Case report: Cutaneous anthrax diagnosed using mNGS of a formalin-fixed paraffin-embedded tissue sample

The metagenomic next-generation sequencing (mNGS) method is preferred for genotyping useful for the identification of organisms, illumination of metabolic pathways, and determination of microbiota. It can accurately obtain all the nucleic acid information in the test sample. Anthrax is one of the most important zoonotic diseases, infecting mainly herbivores and occasionally humans. The disease has four typical clinical forms, cutaneous, gastrointestinal, inhalation, and injection, all of which may result in sepsis or meningitis, with cutaneous being the most common form. Here, we report a case of cutaneous anthrax diagnosed by mNGS in a butcher. Histopathology of a skin biopsy revealed PAS-positive bacilli. Formalin-fixed paraffin-embedded (FFPE) tissue sample was confirmed the diagnosis of anthrax by mNGS. He was cured with intravenous penicillin. To our knowledge, this is the first case of cutaneous anthrax diagnosed by mNGS using FFPE tissue. mNGS is useful for identifying pathogens that are difficult to diagnose with conventional methods, and FFPE samples are simple to manage. Compared with traditional bacterial culture, which is difficult to cultivate and takes a long time, mNGS can quickly and accurately help us diagnose anthrax, so that anthrax can be controlled in a timely manner and prevent the outbreak of epidemic events.

Novel endomorphin analogues CEMR-1 and CEMR-2 produce potent and long-lasting antinociception with a favourable side effect profile at the spinal level

BACKGROUND AND PURPOSE

Endomorphins have shown great promise as pharmaceutics for the treatment of pain. We have previously confirmed that novel endomorphin analogues CEMR-1 and CEMR-2 behaved as potent μ agonists and displayed potent antinociceptive activities at the supraspinal and peripheral levels. The present study was undertaken to evaluate the antinociceptive properties of CEMR-1 and CEMR-2 following intrathecal (i.t.) administration. Furthermore, their antinociceptive tolerance and opioid-like side effects were also determined.

EXPERIMENTAL APPROACH

The spinal antinociceptive effects of CEMR-1 and CEMR-2 were determined in a series of pain models, including acute radiant heat paw withdrawal test, spared nerve injury-induced neuropathic pain, complete Freund's adjuvant-induced inflammatory pain, visceral pain and formalin pain. Antinociceptive tolerance was evaluated in radiant heat paw withdrawal test.

KEY RESULTS

Spinal administration of CEMR-1 and CEMR-2 produced potent and prolonged antinociceptive effects in acute pain. CEMR-1 and CEMR-2 may produce their antinociception through distinct μ receptor subtypes. These two analogues also exhibited significant analgesic activities in neuropathic, inflammatory, visceral and formalin pain at the spinal level. It is noteworthy that CEMR-1 showed non-tolerance-forming analgesic properties, while CEMR-2 exhibited substantially reduced antinociceptive tolerance. Furthermore, both analogues displayed no or reduced side effects on conditioned place preference response, physical dependence, locomotor activity and gastrointestinal transit.

CONCLUSIONS AND IMPLICATIONS

The present investigation demonstrated that CEMR-1 and CEMR-2 displayed potent and long-lasting antinociception with a favourable side effect profile at the spinal level. Therefore, CEMR-1 and CEMR-2 might serve as promising analgesic compounds with minimal opioid-like side effects.

Auranofin-Loaded Chitosan Nanoparticles Demonstrate Potency against Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) remains a clinical challenge due to molecular, metabolic, and genetic heterogeneity as well as the lack of validated drug targets. Thus, therapies or delivery paradigms are needed. Gold-derived compounds including the FDA-approved drug, auranofin have shown promise as effective anticancer agents against several tumors. To improve the solubility and bioavailability of auranofin, we hypothesized that the nanodelivery of auranofin using biodegradable chitosan modified polyethylene glycol (PEG) nanoparticles (NPs) will enhance anticancer activity against TNBC by comparing the best nanoformulation with the free drug. The selection of the nanoformulation was based on synthesis of various chitosan PEG copolymers via formaldehyde-mediated engraftment of PEG onto chitosan to form [chitosan-g-PEG] copolymer. Furthermore, altered physiochemical properties of the copolymer was based on the formaldehyde ratio towards nanoparticles (CP 1-4 NPs). Following the recruitment of PEG onto the chitosan polymer surface, we explored how this process influenced the stiffness of the nanoparticle using atomic force microscopy (AFM), a factor crucial for in vitro and in vivo studies. Our objective was to ensure the full functionality and inherent properties of chitosan as the parent polymer was maintained without allowing PEG to overshadow chitosan's unique cationic properties while improving solubility in neutral pH. Hence, CP 2 NP was chosen. To demonstrate the efficacy of CP 2 NP as a good delivery carrier for auranofin, we administered a dose of 3 mg/kg of auranofin, in contrast to free auranofin, which was given at 5 mg/kg. In vivo studies revealed the potency of encapsulated auranofin against TNBC cells with a severe necrotic effect following treatment superior to that of free auranofin. In conclusion, chitosan-g-PEG nanoparticles have the potential to be an excellent delivery system for auranofin, increasing its effectiveness and potentially reducing its clinical limitations.

Photochemical inactivation as an alternative method to produce a whole-cell vaccine for uropathogenic Escherichia coli (UPEC)

Uropathogenic Escherichia coli (UPEC) is the primary causative agent of lower urinary tract infection (UTI). UTI presents a serious health risk and has considerable secondary implications including economic burden, recurring episodes, and overuse of antibiotics. A safe and effective vaccine would address this widespread health problem and emerging antibiotic resistance. Killed, whole-cell vaccines have shown limited efficacy to prevent recurrent UTI in human trials. We explored photochemical inactivation with psoralen drugs and UVA light (PUVA), which crosslinks nucleic acid, as an alternative to protein-damaging methods of inactivation to improve whole-cell UTI vaccines. Exposure of UPEC to the psoralen drug AMT and UVA light resulted in a killed but metabolically active (KBMA) state, as reported previously for other PUVA-inactivated bacteria. The immunogenicity of PUVA-UPEC as compared to formalin-inactivated UPEC was compared in mice. Both generated high UPEC-specific serum IgG titers after intramuscular delivery. However, using functional adherence as a measure of surface protein integrity, we found differences in the properties of PUVA- and formalin-inactivated UPEC. Adhesion mediated by Type-1 and P-fimbriae was severely compromised by formalin but was unaffected by PUVA, indicating that PUVA preserved the functional conformation of fimbrial proteins, which are targets of protective immune responses. In vitro assays indicated that although they retained metabolic activity, PUVA-UPEC lost virulence properties that could negatively impact vaccine safety. Our results imply the potential for PUVA to improve killed, whole-cell UTI vaccines by generating bacteria that more closely resemble their live, infectious counterparts relative to vaccines generated with protein-damaging methods.

IMPORTANCE

Lower urinary tract infection (UTI), caused primarily by uropathogenic Escherichia coli, represents a significant health burden, accounting for 7 million primary care and 1 million emergency room visits annually in the United States. Women and the elderly are especially susceptible and recurrent infection (rUTI) is common in those populations. Lower UTI can lead to life-threatening systemic infection. UTI burden is manifested by healthcare dollars spent (1.5 billion annually), quality of life impact, and resistant strains emerging from antibiotic overuse. A safe and effective vaccine to prevent rUTI would address a substantial healthcare issue. Vaccines comprised of inactivated uropathogenic bacteria have yielded encouraging results in clinical trials but improvements that enhance vaccine performance are needed. To that end, we focused on inactivation methodology and provided data to support photochemical inactivation, which targets nucleic acid, as a promising alternative to conventional protein-damaging inactivation methods to improve whole-cell UTI vaccines.

Treatment of hypopigmented burn hypertrophic scars with short-term topical tacrolimus does not lead to repigmentation

OBJECTIVES

Dyschromia is an understudied aspect of hypertrophic scar (HTS). The use of topical tacrolimus has successfully shown repigmentation in vitiligo patients through promotion of melanogenesis and melanocyte proliferation. It was hypothesized that HTSs treated with topical tacrolimus would have increased repigmentation compared to controls.

