Intrathoracic negative pressure therapy for pleural empyema using an open-pore drainage film.

BACKGROUND: We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on a case series. MATERIALS AND METHODS: ITNPT represents a further development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements were a thin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, -75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings. RESULTS: In total, 31 patients with stage II and III pleural empyema underwent ITNPT, which was administered during the primary procedure (n = 17) or at revision (n = 14). Treatment duration was a mean of 10 days (2-18 days) with a mean change interval of 4 days (2-6 days). Intrathoracic negative pressure dressings were applied a mean of 3.5 (1-6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has a minimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand. The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is a possible adjunct to surgery. The surgical dressings must be changed repeatedly. The method is suitable for the treatment of complex stage II and III pleural empyemas. CONCLUSION: The OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.

Tips and tricks for endoscopic negative pressure therapy.

Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.

[Tips and tricks for endoscopic negative pressure therapy. German version]. / Tipps und Tricks in der endoskopischen Unterdrucktherapie.

Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.

[First report of urinary endoscopic vacuum therapy : For large bladder defect after abdomino-perineal excision of the rectum. Video paper. German version]. / Erstbeschreibung einer endoskopischen Vakuumtherapie der ableitenden Harnwege : Bei großem Harnblasendefekt nach abdomino-perinealer Rektumexstirpation. Videobeitrag.

PURPOSE: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation and which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdominoperineal resection of the rectum with urine flowing out of the perineal wound. MATERIAL AND METHOD: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters has been developed and is constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy by intravesical endoscopy. RESULTS: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. After 18 days of treatment with the uEVT the bladder defect was healed. After therapy and removal of the catheters the patient had normal micturition. CONCLUSION: A novel small-bore OFD has been developed for EVT. The OFD technique now allows endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

First report of urinary endoscopic vacuum therapy : For large bladder defect after abdomino-perineal excision of the rectum. Video paper.

PURPOSE: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for the treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdomino-perineal resection of the rectum with urine flowing out of the perineal wound. MATERIALS AND METHODS: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters was developed and constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via a transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy via intravesical endoscopy. RESULTS: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. The bladder defect healed after 18 days of treatment with uEVT. After therapy and removal of the catheters, the patient had normal micturition. CONCLUSION: A novel small-bore OFD was developed for EVT. The OFD technique allows for endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

[Complex vacuum therapy of an abdominal abscess from gastric perforation : case report of innovative operative endoscopic management]. / Komplexe Vakuumtherapie einer abszedierenden Magenperforation : Fallbericht eines innovativen operativ endoskopischen Managements.

BACKGROUND: The simultaneous use of abdominal and endoscopic vacuum therapy in a case of an abdominal abscess caused by gastric perforation is demonstrated and innovative operative endoscopic management is described. CASE REPORT: A computed tomography scan performed on a 67-year-old female patient showed a large abscess of the upper abdominal cavity where laparoscopic fundoplication had been performed 6 months previously. Endoscopy showed a transmural perforation of the dorsal wall of the stomach. The gastric perforation was closed and drained using intracavitary endoscopic vacuum therapy. Open pore polyurethane foam drainage was inserted through the defect into the extraluminal cavity for 3 days. A second period of therapy followed using intraluminal therapy with total drainage of the stomach, simultaneous enteral nutrition via a jejunal tube and a vacuum pressure of - 125 mmHg was applied with an electronic vacuum device. The abdominal abscess was drained via laparotomy and intra-abdominal vacuum therapy was performed with an open pore double-layered film using a vacuum pressure of - 75 mmHg. The perforation defect was not treated by operative means. Abdominal vacuum therapy ended 3 days postoperatively and the abdominal wall was closed by suture. Endoscopic vacuum therapy of the gastric perforation was terminated after 7 days and primary wound healing could then be achieved. CONCLUSION: Use of endoscopic and abdominal vacuum therapy as well as new open pore material is an innovative option for operative management.

Investigation of phthalate release from tracheal tubes.

