Enzyme-responsive polymers for microbial infection detection.

There is a pressing need for point-of-care diagnostics indicating early stages of infection. Polymers can respond to enzymes secreted by microorganisms or released by the human immune system. This provokes either a direct color reaction or release of dyes, allowing early-stage detection of wound infections and contamination of medical devices. Conventional methods for the detection of infection indicators are based on slow, laboratory-based procedures and, consequently, do not allow a timely assessment. In contrast, polymer-based materials offer real-time responses in point-of-care devices that, in turn, allow therapists to amend treatment before the infection has become firmly established. The use of protein, polysaccharide and mixed polymer systems provides a sensitive means to detect the low levels of proteases and glycosyl hydrolases produced on initiation of infection in the clinical setting. These polymers can be easily fabricated into various forms that can be directly applied in diagnostic devices.

Ischemic colitis: an unusual case of inferior mesenteric arteriovenous fistula causing venous hypertension. Report of a case.

Mesenteric arteriovenous fistulas are a rare entity. Those involving the inferior mesenteric artery are exceptionally rare with only 13 cases reported in the English literature,1,2 of which only one has been associated with ischemic colitis. Ischemic colitis is a well-recognized clinical entity that typically occurs spontaneously in elderly patients and is not associated with a specific clinical presentation.3 We report a case of ischemic colitis caused by venous hypertension associated with a congenital inferior mesenteric arteriovenous fistula. To our knowledge, this is the first reported case of a mesenteric arteriovenous fistula causing ischemic colitis in a patient without previous gastrointestinal surgery or trauma.

A technique of extending small-bowel mesentery for ileal pouch-anal anastomosis: report of a case.

One of the keys to success in proctocolectomy with ileal pouch-anal anastomosis is obtaining adequate mesenteric length to allow the pouch to reach the anorectum without tension. A multitude of techniques have been described in the literature to gain mesenteric length; however, in most cases these techniques only allow for the correction of a small deficit in the mesenteric length. We encountered a case in which the small-bowel mesentery was severely foreshortened because of a previous small-bowel volvulus just proximal to the loop ileostomy during recovery from the initial stage of his ileal pouch procedure. In this case, the deficit in length required an interposition vein graft to the superior mesenteric artery to facilitate adequate mesenteric length and allow completion of the ileal pouch-anal anastomosis. We report this technique to add another method of mesenteric lengthening to the armamentarium of surgeons performing ileal pouch-anal anastomoses. This technique should only be used as a last resort.

Using negative pressure wound therapy following surgery for complex pilonidal disease: a case series.

Complex pilonidal disease, an uncommon manifestation of an anorectal condition, is characterized by chronic or recurrent abscesses with extensive, branching sinus tracts. Definitive treatment requires wide excision of all involved tissue followed by secondary intention healing or reconstructive surgery. All treatment options have unique advantages and disadvantages. Following recent reports that negative pressure wound therapy after surgery for complex pilonidal disease may be a useful alternative to moist saline dressing treatments, five patients (three men and two women, median age 21 years [range: 16 to 63 years]) with complex pilonidal disease (symptom duration range 6 months to 30 years) were treated on an outpatient basis. Following wide excision under general anesthesia, a portable negative pressure wound therapy device was applied. Mean wound defect size after excision was 11 cm x 4 cm x 5 cm, or 205 cm(3) (range 90 cm(3) to 410 cm(3)). Negative pressure wound therapy was used for an average of 6 weeks (range 4 to 9 weeks) and mean time to complete epithelialization was 12 weeks (range 9 to 22 weeks), including use of moist saline dressings post negative pressure wound therapy. Treatment was discontinued in one patient due to skin irritation. No other complications were observed. Long-term follow-up is required to assess the risk of recurrent pilonidal disease or wound failure following negative pressure wound therapy. Additional studies of negative pressure wound therapy in the management of pilonidal disease are warranted.