Load to failure of common meniscal repair techniques: Effects of suture technique and suture material

Success of meniscal repair with early or immediate motion depends on the ability of the suture fixation to withstand the loads applied. Vertical and horizontal mattress suture techniques were tested using 2-0 Ethibond, and 0-PDS and 1-PDS sutures (Ethicon, Somerville, NJ). Mulberry knot technique was tested with 0-PDS and 1-PDS sutures. Twenty menisci (60 sutures) were tested for each suture material. Sutures were placed 3 to 4 mm from the peripheral edge of the meniscus with double barreled cannulas for vertical and horizontal mattress techniques or a spinal needle for the mulberry knot technique, reproducing clinical techniques of meniscal repair. Mechanical testing of suture fixation was performed to failure at a rate of 10 mm/min on a MTS material testing system (MTS Systems Corp. Minneapolis, MN). Suture pullouts were reported as the load displacement to failure from the inner fragment only, because clinical failure would ensue should a suture pull through the inner fragment of a tear. Vertical mattress technique with 1-PDS suture had significantly greater load to failure than any other combination (P < .05). Analysis of variance showed that the vertical mattress technique had statistically superior pullout strength (P < .0001) compared with the horizontal mattress and mulberry knot techniques, which were statistically similar. There were significant differences (P < .0001) between suture types, with 1-PDS proving best compared with 0-PDS, which was stronger than 2-0 Ethibond. Selection of suture material had the greatest impact on vertical mattress load to failure and was not important to the strength of the other techniques.     

Organization of intensive care units in Europe: lessons from the EPIC study

Objective: To study differences related to intensive care unit (ICU) structure and patient demography between the various countries of Western Europe. Design: Application of data collected by the European Prevalence of Infection in Intensive Care (EPIC) study, a one-day prevalence study. Setting: Voluntary participation of all Western European ICUs. A total of 1417 ICUs responded. Patients: All patients, older than 10 years of age, occupying a bed in the participating ICUs over a 24-h period. 10 038 patient case reports were submitted. Results: The study revealed important differences. In particular, there seems to be a north/south divide with fewer ICU beds and more severely ill patients in the south. The United Kingdom seemed more similar to southern European countries than to the north. Conclusion: While there are similarities between European countries, large differences still remain and are important to identify to enable us to work together to create a more uniform system of intensive care, which will in turn give more effective and efficient patient care. Received: 7 February 1997 Accepted 8 July 1997     

Evaluation of ciprofloxacin versus amoxicillin + clavulanic acid or erythromycin for the empiric treatment of community-acquired pneumonia

For the empiric management of community-acquired pneumonia, ciprofloxacin (750 mg b.i.d.) was compared with two antibiotics frequently used in this indication, i.e., amoxicillin + clavulanic acid and erythromycin. One hundred and forty-two patients were randomized in this prospective study. Among them, the 63 patients with bacteriologically documented disease were evaluated. Clinical recovery was achieved in 73.3% of patients in the ciprofloxacin group (22/30) versus 81.8% of patients in the amoxicillin + clavulanic acid or erythromycin group (27/33) (non-significant difference). Clinical failures seen with ciprofloxacin were found to be correlated with recovery of Streptococcus pneumoniae. Ciprofloxacin is effective in pneumonia but should be used only in cases where Streptococcus pneumoniae can be excluded as the causative agent.     

Reoperation for prosthetic heart valve replacement

From 1974 to 1984, 847 heart valve replacement operations were performed with 1005 prosthetic valves. Thirty-nine (4.6%) were reoperations with 43 prosthetic valve replacements (PVR), on 38 patients. Thirty-three patients had received their initial valve replacement in our hospital and 5 elsewhere. Twenty additional cardiac procedures were required, concomitantly with the prosthesis replacement. Twenty-three patients underwent replacement of a mechanical prosthesis (61%) an average of 4.3 years after initial implantation and 15 patients a bioprosthesis (39%) after 2.8 years. Indications for PVR were endocarditis in 15 patients (39%), prosthesis failure in 13 (34%), periprosthetic leak in 7 (18%), thrombosis in 2 (5%), and a left ventricle subannular aneurysm in 1 (3%). Preoperatively 4 patients were in NYHA functional class II (11%), 15 in class III (39%) and 19 in class IV (50%). Six patients died early postoperatively (15.8%) Various risk factors were analyzed. The early mortality rate was 22% for mechanical prosthesis replacement and 7% for bioprosthesis; 11% for aortic position, 13% for mitral position and 50% to 100% for double valve replacement; 23% for non-elective and 6% for elective operations; 10% for patients with only an initial valve replacement and 43% with additional previous valve operations; 18% for active endocarditis, 15% for prosthesis failure, 14% for periprosthetic leak, 0% for thrombosis and 100% for subannular aneurysm; 0% for patients in class II, 7% in class III and 26% in class IV; 6% in patients with an aortic cross-clamp time less than 2 hours and 24% with more; 27% prior to 1981 and 9% during the last 4 years; and finally 50% in patients over the age of 60.(ABSTRACT TRUNCATED AT 250 WORDS)     