Phthalates are chemicals used extensively in the manufacture of plastics for their desirable physical characteristics. In addition to enhancing the performance of plastics, phthalates have a number of undesirable effects, principally endocrine disruptor effects, that may have adverse effects on reproductive development and functioning. As a result, they have been banned from the manufacture of children's toys. Despite this, they continue to be used in the manufacture of medical devices, including anaesthetic equipment. This study aimed to assess phthalate release from five brands of tracheal tube. Using gas chromatography-mass spectrometry, we analysed phthalate concentrations from samples of ultra pure water in which tracheal tubes had been submerged. Phthalate concentration increased from 6.7 to 149 µg.l(-1) over a period of 4.8 days. Phthalate release from anaesthetic equipment has not previously been documented over short time periods and raises the possibility of iatrogenic endocrine disruption with routine anaesthesia.

Cysteine residues in the C-terminal tail of the human BK(Ca)alpha subunit are important for channel sensitivity to carbon monoxide.

In the presence of oxygen (O(2)), carbon monoxide (CO) is synthesised from heme by endogenous hemeoxygenases, and is a powerful activator of BK(Ca) channels. This transduction pathway has been proposed to contribute to cellular O(2) sensing in rat carotid body. In the present study we have explored the role that four cysteine residues (C820, C911, C995 and C1028), located in the vicinity of the "calcium bowl" of C-terminal of human BK(Ca)-alphasubunit, have on channel CO sensitivity. Mutant BK(Ca)-alphasubunits were generated by site-directed mutagenesis (single, double and triple cysteine residue substitutions with glycine residues) and were transiently transfected into HEK 293 cells before subsequent analysis in inside-out membrane patches. Potassium cyanide (KCN) completely abolished activation of wild type BK(Ca) channels by the CO donor, tricarbonyldichlororuthenium (II) dimer, at 100microM. In the absence of KCN the CO donor increased wild-type channel activity in a concentration-dependent manner, with an EC(50) of ca. 50microM. Single cysteine point mutations of residues C820, C995 and C1028 affected neither channel characteristics nor CO EC(50) values. In contrast, the CO sensitivity of the C911G mutation was significantly decreased (EC(50) ca. 100 M). Furthermore, all double and triple mutants which contained the C911G substitution exhibited reduced CO sensitivity, whilst those which did not contain this mutation displayed essentially unaltered CO EC(50) values. These data highlight that a single cysteine residue is crucial to the activation of BK(Ca) by CO. We suggest that CO may bind to this channel subunit in a manner similar to the transition metal-dependent co-ordination which is characteristic of several enzymes, such as CO dehydrogenase.

Hydrogen sulfide inhibits human BK(Ca) channels.

Hydrogen sulfide (H(2)S) is produced endogenously in many types of mammalian cells. Evidence is now accumulating to suggest that H(2)S is an endogenous signalling molecule, with a variety of molecular targets, including ion channels. Here, we describe the effects of H(2)S on the large conductance, calcium-sensitive potassium channel (BK(Ca)). This channel contributes to carotid body glomus cell excitability and oxygen-sensitivity. The experiments were performed on HEK 293 cells, stably expressing the human BK(Ca) channel alpha subunit, using patch-clamp in the inside-out configuration. The H(2)S donor, NaSH (100microM-10 mM), inhibited BK(Ca) channels in a concentration-dependent manner with an IC(50) of ca. 670microM. In contrast to the known effects of CO donors, the H(2)S donor maximally decreased the open state probability by over 50% and shifted the half activation voltage by more than +16mV. In addition, although 1 mM KCN completely suppressed CO-evoked channel activation, it was without effect on the H(2)S-induced channel inhibition, suggesting that the effects of CO and H(2)S were non-competitive. RT-PCR showed that mRNA for both of the H(2)S-producing enzymes, cystathionine-beta-synthase and cystathionine-gamma-lyase, were expressed in HEK 293 cells and in rat carotid body. Furthermore, immunohistochemistry was able to localise cystathionine-gamma-lyase to glomus cells, indicating that the carotid body has the endogenous capacity to produce H(2)S. In conclusion, we have shown that H(2)S and CO have opposing effects on BK(Ca)channels, suggesting that these gases have separate modes of action and that they modulate carotid body activity by binding at different motifs in the BK(Ca)alphasubunit.

Peptones from diverse sources: pivotal determinants of bacterial growth dynamics.

