The benefit of negative pressure dressings in vascular surgery patients with infrainguinal incisions.

OBJECTIVE: Within the vascular patient population, there is an increased risk of developing wound complications especially in infrainguinal incisions. There has been increasing interest in using closed incisional negative pressure dressings to decrease the risk of wound complications. To assess the efficacy of these incisional wound dressings, we studied surgical site infections (SSI) and seroma rates of infrainguinal incisions in our vascular patient population. METHODS: This was a multi-institutional, retrospective study from July 2015 to June 2019. In 2017, our institution began using the Prevena incisional wound system. Wound complication rates were compared with the non-Prevena group before 2017. There were a total of 100 infrainguinal incisions (left and right combined) that received the Prevena wound system and 138 infrainguinal incisions that had not. The primary end point was to assess for wound complication rates, including SSIs and seroma formation. SSIs were graded based on the American College of Surgeons National Surgical Quality Improvement Plan SSI criteria. Seroma formation was diagnosed based on clinical diagnosis, imaging studies (ultrasound examination, computed tomography scan) or needle aspiration of fluid collection. RESULTS: This analysis showed a statistically significant decrease in the rate of SSIs in the Prevena group when compared with the non-Prevena group (P = .012). There was no statistical difference between the two groups in the rate of seroma formation (P = .155). Of the 100 incisions that received the Prevena wound system, 1.2% (1/82) had a femoral SSI and 22.0% (4/18) had a popliteal SSI. For seroma formation, 24.4% (20/82) had a femoral seroma and 11.1% (2/18) had a popliteal seroma. Of the 138 incisions that did not have the Prevena wound system, 9.6% (10/104) had a femoral SSI and 8.8% (3/34) had a popliteal SSI. For seroma formation, 24.0% (25/104) had a femoral seroma and 8.8% (3/34) had a popliteal seroma. Comorbid conditions were assessed in the two study groups and there was no statistical significance regarding rates of SSIs between the groups. CONCLUSIONS: The use of an incisional negative pressure dressing decreases the rate of SSIs in infrainguinal incisions. Regarding the use of these wound systems for seromas, our study did not show a statistically significant decrease in seroma rates.

A novel model for neuroendocrine toxicology: neurobehavioral effects of BPA exposure in a prosocial species, the prairie vole (Microtus ochrogaster).

Impacts on brain and behavior have been reported in laboratory rodents after developmental exposure to bisphenol A (BPA), raising concerns about possible human effects. Epidemiological data suggest links between prenatal BPA exposure and altered affective behaviors in children, but potential mechanisms are unclear. Disruption of mesolimbic oxytocin (OT)/vasopressin (AVP) pathways have been proposed, but supporting evidence is minimal. To address these data gaps, we employed a novel animal model for neuroendocrine toxicology: the prairie vole (Microtus ochrogaster), which are more prosocial than lab rats or mice. Male and female prairie vole pups were orally exposed to 5-µg/kg body weight (bw)/d, 50-µg/kg bw/d, or 50-mg/kg bw/d BPA or vehicle over postnatal days 8-14. Subjects were tested as juveniles in open field and novel social tests and for partner preference as adults. Brains were then collected and assessed for immunoreactive (ir) tyrosine hydroxylase (TH) (a dopamine marker) neurons in the principal bed nucleus of the stria terminalis (pBNST) and TH-ir, OT-ir, and AVP-ir neurons in the paraventricular nucleus of the hypothalamus (PVN). Female open field activity indicated hyperactivity at the lowest dose and anxiety at the highest dose. Effects on social interactions were also observed, and partner preference formation was mildly inhibited at all dose levels. BPA masculinized principal bed nucleus of the stria terminalis TH-ir neuron numbers in females. Additionally, 50-mg/kg bw BPA-exposed females had more AVP-ir neurons in the anterior PVN and fewer OT-ir neurons in the posterior PVN. At the 2 lowest doses, BPA eliminated sex differences in PVN TH-ir neuron numbers and reversed this sex difference at the highest dose. Minimal behavioral effects were observed in BPA-exposed males. These data support the hypothesis that BPA alters affective behaviors, potentially via disruption of OT/AVP pathways.

A pilot randomised controlled trial of a home-based exercise programme aimed at improving endurance and function in adults with neuromuscular disorders.

