The formulation of an enhanced recovery programme for patients undergoing laryngectomy.

OBJECTIVE: Enhanced recovery programmes have been widely adopted in other surgical disciplines but are not commonplace in head and neck surgery. The authors of this study created a pathway for post-operative laryngectomy patients. METHOD: A multidisciplinary working group reviewed the literature and agreed standards of care. A retrospective audit was conducted to measure current practice against our new pathway; after programme implementation our performance was reaudited in two prospective cycles, with an education programme and review after the first prospective cycle. RESULTS: Statistically significant improvement in performance was realised in catheter and surgical drain removal, opiate analgesia use, mobilisation, and timeliness of swallow assessment. The rate of hospital acquired pneumonia reduced from 23.1 to 9.5 per cent and length of stay reduced by a median of 5.2 days to 14.8 days (non-significant). CONCLUSION: The programme improved consistency of patient care across most areas that were measured. Improving patient stoma training needs to be prioritised.

Scimitar syndrome with bicuspid aortic valve. A case report of cross-sectional non- invasive imaging allowing a complete anatomical and functional assessment.

Scimitar syndrome is a variant of partial anomalous pulmonary venous return with an aberrant vein, the Scimitar vein, draining the right lung to the inferior vena cava instead of the left atrium, resulting in a left-to-right shunt. The classic frontal radiographic finding, designated as "the scimitar sign", is of a scimitar (a Turkish sword) shaped density along the right cardiac border. The diagnosis can be made by echocardiography, and cardiac catheterisation remains the gold standard to assess the left-to-right shunt. However, the place of multimodal cardiac imaging by computed tomography and magnetic resonance imaging is increasing. We report the case of a 26 year-old man presenting with chest pain during a brief panic attack, in whom scimitar syndrome was associated with a bicuspid aortic valve, a clinical association rarely reported in the literature. CT and MRI cardiac imaging was as accurate as echocardiography and hemodynamics, particularly for shunt quantification.

Current concepts on cardiovascular stent devices.

Coronary artery stents used for the treatment of patients with coronary artery disease develop the practice of interventional cardiology after they were first introduced in the mid-1980s. Since then, with dozens of companies involved in the development of new and innovative anti-restenotic drugs, polymeric coatings and stent platforms has made significant progress in this area. Today, the challenge is the conception of the "ideal" coronary stent designed to respond to the patient health difficulty. In this context, the literature in the field is quite dynamic and successful. The aim of this article is to provide a systematic review on the interdisciplinary field literature of the evolution of these medical devices by describing the current status, importance and different types of stents used in clinical practice. After the presentation of cardiovascular problems associated to stenting therapy, the authors describe the bare metal stents, the generations of drug eluting stents and the future in progress directions regarding: the stents based on biodegradable/bioresorbable polymers, polymer-free metal platforms, fully biodegradable scaffolds, as well as drug delivery mediated by stent-targeted magnetic nanoparticles.

A randomised comparison between an inexpensive, general-purpose headlight and a purpose-built surgical headlight on users' visual acuity and colour vision.

To determine if there are any differences in near visual acuity and colour vision between an inexpensive general-purpose light emitting diode (LED) headlight and a purpose-built surgical LED headlight. A prospective study was conducted sequentially comparing near visual acuity and colour vision, the headlights being tested in random order, in a testing room with a constant minimal amount of background light. The participants were NHS employee volunteers, with self-declared normal (or corrected) vision, working in occupations requiring full literacy. For visual acuity, outcome was measured by recording the smallest font legible when using each headlight when the subject read a near visual acuity test card. For colour vision, the outcome was passing or failing the Ishihara test. There was no statistically significant difference between the general-purpose and the purpose-built headlights in users' near visual acuity or colour vision.

Prognosis elements in surgical treatment of complicated umbilical hernia in patients with liver cirrhosis.

INTRODUCTION: The surgical treatment of umbilical hernia in cirrhosis patients raises special management challenges. The attitude upon the repair of these hernias varies from expectancy or elective treatment in early stages of the disease to the surgical treatment only if complications occur. MATERIAL AND METHOD: We have assessed 22 consecutive cases of cirrhosis patients treated for complicated umbilical hernia in the Surgical Department of "Sf. Pantelimon" Emergency Hospital in Bucharest between January 2008 and December 2012. The patients' stratification was done in stages of liver disease based upon Child-Pugh classification. Complications that required emergency repair were the following: strangulation, incarceration and hernia rupture. The postoperative complications were ordered in five grades of severity based upon Clavien classification. RESULTS: The severity of the complications was higher in advanced stages of liver cirrhosis, Child B and C. There were 5 deaths representing 22,7%, four of them in patients with Child C disease stage. CONCLUSION: The incidence of morbidity and mortality after umbilical hernia repair in emergencies increases in advanced stages of liver cirrhosis. It is advisable to prevent complications occurrence and perform surgical repair of umbilical hernia in elective condition.

