Establishment of Over-The-Scope-Clips (OTSC®) in daily endoscopic routine.

BACKGROUND: Alongside the evolution of interventional endoscopy, the need for a more sophisticated closure tool tailored to the treatment of new challenging indications has been increasing rapidly. METHODS: We here present our collected data on 262 Over-The-Scope-Clip (OTSC®) placements in a total of 233 interventions at our institution. Follow-up was focused on clinically lasting success with regards to different indications. RESULTS: Immediate success of OTSC® treatment was observed in 87.1% of all sessions (203/233). The success rates per indication were as follows: spontaneous bleeding 84.8% (28/33); iatrogenic bleeding 100% (20/20); acute perforation 90.3% (65/72); prophylaxis for perforation 100% (24/24); anastomotic leakage 61.1% (11/18); fistulae 80.7% (46/57); diameter reduction of the gastrojejunal anastomosis 100% (6/6); and stent fixation 100% (3/3). At 30-day follow-up, the overall success rate was 67.4% (157/233). The success rates per indication were as follows: spontaneous bleeding 69.7% (23/33); iatrogenic bleeding 90% (18/20); acute perforation 86.1% (62/72); prophylaxis for perforation 100% (24/24); anastomotic leakage 33.3% (6/18); fistulae 29.8% (17/57), diameter reduction of the gastrojejunal anastomosis 83.3% (5/6); and stent fixation 66% (2/3). CONCLUSIONS: Our cohort confirms previous data on the clinical usefulness of the OTSC® in daily routine practice.

Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw.

BACKGROUND: Avulsion fractures of the anterior tibial intercondylar eminence in childhood are rare and are severe injuries of the knee. Since the injury is equivalent in aetiology with ruptures of the anterior cruciate ligament, the treatment requires anatomic reduction and preservation of the stability of the joint. The aim of the study was to demonstrate our experiences with the arthroscopy-guided Herbert-screw fixation in the treatment of displaced tibial eminence fractures in children. METHODS: Between January 2004 and December 2011, a total of eight children were treated surgically with Type II or Type III anterior tibial eminence fractures; another four children with undisplaced, Type I fractures were treated conservatively, applying with cast fixation for 6 weeks. Radiological consolidation, stability and functional outcome were assessed during the follow-up examinations. RESULTS: On the 12th postoperative week, we did not find instability in any of the patients by physical examination. There were only minimal differences found in the functional outcome, comparing the conservatively and operatively treated groups (Lysholm functional scale, average scores: Type I: 97, Type II: 95 and Type III: 94 points). The range of motion (ROM) of the injured knees was identical with healthy sides on the postoperative 6th week. CONCLUSIONS: Our results indicate that the presented method can successfully be applied in the treatment of displaced tibial spine fractures; providing excellent stability and preserving the function of the injured knee in the short-term.

Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia.

BACKGROUND: Neglected and repeated ruptures of the patellar tendon are fortunately an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by contractures of the quadriceps muscle and extensive scar tissue formation, and clinical findings are similar regardless of whether the rupture occurred during or after total knee arthroplasty. In both cases, reconstruction is the treatment. METHODS: Here, we present data on reconstruction of the patellar tendon using our own method, which is performed in the following manner: the fascia flap shafted in the distal direction is separated from the vastus lateralis fascia of the quadriceps muscle, then folded back and fixed to the tibial tuberosity enclosing the patella in a Y shape. We used this new method in sixteen cases. All of the patients were examined clinically for an average of twenty-eight months. The Knee Society score was determined prior to surgery and on follow up. RESULTS: Both the physical and ultrasound monitoring showed that all sixteen tendons healed properly, indicating that there was no need for any further surgical interventions. The mean Knee Society pain and function scores as well as the average range of motion of the knee increased significantly after the operations. CONCLUSION: We believe that the presented method is an acceptable option for functional and biomechanical repair of the patellar tendon for the following reasons: the static balance of the knee joint remains unaltered, the quadriceps muscle is not damaged, and the central pulling direction remains steady.

Colorectal polypectomy during insertion and withdrawal or only during withdrawal? A randomized controlled trial.

