Penetrating colon trauma-the effect of concomitant small bowel injury on outcome

INTRODUCTION

There is limited evidence to suggest that patients with penetrating colon injury have higher complication rates when there is concomitant small bowel (SB) injury.

AIM

We performed a retrospective study looking at outcomes of penetrating colonic trauma in patients with- and without concomitant SB injury.

METHODS

We interrogated our electronic registry over an eight-year period (2012-2020) for all patients over 18 years who had sustained penetrating colon injury and who had survived beyond 72 h. Demographic data, admission physiology, and Injury Severity Score (ISS) were recorded. Two groups of patients were observed: those with colonic injury (no SB injury) and those with combined colon and SB injury. Outcomes observed included leak rates, length of Intensive Care Unit (ICU) stay, length of hospital stay (LOS), morbidity and mortality.

RESULTS

A total of 450 patients were eligible for analysis, of which 257 had colon injury without SB injury and 193 had a combination of colon and SB injury. There was no difference in mechanism of injury between groups. Admission physiology was similar between groups but arterial blood gas values were worse in the combined group. Rates of damage control surgery and ICU admission were higher in the combined group. Primary repair was done in equal proportions between groups but anastomosis was more frequently performed in the combined group. There was no difference in complication rates, including gastro-intestinal complications and suture line leaks. Length of ICU stay, LOS, and mortality were similar between groups. Univariable analysis demonstrated that the presence of concomitant small bowel injury was not an independent risk factor for colonic suture line failure or death.

CONCLUSION

There is no evidence from this data that the presence of a combined penetrating colon and SB injury should change management priorities. Each injury should be treated on its own merit, in the context of the patient's physiology.

Does auxin binding protein 1 control both cell division and cell expansion?

The Auxin-Binding Protein 1 (ABP1) was identified over 30 years ago thanks to it's high affinity for active auxins. ABP1 plays an essential role in plant life yet to this day, its function remains 'enigmatic.' A recent study by our laboratory shows that ABP1 is critical for regulation of the cell cycle, acting both in G(1) and at the G(2)/M transition. We showed that ABP1 is likely to mediate the permissive auxin signal for entry into the cell cycle. These data were obtained by studying a conditional functional knock-out of ABP1 generated by cellular immunization in the model tobacco cell line, Bright Yellow 2.

Accuracy of the WASCA Aberrometer Refraction Compared to Manifest Refraction in Myopia

PURPOSE

To evaluate the accuracy of myopic refraction by a single measurement using the Wavefront Supported Custom Ablation (WASCA) aberrometer (Carl Zeiss Meditec AG, Jena, Germany).

METHODS

We retrospectively compared the refractive errors obtained by manifest refraction and wavefront refraction (WASCA) in 50 eyes of 25 consecutive myopic patients undergoing laser refractive surgery. The sphere ranged from -1.00 to -8.25 diopters (D) and cylinder from 0 to -3.75 D. WASCA measurements under cycloplegia were made and WASCA refractions calculated for a 6-mm analysis zone using the Seidel method within the WASCA. We used the manifest refraction as our best estimate of the true refractive error, therefore accuracy was defined as the difference between manifest refraction and that of the WASCA. Correlation coefficients and mean vector errors between manifest and WASCA refraction were calculated.

RESULTS

High correlation was shown between manifest and WASCA refractions, with correlation coefficients (R2) of 0.97, 0.85, and 0.79 for M, J180, and J45, respectively. Mean power vector error (standard deviation) was 0.22 D (0.39), +0.03 D (0.21), and +0.03 D (0.13) for M, J180, and J45, respectively. Total dioptric power vector error was 0.43 D with 74% eyes within 0.50 D.

CONCLUSIONS

When measuring normal myopic eyes, the concordance between manifest and WASCA refractions was found on average to be high; however, outlier measurements occurred.

A New Night Vision Disturbances Parameter and Contrast Sensitivity as Indicators of Success in Wavefront-guided Enhancement

PURPOSE

To determine the level of success of wavefront-guided repair of night vision disturbances after conventional (Munnerlyn) myopic LASIK using a new parameter to describe higher order aberrations, and to compare the improvements to matched myopic LASIK controls who were symptom-free.

METHODS

We developed a single parameter metric to represent raw spherical aberration (RAWS) to functionally describe the cumulative spherical aberration for an eye over a range of physiological pupil sizes. To derive the RAWS parameter, spherical aberration is plotted over pupil analysis zones from 3000 to 6000 microm. The RAWS parameter (unit = microm2) is then equal to the area under the plot. Sixteen eyes treated for night vision disturbances by wavefront-guided repair were each compared to the mean of four matched control eyes (total 64 eyes) treated by aspheric myopic ablation and without night vision disturbances. Contrast sensitivity and RAWs parameter for spherical aberration were determined for each of the repair eyes and control eyes before and after surgery.

RESULTS

Following wavefront-guided repair, 76% of eyes were subjectively reported to have night vision disturbances improved by at least 80%. The percentage of eyes within normal contrast range increased from 25% to 80% following wavefront-guided repair (P < .05). For the control eyes, LASIK increased RAWS by 126% (RAWS was 122 microm2 preoperatively and 276 microm2 postoperatively). For the night vision disturbances repair eye group, RAWS at presentation was 104% (563 microm2) above the respective postoperative RAWS control eyes. Following wavefront-guided repair, RAWS was decreased (P < .05) to only 49% (410 microm2) above the postoperative control group.

CONCLUSIONS

The RAWS parameter enabled a single digit descriptor of overall higher order aberrations for an eye over the principal physiological pupil range. By comparing RAWS parameter changes in wavefront-guided repair eyes to matched postoperative asymptomatic eyes, we were able to determine the magnitude of the deficit in the symptomatic eyes and the relative efficacy of wavefront-guided repair.