A Novel Timesaving Method for Hepatobiliary Imaging for Suspected Acute Cholecystitis

Objective

To optimize resource utilization of cholescintigraphy for suspected acute cholecystitis with a time-saving method without a loss in diagnostic accuracy.

Oral clonidine pretreatment prior to venous cannulation

Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability.     

Spinal cord injury-induced osteoporosis in veterans

In a cross-sectional study, 132 male veterans with spinal cord injury (average age 37.4 years; injuries sustained from 5 to 23 years ago), underwent dual-energy x-ray absorptiometry, by LUNAR, to define bone mineral density (BMD) in second to fourth lumbar vertebrae and the neck of the right femur (g/cm(2)). The results showed that bone minerals in the lumbar area are reserved better than in the femoral neck. The study on the femoral neck revealed that 81.5% of subjects had osteoporosis and 13.1% osteopenia. Evaluation of lumbar spines also showed that 16.7% of the veterans had osteoporosis and 18.2% osteopenia. A significant difference was observed between vertebral bone density (mean 1.23 g/cm(2)) and the neck of the right femur (mean 0.66 g/cm(2)). There was also a slight negative correlation between bone density and risk of bone fracture in vertebrae and femoral neck. No significant relation between bone density and age, level of injury, spasm, occupation, and postinjury period was reported. A slight negative correlation between weight and bone mineral density and a slight positive correlation between height and bone mineral density were found.     

Serial repositioning of a Günther tulip retrievable inferior vena cava filter in a pediatric patient

We report an 11-year-old boy who required inferior vena cava (IVC) filtration for a prolonged period of time. A retrievable IVC filter was placed and repositioned three times, providing a total of 60 days of IVC filtration. The filter was removed when his risk of pulmonary embolus had decreased substantially. This is a relatively uncommon practice in the pediatric population. The technique is presented, and the available literature is reviewed.     

Prevalence and Management of Prolapse of the Ileoanal Pouch

PURPOSE Known late complications of ileal pouch-anal anastomoses include chronic pouchitis, poor pouch function, or stricture. These may jeopardize the pouch and may require pouch salvage procedures. Prolapse of the ileoanal pouch is a little-known complication infrequently noted in the literature. The objective of this study was to determine the prevalence of this problem and identify approaches used to correct it and salvage the pouch.METHODS The literature was reviewed for publications describing the diagnosis and treatment of patients with ileoanal pouch prolapse. A survey inquiring about experience with ileoanal pouch prolapse was sent to all North American members and fellows of The American Society of Colon and Rectal Surgeons. The survey assessed the number of years that the respondent had been performing ileal pouch-anal anastomoses and the number and type of pouches constructed. The respondents indicated the prevalence of patients with ileoanal pouch prolapse in their practices and length of time from pouch creation to onset of prolapse. They also were asked to indicate presenting symptoms, need for and method of surgical repair, and outcome.RESULTS Two hundred and sixty-nine responses were received (response rate, 19.5 percent). Thirty-five respondents indicated that they had assisted in the care of a total of 83 patients with prolapse of the ileoanal pouch. Prolapse symptoms included external prolapse of tissue, sense of obstructed defecation, seepage, and pain. Patients with pouch prolapse most commonly presented within two years of pouch construction. Fifty-two patients required surgery and were managed by a combination of transanal repair, abdominal pouchpexy, and transabdominal revision or removal. The ileoanal pouch was salvaged in all but one case.CONCLUSIONS Although the incidence of pouch prolapse is relatively low in this survey, the number of cases reported far exceeds the previous known experience. The possibility of this clinical entity should be considered in the differential diagnosis of ileoanal pouch dysfunction. Such recognition should lead to correction of prolapse and pouch salvage in the great majority of patients.Reprints are not available.Read at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 8, 2002. Presented at the Tripartite Meeting, Melbourne, Australia, October 27 to 30, 2002.     

Synthesis,antitubercular activity and pharmacokinetic studies of some schiff bases derived from 1- alkylisatin and isonicotinic acid hydrazide (inh)

N'-(1-alkyl-2,3-dihydro-2-oxo-1H-3-indolyliden)-4-pyridinecarboxylic acid hydrazide derivatives, 3(a-g), were synthesized in a trial to overcome the resistance developed with the therapeutic uses of isoniazid (INH). The lipophilicity of the synthesized derivatives supersedes that of the INH as expressed by Clog p values. The synthesized compounds and INH were tested against bovin, human sensitive and human resist strains of Mycobacterium tuberculosis. Compounds 3a, 3d, 3f and 3g with 1-unsubstituted, 1-propyl, 1-propynyl and 1-benzyl groups respectively exhibited equipotent growth inhibitory activity (MIC 10 micromol) against the tested strains as compared with INH however the later has no activity against human resist strain. Pharmacokinetic study revealed that the rate and extent of absorption of the tested derivatives (3d and 3f) significantly higher than that of INH (p < 0.05). The relative bioavailabilities (F(R)%) were 183.15 and 443.25 for 3f and 3d respectively as compared to INH. These results preliminary indicate the possible use of the prepared derivatives for treatment of tuberculosis infections in order to overcome the resistance developed with INH.     

Structural model of the OPA1 GTPase domain may explain the molecular consequences of a novel mutation in a family with autosomal dominant optic atrophy

Autosomal dominant optic atrophy (ADOA) is the most frequent hereditary optic neuropathy. Three loci have been reported for ADOA: a major locus, harboring all identified mutations to date, maps to 3q28 (OPA1), a second locus is linked to 18q12.2-q12.3 (OPA4) and a third locus on 22q12.1-q13.1 (OPA5) has been reported recently. We describe a six-generation Iranian family in which optic atrophy runs as an autosomal dominant trait with an age of onset at 14-15years. We performed linkage analysis with markers mapping to 3q28 and 18q12.2-q12.3 and found linkage to 3q28. Subsequent sequencing of OPA1 identified a novel heterozygous missense mutation (c.1313A>G) replacing aspartic acid by glycine (p.D438G) in the GTPase domain of OPA1. Interestingly, another missense mutation at the same position (c.1313A>T, D438V) has been reported before in two unrelated German families, indicating a possible mutation hot spot. Further evidence supporting the importance of D438 is its conservation from human to acoelomata. OPA1 is believed to be the human orthologue of yeast MGM1, a dynamin-related protein required for the integrity of mitochondrial DNA. Homology modeling of the OPA1 GTPase domain revealed extensive structural similarity to the Dictyostelium dynamin A GTPase domain and showed that D438 may interact with residues of the G1 and the G4 motifs, which are crucial in coordinating GTP. Based on this analysis, we propose a mechanism which explains the gradual decline of vision in ADOA patients with OPA1 mutations at position 438.