Covered stent to treat saphenous venous graft perforation—A case report

This case report shows the immediate and long‐term clinical result of percutaneous coronary intervention in a patient with total occlusion of saphenous venous graft. The case also highlights the management of venous graft perforation during percutaneous intervention using a covered stent. © 2010 Wiley‐Liss, Inc.     

Esophageal strictures following endoscopic variceal sclerotherapy

We have evaluated 169 patients with portal hypertension receiving endoscopic variceal sclerotherapy in order to assess the predisposing factors, clinical profile, and treatment response of sclerotherapy-induced esophageal strictures. Of the 129 patients included in the final analysis, 20 (15.5%) developed persistent esophageal stricture. No significant difference was found with respect to age, nature of sclerosant (absolute alcohol, ethanolamine oleate, or sodium tetradecyl sulfate), etiology of portal hypertension, Child's class, initial variceal score, or intensity of sclerotherapy schedule between the patients who developed strictures and those who did not. However, female sex (P less than 0.01) and persistent esophageal ulceration (P less than 0.05) did predispose to stricture formation. Sclerotherapy-induced strictures presented with a variable grade of dysphagia, were always solitary, and were localized to the lower end of esophagus. Most of these could be dilated rapidly using Eder-Puestow metal olives (3.15 +/- 0.80 dilatation sessions per patient). Stricture formation did interrupt an effective sclerotherapy program but only temporarily, and successful variceal obliteration could be obtained after stricture dilatation.     

Symptomatic biliary obstruction associated with juxtapapillary duodenal diverticulum

Summary We describe a 56-year-old woman with symptomatic biliary obstruction associated with a duodenal diverticulum. Cholangiography revealed a dilated common bile duct with prominent distal obstruction of unusual configuration. Liver function tests were normal. Pain has not recurred since choledochojejunostomy.     

Development of the human coagulation system in the healthy premature infant

This study was designed to determine the postnatal development of the human coagulation system in the healthy premature infant. Consecutive mothers of healthy premature infants born at either St Joseph's Hospital or McMaster University Medical Centre in Hamilton were asked for consent. One hundred thirty-seven premature infants (30 to 36 weeks of gestational age) entered the study. The premature infants did not have any major health problems and did not require ventilation or supplemental oxygen. Demographic information and a 20-mL blood sample were obtained in the postnatal period on days 1, 5, 30, 90, and 180. Between 40 and 96 premature infants were studied on each day for each of the following tests: prothrombin time, activated partial thromboplastin time, thrombin clotting time, plasminogen; 13 factor assays [fibrinogen, II, V, VII, VIII, IX, X, XI, XII, XIII, high-mol-wt kininogen (HMWK), prekallikrein (PK), von Willebrand factor (vWF)] and eight inhibitors [antithrombin III (AT-III), heparin cofactor II, alpha 2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, C1 esterase inhibitor, protein C (PC), and protein S (PS)]. A combination of biologic and immunologic assays were used. Between 30 to 36 weeks there was a minimal effect of gestational age for levels of AT-III, PC, and factors II and X only; therefore, the entire data set was used to generate reference ranges for these components of the coagulation system for premature infants. Next, the results for the premature infants were compared with those of a previously published study in 118 fullterm infants and with those for adults. An effect of gestational age was shown for plasminogen, fibrinogen, factors II, V, VIII, IX, XI, XII, HMWK, and all eight inhibitors. In general, the postnatal maturation towards adult levels was accelerated in premature infants as compared with the fullterm infants. By 6 months of age, most components of the coagulation system in premature infants had achieved near adult values.     

Hand and forearm dermatoses among veterinarians

BACKGROUND: Infectious and non-infectious hand and forearm dermatoses are frequent in daily veterinary medicine. In this specific occupation there is a serious impact of skin disease on the lives and careers of veterinarians. OBJECTIVE: In this study we clarify the different occupational dermatoses on hands and forearms among veterinarians, using data collected in different dermatological patch-test expert centres in Belgium and the Netherlands. METHODS: Instead of questioning veterinarians themselves, which has been done in different studies in the past, we contacted dermatologists in Belgium and the Netherlands, questioning them about their experiences with dermatoses among veterinarians. RESULTS: Seven dermatologists described a total of 58 veterinarians. Infectious dermatoses were described in 12 cases (20.7%). The non-infectious dermatoses (46 cases, 79.3%) can be classified as contact urticaria and as irritant or allergic contact dermatitis. CONCLUSION: While irritant contact dermatitis accounts for the vast majority of hand and forearm dermatoses among veterinarians, contact urticaria and allergic contact dermatitis also significantly contribute to the occupational morbidity. Repeated hand washing, occlusion under rubber gloves, contact with animal protein fluids during obstetric procedures and contact with antiseptic agents, systemic and topical corticosteroids and antibiotics are the most likely causes of hand and forearm dermatoses among veterinarians.     

Positional cloning of a novel gene on chromosome 16q causing Bardet-Biedl syndrome (BBS2)

Bardet-Biedl syndrome (BBS) is a genetically heterogeneous autosomal recessive disorder with the primary clinical features of obesity, pigmented retinopathy, polydactyly, hypogenitalism, mental retardation and renal anomalies. Associated features of the disorder include diabetes mellitus, hypertension and congenital heart disease. There are six known BBS loci, mapping to chromosomes 2, 3, 11, 15, 16 and 20. The BBS2 locus was initially mapped to an 18 cM interval on chromosome 16q21 with a large inbred Bedouin kindred. Further analysis of the Bedouin population allowed for the fine mapping of this locus to a 2 cM region distal to marker D16S408. Physical mapping and sequence analysis of this region resulted in the identification of a number of known genes and expressed sequence tag clusters. Mutation screening of a novel gene (BBS2) with a wide pattern of tissue expression revealed homozygous mutations in two inbred pedigrees, including the large Bedouin kindred used to initially identify the BBS2 locus. In addition, mutations were found in three of 18 unrelated BBS probands from small nuclear families.