Abdominal dermolipectomy in an abdomen with pre-existing scars: a different concept

Although abdominal dermolipectomy is a frequently performed procedure, few publications have reported on the safety of the procedure in the scarred abdomen. The aim of this study was to stress the possibility of performing a natural-looking abdominoplasty with no complication such as skin necrosis or liponecrosis in the presence of abdominal scars and to clarify that the scarred abdomen is not a great limitation for full abdominoplasty as reported in the literature. Seventy-six abdominoplasties were performed on scarred patients from July of 1997 to June of 2003. Twenty-five patients had oblique subcostal scars, six patients had median supraumbilical scars, three patients had median infraumbilical scars, 10 patients had appendectomy scars, nine patients had paramedian supraumbilical scars, eight patients had paramedian infraumbilical scars, seven patients had long transverse scars of repaired ventral hernias, and eight patients had multiple small scars after laparoscopy. In addition, there were concomitant transverse cesarean delivery scars in 40 patients. All patients underwent full abdominoplasties, plication of the musculoaponeurotic system, and liposuction assistance if required (45 patients). Of 76 subjects, three patients had very limited liponecrosis at the watershed area. Eleven patients (14.5 percent) were morbidly obese and heavy smokers. In comparisons of postabdominoplasty complications, such as liponecrosis, wound infection, and dehiscence with and without liposuction in scarred abdomen, no significant differences were found. Secondary revision was more common among abdominoplasties without liposuction [seven of 45 (15.6 percent) versus 12 of 31 (38.7 percent); p = 0.02]. In conclusion, there is no limitation or contraindication for abdominal dermolipectomy with or without liposuction assistance on the previously scarred abdomen as long as the vascular zones of the abdomen are respected. The abdominal wall dissection is limited to allow only the plication of the musculoaponeurotic system, and aggressive liposuction is avoided.     

2004-2006年肠球菌属临床耐药性分析

调查了2004～2006年肠球菌对临床常用抗菌药物的耐药性,为临床合理治疗肠球菌感染提供理论依据.用Kirby-Bauer纸片扩散法进行药敏试验.屎肠球菌所占的比例已经超过粪肠球菌,成为肠球菌属中最常见的致病菌,并且呈现逐年上升趋势.粪肠球菌对青霉素和氨苄西林的耐药率分别从2004年的42.1%和32.8%下降至2006年的20.7%和15.8%.糖肽类药物对肠球菌属依然保持高度敏感.监测肠球菌的耐药性变化,对于治疗和控制肠球菌感染具有重要的意义.     

Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results

A retrospective study was done on a population of 258 women who had undergone surgery for abdominal dermolipectomy between January of 1991 and May of 1996. The postoperative complications and flaws seen at long-term follow-up are discussed. The surgical techniques used, with or without lipoaspiration, were the infraumbilical plasty and full plasties with horizontal or inverted T scars. Six types of postoperative complications were noted: hemorrhage in 1.2 percent, lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in 6.6 percent, secondary dehiscence of the scar in 2.3 percent, and thromboembolic accidents in 1.2 percent. No significant difference was found in the rate of necrosis development between patients who did and did not undergo lipoaspiration. However, a statistically significant difference was seen in the rate of skin necrosis between the T-type plasty (35.5 percent) and the other two procedures (1.43 percent for infraumbilical plasties and 4.60 percent for full plasties with horizontal scar). With regard to the flaws found at long-term follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9 percent, and the rate of defective scars was 26 percent. No significant difference was found with regard to the rate of flaws. The rate of all secondary surgical procedures was 29.1 percent, but performance of secondary procedures depended on the willingness of the patient and on the surgeon's judgment. Abdominoplasty procedures involve a high risk of early complications. The rate of skin necrosis is clearly augmented in cases of T-type plasty. The need for secondary surgical correction is frequent, and the patient should be reminded of this possibility during preoperative consultation.     

Land application of treated sewage sludge: quantifying pathogen risks from consumption of crops

AIMS: To predict the number of humans in the UK infected through consumption of root crops grown on agricultural land to which treated sewage sludge has been applied in accordance with the current regulations and guidance (Safe Sludge Matrix). METHODS AND RESULTS: Quantitative risk assessments based on the source, pathway, receptor approach are developed for seven pathogens, namely salmonellas, Listeria monocytogenes, campylobacters, Escherichia coli O157, Cryptosporidium parvum, Giardia, and enteroviruses. Using laboratory data for pathogen destruction by mesophilic anaerobic digestion, and not extrapolating experimental data for pathogen decay in soil to the full 30-month harvest interval specified by the Matrix, predicts 50 Giardia infections per year, but less than one infection per year for the other six pathogens. Assuming linear decay in the soil, a 12-month harvest interval eliminates the risks from all seven pathogens; the highest predicted being one infection of C. parvum in the UK every 45 years. Computer simulations show that a protective effect from binding of pathogens to particulate matter could potentially exaggerate the observed rate of decay in experimental systems. CONCLUSIONS: The results confirm, assuming pathogens behave according to our current understanding, that the risks to humans from consumption of vegetable crops are remote. Furthermore the harvest intervals stipulated by the Safe Sludge Matrix compensate for potential lapses in the operational efficiency of sludge treatment. SIGNIFICANCE AND IMPACT OF THE STUDY: The models demonstrate the huge potential impact of decay in the soil over the 12/30-month intervals specified by the Matrix, although lack of knowledge on the exact nature of soil decay processes is a source of uncertainty. The models enable the sensitivity of the predicted risks to changes in the operational efficiency of sewage sludge treatment to be assessed.     

