Rapid screening for pesticides using automated online sample preparation with a high-resolution benchtop Orbitrap mass spectrometer.

For pesticide analysis in food products a common approach is to develop a fast multi-residue method that is capable of identifying and quantifying a large number of analytes in various matrices. This study demonstrates rapid screening and accurate mass confirmation of 116 pesticides in oranges and hazelnuts using an automated online sample preparation method with turbulent-flow chromatography technology coupled to a high-resolution benchtop Orbitrap™ mass spectrometer. The limits of quantification (LOQs) for the majority of analytes are well below the maximum residue limit (MRL) set by the European Union and the Japanese government. The recoveries were in the range of 70-120% for over 75% of analytes in both matrices. The present methodology is suitable for routine pesticides analysis in food safety laboratories.

The latissimus dorsi perforator-based fasciocutaneous flap.

The latissimus dorsi musculocutaneous flap has proven utility in the reconstruction of defects of the breast, chest wall, head and neck, and upper extremity. As a free flap, the latissimus dorsi has become a mainstay for the coverage of severe traumatic tibial/ fibular wounds. We describe a new and useful extension of the latissimus dorsi musculocutaneous unit that consists of a fasciocutaneous segment based on musculocutaneous perforators from the thoracodorsal artery. The vascular anatomy of the flap is described and illustrated with 6 fresh human cadaveric dissections. We also present 3 cases in which in vivo dissections of this flap were performed, 2 at the time of latissimus microvascular transfer and 1 approximately 5 days after microvascular transfer to salvage exposed fractured tibial bone successfully due to distal muscle loss. A pedicled or free latissimus dorsi musculocutaneous flap may be reliably extended and thereby rendered more versatile through the use of the perforator-based fasciocutaneous flap. Benefits and potential applications of the latissimus dorsi perforator-based fasciocutaneous flap are discussed.

Nonmelanotic malignant skin tumors of the hand.

Squamous cell and basal cell carcinomas, the common nonmelanotic skin tumors, are the most frequent malignancies to occur in the hand. In spite of a rising incidence, these tumors are only occasionally seen by the hand surgeon because of their overall rarity. Untreated lesions are locally destructive and may cause functional deficits and death by way of metastasis. Appropriate treatment consists of timely diagnosis, surgical excision with a margin of normal tissue, lymph node dissection for clinically positive nodes or in special circumstances, and careful follow-up for recurrence, metastasis or metachronous lesions. The aggressive nature of some of the rare nonmelanotic skin tumors that may occur in the hand underlines the importance of proper diagnosis of unknown hand tumors.

A prospective comparison of the status of the deep venous system after treatment with intracaval interruption versus anticoagulation.

The safety and efficacy of caval interruption has been well demonstrated. Likewise, comparisons of caval interruption and anticoagulation have shown similar rates of mean and long term clinical outcome. One concern that continues to be voiced is whether or not anticoagulation enhances venous recovery and function. The present study compares outcome by impedance plethysmography, Duplex scanning and clinical sequelae at six months after the acute illness and treatment with either caval interruption or anticoagulation. The results show no significant differences between the two treatment groups.

Use of triscaphe fusion in the treatment of Kienböck's disease.

The disability of Kienböck's disease is a manifestation of carpal collapse. Significant loading for any wrist must be taken on the radial side. Triscaphe arthrodesis provides a support mechanism for the collapsed lunate, a solid bone-cartilage mechanism for load transference to the radius, and maintenance of satisfactory motion.

The Greenfield filter as the primary means of therapy in venous thromboembolic disease.

During a five year period at Akron City Hospital, 165 Greenfield filters were placed in 165 patients. Of this group, 78 patients were available for long term analysis, and of these, 42 did not receive anticoagulation treatment for venous thromboembolic diseases, either acutely or on an outpatient basis. An analysis of the outcome for these 42 patients who had the Greenfield filter only as the primary mode of therapy for the disease included chart review and asking each person a standard set of questions. Leg swelling was the most common complaint, occurring in 33 per cent of patients. Venous stasis ulceration occurred in two patients and recurrent deep venous thrombosis occurred in one patient. When compared with a historical control group with venous thromboembolic disease that was treated with anticoagulation alone, the incidence of these sequelae in Greenfield-treated patients was not significantly different. Finally, in this review, the Greenfield filter is better than 95 per cent effective in the prevention of pulmonary embolism. This is no less effective than anticoagulation alone, the efficacy of which is 95 to 98 per cent. The placement of a Greenfield filter is a safe procedure that can usually be done after a local anesthetic was administered to the patient with a complication rate of less than 10 per cent. Unfortunately, major complications of anticoagulation (usually hemorrhage) are relatively common at a rate of 2 to 15 per cent, and occur more frequently in the older population. It is for reasons of safety of therapy and of an equal or better efficacy that the Greenfield filter is recommended in a broader range of clinical circumstances. In particular, it is concluded that the Greenfield filter should be used as a primary means of therapy in venous thromboembolic disease, particularly in those patients who are more than 65 years of age, when the risks of anticoagulation are most threatening.

