Assessment of Atrial Conduction Time in Patients with Familial Mediterranean Fever

Background: Increased inflammatory activity is known to be a pathophysiologic characteristic of atrial fibrillation. Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Atrial conduction abnormalities in these patients have not been investigated in terms of P‐wave duration, P‐wave dispersion (Pd), and atrial electromechanical delay measured by tissue Doppler echocardiography (TDE). We aimed to assess atrial conduction time in patients with FMF. Methods: A total of 33 patients with FMF (13 males/20 females, 28.4 ± 12.5 years), and 33 controls (13 males/20 females, 28.5 ± 12.1 years) were included. Atrial electromechanical coupling (PA) and intra‐ and interatrial electromechanical delay were measured with TDE. From the 12‐lead electrocardiogram Pd was calculated. Results: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) was significantly higher in FMF patients (58.0 ± 9.0 vs 51.0 ± 5.8, P < 0.001). Interatrial (PA lateral–PA tricuspid) and intraatrial electromechanical delay (PA septum–PA tricuspid) were significantly longer in FMF patients (21.3 ± 7.4 vs 12.9 ± 4.6, P < 0.001 and 4.7 ± 5.5 vs 2.1 ± 1.7, P = 0.01, respectively). Also, Pd and maximum P‐wave duration were significantly higher in FMF patients (42.8 ± 7.9 vs 35.3 ± 6.1, P < 0.001 and 98.6 ± 9.0 vs 93.1 ± 8.5, P = 0.01, respectively). A positive correlation was detected between interatrial electromechanical delay and Pd (r = 0.622, P < 0.001). Plasma level of C‐reactive protein (CRP) correlated with interatrial electromechanical delay and Pd (r = 0.733, P < 0.001; and r = 0.427, P < 0.001, respectively). Conclusion: This study shows that atrial electromechanical delay and Pd are prolonged in FMF patients. Atrial electromechanical delay is closely associated with Pd and plasma level of CRP.     

Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors

OBJECTIVES: To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors. METHODS: Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed. RESULTS: One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 +/- 16.7 min (range, 50-135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 +/- 0.9 days (range, 1-4). After a mean follow up of 14.3 +/- 5.9 months (range, 3-24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney. CONCLUSIONS: Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved.     

Enalapril-induced reversible renal failure during surgery in an infant

Angiotensin-converting enzyme (ACE) inhibitors are widely used as antihypertensive drugs, and serious complications have been described in adults, particularly in the perioperative period. This report concerns a 14-months-old infant who developed prolonged hypotension and reversible renal failure during major surgery for neuroblastoma removal. He was treated for 4 months by the long-acting ACE inhibitor, enalapril, that had been continued until the morning of surgery. This observation, as well as others in adults, suggests that consideration should be given to discontinue the administration of long-acting ACE inhibitors preoperatively in children scheduled to undergo extensive surgical procedure involving large blood or fluid shifts.     

Further Studies on the Immunopathology of Atopic Keratoconjunctivitis using Flow Cytometry

Atopic keratoconjunctivitis (AKC) is an ocular manifestation of systemic hypersensitivity. Although the pathogenesis of AKC is not fully understood, some previous data suggest that a decrease in numbers of suppressor T lymphocyte (Ts) and increase of Th, especially Th2 (the second subgroup of helper T lymphocyte), at the ocular surface may play an important role in the occurrence of the disease. In this study, the percentages of naive-Th (CD4/45RA+) and memory-Th (CD4/29+) cells, and the Th/Ts and memory-Th cells/naive-Th cells ratios were measured in the blood and tear samples of patients with AKC, atopic patients without ocular involvement and normal volunteers, using flow cytometry. Groups were compared using the Mann-Whitney U test. We found that patients with AKC had significantly higher memory-Th cell concentration, and Th/Ts and memory-Th cells/naive-Th cell ratios both in the tear and blood samples compared to normal subjects. While no significant difference existed between the tear samples of the atopic patients without ocular involvement and normal volunteers with respect to the above values, atopic patients had higher percentages of memory-Th cells and higher Th/Ts and memory-Th cells/naive-Th ratios in their blood than normal subjects. The percentages of memory-Th cells, and the Th/Ts and memory-Th cells/naive-Th cell ratios in the tear samples of AKC patients were also found to be higher than that of the atopic patients without ocular involvement, but no significant difference was present between the blood samples of these groups. The percentages of naive-Th cells did not show any significant difference between groups either in tear or blood samples. Since the mean memory-Th cells/naive-Th1 cells ratio in the tear samples of the patients with AKC was higher than in their blood samples, we propose that the localized accumulation of memory-Th2 cells, in addition to the increase of Th/Ts ratios in the external eye may cause AKC in atopic individuals.     