Distribution of phenylethanolamine-N-methyltransferase (PNMT)-immunoreactive neurons in the avian brain

The distribution of neurons immunoreactive to tyrosine hydroxylase and phenylethanolamine-N-methyltransferase (PNMT) were described in adjacent sections of the avian medulla oblongata. PNMT-positive neurons were found in two bilaterally symmetrical columns in the ventrolateral and dorsomedial medulla. Within the ventrolateral column, PNMT cells were centered in and around the lateral paragigantocellular and lateral reticular nuclei. In the dorsomedial medulla, PNMT neurons were concentrated within and around the nucleus of the tractus solitarius. The distribution of PNMT-immunoreactive neurons in the avian medulla is similar to those observed in mammals, except there appears to be a greater number of PNMT-positive cells in the bird.     

Is the beta3-adrenoceptor (ADRB3) a potential target for uterorelaxant drugs?

The management of premature birth still remains unsatisfactory. Since the relative lack of efficiency and/or safety of current tocolytic agents have been highlighted, it is necessary to develop new uterorelaxant drugs deprived of important maternal and foetal side effects. Our work reported in this review focuses on a potential new target for tocolytic drugs, the beta3-adrenoceptor (ADRB3). This third type of ADRB is shown to be present and functional in human myometrium. We demonstrated that ADRB3 agonists are able to inhibit in-vitro spontaneous contractions of myometrial strips, via a cyclic AMP-mediated pathway. Furthermore, we established that ADRB3 is the predominant subtype over the ADRB2 in human myometrium and that its expression is increased in near-term myometrium, compared to non-pregnant myometrium. Finally, we reported that contrary to ADRB2, the human myometrial ADRB3 is resistant to long-term agonist-induced desensitisation. These compelling data confirm the clinical potential interest of ADRB3 agonists in the pharmacological management of preterm labour.     

Regional anaesthesia in ambulatory surgery

Regional anaesthesia provides many advantages and can be practised safely in ambulatory surgery. It provides better postoperative pain control, avoids many complications associated with general anaesthesia and shortens recovery time. However, extra time required, associated complications and acceptance of patients are the factors of concern in practising regional anaesthesia in an ambulatory setting. This review will discuss various regional anaesthesia techniques suitable for outpatients.     

Potential risk factors for infection with Candida spp. in critically ill patients

The incidence, risk factors and prognostic factors for candidal infection were determined in a prospective study of 280 infected patients. Thirty-one (11%) patients were infected with Candida spp., sub-divided into 18 (58%) with C. albicans, and 13 (42%) with non-albicans spp. (six C. glabrata, three C. parapsilosis, and one each of C. krusei, C. tropicalis, C. guilliermondii and C. lusitaniae). Infection with Candida spp. was always associated with concurrent bacterial infection. By univariate logistic regression analysis, the degree of morbidity and the duration of mechanical ventilation were independent predictive factors for death, but infection with Candida spp., was not. Factors associated with Candida spp. infection were the degree of morbidity, intensive care unit length of stay, alterations of immune response, and the number of medical devices involved. By multivariate logistic regression analysis, the only independent risk factor for candidal infection was intensive care unit length of stay.     

The immune response of Drosophila melanogaster

Summary:  The response of the fruit fly Drosophila melanogaster to various microorganism infections relies on a multilayered defense. The epithelia constitute a first and efficient barrier. Innate immunity is activated when microorganisms succeed in entering the body cavity of the fly. Invading microorganisms are killed by the combined action of cellular and humoral processes. They are phagocytosed by specialized blood cells, surrounded by toxic melanin, or lysed by antibacterial peptides secreted into the hemolymph by fat body cells. During the last few years, research has focused on the mechanisms of microbial recognition by various pattern recognition receptors and of the subsequent induction of antimicrobial peptide expression. The cellular arm of the Drosophila innate immune system, which was somehow neglected, now constitutes the new frontier.