The ureteric orifice: the embryologic key to radiologic status of duplex kidneys.

In this study the ureteric orifice position of duplex ureters in the bladder or urethra of children was correlated with the kidney configuration as determined by x-ray examination and in some by surgical excision and biopsy.A previous study¹ of 51 necropsy speciments of duplex kidneys, ureters, and bladders of neonates, revealed a close correlation between ureteric oreteric orifice position and kidney morphology.This clinical study of children further confirms that the position and type of ureteral orifice act as guides to renal order and disorder in duplex kidneys. A radiographic classification of kidney configurrations was invoked to match and correlate form with orifice position. From this cystoradiographic study, it appears that renal abnormalities occur when ureteric buds arise from faulty locations in the Wolffian duct during embryogenesis.     

Verification dosimetry during treatment for helical tomotherapy using radiographic film

Helical tomotherapy (HT) is a novel radiotherapy treatment modality that allows the delivery of intensity modulated radiation in a rotational fashion. Due to the complexity of the treatment approach, it is desirable to have a simple tool for treatment delivery verification. Radiographic film placed under the patient is exposed to dose from most of the possible beam projections and therefore constitutes a useful in vivo dosimetry record of the whole treatment. Measurements were performed during the initial clinical implementation of HT at the London Regional Cancer Centre on all patients during the first treatment fraction. It was possible to predict the optical density of the film using a dose calculation on a phantom of similar size to the patient. The comparison of expected and delivered dose allows the verification of dose delivery patterns which was found to be particularly useful in the case of treatment interruptions. The absolute dose measured with film differed in general by less than 10% from the expected one despite the fact that no build-up was used on the film. The agreement improved with proximity of the primary target to the location of the film on the treatment couch. Due to the rotational delivery mode, radiographic film was shown to be a useful, cheap and convenient method to verify dose delivery in helical tomotherapy.     

A randomized, double-blind, placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery

OBJECTIVE: This study was undertaken to evaluate the effect of triiodothyronine replacement on the early postoperative course of neonates undergoing aortic arch reconstruction. METHODS: We performed a randomized, double-blind, placebo-controlled trial of triiodothyronine supplementation in neonates undergoing either a Norwood procedure or two-ventricle repair of interrupted aortic arch and ventricular septal defect. Patients were assigned to receive a continuous infusion of triiodothyronine (0.05 micro/kg/h) or placebo for 72 hours after cardiopulmonary bypass. Primary end points were a composite clinical outcome score and cardiac index at 48 postoperative hours. RESULTS: We enrolled 42 patients (triiodothyronine n = 22, placebo n = 20). Baseline characteristics were similar in the treatment groups. Study drug was discontinued prematurely because of hypertension (n = 1) and ectopic atrial tachycardia (n = 1), both cases in the triiodothyronine group. Free and total triiodothyronine levels were higher in the triiodothyronine group than in the placebo group at 24, 48, and 72 postoperative hours (P < .001). The median clinical outcome scores were 2.0 (range 0-4) with triiodothyronine and 2.0 (range 0-7) with placebo (P = .046). Compared with those in the placebo group, neonates assigned to triiodothyronine had shorter median time to negative fluid balance (2.0 vs 2.5 days, P = .027). Cardiac index values were 2.11 +/- 0.64 L/min x m2 with triiodothyronine and 2.05 +/- 0.72 L/min x m2 with placebo (P = .81). Heart rate and diastolic blood pressure were not influenced by triiodothyronine supplementation, but systolic blood pressure was higher in the triiodothyronine group (P < .001). No serious adverse events were attributed to triiodothyronine administration. CONCLUSION: Triiodothyronine supplementation was safe and resulted in more rapid achievement of negative fluid balance after aortic arch reconstruction. Cardiac index at 48 hours was not significantly improved.     

Femoral neck surgery using a local anaesthetic technique

Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.