Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy

Background: One hundred eighty-one patients were submitted to laparoscopic common bile duct exploration. Methods: A transcystic approach was used in 147 patients, choledochotomy in 14, and both in 20. The indications to perform a choledochotomy included stones larger than 20 mm, stones proximal to the cystic duct entrance, and cases in which the transcystic duct approach proved impossible or unsuccessful. Results: The common bile duct was drained by a T-tube in four patients, by laparoscopic sphincterotomy in one, by laparoscopic choledochoduodenostomy in one, and by a 10 Fr endoprosthesis in 28. The stent placement was technically feasible in all patients but one. The biliary drainage was adequate. Mean hospital stay was 2.1 days. Complication was limited to one umbilical infection and one self-limited biliary leak. Conclusions: The procedure proved to be technically simple, safe, and efficient, and resulted in a low morbidity rate and short hospital stay. Received: 29 March 1996/Accepted: 12 June 1996     

Intravitreal bevacizumab in aggressive posterior retinopathy of prematurity.

The anatomic response to intravitreal bevacizumab injection in three patients with aggressive, posterior retinopathy of prematurity is described. In all cases, the worse eye was treated with a single intravitreal injection of 0.75 mg of bevacizumab as monotherapy or complementary to laser therapy. In 24 hours, all injected eyes showed regression of the tunica vasculosa lentis and iris vessel engorgement and disappearance of iris rigidity. In addition, plus disease and retinal proliferation began to regress. None of the eyes required additional treatment. Follow-up of up to 10 months     

Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A$3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.     

The interaction of parafluorohexahydrosiladiphenidol at muscarinic receptors in vitro

1. The antagonistic actions of parafluorohexahydrosiladiphenidol (pFHHSiD) at muscarinic receptors has been studied in cardiac muscle, smooth muscle and cell culture preparations. In this paper, the classification scheme of Doods et al. (1987) is employed. This scheme is based upon differential affinities of muscarinic antagonists. pFHHSiD exhibited high pA2 values at M3 receptors mediating contractions of guinea-pig ileum and oesophageal muscularis mucosae (7.8 and 8.2 respectively) whereas low values were determined at M2 receptors mediating negative inotropic responses in guinea-pig atria (6.0). Intermediate pA2 values were determined at M1 receptors mediating contractions of the canine femoral and saphenous veins. 2. The pA2 values of pFHHSiD at receptors mediating endothelial-dependent relaxation of rat aortic rings, rabbit jugular vein and canine femoral artery (7.6-7.9) were similar to those determined on the ileum. However, the pA2 values of pFHHSiD at receptors mediating contractions of the guinea-pig trachea (7.1), which has been previously shown to possess M3 receptors, were different from those determined in the ileum. 3. The similarity in pA2 values of pFHHSiD between the M3 receptors in guinea-pig ileum and the receptors mediating endothelial-dependent relaxations provide further evidence for the role of M3 receptors in this vascular response. Taken together, pA2 values for pFHHSiD range from 7.1 to 8.2, depending upon the M3 preparation used. The selectivity of the compound therefore for the M3 versus the M2 muscarinic receptor ranged from 13 to 163 fold.(ABSTRACT TRUNCATED AT 250 WORDS)     

Traumatic dental injuries and associated factors among Brazilian preschool children

Abstract –  The main objective of this study was to assess the epidemiology of traumatic dental injuries (TDI) to the primary teeth of preschool children and second, to investigate whether TDI were related to anterior open bite and, third, whether TDI are related to socio-economic circumstances in an urban Brazilian population. A clinical examination was performed during the National Day of Children's Vaccination. TDI were classified according to the modified classification proposed by Ellis. In addition to those criteria the presence of tooth discoloration was recorded. An interview was carried out with mothers or guardians. The data collected included mother's level of education and living conditions. The prevalence of TDI was 9.4%. The maxillary central incisors were the most affected teeth. Most children with a TDI experienced traumatic injuries to one tooth (6.3%), while 2.8% had two and 0.4% had three traumatized teeth. The most common crown fracture was in enamel only (68.8%), followed by crown fracture of enamel and dentin (13.8%). Missing teeth following trauma occurred in 10.9% of those with TDI. The prevalence of tooth discoloration was 5.1%. Children with anterior open bite had twice the level the level of TDI compared to those with normal occlusions ( P  = 0.001). Socio-economic factors were not statistically significantly associated with the occurrence of TDI. The prevalence of dental injuries in Brazilian preschool children was low. Children with anterior open bite experienced more dental injuries. Neither of the indicators of socio-economic status was related to the prevalence of TDI.     