Analysis of benefit of anticoagulation after placement of Kimray-Greenfield filter.

The Kimray-Greenfield venal caval filter is widely accepted as a means of preventing pulmonary embolism when medical anticoagulation has failed or complications have developed. When indicated, anticoagulants are usually resumed after placement of the filter. A retrospective study was performed comparing the thromboembolic and postphlebitic complications in patients who continued to receive anticoagulants after placement of the filter versus those who did not. Sixty-eight Kimray-Greenfield filters were placed in 68 patients (43 men and 25 women) during a four year period. After placement of the filter, 26 patients received anticoagulants and 42 did not. Three of those receiving anticoagulants and six of those who did not had significant swelling of the leg; two of those receiving anticoagulants and two of those who did not had a recurrent deep venous thrombosis. There were no instances of recurrent pulmonary embolism. There were no significant differences in the results of these two groups of patients. These results are consistent with those reported in the literature in that no correlation has been found between the use of anticoagulants after placement of the filter and recurrent thromboembolism or stasis sequelae. In view of the complications associated with medical anticoagulation, we recommend its discontinuation in all patients after placement of the Kimray-Greenfield filter.

Complications of the Heimlich maneuver.

This report describes a case of pneumomediastinum in a 3-year-old child following the incorrect performance of the Heimlich maneuver.

Angioscope-assisted occlusion of venous tributaries with prolamine in in situ femoropopliteal bypass: preliminary results of canine experiments.

Ten mongrel dogs underwent left lower extremity in situ femoropopliteal bypass with femoral vein. A 20 to 25 cm myocutaneous bridge was left between femoral and popliteal anastomoses. A 2.8 mm angioscope was introduced intraluminally to visualize venous tributaries (VT). A balloon occlusion catheter was placed alongside the angioscope and directed in each VT. Prolamine was injected into each VT to effect occlusion. Seven dogs were followed up for 1 week and three dogs for 1 month. A total of 34 VT (range one to five per dog) were available for attempted occlusion. Twenty-nine of 84 (85%) VT were able to be occluded based on comparison of pre-VT and post-VT occlusion angiograms. Poor visualization of VT or VT too small to admit the 5F catheter were reasons for failure. We conclude that (1) in the canine model studied angioscope-assisted occlusion of femoropopliteal during bypass is technically feasible, (2) this technical detail makes unnecessary medial thigh dissection for exposure of the vein graft, and (3) during short-term observation prolamine appeared to be a suitable occluding substance.

Experimental pharmacologic cerebroprotection.

In the first part of this experiment, the effects of pharmacotherapy on the neurologic consequences of transient global ischemia were examined in Wistar rats. The control and four experimental groups each contained six rats. In comparison to the control group receiving normal saline (NS) solution, in which no rats survived, all rats given naloxone (Nx) (23 mg/kg), superoxide dismutase (SOD) (10,000 U/kg), or allopurinol (APL) (35 mg/kg), 15 minutes before interruption of cerebral blood flow, survived the 20-minute period of global ischemia (p less than 0.01, p less than 0.01, p less than 0.01, respectively). No rat receiving deferoxamine (DEF) (20 mg/kg) survived the same ischemic period. In the second part of the experiment, the arachidonic acid (AA) content of brain samples was determined by gas chromatography and was used as an indicator of cerebral ischemia. Two control and four experimental groups consisted of six rats each. An ischemia control group received NS, whereas experimental groups were given Nx, SOD, APL, or DEF with the same previous dosage schedule. The animals were decapitated 15 minutes after drug infusion and cerebral ischemia was simulated by incubation of the heads in a 37 degrees C water bath for 60 minutes. AA content of ischemic brain treated with NS was markedly elevated (60.0 +/- 24.1 micrograms/gm of brain tissue), whereas in comparison the AA content of brain treated with Nx (5.1 +/- 3.0 micrograms/gm of brain tissue, p less than 0.05), SOD (3.5 +/- 2.7 micrograms/gm of brain tissue, p less than 0.05), or APL (2.9 +/- 1.5 micrograms/gm of brain tissue, p less than 0.05) all demonstrated much lower levels.(ABSTRACT TRUNCATED AT 250 WORDS)

A new inflatable T tube for completion cholangiography.

A new inflatable T tube has been designed and used in the performance of completion cholangiography following exploration of the common bile duct. The T tube has proved to be useful in avoiding the time delays and frustrations associated with suturing, removal and resuturing of T tubes during identification and removal of common bile duct stones. Furthermore, after clearance of the common bile duct of stones, the inflatable T tube may be left in the common bile duct for the purpose of drainage and postoperative cholangiograms. Finally, the T tube is of sufficient size (14F) to allow any possible postoperative roentgenographic extraction procedures to be done.