Paroxysmal atrial fibrillation due to left atrial appendage herniation and review of the literature

The incidence of the isolated form of partial absence of the pericardium is a rare finding. The authors present a case of an isolated left sided pericardial defect with intrathoracic protrusion of the left atrial appendage found during a left upper lobectomy for lung cancer, unrecognized after serial echocardiographs and computed tomography scan of the thorax. The patient suffered from episodes of atrial fibrillation which disappeared after pericardial defect repair without antiarrhythmic medication.     

Early effect of sodium valproate and carbamazepine monotherapy on homocysteine metabolism in children with epilepsy

Plasma total homocysteine (p-tHcy), serum folate (s-F), serum vitamin B-12 (s-B12) and plasma pyridoxal-5'-phosphate (p-PLP) were measured in epileptic children before and after a 20-week period of sodium valproate (group A, n=32) and carbamazepine (group B, n=20) monotherapy. P-tHcy significantly increased in both groups, s-F and s-B12 significantly increased in group A, while s-F and p-PLP significantly decreased in group B. Our study showed an early effect of antiepileptic drug treatment on homocysteine metabolism.     

Autologous chondrocyte implantation: where do we stand now?

Chondral damage to the young knee is common. In symptomatic patients current surgical treatment has focused on filling the defect with fibrocartilage; however, this tissue has poor resistance to shear forces, leading to failure and the onset of degenerative osteoarthritis.     

Surveillance of monthly antimicrobial consumption rates stratified by patient-care area: a tool for triggering and targeting antibiotic policy changes in the hospital

The profile and temporal trends of antimicrobial use were investigated at a university hospital. Aggregate data were analyzed according to the ATC/DDD methodology. During 1998-2002, hospital-wide antimicrobial use increased by 22%, from 86.97 to 106.24 defined daily doses per 100 bed-days [DDD/100BD]. Pooled usage rates in DDD/100BD, overall percentage increases and annual average increase rates were respectively 109.97, 35.6%, 8.1 for Medical wards, 98.21, 48.7%, 9.1 for Intensive Care Units and 74.46, 34.3%, 5.7 for Hemato-oncology wards. Surgical wards had a fairly constant usage rate (98.36). A shift towards the newer broad-spectrum antibiotics, to the detriment of the older penicillins and cephalosporins, was noted in all hospital areas. Surveillance of antimicrobial consumption using the ATC/DDD system provided a clear picture of its profile. Monthly rates over a sufficient surveillance period allowed the assessment of temporal trends. Stratification of rates according to clinical service allowed areas of concern to be specified and targeted antibiotic policy changes to be initiated.     

Methodology and measurement properties of health-related quality of life instruments: A prospective study of patients undergoing breast reduction surgery

Background  

Breast hypertrophy is associated with clinically important morbidity. A prospective study was conducted to assess the change in health-related quality of life (HRQL) following breast reduction mammoplasty. This paper describes the measurement properties of each of the HRQL questionnaires used.     

Abductor digiti minimi involvement in Dupuytren's contracture of the small finger

PURPOSE: Dupuytren's contracture (DC) is a common, benign, progressive condition. Patterns of involvement of the ulnar side of the hand, specifically the involvement of the abductor digiti minimi (ADM), have received limited attention; therefore, the purpose of this study was to determine the prevalence, patterns of involvement, and surgical outcomes in DC of the small finger. METHODS: A retrospective review was performed on the hands of all patients who had surgery for DC between January 1998 and March 2002 to determine the incidence of ADM involvement. RESULTS: A total of 149 patients had 195 surgeries on 261 digits during this period. Forty-seven percent of cases involved the small finger and 27% of those involved the ADM. Those cases involving the ADM had statistically significantly greater mean preoperative proximal interphalangeal joint (PIPJ) contracture (53 degrees ) as well as postoperative PIPJ contracture (34 degrees ) when compared with those without ADM involvement of the small finger (31 degrees preoperative PIPJ contracture and 15 degrees postoperative PIPJ contracture, respectively). The most common origin pattern of the ADM involvement was found to arise from both the ADM tendon and overlying fascia (77%). The most common insertion pattern was found to be over the middle phalanx (50%). CONCLUSIONS: We conclude that ADM is involved in DC of the small finger in one quarter of cases. Failure to recognize and resect the diseased cord arising from it and its overlying fascia at the time of surgery may account for the poor outcomes seen in DC of the small finger.     

Rickettsia typhi infection presenting as subacute meningitis

We report two children with Rickettsia typhi infection presenting with mild central nervous system manifestations and pleocytosis in cerebrospinal fluid. Murine typhus should be included in the differential diagnosis of meningoencephalitis in children who are residents of endemic areas.