Showing papers by "British Hospital published in 2002"

The principle of helical implants. Unusual ideas worth considering.

Abstract: The clinical use of helical implants (implants extruded over helical paths either periosteal (plates / internal fixators) or intramedullary implants for bone fixation is presented. A helical nail permits more degrees of freedom when choosing an entry point. With a helical periosteal device it is possible to position an implant on different aspects of bone (for instance, laterally in the proximal part of the bone or anteriorly in the distal part of the bone). These options have proven particularly useful when attempting to avoid damage to the vascular system of the femoral head and when performing MIPO bridge plating of humeral shaft fractures. Helical implants open up a new and still unexplored field in bone fixation. Early results have been very encouraging. It is hoped that indications for its use will broaden once the international community of orthopaedic surgeons realizes its existence and its major innovative features.

Necrotizing gangrene of the genitalia and perineum.

Abstract: Background Necrotizing gangrene of the genitalia and perineum is a fulminant, life-threatening condition. This infection is usually polymicrobial and may be idiopathic or secondary to local trauma or surgery. Histologically, it is characterized by obliterative endarteritis and thrombosis of the subcutaneous vessels, fascial necrosis, and leukocytic infiltration. Mortality rates of 25–75% have been reported. Most cases of necrotizing gangrene begin insidiously, with scrotal discomfort and malaise. Later, erythema, increasing pain, and swelling, associated with fever and chills, develop. A biopsy is useful to confirm the clinical diagnosis and to obtain culture samples. Ultrasound imaging may reveal gas or testicular involvement and may help to distinguish this infection from other causes of scrotal pathology. Materials and methods Fifteen patients with necrotizing gangrene of the genitalia and perineum, seen at the Dermatology and Plastic Surgery Sections of our Institutions between 1994 and 1999, are described. Results This series included 11 men (73%) and four women (27%), aged 39–68 years (mean, 51 years). In our series, Clostridium perfingens, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Streptococcus viridans, Acinetobacter baumani, Escherichia coli, and Candida albicans were isolated. Hemodynamic stabilization and monitoring were performed in all patients. Intravenous antimicrobial therapy was promptly instituted. In most cases, two or more drugs were used. Concurrent surgical debridement of all necrotic areas was always required. When needed, split-thickness skin grafts were used to cover the penile shaft. Expanded mesh grafts were used to reconstruct the vulva and other denuded beds. The survival rate in this series was 87%. Conclusions Necrotizing gangrene of the genitalia and perineum continues to be a diagnostic and therapeutic challenge. The usual polymicrobial infection with vascular involvement demands hemodynamic stabilization, systemic antimicrobial therapy, and surgical debridement. In some patients, genital, perineal, and abdominal wall reconstruction is also required.

Higher oxidation and lower antioxidant levels in peripheral blood plasma and bone marrow plasma from advanced cancer patients.

Abstract: BACKGROUND Bone marrow (BM) is an important tissue in the generation of immunocompetent and peripheral blood cells. The precursors of hematopoietic cells in BM undergo continuous proliferation and differentiation and are highly vulnerable to acute and chronic oxidative stress. Little is known about the oxidant and antioxidant status in the BM of untreated patients with nonhematologic tumors. In this study, oxidative stress was evaluated in peripheral blood plasma (PBP) and BM plasma (BMP) from lung carcinoma (LC) and breast carcinoma (BC) patients. METHODS The sample included 13 consecutive untreated LC patients, 15 BC patients, and 11 healthy controls. Luminol-dependent chemiluminescence was used to evaluate oxygen radical generation by peripheral blood neutrophils. Lipid oxidation, assessed by 2-thiobarbituric acid-reactive substances (TBARS), and α-tocopherol, β-carotene, and total ubiquinol-10 levels were determined in PBP and BMP. RESULTS In LC and BC patients, neutrophil chemiluminescence was higher (128% and 264%, respectively) than in controls (P < 0.05). In cancer patients, TBARS levels were higher in both PBP (51% and 243% for LC and BC patients, respectively) and BMP (66% and 305% for LC and BC patients, respectively) than in plasma from controls (P < 0.01). α-Tocopherol and total ubiquinol-10 levels were significantly lower in BMP from BC patients compared with controls. In BC patients, α-tocopherol content in PBP was significantly lower than in controls. CONCLUSIONS Untreated cancer patients presented an imbalance between oxidant generation and lipid-soluble antioxidant levels in favor of the former. Cancer 2002;94:3247–51. © 2002 American Cancer Society. DOI 10.1002/cncr.10611

Evaluation of the Society for Coronary Angiography and Interventions' lesion classification system in 14,133 patients with percutaneous coronary interventions in the current stent era.

Abstract: We recently showed that the ACC/AHA coronary lesion classification could be simplified with no loss of predictive value (SCAI I = patent/non-C; SCAI II = patent/C; SCAI III = occluded/non-C; SCAI IV = occluded/C). We now test this system in a database reflecting current stent usage. Data from 14,133 patients with single-native-vessel interventions recorded in the Society for Coronary Angiography and Interventions (SCAI) Registry from July 1996 to July 1999 were analyzed. Stents were used in 60.2% of procedures. Logistic models predicting angiographic success suggested a slight, clinically insignificant preference for the SCAI classification (c-statistic = 0.692 vs. 0.670). Models using clinical variables to predict major complications were superior to models using only lesion classification. Lesion characteristics were related to outcomes primarily in elective (not acute myocardial infarction) patients. In the current PCI device era, the simpler SCAI classification using 7 variables predicted interventional success and complications as well as or better than the ACC/AHA system requiring 26. Cathet Cardiovasc Intervent 2002;55:1–7. © 2002 Wiley-Liss, Inc.

Dysthyroid optic neuropathy (DON).

Abstract: Dysthyroid Optic Neuropathy (DON) affects a small percentage of patients with Graves disease, but, when it occurs, it can cause significant and permanent loss of vision. DON is treatable if recognized early. Systemic steroids can be effective, but may cause side affects. Orbital injection of steroids may play a role in selected patients. Orbital radiation has a more permanent effect and has gained wide acceptance as a relatively non-invasive method of reversing DON. Surgery to decompress crowded orbits has been used for years and continues to be a viable approach for those patients with optic neuropathy, especially when there is significant proptosis. Optic nerve decompression can also be achieved through a transethmoidal approach.

Case report: peritoneal sarcoidosis in an unusual location.

Abstract: A 48-year-old woman underwent surgery for a lesion seen on ultrasound and interpreted as a uterine myoma. The surgery revealed multiple nodules that had seeded on the omentum, peritoneum, and ovaries. The macroscopic interpretation was either metastasis or tuberculosis. The biopsy showed noncaseating granulomas, and a diagnosis of peritoneal sarcoidosis was reported. The AFB (acid fast bacillus) and Lowenstein-Jensen culture were negative. She was treated with methylprednisolone for 1 year for pulmonary sarcoidosis progression, with a resulting decrease in her DLCO (diffusing lung capacity for carbon monoxide). Computed tomography showed only a slight decrease in the multiple nodules and cysts. She is currently symptom-free.