METHODOLOGY

Full-thickness burns in red Duroc pigs were either treated with excision and meshed split-thickness skin grafting or excision and no grafting, and these wounds formed hypopigmented HTSs (n = 8). Half of the scars had 0.1% tacrolimus ointment applied to the scar twice a day for 21 days, while controls had no treatment. Further, each scar was bisected with half incurring fractional ablative CO2 laser treatment before topical tacrolimus application to induce laser-assisted drug delivery (LADD). Pigmentation was evaluated using a noninvasive probe to measure melanin index (MI) at Days 0 (pretreatment), 7, 14, and 21. At each timepoint, punch biopsies were obtained and fixed in formalin or were incubated in dispase. The formalin-fixed biopsies were used to evaluate melanin levels by H&E staining. The biopsies incubated in dispase were used to obtain epidermal sheets. The ESs were then flash frozen and RNA was isolated from them and used in quantitative reverse transcription polymerase chain reaction for melanogenesis-related genes: Tyrosinase (TYR), TYR-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Analysis of variance test with Šídák's multiple comparisons test was used to compare groups.

RESULTS

Over time, within the grafted HTS and the NS group, there were no significant changes in MI, except for Week 3 in the -Tacro group. (+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (-Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5). Over time, within the ungrafted HTS and the NS group, there were no significant changes in MI. (+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (-Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3). LADD did not lead to any differential change in pigmentation compared to the non-LADD group. There was no evidence of increased melanogenesis within the tissue punch biopsies at any timepoint. There were no changes in TYR, TYRP1, or DCT gene expression after treatment.

CONCLUSION

Hypopigmented HTSs treated with 0.1% tacrolimus ointment with or without LADD did not show significantly increased repigmentation. This study was limited by a shorter treatment interval than what is known to be required in vitiligo patients for repigmentation. The use of noninvasive, topical treatments to promote repigmentation are an appealing strategy to relieve morbidity associated with dyschromic burn scars and requires further investigation.

Central and peripheral mechanism of MOTS-c attenuates pain hypersensitivity in a mice model of inflammatory pain

BACKGROUND

Inflammatory pain is caused by damaged tissue or noxious stimuli, accompanied by the release of inflammatory mediators that often leads to severe hyperalgesia and allodynia with limited therapy options. Recently, a novel mitochondrial-derived peptide (named MOTS-c) was reported to regulate obesity, metabolic homeostasis and inflammatory response. The aim of this study was to investigate the effects of MOTS-c and its related regulatory mechanisms involved in inflammatory pain.

METHODS

Male Kunming mice (8-10 weeks-old) were intraplantar injected with formalin, capsaicin, λ-Carrageenan and complete Freund adjuvant (CFA) to establish acute and chronic inflammatory pain. The effects of MOTS-c on the above inflammatory pain mice and its underlying mechanisms were examined by behavioral tests, quantitative polymerase chain reaction (qPCR), western blotting, enzyme linked immunosorbent assay (ELISA), immunohistochemistry (IHC) and immunofluorescence (IF).

RESULTS

Behavioral experiments investigated the potential beneficial effects of MOTS-c on multiple acute and chronic inflammatory pain in mice. The results showed that MOTS-c treatment produced potent anti-allodynic effects in formalin-induced acute inflammatory pain, capsaicin-induced nocifensive behaviors and λ-Carrageenan/CFA-induced chronic inflammatory pain model. Further mechanistic studies revealed that central MOTS-c treatment significantly ameliorated CFA-evoked the release of inflammatory factors and activation of glial cells and neurons in the spinal dorsal horn. Moreover, peripheral MOTS-c treatment reduced CFA-evoked inflammatory responses in the surface structure of hindpaw skin, accompanied by inhibiting excitation of peripheral calcitonin gene-related peptide (CGRP) and P2X3 nociceptive neurons.

CONCLUSIONS

The present study indicates that MOTS-c may serve as a promising therapeutic target for inflammatory pain.

Using Surgicel-wrapped Merocel to reduce pain during the removal of nasal packing

BACKGROUND

Merocel is a commonly used material for nasal packing; nevertheless, the majority of patients experience pain when the nasal packing is removed.Aims/Objectives: This study aims to introduce a novel technique for nasal packing using Surgicel-wrapped Merocel.

MATERIAL AND METHODS

Patients who underwent septoplasty received either Merocel or Surgicel-wrapped Merocel as nasal packing. Clinical complications related to bleeding and subjective symptoms associated with the packing materials were assessed.

RESULTS

Between 2018 and 2021, a total of thirty-three patients with a deviated nasal septum underwent septoplasty. Among them, eight patients received Merocel nasal packing, while twenty-five patients were treated with the new nasal packing technique involving Surgicel-wrapped Merocel. We observed a significant reduction in pain during removal in the Surgicel-wrapped Merocel group compared to the Merocel group (p = .008). However, no significant differences were noted in other discomforts related to packing or bleeding after removal between these two groups.Conclusions and Significance:Using Surgicel-wrapped Merocel as nasal packing following septoplasty is an effective method to alleviate pain during removal.

The risk of weekend biopsy: Impact of specimen source and fixation status on HER2 assessment in the treatment of advanced gastric cancer (The HER_WEEKEND study)

Accurate evaluation of human epidermal growth factor receptor type 2 (HER2) expression is crucial for determining chemotherapy regimens in gastric cancer. However, formalin fixation status has been identified as an important factor affecting HER2 assessment reliability. This retrospective cohort study aimed to investigate the correlation between sample collection day (weekday vs. weekend) and source (biopsy vs. surgical specimens) in assessing HER2 expression in patients with unresectable advanced/recurrent gastric cancer. Data were collected from gastric cancer patients who received chemotherapy at a single public hospital in Japan from 2008 to 2021. The analysis included 177 patients (109 men, 68 women) with a median age of 68.0 (21-88) years, and the primary outcome was the HER2 positivity rate. The overall HER2 positivity rate was 18.1%, with higher rates on weekdays (20.0%) compared to weekends (12.8%). Biopsies had higher positivity rates on weekdays (23.9%) but lower rates on weekends (11.1%) than surgical specimens. Significant differences were observed in formalin fixation times between weekdays and weekends for both biopsies and surgical samples. The study findings suggest that longer formalin fixation times on weekends may lead to underestimating HER2 expression, particularly in biopsies. Therefore, it is crucial to be cautious of excessive formalin fixation when collecting samples, especially during weekend biopsies.

HPLC and GC Characterization of Dicliptera bupleuroides Aerial Parts and Evaluation of Its Anti-Inflammatory Potential in Vitro, in silico and in Vivo Using Carrageenan and Formalin Induced Inflammation in Rat Models

The current study aimed to evaluate the anti-inflammatory activity of Dicliptera bupleuroides Nees aerial parts methanol extract and its different fractions namely hexane, chloroform, ethyl acetate and butanol in vitro using cyclooxygenase inhibitory assay (COX-2). In vivo anti-inflammatory evaluation was performed using carrageenan and formalin induced inflammation in rat models followed by molecular docking. High performance liquid chromatography (HPLC) and gas chromatography coupled with mass chromatography (GC/MS) analyses were used for chemical analyses of the tested samples. The tested samples showed significant inhibition in COX-2 inhibitory assay where methanol extract (DBM) showed the highest inhibitory potential at 100 μg/mL estimated by 67.86 %. At a dose of 400 mg/kg, all of the examined samples showed pronounced results in carrageenan induced acute inflammation in rat model at 4th h interval with DBM showed the highest efficiency displaying 65.32 % inhibition as compared to the untreated rats. Formalin model was employed for seven days and DBM exhibited 65.33 % and 69.39 % inhibition at 200 and 400 mg/kg, respectively approaching that of the standard on the 7th day. HPLC revealed the presence of caffeic acid, gallic acid and sinapic acid, quercetin and myricetin in DBM. GC/MS analysis of its hexane fraction revealed the presence of 16 compounds belonging mainly to fatty acids and sterols that account for 85.26 % of the total detected compounds. Molecular docking showed that hexadecanoic acid followed by decanedioic acid and isopropyl myristate showed the best fitting within cyclooxygenase-II (COX-II) while nonacosane followed by hexatriacontane and isopropyl myristate revealed the most pronounced fitting within the 5-lipoxygenase (5-LOX) active sites. Absorption, metabolism, distribution and excretion and toxicity prediction (ADMET/ TOPKAT) concluded that most of the detected compounds showed reasonable pharmacokinetic, pharmacodynamic and toxicity properties that could be further modified to be more suitable for incorporation in pharmaceutical dosage forms combating inflammation and its undesirable consequences.

