Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates.

PURPOSE: There is a significant morbidity associated with abdominal wall reconstruction (AWR) with a need for overall improvement during the post-operative management. Scientific literature has proven the use of negative pressure therapy (NPT) in wound healing for orthopedic and cardiac surgery with limited data present on its role in AWR. The goal of this study was to examine whether primary wound events were different between patients who had primary closure with NPT versus patients who only had primary closure after AWR. METHODS: This retrospective study examined the rate of post-operative complications in all open-complex AWR that were done in a similar fashion between May 2008 and July 2011 at two large university teaching hospitals. Wound closure was stringent upon attending surgeon preference without randomization. RESULTS: There were a total of 61 patients who met inclusion criteria with an average age of 54 and 60 % were women. Thirty-two patients had primary closure and 29 patients had primary closure with NPT. The mean length of follow-up was 167 days for both groups. The type of wound closure had an effect on the rate of hernia recurrence and surgical site infections. The application of NPT leads to lower hernia recurrence rate of 25 versus 3% and the type of wound closure had a profound effect on the rate and type of SSI. CONCLUSIONS: The data presented in this study demonstrates a potential advantage for adjunctive NPT in patients undergoing AWR. There is an associated decreased incidence in the overall rate of SSI and hernia recurrence with the use of NPT in those patients undergoing AWR. These results show an advantage for adjunctive NPT.

Aspirin usage is associated with improved prosthetic infrainguinal bypass graft patency.

The American Heart Association recommends that, unless contraindicated, all patients undergoing surgical revascularization for critical limb ischemia should be placed postoperatively on antiplatelet therapy and remain on it indefinitely. The goal of this study was to evaluate if preoperative use of aspirin was associated with improved bypass grafting patency rates and limb salvage. We performed a four-year, retrospective review of one center's experience with open infra-inguinal bypass. We examined the effect pre- and postoperative usage of antiatherosclerotic agents (i.e. aspirin, statin, etc.) have on graft outcomes such as two-year secondary patency, stenosis and limb salvage via univariate Kaplan-Meir survival curve analysis and multiple regression analysis. Our cohort included 165 bypasses in individuals with multiple co-morbidities. The most frequent indication was critical limb ischemia (79%) and most bypasses crossed the knee (63%). Pre- and postoperative aspirin usage was associated with increased two-year secondary prosthetic graft patency over control (preoperative: 78% versus 44%, P < 0.002 and postoperative: 72% versus 50%, P < 0.01). Preoperative aspirin usage was associated with an improvement in the rate of amputation (odds ratio [OR] = 0.44 [95% CI 0.198-0.997]) and stenosis (OR = 0.45 [95% CI 0.217-0.956]). Medications commonly prescribed for atherosclerosis such as aspirin are associated with a significant patency benefit when administered pre- and postoperatively. In a population undergoing infrainguinal bypass with prosthetic graft for predominantly critical limb ischemia, medical optimization should include both pre- and postoperative antiatherosclerotic drug regimens.

Cytoplasmic dynein, the dynactin complex, and kinesin are interdependent and essential for fast axonal transport.

In axons, organelles move away from (anterograde) and toward (retrograde) the cell body along microtubules. Previous studies have provided compelling evidence that conventional kinesin is a major motor for anterograde fast axonal transport. It is reasonable to expect that cytoplasmic dynein is a fast retrograde motor, but relatively few tests of dynein function have been reported with neurons of intact organisms. In extruded axoplasm, antibody disruption of kinesin or the dynactin complex (a dynein activator) inhibits both retrograde and anterograde transport. We have tested the functions of the cytoplasmic dynein heavy chain (cDhc64C) and the p150(Glued) (Glued) component of the dynactin complex with the use of genetic techniques in Drosophila. cDhc64C and Glued mutations disrupt fast organelle transport in both directions. The mutant phenotypes, larval posterior paralysis and axonal swellings filled with retrograde and anterograde cargoes, were similar to those caused by kinesin mutations. Why do specific disruptions of unidirectional motor systems cause bidirectional defects? Direct protein interactions of kinesin with dynein heavy chain and p150(Glued) were not detected. However, strong dominant genetic interactions between kinesin, dynein, and dynactin complex mutations in axonal transport were observed. The genetic interactions between kinesin and either Glued or cDhc64C mutations were stronger than those between Glued and cDhc64C mutations themselves. The shared bidirectional disruption phenotypes and the dominant genetic interactions demonstrate that cytoplasmic dynein, the dynactin complex, and conventional kinesin are interdependent in fast axonal transport.

Fear and loathing in Florida--PPMC's, fee-splitting, and anti-kickback implications.

Many developments are occurring with respect to practice management agreements in Florida. These include the District Court of Appeal affirmance of the Bakarania decision, a bankruptcy court decision to the effect that the PhyMatrix Agreement evaluated in Bakarania constitutes illegal fee-splitting. There was also a new Board of Medicine decision permitting a percentage arrangement under a "management agreement." This article summarizes the recent developments in Florida, as well as some developments in other states, which are relevant for practice management agreements throughout the country.

Structuring group medical practices: labor and employment issues.

This article is the third in a series addressing the general representation factors involved in structuring group medical practices. In this article, selected labor and employment issues frequently encountered by counsel and managers of group medical practices are reviewed, and the impact of various legal restrictions--including the Americans with Disabilities Act--is discussed.

Ovarian abscess as an unusual infectious complication of laser vaporization of the cervix: a case report.

Laser vaporization of the cervix has been reported to have an extremely low incidence of infectious morbidity compared to other treatment modalities. This case report describes the development of an ovarian abscess following laser surgery of the cervix in a patient with no known risk factors for disease.

Structuring group medical practices: liability insurance, retirement plan considerations, and ownership transition.

This article is the fourth in a series addressing the structuring of group medical practice entities, shareholder relationships, and general representation factors. In this article, important considerations relating to liability insurance and pension plans, and both the phasing in and phasing out of shareholders are discussed.

Structuring group medical practices: tax planning aspects.

This article is the first in a series addressing the structuring of group medical practice entities, shareholder relationships, and general representation factors. In this article, a general background in federal tax planning is provided, including strategies for minimization of income tax payment and the potential problems that may be encountered when a group practice is not carefully structured.

Employee v. independent contractor: tax and other considerations for group practices.

The classification of physicians and associated health care professionals as employees or independent contractors in a group practice context is an important and frequently misunderstood issue, with many traps for the unwary. This article discusses the effect of classification on a group's responsibilities, the factors to consider in determining whether a health care professional should be classified as an employee of the group or an independent contractor, and the practical considerations involved in reclassification of an improperly classified worker.

Structuring group medical practices: shareholder and partnership agreements.

This article is the second in a series addressing the structuring of group medical entities, shareholder relationships, and general representation factors. In this article, a number of the legal and business considerations for entering into shareholder and partnership agreements are discussed, and various types of practice structures and recommended group practice agreement provisions are described.