The role of family factors in the association between early adulthood BMI and risk of cardiovascular disease. An intergenerational study of BMI in early adulthood and cardiovascular mortality in parents, aunts and uncles.

BACKGROUND: High body mass index (BMI) in childhood and adolescence is related to cardiovascular disease (CVD). Causality is not established because common genetic or early life socioeconomic factors (family factors) may explain this relationship. We aimed to study the role of family factors in the association between BMI and CVD by investigating if early adulthood BMI in conscripts and CVD mortality in their parents/aunts/uncles are related. METHODS: Data from the Armed Forces Personnel Database (including height and weight among conscripts) were linked with data from the Norwegian Population Registry, generational data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry using unique personal identification numbers. The study sample (N = 369,464) was Norwegian males born 1967-1993, who could be linked to both parents and at least one maternal and one paternal aunt or uncle. Subsamples were identified as conscripts whose parents/aunts/uncles had data on cardiovascular risk factors available from Norwegian health surveys. Cox proportional hazards regression models were used to estimate hazard ratios (HR) of CVD mortality in the parental generation according to BMI categories of conscripts. RESULTS: Parents of conscripts with obesity or overweight had a higher hazard of CVD death (fathers HR obese: 1.99 (1.79, 2.21), overweight: 1.33 (1.24, 1.42) mothers HR obese: 1.65 (1.32, 2.07), overweight: 1.23 (1.07, 1.42)) than parents of normal- or underweight conscripts. Aunts and uncles of conscripts with obesity and overweight had an elevated hazard of CVD death, but less so than parents. Adjustment for CVD risk factors attenuated the results in parents, aunts and uncles. CONCLUSIONS: Family factors may impact the relationship between early adulthood overweight and CVD in parents. These can be genes with impact on BMI over generations and genes with a pleiotropic effect on both obesity and CVD, as well as shared environment over generations.

Utility of frozen section in pediatric and adolescent malignant ovarian nonseminomatous germ cell tumors: A report from the children's oncology group.

PURPOSE: In adult women, most malignant ovarian tumors are epithelial in origin. The use of intra-operative frozen section to distinguish between benign and malignant histology is reliable in guiding operative decision-making to determine the extent of surgical staging required. Pediatric and adolescent patients with ovarian masses have a much different spectrum of pathology with most tumors arising from germ cell precursors. This review was undertaken to assess the concordance between the intra-operative frozen section and the final diagnosis as an aid to guide extent of surgical staging in a group of pediatric and adolescent patients with malignant ovarian germ cell tumors. METHODS: Records of patients aged 0 to 20 years with malignant ovarian germ cell tumors enrolled on Children's Oncology Group study AGCT0132 were reviewed. Pathology reports from patients who had both intra-operative frozen section diagnosis and final paraffin section diagnosis were compared using descriptive statistics. By inclusion criteria for the study, all patients had a final diagnosis of malignancy with required yolk sac tumor, choriocarcinoma or embryonal carcinoma histology. Available central review of pathology final paraffin section slides were compared with final institution pathology reports. RESULTS: Of 131 eligible patients with ovarian germ cell tumors, 60 (45.8%) had both intra-operative frozen section and final paraffin section diagnoses available. Intra-operative frozen section diagnoses were classified as: incorrect diagnosis of benign tumor (13.3%), confirmation of malignancy (61.7%), immature teratoma (16.7%), germ cell tumor not otherwise specified (5%) and no diagnosis provided (3.3%). Intra-operative frozen section was incorrect in 23 of 60 (38.3%) patients evaluated. Central pathology review was concordant with the final institution pathology diagnosis in 76.3% of patients. Central pathology review identified additional germ cell tumor components in 23.7% of patients. CONCLUSIONS: In pediatric and adolescent patients with a confirmed final diagnosis of ovarian germ cell malignancy, intra-operative frozen section diagnosis is not reliable to inform the extent of surgical staging required. Central review by an expert germ cell tumor pathologist provides important additional information to guide therapy.

Difficult Central Venous Cannulation under Laryngeal Mask Airway Anesthesia in Adolescent.

