Component separation repair of incisional hernia: evolution of practice and review of long-term outcomes in a single center.

PURPOSE: To review the long-term outcomes of complex abdominal wall reconstruction using anterior and posterior component separation (CS) techniques in our center. METHODS: This was a descriptive analytical study. Analysis of data from a prospectively collected database of patients who had undergone Component Separation (CS) repair of incisional hernias was performed. Two techniques were used. Anterior component separation (ACS) and posterior component separation with transversus abdominis release (PCS/TAR). Follow-up was clinical review at 6 weeks, 6 months, and 12 months with direct access telephone review thereafter. Long-term outcome data was obtained from electronic records and based on either clinical or CT assessment. Minimum physical follow-up was 6 months for all patients. RESULTS: 89 patients with large incisional hernias underwent CS repair. 29 patients had ACS while 60 underwent PCS/TAR. Mean follow-up was 60 months (range 6-140 months) in the ACS group and 20 months (range 6-72 months) in the PCS group. Twenty-five patients (28%) had simultaneous major procedures including 21 intestinal anastomoses. Twenty-six (29%) of patients had associated stomas. Twenty-seven (30.3%) of the patients had undergone previous hernia repairs. Seromas occurred in 24 (26.97%) patients. Wound infections were more common after ACS. There have been 10 (11.2%) recurrences to date. CONCLUSION: Component separation repair techniques result in good long-term outcomes with acceptable complication rates. They can be performed simultaneously with gastrointestinal procedures with low morbidity. Appropriate patient selection and use of appropriate mesh are important.

Diffuse optical spectroscopic imaging of subcutaneous adipose tissue metabolic changes during weight loss.

BACKGROUND: Changes in subcutaneous adipose tissue (AT) structure and metabolism have been shown to correlate with the development of obesity and related metabolic disorders. Measurements of AT physiology could provide new insight into metabolic disease progression and response to therapy. An emerging functional imaging technology, diffuse optical spectroscopic imaging (DOSI), was used to obtain quantitative measures of near infrared (NIR) AT optical and physiological properties. METHODS: Ten overweight or obese adults were assessed during 3 months on calorie-restricted diets. DOSI-derived tissue concentrations of hemoglobin, water and lipid and the wavelength-dependent scattering amplitude (A) and slope (b) obtained from 30 abdominal locations and three time points (T0, T6, T12) were calculated and analyzed using linear mixed-effects models and were also used to form 3D surface images. RESULTS: Subjects lost a mean of 11.7±3.4% of starting weight, while significant changes in A (+0.23±0.04 mm(-1), adj. P<0.001),b (-0.17±0.04, adj. P<0.001), tissue water fraction (+7.2±1.1%, adj. P<0.001) and deoxyhemoglobin (1.1±0.3 µM, adj. P<0.001) were observed using mixed-effect model analysis. DISCUSSION: Optical scattering signals reveal alterations in tissue structure that possibly correlate with reductions in adipose cell volume, while water and hemoglobin dynamics suggest improved AT perfusion and oxygen extraction. These results suggest that DOSI measurements of NIR optical and physiological properties could be used to enhance understanding of the role of AT in metabolic disorders and provide new strategies for diagnostic monitoring of obesity and weight loss.

Low rates of transmission of SRV-2 and STLV-I to juveniles in a population of Macaca fascicularis facilitate establishment of specific retrovirus-free colonies.

BACKGROUND: Prevalence of simian retrovirus-2 (SRV-2) and simian T lymphotropic virus type I (STLV-I), was unknown in 337 captive cynomolgus macaques. METHODS AND RESULTS: Molecular assays identified 29% of animals as SRV-2 mono-infected, 4% of animals as STLV-I mono-infected and 9% of animals as dual-infected. Of 108 juvenile animals, 83% were SRV-2-negative and no juvenile animal was STLV-I-positive. A subsequent study of juvenile macaques over a period of 2.5 years detected no STLV-I and 10 SRV-2 infections, six of which occurred between testing and day of colony formation. The study also highlighted that an anti-SRV-2 serological response does not presuppose infection. Tissue reservoirs of latent SRV-2 were not identified in suspected SRV-2 infections. CONCLUSIONS: Low transmissibility of the viruses present in the parental cohort and improved knowledge of the host response to SRV-2 has facilitated the creation of specific-retrovirus-free colonies of cynomolgus macaques.