AIMS: In view of the major problems encountered by microbiologists in obtaining reproducible data on growth dynamics in complex media, we studied the effects of different peptones made from different biological sources and produced by numerous manufacturers. METHODS AND RESULTS: Peptones (including casein, gelatin, meat, soy and yeast) were assessed as a constituent of the pre-enrichment broth buffered peptone water (BPW). Generation times (g) and yields of Salmonella serovar Typhimurium were significantly affected by the type of peptone employed with yeast peptones generating yields of 7.04 x 10(9) CFU ml(-1) and gelatin peptones producing 0.81 x 10(9) CFU ml(-1). Medium sterilization was also found to have significant effects (P = 0.000) upon subsequent bacterial growth. Filter sterilization of BPW media produced lower generation times compared with those obtained after sterilization by autoclaving. Finally, it was observed that some peptones which produced good growth when inoculated with healthy organisms, showed relatively poor growth when inocula were sublethally injured by heating. CONCLUSIONS: Variation in peptone as a constituent of BPW has a significant effect on growth and enumeration of bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: Increased consideration with respect to culture media may significantly improve bacterial growth and experimental reproducibility.

Effect of triclosan on the development of bacterial biofilms by urinary tract pathogens on urinary catheters.

OBJECTIVES: To examine (i) the effect of triclosan on the formation of catheter biofilms by urinary tract pathogens and (ii) the diffusion of triclosan through the retention balloons of urinary catheters. METHODS: Models of the catheterized bladder were infected with eight different urinary tract pathogens and the effect of triclosan on biofilm formation was assessed by determining the numbers of viable cells colonizing the catheters and by scanning electron microscopy. HPLC was used to determine the triclosan concentration in urine draining from models that had been fitted with triclosan-inflated silicone catheters. RESULTS: When catheters were inflated with triclosan (10 g/L) the formation of catheter biofilm by Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Proteus mirabilis was prevented. The numbers of Enterococcus faecalis and Providencia stuartii cells colonizing catheters were also significantly reduced (P<0.05). Serratia marcescens, Morganella morganii and Pseudomonas aeruginosa, however, were able to produce extensive catheter biofilms in the presence of triclosan. Only P. mirabilis produced alkaline urine and encrusted the catheters. Concentrations of 0.02-0.16 mg/L of the biocide were detected in urine draining from the model over the 48 h experimental period. CONCLUSIONS: Triclosan diffused through silicone catheter balloons and produced urinary concentrations that prevented catheter encrustation by P. mirabilis and biofilm formation by several other common pathogens of the catheterized urinary tract. It had little effect on urease-producing P. aeruginosa, S. marcescens or M. morganii but these species did not produce alkaline urine or crystalline biofilms.

The spawning pheromone cysteine-glutathione disulfide ('nereithione') arouses a multicomponent nuptial behavior and electrophysiological activity in Nereis succinea males.

The pheromone nereithione (cysteine-glutathione disulfide), which is released by swimming females of the polychaete Nereis succinea to activate spawning behavior of N. succinea males, has recently been identified and synthesized. Nereithione activates sperm release at less than 10(-6) M, one to two orders of magnitude less than oxidized glutathione or any other glutathione derivative tested. The glutathione fragment gamma-glu-cys inhibited sperm release. Nereithione aroused three components of the male nuptial behavior: circling, sperm release, and accelerated swimming. Electrophysiological activity elicited by nereithione near the sperm release site consisted of initial large spikes, cyclic bursting activity, and small spikes lasting up to a minute and was dose dependent, rapid, reversible, and repeatable. This preparation is an excellent model system for characterizing the receptors and functions of a marine pheromone.

Older women's health: clinical care in the postmenopausal years. A roundtable discussion part 2.

Prevention of late-life disability is an important goal in managing the health care of older women. Hormone replacement therapy and regular exercise can protect against osteoporosis and heart disease. Dietary measures can control weight and prevent diabetes. Adequate calcium and vitamin D intake help protect bones from fractures. Mammography and Pap smears are proven screens for early cancer detection. Depression is not unusual in older women, but it is often masked by physical symptoms. Physicians can help women at risk for caregiver burnout by providing referrals and information on community resources. Use of other health professionals, as well as patient education videos and printed materials, can help physicians provide comprehensive care within the time limits of office practice.