Abstract Introduction The management and removal of thoracostomy tubes for trauma-related hemothorax and pneumothorax is controversial. General recommendations exist; however, institutional data related to an algorithmic approach has not been well described. The difficulty in establishing an algorithm centers about individualized patients’ needs for subsequent management after thoracostomy tube placement. In our institution, we use the same protocol for all trauma patients who receive a thoracostomy tube with minimal complications. Purpose To present the clinical outcomes of patients who required a tube thoracostomy for traumatic injury and were managed by an institutional protocol. Methods A retrospective chart review of 313 trauma patients at a single level I trauma institution from January 2008 through June 2012 was conducted. Inclusion criteria were patient age ≥ 18 years, involvement in a trauma, and requirement of a thoracostomy tube. The patients’ charts were reviewed for demographic data, injury severity score (ISS), length of stay (LOS), and chest-tube specific data. Thoracostomy tube complications were defined as persistent air leak, persistent pneumothorax, recurrent pneumothorax, and clotting of thoracostomy tube. The patients were managed per our institutional algorithm. Descriptive statistics were performed. Results Most of the patients who required a thoracostomy tube had blunt-related traumas (271/313; 86.6%), while 42 patients (13.4%) sustained penetrating injuries. There were 215 (68.7%) male patients. The average age at time of injury was 45.7 ± 21.1 years and the mean ISS was 24.9 ± 15.9 (mean ± SD). Elevated alcohol levels were found in 65 of the 247 patients who were tested upon admission (26.3%). Overall, 15 patients (4.8%) developed a thoracostomy tube related complication: persistent air leak in six patients, persistent pneumothorax in six patients, recurrent pneumothorax in two patients, and clotted thoracostomy tube in one patient. The average LOS was 10.4 ± 8.4 days, and the mean length of thoracostomy tube placement was 5.9 ± 4.3 days. Conclusions Our algorithmic thoracostomy tube management protocol resulted in a complication rate of 4.8%. By managing thoracostomy tubes in a systematic manner, our patients have improved outcomes following placement and removal compared to other studies.
Background: Lower capsular contracture rates have been observed with peri-prosthetic fat grafting. We investigated the effect of fat grafting on capsular characteristics and peri-prosthetic collagen density, content, and fiber alignment. Methods: Forty miniature tissue expanders were placed on the backs of 20 rats. After four weeks, both inguinal fat pads were harvested, homogenized, and injected into peri-prosthetic tissue of the right tissue expander (fat graft) while the left served as control. The animals were killed at three (10 rats) and 12 weeks (10 rats), and full thickness peri-prosthetic samples were histologically processed for morphology (H&E) and collagen type and content (picrosirius red). Results: An 8.1% increase in adipose peri-prosthetic thickness was associated with a 10% decrease in collagen content at any time point ( P = 0.004). Fat-grafted capsules displayed a 59% reduction in % total collagen when compared with controls ( P < 0.001). There were no differences in capsular thickness. Fat-grafted samples were 54 times more likely to have a higher inflammation score and 69 times more likely to have a lower capsular density score than their nongrafted counterparts ( P < 0.001 and P = 0.001, respectively). The extent of inflammation decreased over time in all samples ( P = 0.002). Additionally, fat-grafted samples were 67 times more likely to have a lower fiber alignment score than the controls ( P < 0.001). Conclusions: Enhancement of peri-prosthetic tissue with fat grafting decreases collagen content, density, and fiber alignment of implant capsules. These findings support clinical application of fat grafting in prosthetic breast surgery to potentially decrease capsular contracture.
Hyperemesis gravidarum (HG) is reported in 0.5-2% of all pregnancies. The purpose of this research was to evaluate the relationship of maternal HG, neonatal birth weight, and birth outcomes.This is a prospective cohort study of 45 patients diagnosed, by Fairweather's criteria, with HG compared with 306 non-HG control pregnant patients with singleton pregnancies. Sociodemographic and clinical data were obtained from the pregnant patients. Neonatal data were also collected, including indicators of neonatal wellness.Significantly higher incidences of being nonwhite (33% vs 16%; p < .05) and of attaining post-high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 +/- 0.3 kg (mean +/- SEM) relative to mothers in the HG group (10.6 +/- 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23 +/- 0.09 kg vs 3.52 +/- 0.03 kg), younger gestational age (38.4 +/- 0.3 weeks vs 39.7 +/- 0.1 weeks), and a greater length of hospital stay (2.9 +/- 0.5 days vs 1.8 +/- 0.1 day), relative to infants from the control group. After undergoing multivariate analysis, HG was a significant predictor of decreased gestational age and increased hospital length of stay.Infants born of women who had HG are more likely to experience decreased gestational age and increased length of hospital stay. Efficacy of early and aggressive treatment of HG, including nutrition support, in minimizing these outcomes needs to be studied.
A 2-year retrospective study of aetiology, age distribution, seasonal variation and antimicrobial sensitivity patterns of bacteria isolated from patients with meningitis in five Johannesburg hospitals for White, Black, Coloured and Asian patients was performed. Neisseria meningitidis was isolated most frequently, followed by Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli and Streptococcus group B. In the Black population 73% of the meningococcal infections occurred in patients over 3 years of age, and the majority of these infections were caused by serogroup A organisms. Virtually all (93%) of the H. influenzae infections occurred in children of less than 3 years of age. Of the isolates tested, 16% of the meningococci, 4,5% of the H. influenzae and 47% of the pneumococci were resistant to sulphadiazine, ampicillin and penicillin respectively.
A monoclonal antibody was produced against the nuclear casein kinase II (PK-N2)* isolated from rat liver. The antibody was of the IgM class, and showed immunoreactivity towards the higher molecular weight subunit (41K Da) of the protein kinase in Western blots. The antibody was equally reactive towards the PK-N2 isolated from rat ventral prostate indicating that it can recognize the enzyme from different tissues of the rat. The antibody also detected the cytosolic casein kinase II (CK-2) suggesting significant similarity of the antigenic domains in the two forms of this protein kinase. No binding was detected with the nuclear or cytosolic casein kinase I (PK-N1 and CK-1). The antibody did not inhibit the enzyme activity or directly precipitate the enzyme, but when coupled to an affinity matrix and cross-linked with dimethylpimelimidate, it was capable of removing nearly all the PK-N2 activity from solution.
We aim to investigate the benefit of patent foramen ovale (PFO) closure in older patients with embolic stroke of undetermined source (ESUS). Patients were carefully selected after an evaluation by a group of neurologists and cardiologists.
We evaluated the differential effects of feeding two very-low-calorie diets upon the fractions of plasma and urinary carnitine in obese females. Ten subjects received either diet D1, a 420 kcal/day formula diet, or diet D2, a 500-600 kcal/day meat/fish/poultry diet. Plasma and urinary carnitine levels were determined at the start of the study. After 1 month, plasma carnitine levels were obtained; at 2 months, both plasma and urinary carnitine levels were obtained. Subjects receiving diet D2 showed significantly higher levels of plasma total carnitine over the course of the study (p less than 0.05). Plasma short-chain acylcarnitine esters increased and free carnitine declined significantly in both groups during the study period. Subjects receiving D1 excreted significantly less urinary carnitine than those receiving D2. We conclude that long-term ingestion of very-low-calorie diets causes alterations in plasma carnitine metabolism.
