Delayed mesh infection and mesh penetrating the transverse colon and small intestine after abdominal incisional hernia repair.

The occurrence of late-onset mesh infection and mesh invasion into the intestine after abdominal incisional hernia repair is extremely rare. Herein, we describe the first case of late-onset mesh infection and mesh penetrating the transverse colon and small intestine 5 years after incisional hernia repair using an expanded polytetrafluoroethylene mesh. The symptom was drainage from the reddish wound, and computed tomography scan revealed intestinal prolapse with local wall thickening. The mesh removal and small intestine and colon resection were conducted because the small intestine and transverse colon formed a mass containing the mesh inside. The events were caused by the lack of mesh fixation, and the dislodged mesh penetrating the intestinal tract caused the infection. For mesh infections in which conservative treatment is not effective, mesh removal and organ excision should not be delayed regardless whether there is a strong adhesion of the abdominal cavity.

The Antioxidation Mechanism of Polydimethylsiloxane in Oil.

Strong and stable antioxidation effects of polydimethylsiloxane (PDMS) are widely accepted and utilized in commercial frying oil; however, the mechanism is not fully established. On the other hand, canola oil contains about 700 ppm (mg/kg-oil) of the natural antioxidant, tocopherol. Canola oil containing 0, 1 and 10 ppm added PDMS was heated at 180°C for 1 h under stirring, then left for 2-3 days at room temperature; this treatment was repeated 5 times. Compared to pure canola oil, PDMS-containing canola oil exhibited remarkably lower peroxide, p-anisidine and acid values, a lower decrease in tocopherol content but a higher oxygen content during the heating experiments, implicating low oxygen consumption for the oxidation. While PDMS has not been known to exhibit antioxidative effects at ambient temperatures, the present results show that PDMS prevents autoxidation as well as thermal oxidation. In addition, PDMS, not tocopherols, provided the major antioxidative effect during intermittent heating, and the decrease of tocopherols was significantly inhibited by PDMS. Phase contrast microscopy confirmed that PDMS contained in canola oil was suspended as particles. Also, the oxygen content in standing PDMS-containing canola oil decreased as the depth of oil increased, corresponding to the PDMS distribution, which also decreased as the depth of oil increased. Moreover, PDMS had a higher affinity for oxygen than canola oil in a mixture of canola oil/PDMS, 1:1 v/v. Thus, it is suggested that PDMS restricted the behavior of oxygen dissolved in canola oil by attracting oxygen in and around the PDMS particles, which is wholly different from the radical scavenging antioxidation of tocopherol.

A phase III, multicenter, collaborative, open-label clinical trial of sildenafil in Japanese patients with pulmonary arterial hypertension.

BACKGROUND: There is evidence that phosphodiesterase type-5 is effective for the treatment of pulmonary arterial hypertension (PAH). METHODS AND RESULTS: A phase III, multicenter, open-label clinical trial of sildenafil 20mg t.i.d. was conducted in 21 Japanese patients with PAH to examine its efficacy, safety, and pharmacokinetics. The present trial consisted of a screening period and 12-week treatment. Patients who were enrolled in the present trial increased their 6-min walking distance of administration increased at week 12 by 84.2m from baseline. Hemodynamic parameters (eg, mean pulmonary artery pressure and pulmonary vascular resistance), Borg dyspnea scores, and plasma brain natriuretic peptide concentrations also improved compared to baseline. Most patients improved or sustained WHO functional class. Seven subjects, who were examined for the pharmacokinetics of sildefanil, showed relatively large interindividual variations in the C(max), AUC(0-8), C(ss,av), and C(trough) of the drug. Any serious adverse events, severe adverse events, and deaths were not observed. Most of events of undeniable causality were mild or moderate in severity. Sildefanil was well tolerated by the subjects. CONCLUSIONS: Sildenafil 20mg t.i.d. was effective and safe for Japanese patients with PAH.

Electrical stimulation of the rabbit pulmonary artery increases respiratory output.

This study was conducted to test the hypothesis that the pulmonary artery is involved in neural respiratory control and to identify the involved topographical region, if any. Six adult rabbits were anesthetized, artificially ventilated, and the chest was opened. The outer surface of the extra-pulmonary portion of the pulmonary artery was electrically stimulated by monitoring phrenic nerve activity. Phrenic nerve activity increased in three of the six rabbits when the proximal dorsal surface of the pulmonary trunk was stimulated. This positive response was abolished after bilateral vagotomy. In histological examinations we found densely grouped cells, i.e. pulmonary glomic tissue, with a fine nerve bundle in the tissue adjacent to the dorsal surface of the pulmonary trunk where electrical stimulation elicited respiratory augmentation. We suggest that there is a neural substrate which is involved in respiratory control inside the wall of or in the region adjacent to the proximal dorsal surface of the pulmonary trunk. Further studies to anatomically identify the neural substrate and clarify its physiological role in respiratory control are necessary.

Connective tissue-bone onlay graft with enamel matrix derivative for treatment of gingival recession: a case report.

We describe a case of gingival recession in which root coverage and coronal bone regrowth were achieved after treatment with a connective tissue-bone graft and enamel matrix derivative. The connective tissue-bone graft was harvested from a maxillary edentulous area and then curved to fit the root surfaces of the maxillary left central and lateral incisors. Enamel matrix derivative was applied to the root surfaces, and the connective tissue-bone graft was fixed to the interdental bone by a titanium screw. Six months later, the exposed roots were covered with thick gingiva, and coronal regrowth of thick bone was evident at reentry surgery. This technique is useful for esthetic restoration placement with an intracrevicular margin on teeth with a thin, receding gingiva.