Amoxicillin and clavulanate potassium in treating children with suppurative tonsillitis.

To evaluate clinical effects of amoxicillin and clavulanate potassium in the treatment of children with suppurative tonsillitis, 146 children with suppurative tonsillitis were randomly divided into a ceftezole sodium group and an amoxicillin and clavulanate potassium group. The two groups were given anti-infection treatment using different drugs. Symptomatic treatment was carried out once symptoms such as fever appeared. Five to seven days were taken as one treatment course. Blood routine examination and the detection of C-reactive protein (CRP) were performed three days after treatment. Indexes such as the time to the relief of symptoms, the count of white blood cells, the proportion of neutrophil and CRP levels and the incidence of adverse reactions were compared between groups to evaluate the curative effect. The overall response rate of the amoxicillin and clavulanate potassium group was 94.52%, while that of the ceftezole sodium group was 78.08%; the difference was statistically significant (P<0.05). The improvement of white blood cells and CRP levels of the amoxicillin and clavulanate potassium group was more obvious than that of the ceftezole sodium group (P<0.05). The difference of the time to the improvement of symptoms between the two groups had statistical significance; the amoxicillin and clavulanate potassium group was superior to the ceftezole sodium group (P<0.05). No severe drug-related adverse reactions were observed. Amoxicillin and clavulanate potassium dispersible tablet is effective in treating children with suppurative tonsillitis as it can rapidly relieve the clinical symptoms without increasing incidence of adverse reactions.

High Pressure Thermal Sterilization and ε-Polylysine Synergistically Inactivate Bacillus subtilis Spores by Damaging the Inner Membrane.

ABSTRACT: This study was conducted to determine the sterilization effect of a combination of high pressure thermal sterilization (HPTS) and ε-polylysine (ε-PL) on Bacillus subtilis spores. The spores were treated with HPTS (550 MPa at 25, 65, and 75°C) and ε-PL at 0.1 and 0.3%. HPTS and ε-PL synergistically decreased the number of surviving spores and increased the release of the intracellular components in the spore suspension, with the maximal effects from treatment with 550 MPa at 75°C plus 0.3% ε-PL. Maximum fluidity and permeability of the cell inner membrane were observed with 550 MPa at 75°C plus 0.3% ε-PL. Changes in membrane lipids were detected from 3,000 to 2,800 cm-1 by Fourier transform infrared spectroscopy. The results provide new insights into the mechanism by which HPTS and ε-PL synergistically sterilize B. subtilis spores.

[Analysis and evaluation of droplet digital PCR for H.pylori infections in chronic tonsillitis].

Objective:To investigate the measurement effect of droplet digital PCR(dd-PCR) for H.pylori infections in chronic tonsillitis and explore the correlations between H.pylori infections and chronic tonsillitis.Method:The subjects consisted of 48 chronic tonsillitis patients aged between 7 and 52 years scheduled for tonsillectomy.Core biopsy samples from resected tonsillary tissue was tested for H.pylori detection using both RT-PCR and dd-PCR for the CagA and VacA genes.Preoperative patient venous blood samples were also tested for H.pylori antibodies by Enzyme-linked immunosorbent assay(ELISA).ELISA,RT-PCR and dd-PCR were also used to detect expression of CagA and VacA genes in plasma and tissue of 30 cases of obstructive sleep apnea syndrome(OSAHS) and 35 cases of plasma from healthy subjects.Result:The expression of H.pylori antibodies is tested in plasma:48 chronic tonsillitis patients(10.12±3.23)ng/ml, OSAS(9.87±2.43)ng/ml, healthy subjects(9.34±3.38) ng/ml.There was no significant difference between groups in the plasma.The VacA and CagA gene sequences were detected by RT-PCR:48 chronic tonsillitis patients VacA(27.1%),CagA(16.7%),VacA+CagA(16.7%);30 OSAHS,VacA(23.3%),CagA(20.0%),VacA+CagA(16.7%);all of which were also positive by dd-PCR,thus were considered H.pylori infected.Moreover,The expression of VacA and CagA increased in tissues testing by dd-PCR:48 chronic tonsillitis patients VacA(72.9%),CagA(52.1%),VacA+CagA(39.6%);30 OSAHS,VacA(33.3%),CagA(23.3%),VacA+CagA(16.7%).Conclusion:Our study supports the possible role of H.pylori in chronic tonsillitis.H.pylori maybe one of the risk factors of chronic tonsillitis.dd PCR had bettersensitivity and specificity compare to H.pylori serological and RT PCR.Feasible anti H.pylori treatment maybe used for H.pylori associated chronic tonsillitis.

Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.

BACKGROUND AND PURPOSE: Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals. MATERIALS AND METHODS: We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. For each imaging finding, we fit a generalized linear mixed-effects model for the age-specific prevalence estimate clustering in the study, adjusting for the midpoint of the reported age interval. RESULTS: Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age. CONCLUSIONS: Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's clinical condition.

Tumor necrosis factor promotes motor functional recovery in crushed peripheral nerve.

The potential benefits of tumor necrosis factor pretreatment in promoting motor functional recovery of peripheral nerve following low load crush injury were examined. Using a specially designed crush device, rat sciatic nerve was subjected to a low load crush injury of 2-h duration. Recombinant murine tumor necrosis factor and saline were intraperitoneally injected into the experimental and control animals, respectively, prior to nerve crushing. Subsequent motor function was evaluated at intervals by measurement of the sciatic functional index. There was significantly (P < 0.05 to < 0.01) more rapid recovery in the tumor necrosis factor pretreated group as compared to the controls between day 14 and day 28. The sciatic functional index in the tumor necrosis factor group improved to -69.3 +/- 5.3 at day 14 and to nearly normal at day 21. In contrast, the sciatic functional index in the control group was -95.5 +/- 3.1% at day 14 and did not approach normal until day 42. Histological results paralleled the functional findings. The results suggest that tumor necrosis factor pretreatment has the potential to attenuate neurostructural damage and promote motor functional recovery in rat peripheral nerve.

Recombinant human glial growth factor 2 (rhGGF2) improves functional recovery of crushed peripheral nerve (a double-blind study).

This in vivo double-blind study evaluated the effect of recombinant human glial growth factor 2 (rhGGF2), a Schwann cell mitogen, on the recovery of motor function of rat sciatic nerve following crush injury. Seventy three rats were divided into three groups. Group I (n=5), sham operated; Groups II (n=34) and III (n=34) received a 100 g crush load for 2 h over a 5 mm segment of the sciatic nerve. Group III was treated with 1 mg/kg rhGGF2, via subcutaneous injection one day before nerve crush and daily for the following four days. Group II received an equivalent volume of saline as a control. Motor functional recovery was assessed by calculating the sciatic functional index (SFI) and the recovery rate of tetanic contractile force of the extensor digitorum longus (EDL) muscle. Recovery of nerve function was evident at day 11 after crush in the rhGGF2-treated animals, whereas the nerves in controls were still paralyzed. The rhGGF2-treated animals showed a significant improvement of the SFI between days 11-21 postoperatively when compared to controls. The isometric tetanic contractile force was stronger in the rhGGF2-treated group than in controls, with a significant difference at 40 to 70 Hz stimulus frequencies on day 4. Correlation analysis showed that tetanic contractile force had a linear correlation with the SFI. Histologic assessment indicated that the rhGGF2-treated animals showed less severe degeneration and earlier robust remyelination of axons than controls. The results suggest that treatment with rhGGF2 is effective in promoting nerve regeneration as seen in measurements of functional recovery and qualitative assessment of nerve morphology. The mechanism of GGF's protective effect may be related to its direct action on Schwann cells, stimulating their mitosis as well as inducing neurotrophic factors essential to neuronal maintenance and repair.

Combined effect of acute denervation and ischemia on the microcirculation of skeletal muscle.

Using direct in vivo videomicroscopy and a fluorescein dye technique, reperfusion injury after 3 h of ischemia was studied in the acutely denervated cremaster muscle of the rat. Compared with normally innervated controls, ischemia-induced reperfusion injury was more severe in the denervated group and included a delay of blood flow recovery, vortex formation, edema, hemorrhage, and vessel spasm. Vessel size was reduced at the arteriole and small artery level, and there was a decrease of reactive hyperemia. The injury mechanism may be related to a loss of active vasomotion and vascular response to vasoactive substances after denervation. The results suggest that shortening the ischemia time of denervated tissues may reduce ischemia-induced reperfusion injury. Similarly, given the same ischemia time, improved tissue reperfusion may be expected if the nerve supply is maintained.

The effect of acute denervation on the microcirculation of skeletal muscle: rat cremaster model.

