Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate: long-term biocompatibility in over 1,300 mesh fixations.

INTRODUCTION: In adult patients, most inguinal hernias are treated by implanting a prosthetic mesh. To prevent mesh dislocation and thus recurrence, different types of fixation have been proposed. In contrast to penetrating fixation known to cause acute chronic pain, adhesive fixation is becoming increasingly popular as it reduces markedly the risk of injury and chronic pain. Apart from the biological sealants (e.g., fibrin glue), surgical adhesives include a group of synthetic glues and genetically engineered protein glues. For example, cyanoacrylate is used in various medical and veterinary indications due to its fast action, excellent bonding strength and low price. OBJECTIVE: The main objective of this paper was to communicate positive results obtained using n-butyl-cyanoacrylate glue to fix prosthetic meshes in over 1,300 TAPP repairs of primary and recurrent inguinal hernias. The secondary objective was to highlight the rationale (e.g., safety) for using non-fibrin based glue in this type of procedure. METHOD: We present the in vitro and in vivo data necessary for the approval of n-butyl cyanoacrylate Histoacryl(®) glue. We use an equivalent glue, Glubran-2(®), to fix prosthetic meshes in 1,336 laparoscopic TAPP repairs. RESULTS: Standardized tests to detect sensitization, irritation, genotoxicity or systemic toxicity demonstrated the safety and biocompatibility of Histoacryl(®), which met all requirements, including those of ISO 10993. Histological long-term studies in rabbits yielded results comparable to routine suture fixations, with full integration of the mesh into the abdominal wall. The clinical results showed the following advantages: fast application of the glue, reduced postoperative pain, 0.0% infection rate, continuously low recurrence rate and shorter hospital stay. No adverse effects and no complaints were recorded. CONCLUSION: The experimental and clinical data demonstrate the safe use and the excellent cost-benefit ratio of n-butyl cyanoacrylate compared with other techniques of mesh fixation.

Synthesis and evaluation of fluorine-18 labelled compounds for imaging of bacterial infections with pet.

Syntheses of no carrier added (n.c.a.) 6-fluoro-1,4-dihydro-1-cyclopropyl-4-oxo-7-[4-[18F]fluoro-phenacyl-1-piperacinyl]-chinolincarboxylic acid ([18F]COPCA) and n.c.a. 4-[18F]fluoro-benzoyl-ubiquicidin 29-41 ([18F]UBI 29-41) are described. [18F]COPCA was synthesised within 120 min with a radiochemical yield of 9-12%. [18F]UBI 29-41 was synthesised within 150 min with a radiochemical yield of 15-20%. Both compounds had a specific activity of more than 35 GBq/micromol. The biological activity was verified by measuring its binding to Staphylococcus aureus bacteria. Specific binding was found for [18F]UBI 29-41 (12-17%), whereas no specific binding for [18F]COPCA was found.

Ultrastructural analysis of an infected collagen-coated vascular graft.

The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gram-negative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.

[Experimental investigations onto the biocompatibility of coated vascular grafts as a function of the primary disease in various patients groups]. / Experimentelle Untersuchungen zur Biokompatibilität beschichteter Gefässprothesen in Abhängigkeit von der Grundkrankheit verschiedener Patientenkollektive.

INTRODUCTION: This work presents initial experimental results obtained with co-incubation of human neutrophilic granulocytes from patients with various diseases (5 patients each group) and collagen- or silver-coated polyester grafts (25 patients each graft). METHODS: After two-hour co-cultivation of the graft with human granulocytes of different patients (normal controls; peripheral occlusive vascular disease; diabetes mellitus; carcinoma/chemotherapy; sepsis), the following parameters were determined by flow cytometry: CD11b, CD62L, fMLP, CXCR2. RESULTS: The change in the receptor expression was taken as a measure of responsiveness, with statistically significant differences seen within and between the groups. For the silver-coated graft, such differences were mainly noted for the fMLP receptor (p=0.01). For the two-hour incubation with collagen coating, the receptors CD62L and CXCR2 were indicative of differences between the various diseases (CD62L p=0.01; CXCR2 p=0.01). Comparison between the grafts revealed statistically significant differences for the CXCR2 and the fMLP receptors (CXCR2 p=0.00; fMLP p=0.03). CONCLUSIONS: The differences noted between the grafts and between the patients groups are suggestive of an altered responsiveness of the granulocytes to the grafts. This enables new aspects with respect to the genesis of accompanying clinical symptoms.

Prolonged application of closed in-line suction catheters increases microbial colonization of the lower respiratory tract and bacterial growth on catheter surface.

