Associations between anxiolytic medications and ventral hernia repair.

PURPOSE: This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair. METHODS: A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program. RESULTS: Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions. CONCLUSIONS: Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.

Skin flap thickness in cochlear implant patients - a prospective study.

The thickness and quality of the skin overlying a cochlear implant is important for its integrity. It should be thick enough to protect the implant and prevent flap breakdown yet should not be so thick that it impedes the electronic signal or causes difficulty wearing the coil because of loss of the magnetic coupling. The principle of this study was to devise a method to assess the thickness of skin over a cochlear implant receiver stimulator package and prospectively measure this thickness during the first year following surgery. All patients studied were implanted with MED-EL COMBI 40+ implants. The first cohort consisted of 35 adults; the second 23 children. Various methods of measurement were assessed. In this study the principle of the Hall Effect electrode was used to measure the magnetic flux density of the magnet within the receiver stimulator package. Following standardization, results showed that skin thickness significantly thinned in the adult group before stabilizing. This was less obvious in children, probably due to the effect of the skin thickening as the child grows. Knowledge of skin thickness has implications relating to the functioning of an implant and avoiding potential flap related complications.

Fluid and porous media property effects on dense nonaqueous phase liquid migration and contaminant mass flux.

The effects of fluid and porous media properties on dense nonaqueous phase liquid (DNAPL) migration and associated contaminant mass flux generation were evaluated. Relationships between DNAPL mass and solute mass flux were generated by measuring steady-state mass flux following stepwise injection of perchloroethylene (PCE) into flow chambers packed with homogeneous porous media. The effects of fluid properties including density and interfacial tension (IFT), and media properties including grain size and wettability were evaluated by varying the density contrast and interfacial tension properties between PCE and water, and by varying the porous media mean grain diameter and wettability characteristics. Contaminant mass flux was found to increase as grain size decreased, suggesting enhanced lateral and vertical DNAPL spreading with higher fluid entry pressure. Mass flux showed a slight increase as the DNAPL approached neutral buoyancy, likely due to enhanced vertical spreading above the injection point. DNAPL spatial distribution and contaminant mass flux were only minimally affected by IFT and by intermediate-level wettability changes, but were dramatically affected by wettability reversal. The relationship between DNAPL loading and flux generation became more linear as grain size decreased and density contrast between fluids decreased. These results imply that capillary flow characteristics of the porous media and fluid properties will control mass flux generation from source zones.

Cochlear implants: 100 pediatric case conversions from the body worn to the nucleus esprit 22 ear level speech processor.

OBJECTIVE: To assess performance of Nucleus 22 mini system pediatric users converted from the Spectra 22 body-worn to the ESPrit 22 ear-level speech processor using aided thresholds and speech discrimination measures before and after the conversion. STUDY DESIGN: Spectra 22 body-worn speech processor users were chosen using preselection criteria (stable map, ability to report on the quality of the signal, no device problems). The subjects underwent tuning, map conversion, fitting of the ESPrit 22, and aided soundfield threshold and speech discrimination testing. SUBJECTS: The first 100 consecutive conversions are analyzed in this study. Fifty children (50%) were female, and 50 (50%) were male. The average age at implantation was 4.6 years (median 4.3 years, range 1.7 to 11 years). The average age of fitting the ear level speech processor was 11.1 years (median 11 years, range 6.2 to 18.2 years). SETTING: Tertiary referral pediatric cochlear implant center in the United Kingdom. RESULTS: Of the 100 fittings attempted, all Spectra 22 maps could to be converted for use in the ESPrit 22. Of these 100 fittings, 44 were straightforward with no adjustment to map parameters being required, and 56 needed rate reductions and other map adjustments to achieve the conversion. The difference of the mean thresholds before and after the conversion did not exceed 2 dB across the frequencies studied (0.5-4 kHz). In 95% of the cases, the differences were less than 9 dB(A). With regard to speech discrimination testing, the mean threshold before the conversion was 53.4 dB and after the conversion 52.7 dB. Of the 100 conversions, only five children stopped using the ESPrit 22 despite fitting being achieved. CONCLUSION: Conversion from the Spectra 22 body worn to the ESPrit 22 ear level speech processor was found to be feasible in all the 100 cases studied. Only a minority (5%) of children chose not to use the ear level speech processor suggesting that children and parents were satisfied from the conversion.

Early experience with the cochlear ESPrit ear-level speech processor in children.