Although tissue is denervated during replantation of a severed part, tissue transfer, or muscle transplantation, there are few studies concerning the effects of acute denervation on muscle microcirculation. We have described a surgical procedure that totally denervates the rat cremaster muscle. Histological examination of the denervated tissue has given convincing evidence of nerve degeneration and skeletal muscle atrophy, accompanied by electrophysiological evidence of total denervation. The diameters of each component of the microcirculation were measured before and after denervation. Arterioles and arteries ranging in size from 10 to 70 microns in diameter were found to increase significantly in size immediately after acute denervation. Larger arteries and veins did not undergo significant diametrical increases. These findings suggest that total acute denervation significantly increases the diameter of small arteries and arterioles, thereby decreasing the resistance in the arterial bed and increasing blood flow. Since this phenomenon is of limited duration (20 min), it would appear to be ineffective in enhancing reperfusion and oxygenation at the time of reattachment of amputated parts or during vascularized tissue transfers, until methods of prolonging it for several hours or more are found.

Influences of inflation rate and duration on vasodilatory effect by intermittent pneumatic compression in distant skeletal muscle.

Previous study has demonstrated that application of intermittent pneumatic compression on legs can cause vasodilation in distant skeletal muscle at the microcirculation level. This study evaluated the influence of inflation rate and peak-pressure duration on the vasodilatory effects of intermittent pneumatic compression. The cremaster muscles of 50 male rats were exposed and divided into five groups of 10 each. A specially designed intermittent pneumatic-compression device was applied in a medial-lateral fashion to both legs of all rats for 60 minutes, with an inflation rate and peak-pressure duration of 0.5 and 5 seconds, respectively, in group A, 5 and 0 seconds in group B, 5 and 5 seconds in group C, 10 and 0 seconds in group D, and 10 and 5 seconds in group E. Diameters of arterial segments were measured in vessels of three size categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed that the greatest increase in diameter was produced by intermittent pneumatic compression with the shortest inflation rate (0.5 seconds). A moderate increase resulted from compression with an inflation rate of 5 seconds, and no effective vasodilation occurred during compression with the longest inflation rate (10 seconds). When the groups with different inflation rates but the same peak-pressure duration were compared, there was a significant difference between any two groups among groups A, C, and E and between groups B and D. When the groups with different peak-pressure durations but the same inflation rate were compared, compression with a peak-pressure duration of 5 seconds caused a generally similar degree of diameter change as did compression without inflation at peak pressure. The findings suggest that inflation rate plays an important role in the modulation of distant microcirculation induced by intermittent pneumatic compression whereas peak-pressure duration does not significantly influence the vasodilatory effects of the compression. This may be due to the fact that rapid inflation produces a significant increase in shear stress on the vascular wall, which stimulates vascular endothelium to release nitric oxide, causing systemic vasodilation.

Protective effect of 21-aminosteroid pretreatment in peripheral nerve low-load crush injury in mature and immature rats.

The effects of U-74006F (tirilazad mesylate), a 21-aminosteroid antioxidant, on injured peripheral nerve were studied. Twenty-two immature and 44 mature rats were divided equally into two groups. The experimental group received two injections of 3 mg/kg of U-74006F at a 2 hour interval. The control group received the same volumes of a citrate buffer. A 5 mm segment of the sciatic nerve was subjected to a crush load of 100 g for 2 hours. Motor function (sciatic functional index) was assessed to day 48 postoperatively. There was total paralysis of the crushed limb in all rats the first week after crushing. The experimental group had a statistically significant improvement in motor function compared with the controls on days 14, 21, 25, and 28 for the mature rats and on days 11 and 14 for the immature rats. The mature controls attained complete recovery on day 42 and had a significantly slower recovery rate than the immature controls, which had recovered fully by day 25. The recovery rates were almost similar among mature and immature groups pretreated with U-74006F, both of which had fully recovered motor function by day 28. The results indicate that pretreatment with U-74006F can significantly promote peripheral nerve function after low-load crush injury and that the age of the animal influences the rate of peripheral nerve recovery.

Calcitonin gene-related peptide and reperfusion injury.