Higher efficacy of a single dosage albendazole and different soil-transmitted helminths re-infection profiles amongst indigenous Negritos from inland jungle versus those in resettlement at town peripheries

Demarginalization through initiation of resettlement program since 1978 is an inevitable progress faced by the indigenous Orang Asli (OA) population in Peninsular Malaysia. As Malaysian huntergatherers, the Negrito has been exposed to various environmental-cultural variations. These changes may influence the pattern of soil-transmitted helminth (STH) infections, the common malady amongst OA. This study evaluated the deworming effects of single-dosage albendazole (400 mg) and STH-reinfection rate between Negritos who are still living in the inland jungle versus those living in resettlements at town peripheries (RPS). Stool samples from the consented participants were first examined using the direct faecal smear, formalin-ether sedimentation and Kato Katz techniques. Subsequently, stool collections were carried out in three time points following treatment (i.e., 21 days, 3 months and 6 months). In brief, a total number of 54 Negritos (inland: 24; RPS: 30) with a complete set of stool collection was included in this longitudinal study. This study revealed 72.2% cure rate against T. trichiura in the inland but only 15.0% in the RPS. Although the efficacy of albendazole against T. trichiura was ultimately low in the RPS, 62.6% egg reduction rate (ERR) (arithmetic mean) was noted (p = 0.001). For A. lumbricoides and hookworm, high cure rates were found in both communities (85.7-100.0%). Reinfection for T. trichiura was seen in less than 1 month with higher rate in the RPS (90.0%) as opposed to the inland (44.4%) at 21 days following treatment. This study found that the inland OA had better tolerability to single-dosage albendazole and experienced slower STH reinfection rates versus the RPS. Hence, the selection of albendazole dosage should be targeted and the use of single- dosage albendazole (biannually) would be more suitable for the inland OA. Conversely, we propose the use of 3-days albendazole regimens in the resettled RPS population.

Utilisation of semiconductor sequencing for detection of actionable fusions in solid tumours

Oncogenic fusions represent compelling druggable targets in solid tumours highlighted by the recent site agnostic FDA approval of larotrectinib for NTRK rearrangements. However screening for fusions in routinely processed tissue samples is constrained due to degradation of nucleic acid as a result of formalin fixation., To investigate the clinical utility of semiconductor sequencing optimised for detection of actionable fusion transcripts in formalin fixed samples, we have undertaken an analysis of test trending data generated by a clinically validated next generation sequencing platform designed to capture 867 of the most clinically relevant druggable driver-partner oncogenic fusions. Here we show across a real-life cohort of 1112 patients with solid tumours that actionable fusions occur at high frequency (7.4%) with linkage to a wide range of targeted therapy protocols including seven fusion-drug matches with FDA/EMA approval and/or NCCN/ESMO recommendations and 80 clinical trials. The more prevalent actionable fusions identified were independent of tumour type in keeping with signalling via evolutionary conserved RAS/RAF/MEK/ERK, PI3K/AKT/MTOR, PLCy/PKC and JAK/STAT pathways. Taken together our data indicates that semiconductor sequencing for detection of actionable fusions can be integrated into routine diagnostic pathology workflows enabling the identification of personalised treatment options that have potential to improve clinical cancer management across many tumour types.

Antinociceptive Actions of Botulinum Toxin A1 on Immunogenic Hypersensitivity in Temporomandibular Joint of Rats

Botulinum neurotoxin type A1 (BoNT-A) reduces the peripheral peptide and cytokine upregulation in rats with antigen-evoked persistent immunogenic hypersensitivity (PIH) of the temporomandibular joint (TMJ). Herein, we examined the effects of two preparations of BoNT-A, abobotulinumtoxinA (aboBoNT-A; Dysport) and onabotulinumtoxinA (onaBoNT-A; Botox), on spontaneous and evoked nociceptive behaviors, as well as on central neuronal and astroglial activation. The antigen-evoked PIH was induced in rats via repeated systemic and unilateral intra-articular (i.a.) injections of methylated bovine serum albumin (mBSA). Rats were subsequently injected with unilateral i.a. aboBoNT-A (14 U/kg), onaBoNT-A (7 U/kg), or the vehicle (saline). After i.a. treatments, spontaneous and mechanically evoked nocifensive behaviors were assessed before and after the low-dose i.a. formalin (0.5%) challenge. The central effects of BoNT-A were assessed by an immunohistochemical analysis of cleaved synaptosomal-associated protein 25 (cSNAP-25) presence, c-Fos, GFAP, and CGRP expression in the trigeminal nucleus caudalis (TNC). Both BoNT-A preparations similarly reduced the formalin-induced spontaneous pain-related behaviors and mechanical allodynia of the hypernociceptive rats. Likewise, their effects were associated with the central occurrence of cSNAP-25 and reduction of c-Fos and GFAP upregulation in the TNC. BoNT-A antinociceptive activity on the PIH is associated with the toxin axonal transport to trigeminal sensory areas and reduction of neuronal and glial activation in central nociceptive regions.

The effects of a therapeutic formalin bath on selected immunological and oxidative stress parameters in common carp (Cyprinus carpio)

Formalin is commonly used as a component of antiparasitic baths in fisheries. In this study the impact of this bath on the immune profile and oxidative stress parameters was evaluated. A formalin bath was prepared in the concentration of 185.3 mg L^-1 (0.17 mL L^-1) at a temperature of 20 °C. A total of 96 common carp Cyprinus carpio (Linnaeus, 1758) individuals were immersed in this bath for 60 min. The effects were monitored immediately, and then after 24, 48 h and 10 days following the treatment. The study revealed the most effects 10 days after the treatment, when we observed the decrease of lysozyme in skin mucus, the decrease of anti-inflammatory cytokine transforming growth factor beta in gill tissue and increase of interleukin 10 in cranial kidney tissue. The pro-inflammatory cytokine interleukin 1b showed an increase in gill tissue immediately after the bath and the increase in glutathione peroxidase in gill tissue was also observed 24 h and 10 days after bath treatment. The other investigated parameters did not show any significant changes. In conclusion, even though the formalin bath elevated some parameters as mentioned above, formalin used in the bath is probably safe as an antiparasitic treatment of fish.

Single-center experience in the surgical treatment of combined lung Echinococcosis

Objectives:

To compare results of surgical treatment and complications of patients with unilateral or bilateral thoracic and combined pulmonary echinococcosis.

Methods:

This cross-sectional analysis of a prospective study was conducted in the Department of Thoracic and Pediatric Surgery, Scientific Center of Surgery, Almaty, Kazakhstan among 598 patients with pulmonary echinococcosis, who had surgical treatment with various surgical methods, depending on the prevalence of echinococcosis, as follows: right lung in 357 (59.5%) patients, left lung in 243 (40.5%) patients, bilateral in 95 (15.8%) patients, and complicated echinococcosis in 317 (52.8%) patients. Length of stay per hospital stay has been decreased (p<0.0001) by video-thoracoscopic echinococcectomy with the high-energy laser (HEL) treatment of cyst, than after echinococcectomy by cyst treatment with povidone-iodine. Treatment with formalin presented the most longest hospital stay (p<0.0001)

Results:

Comparative analysis of patients with uncomplicated and complicated pulmonary echinococcosis showed a high frequency of postoperative complications associated with complicated echinococcosis (OR = 2.2, p<0.0001).

Conclusion:

Despite the success of surgical treatment of pulmonary echinococcosis, issues of intraoperative dissemination and safety remain, and treatment success rates can be improved. These factors require further prospective multicenter studies.

Outpatient application of formalin for chronic rectal bleeding after prostate irradiation: a quasi-experimental study

PURPOSE

The aim of this quasi-experimental study is to evaluate a novel technique for an outpatient application of formalin for chronic rectal bleeding after prostate irradiation.