We report a case of difficult central venous cannulation under general anesthesia with laryngeal mask airway in a young female child. Our case demonstrated a difficulty in surgically finding the right internal jugular vein due to neck veins displacements by laryngeal mask airway, which caused morbidity such as prolonged surgical duration and excessive blood loss. Once the laryngeal mask airway was replaced with endotracheal tube, the internal jugular vein appeared on surface and procedure was successfully completed in a few minutes. Such difficulties warrant an alternate approach in airway management in order to prevent major adverse effects.

Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification.

The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009-August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.

Identifying the catalytic acid/base in GH29 α-L-fucosidase subfamilies.

While the catalytic nucleophile in the configuration-retaining α-L-fucosidases from family GH29 is fully conserved with respect to sequence, there is no fully sequence-conserved acid/base residue candidate across the family. X-ray crystallographic studies and kinetic characterizations have allowed the identification of this residue in a few cases, and a recent combination of phylogenetic tree analyses with substrate specificity data has allowed the division of GH29 enzymes into two subfamilies, A and B, allowing the probable assignment of these residues. Here, we perform detailed kinetic and mechanistic characterizations of the corresponding alanine mutants and other candidates. Through comparison of kinetic parameters obtained for the hydrolysis of fucosyl substrates with activated leaving groups by these mutants with those of the corresponding wild-type enzymes, in conjunction with the demonstration of azide rescue, we largely confirm the acid/base residue predictions for the GH29 fucosidases from the two subfamilies.

Kommerell's diverticulum: an unusual cause of unilateral vocal cord palsy?

Kommerell's diverticulum is a rare congenital anomaly of the aortic arch system in which there is a left- or right-sided aortic arch with an aberrant subclavian artery on the contralateral side. Patients with this anomaly can be asymptomatic or have features of tracheal or oesophageal compression. However, there is a rising suspicion that it may be a rare cause of unilateral vocal cord palsy through its compression of the recurrent laryngeal nerve. We describe a patient who had a long history of hoarse voice and left vocal cord palsy with no other obvious cause, who was found to have a Kommerell's diverticulum on a contrast-enhanced computed tomography scan.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan.

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Offspring birth weight and cardiovascular mortality among parents: the role of cardiovascular risk factors.

An inverse association between offspring birth weight (BW) and higher risk of parental cardiovascular disease (CVD) mortality and morbidity has been reported. Shared environmental, genetic and intrauterine factors may be responsible for explaining these associations. We studied the role of parental CVD risk factors in the association between offspring BW and CVD mortality among mothers and fathers. All births registered in Medical Birth Registry Norway (1967-2012) were linked to three health surveys, National Educational Registry and Cause of Death Registry. Number of births with information of parental CVD risk factors available for the analyses was 1,006,557 (520,670 for mothers and 485,887 for fathers). Cox proportional hazards regression models were used, following CVD deaths in parents from 1974 to 2012. An inverse association between offspring BW and CVD mortality was observed among both parents: hazard ratio 1.60 (1.44-1.75) for mothers and 1.16 (1.10-1.23) for fathers. Among mothers, adjustment for smoking, triglycerides and diabetes reduced the risk to 1.36 (1.25-1.52), 1.57 (1.43-1.73) and 1.58 (1.43-1.79), respectively. Adjustment for diastolic blood pressure (DBP) and systolic blood pressure (SBP) both reduced the risk to 1.53 (1.37-1.66). Among fathers, adjustments for smoking, DBP, SBP reduced the risk to 1.08 (1.02-1.15), 1.13 (1.06-1.19) and 1.14 (1.08-1.22), respectively. Triglycerides and diabetes both reduced the risk to 1.15 (1.09-1.12). Our results indicate that shared environmental factors might be important in the association. A stronger association in mothers suggest that intrauterine factors also are at play.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan / Prevalência de leishmaniose cutânea na maior cidade populosa de Karachi, Paquistão

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p<0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

