed considerable congestion and inflammation, which limited the evaluation of the regeneration status of the inferior vena cava of the surviving animals. Results were obtained from a few animals that displayed satisfactory recovery status. On the 3rd day after the stab by either the Zr or St injection needle, a relatively large proportion of the hemostatic clots became incorporated into the collagenous tissue, i.e. the tunica adventitia. A marked contraction of the tunica media was also observed, similar to that on the 1st day, following the needle injury. In the case of the endothelium (tunica intima), the injury caused by the Zr needle was reinfiltrated by adult stem cells 3 days after the stab, but the tunica media, composed of endothelial cells, still contained relatively contracted collagenous material. In addition, several interesting cell colonies were observed in the medial layer at the short distance from the boundary of the damaged tissue. It was assumed that these colonies produced medial tissue composed of collagenous supporting tissue or smooth muscle cells. In the experiment using the St needle, the incorporation of [2-(14)C]-thymidine into the nucleus of the stem cells was observed in the small capillaries of the tunica media, but not in the support cells of the latter.

Injury caused by self-inoculation with a vaccine of a Freund's complete adjuvant nature (Gudair) used for control of ovine paratuberculosis.

OBJECTIVE: To document the occurrence and consequences of accidental self-inoculation of vaccinators (producers, farm employees, contractors) with the recently registered Gudair vaccine for the control of ovine paratuberculosis in Australia. DESIGN AND PROCEDURE: A survey of the first 50 primary producers permitted to use the vaccine in sheep and a description of six cases of accidental self-inoculation for which medical attention was sought, and which occurred after the vaccine became widely available. RESULTS: The survey recorded that, of 37 respondents vaccinating 155,523 sheep, there were 21 incidents of exposure to the vaccine, an overall rate of one incident per 7406 vaccinations. In five of these incidents there was only superficial skin contact with vaccine; in 16 there was needle penetration without vaccine injection. There were no reports of self-inoculation with vaccine. Six cases of self-inoculation with Gudair vaccine that required medical intervention are described. Of these five were in males and one in a female; four involved injection of vaccine into the leg and single cases involved a foot or hand. Most cases required surgical removal of the injected vaccine to allow wound repair; three required extensive surgery and open drainage. Even with surgery recovery took as long as 9 months. Possible risk factors for self-inoculation and the resulting outcome are discussed. CONCLUSIONS: Gudair ovine paratuberculosis vaccine can cause prolonged granulomatous inflammation if inadvertently injected into human tissue. After.self-inoculation, early surgical debridement of the damaged tissue and drainage to remove the vaccine material are advised to avoid progression to extensive necrosis.

Dangers of dermatologic surgery: protect your feet.

Dermatologists frequently utilize scalpels, which are reported to be to culprit in around seven percent of the 385,000 sharps-related injuries sustained by healthcare personnel a year. Injuries from sharp devices are associated with the occupational transmission of more than 20 pathogens. Dropped scalpels may penetrate unprotected lower extremity skin, and there is no published data regarding what a shoe's actual degree of protection is against the danger of falling sharps. The purpose of this study was to evaluate and determine which types of shoes will protect their wearers. Although every shoe decreased falling sharp's degree of penetration into the feet, shoes cannot be relied on to prevent injury. More than half of the shoes allowed the scalpel blade to pass through the shoes and penetrate into the meat.

Mid-gestation right basal ganglia lesion: clinical observations in two children.

OBJECTIVE: To describe the neurobehavioral syndrome in two children with destruction of the right basal ganglia ostensibly from amniocentesis needle penetration at 17 weeks of gestation. BACKGROUND: Early-life unilateral lesions of the basal ganglia are rare and the resulting syndrome not described. METHODS: Both children had repeated clinical assessments, MRI and (18)F-fluorodeoxyglucose PET scans, and psychometric and achievement testing over 10 years. RESULTS: Right basal ganglia destruction was similar and virtually coextensive in both children; optic nerve and oculomotor dysfunction were disparate. One had a right temporal pole porencephalic cyst with anomalous overlying cortex. The clinical syndrome included left hemiparesis with distal spasticity and without hypotrophy; extraocular movement disorders; severe episodic disinhibition, impulsiveness, hitting reflexively, and extreme emotional lability. Outbursts of screaming and cursing resembled "sham rage." Both had mild intellectual retardation with competent language but poor nonverbal and visual-spatial abilities, visual memory, and daily living and socialization skills. CONCLUSIONS: The shared behavioral and cognitive syndrome is most reasonably attributed to the right basal ganglia lesions, which were complete and coextensive in both, whereas other lesions were partial, milder, and disparate. Early destruction of the right basal ganglia may preclude normal development of right hemisphere functions without evidence of plasticity and appears associated with intense disinhibition and impulsiveness of aggressive attack activities and with general lability and dyscontrol of emotion.