METHODS

This is a quasi- experimental clinical trial developed between January 2010 and July 2015, including 35 patients with chronic radiation rectitis (CRP) due to a previous prostate radiation course. The study's eligibility was (1) completed external beam radiation therapy for prostate carcinoma >6 months previously, (2) rectal bleeding, defined as a frequency of >1× per week and/or needing of blood transfusions, and (3) diagnosis of chronic proctitis at colonoscopy. The 5% formalin application was performed by a custom applicator, which requires neither anesthesia nor sigmoidoscopy. The endpoint of the study was bleeding cessation and hemoglobin level.

RESULTS

The onset of bleeding due to chronic rectitis was 12 months (6-36). During a median follow-up of 24 months, the rate of overall efficacy was 94%. The sustained complete response in 1 and 2 years was 80% and 73%, respectively. The Hb mean pre- and post-treatment differed significantly (12.2 vs 14.4, p = 0.0001). The rates of blood transfusion differed significantly, pre- and post-treatment (17% vs 5.7%, p = 0.031).

CONCLUSION

The technique is very effective and safe, resulting to a significant improvement of hemoglobin levels and quality of life scores. Further studies are warranted to compare this technique with other treatment options for chronic radiation-induced rectal bleeding.

Comparative study between biodegradable nasopore (BNP) and Merocel hemox 10 cm after septo-turbinoplasty procedure

OBJECTIVE

The purpose of our study was to compare Merocel (Merocel Hemox 10 cm) and BNP (biodegradable nasopore) during a septoturbinoplasty procedure in terms of efficiency and patient comfort.

PATIENTS AND METHODS

We carried out a retrospective review of 72 patients who had undergone septoturbinoplasty between January 2015 and January 2016. Each group, packed with BNP or Merocel Hemox 10 cm was composed of 36 patients. A standard visual analogue scale ranging from zero (no symptoms) to 10 (the most severe symptoms) was used to assess subjective symptoms. To compare the usefulness of materials we evaluated the postoperative bleeding, infection and adhesion after the removal of packing with and endoscopic examination using a 5-point scale (zero, absent; 1, mild; 2, moderate; 3, severe; and 4, very severe). Secretions and crusts were evaluated 1 week and 4 weeks after surgery in both groups using a 5-point scale (zero, absent; 1, mild; 2, moderate; 3, severe; and 4, very severe).

RESULTS

A total of 72 patients were enrolled in the study, 45 women and 27 men; age range 15-78 with a mean age of 47 years. In the group A (Merocel group), 21 cases showed grade 1 bleeding (58%), 11 cases grade 2 (30%) and 4 patients grade 0 (11.1%). In the group B (BNP group), 29 cases showed grade 0 bleeding (80.56%) and 7 cases showed grade 1 bleeding (19.44%). There was a statistical significant difference between the Merocel group and the BNP group in terms of bleeding after removal of packing material (p < 0.05). In the group A, 16 patients developed mild adhesion (44%), 8 patients moderate adhesion (22.2%), 3 patients severe adhesion (8.33%) and 1 patient very severe adhesion (2.77%). BNP nasal packing didn't cause any adhesion in 25 patients (69.4%), 11 patients developed mild adhesion (30.5%). So there was a statistical significant difference between group A and group B regarding the adhesion (p < 0.05). There was a statistically significance reduction of nasal secretions and crusts at a week after surgery in the BNP group vs. Merocel group. The difference is not statistically significant 4 weeks after surgery. About the severity of symptoms related to nasal packing, we found a statistically significant difference (p < 0.05) between Merocel and BNP group regarding the pain during packing removal, the general satisfaction and the pressure.

CONCLUSIONS

Biodegradable nasopore reduced pain and patient discomfort during packing removal and causes less bleeding compared to Merocel hemox 10 cm. This type of material can be used after septoturbinolplasty.

Endoscopic versus external repair of orbital blowout fractures

OBJECTIVES: This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit.

STUDY DESIGN AND SETTING: This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications.

RESULTS: Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma.

CONCLUSIONS: Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.

© 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.

Non-surgical interventions for late rectal problems (proctopathy) of radiotherapy in people who have received radiotherapy to the pelvis

BACKGROUND

This is an update of a Cochrane review first published in 2002, and previously updated in 2007. Late radiation rectal problems (proctopathy) include bleeding, pain, faecal urgency, and incontinence and may develop after pelvic radiotherapy treatment for cancer.

OBJECTIVES

To assess the effectiveness and safety of non-surgical interventions for managing late radiation proctopathy.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2015); MEDLINE (Ovid); EMBASE (Ovid); CANCERCD; Science Citation Index; and CINAHL from inception to November 2015.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing non-surgical interventions for the management of late radiation proctopathy in people with cancer who have undergone pelvic radiotherapy for cancer. Primary outcomes considered were: episodes of bowel activity, bleeding, pain, tenesmus, urgency, and sphincter dysfunction.

DATA COLLECTION AND ANALYSIS

Study selection, 'Risk of bias' assessment, and data extraction were performed in duplicate, and any disagreements were resolved by involving a third review author.

MAIN RESULTS

We identified 1221 unique references and 16 studies including 993 participants that met our inclusion criteria. One study found through the last update was moved to the 'Studies awaiting classification' section. We did not pool outcomes for a meta-analysis due to variation in study characteristics and endpoints across included studies.Since radiation proctopathy is a condition with various symptoms or combinations of symptoms, the studies were heterogeneous in their intended effect. Some studies investigated treatments targeted at bleeding only (group 1), some investigated treatments targeted at a combination of anorectal symptoms, but not a single treatment (group 2). The third group focused on the treatment of the collection of symptoms referred to as pelvic radiation disease. In order to enable some comparison of this heterogeneous collection of studies, we describe the effects in these three groups separately.Nine studies assessed treatments for rectal bleeding and were unclear or at high risk of bias. The only treatments that made a significant difference on primary outcomes were argon plasma coagulation (APC) followed by oral sucralfate versus APC with placebo (endoscopic score 6 to 9 in favour of APC with placebo, risk ratio (RR) 2.26, 95% confidence interval (CI) 1.12 to 4.55; 1 study, 122 participants, low- to moderate-quality evidence); formalin dab treatment (4%) versus sucralfate steroid retention enema (symptom score after treatment graded by the Radiation Proctopathy System Assessments Scale (RPSAS) and sigmoidoscopic score in favour of formalin (P = 0.001, effect not quantified, 1 study, 102 participants, very low- to low-quality evidence), and colonic irrigation plus ciprofloxacin and metronidazole versus formalin application (4%) (bleeding (P = 0.007, effect not quantified), urgency (P = 0.0004, effect not quantified), and diarrhoea (P = 0.007, effect not quantified) in favour of colonic irrigation (1 study, 50 participants, low-quality evidence).Three studies, of unclear and high risk of bias, assessed treatments targeted at something very localised but not a single pathology. We identified no significant differences on our primary outcomes. We graded all studies as very low-quality evidence due to unclear risk of bias and very serious imprecision.Four studies, of unclear and high risk of bias, assessed treatments targeted at more than one symptom yet confined to the anorectal region. Studies that demonstrated an effect on symptoms included: gastroenterologist-led algorithm-based treatment versus usual care (detailed self help booklet) (significant difference in favour of gastroenterologist-led algorithm-based treatment on change in Inflammatory Bowel Disease Questionnaire-Bowel (IBDQ-B) score at six months, mean difference (MD) 5.47, 95% CI 1.14 to 9.81) and nurse-led algorithm-based treatment versus usual care (significant difference in favour of the nurse-led algorithm-based treatment on change in IBDQ-B score at six months, MD 4.12, 95% CI 0.04 to 8.19) (1 study, 218 participants, low-quality evidence); hyperbaric oxygen therapy (at 2.0 atmospheres absolute) versus placebo (improvement of Subjective, Objective, Management, Analytic - Late Effects of Normal Tissue (SOMA-LENT) score in favour of hyperbaric oxygen therapy (HBOT), P = 0.0019) (1 study, 150 participants, moderate-quality evidence, retinol palmitate versus placebo (improvement in RPSAS in favour of retinol palmitate, P = 0.01) (1 study, 19 participants, low-quality evidence) and integrated Chinese traditional plus Western medicine versus Western medicine (grade 0 to 1 radio-proctopathy after treatment in favour of integrated Chinese traditional medicine, RR 2.55, 95% CI 1.30 to 5.02) (1 study, 58 participants, low-quality evidence).The level of evidence for the majority of outcomes was downgraded using GRADE to low or very low, mainly due to imprecision and study limitations. 

