Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair.

PURPOSE: Composite mesh prostheses incorporate properties of multiple materials for use in open ventral hernia repair (OVHR). This study examines clinical outcomes in patients who underwent OVHR with a polypropylene/expanded polytetrafluoroethylene (ePTFE) composite graft containing a novel polydioxanone (PDO) absorbable ring to facilitate placement and graft positioning. METHODS: Data were prospectively collected on consecutive patients undergoing OVHR using a synthetic composite mesh. Seven centers enrolled patients during the study period. All patients underwent a standardized surgical procedure consisting of OVHR with sublay intraperitoneal placement of mesh. Mesh fixation was accomplished with peripheral tacks and transfascial sutures. RESULTS: One hundred and nineteen patients underwent OVHR with the composite mesh. Average age was 55.8 years; there were 71 (59.7 %) females and 48 (40.3 %) males with mean BMI of 33.5 ± 7.1 kg/m(2). One hundred and two (85.7 %) patients presented with primary ventral hernias. Mean defect size was 13.6 cm(2), and mean mesh size was 113.6 cm(2). Most patients (67 %) were discharged the day of surgery. Twelve patients (10.1 %) experienced complications in the perioperative time period primarily consisting of seroma (4.2 %) and ileus (1.7 %). Two patients required reoperation and mesh removal in the early postoperative period for infection and herniorrhaphy site pain, respectively. There was a decline in pain and movement limitation scores between baseline and 1-year follow-up. Six-month (n = 109) and twelve-month (n = 99) follow-up revealed no hernia recurrences (95 % CI 0-3 %, and 0-4 %, respectively). CONCLUSIONS: The use of this second-generation composite mesh was associated with no hernia recurrences and a low complication rate after open ventral hernia repair.

Simultaneous management of ipsilateral gonarthritis and ununited tibial stress fracture: combined total knee arthroplasty and internal fixation.

Nonunion of a proximal tibial stress fracture is rare and can be difficult to manage, especially if associated with ipsilateral gonarthritis. Three patients with nonunion of a proximal tibial stress fracture adjacent to an arthritic knee joint were managed by performing simultaneous total knee arthroplasty and internal fixation of the fracture site. The technique involved performing a total knee arthroplasty with angular correction at the site of the extra-articular and intra-articular deformity, bone grafting of the nonunion site, and stabilization of the fracture with a long uncemented intramedullary stemmed tibial component and a unicortical plate. Fibular ostectomy was required during the index surgery in 2 cases to achieve the desired angular correction. In all 3 patients, healing of the nonunion site and limb realignment was achieved. There were no complications or infections associated with the surgery. All patients progressed to full weight bearing at 3 months and had clinical and radiographic union of the nonunion site at 6 months.

In vivo and in vitro effect of ozone and formaldehyde on human nasal mucociliary transport system.

The effect of ozone and formaldehyde on the nasal mucociliary transport system after short-term exposure was comparatively evaluated in human by using in vivo and in vitro test systems. Concentrations of ozone used were 10, 100, 500 and 1000 micrograms/m3 of ozone and of formaldehyde 100, 500 and 5000 micrograms/m3. The in vivo effect of ozone was monitored by measuring the saccharin transport time before and two hours after exposure to ozone. The in vitro effect of ozone and formaldehyde was evaluated by quantifying the ciliary beat frequency (CBF) of isolated respiratory epithelial cells before and after one, two, and three hours of exposure. Control experiments were performed using synthetic air. Ozone had no effect on the human nasal mucociliary transport system under the conditions tested here. Neither in vivo nor in vitro any significant changes of saccharin transport time nor CBF were measured. In contrast, formaldehyde significantly reduced (67.1%) CBF at the highest dosis (2 hours, 5000 micrograms/m3). These results will be discussed according to the environmental impact of ozone and formaldehyde in air pollutants and compared to sulphur dioxide and nitric oxide, which were tested under similar conditions, and to results revealed from animal experiments.

