Typical carcinoids and neuroendocrine carcinomas of the stomach: differing clinical courses and prognoses

Background

Gastric endocrine tumors are usually classified as 3 types of well-differentiated endocrine tumors (typical carcinoids or carcinoids) and poorly differentiated carcinomas (neuroendocrine carcinomas [NECs]).

Methods

From 1993 to 2008, 97 patients (73 men and 24 women) were diagnosed with gastric neuroendocrine tumors at the Asan Medical Center.

Results

Of the 45 patients with typical carcinoids, 37 underwent surgery (eg, endoscopic resection). Of the 52 patients with NECs, 43 underwent surgery (eg, radical gastrectomy). One patient died of recurrence of the typical carcinoids, whereas 26 patients with NECs died of related diseases (P < .05). The rates of survival and recurrence did not significantly differ by type of typical carcinoid (P > .05).

Conclusions

Regardless of the type, carcinoids that are not yet advanced can be effectively treated with minimal endoscopic or laparoscopic surgery. However, all NECs and advanced carcinoids should be treated with radical gastrectomy.     

Predictors of outcome in children and adolescents with rhabdomyosarcoma of the trunk--the St Jude Children's Research Hospital experience

Purpose

The aim of this study was to determine predictors of outcome in childhood truncal rhabdomyosarcoma.

Methods

Retrospective chart review evaluating the impact of demographic features, disease characteristics, and the extent and timing of surgical intervention on outcome was performed.

Results

Thirty-three patients with a median age of 8 years were identified. Most had advanced Intergroup Rhabdomyosarcoma Study group III (n = 13) or group IV (n = 9) disease. Primary site included 20 (61%) chest wall, 6 (21%) paraspinal, 5 (15%) periscapular, and 1 (3%) abdominal wall. Most tumors were embryonal (n = 21), larger than 5 cm (n = 27), and locally invasive (n = 13); 7 had positive nodes.Tumor size, nodal status, and gross total tumor resection (upfront or delayed) were significant predictors of event-free and overall survival. Tumors 5 cm or smaller were amenable to upfront surgical resection (P = .007). In patients with tumors larger than 5 cm, resection at any time was associated with a 10-year overall survival 57% ± 13% compared with 8% ± 5% in those who had no surgery (P = .003). Tumor recurrence was local in 44% of cases, and survival after local recurrence was rare (1 of 8).

Conclusion

Tumor size, nodal status, and gross total resection at any time are significant predictors of outcome in truncal rhabdomyosarcoma. Gross tumor excision should be the goal of surgical intervention in this disease.     

The utility of diagnostic laparoscopy in the evaluation of anterior abdominal stab wounds

Background

To assess if diagnostic laparoscopy (DL) is superior to nonoperative modes (serial abdominal examination with/without computed axial tomography [CAT] and diagnostic peritoneal lavage) in determining the need for therapeutic laparotomy (TL) after anterior abdominal stab wound (ASW).

Methods

Retrospective review of ASW patients. Patients were divided into group A (DL/exploratory laparotomy) to identify peritoneal violation (PV) and group B (initial nonoperative modes).

Results

Seventy-three patients met inclusion criteria. In group A (n = 38), 29 patients (76%) had PV by DL and underwent exploratory laparotomy. Only 10 (35%) underwent TL (sensitivity for PV = 100%; specificity and positive predictive value of PV in determining need for TL = 29% and 33%, respectively). In group B (n = 35), 7 patients (20%) underwent TL, yielding an improved specificity (96%) and positive predictive value (88%).

Conclusions

We find no role for DL in the evaluation of ASW patients solely to determine PV.     

Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes

Background

Diabetic patients may be more prone to penile-implant infections than other men.

Objective

We sought to determine whether revision surgeries due to infection were less common in diabetic men after implantation of an inflatable penile prosthesis (IPP) impregnated with minocycline and rifampin (M/R) versus a nonimpregnated prosthesis.

Design, setting, and participants

Infection-related revisions for M/R-impregnated and nonimpregnated implants were compared during a retrospective review of patient-implant and removal data recorded in the manufacturer's database. The data set included men with diabetes as an etiology of erectile dysfunction and who were implanted with their first IPPs between 2001 and 2008.

Intervention

All men received three-piece IPPs.

Measurements

The number of first revisions due to infection reported at any time during the study period were summarized for each group. Freedom from infection-related revisions for initial M/R-impregnated implants were compared to nonimpregnated implants with ≤84 mo of follow-up using life-table survival analysis. Infection-free survival was also compared for diabetics versus nondiabetics.