The Mhc class II DRB genotype of Macaca fascicularis does not influence infection by simian retrovirus type 2.

Simian retrovirus type 2 (SRV-2) is a natural pathogen of Macaca fascicularis. Although SRV-2 may be endemic in macaque colonies, it is not necessarily detected in all individuals suggesting differential susceptibility to SRV-2; factors contributing to this susceptibility are not fully understood. We have investigated the role of host genetic origin on virus susceptibility. We have shown that high levels of anti-SRV-2 antibodies correlate with failure to establish persistent virus infection, thus we targeted our genetic analysis of virus susceptibility with an investigation of the role of the polymorphic macaque major histocompatibility complex (MHC) class II locus. DRB genotypes, both novel and previously characterised, were identified in individuals and family groups. A discordance with SRV-2 infection status suggests that an Mhc II DRB genotype is not overtly associated with the outcome of viral infection.

Natural infection and transmission of SV40.

The kinetics of conversion to SV40 seropositivity of cynomolgous macaques were followed as part of the health monitoring of a breeding colony to examine possible routes of transmission. The data suggest that transmission is neither vertical nor perinatal, and that conditions of husbandry might reduce the frequency of spread between animals.

Sub-clinical parasitism in spring-born, beef suckler calves: epidemiology and impact on growth performance during the first grazing season.

Sub-clinical parasitism in spring-born single suckled beef calves was investigated from the middle of their first grazing season until weaning or housing later the same year. The study was conducted on four beef suckler herds in southern England over a 3-year period and involved a total of 334 spring-born beef suckler calves and their dams. The animals were grazed extensively on pastures naturally infected with nematode larvae. At the start of each period of observation, faecal samples were taken from calves and cows and subjected to routine worm egg counts; calves were re-sampled at the end of the grazing season. In July in each year and at each location the calves were ranked by initial weight within sex, paired according to rank and randomly allocated to either an untreated control group or a group in which the calves were each treated with an ivermectin sustained-release (SR) bolus. The calves in both trial groups, and their dams, were grazed together until weaning or housing. The calves were weighed at the initial allocation and at the end of the study. The adult cows were not treated with any anthelmintic during the study. The faecal nematode egg counts (FECs) conducted in July showed that the suckler cows were excreting worm eggs at low concentrations: range 0-100 eggs per gram (epg), with one individual count of 500epg, 88% of the cows sampled had counts of <50epg. Similarly, the counts from the calf samples were fairly low in July: range 0-250epg, 73% of the calves sampled had counts of <50epg. By the end of the grazing season, the faecal samples from the untreated control calves showed higher values: range 0-650epg, with only 58% having an epg of <50. The average rate of daily liveweight gain in the untreated heifer calves was 0.79kg per day, the corresponding figure for the heifer calves treated with the ivermectin SR bolus in mid-summer was 0.88kg per day; the difference of 90g per day was significantly different (P=0.0118). The average rate of daily liveweight gain in the untreated bull calves was 0.91kg per day, the corresponding figure for the bull calves treated with the ivermectin SR bolus in mid-summer was 1.01kg per day; the difference was significantly different (P=0.0169).

Treatment of facial verrucae with topical imiquimod cream in a patient with human immunodeficiency virus.

Imiquimod is a recently developed imidazoquinolin heterocyclic amine that is an immune response modifier. Treatment with topical 5% imiquimod cream has shown promising results in the treatment of genital warts in immunocompetent individuals. We report here the first case of successful treatment with topical 5% imiquimod cream of facial verrucae in an individual with human immunodeficiency virus.

Pedunculated malignant melanoma.