Ocular explosion after peribulbar anesthesia.

We report 3 cases of globe rupture after peribulbar anesthesia. We discuss the predisposing factors, presenting features, and visual outcome after this complication. Globe explosion is a severe complication of inadvertent intraocular injection during peribulbar anesthesia. Visual outcome after vitrectomy is generally poor; however, cases that do not develop a retinal detachment may achieve good results.

Mechanical and pathologic consequences of induced concentric anular tears in an ovine model.

STUDY DESIGN: Relations between induced concentric tears in the sheep disc and the mechanics of the intervertebral joint and vertebral body bone were analyzed. OBJECTIVE: To examine the effect of concentric disc tears on the mechanics of the spine. SUMMARY OF BACKGROUND DATA: Degeneration of the intervertebral disc results in changes to the mechanics and morphology of the spine, but the effect of concentric disc tears is unknown. METHODS: In this study, 48 merino wethers were subjected to surgery, and discs were randomly selected for either a needlestick injury or induction of a concentric tear in the anterior and left anterolateral anulus. Sheep were randomly assigned to groups for killing at 0, 1, 3, 6, 12, and 18 months. From each sheep, two spine segments were mechanically tested: one with a needlestick injury and one with a concentric tear. Macroscopic disc morphology was assessed by three axial slices of the disc. Sagittal bone slices were taken from cranial and caudal vertebral bodies for histologic analysis. RESULTS: Induced concentric tears decrease the stiffness of intact spine segments in left bending and the disc alone in flexion. In all other mechanical tests, the needlestick injury had the same effect as the induced concentric tear. In the isolated disc, the disc stiffness at 6 months was increased for right bending, as compared with the response at 1 month. This was associated with increased anterior lamellar thickening and increased vertebral body bone volume fraction. CONCLUSIONS: Concentric tears and needlestick injury in the anterior anulus lead to mechanical changes in the disc and both anular lamellar thickness and vertebral body bone volume fraction. A needlestick injury through the anulus parallel to the lamellae produces progressive damage.

Expression of vascular endothelial growth factor by reactive astrocytes and associated neoangiogenesis.

Injury to the central nervous system (CNS) invokes a reparative response known as astrogliosis, characterized largely by hypertrophy, proliferation and increased expression of glial fibrillary acidic protein (GFAP), resulting in reactive astrocytosis. Based on our prior observation that peritumoral reactive astrocytes express Vascular Endothelial Growth Factor (VEGF), a highly potent and specific angiogenic growth factor, we have hypothesized that reactive astrocytosis also contributes to the neovascularization associated with astrogliosis. To evaluate this hypothesis we evaluated human surgical/autopsy specimens from a variety of CNS disorders that induce astrogliosis and an experimental CNS needle injury model in wild type and GFAP:Green Fluorescent Protein (GFP) transgenic mice. Using computer image semi-quantitative analysis we evaluated the number of GFAP-positive reactive astrocytes, degree of VEGF expression by these astrocytes, associated Factor VIII-positive microvascular density (MVD) and Ki-67 proliferating endothelial cells. The degree of reactive astrocytosis correlated to levels of VEGF immunoreactivity and MVD in the neuropathological specimens. The mouse-needle-stick brain injury model demonstrated this correlation was temporally and spatially related and maximal after 1 week. These results, involving both human pathology specimens augmented by experimental animal data, supports our hypothesis that the neoangiogenesis associated with reactive astrogliosis is correlated to increased reactive astrocytosis and associated VEGF expression.

