Preventing Intra-Abdominal Adhesions With Polylactic Acid Film: An Animal Study

PURPOSE The aim of this study was to evaluate the efficacy of an absorbable polylactic acid film (SurgiWrap^TM) in preventing postoperative intra-abdominal adhesions in an animal model.METHODS Forty-four female Sprague-Dawley rats underwent laparotomy with subsequent cecal wall abrasion and abdominal wall injury. Rats were divided equally between untreated and treated groups. Treated rats had a polylactic acid film (SurgiWrap^TM) placed between the cecal and abdominal wall defects. Rats in the untreated group received no barrier material. The animals were killed on postoperative day 21. Two blinded observers, using predetermined criteria, graded the cecum-to-abdominal wall adhesions and estimated the percent of cecal surface area involved in the adhesion. The adhesions were classified as absent, moderate, or severe.RESULTS Four rats died postoperatively. Of surviving rats, all of the rats in the untreated group had cecum-to-abdominal wall adhesions, whereas 42.1 percent of rats in the treated group had no adhesions between the cecum and the abdominal wall (two-tailed, P = 0.001). Altogether, 28.6 percent and 71.4 percent of untreated rats experienced moderate and severe adhesions, respectively, compared to 47.4 percent and 10.5 percent of treated rats (two-tailed, P < 0.001).CONCLUSIONS Strategic placement of polylactic acid film during abdominal surgery is associated with a significantly reduced rate and severity of postoperative intra-abdominal adhesions in this model. A technique for film placement is suggested.Macropore Biosurgery, Inc. supported this work.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 9 to 13, 2004.     

Trampoline use as physiotherapy for cystic fibrosis patients

Physicians and physiotherapists who care for CF patients have recommended the use of trampolines as a physiotherapeutic tool for enhancing cardiopulmonary performance, encouraging sputum production, and improving general well-being. Despite some therapeutic and recreational benefits associated with trampoline use, papers in the general pediatric population mostly document an increased incidence of injuries, ranging from minor trauma to spinal cord injuries and even death. The aim of this review is to examine the accumulated published data regarding the use of trampolines, to assess their potential contributions and disadvantages for CF patients, and to define whether trampoline use should be recommended. An extensive search in the published medical literature retrieved approximately 60 articles that primarily dealt with trampolines, out of which only two dealt with CF. The preponderance of these articles are reports pertaining to injuries related to the use of trampolines, with only a few describing the medical, physiologic, and/or psychological benefits of trampolines. Based on the accumulated data, the presumed benefits of trampoline use for CF patients are not proven. Furthermore, the suggested benefits could be acquired using other types of exercise. Weighing the known risks of trampolines against the potential benefits that are not unique to this modality suggests that the use of trampolines for CF should not be recommended.     

Acoustic vs. spirometric assessment of bronchial responsiveness to methacholine in children.

To study wheezing as an indicator of bronchial responsiveness during methacholine challenge (MC) in children, we used computer analysis of respiratory sounds and compared wheeze measurements to routine spirometry. MC was performed in 30 symptomatic subjects (sympt), age 11 ± 3.1 years (mean ± SD), with suspected asthma and in 12 controls (contr), age 10 ± 3.4 years. Respiratory rate (RR), spirometry, arterial oxygen saturation (Sa, _O2), and cough were registered until the concentration provoking a ≥ 20% fall in forced expiratory flow in 1 second (FEV₁; PC₂₀), or the end point (8 mg/mL) was reached. For 1 min after each inhalation, sounds over the trachea and posterior right lower lobe were recorded together with calibrated airflow. Computer analysis of respiratory sounds was used for objective wheeze quantification. Wheezing was measured as its duration relative to inspiration (T_w/T_i,) and expiration (T_w/T_e,). Seventeen of the sympt group developed wheezing (sympt/W) with ≥ T_w/T_i, or ≥ 5% T_w/T_e Thirteen of the sympt did not wheeze (sympt/no W). Three contr developed wheeze (contr/w) while 9 did not (contr/no W). In sympt/W, RR increased from 20 ± 6.2 per min at baseline to 25 ± 9.2 (P < 0.05) at the MC concentration provoking wheeze (PC_w), and Sa_O2, decreased from 97.4 ± 1.2% to 95.3 ± 2.4 (P < 0.05). In contr/W, RR did not change, but Sa_O2, decreased from 97.3 ± 1.5% to 95.7% ± 1.2% (P < 0.05). Wheezing occurred at both recording sites and was as common during inspiration as during expiration. In subjects who had both PC_w and PC₂₀, these variables correlated well (r = 0.82, P < 0.0001). Three SW did not reach PC₂₀ (maximum fall in FEV₁ 8%, 12%, and 18%). On the other hand, 6 of 13 sympt/no W and 2 of 12 contr/no W had a positive MC. Thus, wheezing during MC had a sensitivity of 68% and a specificity of 82%. Acoustic measurements were reproducible in 14 subjects who performed a second MC within 2–10 months. We conclude that wheezing during MC in children strongly suggests airway hyperresponsiveness; however, wheeze detection cannot fully replace spirometry in bronchial provocation testing. © 1993 Wiley-Liss, Inc.     