Results and limitations

Mean age was 59.1 yr for the 6071 diabetic men in the M/R-impregnated group. The nonimpregnated group included 624 diabetics with a mean age of 57.6 yr. Initial revisions due to infection were reported for 1.47% of M/R-impregnated versus 4.17% of nonimpregnated implants. At 7 yr, the rate of infection-related revisions was significantly lower for M/R-impregnated (1.62%) than for nonimpregnated implants (4.24%; log-rank p < 0.0001). Diabetic men had a significantly higher rate of revisions due to infection at 7 yr (1.88%) than men without diabetes (1.53%; log-rank p = 0.0052).

Conclusions

This long-term evidence from the largest known database of diabetic IPP recipients establishes that the use of an antibiotic-impregnated IPP can decrease revisions due to infection. Reducing the incidence of this devastating complication represents a significant medical advance in erectile restoration for diabetic patients.     

One hundred patients with recurrent pectus excavatum repaired via the minimally invasive Nuss technique--effective in most regardless of initial operative approach

Purpose

Controversy exists as to the best operative approach to use in patients with failed pectus excavatum (PE) repair. We examined our institutional experience with redo minimally invasive PE repair along with the unique issues related to each technique.

Methods

We conducted an institutional review board-approved review of a prospectively gathered database of all patients who underwent minimally invasive repair of PE.

Results

From June 1987 to January 2010, 100 patients underwent minimally invasive repair for recurrent PE. Previous repairs included 42 Ravitch (RAV) procedures, 51 Nuss (NUS) procedures, 3 Leonard procedures, and 4 with previous NUS and RAV repairs. The median Haller index at reoperation was 4.99 (range, 2.4-20). Fifty-five percent of RAV patients and 25% of NUS patients required 2 or more bars (P = .01). Two RAV patients had intraoperative nonfatal cardiac arrest owing to thoracic chondrodystrophy—1 at insertion and 1 upon removal. Bar displacements occurred in 12% RAV and 7.8% NUS patients (P = .05). Overall reoperation for bar displacement is 9%.

Conclusions

The minimally invasive NUS technique is safe and effective for the correction of recurrent PE. Patients with prior NUS repair can have extensive pleural adhesions necessitating decortication during secondary repair. Patients with a previous RAV repair may have acquired thoracic chondrodystrophy that may require a greater number of pectus bars to be placed at secondary repair and greater risk for complications. We have a greater than 95% success rate regardless of initial repair technique.     

Influence of interleukin-6 promoter polymorphism -174 g/c on kidney graft outcome

Background

The cytokine interleukin-6 (IL-6) is important in both immune responses and cardiovascular diseases. The IL-6 promoter polymorphism −174 G/C is associated with increased plasma concentrations of IL-6. The relationship between IL-6 polymorphisms and graft survival, cardiovascular events, and new-onset diabetes mellitus after kidney transplantation is controversial.

Objective

To analyze whether IL-6 (−174 G/C) polymorphism influences kidney graft survival or development of chronic allograft nephropathy, cardiovascular events, or new- onset diabetes.

Methods

The IL-6 promoter polymorphism (−174 G/C) was analyzed using the polymerase chain reaction with sequence-specific primers in 335 kidney transplant recipients. Data for graft survival, chronic graft nephropathy, cardiovascular events, and new-onset diabetes were obtained retrospectively from clinical records. Categorical variables were compared between individuals with CC, GG, and GC genotypes using χ² tests. Survival analysis was performed using the Kaplan-Meier method, comparing groups using the log-rank test.

Results

No significant differences were observed in 5-year graft survival between individuals with CC and GC/GG genotypes (85.3% vs 77.1%; P = .22). Nor were significant differences noted in the rates of chronic allograft nephropathy (37.5% vs 33.8%; P = .48), cardiovascular events (10.0% vs 23.0%; P = .10), or new-onset diabetes (7.5% vs 11.8%; P = .28).

Conclusion

There is no association between IL-6 (−174 G/C) polymorphism and graft survival or development of chronic allograft nephropathy, cardiovascular events, or new- onset diabetes.     

Attitudes toward islet cell and tissue xenotransplantation among kidney and liver patients on the transplant waiting list

Introduction

Research into xenotransplantation is centered on the fields of organs, tissues, and cells. However, the use of animals in this therapy is creating social rejection among the general public as well as among patients on the transplant waiting list.