Children with type 2 diabetes: the risks of complications

Type 2 diabetes is an increasing problem in children. Two decades ago it had been described only in selected groups, e.g. the Pima Indians. Childhood type 2 diabetes appears to be similar to the metabolic syndrome in adults and is characterized by obesity, hyperglycaemia and insulin resistance. It can present a diagnostic challenge in children, as they can present with diabetic ketoacidosis; the measurement of autoantibodies and C-peptide levels may be helpful. The logarithmic association between the risk of complications with increasing glycaemia which has been established for adults with type 2 diabetes is likely to hold true for children but the conclusions of trials in adults must be extrapolated with caution. Little is known about the onset and progression of macrovascular disease in affected children but it is almost certain that they will develop an excess of premature cardiovascular disease. However, the importance of reducing glycaemia in younger adults with diabetes, in order to minimize the incidence of microvascular complications, has been unequivocally demonstrated in the Diabetes Control and Complications Trial (DCCT). Diet and exercise have a major role to play in the treatment and prevention of type 2 diabetes in children as well as adults - the escalation of type 2 diabetes throughout the developed world is a major public health problem. Extrapolating data from adults, metformin appears to be the logical first-line treatment in children with type 2 diabetes; sulphonylureas are also used but neither of these agents have been evaluated in trials in children and are not licensed for such use. With regard to other newer agents, it seems wise to use well-established drugs with a long track record and for which the long-term safety data are available.     

Occurrence of Didymella ascospores in western and southern Poland in 2004–2006

The concentration of airborne Didymella spores has been investigated at two monitoring sites situated along the west–south transect in Poland (Szczecin, Kraków), i.e. from a height of 100 to 219 m, respectively, above sea level. The aerobiological monitoring of fungal spores was performed by means of two Lanzoni volumetric spore traps. The high Didymella spore numbers were observed at both cities in June, July and August. Statistically significant correlations have been found mainly between the Didymella spore concentrations in the air and the minimum air temperature and relative air humidity. The spore count of Didymella is determined by the diversity of local flora and weather conditions, especially by the relative air humidity. The identification of factors that influence and shape spore concentrations may significantly improve the current methods of allergy prevention.     

Enteric bacteria isolated from acute diarrheal patients in the Republic of Korea between the year 2004 and 2006

In an epidemiological survey of human enterobacterial infections in the Republic of Korea during three years from 2004 to 2006, we isolated 1,784 (6.2%, isolation rate of enteropathogens from stool samples) in 2004, 2,547 (9.5%) in 2005 and 3,506 bacteria (12.3%) from people who visited clinics. Among the isolated bacteria, pathogenic Escherichia coli, especially, EAEC was the most frequently identified pathogen in both urban and rural regions followed by Staphylococcus aureus, Salmonella species, Bacillus cereus, Vibrio parahaemolyticus, Campylobacter jejuni, Clostridium perfringens, and Shigella species. Distinct seasonality was found in V. parahaemolyticus species, while this pathogen showed no age-specific patterns. However, other bacteria, i.e., pathogenic E. coli, S. aureus, Salmonella spp., and B. cereus showed similar seasonality throughout the year, showing a slight increase in the infection rate during the summer months and high prevalence among children under 10 years of age and elder-age people. The antibiotic susceptibility patterns of pathogenic E. coli, Salmonella spp., and S. aureus showed high resistance to penicillins. However, both pathogenic E. coli and Salmonella spp. were susceptible to several cephems, imipenem, and amikacin. Moreover, S. aureus strains resistant to vancomycin were not found. In conclusion, these surveillances can play an important role for the control and prevention to the diseases originated by enteritis bacteria.     

Cadmium exposure in the population: from health risks to strategies of prevention

