Wound healing after laser skin resurfacing: the effect of a silver sulfadiazine-hyaluronic acid-containing cream under an occlusive dressing.

INTRODUCTION: Occlusive dressings promote wound healing after laser skin resurfacing. Our goal was to evaluate whether a cream containing hyaluronic acid-silver sulfadiazine could improve this process. METHODS: Ten guinea pigs received laser resurfacing on the skin of their backs. Polyurethane foam film adhesive dressing was applied. A cream containing hyaluronic acid-silver sulfadiazine was applied under the dressing over half of the wound. Skin biopsies were taken at days 2, 4, 7 and 9 and examined by a pathologist blinded to the study. RESULTS: Re-epithelialization appeared to occur faster in the cream-treated areas, together with a lower level of acute inflammation in the early phase of the healing process. CONCLUSIONS: The cream containing silver sulfadiazine/hyaluronic acid seems to improve wound healing after laser skin resurfacing in guinea pigs. The clinical application of this finding on humans should be assessed.

Intraneural ganglion of the superficial peroneal nerve: a case report.

Ganglia affecting the peripheral nerves of the foot and ankle are rare. The most frequent location of occurrence is the common peroneal nerve at the level of the fibular neck. We report the case of an intraneural ganglion of the superficial peroneal nerve and its branches. Although there have been many previous reports of intraneural ganglion involvement with the common peroneal nerve, deep peroneal nerve, sural nerve, and the posterior tibial nerve, to our knowledge, this is the first reported occurrence of an intraneural ganglion distinctly localized to the superficial peroneal nerve and its branches. The presumptive diagnosis was made preoperatively using magnetic resonance imaging, and then confirmed postoperatively by pathologic examination. Despite the use of operative magnification, it was impossible to remove all of the cyst elements within the nerve trunk, because the nerve fascicles were intimately intertwined. Therefore, complete resection of the common trunk of the superficial peroneal nerve and its terminal branches was performed, and the proximal stump was buried in a hole in the distal fibula. Two years after the surgery, the patient was pain free and asymptomatic except for cutaneous anesthesia in the distribution of the superficial peroneal nerve.

Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review.

This study reviews the predictive value of maximum oxygen consumption (VO2max) and anaerobic threshold, obtained through cardiopulmonary exercise testing, in calculating peri-operative morbidity and mortality in non-cardiopulmonary thoraco-abdominal surgery. A literature review provided nine studies that investigated either one or both of these two variables across a wide range of surgical procedures. Six of the seven studies that reported sufficiently detailed results on peak oxygen consumption and four of the six studies that reported sufficiently detailed results on anaerobic threshold found them to be significant predictors. We conclude that peak oxygen consumption and possibly anaerobic threshold are valid predictors of peri-operative morbidity and mortality in non-cardiopulmonary thoraco-abdominal surgery. These indicators could potentially provide a means of allocating increased care to high-risk patients.

Laparoscopic approach to incarcerated and strangulated inguinal hernias.

INTRODUCTION: Acute inguinal hernias are a common presentation as surgical emergencies, which have been routinely managed with open surgery. In recent years, the laparoscopic approach has been described by several authors but has been controversial amongst surgeons. We describe the laparoscopic approach to incarcerated/strangulated inguinal hernias based on a review of the literature with regards to its feasibility in laparoscopically managing the acute hernia presentation. METHODS: A systematic literature search was carried out including Medline with PubMed as the search engine, and Ovid, Embase, Cochrane Collaboration, and Google Scholar databases to identify articles reporting on laparoscopic treatment, reduction, and repair of incarcerated or strangulated inguinal hernias from 1989 to 2008. RESULTS: Forty-three articles were found, and 7 were included according to the inclusion criteria set. Articles reporting on the use of laparoscopy for the evaluation of the hernia but not reducing and repairing it, the use of the open technique, elective hernia repairs, pediatric series, review articles, and other kinds of hernias were excluded after title and abstract review. This resulted in 16 articles that were reviewed in full. Of these 16 articles, 7 reported on the use of the laparoscopic approach exclusively. From these 7 studies, there were 328 cases reported, 6 conversions, average operating time of 61.3 minutes (SD+/-12.3), average hospital stay of 3.8 days (SD+/-1.2), 34 complications (25 of which were reported as minor), and 17 bowel resections performed either laparoscopically or through a minilaparotomy incision guided laparoscopically. CONCLUSION: The laparoscopic repair is a feasible procedure with acceptable results; however, its efficacy needs to be studied further, ideally with larger multicenter randomized controlled trials.