Objective

The objective of this study was to analyze the attitudes of patients on the waiting list toward a possible transplantation of cells or tissues of animal origin.

Materials and Methods

The study included patients on the kidney and liver transplant waiting lists from January 2003 until December 2005 (N = 373). Attitudes toward xenotransplantation were assessed using a psychosocial questionnaire about the donation of animal organs. The questionnaire was administered through a direct personal interview.

Results

With regard to the xenotransplantation of tissues and cells, 83% of kidney patients (n = 177) were in favor and 17% (n = 37) were not in favor of both options. Patients who were more in favor for tissues and also for cells were young respondents (P = .016; age P = .006) and those with a formal education (P = .002; education P = .001). Among liver patients, 85% (n = 134) were in favor and 15% (n = 24) were not in favor. Those who were more in favor for tissues included elderly patients (P = .028) and those with descendents (P = .001); for cells, those who were more in favor were those who were married (P = .011), were older (P = .009), and had children (P < .000). No significant differences were observed between the groups.

Conclusion

Patients on the solid organ transplant waiting lists showed favorable attitudes toward tissue and cell xenotransplantation.     

Evaluation of multiple risk-associated single nucleotide polymorphisms versus prostate-specific antigen at baseline to predict prostate cancer in unscreened men

Background

Although case-control studies have identified numerous single nucleotide polymorphisms (SNPs) associated with prostate cancer, the clinical role of these SNPs remains unclear.

Objective

Evaluate previously identified SNPs for association with prostate cancer and accuracy in predicting prostate cancer in a large prospective population-based cohort of unscreened men.

Design, setting, and participants

This study used a nested case-control design based on the Malmö Diet and Cancer cohort with 943 men diagnosed with prostate cancer and 2829 matched controls. Blood samples were collected between 1991 and 1996, and follow-up lasted through 2005.

Measurements

We genotyped 50 SNPs, analyzed prostate-specific antigen (PSA) in blood from baseline, and tested for association with prostate cancer using the Cochran-Mantel-Haenszel test. We further developed a predictive model using SNPs nominally significant in univariate analysis and determined its accuracy to predict prostate cancer.

Results and limitations

Eighteen SNPs at 10 independent loci were associated with prostate cancer. Four independent SNPs at four independent loci remained significant after multiple test correction (p < 0.001). Seven SNPs at five independent loci were associated with advanced prostate cancer defined as clinical stage ≥T3 or evidence of metastasis at diagnosis. Four independent SNPs were associated with advanced or aggressive cancer defined as stage ≥T3, metastasis, Gleason score ≥8, or World Health Organization grade 3 at diagnosis. Prostate cancer risk prediction with SNPs alone was less accurate than with PSA at baseline (area under the curve of 0.57 vs 0.79), with no benefit from combining SNPs with PSA. This study is limited by our reliance on clinical diagnosis of prostate cancer; there are likely undiagnosed cases among our control group.

Conclusions

Only a few previously reported SNPs were associated with prostate cancer risk in the large prospective Diet and Cancer cohort in Malmö, Sweden. SNPs were less useful in predicting prostate cancer risk than PSA at baseline.     

Outcomes of surgical and radiologic placed implantable central venous access ports

Background

Recent literature suggests implantable central venous access ports (ICVAPs) can be placed by interventional radiologists with fewer complications and lower expenses when compared with surgeons. An analysis of outcomes and expenses of ICVAP placement by service was conducted.

Methods

Three hundred sixty-eight ICVAPs were placed over 3 years at a 230-bed community teaching hospital. A retrospective review of these procedures was conducted. Data recorded for each procedure included patient demographics, reason for placement, indwelling port days, complications, billed charges, and reimbursement.

Results

Two hundred seventy-six (75%) ICVAPs were placed by interventional radiologists, while surgeons placed the remaining 92 ports (25%). Short-term complications were identified in 7 interventional radiologist-placed ports (2.5%) and 1 surgically placed port (1.1%), P = .42. Billed charges were greater for interventional radiologist-placed ports ($5,301 vs $4,552, P = .0001). In contrast, reimbursement was greater for surgically placed ports: interventional radiologist 31.3% of charges, surgery 42.8%, P = .049.

Conclusion

Reimbursement and charges demonstrated significant differences between surgeons and interventional radiologists. Prior assertions that ports placed by interventional radiologists are less expensive with fewer complications may no longer be valid.     