AUTHORS' CONCLUSIONS

Although some interventions for late radiation proctopathy look promising (including rectal sucralfate, metronidazole added to an anti-inflammatory regimen, and hyperbaric oxygen therapy), single small studies provide limited evidence. Furthermore, outcomes important to people with cancer, including quality of life (QoL) and long-term effects, were not well recorded. The episodic and variable nature of late radiation proctopathy requires large multi-centre placebo-controlled trials (RCTs) to establish whether treatments are effective. Future studies should address the possibility of associated injury to other gastro-intestinal, urinary, or sexual organs, known as pelvic radiation disease. The interventions, as well as the outcome parameters, should be broader and include those important to people with cancer, such as QoL evaluations.

[Comparative study on packing with or without Merocel after endoscopic sinus surgery]

OBJECTIVE

To investigate the clinical effect of nasal packing with or without Merocel after endoscopic sinus surgery (ESS) in short and long term.

METHOD

A total of 112 patients with chronic rhinosinusitis who received endoscopic sinus surgery were randomly divided into two groups: packed group and non-packed group. In packed group, there were 37 cases, of which 10 cases were combined with allergic rhinitis and 11 cases received correction of nasal septum at the same time. In non-packed group, there were 75 cases, of which 15 cases were combined with allergic rhinitis and 26 cases received correction of nasal septum at the same time.Visual analogue score (VAS), Nasal bleeding and sinonasal outcome Test-22 (SNOT-22) were used to evaluate the clinical effect between two groups in short and long term respectively.

RESULT

The VAS of nasal obstruction, rhinodynia, dysphoria, epiphora, itching, sneeze, headache and facial pain in non-packed group were significantly lower than those in packed group (P < 0.05). Within 48 hours after ESS, the amounts of nasal bleeding were 0-45 ml (median 3 ml) in packing group and 0-18 ml (median 2 ml) in non-packing group. There were significant difference between two groups (Z = -3.54, P = 0.00). The difference value of postoperative and preoperative SNOT-22 of the packed group was 38.47 ± 20.25 and the non-packed is 41.03 ± 22.73 six months after ESS (t = 0.58, P = 0.56). Each group had one case of nasal adhesion. And as for middle turbinate dislodgement, there was one case in the packed group and two cases in the unpacked group. There was no case of nasal septum hematoma in the packed group, but two cases in the un-packed group. The results showed that there was no significant difference of clinical effect between the postoperative packing and unpacking groups.

CONCLUSIONS

It is safe and practicable to manage chronic rhinosinusitis without nasal packing after ESS, which in short term not only decrease discomfort, but also reduce nasal bleeding. Also, there is no significant difference of clinical effect between the postoperative packing and unpacking groups in long the term.

The impact of different nasal packings on postoperative complications

OBJECTIVE

The objective of this study was to find out if there is any association between the use of nasal packings and nasal synechia formation, septal perforation, postoperative infection and epistaxis in patients who underwent septoplasty and concha reduction operations.

METHODS

This retrospective study was conducted at a tertiary referral center. One hundred thirty patients were randomly selected among patients who underwent endonasal surgery in Namık Kemal University Hospital between January 1st 2012 and August 1st 2013. Retrospective analysis of these patients' files, including operative reports and follow-up notes, was done. The postoperative findings of patients who had septal splints and Merocel nasal packings were compared and analyzed for statistical significance.

RESULTS

The results of the study showed a statistically significant difference in the frequency of synechia formation between two groups (p<0.05). The frequency of synechia formation was found to be higher in the Merocel packing group. However, no statistically significant difference was found between groups in terms of postoperative infection, septal perforation, and epistaxis (p>0.05).

CONCLUSION

Our findings suggest that intranasal splints are superior to Merocel nasal packings in terms of preventing nasal synechia formation. Insertion of a septal splint after nasal surgery should be preferred to avoid this complication. On the other hand, other factors should be sought in the etiology of postoperative infection, septal perforation, and epistaxis.

Double patch technique for repairing postinfarction ventricular septal defect

We report 2 cases in which the double patch technique was used to repair an anterior postinfarction ventricular septal defect. To do this, we modified infarct exclusion as follows: In addition to a conventional patch excluding the infarcted muscle, another small patch is used to directly close the septal defect. Gelatin-resorcin-formal glue is applied between the double patches, which prevent the glue from being washed away and enhance it to polymerize stably, thereby rapidly stabilizing the infarcted myocardium with the endocardial patch. Echocardiography immediately after operation showed the infarcted septum had completely adhered to the endocardial patch. Both patients demonstrated satisfactory postoperative hemodynamics. Although 1 patient did well, the other died 6 months postoperatively due to complications of pneumonia and gastrointestinal bleeding secondary to colon carcinoma. This double patch technique appears useful, although further experience is needed to verify its safety and efficacy.

Merocel versus Nasopore for nasal packing: a meta-analysis of randomized controlled trials

Objective

To compare the clinical outcomes, including efficacy and complications, of Merocel versus Nasopore as a nasal packing material after nasal surgery.

Methods

Relevant randomized controlled trials were identified from electronic databases (The Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure and Chinese Biomedical Database). Conference proceedings and references from identified trials and review articles were also searched. Outcome measures were pain during nasal packing, pain and bleeding upon packing removal, pressure sensation, nasal blockage, formation of synechiae, mucosal healing, and patients' general satisfaction.

Results

Seven randomized controlled trials met criteria for analysis. Compared with Merocel, Nasopore significantly reduced patients' subjective symptoms including in situ pain (pain experienced while packing is in place), nasal pressure, pain and bleeding during packing removal, and increased patients' general satisfaction with nasal packing. There were no significant differences in nasal obstruction, adhesion and mucosal healing between the Merocel and Nasopore groups.

Conclusions

Preliminary evidence suggests that Nasopore may be superior to Merocel as a nasal packing material with regard to in situ pain, pain and bleeding upon removal, pressure, and general satisfaction and does not differ from Merocel in terms of nasal obstruction, tissue adhesion, and long-term mucosal healing.

[A meta-analysis compare rapid rhino with merocel for nasal packing]

OBJECTIVE

To assess the efficacy and adverse reaction of nasal packing materials Rapid Rhino and Merocel.

METHOD

We searched the database PubMed, EMBASE, Cochrane Library, CBM, CNKI, VIP and WANFANG database on line by computer, and traced the related references. Randomized controlled trials(RCTs) of rapid rhino and merocel as nasal packing materials were included. The quality of the included documents was evaluated by the criterion of Cochrane handbook 5.1. The cochrane collaboration's Revman 5.1 software was used for data analysis.

RESULT

Four RCTs involving 115 patients were identified. Meta-analyses showed that Rapid Rhino produced significantly lower pain and discomfort during insert of pack [MD = 1.37, 95% CI (0.13, 2.60), P < 0.05], whereas less pain and discomfort during removal of pack [MD = 2.88, 95% CI (2.34, 3.41), P < 0.01]. Rapid Rhino associated with a significantly slighter degree of fullness raised after insertion [MD = 1.15, 95% CI (0.75, 1.55), P < 0.01, and the same situation happened after 6 hours [MD = 1.15, 95% CI (0.75, 1.55), P < 0.01]. Rapid rhino caused to less reactionary bleeding when pack removal [MD = 0.26, 95% CI (0.12, 0.39), P < 0.01], rapid rhino was easier for the healthcare worker during insert and removal. There was no significant difference between two packs on the efficiency of hemostatic [OR = 1.00, 95% CI (0.38, 2.61), P > 0.05].

