Surgical debridement of craniocervical necrotizing fasciitis: the window of opportunity

Craniocervical necrotizing fasciitis (CCNF) has a potentially high morbidity and mortality. Late presentation, shock and disseminated intravascular coagulation are associated with a particularly poor prognosis. Early recognition and aggressive treatment is advised. A case report is presented of a late presentation of necrotizing fasciitis of the face, neck and anterior thoracic wall. Despite adverse prognostic indicators, surgical debridement was performed. Intensive medical treatment included continuous renal replacement therapy and intravenous immunoglobulin. Survival in this case illustrates that the window of opportunity for surgically treating CCNF extends to the advanced stages of the disease, albeit with increased morbidity.

Scarring in external dacryocystorhinostomy: fact or fiction?

PURPOSE

To determine patients' long-term satisfaction with external dacryocystorhinostomy (DCR) with respect to the visibility of the scar and the resolution of symptoms.

METHOD

A single postal questionnaire with stamped addressed envelope for reply was sent to 204 sequential external primary DCR patients operated on by AAM from January 1999 to April 2002.

RESULTS

Of the 79% who replied, 67% rated the scar as invisible with 97% happy with the scar. In 92% the epiphora was either improved or cured and 85% would recommend the operation. Younger patients were significantly more likely to rate the scar as visible but equally likely to rate the scar as good or better. Women were no more likely than men to rate the scar as visible, but if visible, were more likely to consider the scar poor.

CONCLUSIONS

There was an excellent response rate for a single questionnaire. Patient satisfaction with the DCR scar is very high, with the majority considering the scar invisible. Only 3% remained unhappy with the scar. Overall patient satisfaction with external DCR is very high, for the majority of patients the procedure is effective, and 85% would recommend the operation.

Haplotype analysis of the SDF-1 (CXCL12) gene in a longitudinal HIV-1/AIDS cohort study

The stromal-derived factor-1 (SDF-1) chemokine gene encodes the only natural ligand for CXCR4, the coreceptor for the pathogenic X4 HIV-1 strains. A single-nucleotide polymorphism (SNP) in the 3' untranslated region (SDF1-3'A=rs1801157) of SDF-1 was reported to be protective against infection and progression in some, but not other, epidemiological studies. To identify additional alleles that may influence HIV-1 infection and progression to AIDS, nine SNPs (including rs1801157) spanning 20.2 kb in and around the SDF-1 gene were genotyped in over 3000 African American (AA) and European American (EA) participants enrolled in five longitudinal HIV-1/AIDS natural cohort studies. Six or five haplotypes were present at frequencies greater than 5% in AA or EA, respectively. Six of the nine SNPs occur on only one common haplotype (>5%), while the remaining three SNPs were found on multiple haplotypes, suggesting a complex history of recombination. Among EA, rs754618 was associated with an increased risk of infection (OR=1.50, P=0.03), while rs1801157 (=SDF1-3'A) was associated with protection against infection (OR=0.63, P=0.01). In the MACS cohort, rs1801157 was associated with AIDS-87 (RH=0.31, P=0.02) and with death (RH=0.18, P=0.02). Significant associations to a single disease outcome were found for two SNPs and one haplotype in AA.

Evaluation of red blood cells stored at -80 degrees C in excess of 10 years

BACKGROUND

RBCs frozen in 40 percent (wt/vol) glycerol are currently approved by the FDA and the AABB for storage at -80 degrees C for up to 10 years.

STUDY DESIGN AND METHODS

This study examined 20 RBC units that had been cryopreserved in 40 percent (wt/vol) glycerol and stored at -80 degrees C for up to 22 years. Measures of the freeze-thaw-wash (FTW) recovery, ATP, 2,3-DPG, methemoglobin, RBC indices, morphology, and osmotic fragility were made immediately after deglycerolization and after 24 hours of storage at 4 degrees C.

RESULTS

RBCs frozen for longer than 10 years had acceptable mean FTW recovery, normal oxygen transport function, RBC morphology, RBC indices, methemoglobin, and osmotic fragility. Statistical analysis indicated that the in-vitro viability and function of cryopreserved RBCs was not dependent on the length of frozen storage or postthaw storage at 4 degrees C but did correlate with the storage length at 4 degrees C before cryopreservation.

CONCLUSION

The data reported in this study demonstrate that RBCs can be stored at -80 degrees C beyond 10 years with acceptable in-vitro quality and suggest that more defined criteria for the cryopreservation process be adopted.

Electrochemical hydrodehalogenation of 2,4-dibromophenolin paraffin oil using a solid polymer electrolyte reactor

A new technology for remediation of halogenated organics-oil systems, which can cause serious environmental problems, has been demonstrated using the electrochemical hydrodehalogenation of 2,4-dibromophenol (DBP) in paraffin oil in a solid polymer electrolyte reactor. The reactor has been evaluated in terms of cathode materials and structure and the ratio of the cathode surface area to the solution volume. A cathode of titanium minimesh with a palladium electrocatalyst produced by electrodeposition was particularly effective. Current efficiencies of up to 85% and percentage of DBP removal of up to 62%, space-time yields of up to 7.6 kg DBP m(-3) h(-1), and energy consumption as low as 1.6 kW h (kg of DBP)(-1) were achieved. The reactor showed stable operation for periods of up to 170 h. The results demonstrated that electroreduction could be an alternative technology to electrooxidation forthe treatment of wastes and toxic halogenated compounds, making the process simpler in comparison to electrooxidation.