Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Low soluble Fas (sFas) and sFas ligand (sFasL) content in breast milk after preterm as opposed to term delivery

AIM: Various mechanisms of innate immunity and gastrointestinal integrity are potentially affected by soluble Fas (sFas) and sFas ligand (sFasL). Assuming that sFas and sFasL in milk reflect cellular events during lactogenesis, we aimed to assess the impact of premature parturition and duration of lactation on the concentrations of sFas and sFasL in human milk. PATIENTS AND METHODS: The content of the soluble form of the cell surface receptor Fas (sFas) and its natural ligand (sFasL) was measured in human breast milk of 44 healthy mothers after preterm (<35 wk, n=21) and term (>37 wk, n=23) delivery. Milk was furthermore classified as immature breast milk (days 4-7 of lactation) or mature breast milk (days 35-45 of lactation). Breast milk (2-3 ml) was sampled 5 min after the start of breastfeeding by manual expression or milk pump, and stored at -20 degrees C until analysis by an ELISA. RESULTS: sFas and sFasL concentrations were lower in immature milk after preterm compared to term delivery (sFas: 1.71; 1.38-2.47 ng/ml vs 3.03; 2.02-4.30 ng/ml, p < 0.001; sFasL: 0.13; 0.07-0.21 ng/ml vs 0.29; 0.15-0.60 ng/ml, p < 0.001 [median +/- interquartile range]). Mature milk samples, taken 1 mo later from both gestational groups, did not differ in sFas/sFasL content. Soluble Fas was positively correlated with sFasL in the same sample of immature (p < 0.001) and mature human milk (p < 0.05). A positive correlation was found between sFas and sFasL in immature and mature milk samples of the same mother (p < 0.01). The body mass index of the mothers and duration of pregnancy were positively correlated with the sFas and sFasL content in immature milk (p < 0.05 and p < 0.01, respectively) but not in mature milk. CONCLUSION: Preterm newborn infants fed with breast milk have a lower intake of sFas and sFasL compared to term neonates. Our results demonstrate that preterm delivery affects breast milk composition.     

Risk factors for fetal-to-maternal transfusion in Rh D-negative women--results of a prospective study on 942 pregnant women

AIMS: To investigate the incidence of severe fetal-to-maternal transfusion after delivery and to identify risk factors. MATERIAL AND METHODS: In a prospective study at the Department of Obstetrics, Charité, Campus Virchow-Klinikum, Berlin, Germany, we analyzed the incidence of severe fetal-to-maternal transfusion (>10 ml) and fetal-to-maternal hemorrhage (>25 ml) in Rh D-negative pregnant women after delivery of Rh D-positive infants. 942 women were included in the study and Kleihauer-Betke tests were performed. The results were compared to perinatal data. RESULTS: Fetal-to-maternal hemorrhage occurred in 13 cases out of 942 (incidence of 1.3%) and severe fetal-to-maternal transfusion in 61 cases (6.5%). In all of the cases with fetal-to-maternal hemorrhage, mothers were compatible with their infants in ABO-system. The incidence of fetal-to-maternal transfusion and its severe form was significantly higher in twin pregnancies (7/21 cases and 5/21 cases respectively, 33.3% and 23.8%) than in singleton pregnancies (22.5%, and 5.9%, P<0.001). All other factors, such as maternal age, parity, ethnicity, mode of delivery, presentation, duration of first and second stage of labor, CTG, or Apgar score were not associated with an increased risk of severe fetal-to-maternal transfusion. CONCLUSIONS: Twin pregnancy is the only independent risk factor for severe fetal-to-maternal transfusion. ABO-incompatibility between mother and infant seems to be protective against Rh D-alloimmunization.     

No influence of high- and low-carbohydrate diet on the oral glucose tolerance test in pregnancy

OBJECTIVE: Our objective was to determine the influence of the carbohydrate content of the diet preceding the oral glucose tolerance test (OGTT) in pregnancy on the test results and to evaluate the necessity of the recommended preparatory high-carbohydrate diet. STUDY DESIGN: Thirty-four women from our outpatient clinic were enrolled in this prospective study. After giving informed consent, each women underwent a 90-min lesson (supervised by a dietary assistant) covering the carbohydrate, protein and fat content of different foods. Women were then randomized and in a crossover design started a diet with either a low or a high carbohydrate content. We were aiming at a carbohydrate intake of 40% in the low-carbohydrate week (LCH) and 50% in the high-carbohydrate week (HCH). Compliance was monitored by a detailed food diary which the women kept and which included the weight of the foods they consumed. RESULTS: The actual dietary intakes as calculated from the food diaries showed that the mean caloric intake was 1801 +/- 314 kcal in the LCH and 2118 +/- 312 kcal in the HCH week (<0.001). During the LCH diet, CH intake was 39 +/- 6.1% and 49 +/- 6.6% in the HCH week (P < 0.001). The carbohydrate intake per kilogram bodyweight was 30 +/- 5.3 kcal vs. 35 +/- 5.2 kcal (P < 0.001). The number of patients diagnosed with gestational diabetes was two in the LCH and three in the HCH week (not significant). The sum of the OGTT values (fasting, 1 h and 2 h) after the LCH was 18.9 +/- 2.1 mmol/l vs. 18.8 +/- 2.1 mmol/l after the HCH (P = 0.51). No differences could be found in both groups regarding the fasting, 1-h, or 2-h glucose values. Including patients with a CH difference of at least 5%, 10%, and 15% carbohydrate between the weeks, we still did not observe any differences in the OGTT sum. We also looked at a possible influence of the CH content of the diet on the day before the test and of the last meal before the OGTT results and observed there was none. CONCLUSION: This is the first study which has observed the influence of the previous day's meal on the test results. We conclude from our results that the carbohydrate percentage of the preparatory diet did not influence the results of an OGTT, even when we increased the difference in carbohydrate intake stepwise up to 15%. This might indicate that a preparatory diet before the OGTT is not necessary for women with normal nutritional behavior.     

Hypertension: pathophysiology and treatment

Arterial hypertension is a major cause of morbidity and mortalitybecause of its association with coronary heart disease, cerebrovasculardisease and renal disease. The extent of target organ involvement(i.e. heart, brain and kidneys) determines outcome. North Americanstudies have shown that hypertension is a major contributorto 500 000 strokes (250 000 deaths) and 1 000 000 myocardialinfarctions (500 000 deaths) per annum.     

The surgical hypertensive patient

We reviewed the pathophysiology and treatment of hypertensionin a recent edition of this journal (see key references). Inthis article, we discuss the management of the hypertensivepatient presenting for surgery and anaesthesia.