Predictors of malignancy in screen-detected breast masses with indeterminate/equivocal (grade 3) imaging features

Background

The mammographic grading system used by BreastScreen Australia accredited programs requires needle biopsy of lesions with indeterminate features (grade 3). We wished to determine the predictors of malignancy for these common lesions, so as to reduce surgery for benign lesions.

Design

Grade 3 masses assessed between Jan 1996-Dec 2005 are included. New or changing lesions were identified through film review. Imaging, demographic and final outcome data were tabulated. Statistical analysis was performed to determine the predictors of malignancy.

Results

1181 lesions, including 623 new or changing masses are assessed. Of these 98 (8.3%) were malignant. Malignancy was found in 3% first round masses versus 13% of new or changing lesions. Withholding needle biopsy results, interval change (OR 2.85, p = 0.0001), increasing age (p = 0.0001) and diameter were independent predictors of malignancy, lesion diameter having an inverse relationship with malignancy.Once needle biopsy results were included, this parameter became the sole predictor of malignancy as other factors lost significance in a multivariate model.

Conclusion

Surgical biopsy is not indicated in well-sampled grade 3 masses with benign needle biopsy results. Surgery is valuable for diagnosis or treatment of the remaining such masses without benign needle biopsy results.     

Differential use of Erk1/2 and transforming growth factor beta pathways by mid- and late-gestational murine fibroblasts

Background

Previously, we demonstrated the rapid closure of mid-gestational excisional murine wounds at 32 hours. In this study, we theorized that mid-gestational wounds would be completely regenerated, whereas late-gestational wounds would heal with scar formation at 48 hours. Furthermore, we theorized that mid- and late-gestational fibroblasts differentially use the transforming growth factor β and mitogen-activated protein kinase pathways.

Methods

Three-millimeter excisional cutaneous wounds were made on murine mid- (embryonic day 15 [E15]) and late-gestational (E18) fetuses and harvested at 48 hours for histology. Percent wound closure was calculated. E15 and E18 fibroblasts were cultured overnight for in vitro scratch wound assay in the presence of the activin receptor-like kinase 4-5-7, Erk1/2, and p38 inhibitors.

Results

E15 wounds healed in a regenerative manner, whereas E18 wounds exhibited scar formation. In vitro scratch closure was similar in the E15 and E18 groups at 8 hours; yet, it increased in E15 compared with E18 groups with activin receptor-like kinase 4-5-7 and Erk1/2 inhibitors. p38 inhibition resulted in reduced scratch closure in both groups.

Conclusion

The scarless mid-gestational excisional wounds compared with the scar-forming late-gestational wounds provides a model to study scar formation. This study also suggests that variable transforming growth factor β and Erk1/2 signaling may influence differences in wound closure between mid- and late-gestational wounds.     

Using multiple imputation and propensity scores to test the effect of car seats and seat belt usage on injury severity from trauma registry data

Background

Missing data and the retrospective, nonrandomized nature of trauma registries can decrease the quality of registry-based research. Therefore, we used multiple imputation and propensity scores to test the effect of car seats and seat belt usage on injury severity in children involved in motor vehicle crashes.

Methods

All children admitted after injury from motor vehicle crashes who had complete data on seat belt or car seat usage from 2003 to 2006 were included in the study. The sample was divided into children younger than 4 years (n = 130) or 5 years or older (n = 575) and analyzed for seat belt usage, car seat usage, injury severity score, revised trauma score, and Glasgow Coma Scale score. Data were analyzed before and after matching on propensity scores after multiple imputation.

Results

There were no outcome differences between car seat users and non-car seat users. However, there were significant improvements in injury severity score (7.0 vs. 10.1, P = .002) and revised trauma score (7.6 vs 7.3, P = .013 for seat belt users compared to nonusers) even after matching on propensity score.

Conclusion

Multiple imputation and propensity scores demonstrated the efficacy of seat belts, but not car seat in this preliminary study. This statistical method can strengthen registry-based research.     

Fascia iliaca compartment block reduces emergence agitation by providing effective analgesic properties in children

Study Objective

To determine whether fascia iliaca compartment block (FICB) reduces emergence agitation.

Design

Prospective, randomized, blinded clinical trial.

Setting

Operating room and Postanesthesia Care Unit (PACU) of a university hospital.

Patients

64 ASA physical status 1 and 2 pediatric patients aged three to 7 years, scheduled for orthopedic surgery involving the anterior or lateral thigh.

Interventions

Patients enrolled in the FICB group received FICB immediately after the operation, while control group patients received intravenous (IV) patient/parent-controlled analgesia (PCA) with fentanyl.

