Outcomes following stoma formation in patients with spinal cord injury.

AIM: The formation of a diverting stoma of the bowel in patients with spinal cord injury (SCI) is a useful option in managing problems associated with prolonged bowel care, pressure ulcers and neurogenic bowel. This descriptive study examines surgical outcomes and the effect on an individual's health-related quality of life (HrQoL) in this complex group of patients. METHODS: Data were retrospectively collected in all patients with SCI who underwent a diverting stoma at Prince of Wales Hospital, Sydney, between January 2013 and January 2018 via a self-report questionnaire developed specifically for the study. RESULTS: Forty-three individuals were identified of whom 26 responded. 73% were men with a mean age of 45 years. The reasons for stoma formation included sacral pressure ulcer (50%), prolonged bowel care (35%), faecal incontinence (19%), constipation (8%), autonomic dysreflexia (8%), carer difficulties (8%) and haemorrhoids (4%). 76% of patients reported an improvement in HrQoL with 72% scoring their satisfaction with a stoma ≥ 8/10. CONCLUSION: While stoma formation is often seen as a treatment of last resort, our study has shown that it is an effective management option for a number of conditions post-SCI. It can improve HrQoL and has a high level of satisfaction amongst patients. Ideally, patients who could potentially benefit from a stoma should be identified early and receive appropriate education and counselling to help facilitate informed and timely decision-making and reduce adverse bowel related impact on quality of life and adjustment post-SCI.

[Acute abdominal trauma]. / Traumatisches akutes Abdomen.

BACKGROUND: In patients with multiple trauma, abdominal involvement is a particularly relevant injury pattern. Depending on the intensity and manner of injury, heterogeneous but often typical organ manifestations result. Knowledge of these injury patterns is essential for targeted diagnostics and treatment. OBJECTIVE: This review provides a presentation of typical forms of abdominal injury with appropriate radiological techniques and where applicable treatment. MATERIAL AND METHODS: Experiences and case examples from a supraregional trauma center are presented and discussed with the results of a Medline literature search and relevant parts of the german S3 guidelines on polytrauma. RESULTS: Traumatic abdominal injuries are subdivided into blunt and penetrating injuries. Among these groups, blunt trauma with splenic injury being most frequent followed by liver and kidney involvement. In penetrating abdominal injuries hollow visceral organs are most frequently affected. For diagnosis, ultrasound and with escalating injury severity, multidetector computed tomography (MDCT) are the most important methods. For years there has been an ongoing trend towards conservative management and interventional hemorrhage control. This is driven by improvements in imaging that enable a more precise classification and indications for subsequent treatment. CONCLUSION: Progress in radiology has led to an increasingly more important role for radiology in the management of traumatic abdominal injury. Therefore, it is crucial for the radiologist to gain interdisciplinary knowledge of the relevant trauma mechanisms and injury patterns of the severely injured patient in order to provide a treatment process that provides the optimal outcome.

Ergonomic port placement in laparoscopic colorectal surgery.

AIM: Port placement in laparoscopic surgery has important ergonomic implications. A manipulation angle (MA) of 60° has been shown to maximize task efficiency. We calculated the MA used during various stages of both right hemicolectomy (RH) and high anterior resection (AR). METHOD: We compared two methods of port placement for each operation. RH-PP1 included ports in the left iliac fossa and left upper quadrant. RH-PP2 included ports suprapubically and in the left iliac fossa. We calculated the MA of each of these methods in mobilizing both the caecum and hepatic flexure. AR-PP1 included ports in the right iliac fossa and right upper quadrant. AR-PP2 included ports suprapubically and in the right iliac fossa. We calculated the MA of each of these methods in mobilizing the splenic flexure, descending-sigmoid junction and the recto-sigmoid junction. RESULTS: For RH-PP1, the mean MA for mobilizing the caecum and hepatic flexure was 38° and 52°, respectively. For RH-PP2, the mean MA for mobilising the caecum and hepatic flexure was 58° and 44°, respectively. For AR-PP1, the mean MA for mobilizing the splenic flexure, the descending-sigmoid junction and the recto-sigmoid junction was 77°, 41° and 18°, respectively. For AR-PP2, the mean MA for mobilizing the splenic flexure, the descending-sigmoid junction and the recto-sigmoid junction was 40°, 56° and 34°, respectively. CONCLUSION: There are no two port placements that will allow for an ideal MA at every stage of mobilization for either right- or left-sided resection.