CONCLUSION

The application of Rapid Rhino caused less pain and fullness, leaded to slighter bleed than Merocel when insertion and removal. There was no significant difference between two packs on the efficiency of hemostatic when used for epistaxis or after routine nasal surgery.

Gastrointestinal mucositis: focus on the treatment of the effects of chemotherapy and radiotherapy on the rectum

In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a combination of both therapies was discussed. his article continues that discussion but in respect to the injury that these rapies cause to the gastrointestinal tract. Like oral mucositis, gastrointestinal mucositis is a significant problem in oncology, as it causes very serious pathologies along the alimentary tract, damaging the quality of life of the oncologic patient, and sometimes the damages are life-threatening. The most vulnerable organs of the gastrointestinal tract to radiation and chemotherapy toxicities are the small intestine, colon, and rectum. This article concentrates on the chronic rectum and anus toxicities of radiotherapy and escribes two compounding preparations to treat chronic radiation induced proctitis with rectal bleeding. As in oral mucositis, although substantial scientific progress has been made in learning more about this pathology, current treatments to manage gastrointestinal mucositis is inadequate.

Effect of septoplasty and per-operative antibiotic prophylaxis on nasal flora

OBJECTIVES

Septoplasty is one of the most commonly performed procedures in otolaryngology practice. Prophylactic use of antibiotics is controversial. Disruption of nasal flora may predispose individuals to infection. We investigated the effect of antibiotic prophylaxis and septoplasty on nasal flora.

METHODOLOGY

We included 115 consecutive patients who underwent septoplasty because of symptomatic nasal septal deviation. Patients were divided into study and control groups. Study patients received prophylactic parenteral sodium cefazoline twice a day beginning intra-operatively and while the nasal packing remained in the nose for 48 h, and expandable polyvinyl acetate (Merocel) packing covered with antibiotic ointment containing 0.2% nitrofurazone was inserted into each nostril at the end of the operation. Control patients received neither parenteral antibiotic prophylaxis nor antibiotic ointment around the Merocel packs. Both groups received oral prophylactic cefuroxime axetil for 5 d after nasal packing was removed. Nasal flora was determined pre-operatively, post-operatively when nasal packing was removed, and 3 mo after surgery.

RESULTS

Study patients were compared to control patients at pack removal and 1 mo after surgery The effect of antibiotic use in septoplasty on nasal flora was as follows: Increased isolation rate of gram-positive rods (p = 0.007), decreased methicillin-sensitive coagulase-negative staphylococci (p = 0.002). Pre-operative and post-operative culture results at 3 mo were compared. The effect of septoplasty on nasal flora was as follows: Decreased coagulase-negative staphylococci (p = 0.05), decreased Klebsiella (p < 0.001), decreased gram-positive rods (p < 0.001), increased methicillin-sensitive Staphylococcus aureus (p < 0.001).

CONCLUSIONS

Septoplasty increases S. aureus colonization and decreases normal flora. Antibiotics do not protect against S. aureus colonization and contribute to a decrease in normal flora. Antibiotics do not seem to confer benefit in terms of flora changes. Studies investigating flora changes with a longer follow-up should be conducted.

Immune enhancement of chemotherapeutants on lymphocystis disease virus (LDV) infected Paralichthys olivaceus

In olive flounder, Paralichthys olivaceus infected with lymphocystis disease virus (LDV) bath treatment with formalin, hydrogen peroxide or Jenoclean at 50, 100, and 200 ppm daily 10 min for 60 days enhanced the innate immune response and disease resistance. Jenoclean enhanced the immune parameters at the lowest concentration of 50 ppm; on the other hand, hydrogen peroxide bath treatment enhanced the immunity level at 100 ppm, while formalin was effective only at 200 ppm. A low cumulative mortality and high relative percent survival was noted in Jenoclean treated group followed by formalin and hydrogen peroxide treated groups. In olive flounder at low concentrations of 50 ppm or 100 ppm hydrogen peroxide and Jenoclean effectively prevent LDV infection.

Evolution and prognosis of necrotic primary teeth after pulpectomy

PURPOSE

To study the evolution of 308 necrotic primary teeth after pulpectomy technique with resorbable paste (Kri-1 + calcium hydroxide + metacresol-formaldehyde) after 30 months.

METHODS

134 children between 2-9 years were included, among which they had 348 pulpectomized teeth. Out of these 348 teeth, 308 had necrotic pulp and were included in the study. The filling material consisted of a paste based on Walkhoff's master formula and consisted of the combination of Kri-1a (80.8% iodoform, 2.025% parachlorophenol, 1.215% menthol, 4.68% camphor and excipient 15 mg), pure calcium hydroxide and metacresol formaldehyde (metacresol 20 mg, formaldehyde 20 mg, eugenol 20 mg, eucalyptus 6 mg and excipient 40 mg). Root canal filling was performed in one session by one operator.

RESULTS

Pain, swelling, and fistula resolution was observed in most cases at the first recall. Progressive remission of radiolucent areas was also observed. A relationship between fistula and radiolucency in pre-treated furcation area was observed, and, in some cases, premature eruption of permanent teeth was recorded. Only two cases out of 308 treated teeth required extraction.

Comparison of rapid rhino and merocel nasal packs in endonasal septal surgery

OBJECTIVE

Our study compared Rapid Rhino (RR; Applied Therapeutic Ltd, Leicestershire, UK) and Merocel (Medtronic Xomed, Jacksonville, FL) nasal packing materials in endonasal septoplasty surgery in terms of postoperative patient comfort and reactionary bleeding.

PATIENTS AND METHODS

Fifty-one patients underwent endonasal septoplasty. One nasal cavity was packed with Merocel packs and the RR pack was used for the other side. The pain and nasal fullness levels on each side were studied at 1 and 6 hours postoperatively. Pain level was also studied during the removal of the nasal packs on the second day. These levels were scored on the basis of a visual analogue scale (VAS) between 0 and 10. Reactionary bleeding after nasal pack removal was also recorded. The Wilcoxon test was used for statistical analysis of the VAS scores, and the McNemar test was used for comparison of bleeding levels after pack removal. A p value<.05 was considered to be statistically significant.

RESULTS

Minimal bleeding was noted in 15 patients following Merocel pack removal; however, no bleeding was seen following RR pack removal. Comparison of the VAS scores of pain and nasal fullness of each nasal pack at 1 and 6 hours postoperatively showed a statistically significant difference (p<.05). Similarly, comparison of the pain level for pack removal and bleeding after removal on the second postoperative day demonstrated a statistically significant difference (p<.05 and p=.001, respectively).

CONCLUSION

RR is more tolerable by patients than Merocel after septoplasty surgery. RR also has some advantages, namely, easy pack removal and less reactionary bleeding.

Recommendation for appropriate use of GRF glue in the operation for acute aortic dissection

BACKGROUND

Because an excessive use of activator (formaldehyde + glutaraldehyde) is supposed to be responsible for later adverse events after the use of gelatin resorcin formalin (GRF) glue in surgery for acute aortic dissection, we have tried to use a minimum dose of activator when the GRF glue was applied. We compare our midterm surgical results for acute aortic dissection with and without the use of GRF glue.

METHODS

Forty-nine consecutive operated cases with Stanford type A acute aortic dissection within 48 h from onset from 1992 to 2005 were retrospectively analyzed. GRF glue was used in 21 cases (18 proximal and 14 distal anastomosis sites) since 1995 with outer felt reinforcement (GRF group).

RESULTS

There was no operative deaths. In-hospital mortality was 4.8% in the GRF group and 7.1% in the control group (P = 0.7308). Intraoperative blood loss and transfusion requirements were similar between groups. The patency of the distal false lumen after the operation (57% vs. 55%, P = 0.8855), the 3-year survival estimate (82% +/- 10% vs. 92% +/- 6%, P = 0.4219), and the 3-year actuarial freedom from a reoperation of 92 anastomoses (97% +/- 3% vs. 100%, P = 0.4986) were similar between the GRF group and the control group, respectively. A multivariate Cox's proportional hazard model identified no significant predictor for midterm death or reoperation.

CONCLUSIONS

The use of GRF glue for type A acute aortic dissection seems as clinically safe as other options with regard to midterm death or reoperation when applied appropriately with felt reinforcement.

