Fluid resuscitation protocols for burn patients at intensive care units of the United Kingdom and Ireland

Introduction: The objective of this study was to determine the thermal injury fluid resuscitation protocols at intensive care units (ICUs) in the United Kingdom and Ireland

The effect of harvesting techniques and cardiovascular risk factors on endothelial function of human coronary artery bypass grafts

Endothelial dysfunction is a common pathophysiological feature which develops in the evolution of cardiovascular diseases. Strategies to maintain a healthy endothelium or to reverse endothelial dysfunction are crucial for the normal function of the cardiovascular system and the maintenance of cardiovascular health. Endothelial dysfunction is observed both in the coronary and peripheral vasculature. Studies have demonstrated that surgical preparation of coronary artery bypass grafts can cause endothelial dysfunction and influence the viability and patency of these grafts. An important consideration in the improvement of surgical techniques is to prevent damage to the endothelium during harvesting and implantation. The relative influence of the Mayo stripper minimally invasive long saphenous vein (LSV) harvesting technique and the influence of internal mammary artery (IMA) pedicle width in preserving the integrity of endothelial function are uncertain. Increased production of reactive oxygen species, in particular, superoxide and radicals derived from superoxide, has been associated with endothelial dysfunction in animal models of disease, and there is increasing evidence of a link between oxidative stress and endothelial dysfunction in humans. It has been reported that endothelial dysfunction and increased oxidative stress may predict future events in patients with coronary artery disease. However, concurrent and comparative data on endothelial function, direct measures of superoxide in human vessels, and biomarkers of oxidative stress are not available simultaneously in patients with coronary artery disease nor in control subjects with no documented cardiovascular disease. Circulating biomarkers of oxidative stress have been investigated in patients with essential hypertension and in control subjects, but the relationship between these markers and endothelial function has not been examined. In addition, although the degree of endothelial function has been consistently linked to the number of risk factors present in patients with coronary artery disease, the relative importance of individual risk factors in determining levels of oxidative stress and endothelial function remains uncertain. To address these questions, this thesis studied the influence of harvesting techniques and cardiovascular risk factors on endothelial function of human blood vessels commonly used in coronary artery bypass grafting

Brachial neuropathy 22 years after radiation therapy for fibrosarcoma: a case report

This case report presents a 56-year-old man with right upper limb weakness which arose 22 years after initial local radiation treatment for a grade III fibrosarcoma. Nerve conduction studies revealed impairment of all three major upper limb nerves compared with the left, with particular impairment of the median and ulnar nerves in the most fibrotic area that had been irradiated. In addition, the patient received multiple courses of chemotherapy. The occurrence of radiation-induced brachial plexopathy should be considered in patients presenting with limb pain or weakness even many years after radiation therapy

Ethics and surgery during the COVID-19 pandemic: principles are no different

CITATION: Banieghbal, B. & Al-Benna, S. 2020. Ethics and surgery during the COVID-19 pandemic: principles are no different. South African Journal of Surgery, 58(3):122, doi:10.17159/2078-5151/2020/v58n3a3348.The original publication is available at: http://www.scielo.org.zaEthics can perhaps falsely give the appearance of being a complex subject, but in clinical terms it is really about forming a judgment based on the available facts of an individual case and assessing the relative risks, burdens and benefits of different courses of action. This task is done by making reference to appropriate ethical and legal frameworks. While additional training may be needed to gain familiarity with these frameworks, it is not necessary for practicing healthcare professionals to be expert in these fields. Surgeons need to be aware of ethical and legal issues that apply to a case as they execute the process of consultation and decision makingPublisher's versio

Considerations for breast reconstructive surgery in South Africa during the COVID-19 pandemic

CITATION: Al-Benna, S. & Gohritz, A. 2020. Considerations for breast reconstructive surgery in South Africa during the COVID-19 pandemic. South African Journal of Surgery, 58(3):126-127, doi:10.17159/2078-5151/2020/v58n3a3348.The original publication is available at: http://www.scielo.org.zaENGLISH ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic has added a layer of complexity to surgical decision making particularly for complex reconstructive oncological surgery. In the absence of data on which to base validated strategies for breast reconstruction in the South African context, this article discusses the current trends in management and potential approaches which could be employedPublisher's versio

Biphasic Synovial Sarcoma of the Extremity: Quadruple Approach of Isolated Limb Perfusion, Surgical Ablation, Adipofascial Perforator Flap and Radiation to Avoid Amputation

Synovial sarcoma is a rare type of soft tissue sarcoma that occurs mostly in young adults, and it is always regarded as a high-grade tumor. Here, we report the case of a 31-year-old German Caucasian male with synovial sarcoma of the wrist who was offered amputation at his local hospital. After referral to our Reference Centre for Soft Tissue Sarcoma, the quadruple approach of isolated limb perfusion, surgical ablation, adipofascial perforator flap and radiation avoided amputation and enabled preservation of good hand function with no evidence of recurrence or metastasis after 1 year

Papillon-Lefèvre syndrome and squamous cell carcinoma: a case report

Papillon-Lefèvre syndrome is a rare autosomal recessive genodermatosis characterised by palmoplantar hyperkeratosis and severe early-onset periodontitis. The development of malignant cutaneous neoplasms within the hyperkeratotic lesions of the syndrome is very rare. Here, we report on a 67-year-old German Caucasian male with Papillon-Lefèvre syndrome associated with recurrent squamous cell carcinoma. Treatment is symptomatic and not always satisfactory

Evaluation of signal transduction pathways after transient cutaneous adenoviral gene delivery

<p>Abstract</p> <p>Background</p> <p>Adenoviral vectors have provided effective methods for <it>in vivo </it>gene delivery in therapeutic applications. However, these vectors can induce immune responses that may severely affect the ability of vector re-application. There is limited information about the mechanisms and signal transduction pathways involved in adenoviral recognition. For optimization of cutaneous gene therapy it is necessary to investigate molecular mechanisms of virus recognition in epidermal cells. The aim of this study was to investigate the signal transduction of the innate immunity after adenoviral DNA internalization in keratinocytes.</p> <p>Methods</p> <p><it>In vitro</it>, keratinocytes were transfected with DNA, in the presence and absence of inhibitors for signalling molecules. <it>In vivo</it>, immunocompetent and athymic mice (n = 3 per group) were twice transduced with an Ad-vector.</p> <p>Results</p> <p>The results show an acute induction of type-I-interferon after <it>in vitro </it>transfection. Inhibition of PI3K, p38 MAPK, JNK and NFkappaB resulted in a decreased expression of type-I-interferon. In contrast to immunocompetent mice, athymic mice demonstrated a constant transgene expression and reduced inflammatory response <it>in vivo</it>.</p> <p>Conclusion</p> <p>The results suggest an induction of the innate immunity triggered by cytoplasm localised DNA which is mediated by PI3K-, p38 MAPK-, JNK-, NFkappaB-, JAK/STAT- and ERK1/2-dependent pathways. A stable transgene expression and a reduced inflammatory response in immunodeficient mice have been observed. These results provide potential for an effective adenoviral gene delivery into immunosupressed skin.</p