Ovine Forestomach Matrix in the Surgical Management of Complex Volumetric Soft Tissue Defects: A Retrospective Pilot Case Series.

Background: Volumetric soft tissue loss is an urgent surgical issue and can frequently lead to suboptimal outcomes for patients due to significant soft tissue loss, compromised vital structures, and contamination. Ovine forestomach matrix (OFM) has demonstrated clinical success in the surgical management of soft tissue defects, especially in contaminated fields, and provides an effective option for immediate coverage of exposed vital structures before definitive closure. Methods: This retrospective pilot case series (n = 13 defects) evaluated the clinical effectiveness of OFM (graft and/or particulate formats) in the surgical management of contaminated volumetric soft tissue defects. Patients presented with significant soft tissue loss, often with exposed viscera, tendon, bone, or muscle, and were treated with OFM as part of their inpatient surgical management. All patients had at least 1 significant comorbidity with the potential to complicate their healing trajectory. The primary study endpoint was time to 100% granulation tissue coverage (days), and the secondary endpoint was any device-related postoperative complications. Results: A total of 13 volumetric soft tissue defects were evaluated in 10 patients who underwent surgical reconstruction. Mean defect age was 3.5 ± 5.6 weeks, and mean area was 217.3 ± 77.9 cm2. Most defects had exposed structures (85%), and all defects were Centers for Disease Control and Prevention grade 2 or higher. Mean time to 100% granulation tissue formation was 23.4 ± 9.2 days, with a median product application of 1.0. Staged reconstruction was used in 7 of 13 defects, with the remainder (6 of 13) left to heal via secondary intention using standard wound care protocols. There were no major postoperative infections or adverse events (mean follow-up, 7.4 ± 2.4 weeks.). Conclusions: This retrospective pilot case series builds on a growing body of evidence that OFM can be utilized to facilitate the formation of functional, well-vascularized soft tissue in large contaminated volumetric soft tissue defects.

Unusual case of subarachnoid haemorrhage in patient with Fabry's disease: case report and literature review.

Fabry's disease is a rare, X linked recessive disease affecting 1 in 40 000 persons. The symptoms result from a lack of or a non-functioning enzyme α galactosidase, which leads to globotriaosylceramide accumulation in the walls of blood vessels. Mortality is generally from cardiac or renal complications and death from subarachnoid haemorrhage is distinctly rare. The authors report a man with Fabry's disease who died after subarachnoid haemorrhage from a progressively enlarging fusiform basilar aneurysm.

Chronic sodium-retaining action of insulin in diabetic dogs.

Insulin-mediated sodium retention is implicated as a mechanism for hypertension in metabolic syndrome and type II diabetes. However, there is no direct experimental evidence for a sustained antinatriuretic effect of insulin outside of rodents, and all previous studies in dogs have been negative. This study used a novel approach to test for a chronic sodium-retaining action of insulin in dogs, by testing the hypothesis that natriuresis in type I diabetes is dependent on the decrease in insulin, rather than being due solely to osmotic actions of hyperglycemia. Dogs were chronically instrumented and housed in metabolic cages. Fasting blood glucose in alloxan-treated dogs was maintained at ~65 mg/dl by continuous intravenous insulin infusion. Then, a 6-day diabetic period was induced by either 1) decreasing the insulin infusion to induce type I diabetes (D; blood glucose = 449 ± 40 mg/dl) or 2) clamping the insulin infusion and infusing glucose continuously (DG; blood glucose = 470 ± 56 mg/dl). Control urinary sodium excretion (UnaV) averaged 70 ± 5 (D) and 69 ± 5 (DG) meq/day and increased on day 1 in both groups. UnaV remained elevated in the D group (115 ± 15 meq/day days 2-6), but it returned to control in the DG group (69 ± 11 meq/day days 2-6) and was accompanied by decreased lithium clearance. Thus, insulin had a sustained antinatriuretic action that was triggered by increased glucose, and it was powerful enough to completely block the natriuresis caused by hyperglycemia. These data may reveal an unrecognized physiologic function of insulin as a protector against hyperglycemia-induced salt wasting in diabetes.