Fiber technology for reliable repair of skeletal muscle.

Conventional soft-tissue reclosure methods-sutures and staples-require substantial organized-collagen content. Some tissues lack extensive intrinsic collagenous content. Wound disruption consequences range from newly closed abdominal wounds bursting open, to post-cesarean wombs splitting at delivery, to heart valves loosening. Although sutures do approach the theoretical limit of normal force transfer-cross-sectional area times compressive strength, a different paradigm-shear force transfer across the far greater surface attainable by fine fibers parallel to the potential disruptive force could exceed that theoretical limit. Capacity is now the product of frictional coefficient, existing tissue pressure, and contact area. Using a device comprising bundles of poly(ethylene terephthalate) fibers through tissue, we previously coupled muscles to devices and bones. Here we tested an analogous device for reclosing fascia-stripped abdominal wall muscles. In 28 rabbits, fascia-deprived rectus abdominus muscles were reclosed, using the experimental device or conventional sutures. Testing muscles from the 21 three-week survivors, (with closure devices retained-the usual clinical practice) demonstrated experimental failure strength which exceeded that of controls by 58%. Histologically, solid tissue elements did in-grow between fibers for an extensive tissue-prosthetic interface. Both histology and mechanical performance suggest the fiber technology presented herein surpasses conventional sutures in closure of collagen-deficient tissues.

Addiction medicine.

Diagnoses for substance dependence and abuse have been modified in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. The Food and Drug Administration approved marketing of naltrexone as a medication for alcohol-dependence treatment.

Addiction medicine.

There are indications of a rise in the percentage of eighth graders who have tried marijuana and inhalants. A low level of response to alcohol challenge may be a marker for future alcoholism. Anabolic-androgenic steroid abuse is being discussed more often in the context of substance abuse.

The acquired immune deficiency syndrome (AIDS) and suicidal behavior in alcohol-dependent homosexual men.

Three alcohol-dependent homosexual men with suicidal ideation and behavior consciously attempted to contract the acquired immune deficiency syndrome (AIDS) as a means of committing suicide. The authors briefly examine the interrelationship among alcoholism and substance abuse, homosexuality, suicidal behavior, and AIDS; implications for the substance abuse treatment setting are noted. Early diagnosis and treatment of depression and substance abuse in homosexual men or parenteral drug abusers may prevent the spread of AIDS and reduce hidden suicidal potential.

Histamine stimulation of digestive enzyme secretion by in vitro rabbit pancreas.

Histamine (10(-3) M) was found to stimulate pancreatic enzyme secretion from in vitro isolated rabbit pancreas preparations. Histamine produced a peak and then a sustained stimulated secretory rate. Secretion of amylase, lipase, trypsinogen, chymotrypsinogen, and total radio active protein were all found to be stimulated. Although fluid output was slightly increased by histamine, enzyme concentrations in secretion were elevated. This, along with the observed sustained release rate, rules out washout effects. Histamine produced a significant response at 10(-5) M with ED50 being about 3 x 10(-5) M and maximal responses produced by 10(-3) M. Histamine stimulation can be blocked with mepyramine (10(-4) or 10(-5) M) or mepyramine in combination with cimetidine. The observed behavior of the pancreas suggests a similarity with pepsinogen secretion in the stomach.

Comparative study of diarrhea associated with clindamycin and ampicillin therapy.

The incidence of diarrhea associated with clindamycin and ampicillin was studied prospectively among 606 adult inpatients during a 12-month period. Clindamycin was administered to 288 patients of whom 145 received clindamycin in combination with ampicillin. A comparable group of 318 patients received ampicillin alone. Underlying diseases, diets and medications other than antibiotics studied were implicated in the etiology of diarrhea in 25--40% of patients. The incidence of diarrhea due to ampicillin and clindamycin was 3.8 and 4.2%, respectively (P greater than 0.05). The incidence of diarrhea in patients who received both drugs was 9.0% (P less than 0.05). Diarrhea which developed after completion of antibiotic therapy was two-to-three fold longer in duration than that which occurred during drug administration. This finding underscores the necessity to follow patients closely for at least four to six weeks after receiving such medications.

Placenta accreta, increta, and percreta. A survey of 40 cases.

Forty patients with placenta accreta, increta, or percreta are presented. Clinical features revealed an average age of 29.5 years and an average parity of 3-2-1. Twenty-five had no antepartum complications. Nine were admitted with silent hemorrhage, of which 6 had a total placenta previa and 1 a low-lying previa. Postpartum hemorrhage occurred in 39% with an associated perinatal mortality of 25% and 1 maternal death. Histopathologic evaluations revealed the predominant factor to be an absent decidua. Etiologic in decidual deficiency was a previous cesarean section (12 patients). Therapy consisted of total abdominal hysterectomy in 38 patients.

The infectious diarrheas.

In most cases, the physical examination will not adequately differentiate between the various infectious entities, though a careful history may be helpful. A stool guaiac test can help differentiate between invasive organisms and toxigenic organisms. All the organisms described usually cause a self-limited illness, and therapy is directed toward the control of symptoms.