Acute Aortic Valve Rupture Secondary to Blunt Chest Trauma

Abstract Cardiac valve injury after blunt chest trauma is rare. We present a case of blunt chest trauma resulting in an isolated aortic valve rupture treated with aortic valve replacement . (J Card Surg 2010;25:381‐382)     

A brief marijuana intervention for non-treatment-seeking young adult women

We randomized 332 women, 18-24 years old, who were not explicitly seeking treatment for their marijuana use to either a two-session motivationally focused intervention or an assessment-only condition. Assessed by timeline follow-back methodology, participants reported using marijuana 57% of days in the 3 months prior to study entry. Intervention effects on the likelihood of marijuana use were not statistically significant at 1 month (odds ratio [OR] = 0.77, p = .17), significant at 3 months (OR = 0.53, p = .01), and no longer significant at 6 months (OR = 0.74, p = .20). Among the 61% of participants endorsing any desire to quit using marijuana at baseline, significant intervention effects on the likelihood of marijuana use days were observed at 1 month (OR = 0.42, p = .03), 3 months (OR = 0.31, p = .02), and 6 months (OR = 0.35, p = .03). A two-session brief motivational intervention reduced marijuana use among young women not seeking treatment. Women with a desire to quit showed a greater and more durable response.     

Motivational and mindfulness intervention for young adult female marijuana users

This pilot study tested the efficacy of a brief intervention using motivational interviewing (MI) plus mindfulness meditation (MM) to reduce marijuana use among young adult females. Thirty-four female marijuana users between the ages of 18 and 29 were randomized to either the intervention group (n = 22), consisting of two sessions of MI-MM, or an assessment-only control group (n = 12). The participants' marijuana use was assessed at baseline and at 1, 2, and 3 months posttreatment. Fixed-effects regression modeling was used to analyze treatment effects. Participants randomized to the intervention group were found to use marijuana on 6.15 (z = −2.42, p = .015), 7.81 (z = −2.78, p = .005), and 6.83 (z = −2.23, p = .026) fewer days at Months 1, 2, and 3, respectively, than controls. Findings from this pilot study provide preliminary evidence for the feasibility and effectiveness of a brief MI-MM for young adult female marijuana users.     

Pediatric robotic-assisted laparoscopic diverticulectomy

Congenital bladder diverticula are rare anomalies of the bladder. Patients present with infection, hematuria, and/or urinary obstruction. We report on the case of a 12-year-old boy who developed gross hematuria and recurrent infection owing to a 12-cm bladder diverticulum. Robotic-assisted laparoscopic diverticulectomy was performed. We describe the first reported robotic-assisted laparoscopic diverticulectomy in a pediatric patient.     

Marijuana Use among Young Women in a Primary Care Setting

OBJECTIVE To evaluate the prevalence of marijuana use among young women, ages 18–24, within a primary care setting. DESIGN From 2/05 to 12/05, women completed a brief, anonymous self-report screening instrument in two urban primary care clinics for potential participation in a randomized controlled trial of an intervention to reduce marijuana use and sexual risk-taking behavior. During the last few months of recruitment, women who completed the screening instrument were also asked to provide a urine sample to test for the presence of marijuana and other drugs. RESULTS Of the 607 women who completed the screening instrument, 38.6% reported lifetime marijuana use, 8.4% used marijuana at least monthly, and 1.7% reported using marijuana daily. Within this ethnically diverse sample (45% Hispanic), women who used marijuana at least monthly were more likely to smoke cigarettes (OR = 2.03, 95% CI = 1.04, 3.96), binge drink at least once a month (OR = 2.66, 95% CI = 1.34, 5.28), and to have ever used other drugs (OR = 2.91, 95% CI = 1.31, 6.45). Of the 67 urine samples provided, 60 (89.6%) were concordant with self-reported use, but six of the seven discordant samples were positive despite negative self-report. CONCLUSIONS The prevalence of marijuana use and binge drinking in this ethnically diverse sample of young, female primary care patients was lower than rates reported in national surveys. Providers should consider marijuana use as a part of a process that addresses more prevalent high-risk behaviors, bearing in mind that these behaviors may be underreported during routine screening.     

Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients. A randomized, double-blind, multinational study

OBJECTIVE: This was a double-blind, randomized multicentre trial comparing efficacy and safety of brivudin (125 mg, once a day) and famciclovir (250 mg, three times a day), both given orally for 7 days, in the treatment of herpes zoster. METHODS: A total of 2027 immunocompetent zoster patients>or=50 years with zoster-related pain at presentation were included. Outcome measures embraced prevalence of postherpetic neuralgia (PHN), defined as at least moderate pain 3 months after treatment initiation, duration of PHN, prevalence and duration of zoster-associated pain (ZAP), duration of vesicle formation and rash healing. RESULTS: The prevalence of PHN at month 3 was 11.3% with brivudin and 9.6% with famciclovir [per-protocol (PP) population]. Equivalence of the two drugs could be demonstrated (P=0.01, PP and intention-to-treat analysis). The median duration of PHN was 46.5 days with brivudin and 58 days with famciclovir (P=0.54, PP analysis). Prevalence and duration of ZAP did not differ significantly between treatment groups. The prevalence of PHN was higher in patients>or=65 years (brivudin: 16.4%, famciclovir: 16.4%), and in patients with severe rash (brivudin: 13.4%, famciclovir: 15.7%), without significant differences between treatment groups. In patients>or=65 years, median duration of PHN was shorter with brivudin than with famciclovir (39.5 vs. 57.5 days), although the difference was not statistically significant. The two drugs had equivalent efficacy in being able to accelerate the stop of vesicle formation, and lesion healing. Adverse events were similar in nature and prevalence among groups. CONCLUSIONS: The study demonstrated equivalent efficacy of brivudin and famciclovir in the treatment of herpes zoster regarding the prevention of chronic pain and the resolution of signs and symptoms of acute herpes zoster. Compared with famciclovir, brivudin provides equivalent efficacy and safety at a more convenient once-daily dose schedule.     

Association between human recombinant EPO and peripheral vascular disease in diabetic patients receiving peritoneal dialysis

Peripheral vascular disease is a serious and frequent problem in diabetic patients. Since the beginning of the widespread use of erythropoietin (EPO), we have noted an increase in peripheral vascular disease in diabetic patients receiving peritoneal dialysis and erythropoietin. This prompted us to study the effects of erythropoietin on peripheral vascular disease in patients receiving peritoneal dialysis. We retrospectively reviewed medical records of all diabetic patients in our program who received peritoneal dialysis from 1990 to 1996. Demographic and laboratory data as well as EPO use data were collected. Hospital days and occurrence of vascular events (defined as peripheral vascular surgery, amputation, or recommendation of vascular surgery or amputation by a vascular surgeon) were determined for diabetic patients receiving peritoneal dialysis. Comparisons were made between those who received EPO and those who did not received EPO, as well as comparing vascular events in 28 patients who received peritoneal dialysis before and after beginning EPO. Patients who received erythropoietin were found to have a significantly shorter time to a first vascular event, a greater number of vascular events, and more hospital days associated with vascular disease than diabetic patients who did not receive erythropoietin. With multivariate analysis, significant risk factors for the development of peripheral vascular disease in these patients were erythropoietin use, erythropoietin dose, and smoking. Twenty-eight patients who initially performed peritoneal dialysis without receiving EPO, and later received EPO, had a significant increase in vascular events, including amputations only while receiving EPO. We found the use of erythropoietin to be associated with peripheral vascular events in diabetic patients who receive peritoneal dialysis. Further investigation is warranted.     

Accuracy of a new low-flow sidestream capnography technology in newborns: a pilot study.

OBJECTIVE: To evaluate the accuracy of a new low-flow sidestream capnography technology and analyze components of the capnogram in mechanically ventilated newborns with and without pulmonary disease. METHODS: Twenty patients were prospectively identified. Eligible infants were mechanically ventilated and had an indwelling arterial catheter. Two groups were identified: newborns who were receiving mechanical ventilation for pulmonary diseases, and newborns who were receiving postoperative mechanical ventilation for nonpulmonary conditions. End-tidal CO(2) (PetCO(2)) was measured for 1-minute pre- and post-arterial blood sampling, and PetCO(2) and PaCO(2) were compared for each patient. Eight quantitative waveform parameters were also measured on all patients. RESULTS: Newborns in the pulmonary group (n=13) (persistent pulmonary hypertension of the newborn/meconium aspiration syndrome, respiratory distress syndrome, pneumonia) and newborns in the control group (n=7) were matched for birth weight, gestational age, and postnatal age. PetCO(2)-PaCO2 Gradient values were higher in the pulmonary group (7.4+/-3.3 mm Hg) than controls (3.4+/-2.4 mm Hg). Four waveform parameters (ascending slope, alveolar angle, alpha angle, descending angle) were identified, which independently differentiated patients with pulmonary disease from controls. CONCLUSIONS: Low-flow capnography with Microstream technology accurately measured alveolar CO(2) in newborns without pulmonary disease, as demonstrated by normal PetCO(2)-PaCO(2) gradients. The measured PetCO(2)-PaCO(2) gradient, as expected, was significantly higher in newborns with pulmonary disease. We also identified four quantitative waveform parameters that may be useful in differentiating between mechanically ventilated newborn patients with and without lung disease.     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.