BACKGROUND: The pedunculated melanoma is an unusual variant of nodular melanoma that presents a challenge in staging and management. OBJECTIVE: We discuss the clinical and histopathologic characteristics of a case of pedunculated melanoma and present a brief review of the literature. METHODS: Routine stain with hematoxylin and eosin was performed on tissue specimens. RESULTS: The pedunculated melanoma was excised. Sentinel lymph node dissection was performed and was negative for the presence of melanoma. CONCLUSIONS: Pedunculated melanoma is a rare type of melanoma. Conventional staging methods for melanoma may not be reliable in this type of tumor. Complete workup, possibly including sentinel lymph node dissection, should be performed in all patients with pedunculated melanomas.

Nonablative treatment of rhytids with intense pulsed light.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy and complication rate of a nonablative nonlaser light source in the treatment of rhytids. Laser resurfacing, in the treatment of facial rhytids, has involved ablative methods, with their associated complications and limitations. Rhytid improvement requires dermal collagen remodeling. Interest has begun to focus on the use of wavelengths that preserve the epidermis but deliver enough energy to promote rhytid improvement. STUDY DESIGN/MATERIALS AND METHODS: Thirty subjects with class I-II rhytids and Fitzpatrick skin types I-II were treated with up to four treatments with an intense pulsed light source. Subjects were evaluated 6 months after the final treatment. RESULTS: Twenty-five subjects showed some improvement in the quality of skin. No subjects were found to have total resolution of rhytids. CONCLUSION: Nonlaser intense pulsed light may effectively improve some facial rhytids. Such improvement can occur without epidermal ablation.

The use of the erbium:YAG laser for the treatment of class III rhytids.

BACKGROUND: The erbium:YAG (Er:YAG) laser can be used for precise tissue ablation with minimal thermally induced damage. Because of its ability to superficially ablate tissue, the Er:YAG laser can be used to improve fine rhytids with rapid epidermal reepithelialization. It has not been shown that the Er:YAG laser can successfully treat deeper rhytids where some thermal damage may lead to more optimal collagen remodeling. OBJECTIVE: We chose to evaluate the efficacy of multiple superficial Er:TAG laser sessions in the treatment of deeper class III rhytids. METHODS: Twenty subjects were selected for this study. All treated subjects had class III rhytids and were Fitzpatrick I-III skin phenotypes. All subjects were treated with four Er:YAG laser passes at 5 J/cm2. Three months after the initial treatment, a second treatment with similar parameters was repeated. Six months after the initial treatment, a third laser session with identical parameters was undertaken. Subjects were evaluated for laser efficacy and postlaser complications. RESULTS: Although no subjects showed improvement after the first laser session, mild to excellent improvement was noted 6 months after the third Er:YAG laser treatment. CONCLUSION: The Er:YAG may be used successfully in the treatment of class III rhytids. Multiple sessions may be required.

Sensitivity of Escherichia coli to proline analogues during osmotic stress and anaerobiosis.

The sensitivity of wild-type Escherichia coli K-12 to a series of proline analogues was determined in cultures containing increasing concentrations of NaCl under both aerobic and anaerobic conditions. The bacteria were most sensitive to L-azetidine-2-carboxylate and L-thiazolidine-4-carboxylate. The minimum inhibitory concentrations for these compounds decreased progressively during osmotic stress, but the bacteria were much more sensitive to these proline analogues under aerobic conditions than during anaerobiosis. The reduced sensitivity under anaerobic conditions did not reflect degradation of the compounds in the culture medium. Since both urine and medullary renal tissue contain relatively low oxygen concentrations, these results raise doubts about the potential use of proline or glycine betaine analogues in treating urinary tract infections.

Oxytocin excites neurones in the bed nucleus of the stria terminalis of the lactating rat in vitro.

Unit recordings were made in the bed nucleus of the stria terminalis in brain slices obtained from lactating rats. Addition of 10(-8) to 10(-6) M oxytocin to the perfusate caused a reversible and repeatable excitation in 28/53 (53%) of neurones. The excitatory effect of oxytocin was completely blocked in the presence of the antagonist [d(CH2)5,D-Tyr(OEt)2,Val4,Cit8]vasopressin (5 x 10(-7) M) and a smaller excitation was achieved with equimolar concentration of arginine vasopressin, implicating the involvement of an oxytocin receptor. This effect is discussed in relation to the actions of centrally administered oxytocin in the lactating rat.