Calcitonin gene-related peptide is a potent intrinsic vasodilator, can induce prostacyclin release, and may inhibit membrane lipid peroxidation. This study examines the effect of calcitonin gene-related peptide on vessel diameters, capillary perfusion, and contractile function of skeletal muscle after 4 or 5 hours of ischemia and during immediate reperfusion using the rat cremaster muscle model. Forty-two male rats were used; half of these received 0.2 ml of 10(-7) M calcitonin gene-related peptide after 0, 15, and 30 minutes of reperfusion, while the other half received normal saline as a control. By means of intravital videomicroscopy, the diameters of 10 vessels per muscle were measured prior to ischemia and during reperfusion. The fluorescein filling area was determined at 15, 30, and 60 minutes of reperfusion. After 1 hour of reperfusion, muscle function was examined in vitro by quantifying the contractile response to electric field stimulation of the muscles in an organ bath system. There was a significant increase in the diameter of the arterioles, but not the small arteries, at every time point from 10 to 60 minutes of reperfusion. The fluorescein filling area was increased in treated muscles at every time point. Contractile function was not significantly preserved. In light of the ability of calcitonin gene-related peptide to relieve vasospasm and improve capillary perfusion, it may be useful in reducing reperfusion injury in the future.

Studies of ischemia-reperfusion injury in skeletal muscle: efficacy of 21-aminosteroids on microcirculation and muscle contraction after an extended period of warm ischemia.

The present study was conducted to elucidate the effects of tirilazad mesylate (U-74006F), a potent inhibitor of lipid peroxidation, on vessel diameter, capillary perfusion, and contractile function of rat cremaster muscle during a 90-minute reperfusion period that followed 4 hours of warm ischemia. Two groups of 32 animals were treated with either 3 mg/kg U-74006F or the vehicle (citrate buffer) alone 30 minutes before ischemia, 90 minutes after ischemia, and immediately before reperfusion. With use of intravital videomicroscopy, the internal luminal diameters of preselected vessels were measured prior to ischemia and during reperfusion. The area that filled with fluorescein was determined at 15-minute intervals for as long as 90 minutes of reperfusion, and contractile function was examined in vitro in an organ bath at that point. In the U-74006F group, after 90 minutes of reperfusion the vessel diameters returned completely to baseline and the diameters of all three categories of vessels at every time point from 10 to 90 minutes of reperfusion had significantly more rapid recovery than the controls. Although some evidence of more rapid fluorescence was noted in the U-74006F group, the two groups did not differ significantly at any time period of reperfusion. In response to tetanic stimulation, the muscles treated with U-74006F had a significantly greater contractile force at all stimulation frequencies than the control muscles. Our findings indicate that pretreatment with U-74006F can effectively decrease the rise of vascular resistance and preserve the contractile function of skeletal muscle during early reperfusion, thereby attenuating ischemia-reperfusion injury.

Protective effect of hypothermia on contractile force in skeletal muscle.

The clinical success of limb replantation and tissue transfer is partly dependent on the duration of ischemia experienced by the amputated part. This study focused primarily on the damage that occurs during this ischemic period. An experimental system was implemented that allowed the observation of contractile function in totally isolated skeletal muscle after ischemia. Contractile function was selected as an indicator of ischemic damage because normal function is the ultimate goal of replantation. All experiments were performed on the rat extensor digitorum longus. The muscles were subjected to ischemic periods of 1.5, 3.0, and 5.0 hours and were stored in either a hypothermic (4 degrees C) or a room-temperature (23 degrees C) environment during the ischemic interval. After the ischemic period, all muscles were transferred to a tissue bath and were subjected to contractility testing, followed by fatigue testing. In both groups, muscle function decreased as the ischemic interval was increased. A significant difference in function between the normal control and the muscles of both ischemic groups implied that ischemic injury had occurred in the hypothermic and room-temperature muscles, even with the relatively short 1.5-hour ischemic interval. After each ischemic interval however, the hypothermic muscles produced significantly greater contractile force than the room-temperature muscles in both the contractility and the fatigue tests. After 1.5 hours of ischemia, the contractile force in the hypothermic group was about three times as great as that observed in the room-temperature group. These results indicated that muscle function after a period of totally isolated ischemia is protected by hypothermic preservation. They also support the advisability of storage of amputated parts and free muscle flaps in hypothermic environments before replantation even after relatively brief intervals of ischemia.

Motor functional and morphological findings following end-to-side neurorrhaphy in the rat model.