O estudo foi realizado de setembro de 2018 a abril de 2019 para determinar a prevalência de leishmaniose tegumentar em seres humanos que vivem em seis distritos de Karachi. Pessoas suspeitas foram rastreadas para a doença e os casos positivos foram identificados com base em lesões de pele e amostras de sangue. As amostras foram observadas montando seu esfregaço. Um total de 207 indivíduos de diferentes idades e grupos sexuais foi investigado, no entanto apenas 192 (92%) dos casos suspeitos foram encontrados para ter a doença; 64% dos casos eram do sexo masculino, que foram significativamente elevados (p < 0,05), e do sexo feminino 36%. A lesão foi detectada com maior frequência entre os jovens de 21 a 30 anos (31%) em comparação com os outros grupos. Em ambos os sexos, as pernas estavam mais infectadas (25% homens + 20% mulheres), seguidas pelos braços (20% homens + 0% mulheres) e rosto (15% homens + 11% mulheres). As partes mistas do corpo mostraram as infecções mais baixas (4% homens + 5% mulheres). Em conclusão, as infecções de leishmaniose mais altas e mais baixas foram observadas no Distrito Oeste (23% homens + 9% mulheres) seguido pelo Distrito Leste (15% homens + 7% mulheres), Distrito Malir (11% homens + 4% mulheres), Distrito Central (7% homens + 5% mulheres), Distrito Korangi (4% homens + 7% mulheres) e Distrito Sul (4% homens + 4% mulheres), respectivamente.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan

Abstract. The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Resumo O estudo foi realizado de setembro de 2018 a abril de 2019 para determinar a prevalência de leishmaniose tegumentar em seres humanos que vivem em seis distritos de Karachi. Pessoas suspeitas foram rastreadas para a doença e os casos positivos foram identificados com base em lesões de pele e amostras de sangue. As amostras foram observadas montando seu esfregaço. Um total de 207 indivíduos de diferentes idades e grupos sexuais foi investigado, no entanto apenas 192 (92%) dos casos suspeitos foram encontrados para ter a doença; 64% dos casos eram do sexo masculino, que foram significativamente elevados (p 0,05), e do sexo feminino 36%. A lesão foi detectada com maior frequência entre os jovens de 21 a 30 anos (31%) em comparação com os outros grupos. Em ambos os sexos, as pernas estavam mais infectadas (25% homens + 20% mulheres), seguidas pelos braços (20% homens + 0% mulheres) e rosto (15% homens + 11% mulheres). As partes mistas do corpo mostraram as infecções mais baixas (4% homens + 5% mulheres). Em conclusão, as infecções de leishmaniose mais altas e mais baixas foram observadas no Distrito Oeste (23% homens + 9% mulheres) seguido pelo Distrito Leste (15% homens + 7% mulheres), Distrito Malir (11% homens + 4% mulheres), Distrito Central (7% homens + 5% mulheres), Distrito Korangi (4% homens + 7% mulheres) e Distrito Sul (4% homens + 4% mulheres), respectivamente.

Comparing the endothelialisation of extracellular matrix bioscaffolds with coated synthetic vascular graft materials.

INTRODUCTION: Existing synthetic vascular grafts have unacceptably high failure rates when replacing below knee arteries. In vitro endothelialisation is a technique, which has been shown to enhance the patency rates of below knee vascular grafts. Synthetic materials are however poor cellular substrates and must be combined with coatings to promote cellular growth and attachment. The most common coating clinically is fibrin-coated ePTFE. The aim of our study was to compare the endothelialisation of fibrin-coated ePTFE with novel extracellular matrix (ECM) biomaterials that we hypothesise will provide a superior substrate for cell growth. METHODS: Human endothelial cells were cultured on ECM scaffolds and fibrin-coated ePTFE. Uncoated Dacron and ePTFE acted as controls. The cells were examined for viability, phenotype, adhesion and proliferation. Cell morphology was accessed using scanning electron microscopy. RESULTS: Cells remained viable and produced von Willebrand factor on all substrates tested. ECM scaffolds and fibrin-modified ePTFE achieved statistically higher attachment efficiency when compared to both uncoated synthetic graft materials (p ≤ 0.001). At 90 min 80 ± 3.6% of cells had attached to the ECM scaffold compared to Dacron (30 ± 4.5%, n = 3) and ePTFE (33 ± 2.5%, n = 3). There was no difference in adhesion rates between ECM scaffolds and fibrin-coated ePTFE (p = 1.00). Endothelial cells proliferated fastest on ECM scaffolds when compared to all other materials tested (p < 0.001) and reached confluency on day seven. CONCLUSION: ECM bioscaffolds offer an improved substrate for promoting rapid endothelialisation compared to fibrin-coated ePTFE by combining firm cellular anchorage and superior cell expansion.