A modified direct lateral approach for primary and revision total hip arthroplasty. A prospective analysis of 453 cases.

A prospective analysis of 453 consecutive primary and revision total hip arthroplasties (THAs) were reviewed. The modified direct lateral approach was used in 306 of 319 (96%) primary THAs and 115 of 134 (86%) revision cases for a total of 421 of 453 (93%) procedures. There were three dislocations in the revision group of patients. All three patients had at least two previous arthroplasties prior to their index surgery and at the time of surgery were noted to have very poor tissue quality, making the repair difficult. There were no postoperative dislocations in the primary THA group, with an overall dislocation rate of 0.7%. The incidence of postoperative limp in the primary THA group was 18%. The overall incidence, including revision surgery, was 27%. The presence of a persistent limp after initial rehabilitation was dependent on the number of previous surgeries, leg-length discrepancy greater than 2.7 cm, revision THA requiring a proximal femoral allograft, and preexisting deformities. Limp was therefore believed not to be related to the use of the modified direct lateral approach.

Segmental transport after unreamed intramedullary nailing. Preliminary report of a "Monorail" system.

The Ilizarov method of segmental bone transport has been shown to be an alternative to more conventional treatments of posttraumatic bony defects. After extensive clinical experience with the unreamed tibial nail in open fractures up to Grade IIIb, a new monorail fixation system for callus distraction and segmental bone transport was devised. This Monorail system is composed of an unreamed intramedullary (IM) nail and a unilateral AO distraction device. The new fixation method and the preliminary clinical experience are reported here. Four patients who previously sustained Grades II-IIIb open tibial fractures had an average bony defect of 9 cm. Two patients had previous bony infections. All patients had had serial debridements and myocutaneous flaps were required in three patients. An unreamed IM nail was inserted, and the transport device was applied. After an osteotomy, segmental transport was carried out until docking was achieved. The external fixator was removed after interlocking of the transported segment. The mean duration of external fixation was 17.9 days/cm and the mean period until roentgenographic consolidation of the distraction and nonunion site was 41.2 days/cm. There were two pin-tract infections but no IM infections. One nail broke after osseous consolidation of the regenerate at the distal interlocking site and required exchange. The goal of transport was achieved in all cases without angular or rotational deformity or length discrepancy. There were no neurovascular injuries.

Experience with the Orthofix device for limb lengthening.

The DeBastiani technique is recommended for lengthenings in children and adolescents. The Orthofix device may also be employed for immediate correction of angular and rotational deformities followed by lengthening in pediatric patients. Caution is advised when employing this method in other patients. Lengthening should be avoided through areas of previously damaged or osteoporotic bone. This is especially true in adult patients who have exhibited less than optimal osteogenesis even in the best conditions. Bilevel lengthening or early internal fixation should be considered in adult patients when using this method. Bone formation attained with the DeBastiani method in achondroplastic patients has been encouraging. However, lengthening in achondroplastic patients is rarely indicated owing to the limitation of absolute height gained and the relative complication rate. DeBastiani's callotasis method of lengthening utilizing the Orthofix device offers several advantages when compared with the Wagner and Ilizarov methods. The Orthofix device is a versatile lengthener that offers the best overall biomechanical stability and the capability for dynamization. The application is relatively simple and requires less operative time than that of the circular frames. There is less risk of neurovascular injury with the use of half-pins, and radiographic evaluation is simplified. Bone formation with the Orthofix equals that attained with the Ilizarov device and has significantly diminished the need for bone grafting and internal fixation frequently required using the Wagner method. In children and adolescents, the total number of anesthetics required is reduced using the DeBastiani method owing to a lower complication rate and office pin removal.

Catfish stings to the hand.

