Absence of the inferior vena cava in a patient with omphalocele: Two-dimensional echocardiographic and cineangiographic findings

Summary We report an unusual form of absence of the inferior vena cava (IVC) in a patient with a repaired omphalocele. Two sets of bilateral paravertebral veins served as the channels of systemic venous return from the lower half of the body. These veins were narrower than typical azygos or hemiazygos continuation in the absence of the IVC, with the result that a catheter from the femoral vein could not reach the right atrium (RA). Other associated venous-side anomalies were present, including a chamber between the hepatic vein (HV) and RA, narrowing and angulation at the junction between the HV and the chamber, and a subaortic innominate vein. All these anomalies were demonstrated by two-dimensional and color Doppler echocardiography. The recognition of these venous anomalies is important for cardiac catheterization or IVC cannulation for cardiopulmonary bypass in patients with omphalocele.     

Single ventricle and single atrium with anomalous hepatic venous drainage and azygos continuation of inferior vena cava in an adult patient

In a 37‐year‐old patient, ultrasonography showed and CT confirmed the presence of single ventricle, single atrium, azygos continuation of inferior vena cava, anomalous hepatic vein drainage, and persistent left superior vena cava. Such a constellation of cardiovascular anomalies is exceptionally diagnosed in adulthood. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :458–461, 2015     

不同种宫内节育器避孕效果比较500例分析

目的：本文通过回顾性研究对本院五年来放置曼月乐（A组）、吉妮（B组）与高支撑不锈钢圆形环（C组）三种宫内节育器IUD的不同避孕效果进行分析。方法：将500例妇女随机按意愿放置曼月乐、吉妮与高支撑不锈钢圆环三种宫内节育器,自然分成3组,分别随访24个月,对其避孕效果、2年累计不良事件停用率（停用率包含带器妊娠、出血取出、腹痛腰痛取出、脱落率;不含自主和有生育要求而取出者）以及2年续用率进行观察和分析。结果：3种宫内节育器的带器妊娠率相比无显著差异（P〉0．05）;出血取出、腹腰痛取出、脱落率等停用率曼月乐与吉妮组比较无显著性差异（P〉0．05）,两组分别与高支撑不锈钢圆环组相比差异显著（P〈0．01,P〈0．01）;2年累计不良事件停用率分别为3．42％、4．88％和18．19％,曼月乐组最低,与吉妮组比较无显著差异（P〉0．05）,两组分别与c组相比差异显著（P〈0．01,P〈0．01）;2年续用率分别为89．96％、86．33％和65．69％,曼月乐组最高,与吉妮组比较无显著性差异（P〉0．05）,两组分别与C组相比差异显著（P〈0．01,P〈0．01）。结论：曼月乐组和吉妮组副反应小,停用率低且续用率高,是避孕效果较为理想的宫内节育器。     

Enucleation of Esophageal Leiomyoma with Azygos Continuation of the Inferior Vena Cava: Report of a Case

We herein report a rare case of esophageal leiomyoma in an 18-year-old woman with azygos continuation of the inferior vena cava. A submucosal tumor was located in the left wall of the esophagus behind the carina. The enlarged azygos vein made video-assisted thoracic surgery so difficult that conversion to a minithoracotomy and transection of the right superior intercostal vein were necessary to fully visualize the tumor. A pathological diagnosis revealed leiomyoma. Our experience suggests that a transection of the right superior intercostal vein is effective for the proper exposure of an esophageal tumor located behind the carina in a patient with an enlarged azygos vein.     

Visual interpolation is not scale invariant

According to the scale-dependence hypothesis, the visual interpolation of contour fragments depends on the retinal separation of endpoints: as the retinal size of a partially occluded angle increases, the interpolated contour gradually deviates from the shortest connecting path and approaches the shape of the unoccluded angle. In the field model, as the retinal size increases the strength of good continuation increases while the strength of the minimal-path tendency decreases. To test the scale-dependence hypothesis--as well as other hypotheses connected to inclusion, support-ratio dependence, and extended relatability--we ran two experiments using the probe localization technique. Stimuli were regular polygons with rectilinear contours bounding symmetrically occluded angles. Retinal size was manipulated by changing viewing distance. Observers were asked to judge if a probe, briefly superposed on the occlusion region, was inside or outside the amodally completed angle. Retinal size strongly influenced the penetration of interpolated trajectories in the predicted direction. However, support ratio and interpolated angle size interacted with retinal size, consistently with the idea that unification factors are effective within a spatial window. We modified the field model to include the size of such a window as a new parameter and generated model-based trajectories that fitted empirical data closely.     

Good continuation with kinetic edges

We examined the perceptual formation of extended contours from second-order kinetic-edges created by motion discontinuities. Paths were formed by spatially separate kinetic-edge elements, aligned along smooth paths, and embedded in randomly oriented noise elements. Path detection was severely degraded when the sign of motion contrast alternated along the path compared to when the same sign was used, or if random motion direction was assigned to each edge element, or if alternating opposite motion directions was used along the paths. Performance increased monotonically with the length of the path. Irrespectively of path curvature a fast temporal summation occurs within the first 200-400 ms and then levels off. Hence, the kinetic-edge grouping is relatively fast and a pure second-order process that senses whether the motion is globally in the same phase and direction along extended contours.     