Endovenous radiofrequency ablation: no value in short-term duplex ultrasound follow-up.

INTRODUCTION: Endogenous radiofrequency ablation (RFA) is a proven treatment for varicose veins that has equal efficacy to surgical stripping. It offers the benefit of reduced post operative pain and wound infection and quicker return to work. AIM: To carry out a clinical audit of patients undergoing RFA to monitor outcomes, complication rates, follow-up sclerotherapy and to assess the need for post-operative duplex scan. METHODS: A retrospective analysis was performed of 174 procedures carried out from January 2011 to March 2012. Patients were pre-assessed with history, physical exam and duplex ultrasound. They were followed up at 3 months with same. CEAP classification was applied to check for post-operative improvement. RESULTS: 174 procedures, including 165 great saphenous vein and 9 short saphenous vein ablations were carried out on 154 patients. The duplex occlusion rate at 3 months was 99 %. 141 patients (81 %) showed a reduction in CEAP score with average CEAP decreasing from 2.37 to 0.96. Overall the complication rate was low at 7 %. Paraesthesia was the most common complication with 7 cases (4 %). There were no DVTs. 45.4 % of patients went on to have follow-up sclerotherapy for venous flares. CONCLUSION: RFA is a safe and effective treatment for varicose veins. There is no benefit in performing routine short term follow-up duplex scan due to the high occlusion rates.

Successful Treatment of Acute on Chronic Mesenteric Ischaemia by Common Iliac to Inferior Mesenteric Artery Bypass.

Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required. Here we present a case involving a 72-year-old woman with acute on chronic mesenteric ischaemia. She was a high risk surgical patient with severe unreconstructable stenotic disease of the SMA and celiac arteries. She was successfully treated with single vessel revascularisation of the inferior mesenteric artery (IMA) via a common iliac to IMA reversed vein bypass. At two-year follow-up, the graft remains patent and the patient continues to be symptom-free and is maintaining her weight.

Maternal nutrition in pregnancy and metabolic risks among neonates in a Pakistani population, a pilot study.

The aim of this study was to observe the association between maternal undernutrition and metabolic risk indicators in newborns at birth. Fifty-nine expectant mothers between 28 and 40 weeks of gestation were included after obtaining their informed consent. Mothers were divided into undernourished, normally nourished and overnourished groups. A total of 54 deliveries were followed-up, and cord blood samples were collected. Metabolic status at birth was assessed by determining the cord blood concentrations of glucose, insulin and lipids and by measuring insulin resistance through homeostasis model assessment. Metabolic risk indicators in the offspring were compared following mothers' nutrition status (under and normal nourished groups). We found that concentrations of glucose (5.31±2.01 v. 4.69±2.22 mmol/l, P=0.01), total cholesterol (2.51±1.52 v. 1.84±0.66 mmol/l, P=0.04), triglycerides (0.85±1.12 v. 0.34±0.24 mmol/l, P=0.00) and low-density lipoprotein (LDL)-cholestrol (1.26±0.93 v. 1.02±0.50 mmol/l, P=0.04) were significantly high in the offspring born to undernourished mothers. LDL-cholestrol remained significantly high in the undernourished group even after adjustment for potential confounders. Furthermore, a weak association was observed between maternal body fat mass with serum leptin (r=0.272, P=0.05) and maternal body mass Index with LDL-cholestrol in the cord blood (r=0.285, P=0.05). Our results showed that offspring of undernourished mothers had a relatively higher metabolic risk profile including LDL-cholestrol compared with normal nourished group, suggesting that maternal undernutrition may influence metabolic risk markers of the newborn at birth. We recommend that these results should be confirmed by a longitudinal study with a larger sample size.

Quality of life, continence and frequency of pouchitis following laparoscopic versus open colectomy and ileal pouch-anal anastomosis: an Irish perspective.