Catfish skin toxin and the venom from their dorsal and pectoral spines may cause a menacing sting. Although these stings are often innocuous, severe tissue necrosis may occur. The hand is the most common site of catfish stings. Two cases of catfish stings of the hand are presented. In one of these cases gangrene of the long and small fingers developed requiring amputation. Symptoms are caused by hemolytic, dermonecrotic, edema-promoting, vasospastic, and lethal components of the venom and skin toxins. Local or regional anesthesia is administered to relieve pain and vasospasm. Empiric intravenous antibiotics are administered to cover common aquatic organisms. Wounds with progressive worsening of erythema, swelling, pain, or cyanosis should be irrigated to wash out residual toxin, and debrided of any retained spine fragments or necrotic tissue.

Vein patch angioplasty for brachial arterial occlusion after cardiac catheterization.

Brachial artery thrombosis may be encountered after cardiac catheterization using the Sones technique. Differing opinions have been reported regarding the optimal management of this injury. During the past five years, 20 patients have had surgical repair of the brachial artery after trauma from cardiac catheterization. Satisfactory results have been obtained in the majority of cases with local arterial thrombectomy and debridement with vein patch angioplasty. Arterial resection or vein bypass was needed in unusual cases. This injury should be repaired acutely to avoid long-term functional disability in all patients who present with a pulseless upper extremity.

Extrapunitive Attributions.

What holds true in areas covered by attribution theory might also hold true in a noncognitive domain in which external factors are also distinguished from internal factors. Thus, extrapunitive attribution might depend on high distinctiveness and high consensus. In this factorial experiment in which 315 South African students were divided into four treatment groups, it depended on low distinctiveness but not on consensus. Here, however, distinctiveness was made an attribute of the actor. Being a group member diffused responsibility and facilitated extrapunitive attribution.

Tinted lenses and dyslexics--a controlled study. SPELD (S.A.) Tinted Lenses Study Group.

We have carried out a randomised prospective controlled trial of the effect of tinted lenses on the reading ability of 24 non-asthmatic dyslexic children aged between nine and twelve years. Reading ability was assessed using the Neale Analysis of Reading. After one school term, there was no significant difference in the change in reading age between treatment and control groups. After two school terms (approximately six months), only 11 children (44%) were still wearing the glasses. Of 381 suitable subjects for entry into the study, 208 were excluded because of a diagnosis of asthma (to avoid effects of medication on cerebral function). As a result, we may have excluded subjects who would have responded favourably to tinted lenses.

Production and ecological significance of yeast cell wall-degrading enzymes from oerskovia.

Motile actinomycetes capable of degrading walls of viable yeast cells were isolated from soil and identified as Oerskovia xanthineolytica. A lytic assay based on susceptibility of enzyme-treated cells to osmotic shock was developed, and 10 of 15 strains of O. xanthineolytica, Oerskovia turbata, and nonmotile Oerskovia- like organisms from other collections were found to possess yeast lytic activities. All lytic strains produced laminaranase and alpha-mannanase, but the amounts, determined by reducing group assays, were not proportional to the observed lytic activities. The Oerskovia isolates demonstrated chemotactic, predatory activity against various yeast strains and killed yeasts in mixed cultures. Of 15 carbon sources tested for production of lytic enzyme, purified yeast cell walls elicited the highest activity. Glucose repressed enzyme production and caused cells to remain in the microfilamentous and motile rod stages of the Oerskovia cell cycle. Crude lytic activity was optimal at pH 5.6 to 7.0 and inactivated by heating for 6 min at 50 degrees C. Partial purification by isoelectric focusing showed that all lytic activity was associated with four beta-(1-->3)-glucanases. The absence of protein disulfide reductase, N-acetyl-beta-d-hexosaminidase, and phosphomannanase in crude preparations indicated that the principal enzyme responsible for yeast wall lysis was a beta-(1-->3)-glucanase that produced relatively little reducing sugar from yeast glucan.

Yeast spheroplasts formed by cell wall-degrading enzymes from Oerskovia sp.

Oerskovia sp. produces inducible extracellular enzymes which degrade the walls of various yeasts. Yeast spheroplasts are formed from both log- and stationary-phase cells.