Nerve repair cannot always be achieved by the conventional end-to-end technique. This study evaluated the functional recovery of nerves repaired with end-to-side neurorrhaphy in a rat model. The right peroneal nerves of 80 female rats were transected and divided into four groups. In group A, the nerve ends were separated and remained unrepaired; in group B, the distal peroneal ends were directly sutured to the epineurium of the tibial nerves in end-to-side fashion; in group C, the distal ends were sutured through an epineurial window at the repair site in end-to-side fashion; and in group D, the nerve ends were reconnected by the traditional end-to-end technique. Evaluation included gait analysis by calculation of a peroneal functional index, measurement of contractile function of the extensor digitorum longus muscle, wet weight of the extensor digitorum longus, and histological examination. The findings of this study suggested the following: (a) end-to-side neurorrhaphy allows effective motor functional recovery, demonstrated by earlier improvement of the peroneal functional index, stronger muscle contractile function, greater muscle weight, and higher density of regenerated axons compared with unrepaired nerves; (b) removal of the epineurium of the donor nerve at the nerve coaptation site increases the effectiveness of end-to-side neurorrhaphy, but the epineurium appears to be a partial barrier to axonal regeneration; (c) removal of the epineurium does not affect the structure and function of the donor nerve; and (d) end-to-end repair achieved the best functional recovery among the four groups; therefore, end-to-side repair should be considered as a potential alternative only when no proximal nerve is available.

Intermittent pneumatic compression of legs increases microcirculation in distant skeletal muscle.

Intermittent pneumatic compression has been established as a method of clinically preventing deep vein thrombosis, but the mechanism has not been documented. This study observed the effects of intermittent pneumatic compression of legs on the microcirculation of distant skeletal muscle. The cremaster muscles of 80 male rats were exposed, a specially designed intermittent pneumatic-compression device was applied to both legs for 60 minutes, and the microcirculation of the muscles was assessed by measurement of the vessel diameter in three categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed significant vasodilation in arterial and venous vessels during the application of intermittent pneumatic compression, which disappeared after termination of the compression. The vasodilation reached a maximum 30 minutes after initiation of the compression and could be completely blocked by an inhibitor of nitric oxide synthase, NG-monomethyl-L-arginine (10 micromol/min). A 120-minute infusion of NG-monomethyl-L-arginine, beginning coincident with 60 minutes of intermittent pneumatic compression, resulted in a significant decrease in arterial diameter that remained at almost the same level after termination of the compression. The magnitude of the decrease in diameter in the group treated with intermittent pneumatic compression and NG-monomethyl-L-arginine was comparable with that in the group treated with NG-monomethyl-L-arginine alone. The results imply that the production of nitric oxide is involved in the positive influence of intermittent pneumatic compression on circulation. It is postulated that the rapid increase in venous velocity induced by intermittent pneumatic compression produces strong shear stress on the vascular endothelium, which stimulates an increased release of nitric oxide and thereby causes systemic vasodilation.

Interleukin-1 beta promotes functional recovery of crushed peripheral nerve.

This study was conducted to elucidate the role of the cytokine interleukin-1 beta on peripheral nerve recovery following crush injuries of two different magnitudes. Eighty-eight female rats were divided into four groups. A 5-mm segment of the right sciatic nerve was subjected to a 100-g crush load for 2 hours in the rats in Groups A1 and B1 or to a 15,000-g crush load for 10 minutes in the rats in Groups A2 and B2. The rats in Groups A1 and A2 received 10 microg/100 g body weight human recombinant interleukin-1 beta intraperitoneally 48, 24, and 1 hours before the nerve injury. The rats in Groups B1 and B2 were treated with an equal volume of normal saline solution with identical schedule guidelines. Walking-track tests (sciatic functional index) performed at intervals until 56 days after the crush and measurements of the contractile force of the extensor digitorum longus muscle made until 28 days were used to evaluate functional recovery of the nerve. During the second week after injury, the rats treated with interleukin-1 beta (A1) had an earlier recovery on the walking track than did those treated with saline solution (B1); this difference reached significance (p < 0.05) at day 11. Although Group A2 demonstrated a trend toward earlier recovery compared with Group B2, there was no significant difference between the two groups. After low or high-load crush injury, tetanic contractile forces were greater in the rats treated with human recombinant interleukin-1 beta than in those treated with saline solution. The results suggest that treatment with human recombinant interleukin-1 beta before crush injury can promote function in the peripheral nerve after the injury. However, the mechanisms that underlie the observed beneficial effects are not completely understood and only speculations can be made.

The functional recovery of peripheral nerves following defined acute crush injuries.