Development and in vitro evaluation of furosemide transdermal formulations using experimental design techniques.

The in vitro skin permeation of furosemide, a commonly used loop diuretic, through human epidermis, as a preliminary step towards the development of a transdermal therapeutic system, was examined. A screening study was carried out, in order to estimate the effects of the type, the concentration of enhancer and the concentration of gelling agent on the cumulative amount of furosemide permeated through human epidermis, using a 3(3) factorial design. The type and the concentration of enhancer were further evaluated as they were found to affect significantly furosemide permeation. In order to further increase the amount of the drug permeated, the combination of two enhancers, Azone and oleyl alcohol, at three concentration levels was employed, using an optimization technique. The results indicated that higher amounts of furosemide permeated were observed when Azone was used at 5.0-6.5% (v/v) and oleyl alcohol at 7.5-9% (v/v), in the gels used. These formulations seem to be suitable for possible transdermal delivery of furosemide for pediatric use.

A simple empirical model for activated sludge thickening in secondary clarifiers.

A simple empirical model for the thickening function of the activated sludge secondary clarifiers is presented. The proposed approach relies on the integration of previous models and it is based on the phenomenon of dilution of the incoming activated sludge in the feeding well of the settling tanks. The method provides a satisfactory description of sludge stratification within the clarifier. The only requirements are limited to parameters which are readily incorporated into the routine analysis performed in an activated sludge plant, thereby eliminating the need for additional experimental or computational effort. The method was tested in a full-scale activated sludge plant and it was found that it describes fairly well the return sludge concentration, the diluted sludge blanket concentration, the sludge blanket solids concentration and the sludge blanket height of full-scale secondary clarifiers.

Wastewater management in coastal urban areas: the case of Greece.

The continuously increasing quantities of municipal and industrial wastewater discharged into the sea environment degrade the quality of the water. In this paper, the recent technologies are evaluated, and the practices recommended for the wastewater treatment in coastal urban areas are analyzed, with respect to the requirements of the EU legislation. Also the principles for the disposal of the treated wastewater are discussed. Finally, a brief review of the current situation of wastewater management in Greece is given, regarding the treatment strategies previously presented

Intense pulsed light is effective in treating pigmentary and vascular complications of CO(2) laser resurfacing.

Prolonged erythema and hyperpigmentation are frequently encountered side effects of laser skin resurfacing. The author has found intense pulsed light to be effective in the treatment of erythema and hyperpigmentation resulting from laser skin resurfacing in the periorbital area. (Aesthetic Surg J 2002;22:489-491.).

Optimization of in vitro skin permeation by lactic acid from gel formulations.

The purpose of this study was to evaluate the effect of the concentration as well as the vehicle's pH on in vitro skin permeation by lactic acid from gel formulations, using an optimization technique. Nine gels containing 3%, 6%, and 9% (w/w) lactic acid in three different phosphate buffers, with pH values of 2.8, 3.8, and 4.8, were prepared and were applied in modified Franz diffusion cells. The pH of the vehicles and the lactic acid concentrations were used to create a mathematical model that correlates these factors with the cumulative amount of lactic acid permeated through human cadaver epidermis. For this purpose, the optimization technique 3(2) was applied. It was found that the correlation of the above factors can be adequately described with a polynomial equation, which can be used for predicting the cumulative amounts of lactic acid permeated. The results indicated that as the lactic acid's concentration increased, the cumulative amount permeated also increased after 24 h at all pH values. Moreover, the amount of lactic acid permeated decreased as the pH of the gels was increased. The greater amount permeated at all time intervals (6 h, 9 h, 12 h, and 24 h) was obtained when the concentration of lactic acid was 9% and the pH of the gel formulation was 2.8.

Anatomy: the future teaching of undergraduates.

The time devoted to the teaching of anatomy to medical students has long been under pressure. Much work has been devoted to how best to teach anatomy in both a time-efficient and cost-effective manner. This article discusses the main methods of teaching anatomy and their respective advantages and disadvantages as evidenced in the literature. Suggestions are made as to how best to teach anatomy to medical students in the future.

Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study.

Pelvic varicose veins secondary to ovarian vein reflux are common and can present with clinical pelvic congestion syndrome (PCS). After assessment with duplex ultrasound and venography, treatment often involves surgical ovarian vein ligation and more recently embolization of the ovarian vein(s) followed by ultrasound-guided foam sclerotherapy (UGFS) of the pelvic tributaries. This paper presents one out of many PCS patients treated with UGFS of the pelvic tributaries alone, with clinically symptomatic improvement.

