Repair of transversely incised abdominal wall fascia in a rabbit model.

OBJECTIVE: To compare several commonly used methods of closing transversely incised anterior abdominal wall in order to determine which technique results in the strongest incisional tensile strength. METHODS: Thirty-six rabbits were randomized to receive either interrupted or continuous closure with 0-Vicryl. Within these groups, each animal was randomized to one of three different bite and interval techniques: 1-cm bites/0.5-cm intervals, 1-cm bites/1-cm intervals, and 2-cm bites/1-cm intervals. Each rabbit received three to four transverse abdominal wall incisions of approximately 3-8 cm in length. The incisions were excised en bloc and stored at -70C at postoperative week 1, 2, or 4 in a random fashion. Representative 1-cm strips were harvested from each incision after thawing. The Instron tensiometer was used to determine the maximum intrinsic tensile strength required to disrupt each tissue strip at the incision. Statistical analysis was performed using analysis of variance, two-sample t test, Scheffé multiple comparison, and Kruskal-Wallis test. RESULTS: Two hundred thirty-seven strips were analyzed. The mean maximum tensile strength of all of the interrupted and continuous suture repairs was 48 and 38 lb, respectively (P < .001). The maximum tensile strength for interrupted closures was achieved at week 1 and was similar at week 4. The continuous closure was weakest at week 1 and increased to a maximum value during week 4. There was no difference in maximum tensile strength between the interrupted and continuous closure groups at week 4. There was no significant difference in the maximum tensile strength of the three repair techniques. The mean maximum tensile strength of all specimens was significantly less among those harvested during weeks 1 and 2 compared with week 4 (P = .001). CONCLUSION: In this randomized study, the interrupted closure had a greater maximum tensile strength than the continuous closure in repair of transverse incisions during the first 2 postoperative weeks. Both repair methods were associated with a similar maximum tensile strength at 4 postoperative weeks. Repair techniques using different bite sizes and intervals resulted in similar maximum tensile strengths.

Laser ablation of squamous cell carcinoma in situ of the anal canal. A case report.

A case of squamous cell carcinoma in situ of the anal canal was discovered incidentally during a hemorrhoidectomy in a man. The anal canal was evaluated by colposcopy prior to ablation of the lesion with a CO2 laser. To our knowledge, this technique has not been reported previously.

Vesicouterine fistula after cesarean section. A case report.

A 27-year-old woman, gravida 3, para 2002, underwent repeat cesarean section and inadvertent cystotomy, with subsequent development of a vesicouterine fistula. The fistula did not resolve with prolonged bladder catheterization and required total abdominal hysterectomy with resection of the fistula tract and primary closure for definitive treatment.

Parasites of the black-tailed jackrabbit in north central Colorado.

Forty-four black-tailed jackrabbits, Lepus californicus melanotis Mearns, 1890, were collected near Denver from August, 1972, through July, 1973, and amined for parasites. Recovered parasites and their infection rates were: Eimeria sp. 100%, Cittotaenia sp.27%, coenuri of Multiceps sp. 57%, Cediopsylla inaequalis 14%, Hoplopsyllus affinis 9%, Haemodipsus setoni 2%, Dermacentor andersoni 14%, and Haemaphysalis leporis-palustris 25%.

Partial hydatidiform molar pregnancy presenting with severe preeclampsia prior to twenty weeks gestation: a case report and review of the literature.

A previously healthy 37-year-old Latin American female presented at 17 6/7 weeks gestation with clinical manifestations of preeclampsia. Ultrasound revealed a growth-retarded fetus with hypoechoic bowel, a thickened cystic placenta, bilateral multicystic adnexal masses, and oligohydramnios. The patient had laboratory evidence of hyperthyroidism and the maternal serum alpha-fetoprotein was 12.3 multiples of the mean. Subclinical disseminated intravascular coagulation rapidly ensued and an induction of labor was performed. This was productive of a 110-g female fetus with a markedly distended abdomen and syndactyly. The placenta weighted 650 g with gross hydropic changes throughout. The clinical aspects of this case and review of the literature on partial molar pregnancies will be discussed.

An unusual cutaneous reaction to anticoagulant therapy.

Unusual complications of warfarin therapy include cutaneous necrosis and the "purple toe syndrome." The latter is more common in men and is not associated with vascular compromise; it usually occurs 3 to 8 weeks after warfarin therapy is begun and may persist for many months after the medication is discontinued. The following is a case of a 63-year-old woman who received warfarin therapy in conjunction with heparin for treatment of a left leg deep vein thrombosis. Approximately 8 hours after receiving her first dose of warfarin (15 mg), she developed acute pain, edema, and discoloration of the entire left leg to the mid-thigh, most prominent in the left great toe. After discontinuation of warfarin therapy, her symptoms completely resolved within 48 hours. This may be a report of a new cutaneous lesion associated with anticoagulant therapy.