Induction of tracheal stenosis in a rabbit model-endoscopic versus open technique.

OBJECTIVE: To evaluate and compare open versus endoscopic methods of inducing tracheal stenosis in the New Zealand white rabbit model. STUDY DESIGN: Prospective randomized control, pilot study. SUBJECTS AND METHODS: Fifteen New Zealand white rabbits were used in the study. Induction of tracheal stenosis was performed through an open incision in 6 rabbits, an endoscopic approach was utilized in 8 rabbits, and 1 rabbit served as the control. The open approach was performed by brushing the tracheal mucosa 10 times through an anterior tracheotomy with a nylon brush. The endoscopic method was achieved using a rigid bronchoscope and at a measured distance below the cricoid cartilage, passing the same nylon brush four times in each of four quadrants. Repeat endoscopies for evaluation of stenosis progression were performed at 2 and 3 weeks on all rabbits. RESULTS: In the open group, we observed no stenosis with one mortality as a result of gastroenteritis due to antibiotic use. In the endoscopic group, all animals achieved some degree of stenosis by 14 days, with a mean airway narrowing of 43%. The two deaths in the endoscopic group occurred in the immediate postoperative period secondary to laryngeal edema. The endoscopic procedure was 5 minutes in duration. CONCLUSION: The endoscopic technique is an effective method of achieving circumferential tracheal stenosis in the rabbit model. Advantages include simple instrumentation, an endoscopic approach, potential for decreased costs, and more reliable results.

Nutritional status and socioeconomic change among Toba and Wichí populations of the Argentinean Chaco.

The prevalence of overweight and obesity is growing at an accelerated pace in disadvantaged populations. Indigenous populations all over the world, whose lifestyle is changing rapidly and drastically, seem to be particularly prone to show an increased prevalence of overweight and its co-morbidities among adults. The aim of this study was to evaluate the association between socioeconomic and nutritional statuses in adults of two indigenous populations of the Argentine Gran Chaco: the Toba and Wichí of the province of Formosa. Originally hunter-gatherers, they are now more settled and engage in temporary wage labor and local political positions. A total of 541 adults (>20 years old) participated in the study. Almost 50% of the adult Toba and 34% of the adult Wichí were overweight and 10% of adults in both populations were obese. Socioeconomic status was positively associated with body mass index in both populations. Furthermore, political connectedness with the non-indigenous sector, as in the case of community leaders, was highly correlated with obesity. Differences within and between groups can be explained by biocultural factors that include gender, diet (foraged vs store-bought), lifestyle (sedentary vs more active), and history of political power. Our study highlights the interactions among social, cultural, and political economic variables, such as political hierarchies within the group or degree of social connectedness with community leaders. By making these variables an integral part of our analysis and interpretation, we hope to improve our understanding of the situation of indigenous populations in transition.

Wound infection rates in elective plastic surgery for HIV-positive patients.

BACKGROUND: Human immunodeficiency virus (HIV)-positive patients suffer from a unique set of aesthetic challenges, frequently requiring plastic and reconstructive surgical intervention. This study was designed to evaluate the overall wound infection rates for elective surgery in this patient population, focusing specifically on differences between transdermal (both open and minimally invasive) and transoral procedures. METHODS: Charts were reviewed for all patients with an International Classification of Diseases, Ninth Edition code of V08 (asymptomatic HIV infection, CD4 count >200 cells/microl) who underwent surgery by the senior author (S.P.D.) at this tertiary care hospital between January 1, 2000, and October 1, 2007 (39 patients, 98 procedures). Indication for surgery, type of procedure performed, wound infection rates, length of follow-up, status of HIV infection, and HIV treatment status were all documented. Data were collected according to internal review board protocol. Infection rates were compared between study groups and with the existing surgical literature. RESULTS: Statistical analysis revealed no significant difference in wound infection rate between open and minimally invasive procedures when a transdermal approach is used (10 percent and 0 percent, respectively; p > 0.05). However, there was a significantly increased infection rate in transoral surgery when compared with these two groups (71 percent; p < 0.001). CONCLUSIONS: These findings indicate that there is a greatly increased risk of wound infections for HIV-positive patients undergoing transoral surgery when compared with transdermal surgery and historical norms.