We focus on the recent evidence that elucidates our understanding about the effects of cadmium (Cd) on human health and their prevention. Recently, there has been substantial progress in the exploration of the shape of the Cd concentration-response function on osteoporosis and mortality. Environmental exposure to Cd increases total mortality in a continuous fashion without evidence of a threshold, independently of kidney function and other classical factors associated with mortality including age, gender, smoking and social economic status. Pooled hazard rates of two recent environmental population based cohort studies revealed that for each doubling of urinary Cd concentration, the relative risk for mortality increases with 17% (95% CI 4.2–33.1%; P < 0.0001). Tubular kidney damage starts at urinary Cd concentrations ranging between 0.5 and 2 μg urinary Cd/g creatinine, and recent studies focusing on bone effects show increased risk of osteoporosis even at urinary Cd below 1 μg Cd/g creatinine. The non-smoking adult population has urinary Cd concentrations close to or higher than 0.5 μg Cd/g creatinine. To diminish the transfer of Cd from soil to plants for human consumption, the bioavailability of soil Cd for the plants should be reduced (external bioavailability) by maintaining agricultural and garden soils pH close to neutral (pH-H₂O of 7.5; pH-KCL of 6.5). Reducing the systemic bioavailability of intestinal Cd can be best achieved by preserving a balanced iron status. The latter might especially be relevant in groups with a lower intake of iron, such as vegetarians, and women in reproductive phase of life. In exposed populations, house dust loaded with Cd is an additional relevant exposure route. In view of the insidious etiology of health effects associated with low dose exposure to Cd and the current European Cd intake which is close to the tolerable weekly intake, one should not underestimate the importance of the recent epidemiological evidence on Cd toxicity as to its medical and public health implications.     

Freshwater salinization syndrome: from emerging global problem to managing risks

Freshwater salinization is an emerging global problem impacting safe drinking water, ecosystem health and biodiversity, infrastructure corrosion, and food production. Freshwater salinization originates from diverse anthropogenic and geologic sources including road salts, human-accelerated weathering, sewage, urban construction, fertilizer, mine drainage, resource extraction, water softeners, saltwater intrusion, and evaporative concentration of ions due to hydrologic alterations and climate change. The complex interrelationships between salt ions and chemical, biological, and geologic parameters and consequences on the natural, social, and built environment are called Freshwater Salinization Syndrome (FSS). Here, we provide a comprehensive overview of salinization issues (past, present, and future), and we investigate drivers and solutions. We analyze the expanding global magnitude and scope of FSS including its discovery in humid regions, connections to human-accelerated weathering and mobilization of ‘chemical cocktails.’ We also present data illustrating: (1) increasing trends in salt ion concentrations in some of the world’s major freshwaters, including critical drinking water supplies; (2) decreasing trends in nutrient concentrations in rivers due to regulations but increasing trends in salinization, which have been due to lack of adequate management and regulations; (3) regional trends in atmospheric deposition of salt ions and storage of salt ions in soils and groundwater, and (4) applications of specific conductance as a proxy for tracking sources and concentrations of groups of elements in freshwaters. We prioritize FSS research needs related to better understanding: (1) effects of saltwater intrusion on ecosystem processes, (2) potential health risks from groundwater contamination of home wells, (3) potential risks to clean and safe drinking water sources, (4) economic and safety impacts of infrastructure corrosion, (5) alteration of biodiversity and ecosystem functions, and (6) application of high-frequency sensors in state-of-the art monitoring and management. We evaluate management solutions using a watershed approach spanning air, land, and water to explore variations in sources, fate and transport of different salt ions (e.g. monitoring of atmospheric deposition of ions, stormwater management, groundwater remediation, and managing road runoff). We also identify tradeoffs in management approaches such as unanticipated retention and release of chemical cocktails from urban stormwater management best management practices (BMPs) and unintended consequences of alternative deicers on water quality. Overall, we show that FSS has direct and indirect effects on mobilization of diverse chemical cocktails of ions, metals, nutrients, organics, and radionuclides in freshwaters with mounting impacts. Our comprehensive review suggests what could happen if FSS were not managed into the future and evaluates strategies for reducing increasing risks to clean and safe drinking water, human health, costly infrastructure, biodiversity, and critical ecosystem services.

     

Drowning risks to epileptic children: a study from Hawaii.

The role of epileptiform seizures in causing drowning and near-drowning among children was studied by examining the case reports of all 140 childhood immersion accidents that occurred in an area of Hawaii over five years. Four of the 140 immersion accidents were caused partly by epileptiform seizures, but none were fatal. The combined results of the Hawaiian and Brisbane studies (total population studied over five years 1 600 000) showed that no epileptic children died from accidents in the sea or in swimming pools; and the 2.9% incidence of immersion accidents due to seizures in the Hawaiian study compares well with the incidence found in other series. If an epileptic child is mentally normal, well controlled with anticonvulsants, and supervised in the water then the risk of drowning is very small.     

Radiation dose and risks to fetus from nuclear medicine procedures

This article discusses issues regarding administration of radiopharmaceuticals to pregnant women. Standardized dose estimates and possible biological effects on the unborn child are presented. Current and future mathematical models (phantoms) are discussed. Standardized dose estimates for pregnant women at several stages of gestation based on the current generation of phantoms are given. Issues related to administration of radioiodines, particularly ¹³¹I-NaI, are presented. Iodine concentrates in the fetal thyroid and therefore can give very high doses, even resulting in complete destruction of the fetal thyroid. Strategies for preventing unwanted administrations of radiopharmaceuticals to these patients, and for strategies for mitigating radiation doses, should an unwanted administration occur, are discussed.     

Extrapolations from species to species and from various cell types in assessing risks from chemical mutagens

Strategies for estimating human mutation frequencies can be based on extrapolations of dose: mutation ratios in other species.