Ocular explosions from periocular anesthetic injections: a clinical, histopathologic, experimental, and biophysical study.

OBJECTIVES: An increasing number of cases are being recognized in which a periocular anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or "explodes." The objectives of the current study were to (1) analyze this injury clinically and histopathologically through a series of seven case reports; (2) reproduce the injury experimentally in human eyebank eyes, live anesthetized rabbit eyes, and human cadaveric eyes; (3) investigate the biophysical basis of the injury; and (4) outline recommendations to help decrease the risk of ocular rupture with periocular injections. DESIGNS/PARTICIPANTS: Clinical, histopathologic, experimental animal, autopsy eye, and theoretical biophysical study. METHODS: The clinical and histopathologic findings of the patients' eyes were documented. Human eyebank eyes, live anesthetized rabbit eyes, and human cadaveric eyes were exploded via direct intraocular saline injection. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were used to investigate theoretically the biophysics of the injury. RESULTS: The findings of anterior and posterior scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed clinically and experimentally. In some clinical and experimental cases, the anterior segment appeared entirely normal despite a posterior rupture. The surgeon proceeded with and completed the cataract surgery in two of the seven clinical cases without knowledge of the rupture. The pressure required to produce such an injury is in the range of 2800 to 6400 mmHg, and this pressure is more easily attained with a 3-ml syringe than with a 12-ml syringe. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by (1) the use of a blunt needle and a 12-ml syringe, (2) aspirating the plunger and wiggling the syringe before injection, (3) discontinuing the injection if corneal edema or resistance to injection is noted, and (4) inspecting the globe for evidence of intraocular injection before ocular massage or placement of a Honan balloon. On recognition of an ocular explosion, immediate referral to and intervention by a vitreoretinal surgeon is optimal.

The interstitial response to renal injury: fibroblast-like cells show phenotypic changes and have reduced potential for erythropoietin gene expression.

To define the potential for erythropoietin gene expression in injured kidneys, marker gene expression was examined in transgenic mice bearing a homologously recombined erythropoietin--simian virus 40 T antigen (Epo-TAg) transgene. Three types of renal injury were studied: ureteric obstruction, global ischemia following clamping of the renal pedicle, and focal needlestick injury. All modes of injury were associated with an expansion of the interstitial space, which contained an increased number of cells. Alterations observed in the interstitial fibroblast-like cells included an increased number and complexity of cellular processes, enhanced expression of contractile elements, particularly of the intermediate filament desmin, and reduced expression of ecto-5'-nucleotidase. Following each type of injury there was a focal or general reduction in the proportion of such cells that could be stimulated to express Epo-TAg. However, some positively staining cells were present even in severely injured regions and more could be recruited to express Epo-TAg by severe anemic or hypoxic stimulation, indicating that cells with the potential for erythropoietin gene expression were neither absent nor completely refractory to stimulation in these regions. In all injured kidneys, Epo-TAg expression was limited to the fibroblast-like population. Double labeling experiments showed that cells expressing Epo-TAg also expressed increased amounts of desmin, demonstrating that the myofibroblast features which develop in response to injury and the capacity for erythropoietin gene expression are not mutually exclusive.

[Skin lesions after injection abuse. Chronic changes caused by ketobemidone (Ketogan)]. / Hudskader efter injektionsmisbrug. Kroniske forandringer forårsaget af ketobemidon (Ketogan).

Local complications of repeated injections of pentazocine are known among drug abusers. We hereby describe similar reactions in three patients who for several years had abused the opioid analgetic ketobemidone for chronic pain after abdominal surgery, and in six drug addicts who regularly injected ketobemidone tablets dissolved in water. In all nine patients an impressive clinical picture with disfiguring woody fibrosis and multiple irregular ulcers and scars surrounded by hyperpigmentation on the upper and lower extremities was seen. The skin lesions had been mistaken for aggressive forms of panniculitis, pyoderma gangrenosum or selfmutilation. Following direct questioning most patients admitted self-administration of the drug to the affected areas. The patients showed an apparent indifference about their extensive disabling skin disease, and no obvious complaints of pain, contrary to what might be expected from the pronounced tissue destruction and inflammation at the injection sites.