An in vitro release study of indomethacin from nanoparticles based on methyl methacrylate/glycidyl methacrylate copolymers.

Indomethacin was coupled onto some macromolecular nanostructures based on methyl methacrylate copolymers with glycidyl methacrylate and tested as a model drug. The polymeric matrices were synthesized by radical emulsion copolymerization with and without the presence of a continuous external magnetic field of 1500 Gs intensity. Mathematical analysis of the release data was performed using Higuchi, Peppas-Korsmeyer equations. NIR chemical imaging (NIR-CI) was used to provide information about the spatial distribution of the components in the studied nanostructures. This opportunity was used to visualize the spatial distribution of bioactive substances (indomethacin) into the polymeric matrix, as well as to evaluate the degree of chemical and/or physical heterogeneity of the bioactive samples. The release rate dependence on the synthesis conditions as well as on the chemical compositions of the tested polymeric systems, it was also evidenced.

Sol gel method performed for biomedical products implementation.

Sol-gel technology is an impressive and instructive innovation in science that necessitates a multidisciplinary approach for its important applications in the practice. An important peculiarity of the sol gel technology is the possibility to control the mechanism and kinetics of the chemical reactions, thus monitoring the final structure (particle size, porosity, thin layer thickness) of the materials. The low processing temperature combined with the intrinsic bio-compatibility and environmental friendliness of the implied components makes it an ideal method applied in different biomedical purposes: the synthesis of porous matrices for entrapping of organic and inorganic compounds, sensor molecules, enzymes and many other biological molecules, selective coatings for optical and electrochemical biosensors, stationary phases for chromatography, immunoadsorbent and solid-phase extraction materials, controlled release agents, solid-phase biosynthesis, and unique matrices for biophysical studies. It is therefore the scope of this review to provide a few insights of the recent progresses made in sol-gel-based materials for biomedical applications.

Nanocomposite indium tin oxide thin films: formation induced by a large oxygen deficiency and properties.

We report on the formation and properties of nanocomposite indium tin oxide thin films which are grown by pulsed-electron beam deposition under a low oxygen pressure leading to the formation of highly non-stoichiometric indium tin oxide films. For growth at room temperature these films are amorphous and insulating, while at higher temperatures, the oxygen deficiency leads to a disproportionation reaction with the formation of metallic clusters (indium or indium tin clusters) embedded in a stoichiometric crystalline indium tin oxide. This matrix is well crystallized and even epitaxial for growth on c-cut sapphire single crystal substrates. The presence of the metallic clusters induces specific transport properties, i.e. a metallic conductivity at room temperature followed by a superconducting transition at low temperature (about 6 K). Moreover, the solid-liquid and liquid-solid phase transitions in the metallic clusters can be clearly seen from the resistivity curves as a function of temperature (in the room temperature to 450 K range), through specific changes in resistivity and the appearance of a hysteresis cycle.

Alpha- and beta-secretase activity as a function of age and beta-amyloid in Down syndrome and normal brain.

Aged individuals with Down syndrome (DS) develop Alzheimer's disease (AD) neuropathology by the age of 40 years. The purpose of the current study was to measure age-associated changes in APP processing in 36 individuals with DS (5 months-69 years) and in 26 controls (5 months-100 years). Alpha-secretase significantly decreased with age in DS, particularly in cases over the age of 40 years and was stable in controls. The levels of C-terminal fragments of APP reflecting alpha-secretase processing (CTF-alpha) decreased with age in both groups. In both groups, there was significant increase in beta-secretase activity with age. CTF-beta remained constant with age in controls suggesting compensatory increases in turnover/clearance mechanisms. In DS, young individuals had the lowest CTF-beta levels that may reflect rapid conversion of beta-amyloid (Abeta) to soluble pools or efficient CTF-beta clearance mechanisms. Treatments to slow or prevent AD in the general population targeting secretase activity may be more efficacious in adults with DS if combined with approaches that enhance Abeta degradation and clearance.

Evaluation of the stimulatory capacity of procaine on Na transport through frog skin.

Procaine has different effects on various ionic conductive pathways through the frog skin. We investigated the season and temperature dependence of the stimulation by mucosal procaine, of the Na-conductive pathway. For this stimulation, we found higher half-maximal saturation constants (KNa) in winter animals (6.38 +/- 0.8 mmol/l), than in summer ones (4.03 +/- 0.7 mmol/l). Summer frogs kept for 2 weeks at 4 degrees C, reacted like winter frogs (6.24 +/- 0.8 mmol/l). However, the maximal sodium currents (INa max) did not depend on temperature adaptation. Procaine-induced increased of KNa is associated with an increase of INa. The effects of procaine associated with BIG (benzoylimidazole-2-guanidine) were non-additive, while with vasopressin they were additive. A biphasic, dose-dependent response was recorded after procaine application to the inner surface. Vasopressin counteracted the serosal procaine-induced inhibition of the Na-transport.