clinicaltrials.gov Identifier: NCT00442494.

Laccases are phenol-oxidizing, usually four-copper containing metalloenzymes. For industrial and biotechnological purposes, laccases were among the first fungal oxidoreductases providing larger-scale applications such as removal of polyphenols in wine and beverages, conversion of toxic compounds and textile dyes in waste waters, and in bleaching and removal of lignin from wood and non-wood fibres. In order to facilitate novel and more efficient bio-catalytic process applications, there is a need for laccases with improved biochemical properties, such as thermostability and thermotolerance. This review gives a current overview on the sources and characteristics of such laccases, with particular emphasis on the fungal enzymes.

Background and Aims: this multicenter prospective observational study defined the incidence and risk factors of surgical wound infections (Swi) after infrarenal aortic and lower limb vascular surgery procedures and evaluated the severity and costs of these infections.Methods: the study cohort comprised of 184 consecutive patients. postoperative complications were recorded. the additional costs attributable to Swi were calculated.Results: eighty-four (46%) patients had critical ischaemia, 81 (45%) patients underwent infrainguinal bypass surgery and 64 (35%) received vascular prosthesis or prosthetic patch. forty-nine (27%) patients developed Swi. Staphylococcus aureus was the leading pathogen cultured from the wound. forty-seven of the 49 infected wounds responded to and healed with the treatment. Swi was the cause of one major amputation. independent predictors for Swi were infrainguinal surgery (or 7.2, 95% cl 2.92-17.65, p < 0.001), obesity (or 6.1, 95% cl 2.44-15.16, p < 0.001) and arteriography injection site within the operative area (or 2.5, 95% cl 1.13-5.48, p = 0.02). the average cost attributable to Swi was 3320 €.Conclusion: the incidence of Swi after vascular surgery is high. the risk factors for Swi are infrainguinal surgery, obesity and arteriography injection site within the operative area. Swi increases morbidity and costs of operative treatment.

NCT00659542 (http://www.clinicaltrials.gov).

IntroductionBochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood - the clinical manifestation of symptoms and diagnosis in adults is extremely rare. There are fewer than 20 cases of right-sided Bochdalek hernia reported in adults in the literature.Case presentationWe review a case of a 38-year-old woman with a right-sided Bochdalek hernia who was experiencing abdominal pain and pleural effusion. The diagnosis of Bochdalek hernia was made by chest X-ray and computed tomography. The right lobe of the liver and flexura hepatica of the colon were herniated into the thorax cavity. The hernia was treated via thoracotomy assisted with laparoscopy and she made an uneventful recovery.ConclusionWe report a rare case of a right-sided Bochdalek hernia for which our patient was treated successfully. Even though rare, this disorder should be recognised, examined and treated appropriately to avoid complications.

There are no studies evaluating S(+)-ketamine for pain management after sternotomy. In this prospective, randomized, double-blind, placebo-controlled clinical trial, we evaluated the efficacy and feasibility of S(+)-ketamine as an adjunctive analgesic after cardiac surgery. Ninety patients scheduled for elective coronary artery bypass grafting (CABG) were randomized to receive either a 75 microg/kg bolus of S(+)-ketamine followed by a continuous infusion of 1.25 microg . kg(-1) . min(-1) for 48 h (n = 44) or placebo (normal saline bolus and infusion) (n = 46). From the time of tracheal extubation, patients could access an opioid (oxycodone) via a patient-controlled analgesia device, and the cumulative oxycodone doses were measured over 48 h. Pain was evaluated on a visual analog scale three times daily. The quality of recovery, patient satisfaction with pain management, and adverse effects were recorded. The cumulative oxycodone consumption during the first 48 postoperative hours was less in the S(+)-ketamine group (103 +/- 44 mg) than in the placebo group (125 +/- 45 mg; mean difference, 22 mg; 95% confidence interval for the difference, 3-40 mg; P = 0.023). Pain scores did not differ between the groups at rest (P = 0.17) or during a deep breath (P = 0.23). Patient satisfaction was superior in S(+)-ketamine-treated patients: 26 (60%) of 44 in the S(+)-ketamine group compared with 16 (35%) of 46 in the placebo group were very satisfied with the analgesic management (P = 0.032). Nausea and vomiting were the most common adverse events, with similar frequencies in both groups. Four patients in the S(+)-ketamine group developed transient hallucinations during the infusion, versus none in the placebo group. In conclusion, small-dose S(+)-ketamine decreased opioid consumption in CABG patients during the first 48 h after surgery.

No abstract

The use of triclosan-coated sutures does not reduce the incidence of SWI after lower limb vascular surgery.