BACKGROUND: This study aims to assess quality of life outcomes, continence, rates of pouchitis and predictors of pouchitis for patients undergoing laparoscopic versus open three-stage ileal pouch-anal anastomosis (IPAA) surgery in our institution. METHODS: Forty-two patients having had three-stage (IPAA) surgery were identified. One was excluded as they had undergone pouchectomy. A postal questionnaire followed by telephone contact was undertaken. The questionnaire was based on The Gastrointestinal Quality of Life Index (GIQLI) and Wexner/Cleveland Clinic Faecal Incontinence Symptom Severity Scoring Systems. AIMS: Our aim was to assess morbidity, quality of life, incidence of pouchitis and continence following restorative panproctocolectomy and IPAA. RESULTS: Thirty-five patients completed the response. The median age at colectomy of our patient population was 32 years. 57 % were male and 43 % were female. 54.3 % of cases were carried out laparoscopically. 8/19 patients who had laparoscopic surgery had pouchitis (42.1 %) versus 9/16 patients who had open surgery (56.3 %). The median Wexner score was 0. Nine patients (25.7 %) had a GIQLI score that was within or above the range reported for healthy controls. The rate of complications was 31.7 % for emergency cases and 25.7 % for elective cases. The rate of pouchitis in this group was 48.5 %. Overall pelvic sepsis rate was 12.8 %. CONCLUSIONS: Ileal pouch-anal anastomosis is a successful and well-tolerated procedure with 94 % of patients opting to have the surgery again. Preliminary results do not show any significant difference in the incidence of pouchitis following laparoscopic surgery.

Effects on pubertal growth and reproduction in rats exposed to lead perinatally or continuously throughout development.

The reproductive, endocrine, and growth effects of developmental lead exposure were assessed using a rat model in which 0.6% lead acetate (w/v) was administered in the drinking water ad libitum during different developmental periods to determine if lead actions were a result of direct effects of continuous exposure to the metal ion or secondary to disrupted neonatal "endocrine imprinting." Sprague Dawley rats were exposed to lead: (1) from gestational d 5 through birth; (2) during pregnancy and lactation; (3) during lactation only; (4) from birth through adulthood; or (5) from gestational d 5 through adulthood. Lead effects were measured on the development of aspects of the reproductive system, adult sex steroid levels, and growth rates in both male and female animals. The relative weights of male secondary sex organs in adult offspring were not significantly affected in any of the lead-treated groups. In contrast, female pups exposed to lead from birth through adulthood or from gestational day 5 through adulthood were observed to have significantly delayed vaginal opening and disrupted estrus cycling. These effects on female reproductive physiology were not observed in animals where lead exposure was confined only to pregnancy or lactation. Significant suppression of adult mean serum testosterone levels was only observed in male pups exposed to lead continuously from gestational age 5 d throughout life. Lead decreased birth weight in all animals exposed in utero and mean body weights were significantly decreased in all lead-treated groups up to weaning. Analysis of growth curves revealed that all lead-treated groups had significantly reduced growth rates during lactation. However, in addition, in male pups exposed to lead during pregnancy and lactation, from birth or from gestational age 5 d, growth rates were also significantly reduced during puberty. Postpubertal growth rates were unaffected in any lead-treated group. Thus, delayed female reproductive development and suppression of adult male serum testosterone concentration required continuous exposure to the heavy metal. Little evidence was observed for an alteration of "endocrine imprinting" by lead on either reproductive or growth parameters. Exposure during early development (pregnancy and lactation) resulted in no permanent effects in this model other than small (10%) decreases in the body weight of pups postpuberty.

Recurrence and chronic pain after mesh fixation with skin staples versus sutures in Lichtenstein's inguinal hernioplasty: a retrospective cohort study.