Vital pulpotomy in the primary dentition: attitudes and practices of community dental staff in Wales

OBJECTIVE

The International Agency for Research on Cancer (IARC) has classified formaldehyde as carcinogenic to humans, leaving the dental profession to look for viable substitutes to formocresol in the vital pulpotomy technique. This study was designed to examine the attitudes and practices of Community Dental Service (CDS) staff in Wales in relation to vital pulpotomy for primary molars 18 months following the IARC's press release.

METHODS

The study employed a postal questionnaire.

RESULTS

Questionnaires were returned by 79 (78.2%) of the CDS staff surveyed, yielding a sample of 65 dentists practising the technique. The most commonly used pulpotomy agents were formocresol, paraformaldehyde and ferric sulphate. Twenty-seven (41.5%) dentists expressed concern regarding their preferred pulpotomy agent and 17 (26.2%) were considering changing their technique. Only one respondent (1.5% of the sample) routinely took preoperative radiographs; follow-up radiographs were routinely taken by only three dentists (4.6%). Only 44 respondents (67.7%) always used local anaesthesia for this form of treatment. Amalgam was the most commonly used restorative material. Twenty-two respondents (33.8%) stated that they would pulp treat a primary molar on more than one occasion.

CONCLUSIONS

The results of this study suggest that there is need for relevant continuing professional development courses for CDS staff in Wales.

The evaluation of the use of a delayed surgical obturator in dentate maxillectomy patients by considering days elapsed prior to commencement of postoperative oral feeding

STATEMENT OF PROBLEM

As a prosthodontic treatment for a maxillectomy patient in the initial postoperative period, immediate surgical obturators during surgery have been advocated to restore and maintain the patient's oral function to a reasonable level. However, these may fit poorly because they are fabricated using preoperative casts.

PURPOSE

The purpose of this study was to determine the comparative usefulness of a delayed surgical obturator.

MATERIAL AND METHODS

During the period from 2000 to 2004, 29 patients underwent prosthodontic treatment after maxillectomy. Twenty-three patients who were dentate postoperatively and were treated with polyvinyl acetal (Merocel) packing and a delayed surgical obturator were included in this study. Patients who were edentulous postoperatively, who were treated with an immediate surgical obturator or whose data were incomplete were excluded. The records of 23 patients were reviewed to determine the usefulness of using a delayed surgical obturator by counting days required to start postoperative oral feeding. The median of days elapsed prior to commencement of postoperative oral feeding was compared with data from a study by Lapointe et al (1996). In the Lapointe et al study, the median days elapsed prior to beginning a clear fluid diet was 2 in the group using immediate surgical obturators. The data were analyzed using the 1-sample Wilcoxon signed rank test (alpha=.05).

RESULTS

Days elapsed prior to commencement of postoperative oral feeding were less than those reported previously. Patients with Merocel packing began oral feeding, on average, 1.48 days after the maxillectomy. The median number of days elapsed prior to commencement of postoperative oral feeding was 1. This time was earlier than the 2 days for the Lapointe et al study (P=.0074). No major postoperative care complications occurred among the maxillectomy patients treated with a delayed surgical obturator.

CONCLUSION

Delayed surgical obturators were successful in terms of the postoperative care of dentate maxillectomy patients and did not increase patient discomfort during early rehabilitative management.

Comparison of butyl-2-cyanoacrylate, gelatin-resorcin-formaldehyde (GRF) compound and suture in stabilization of cartilage grafts in rabbits

Cartilage grafting is an interesting option for rhinoplasties refinements.

AIM

To compare butyl-2-cyanoacrylate, compound gelatin-resorcin-formaldehyde (GRF) and suture control to determine the efficacy of these tissue glue preparations in securing grafted cartilage.

STUDY DESIGN

Experimental.

METHODS

Fifteen male adult New Zealand rabbits were submitted to a surgical procedure to harvest 6 auricular cartilage grafts from each animal. 2 of these grafts in each animal were glued together with butyl-2-cyanoacrylate, 2 with compound gelatin-resorcin-formaldehyde and 2 sewn together with nylon suture. These sandwich grafts were then glued or sewn to the periosteum of the calvaria. After 2, 6 and 12 weeks, groups of 5 animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion and deformities of the grafts were also evaluated.

RESULTS

There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. There was no statistical difference between the 3 materials of graft stabilization in relation to the inflammatory reaction in all evaluated periods. There wasn't detachment neither deformity in the cartilage sandwiches sewn with suture. The majority of detachment and deformed cartilages were found among those glued with cyanoacrylate. The number of deformed cartilages was directly related to the number of detached cartilages. The data were statistically significant (p< 0.05).

CONCLUSION

The compound gelatin-resorcin-formaldehyde revealed to be a stabilization material for cartilage grafts in rabbits better than butyl-2-cyanoacrylate. The compound gelatin-resorcin-formaldehyde was also better than the suture when comparing its fixation to the periosteum.

Formalin application for the treatment of radiation-induced hemorrhagic proctitis

Radiation-induced hemorrhagic proctitis (RIHP) is a serious complication of pelvic irradiation, and a 4% formalin solution has been used for 20 years in treating this sequelae. The first case involving formalin application for treatment of RIHP in Korea was reported in 1996, but there are no additional studies beyond this date. Our study reviews the use of formalin instillation and selective application. The purpose of this study was to retrospectively evaluate the outcome of such treatments, beginning with the first case at our hospital. From 1996 to 2005, five RIHP patients had received formalin treatment for RIHP symptoms intractable to other medical treatments. All treatments were performed by a single surgeon in the operating room, under spinal anesthesia or intravenous sedation. The mean duration of symptoms before treatment was 15.6 months (which was longer than in other studies), and the transfusion before treatment varied from once per month to twice per week. Using sigmoidoscopy, 100 ml of a 4% formalin solution was instilled directly (or by using a formalin-soaked gauze) and irrigated for five minutes. Formalin-soaked cotton was then applied selectively to focal remnant lesions. Four patients improved after the first treatment, but one patient received the treatment twice because of recurrent symptoms. Complications after treatment included perianal pain (one case), and aggravated incontinence (one case), which improved three months after conservative management. In conclusion, the formalin combination application method in our study is comparable to other formalin treatments for intractable RIHP.

Application of 10 percent formalin for the treatment of radiation-induced hemorrhagic proctitis

PURPOSE

Rectal instillation of 4 percent formalin solution has been described as a successful treatment for hemorrhagic radiation proctitis recalcitrant to medical treatment. We present our experience with a new method of treatment involving the topical application of 10 percent buffered formalin, which is well tolerated and suitable for office use.

METHODS

Patients with marked or refractory rectal bleeding and clinical features consistent with radiation proctitis were reviewed. Treatment involved direct application of a 10 percent buffered formalin solution to the affected mucosa using a 16-inch cotton tip applicator applied through a proctoscope in the office setting.

RESULTS

A total of 100 patients with a mean age of 75 (range, 49-91) years were followed for 18 (range, 1-79) months. The interval from radiation exposure to formalin treatment was 21 months. Overall, 93 percent of patients had cessation of bleeding after an average of 3.5 formalin applications at two-week to four-week intervals. Patients with severe (Grade 3) proctitis and those taking aspirin required an average of 1.5 additional treatments. A total of eight patients rebled at a mean of 24 months from treatment; however, all responded to further applications of formalin. Three patients complained of anal pain and one experienced dizziness postprocedure for a complication rate of 1.1 percent.

CONCLUSIONS

We present a simple, cost-effective, and well-tolerated method of controlling hemorrhagic radiation proctitis. It is performed by using materials readily available in the office of a colon and rectal surgeon, eliminating the need for bowel preparation, anesthesia, or a surgical suite.