This study evaluates the effect of crushing load on functional recovery of the sciatic nerve. Male Sprague-Dawley rats were divided into five groups: sham operation, resected sciatic nerve, and 100 g (13 mm Hg/mm2), 500 g (50 mm Hg/mm2), and 15,000 g (1,000 mm Hg/mm2) of sciatic crush load (groups 1-5). In groups 3-5, a 5-mm segment of sciatic nerve was crushed for 10 min using a specially designed crushing device. Motor functional recovery was assessed from hind-limb walking tracks by calculating a sciatic functional index. There was no detectable functional deficit in the group receiving sham operations, while the resected sciatic nerve group exhibited complete dysfunction for the full duration of the experiment. All groups subjected to crush exhibited an initial deficit that gradually recovered to normal by day 14 (100-g crush), day 39 (500-g crush), and day 53 (15,000-g crush). Histological changes were also related to the initial crushing load and the length of the recovery period. Results indicate that the crushing device described is able to administer an adjustable, defined crush injury to the rat sciatic nerve, and that the functional deficit resulting from such an injury can be easily monitored with a sciatic functional index. The rate of recovery of crushed nerves was directly related to the initial load. All crushed nerves recovered in this experiment, even after the application of a 15,000-g load for 10 min.

Pediatric surgery on the Internet: is the truth out there?

BACKGROUND: The enormous amount of unmonitored medical information on the Internet prompted this investigation into the quality of pediatric surgery information on the Internet. METHODS: The Internet was searched for information on diaphragmatic hernia (CDH), abdominal wall defects (AWD), pediatric inguinal hernia (IH), and pectus excavatum (PE). Websites were characterized, classified, and evaluated for completeness, accuracy and bias toward or against the medical profession. RESULTS: A total of 141 websites were evaluated (N(CDH) = 37, N(AWD) = 49, N(IH) = 26, N(PE) = 29). A total of 59.6% targeted medical professionals, and 46.8% targeted the lay population. A total of 58.2% described symptoms and diagnosis. Etiology, pathology, surgery, postoperative course, and prognosis each were addressed by under 40%. A total of 58.2% were accountable for the information presented. A total of 93.1% were incomplete, 75.7% contained accurate information, and 97.7% were positive or neutral toward medical treatment. Among diagnoses, CDH had the highest percentage of websites owned by academic institutions. PE had the highest percentage of websites owned by lay people. PE websites also were the least accurate. CONCLUSIONS: Internet information on pediatric surgery varies significantly in quality. Lay people own most websites targeted at the lay audience, and the information may not reflect the opinions of most pediatric surgeons. Increasing use of the Internet by parents seeking medical information warrants an organized approach to ensure complete and accurate information online.

The effect of exposure time on microsurgical anastomoses of experimentally crushed arteries.

Replantation after crushing amputation has a relatively low success rate. Although the mechanism of trauma is a major factor in failure, the time lapse before vessel anastomosis may also be a contributing factor. In this study, we observed the influence of the interval between vessel injury and surgical treatment on thrombus formation and healing after controlled crushing. Seventy-five Sprague-Dawley rats were used. A segment of femoral artery was clamped to create warm ischemia for 8 hours and crushed with a 15 kg load for one hour. After the loading device was removed the crushed segments were transected and the vessel ends exposed to the adjacent tissues and blood for 0, 2, 4 and 6 hours (groups II-V, respectively) prior to being anastomosed with standard microsurgical technique. The vessel samples were harvested at days 1, 2 and 7, respectively, and evaluated by light microscopy and scanning electron microscopy (SEM). The patency rate of the anastomoses was 97.3% at harvest and reendothelialization was completed at day 7. Three anastomoses with 4 or 6 hours exposure showed thrombosis, or clotting. The results indicated that up to 6 hours exposure time did not have a significant influence on thrombus formation or the healing process of vessels under the controlled conditions of this study.

Vasodilator action of pentoxifylline on microcirculation of rat cremaster muscle.

Pentoxifylline improves microvascular blood flow in conditions of vascular insufficiency. The clinical benefits of pentoxifylline have been attributed to its effects on the cellular elements of whole blood, although a few studies suggest it may also be a vasodilator. The purpose of this study was to determine whether pentoxifylline has a vasodilator effect on the luminal diameter of small arteries preconstricted with norepinephrine and on resting small arteries in the rat cremaster muscle. Intravital videomicroscopy was used in order to observe directly the vasodilator capacity of topically applied pentoxifylline. The results reveal that pentoxifylline (100 microM and more) can significantly dilate small arteries preconstricted with norepinephrine. Pentoxifylline had no effect on the diameter of resting small arteries. These results suggest that vasodilation may play a role in the ability of pentoxifylline to improve arterial blood flow.