Continuation electroconvulsive therapy for relapse prevention in middle-aged and elderly patients with intractable catatonic schizophrenia

The authors have previously studied the short-term effect of the first acute electroconvulsive therapy (ECT) course (phase 1 study) on intractable catatonic schizophrenia and the 1-year relapse rate after response to the acute ECT (phase 2 study) in middle-aged and elderly patients. Results indicated that, although acute ECT has an excellent short-term effect, the 1-year relapse rate after response to acute ECT is high despite the use of continuation neuroleptics. In the present prospective study the effect was explored of continuation ECT with neuroleptics on the prevention of relapse after response to a second acute ECT course in the relapsed participants of the phase 2 study. The present study included seven consecutive patients > 45 years of age with catatonic schizophrenia (Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) who relapsed (despite the use of neuroleptics) within 1 year after response to the first acute ECT course, and then responded to the second acute ECT course. The patients were given continuation ECT combined with neuroleptics; four ECT sessions at weekly intervals, then four ECT sessions every 2 weeks, then three ECT sessions every 4 weeks. Clinical symptoms were evaluated by means of the Brief Psychiatric Rating Scale (BPRS) weekly for 48 weeks or until relapse. Relapse was defined as a BPRS score of at least 37 for 3 consecutive days. Three out of the seven patients (42.9%) had a sustained response to ECT during the 1-year follow-up period. In the seven patients the probability of relapse within 1 year under treatment with neuroleptics alone (phase 2 study) was statistically higher than that under continuation ECT combined with neuroleptics (present study). No statistical differences were seen between the phase 2 study and the present study in the severity of psychiatric symptoms, global social function, the number of acute ECT sessions or the dosage of neuroleptics. No patient experienced a severe cognitive or physical adverse effect resulting from continuation ECT. Continuation ECT with neuroleptics is an efficacious and safe treatment for maintaining a response in middle-aged and elderly patients with intractable catatonic schizophrenia who have relapsed after a positive response to acute ECT despite the use of continuation neuroleptics.     

保持下颌骨连续性的舌癌口底癌根治术后复发因素的探讨

为了提高舌癌口底癌手术疗效，作者对４７例施行保持下颌骨连续性的舌癌口底癌联合根治术的复发因素进行分析。结果显示：术后复发１４例，复发率为２９．８％。局部复发均在原发灶的内侧软组织。９例舌侧缘口底后部癌中有５例复发（５５．６％），而５例舌侧缘前部癌中无１例复发，两者比较有显著性差异（Ｐ＜０．０５）；Ｔ３～４复发率（４８．０％）明显高于Ｔ１～２复发率（９．１％），Ｐ＜０．０１；有同侧颈淋巴结转移者的复发率（５４．５％）高于无颈淋巴结转移者的复发率（２２．２）％，Ｐ＜０．０５。作者认为：对适应证恰当的病例，术后复发与保持下颌骨连续性无关，而与肿瘤原发部位、大小、颈淋巴结转移及切除范围有关。     

Norplant® implants in the UK: First year continuation and removals

Norplant^® implants are a long-term, reversible hormonal method of contraception consisting of six flexible capsules placed subdermally in the inner aspect of the nondominant arm. Norplant implants were introduced into the UK in October 1993 although they had been used previously in some countries for up to ten years. The insertion and removal techniques require skills training and therefore it is important to assess early experience with the method.

This survey looks at the first year continuation rate of Norplant implants in the UK from a total of 2,129 insertions. From these insertions, 133 removals were documented and described, using a checklist of features. The continuation rate for Norplant implants use was 96.5% at six months and 85.2% at one year. None of the reasons for discontinuation were of a serious nature. The most common reason given was menstrual change (50.4% of all removals, 3% of all women included in the survey), which is in line with other reported studies.

Of the removals, 71.5% were reported as straightforward (of these 65.6% were completed within 20 minutes). In the first year of use, Norplant implants were associated with high continuation rates and the removal procedure was, in the majority of cases, completely straight-forward.     

Continuation phase treatment with bupropion SR effectively decreases the risk for relapse of depression.

BACKGROUND: This was the first controlled continuation phase study (up to 1-year total treatment) to evaluate the safety and efficacy of bupropion SR for decreasing the risk for relapse of depression in patients who responded to bupropion SR. METHODS: Patients with recurrent major depression were treated with bupropion SR 300 mg/day during an 8-week open-label phase. Responders (based on Clinical Global Impressions Scale for Improvement of Illness scores) entered a randomized, double-blind phase where they received bupropion SR 300 mg/day or placebo for up to 44 weeks. After randomization, relapse was defined as the point at which the investigator intervened by withdrawing the patient from the study to treat depression. RESULTS: Four hundred twenty-three patients were randomized. A statistically significant difference in favor of bupropion SR over placebo was seen in the time to treatment intervention for depression when survival curves were compared (log-rank test, p =.003). Statistically significant separation between bupropion SR and placebo began at double-blind week 12 (p <.05). Adverse events in bupropion SR-treated patients accounted for 9% and 4% of discontinuations from the open-label and double-blind phases, respectively. CONCLUSIONS: Bupropion SR was shown to be effective and well tolerated in decreasing the risk for relapse of depression for up to 44 weeks.