Late Results of Gelatin?Resorcin?Formalin Glue-aided Repair in Acute Type A Aortic Dissection

Gelatin-resorcin-formalin (GRF) glue has been used to obliterate the false lumen of dissected aortas, resulting in reduced mortality. However, because of the cytotoxicity of formalin, the application of GRF remains controversial. In this study, a total of 138 consecutive patients with acute type A dissection since 1995, who underwent emergency graft replacement, were reviewed. The mean age was 65.5 years. The hospital mortality rate was 6.5%. In-hospital re-exploration rate and patency rate of the false lumen were 6.5% and 24.7%, respectively. The actuarial survival rates were 81.5% after 5 years and 54.8% after 10 years. Reoperation-free rates were 87.9% after 5 years and 72.3% after 10 years. Tissue necrosis or aneurismal degeneration was not demonstrated at reoperation. In conclusion, GRF glue demonstrats excellent tissue adhesion and hemostasis capability, and contributes to improve surgical results.

Histopathological comparison of topical therapy modalities for acute radiation proctitis in an experimental rat model

AIM: To evaluate the prevalent topical therapeutic modalities available for the treatment of acute radiation proctitis compared to formalin.

METHODS: A total of 120 rats were used. Four groups (n = 30) were analyzed with one group for each of the following applied therapy modalities: control, mesalazine, formalin, betamethasone, and misoprostol. A single fraction of 17.5 Gy was delivered to each rat. The rats in control group rats were given saline, and the rats in the other three groups received appropriate enemas twice a day beginning on the first day after the irradiation until the day of euthanasia. On d 5, 10, and 15, ten rats from each group were euthanized and a pathologist who was unaware of treatment assignment examined the rectums using a scoring system.

RESULTS: The histopathologic scores for surface epithelium, glands (crypts) and lamina propria stroma of the rectums reached their maximum level on d 10. The control and formalin groups had the highest and mesalazine had the lowest, respectively on d 10. On the 15^th d, mesalazine, betamethasone, and misoprostol had the lowest scores of betamethasone.

CONCLUSION: Mesalazine, betamethasone, and misoprostol are the best topical agents for radiation proctitis and formalin has an inflammatory effect and should not be used.

Long-term effects in distal coronary anastomoses using different adhesives in a porcine off-pump model

OBJECTIVE

Adhesives are useful supplements to seal distal coronary anastomoses, particularly in patients who receive less-invasive coupling techniques. Information regarding long-term structural effects after application, however, is limited. The purpose of this large animal study was to examine the effects of 3 different commercially available surgical adhesives.

METHODS

Twelve end-to-side anastomoses were created between the left internal thoracic artery and the left anterior descending coronary artery in a porcine beating heart model. Three different adhesives were applied externally and circumferentially to the anastomosis site. In group I (n = 4) gelatin-resorcinol-formaldehyde glue (Cardial, Technopole, Sainte-Etienne, France), in group II (n = 4) n-butyl-2-cyanoacrylate glue, and in group III (n = 4) albumin-glutaraldehyde glue were used. All anastomoses were examined intraoperatively by flow measurement. After 3 months the anastomoses were reassessed for patency and the vessels were evaluated histologically.

RESULTS

By means of 4 stay sutures and subsequent glue application, anastomoses could be created successfully on the first attempt in all animals. Perioperative flow through the left internal thoracic artery was similar in all groups. In 4 animals an additional suture was placed to control bleeding. After 3 months, the patency rate was 83.3% (10/12). In group I all anastomoses were patent whereas in both groups II and III one anastomosis was occluded. None of the adhesives caused impaired vessel wall healing but they did demonstrate moderate-to-dense adhesions to the surrounding tissue. On histologic examination, gelantin-resorcinol-formaldehyde glue exhibited minimal tissue reaction (foreign-body granuloma) whereas n-butyl-2-cyanoacrylate glue showed moderate reaction. In contrast, albumin-glutaraldehyde glue caused severe inflammatory reaction with extensive fibroblastic proliferation.

CONCLUSION

Construction of an end-to-side internal thoracic artery-coronary artery sleeve anastomosis using adhesives was feasible in the pig. Among the tissue adhesives used in this study, gelantin-resorcinol-formaldehyde glue appeared to be superior to cyanoacrylate and albumin-glutaraldehyde glue. The latter one, however, caused severe adverse histologic effects and thus cannot be recommended for bonding coronary anastomoses.

Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis

OBJECTIVES

A prospective non-blinded randomized controlled trial to compare the efficacy of Merocel and RapidRhino nasal packs in the treatment of anterior epistaxis.

METHODS

Fifty-two consecutive participants admitted with anterior epistaxis refractory to digital pressure or nasal cautery were randomized to treatment using one or other of the nasal packs. Patients who required repacking because of continued bleeding, only the first packs were included in the analysis. Haemostatic properties of the packs were measured by grading bleeding during and after removal of the pack (0-4, where four is uncontrollable) and by noting if the nose was re-packed or not. The difficulty of insertion and removal (graded 0-3 by clinician where 3 is the most difficult) and the participant's perception of discomfort (graded 0-10, where 10 is the worst pain) during insertion and removal of the pack were also measured.

RESULTS

For bleeding, the mean values for Merocel and RapidRhino during packing and after pack removal were not significant (P = 0.38 and 0.82 respectively). The mean values of patient discomfort on insertion were 6.9 and 5.0 (P = 0.01), and for discomfort on removal were 4.6 and 3.4 (P = 0.05) respectively. The mean values of insertion graded by the clinician were 1.7 and 0.9 (P = 0.0003), and for removal were 1.4 and 0.4 (P < 0.0001).

CONCLUSIONS

RapidRhino and Merocel are equally effective in the control of anterior epistaxis but RapidRhino is significantly more comfortable for the patient and easier for the healthcare worker during insertion and removal.

Treatment of haemorrhagic radiation-induced proctopathy using small volume topical formalin instillation

BACKGROUND

Between 2 and 5% of patients undergoing pelvic radiotherapy develop chronic radiation proctopathy, occurring as a result of damage to the rectal mucosa during the treatment. Rectal bleeding of varying severity can occur as a consequence. There have been no formal trials of treatment for haemorrhagic radiation proctopathy and a variety of methods are currently used.

AIM

In a retrospective study of 20 patients treated at a single centre, we assessed the efficacy of small volume topical formalin instillation to control bleeding from radiation proctopathy.

METHOD

Patients were treated by a single operator using 20 mL of a 5% solution of formalin instilled into the rectum via a flexible sigmoidoscope for 3 min. Patients were followed up for an average of 22.7 months (range: 2-69).

RESULTS

A single session of formalin treatment was effective in 13 of 20 (65%) patients and a further four (20%) patients responded to a second treatment. No complications of the treatment was identified.

CONCLUSION

Small volume formalin instillation therapy appears to be safe and effective in the context of haemorrhagic radiation proctopathy. The technique is simple, inexpensive, quick and requires no sedation. We suggest that it should be considered as a first line for patients presenting with this distressing condition.

Therapeutic effects of gelatin-resorcin-formal glue in the treatment of postoperative fistula following a low anterior resection: report of a case

Postoperative fistulas are among the most difficult and distressing of surgical problems. We describe a case of a discharging fistula that developed after low anterior resection and was successfully treated with a new biologic adhesive agent, gelatin-resorcin-formal glue. To our knowledge, this is the first reported case of a postoperative fistula after colorectal surgery successfully treated with gelatin-resorcin-formal glue. In conclusion, gelatin-resorcin-formal glue is useful for uncontrollable postoperative fistula.

Aortopulmonary Fistula Occurring 4 Years After Replacement of the Ascending Aorta

A 62-year-old man presenting with congestive heart failure due to a fistula between an aortic pseudoaneurysm and the right pulmonary artery is described. The shunt occurred 4 years after aortic valve and supracoronary graft replacement and was diagnosed by transesophageal contrast echocardiography. After redo surgery the patient made an uneventful recovery.

Treatment for simple plantar verrucae: monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone

Verrucae are small, benign, highly vascular epithelial neoplasms that occur singly or in a multiple presentation. Plantar verrucae are usually caused by infection with human papillomavirus types 1, 2, and 4. A clinical trial was conducted to assess the safety and efficacy of monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone in the treatment of simple plantar verrucae. Of 57 patients enrolled in the study, 26 were in the monochloroacetic acid and 10% formaldehyde group and 31 were in the 10% formaldehyde alone group. The overall cure rate for this population was 61.4%. There was no statistically significant difference in the cure rate between treatment groups.