Cebus paraguayanus and Cebus nigritus (Primates, Platyrrhini): a comparative genomic hybridization analysis.

Primate genomes show a great karyological variability while the DNA content variation is scarce. The biggest genome size occurs in Cercophitecus cephus (Catarrhini, Cercophitecidae) with 5.26 pg whereas the smallest one is described for Callicebus torquatus (Platyrrhini, Callithricidae) with 2.26 pg. Over the last 20 years different authors have been studying the Platyrrhini genomes on a chromosomal level. Among them, Cebus (Cebidae) being considered the most ancestral and conserved karyotype in relation to human karyotype has been extensively studied. Cebus genome sizes range from 3.40 to 3.98 pg. The species that inhabit Argentina, where they reach the most southern natural distribution, Cebus paraguayanus (CPA) and Cebus nigritus (CNI), have been extensively studied with classical cytogenetic comparisons focusing on banding pattern behavior. In the present study we performed comparative genomic hybridization (CGH) between these two closely related species with the aim of going a step further in the dissection of Cebus genomes. CGH evidenced that the DNA imbalances between them involved different genome regions, i.e. preferentially repetitive DNA in CPA and coding or very disperse DNA in CNI. Particularly, CNI showed species-specific DNA in more than 9 chromosomal pairs with a red/green (r/g) ratio ranging from 1.7 to 4, meaning that CNI presents at least twice as much DNA than CPA in those chromosomal segments. CPA showed species-specific DNA in the telomeric region of at least 3 chromosomal pairs with an r/g ratio of 0.5. They also showed a DNA gain in the chromosomal pairs with extracentromeric heterochromatin. Our findings modify the widespread idea of considering the heterochromatin proportion as the only difference between CPA and CNI. In Cebus then, the diversification process could be mediated by little changes in DNA content accompanied by a euchromatin-heterochromatin interaction although maintaining a minimum proportion like the one observed in CNI.

Karyological diagnosis of Cebus (Primates, Platyrrhini) in captivity: detection of hybrids and management program applications.

Genetic data are very important for conservation programs in wild population as well as in captive conditions. Primates in zoos or breeding centers are often maintained in groups without geographic origin or genetic heritage information. These lead to the incorrect assignment of species and introduce an artificial reproductive barrier, which in turn constitutes inadequate management of the colonies. A karyological analysis of specimens from a Primate Reproduction Center, considered as Cebus apella (Platyrrhini), was performed. Cell cultures were conducted from peripheral blood samples following standard cytogenetic methods. A fluorescence in situ hybridization (FISH) procedure was applied in mitotic metaphases using two probes: A specific probe of the extracentromeric heterochromatin (He+) of Cebus, and a human chromosome 21 probe. The latter was chosen due to the known homeology with the euchromatic region limiting with 11qHe+ of Cebus. The species status was determined for at least half of the animals and identified a hybrid specimen using this combined FISH protocol. This procedure is an accurate diagnostic methodology for taxonomic determinations and, therefore can be used for management of reproduction in colonies.