The ESPrit ear-level speech processor has recently become available in the United Kingdom for use with the Nucleus CI24M multichannel cochlear implant. We report on the use of this ear-level processor with 6 children, ages 8 to 15 years. In this study, all patients were initially fitted with the SPrint body-worn processor, this being a prerequisite for programming the ESPrit. Five of the children were fitted successfully with the ESPrit and are using their devices consistently. The results show that patient experience with the ESPrit has been favorable, although there have been some device and programming difficulties. Aided threshold measures show that the ESPrit processor performs at least as well as the SPrint processor, with a trend toward improved aided thresholds for the ESPrit processor compared with the SPrint processor. Further study of the functional benefit of both of these devices may confirm these potential gains. The ESPrit device currently has a disadvantage for children in that it does not support FM radio hearing aid use. Finally, caution is advised in the fitting of the ESPrit in very young children or inexperienced listeners, because of difficulties in monitoring device function.

Studies on seeds. IV. Lipid composition of bean cotyledon vesicles.

Lipid content has been determined for two types of lipid-rich vesicles isolated from bush bean cotyledon at 24 hr of germination. The larger, nonassociating vesicles are four to six times richer in triglyceride than the smaller vesicles which associate strongly among themselves, as well as with smooth membranes in the cell. The larger vesicles contain about 640 micromoles of phospholipid per gram of protein, while the smaller vesicles have only one-half to two-thirds as much phospholipid per gram of protein. The ratio of individual phospholipids in both kinds of vesicles is close to 20% phosphatidylethanolamine, 60% phosphatidylcholine, and 20% phosphatidylinositol. The fatty acid composition of all phospholipids is similar, and quite different from that of triglyceride, which contains twice as much linolenic acid and less than one-fourth as much palmitic acid. Pea cotyledon has quantitatively the same lipid content as bean cotyledon.

Studies on seeds. 3. Isolation and structure of lipid-containing vesicles.

Two structurally distinct lipid vesicles are present in pea and bean cotyledons during the first few days of germination. Both were isolated by sucrose density gradient centrifugation without significant morphological changes. Lipid vesicles of one type were elongated into a sausage-like or flattened-saccular shape, and were interassociated into sheets which were usually one vesicle thick. These sheets remained intact during homogenization and centrifugation, because some of the lipid vesicles in the sheet were interconnected through their bounding membranes, and because there seemed to be a bonding substance between adjacent vesicles. These vesicles were called "composite" lipid vesicles to distinguish them from the more usual, or "simple," lipid vesicles of other plant and animal tissues. Lipid vesicles of the other type were usually larger than the composite lipid vesicles and were always spherical in form. These vesicles remained single and did not interassociate into sheets. They were probably equivalent to the simple lipid vesicles of other tissues.

Studies on seeds. II. Origin and degradation of lipid vesicles in pea and bean cotyledons.

At least two kinds of lipid vesicles are present in pea and bean cotyledons which can be recognized at seed maturity on the basis of whether they do or do not interassociate into lipid vesicle sheets. Those that do interassociate into sheets are also characterized by (a) their association with plastids or plasma membranes during dormancy, and (b) the unique transformation into flattened saccules that they undergo during the first few days of seed germination. These interassociated (or composite) lipid vesicles have been found in only a few seeds and may be restricted to certain classes of plants and/or certain states of cellular development. Lipid vesicle-to-saccule transformation is predominantly confined to the germinating seed. However, some lipid vesicle-derived saccules are already present in some cells even before the seed reaches maturity. These partially transformed vesicles and saccules remain unchanged over dormancy, and then resume their transformation when the seed is germinated. This suggests that some stages of seed germination are already underway before the seed reaches maturity and are only resumed at seed germination. The lipid vesicles that do not interassociate into sheets (i.e., the simple lipid vesicles) are present in all tissues at all states of cellular development. These vesicles do not undergo any conspicuous structural changes during development.

Studies on seeds. I. Fixation of seeds.

Several fixation procedures were studied to determine those most suitable for preservation of seeds during late stages of development and early stages of germination. These are the periods when the tissues are partially dehydrated and are most difficult to fix for electron microscopy. It was found that a prefixation with a mixture of glutaraldehyde, reconstituted formaldehyde (i.e. paraformaldehyde), and acrolein, followed by a postfixation in OsO(4) or KMnO(4), gives very acceptable images. The results also indicate that glutaraldehyde is necessary for preservation of cell shape, paraformaldehyde for stabilization of reserve proteins, and acrolein for rapid penetration of tissues. Phosphate, cacodylate, and collidine are all acceptable buffers, although collidine gives the most consistent results.

Studies on seeds: v. Microbodies, glyoxysomes, and ricinosomes of castor bean endosperm.

Glyoxysomes, a form of microbody, are present in castor bean endosperm during the first 8 days of seed germination. They have a "typical" microbody form and are shown histochemically to contain catalase. The catalase label is distributed throughout the microbody and is not an exclusive feature of the crystalline or amorphous core.Castor bean endosperm contain a second cytosome, only slightly larger than the glyoxysomes, which is bound by a rough-surfaced membrane and which does not label for catalase. We have not observed these cytosomes in other tissues, suggesting that they may have a specific cellular function characteristic of castor bean endosperm.