BACKGROUND AND STUDY AIMS: Removal of colorectal polyps is routinely performed during withdrawal of the endoscope. However, polyps detected during insertion of the colonoscope may be missed at withdrawal. We aimed to evaluate whether polypectomy during both insertion and withdrawal increases polyp detection and removal rates compared with polypectomy at withdrawal only, and to assess the duration of both approaches. PATIENTS AND METHODS: Patients were included into the study when the first polyp was detected, and randomized into two groups; in group A, polyps ≤ 10 mm in diameter were removed during insertion and withdrawal of the colonoscope, while in group B, these polyps were removed at withdrawal only. Main outcome measures were duration of colonoscopy, number of polyps detected during insertion but not recovered during withdrawal, technical ease, patient discomfort, and complications. RESULTS: 150 patients were randomized to group A and 151 to group B. Mean (± standard deviation [SD]) duration of colonoscopy did not differ between the groups (30.8 ± 15.6 min [A] vs. 28.5 ± 13.8 min [B], P = 0.176). In group A 387 polyps (mean 2.58 per colonoscopy) were detected and removed compared with 389 polyps detected (mean 2.58 per colonoscopy) in group B of which 376 were removed (13 polyps were missed, mean size [SD] 3.2 [1.3] mm; 7.3 % of patients). Patient tolerance was similar in the two groups. CONCLUSIONS: Removal of polyps ≤ 10 mm during withdrawal only is associated with a considerable polyp miss rate. We therefore recommend that these polyps are removed during both insertion and withdrawal.

Retrospective analysis of varicella zoster virus (VZV) copy DNA numbers in plasma of immunocompetent patients with herpes zoster, of immunocompromised patients with disseminated VZV disease, and of asymptomatic solid organ transplant recipients.

BACKGROUND: Varicella zoster virus (VZV) causes significant morbidity and mortality in immunocompromised patients. Subclinical reactivation has been described in solid organ recipients and has been associated with graft versus host disease in bone marrow transplantation. Newer studies assessing the prevalence and impact of subclinical VZV reactivation in solid organ transplant (SOT) recipients are lacking. METHODS AND RESULTS: In a first step we developed a highly sensitive quantitative polymerase chain reaction (qPCR) assay for VZV DNA with a detection limit of < or = 20 copies/mL. Using this assay, we retrospectively analyzed plasma samples of different patient groups for VZV DNA. VZV DNA was found in 10/10 plasma samples of immunocompetent patients with herpes zoster (VZV copy numbers/mL: mean+/-SEM 1710+/-1018), in 1/1 sample of a human immunodeficiency virus-infected patient with primary VZV disease (15,192 copies/mL) and in 4/4 plasma samples of immunocompromised patients with visceral VZV disease (mean of first value 214,214+/-178,572). All 108 plasma samples of asymptomatic SOT recipients off any antiviral therapy, randomly sampled over 1 year, were negative for VZV DNA. CONCLUSION: Our qPCR assay proved to be highly sensitive (100%) in symptomatic VZV disease. We did not detect subclinical reactivation in asymptomatic SOT recipients during the first post-transplant year. Thus, subclinical VZV reactivation is either a rare event or does not exist. These data need to be confirmed in larger prospective trials.

Anchoring of canine linkage groups with chromosome-specific markers.

A high-resolution genetic map with polymorphic markers spaced frequently throughout the genome is a key resource for identifying genes that control specific traits or diseases. The lack of rigorous selection against genetic disorders has resulted in many breeds of dog suffering from a very high frequency of genetic diseases, which tend to be breed-specific and usually inherited as autosomal recessive or apparently complex genetic traits. Many of these closely resemble human genetic disorders in their clinical and pathologic features and are likely to be caused by mutations in homologous genes. To identify loci important in canine disease genes, as well as traits associated with morphological and behavioral variation, we are developing a genetic map of the canine genome. Here we report on an updated version of the canine linkage map, which includes 341 mapped markers distributed over the X and 37 autosomal linkage groups. The average distance between markers on the map is 9.0 cM, and the linkage groups provide estimated coverage of over 95% of the genome. Fourteen linkage groups contain either gene-associated or anonymous markers localized to cosmids that have been assigned to specific canine chromosomes by FISH. These 14 linkage groups contain 150 microsatellite markers and allow us to assign 40% of the linkage groups to specific canine chromosomes. This new version of the map is of sufficient density and characterization to initiate mapping of traits of interest.

Toward a framework linkage map of the canine genome.

Selective breeding to maintain specific physical and behavioral traits has made the modern dog one of the most physically diverse species on earth. One unfortunate consequence of the common breeding practices used to develop lines of dogs with the desired traits is amplification and propagation of genetic diseases within distinct breeds. To map disease loci we have constructed a first-generation framework map of the canine genome. We developed large numbers of highly polymorphic markers, constructed a panel of canine-rodent hybrid cell lines, and assigned those markers to chromosome groups using the hybrid cell lines. Finally, we determined the order and spacing of markers on individual canine chromosomes by linkage analysis using a reference panel of 17 outbred pedigrees. This article describes approaches and strategies to accomplish these goals.