Lactated Ringer with 1% dextrose: an appropriate solution for peri-operative fluid therapy in children

Peri-operative blood glucose, total protein, and electrolytes values were measured in children (3–120 months) scheduled for minor surgery and randomly assigned to three groups according to the type of fluids administered during anaesthesia: children of RL group (n= 27) received lactated Ringer, those of RLD1 group (n= 25), 1% dextrose in lactated Ringer, and those in RLD2.5 group (n= 27), 2.5% dextrose in 0.4 N saline (50% D5, 50% RL) (63 mmol·l^-1). Infusion rate was set according to children's age and weight. Fluids were infused throughout the study with volumetric infusion pumps. Blood samples were obtained at induction (T0), at the end of surgery (T1), 30 and 60 min later (T2, T3). Pre-operative blood values were within the normal ranges except for high total protein values in all groups of children and for asymptomatic hypoglycaemia (2.3 and 2.5 mmol·l^-1) in two children. Blood glucose increased significantly in the three groups post-operatively (P < 0.001), and this increase was related to the amount of glucose infused. Glucose values differed significantly between groups at T1 and T2, while blood glucose values were back to the normal ranges at T2 and T3 in the RL group. Sodium values remained unchanged post-operatively in both RL and RLD1 groups, while a significant decrease was observed in the RLD2.5 group (P < 0.001). Total protein decreased in the three groups post-operatively (P < 0.001) towards normal values. These data suggest that RLD1 is appropriate for peri-operative fluid therapy in children. Its administration at the infusion rate used in this study, resulted in moderate post-operative hyperglycaemia while avoiding the risk of peri-operative hypoglycaemia, maintaining a constant extracellular fluid composition and correcting pre-operative fluid deficit.     

Clinical Use of an Intraoral Silicoating Technique

I A ceramic fracture rate of metal-ceramic fixed prosthodontics of up to almost 9% calls for an efficient and effective intraoral repair system. For the repair of fractured veneering material, an intraoral silicoating technique was introduced. In contrast to other repair techniques, the silicoating can successfully be used on a variety of dental restorative materials and, therefore, offers additional applications in the field of the intraoral adhesive technique. This silicoating technique, consisting of a chairside air-abrasion device filled with a specific silica-coated air-abrasion medium, has been used intraorally by the authors since 1993 for clinical purposes. The clinical procedure is described for different applications in the field of the adhesive technique: intraoral repair, preconditioning of core buildups, implant abutments, and surfaces of fixed prosthodontics for the bonding of orthodontic brackets or periodontal splints.     

Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies

Background: Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an α2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta‐analysis of studies comparing premedication with clonidine to Benzodiazepines. Methods: A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed. Results: Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post‐operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post‐operative nausea and vomiting (PONV). Discussion: Premedication with clonidine is superior to midazolam in producing sedation, decreasing post‐operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result.     

Effect of renin–angiotensin–aldosterone system (RAAS) blockade on visfatin levels in diabetic nephropathy

Aim: Plasma visfatin levels are elevated in diabetic nephropathy in parallel to the severity of proteinuria and glomerular filtration rate. The aim of this study was to find out whether the renin–angiotensin–aldosterone system (RAAS) blockage has any effect on the plasma visfatin levels. Methods: Thirty‐two patients with diabetic proteinuria (>500 mg/day) with a normal glomerular filtration rate (GFR) and 33 healthy subjects were enrolled. Patients were treated with ramipril 5 mg daily for 2 months. Proteinuria, GFR, high‐sensitivity C‐reactive protein (hsCRP), visfatin, flow‐mediated dilatation (FMD) and homeostasis model assessment of insulin resistance (HOMA‐IR) index measurements were performed both before and after the treatment. Results: The plasma visfatin, and hsCRP levels of the patients were significantly higher and the FMD was significantly lower (P < 0.001 for all). The visfatin levels were significantly correlated to FMD, systolic and diastolic blood pressures, proteinuria, eGFR, HOMA‐IR and hsCRP. Ramipril treatment resulted in a significant decrease in plasma visfatin, proteinuria, hsCRP, HOMA‐IR and increase in FMD (P < 0.001) in patients (P < 0.001 for all). Conclusion: The present study suggests that plasma visfatin levels are related to the endothelial functions, inflammation and the severity of proteinuria in diabetic nephropathy. Treatment with ramipril causes a significant decrease in visfatin levels along with the improvement of proteinuria, endothelial dysfunction and inflammatory state in diabetic nephropathy.