Measurements

Severity of agitation and pain were evaluated using the Pediatric Agitation and Emergence Delirium (PAED) scale and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Data were collected at 10-minute intervals in the PACU. The results were analyzed using the t-test.

Main Results

PAED scores in the FICB group were significantly lower than those of the control group on arrival at the PACU (7.3 ± 2.9 vs 10.4 ± 3.2, P < 0.001). The FICB group also had significantly lower CHEOPS pain scores than the control group, both on arrival at the PACU and 10 minutes after arrival (6.4 ± 1.5 vs 10.4 ± 1.8, P < 0.001 and 6.7 ± 1.6 vs 8.0 ± 1.4, P = 0.009, respectively).

Conclusion

In children having surgery on the thigh, FICB effectively reduced the severity of emergence agitation and postoperative pain during the immediate postoperative period.     

Emergence of community-acquired methicillin-resistant Staphylococcus aureus soft tissue infections

Purpose

Our objective is to describe the changing incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and its treatment within East Tennessee.

Methods

A retrospective chart review of 245 patients treated with incision and drainage of soft tissue infections from March 2000 to September 2005 was completed. Consent was obtained from our local institutional review board. Forty patients were excluded because no cultures were recorded or because they failed the criteria for the diagnosis of CA-MRSA. We examined our data using χ² analysis. P value of less than .05 was considered statistically significant.

Results

The most common organism cultured was CA-MRSA (33%; 67 of 205). Non-CA-MRSA accounted for 4% (9 of 205). The age of patients ranged from 1 month to 21 years, with a mean age of 6.5 years. Stratified by year, the incidence of positive cultures for CA-MRSA has increased 159% since 2004 and 868% since 2003. In addition, the average age of patients has decreased from 8.3 years in 2000 to 6.1 years in 2005.

Conclusions

Community-acquired MRSA has emerged as the dominant source of soft tissue infection requiring incision and drainage regardless of site in East Tennessee. This has caused a change in the choice of empiric antibiotic treatment of soft tissue abscesses in our region. These infections now account for the third most common reportable disease to the Department of Health in East Tennessee.     

Use of angioembolization as an effective technique for the management of pediatric solid tumors

Purpose

In oncology practice, angioembolization has been reported for tumor reduction before surgery, treatment of life-threatening conditions, and for palliative care. Nevertheless, the overall experience with angioembolization for the treatment of tumors is limited. We report our experience in 7 nonvascular solid pediatric tumors.

Materials and Methods

A retrospective review was carried out of medical records from pediatric patients (0-18 years) with solid nonvascular tumors who underwent angioembolization in the last 5 years at our institution.

Results

Seven patients underwent embolization: 2 neuroblastomas, 1 metastatic paraganglioma, 1 hepatoblastoma, 1 myofibroblastic tumor, 1 osteosarcoma, and 1 undifferentiated sarcoma. The reason for angioembolization was preparation for surgery (3), treatment of a life-threatening event (1), or palliative care (3). Each case is presented and discussed. The outcome was subsequent complete surgical resection in 3 cases, tumor vanished in 1 case, symptom control was achieved in 1, and the other 2 patients improved their survival and quality of life, however, died of disease progression.

Conclusions

Tumor angioembolization may enter the treatment algorithm for selected patients who have to face difficult or unwarranted surgical procedures or have diseases where conventional therapies have failed.     

Disease-specific survival of men with prostate cancer detected during the screening interval: results of the European randomized study of screening for prostate cancer-Rotterdam after 11 years of follow-up

Background

In a screening program, interval cancers are cancers diagnosed between two screening visits.

Objective

To assess the disease-specific survival (DSS) of men with prostate cancer (PCa) detected during the screening interval.

Design, setting, and participants

Within the European Randomized Study of Screening for Prostate Cancer section Rotterdam, 42 376 men identified from population registries (55-74 yr of age) were randomized to a screening or control arm. The median follow-up was 11 yr.

Intervention

Men with prostate-specific antigen ≥3.0 ng/ml were recommended to undergo lateralized sextant biopsy. The screening interval was 4 yr.

Measurements

The disease-specific mortality of men with interval cancers was compared with that of men with PCa in the control arm; the secondary end point was overall mortality. An independent committee determined the causes of death.