Femoral vein duplication: incidence and potential significance.

OBJECTIVE: The purpose of this study was to determine the prevalence of femoral vein duplication and the incidence of bilateral anomalies in a normal cohort of patients presenting with varicose veins. METHODS: Two hundred and forty patients underwent bilateral lower limb deep venous ultrasound examination with particular attention to the femoropopliteal segment. RESULTS: The incidence of femoral vein duplication was 41%. Of the 140 people with femoral vein duplications, 60 (42%) were bilateral and 80 (57%) were unilateral. CONCLUSION: Femoral vein duplication is a common anatomical variant of the lower limb deep venous system. Ultrasound in skilled and experienced hands with the latest ultrasound units can readily demonstrate this venous anomaly on a consistent basis.

Three cases of stroke following peripheral venous interventions.

We report three cases of stroke in association with peripheral venous interventions that each included foam ultrasound-guided sclerotherapy (UGS). All three female patients experienced a right middle cerebral artery (MCA) stroke causing dysphasia and left hemiparesis. A patent foramen ovale was found in each patient. The first incident occurred two days after foam UGS to treat small tributaries of a great saphenous vein (GSV). Paradoxical clot embolism was presumed in this case where concurrent deep vein thrombosis with non-occlusive thrombus in a medial gastrocnemius vein extending to the popliteal vein was detected on ultrasound. The second case occurred immediately at the completion of foam UGS and ambulatory phlebectomy to treat GSV tributaries. Paradoxical gas embolism was demonstrated in this patient confirmed by visualization of bubbles in the right MCA on CT angiography. The third case occurred one day after endovenous laser ablation (1470 nm) and foam UGS to treat both great and small saphenous veins. No specific cause could be confirmed in this patient. Sodium tetradecyl sulphate foam was used in all three cases (3%, 16 mL; 1.5%, 4 mL and 3%, 25 mL, respectively). All three patients recovered completely within a few days.

Laser-assisted blepharoplasty and inferior lateral retinaculum plication: skin contraction versus skin traction.

Blepharoplasty is one of the most commonly performed operations in plastic surgery, especially among middle-aged patients. Ablative lasers, especially the carbon dioxide laser, assist in tissue cutting and hemostasis. These lasers also offer skin resurfacing with its unique advantages despite the prolonged downtime. The authors present their laser-assisted blepharoplasty experience and the recent addition of one simply performed, inferior lateral retinaculum plication to the procedure (single suture traction technique, SSTT). Hence, the need for laser skin resurfacing of the lower eyelid has been reduced due to the skin traction applied, avoiding the long period required for resolution of erythema and potential hyperpigmentation. Furthermore, the tightening effect on the canthal ligament offers a more youthful look to the surgically treated eye.

Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection.

BACKGROUND AND METHODS: The comparative benefits and drawbacks of straight coloanal anastomosis (CAA), colonic J-pouch and coloplasty anastomosis after anterior resection are uncertain. Studies published between 1986 and 2005 of colonic J-pouch versus transverse coloplasty or straight CAA were analysed. Endpoints included postoperative complications, and functional and physiological outcomes measured within 6 months, 1 year and 2 years or more after the procedure. A random-effect model was used to aggregate the study endpoints and assess heterogeneity. RESULTS: Thirty-five studies containing 2240 patients (1066 straight CAA, 1050 J-pouch and 124 coloplasty) were included. There was no significant difference in postoperative complications between the three groups. There was a significant reduction in the frequency of defaecation per day by 1.88, 1.35 and 0.74 motions at the three time intervals in the J-pouch group compared with the straight CAA group. Faecal urgency was less prevalent in patients with a J-pouch than those with a straight CAA (odds ratio 0.27 at 6 months or less and 0.21 at 1 year). There was no difference in functional outcome between J-pouch and coloplasty anastomosis. CONCLUSIONS: The colonic J-pouch provided functional benefits over straight anastomosis with no increase in postoperative complications. Coloplasty appeared to have similar benefits but further studies are required for validation.

Effect of cold temperature on the composition of different lipid classes of the foodborne pathogen Listeria monocytogenes: focus on neutral lipids.