Uses and limitations of two molecular cytogenetic techniques for the study of arrested embryos obtained through assisted reproduction technology

We studied chromosomal abnormalities in arrested embryos produced by assisted reproductive technology with fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH) in order to determine the best technique for evaluating chromosomal aneusomies to be implemented in different situations. We examined individual blastomeres from arrested embryos by FISH and arrested whole embryos by CGH. All of the 10 FISH-analyzed embryos gave results, while only 7 of the 30 embryos analyzed by CGH were usable. Fifteen of the 17 embryos were chromosomally abnormal. CGH provided more accurate data for arrested embryos; however, FISH is the technique of choice for screening in preimplantation genetic diagnosis, because the results can be obtained within a day, while the embryos are still in culture.

Heterochromatin and chromosome evolution: a FISH probe of Cebus apella paraguayanus (Primate: Platyrrhini) developed by chromosome microdissection

Neotropical Primate karyotypes are highly variable, particularly in the heterochromatic regions, not only regarding the amount of heterochromatin, but also the composition. G and C banding and FISH techniques provide useful information to characterize interspecific relationships. We used chromosome microdissection to develop a FISH probe of the chromosome 11 heterochromatic block (11qHe+) of Cebus apella paraguayanus (CAPp). Fragments of the 11qHe+ microdissected from fibroblast cell culture were collected in a PCR tube, amplified by degenerate oligonucleotide primer-PCR and subsequently labeled. The specificity of the FISH probe was confirmed in metaphases of some Ceboidea species. Signals were located in the He+ of chromosomes 4, 11, 12, 13, and 19 of CAPp and in the He+ of chromosomes 4, 12 and 13 of C. a. nigritus (CAPn); no signals were observed when other Ceboidea species were analyzed. We propose that the heterochromatin observed in CAPp and CAPn is specific for these species. We consider this C. apella heterochromatin identity as a possible key for the interpretation of chromosomal evolution in these Ceboidea.

In situ DNAse I sensitivity assay indicates DNA conformation differences between CHO cells and the radiation-sensitive CHO mutant IRS-20.

The radiosensitive mutant cell line IRS-20, its wild type counterpart CHO and a derivative of IRS-20 with a transfected YAC clone (YAC-IRS) that restores radioresistance were tested for DNAse I sensitivity. The three cell lines were cultured under the same conditions and had a mitotic index of 2-5%. One drop of fixed cells from the three lines was always spread on the same microscopic slide. After one day of ageing, slides were exposed to DNAse I and stained with DAPI. Images from every field were captured and the intensity of blue fluorescence was measured with appropriate software. For untreated cells, the fluorescence intensity was similar for all of the cell lines. After DNAse I treatment, CHO and YAC-IRS had an intensity of 85% but IRS-20 had an intensity of 60%, when compared with the controls. DNAse I sensitivity differences between the cell lines indicate that overall conformation of chromatin might contribute to radiation sensitivity of the IRS-20 cells.

Molecular cytogenetics in metaphase and interphase cells for cancer and genetic research, diagnosis and prognosis. Application in tissue sections and cell suspensions

As the pioneer among molecular cytogenetics techniques, fluorescence in situ hybridization (FISH) allows identification of specific sequences in a structurally preserved cell, in metaphase or interphase. This technique, based on the complementary double-stranded nature of DNA, hybridizes labeled specific DNA (probe). The probe, bound to the target, will be developed into a fluorescent signal. The fact that the signal can be detected clearly, even when fixed in interphase, improves the accuracy of the results, since in some cases it is extremely difficult to obtain mitotic samples. FISH is still used mostly in research, but there are diagnostic applications. New nomenclature is being developed in order to define many of the aberrations that were not distinguished before FISH. Prenatal diagnosis of aneuploidies and malignancies are promptly detected with FISH, which is very useful in critical cases. In some tumors, where chromosomal abnormalities are too complicated to classify manually, the technique of comparative genomic hybridization (CGH), a competitive FISH, allows examiners to determine complete or partial gain or loss of chromosomes. CGH results allow the classification of many tumor cell lines and along with other complementary techniques, like microdissection-FISH, PRINS, etc., increase the possibility of choosing an appropriate treatment for cancer patients

[Drug tests on 198 drivers involved in an accident]. / Analyses toxicologiques pratiquées sur 198 conducteurs accidentés.