A linkage map of the canine genome.

A genetic linkage map of the canine genome has been developed by typing 150 microsatellite markers using 17 three-generation pedigrees, composed of 163 F2 individuals. One hundred and thirty-nine markers were linked to at least one other marker with a lod score > or = 3.0, identifying 30 linkage groups. The largest chromosome had 9 markers spanning 106.1 cM. The average distance between markers was 14.03 cM, and the map covers an estimated 2073 cM. Eleven markers were informative on the mapping panel, but were unlinked to any other marker. These likely represent single markers located on small, distinct canine chromosomes. This map will be the initial resource for mapping canine traits of interest and serve as a foundation for development of a comprehensive canine genetic map.

Fatal occupational injuries in US industries, 1984: comparison of two national surveillance systems.

This paper compares the results of analyses of 1984 fatalities as identified in the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatality (NTOF) data base with those of the Bureau of Labor Statistics' Annual Survey of Occupational Injuries and Illnesses (AS) for 1984. The fatality rates for industries were similar in both analyses; however, differences in number of injuries suggest underrepresentation in the AS of fatal injuries in several, high-risk industries. Differences and similarities in methods and results between the two national surveillance systems are described and their application to research and injury prevention are discussed.

Physician drug use: availability or occupational stress?

The research examines the nature and frequency of reported drug use in a sample of health professionals and considers occupational stress as a possible explanation for the high rate of drug use among physicians. Anonymous questionnaires, eliciting drug use frequency and occupational stress, were sent to physicians and dentists practicing in West Virginia. Physicians report greater drug use than dentists, even though dentists also have legal access to prescription drugs. Among physicians there is a significant positive relationship between occupational stress and the use of selected drugs. This finding lends tentative support to the hypothesis that drug use among physicians is not primarily a function of drug availability.

Studies on the mechanism of inhibition of redox enzymes by substituted hydroxamic acids.

Substituted primary hydroxamic acids were found to inhibit the catalytic activity of a number of redox enzymes. The inhibition was not related to the nature of the metal-active site of the enzyme nor to the nature of the oxygen-containing substrate. Two easily available enzymes, mushroom tyrosinase (monophenol,dihydroyphenylalanine:oxygen oxidoreductase, EC 1.14.18.1) and horseradish peroxidase (donor:hydrogen-peroxide oxidoreductase, EC 1.11.1.7), which were potently inhibited by hydroxamic acids, were chosen for more detailed study. A kinetic analysis of the inhibitory effects on the partially purified tyrosinase of mushroom (Agaricus bispora) revealed that inhibition was reversible and competiitive with respect to reducing substrate concentration, but was not competitive with respect to molecular oxygen concentration. A spectrophotometric and EPR study of the binding of salicylhydroxamic acid to horseradish peroxidase revealed that his hydroxamic acid was bound to the enzyme in the same manner as a typical substrate, hydroquinone. Spectroscopic and thermodynamic measurements of the binding reactions suggested that this binding site is close, to but, not directly onto, the heme group of the enzyme. From these results it is concluded that the mode of inhibition of hydroxamic acid need not be, as generally supposed, by metal chelation, and mechanisms involving either hydrogen bonding at the reducing substrate binding site or the formation of a charge transfer complex between hydroxamic acid and an electron-accepting group in the enzyme are considered to be more feasible. The relevance of these findings to deductions on the nature of other hydroxamic acid-inhibitable systems is discussed.

Quantitative gas-chromatographic flame-ionization method for chloramphenicol in human serum.

We describe a flame-ionization gas-chromatographic procedure for determination of the potentially toxic antibiotic, chloramphenical, in serum. The serum (500 mul) is extracted into ethyl acetate and nonpolar impurities are subsequently partitioned into hexane. The drug is chromatographed as its bis-trimethylsilyl derivative, with the analog thiamphenicol as the internal standard. Within-run precision (CV) is 4.4% at a serum concentration of 41 mg/liter and 9.2% at a concentration of 5 mg/liter. Over a six-month period, the run-to-run variation was 5.1% at 40 mg/liter (n = 24). Results by the gas-chromatographic method compared well with those by an established colorimetric procedure; mean concentrations for the comparison samples in the two procedures were 18.4 mg/liter and 17.6 mg/liter, respectively (n = 27), with a coefficient of correlation of 0.998. The gas-chromatographic method is more precise and specific than classical microbiological procedures and is suitable for routine therapeutic monitoring of serum chloramphenicol concentrations.