In this work a thorough consideration of the membrane lipid composition of Listeria monocytogenes together with DSC analysis is described in order to estimate the biological importance of lipid changes during low-temperature adaptation. Furthermore, these studies provide comparative data for fatty acid changes for neutral, NL and polar lipids, PL separately. The cold adaptation (5 degrees C) response of L. monocytogenes showed (i) an increase in the level of NL content (30%) among the total lipids, TL and (ii) that the increase (7-fold) in the anteiso-15:0/anteiso-17:0 fatty acid ratio, FAr, for cold NL was at variance with the ratio for TL and PL (about 10-fold). We correlated our findings with DSC studies on phase transition temperature (Tc), enthalpy difference (DeltaH) and peak range of the transition for TL, PL, NL (from cultures at 30 and 5 degrees C); The decrease of Tc (10.5 degrees C) and DeltaH (51%) for TL is a reflection of the decrease of Tc (11.5 degrees C) and DeltaH (56%) for PL. This large decrease is interpreted by the high (10-fold) increase of a-15:0/a-17:0 FAr of PL5 degrees C. In NL the decrease of Tc (3 degrees C) and of DeltaH (42%) is interpreted by both adaptation mechanisms: the (lower) 7-fold increase of anteiso-15:0/anteiso-17:0 FAr and the NL percentage calculated from increased mass values. The peak range of TL5 degrees C (from -15 to 25 degrees C) is a reflection of the peak range of NL5 degrees C, which is unchanged, as is the peak range of NL30 degrees C.

A complete dynamic model of primary sedimentation.

A dynamic mathematical model for the primary clarifier of a wastewater treatment plant is described, which is represented by a general tanks-in-series model, to simulate insufficient mixing. The model quantifies successfully the diurnal response of both the suspended and dissolved species. It is general enough, so that the values of the parameters can be replaced with those applicable to a specific case. The model was verified through data from the Biological Centre of Metamorfosi, in Athens, Greece, and can be used to assist in the design of new plants or in the analysis and output predictions of existing ones.

Development of terminal hair following skin lesion treatments with an intense pulsed light source.

Laser and other light sources have been used to treat vascular and pigmented skin lesions and to remove tattoos and unwanted hair, with varying degrees of success and various side effects. It has not yet been reported that hair growth can occur as a side effect of such treatments. In this paper two cases are presented, one port wine stain and one tattoo, that were each treated several times with an intense pulsed light source (IPLS) for removal. Terminal hair, not present before treatment, partially developed in treated areas of both lesions. Local inflammatory reactions are believed to trigger such outcomes.

Does laparoscopic surgery offer adequate clearance in rectal cancer?--A discussion.

Currently in the UK, the national institute of clinical excellence (NICE), only advocates laparoscopic surgery for rectal cancer as part of commissioned clinical trials. Laparoscopic teaching, training and techniques have evolved greatly and offer many benefits to patients, whilst remaining technically demanding to surgeons still on the slope of the learning curve. Can such minimally invasive techniques be used with the same results as open surgery in the treatment of rectal cancer? Are laparoscopic colorectal surgeons able to achieve the same clearance of tumours and so avoid recurrence at the same rate compared to conventional techniques? The discussion to follow, aims to shed some light on such questions and briefly review some of the literature. If laparoscopic anterior resections and abdominoperineal resections achieve the same results as open procedures, then should these techniques be more widely taught and practised? Surely the peri-operative cost of these laparoscopic procedures does not over shadow the potential outcome from much less traumatic surgery?

Ion pair formation as a possible mechanism for the enhancement effect of lauric acid on the transdermal permeation of ondansetron.

Transdermal application can be an alternative drug delivery route for ondansetron, an antiemetic drug. Previous studies found that fatty acids, namely oleic and lauric, were the most effective penetration enhancers. The aim of this study was to investigate the formation of an ion pair between ondansetron and lauric acid as a possible mechanism of its enhancing action. Several techniques were used to reveal the formation of an ion pair complex. Partitioning experiments, where the n-octanol/water coefficient was measured, showed an increase in the distribution coefficient in the presence of the acid, possibly as a result of the formation of more lipophilic ion pairs between the charged molecules of ondansetron and lauric acid. Further evidence of complex formation between ondansetron and lauric acid, was gained from the 13C-nuclear magnetic resonance (13C-NMR) spectra of ondansetron, lauric acid, and their mixture (molar ratio 1:1). The NMR spectra revealed alterations to the magnetic environment of the carbon atoms adjacent to the ionized group, which are the carbonyl group of the acid and the nitrogen of the imidazole ring of ondansetron. This evidence substantiates the theory of ion pair formation. Finally, thermal analysis of the binary mixtures of ondansetron and lauric acid revealed the formation of an additional compound, with different melting point from pure ondansetron and lauric acid, which is thermodynamically favored.