BACKGROUND: Microorganisms become attracted to polymer surfaces for a number of reasons including positive charge of biomaterial or concentration of nutrients on the biomaterial surface. Many bacteria additionally possess specific receptors for the interaction with extracellular host protein components that adhere on the biomaterial surface. Several authors suggest that application of closed in-line polypropylene suction catheters (CISC) in intubated patients for more than 24 h is safe and can reduce the costs associated with mechanical ventilation. Therefore, we evaluated the possible role of prolonged application of CISC to cause enhanced colonization of both the biomaterial and the lower respiratory tract. MATERIALS AND METHODS: The prospective, randomized study included 23 mechanically ventilated patients. The CISC tips, adjacent segments and tracheobronchial aspirates of each patient were examined for microbial growth. RESULTS: Application for 72 h significantly enhanced the microbial growth on the CISC tips and on the adjacent catheter segment. Usage for 3 days led to a significant increase in colonization in the lower respiratory tract. CONCLUSION: Normal saline instillation in conjunction with endotracheal suctioning may lead to a dispersion of microorganisms into the lower respiratory tract. More effective self-cleaning mechanisms are necessary to decontaminate the CISC surface after suctioning.

Tinea barbae caused by a zoophilic strain of Trichophyton interdigitale.

A deep absceding infection is reported of the inframandibular part of the face of a 22-year-old male student due to a zoophilic strain of Trichophyton interdigitale. The fungus was probably acquired from the cat of the patient. Initial therapy by a general practitioner was with topical glucocorticoids and oral antihistaminica. The patient developed a severe phlegmoneous inflammation of the bearded part of the face. Later, the patient was successfully treated by a combination of itraconazole and fluconazole. Identification of the species was confirmed by light and scanning microscopy as well as sequence analysis of the internal transcribed spacer region of the ribosomal DNA.

Assembly mechanism of the oligomeric streptolysin O pore: the early membrane lesion is lined by a free edge of the lipid membrane and is extended gradually during oligomerization.

Streptolysin O (SLO) is a bacterial exotoxin that binds to cell membranes containing cholesterol and then oligomerizes to form large pores. Along with rings, arc-shaped oligomers form on membranes. It has been suggested that each arc represents an incompletely assembled oligomer and constitutes a functional pore, faced on the opposite side by a free edge of the lipid membrane. We sought functional evidence in support of this idea by using an oligomerization-deficient, non-lytic mutant of SLO. This protein, which was created by chemical modification of a single mutant cysteine (T250C) with N-(iodoacetaminoethyl)-1-naphthylamine-5-sulfonic acid, formed hybrid oligomers with active SLO on membranes. However, incorporation of the modified T250C mutant inhibited subsequent oligomerization, so that the hybrid oligomers were reduced in size. These appeared as typical arc lesions in the electron microscope. They formed pores that permitted passage of NaCl and calcein but restricted permeation of large dextran molecules. The data indicate that the SLO pore is formed gradually during oligomerization, implying that pores lined by protein on one side and an edge of free lipid on the other may be created in the plasma membrane. Intentional manipulation of the pore size may extend the utility of SLO as a tool in cell biological experiments.

Simultaneous identification of campylobacters and prediction of quinolone resistance by comparative sequence analysis.

Comparative sequence analysis of a 30-bp segment in the quinolone resistance-determining region of campylobacters not only allows for the detection of base changes associated with resistance but also is a powerful tool for species identification based on silent mutations.

[Radiologic findings of lymphangiomyomatosis: a case report]. / Radiologische Befunde der Lymphangiomyomatose: Ein Fallbericht.

Lymphangiomyomatosis (LAM) is a rare disease that occurs predominantly in women of reproductive age. We report on a 17-year old female patient with chylothorax and smooth muscle proliferation of lymphatic vessels in the retrocrural, retroperitoneal and mesenteric space. Radiological procedures and especially computerized tomography proved particularly suitable for detecting abdominal changes and their localisation.

Effect of proteases and other treatments on the proliferative assembly of tight junction strands in the rat prostate tissue.

As already observed with the freeze-fracture technique by Kachar and Pinto da Silva (1981) incubation of excised rat ventral prostate tissue at 37 degrees C results in proliferation of tight junction strands over the lateral membranes of the epithelial cells, an effect not occurring after incubation at 4 degrees C. Our investigations have shown that a pretreatment with protease inhibitor Contrykal at 4 degrees C suppresses the proliferation of tight junction strands at 37 degrees C. On the other hand the added proteases trypsin and pronase induce the proliferation already at 4 degrees C. The effect was lowered by higher concentrations of pronase. Incubation with solutions of the non-ionic detergent Triton X-100 at 4 degrees C could also induce tight junction proliferation, whereas this effect was nearly absent after an incubation at 4 degrees C with a hyperosmotic solution of arabinose and with 50% acetone. No relation was found between proliferation of tight junction strands and cluster formation of intramembraneous particles. In conclusion of the results a small protein or a peptide resembling fusions proteins is assumed as trigger for formation of tight junction strands, acting by destabilization of the bilayer arrangement of membrane lipids.