Genetic variants of WNK4 in whites and African Americans with hypertension

Human chromosome 17q has been implicated to contain a gene that influences hypertension susceptibility. This region contains the WNK4 gene that causes the mendelian disorder pseudohypoaldosteronism type II, characterized by high potassium levels and hypertension. The goal of this study was to identify genetic variants in all exons of WNK4 in hypertensive individuals and to examine the association of these variants with essential hypertension. Single-nucleotide polymorphims (SNPs) were identified by sequencing the entire coding region in 32 whites and 32 African Americans with hypertension. A single SNP in whites and 8 SNPs in African Americans were genotyped in a larger cohort of whites (165 hypertensives; 91 normotensives) and African Americans (120 hypertensives; 98 normotensives). The frequency of the rare allele differed significantly between hypertensive whites (13.0%) and normotensive whites (7.1%, P=0.040) for the single intronic SNP (bp 1 156 666). This difference remained significant after adjusting for body mass index and sex (P=0.035). Genotypic frequencies differed significantly between hypertensive and normotensive individuals when a dominant model either with (P=0.027) or without (P=0.028) covariate adjustment was assumed. The odds ratio for hypertension was 2.28 for AA or AG individuals vs those with the GG genotype (95% confidence interval, 1.09 to 4.75). No significant differences in allelic or genotypic frequencies were observed in African Americans for any SNPs. The finding in whites is consistent with the hypothesis that polymorphisms in WNK4 influence the risk of hypertension. However, because the associated SNP does not appear to be a functional variant and the limitations of case/control association studies, confirmation of these results in additional cohorts is warranted.     

Solitary eosinophilic granuloma of the pelvis in children

We present three cases of eosinophilic granuloma of the ilium in children. Imaging investigations (computed tomography and magnetic resonance imaging) did not elucidate the disease but rather revealed patterns more like malignant tumours than a benign condition. However, these investigations were of value in directing the surgeon to the correct site for biopsy.     

Fetal supraventricular tachycardia diagnosed and treated at 13 weeks of gestation: a case report.

Supraventricular tachycardia (SVT) is the most commonly encountered clinically significant tachycardia in the fetus. When SVT is sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction. Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal SVT diagnosed at 13 weeks of gestation. Treatment with digoxin and flecainide was successful; the heart rate returned to sinus rhythm within one day, and fetal hydrops resolved within 8 days of treatment. We suspect that as more first-trimester examinations are performed, more cases with SVT will be diagnosed. We discuss the treatment protocol, and suggest that co-administration of two drugs that act synergistically may be more efficient than monotherapy, which is currently used as the first line of treatment. In addition, we discuss the potentially deleterious effect of heart failure encountered at an early developmental stage on the central nervous system. More data need to be collected in order to substantiate a clear recommendation regarding optimal management.     

Still''s disease associated with adenovirus infection and defect in adenovirus directed natural killing.

Low natural killer (NK) activity towards adenovirus infected fibroblasts was detected in the peripheral blood of a child with Still's disease and was not normalised by the addition of interferon alfa or interleukin 2. NK cytotoxicity directed at K 562 target cells or polio infected fibroblasts was normal. This specific NK deficiency might have contributed to the development of the child's Still's disease.     

Dietary Acculturation Process of Israeli Women Who Immigrated to the United States as Adults

The purpose of this study was to contribute to the knowledge of the dietary acculturation of women who immigrated to the U.S. as adults from Israel. Participants (N = 6) were women of Israeli descent and lived in Massachusetts. Data was collected using interviews constructed of three parts: dietary recall, questions on causes for altering food choices, and participant observation. Qualitative analysis of the data led to identification of changes in consumption of food and beverages, weight and exercise change, food as culture, and the relocation process. We found that predisposing factors are key elements in influencing behavioral change in food consumption.