Effective wound closure with a new two-component wound closure device (Prineo™) in excisional body-contouring surgery: experience in over 200 procedures

In excisional body-contouring surgery the surgeon is often confronted with time-consuming closure of long wounds. Recently, a new combination of a self-adhering mesh together with a liquid 2-octyl cyanoacrylate adhesive (Prineo™; Ethicon, Inc., Somerville, NJ, USA) has been introduced to replace intracutaneous running suture.

A randomized comparison of microtip and air-charged catheter for the measurement of maximum urethral closure pressure

Measurements of maximum urethral closure pressure (MUCP) are a part of urodynamic investigations preceding an incontinence surgery and a part of urethral function tests.

Rapid climate change during the Weichselian Lateglacial in Ireland: Chironomid-inferred summer temperatures from Fiddaun, Co. Galway

A lacustrine sediment core from Fiddaun, western Ireland was studied to reconstruct summer temperature changes during the Weichselian Lateglacial. This site is located close to the Atlantic Ocean; and so is potentially sensitive to climatic changes associated with changes in ocean circulation. The record, comprising the end of the Weichselian Pleniglacial to the early Holocene, was analysed for fossil chironomids, lithology, and oxygen and carbon isotopes in the sedimentary carbonates. These proxies clearly show rapid warming at the onset of the Lateglacial Interstadial, relatively high summer temperatures during the Interstadial, pronounced cooling during the Younger Dryas, and subsequent warming at the transition to the Holocene. Chironomid-inferred mean July air temperatures for the Interstadial are ~12.5–14.5 °C, ~7.5 °C for the Younger Dryas, and ~15.0 °C for the early Holocene. Furthermore, this research provides evidence for at least two cold events during the Interstadial. These more moderate temperature oscillations can be correlated to Greenland Interstadial events 1b and 1d, on the basis of the age-depth model for the Fiddaun sequence. Based on multiple proxies, the first cold oscillation (GI-1d) was the more severe of the two in Ireland.

Determining gypsum growth temperatures using monophase fluid inclusions-Application to the giant gypsum crystals of Naica, Mexico

Determining the formation temperature of minerals using fluid inclusions is a crucial step in understanding rock-forming scenarios. Unfortunately, fluid inclusions in minerals formed at low temperature, such as gypsum, are commonly in a metastable monophase liquid state. To overcome this problem, ultra-short laser pulses can be used to induce vapor bubble nucleation, thus creating a stable two-phase fluid inclusion appropriate for subsequent measurements of the liquid-vapor homogenization temperature, T-h. In this study we evaluate the applicability of T-h data to accurately determine gypsum formation temperatures. We used fluid inclusions in synthetic gypsum crystals grown in the laboratory at different temperatures between 40 degrees C and 80 degrees C under atmospheric pressure conditions. We found an asymmetric distribution of the T-h values, which are systematically lower than the actual crystal growth temperatures, T-g; this is due to (1) the effect of surface tension on liquid-vapor homogenization, and (2) plastic deformation of the inclusion walls due to internal tensile stress occurring in the metastable state of the inclusions. Based on this understanding, we have determined growth temperatures of natural giant gypsum crystals from Naica (Mexico), yielding 47 +/- 1.5 degrees C for crystals grown in the Cave of Swords (120 m below surface) and 54.5 +/- 2 degrees C for giant crystals grown in the Cave of Crystals (290 m below surface). These results support the earlier hypothesis that the population and the size of the Naica crystals were controlled by temperature. In addition, this experimental method opens a door to determining the growth temperature of minerals forming in low-temperature environments.

Iatrogenic atrial septal defect, erosion of the septum primum after device closure of a patent foramen ovale as a new medical entity

Iatrogenic atrial septal defects are described in 2 patients. They occurred after implantation of Amplatzer occluders to close a patent foramen ovale. While device erosions to the extra-atrial space have been described, erosion induced atrial septal defects are a new medical entity. They may be fairly common in the situation of an atrial septal aneurysm whipping the rim of the device incessantly. They are clinically silent and benign and require echocardiography for detection. A second device solved the problem in the cases described.

Instant percutaneous closure of patent foramen ovale in patients with acute myocardial infarction and normal coronary arteries

Two young women with angiographically normal coronary arteries suffered an acute myocardial infarction. Both were found to have a patent foramen ovale (PFO), the likely pathway of a paradoxical embolus causing the infarction. The PFOs were diagnosed and closed percutaneously with an Amplatzer PFO Occluder during the emergency coronary angiography.

Analysis of stapling versus endoloops in appendiceal stump closure

BACKGROUND: The effectiveness of various appendiceal stump closure methods has not been evaluated systematically. The aim of this study was to compare the morbidity of stump closure by stapling or use of endoloops. METHODS: A non-concurrent cohort study of prospectively acquired data was performed. The primary outcome variable was the rate of intra-abdominal surgical-site infection. Secondary outcome measures were complications, duration of intervention, hospital stay, rate of readmission to hospital and the difference in direct costs of the operation. RESULTS: Staples were used in 60.5 per cent and endoloops in 39.5 per cent of 6486 patients operated on for suspected appendicitis between January 1995 and December 2003. Among 4489 patients with acute appendicitis the rate of intra-abdominal surgical-site infection was 0.7 per cent in the stapler group and 1.7 per cent in the endoloop group (P = 0.004). The rate of readmission to hospital was 0.9 and 2.1 per cent respectively (P = 0.001). CONCLUSION: Application of a stapler for transection and closure of the appendiceal stump in patients with acute appendicitis lowered the risk of postoperative intra-abdominal surgical-site infection and the need for readmission to hospital.

The correlation of urethral resistance pressure with maximum urethral closure pressure and stress incontinence

OBJECTIVE: Aim of the study was to correlate urethral retro resistance pressure with the maximum urethral closure pressure (MUCP) and functional urethral length (FUL) in patients with urinary incontinence and healthy individuals. STUDY DESIGN: Two hundred and twenty patients with the complaint of urinary incontinence had a urodynamic examination including urethral pressure profiles and URP. Additionally, 15 healthy individuals without the complaint of any incontinence had their URP and urethral pressure profiles measured. The correlation of MUCP, FUL and URP were calculated using Graph Pad Instat 4.0 for windows. RESULTS: URP correlates well with the diagnosis of urodynamic stress incontinence. Correlation coefficient between URP and MUCP is 0.9262. Healthy individuals have significantly higher values for URP and MUCP. CONCLUSION: URP is a valuable less invasive test than conventional urethral function tests for the diagnosis of urodynamic incontinence with an excellent correlation of MUCP and URP.

Atrial septal defect closure in a patient with "irreversible" pulmonary hypertensive arteriopathy

The presence of irreversible pulmonary hypertension in patients with atrial septal defect (ASD) is thought to preclude shunt closure. We report the case of a woman with plexiform pulmonary arteriopathy secondary to an ostium secundum ASD who was able to successfully undergo percutaneous shunt closure following therapy with chronic intravenous prostacyclin (Flolan). One year after closure, the patient was weaned off Flolan over a period of 7 months following the institution of oral Bosentan therapy. Our case illustrates how aggressive vasodilator therapy with prostaglandins may be capable of reducing pulmonary artery pressure and permitting shunt closure in a patient once considered to have "inoperable" pulmonary arteriopathy.