Effects of neonatal bilateral eye enucleation on postnatal development of the monoamines in posterior thalamus of the rat

Summary Levels of dopamine (DA), noradrenaline (NA) and 5-hydroxytryptamine (serotonin, 5-HT) and their metabolites, and the activities of tyrosine hydroxylase (TH), tryptophan hydroxylase (TPH) and monoamine oxidase A and B (MAO-A and MAO-B) have been determined in the rat posterior thalamus after enucleation during postnatal development. DA and 5-HT turnover rate have been measured as 3,4-dihydroxyphenylalanine (DOPA) and 5-hydroxytryptophan (5-HTP) accumulation rates after central decarboxylase inhibition by 3-hydroxybenzylhydrazine (NSD-1015). The major changes were an increase in noradrenergic and serotoninergic metabolism in enucleated animals compared with control animals. A decrease of the MAO-A to MAO-B ratio during postnatal development was found.Abbreviations DA dopamine - DOPAC 3,4-dihydroxyphenylacetic acid - HVA homovanillic acid - DOPA 3,4-dihydroxyphenylalanine - NA noradrenaline - MHPG 3-methoxy-4-hydroxyphenylgly-col - NMN normetanephrine - TRP tryptophan - 5-HTP 5-hydroxytryptophan - 5-HT serotonin - 5-HIAA 5-hydroxy-3-indolacetic acid - TH tyrosine hydroxylase - TPH tryptophan hydroxylase - MAO-A monoamine oxidase-A - MAO-B monoamine oxidase-B Recipients of fellowships from I.I.E. del FISS Reincorporación de doctores y tecnólogos del M.E.C., and Perfeccionamiento de doctores y tecnólogos del MEC, Spain     

Gestación heterotópica espontánea

Heterotopic pregnancy is the combination of intrauterine and ectopic pregnancy. This potentially fatal condition rarely occurs in spontaneous conception cycles and consequently its diagnosis requires a high index of suspicion. We report a case of heterotopic pregnancy in a 30-year old primipara with no known risk factors who presented with acute abdominal pain due to a spontaneous heterotopic pregnancy. The ectopic pregnancy was resected via laparoscopy. After surgery, the intrauterine pregnancy was uneventful.     

Accidental hydrocarbon ingestion cases telephoned to a regional poison center

One hundred eighty-four telephone calls to the Texas State Poison Center concerning accidental hydrocarbon ingestion were reviewed in an attempt to define the risk of developing any subsequent medical problem requiring therapeutic intervention. Special attention was given to changing symptom severity in an attempt to evaluate its usefulness in predicting future complications. One hundred twenty patients (65%) had no initial symptoms and remained asymptomatic throughout an 18-hour follow-up period. Sixty-two (34%) of patients had symptoms initially but quickly became asymptomatic. Two (1%) developed significant complications (one chemical pneumonitis, one death). These data suggest that the risk of significant complications after accidental hydrocarbon ingestion is low (approximately 1% of patients at risk). Patients who are asymptomatic or who quickly become asymptomatic can be watched safely at home, and referral of asymptomatic patients to a hospital may be unwarranted.     

Ischemic stroke complicating cardiac catherization: case report.

Ischemic stroke occurs in 0.2-0.4% of patients undergoing left heart catheterization, and is responsible for 5-10% of the mortality associated with the procedure. The main predisposing factors for this complication are female gender, complex atherosclerotic plaques in the ascending aorta, and peripheral arterial disease. The possibility of timely intervention with reperfusion therapy supports close clinical monitoring during the immediate post-catheterization period. The cardiologist should be familiar with the various types of stroke reperfusion therapy and its indications according to the time interval between catheterization and the stroke. The decision should be discussed with neurology and neuroradiology.