PURPOSE: Reduction in operating time has been reported with skin staples instead of original technique of mesh fixation with sutures in Lichtenstein's hernioplasty. Few studies have been conducted, however, with inadequate follow-up and variable results. We have undertaken this study to compare the duration of surgery and incidence of recurrence (beyond 1 year) and chronic pain after mesh fixation with staples versus sutures. METHODS: In this retrospective cohort study, adult males with primary unilateral inguinal hernia who underwent open Lichtenstein's hernioplasty from January 2009 till October 2010 were included. All patients with recurrent hernia, concomitant surgery, follow-up less than 1 year and missing data were excluded. Data collection was done via questionnaire and telephonic interviews. Outcomes are recurrence, chronic pain and duration of surgery. RESULTS: We reviewed 70 patients in each group. At median follow-up of 21 months (range 12-34), there was 0 % recurrence in both the groups and chronic pain was 4.4 % higher in suture versus staple group (11.4 vs. 7 %, p value = 0.7). Median duration of surgery was 30 min higher in suture as compared to staple group (90 vs. 60 min, p value = 0.004). CONCLUSION: Our study confirms that staples are superior to the sutures due to shorter operative time and do not cause any additive risk of recurrence or chronic pain. Prospective trial with long-term follow-up for each patient is required to validate these findings in order to generate definite guidelines.

Initial experience of double-layer tension free reconstruction of abdominal wall defects with porcine acellular dermal collagen implant and polypropylene mesh.

INTRODUCTION AND AIM: Various techniques have been proposed for the repair of abdominal wall defects (AWD) with varying rates of success. Despite the development of new materials and modifications of surgical technique, no single approach has emerged as the optimum way to close large AWD. We report a method for repairing large incisional and recurrent abdominal wall hernias using a double-mesh technique. The defect is closed using an underlay biological implant and an onlay synthetic mesh, which is 'quilted' to the underlying abdominal wall and biological implant. The current study reports our initial experience with this approach in ten consecutive patients operated on for large AWD. METHODS: In this prospective observational study the following data were collected: age, gender, previous surgery, co-morbidities, situation and size of the defect, antibiotic therapy, hospital stay, postoperative complications and bacteriology in case of infection. The patients were reviewed at 1, 3 and 6 months, and 1-year postsurgery. RESULTS: Overall all ten AWD of ≥ 75 cm(2) were reconstructed successfully using the quilting technique. Median age of patients was 61 years (range 47-73 years); male:female ratio was 3:2 and median weight was 107.5 kg. Two patients developed a wound infection and were treated successfully with antibiotics. At median follow-up of 15.5 months (range 6-29 months) there was no case of recurrence. CONCLUSION: The use of double-layer of porcine acellular dermal collagen implant and polypropylene mesh in reconstruction of AWD can be considered a safe and effective treatment. The early short-term results are encouraging with few complications.

Umbilical arterial catheter insertion length: in quest of a universal formula.

OBJECTIVE: The study was aimed at comparing the accuracy in length of insertion of umbilical arterial catheter in all new born groups stratified according to weight, by using two different methods, that is, Wright et al./Case (Group I): (4 × Body wt (BW) (kg)) +7; Shukla et al./Control (Group II): (3 × BW (kg)) +9. STUDY DESIGN: It was a randomized open label case control study in a Level III tertiary level Neonatal Intensive Care Unit over 9 months. RESULT: The babies in both the groups were similar in relation to weight, gender, prematurity and weight subgroups. Under insertion was seen in 8% (4/50) of babies in group I and over insertion was seen in group II where it was 32.6% (16/49). There was a reduction of 82% abnormal insertions and repositioning by using the Wright's formula as compared with the Shukla's formula in preterm babies. Statistically significant reduction in repositioning was seen in all babies <1500 g in Group I and under insertion seen in 8% of babies in group I did not attain statistical significance (P=0.34). CONCLUSIONS: There is no universal formula, which gives the accurate length of placement of an umbilical arterial catheter, but Wright's formula comes closer in neonates with different weight sub groups.

Venous drainage, a simple method to prevent the systemic consequences of ischaemia-reperfusion injury in acute lower limb ischaemia.

BACKGROUND: Ischaemia-reperfusion injury (I-R injury) is a recognised and potentially fatal complication following revascularisation of an ischaemic limb. Prevention of reperfusion injury is the focus of much research, but effective drug regimens have yet to be established into clinical practice. CASE REPORT: Here we present a man with prolonged, severe lower limb ischaemia, successfully treated with a novel surgical technique for preventing I-R injury. Prior to revascularisation, the common femoral vein was cannulated and the harmful venous effluent was drained. The patient made an excellent recovery, the limb was salvaged and no systemic complications were encountered.