OBJECTIVES: A prospective analytical study was performed in a large population of drivers implicated in traffic accidents to determine the significance of drug levels observed in blood, urine, saliva and sweat and which assays are best to perform in each sample. METHODS: Samples of blood (7.5 ml), urine (10-20 ml), saliva (salivette Sarstedt) and sweat (cosmetic pad spiked with water-isopropanol) were systematically collected in drivers implicated in non-fatal traffic accidents from March to November 1999. The samples were tested for pharmaceuticals (barbiturates, benzodiazepines, anti-depressants, neuroleptics, antiepileptics and antihistamines) and for drugs of abuse by hyphenated chromatographic methods (LC/DAD, GC/MS and LC/MS). RESULTS: A total of 198 drivers (bicycle, motorbike, car, truck) were tested (age range 13-57 years, 82% males). Blood alcohol was positive in 27 cases (13.7%), ranging from 0.11 to 3.19 g/l (mean 1.49 g/l), being > 0.5 g/l in 21 cases. Cannabis was the most frequently observed illicit drug (9.6% of the cases). Its formal pharmacological effect could only be documented by blood testing using GC/MS. Even in the hospital setting, urine collection was difficult. In 16% of the cases, this fluid was missing. Parent compounds were excreted in both saliva and sweat. On-site devices devoted to urine and metabolites were inapplicable. Concentrations in sweat and saliva were very low, particularly for benzodiazepines and cannabis. There was also a risk of external contamination for sweat. CONCLUSION: Saliva might be a good substitution fluid for blood for sample taking on the road side.

An optimized fluorescence in situ hybridization procedure for detecting rye chromosomes in wheat.

In situ hybridization with an interspersed repeat clone from rye, pSc119, was shown to be useful for detecting rye chromosomes introduced into wheat. However, since pSc119 also shows strong hybridization to a few sites in certain wheat chromosomes, small rye chromosome segments added to wheat may be difficult to detect. In this study, detection of rye chromosomes present in triticale and triticale X wheat hybrids was accomplished with the use of a subfragment from pSc119 (pSc119.1) whose sequence is dispersed throughout the rye chromosomes and only weakly cross-hybridizes to a few telomeric and centromeric regions of wheat. The in situ hybridization conditions were optimized to readily distinguish rye chromosomes from wheat chromosomes without the need for intensive analysis of hybridization patterns. Rye chromosomes were readily detected using fluorescence in situ hybridization. Fluorescence detection provided increased sensitivity over enzymatic detection and allowed signals to be amplified with repeated use of biotinylated anti-avidin antibody and avidin-FITC. Detection of rye chromatin was further optimized by doubling the probe concentration. Finally, double exposure photography of the same cell with two different filters provided another means to further increase the contrast between rye and wheat chromosomes.

[The transfer of newborn infants. Experience of a department of neonatology]. / Le transfert des nouveau-nés. Expérience d'un service de néonatologie.

The results of 6 years of neonatal transport to the neonatology unit of the Hautepierre hospital (January, 1980 to December, 1985) are reported. During that period 1866 neonates were transferred from maternities of Strasbourg and its region to the neonatology unit, representing 23.77% of total admissions. The 350 premature babies born before or at 32 weeks of pregnancy amount to 55% of babies born at the same gestational age. Mortality in that group (46.52%) was associated mainly with hyaline membrane disease and intraventricular haemorrhage. Neonatal infections and congenital malformations were seen in children born after 32 weeks. To improve the quality of transport and reduce morbidity and mortality, the biological and haemodynamic parameters of the neonates should be stabilized prior to their transfer, and all the necessary precautions (i.e. ventilation, oxygenation, temperature, glycaemia, asepsis) should be observed at every stage of their journey. In high-risk pregnancies, "transfer in utero" to a neonatal intensive care unit undoubtedly is the best solution.