AIM: To investigate the feasibility and effect of a home-based exercise programme on walking endurance, muscle strength, fatigue and function in people with neuromuscular disorders (NMDs). METHODS: 20 adults with NMDs recruited to a control (n = 11) or exercise (n = 9) group were assessed by blinded assessors at baseline and at week 8. Walking and strengthening exercises were given to the exercise group in an 8-week home exercise programme. A 2-min walk distance was the main outcome measurement; isometric muscle strength, fatigue and function were secondary measurements. RESULTS: 2-min walk distances were not found to change in either group (p>0.05; control: mean 14.50 (SD 22.06) m; exercise: mean 2.88 (SD 20.08) m), and no difference was observed in the change scores between groups (p>0.05). Leg muscle strength increased in the exercise group (p<0.05) but not in the control group (p>0.05). Significance was reached between the groups with respect to the difference in change in muscle strength scores in the right quadriceps (p<0.05; control: mean -2.82 (SD 4.87) kg; exercise: mean -7.08 (SD 2.82) kg). No change was observed in fatigue or function scores (p<0.05). CONCLUSIONS: A home-based approach aimed at improving endurance in adults with NMDs is feasible and further investigation on a larger sample is warranted.

Shoulder and elbow function following Marchetti-Vicenzi humeral nail fixation.

Humeral nailing has been associated with reduction of shoulder and elbow function. We present the results of fixation of 15 diaphyseal humeral fractures with Marchetti-Vicenzi nails (B Braun Medical Aesculap). Shoulder and elbow functions were assessed by the Constant shoulder and Mayo elbow scoring systems. The average Constant Shoulder score was good (82.5/100) and the average Mayo Elbow Score was excellent (95.4/100). The indications for surgery included nonunion, pathological fractures and poor fracture position. The mean follow-up was 67 weeks with an average interval to surgery of 19 weeks. The mean time to union was 19 weeks. All the fractures united without any patient requiring any further procedure. There were two postoperative radial nerve palsies and one median nerve palsy, however two patients had complete recovery and one had partial recovery of the radial nerve. There was one deep infection requiring removal of the implant. There were no implant failures. Based on our experience, the Marchetti-Vicenzi humeral nail appears as a relatively safe implant and its use has been associated with preservation of good shoulder and elbow functions.

Fracture of an elastic humeral nail. A case report.

The use of elastic intramedullary nails for the treatment of diaphyseal fractures of the humerus has been associated with few complications. We report a fracture of an elastic Marchetti-Vicenzi nail used to treat a pathological fracture of the humerus. The failure of the intramedullary nail followed low-energy trauma and was presumably the end result of metal fatigue, as the original fracture had only healed after 13 months.

Dislocation of Insall-Burstein II modified total knee arthroplasty.

Dislocation of total knee arthroplasty is a rare but serious complication. The experience with the Insall-Burstein II modified knee prosthesis, which was designed to address the issue of dislocation, has been favorable. We present a series of 3 dislocations in 1,500 total knee arthroplasties done with this prosthesis, accounting for about 0.2% of cases.

Biosynthesis of tetrahydroanthraquinones in fungi.

The tetrahydroanthraquinones (1S,3S)-austrocortilutein (4) and (1S,3S)-austrocortirubin (7) are octaketides formed in the fruit bodies of the fungus Dermocybe splendida via the gentiobioside 2 of the dihydroanthracenone (S)-torosachrysone (1).

Pelvic insufficiency fracture with diastasis of the pubic symphysis after irradiation: a case report.

A 61-year-old woman was seen with diastasis of the symphysis pubis and insufficiency fractures of the wings of both ilia after irradiation for carcinoma of the cervix. The characteristics and treatment of these fractures are discussed.

The use of the probe in arthroscopic examination of the knee.

Careful examination of the results of 500 arthroscopic examinations of the knee showed that significant diagnostic information was gained by use of the probe in 52 knees. However, survey results show that in northwest England only 67% of surgeons always perform an arthroscopy prior to meniscectomy and only 41% of surgeons used a probe at every examination. Failure to use the probe at every examination may result in missed pathology.

The safety of the Denis Browne abduction harness in congenital dislocation of the hip.

The Denis Browne abduction harness was used in the management of 127 abnormal hips in 104 children at Queen Mary's Hospital for Children from 1966 to 1980, both as the initial treatment for unstable hips recognised soon after birth, and for children presenting later and whose hips first required reduction by gradual abduction in traction. The incidence of significant avascular necrosis was 3.1%, and occurred only in the primary treatment group, emphasising again the need for gentle care of infant hips. There have been no other significant complications and the appliance has functioned well.

Locked knee and osteochondritis dissecans.

Two patients presenting with a locked knee are described. In both cases a loose body from an osteochondritis dissecans defect had wedged beneath the anterior horn of the lateral meniscus, creating a block to extension which could not be reduced. Arthroscopy and arthroscopic methods proved unsuccessful in the removal of the loose body.