Results and limitations

In the screening arm, 139 men were diagnosed with interval cancer of whom 8 died of the disease. In the control arm, the corresponding numbers were 1149 and 128, respectively. When comparing men with interval cancer to men with PCa in the control arm, no statistically significant difference in disease-specific mortality (hazard ratio [HR]:1.12; 95% confidence interval [CI], 0.53-2.36; p = 0.77) and overall mortality (HR: 0.98; 95% CI, 0.68-1.38; p = 0.90) was found, adjusted for age, prognostic factors, and treatment modality. The follow-up is too limited to address the difference in DSS stratified for screening interval.

Conclusions

In the setting of population-based PCa screening at 4-yr intervals, the DSS of men with interval cancer seems to be similar to that of men with PCa in the control arm. Given that interval cancers contribute significantly to PCa mortality, further benefit in DSS in the screening arm may be achieved by decreasing the occurrence of interval cancer. However, the balance between mortality reduction and overdiagnosis should be preserved.

Trial registration

ISRCTN49127736.     

Laparoscopic Tenckhoff catheter placement in children using a securing suture in the pelvis: comparison to the open approach

Background/Purpose

Secure placement of peritoneal dialysis (PD) catheters in the pelvis has been described by various techniques. We describe minimally invasive placement using an Endo Close device, securing the catheter in the pelvis, and compare this method with standard open technique in children.

Methods

A retrospective institutional review was conducted for children requiring PD access from 2001 to 2007. Patients were grouped into laparoscopic with secure placement (SP) and open placement (OP) groups. Groups were cohort-matched based on age, paying particular attention to the number of catheter migrations.

Results

Twenty-seven patients underwent 36 procedures in SP, whereas 23 patients in OP had 32 catheter-related procedures. Exit site infections were decreased in SP (0.57 vs 1.33 episodes per patient-year). There was no difference in the number of catheter migrations (3 vs 5); however, time to migration was statistically longer in the SP group (9 vs. 2.4 months, P < .05).

Conclusions

Laparoscopic placement of PD catheters using a securing suture in the pelvis is a more durable technique when compared to open placement. Extending the catheter migration time is important in children when PD is used as a bridge to renal transplantation.     

An in vitro biofilm model to examine the effect of antibiotic ointments on biofilms produced by burn wound bacterial isolates

Purpose

Topical treatment of burn wounds is essential as reduced blood supply in the burned tissues restricts the effect of systemic antibiotics. On the burn surface, microorganisms exist within a complex structure termed a biofilm, which enhances bacterial resistance to antimicrobial agents significantly. Since bacteria differ in their ability to develop biofilms, the susceptibility of these biofilms to topically applied antibiotics varies, making it essential to identify which topical antibiotics efficiently disrupt or prevent biofilms produced by these pathogens. Yet, a simple in vitro assay to compare the susceptibility of biofilms produced by burn wound isolates to different topical antibiotics has not been reported.

Methods

Biofilms were developed by inoculating cellulose disks on agar plates with burn wound isolates and incubating for 24 h. The biofilms were then covered for 24 h with untreated gauze or gauze coated with antibiotic ointment and remaining microorganisms were quantified and visualized microscopically.

Results

Mupirocin and triple antibiotic ointments significantly reduced biofilms produced by the Staphylococcus aureus and Pseudomonas aeruginosa burn wound isolates tested, as did gentamicin ointment, with the exception of one P. aeruginosa clinical isolate.

Conclusions

The described assay is a practical and reproducible approach to identify topical antibiotics most effective in eliminating biofilms produced by burn wound isolates.     

Costochondral changes in the chest wall after the Nuss procedure: ultrasonographic findings

Purpose

The Nuss procedure is one of the most popular surgeries for correcting pectus excavatum. However, little is known regarding stress and strain on the deformed ribs after inserting the pectus bar. We used ultrasonography to investigate costochondral changes before and after the Nuss procedure.

Methods

Ninety-five patients underwent the Nuss procedure between July 2007 and February 2008 at 2 institutions. Chest ultrasonography, specifically of the bones and cartilage, was performed 1 day before and 1 week after the operation.

Results

Postoperatively, all patients showed various degrees of deformation from the second to sixth cartilages bilaterally. The cartilages were not fractured. Of these patients, 28 (29.5%) had significant changes, including acute angulation of the costochondral junction and rib fractures near the pectus bar. These changes were associated with increased age (P < .01) and the degree of postoperative sternum elevation (P < .01). The pectus index and sex were not significant predictors of rib damage.

Conclusions

The Nuss procedure created significant stress and strain over the deformed cartilages. Approximately 29% of the patients showed localized, self-limited costochondral changes via chest ultrasonography.