Bland‐White‐Garland syndrome: Choice of surgical technique

An anomalous origin of the left coronary artery from the pulmonary artery (Bland‐White‐Garland syndrome) was diagnosed in a 48‐year‐old woman complaining of angina for 2 years. The patient underwent surgical repair with ligation of the left coronary artery at the ostium, and a left internal mammary artery (LIMA) to the left anterior descending (LAD) coronary artery bypass. Arterial pressure monitoring and blood gas analysis of pulmonary artery and LAD was carried out before and after ligation and after LIMA to LAD anastomosis. We demonstrated an increase in systolic blood pressure in the LAD with the ligation of the fistula which did not improve significantly with LIMA to LAD reperfusion. However, there was an increase in coronary diastolic pressure with a persistent diastolic gradient. Review of the available literature and comparative analysis of different procedures suggests that ligation of the ostium plus off‐pump LIMA to LAD grafting could be the procedure of choice in adults with this rare but potentially life‐threatening, congenital coronary anomaly.     

O等位基因引起ABO基因型与表现型定型差异

保证输血时血清学方面的安全,首要的是对受血者与献血者ABO血型定型,血清学检查通常分两个步骤.正定型通常使用鼠源单克隆抗体检测红细胞表面是否存在A或B抗原.互补的实验即反定型,利用当红细胞上缺乏A或B抗原时,人群可天然产生相对应的抗体的原理,检测血清中是否存在抗-A或者抗-B抗体.确定了受血者红细胞表面的ABO抗原以及血浆中的抗体,便能确定血型,为其提供相合的血液.     

Ultrasound measurement of fetal adrenal gland in fetuses with intrauterine growth restriction,an early predictive method for adverse outcomes

Objectives: Comparing the sonographic measurements of fetal adrenal gland in pregnancies with intrauterine growth restriction (IUGR) versus healthy controls and to assess whether the changes in adrenal gland measurements could predict adverse pregnancy outcomes in IUGR fetuses.

Methods: This prospective cohort study evaluated 97 pregnant women (48 with IUGR pregnancies and 49 healthy controls) during their third gestational trimester. All mothers underwent two dimensional ultrasonography of the fetal adrenal gland, and the fetal zone in transverse, sagittal, and coronal planes. Adrenal gland volume (AGV) and fetal zone volume (FZV) were calculated and corrected (c) for fetal weight. The mothers were then followed until delivery.

Results: Fetuses in the IUGR group had larger corrected adrenal gland volume (c_AGV) and smaller corrected fetal zone volume (c_FZV) compared to the fetuses in the control groups (p?p?Conclusions: Third trimester fetal adrenal gland sonography could potentially be used as an easy noninvasive method for identifying those IUGR fetuses who might have poorer outcomes.     

Cervical gland area: a new sonographic marker in predicting preterm delivery

Purpose  

Preterm delivery is one of the important causes of morbidity and mortality in newborns. Nowadays, a new sonographic marker is suggested for prediction of preterm delivery which is termed “Cervical Gland Area” (CGA). Absence of normal mucosal glands of the cervix can be utilized as a predictor in preterm delivery. This study was performed to evaluate the role of absence of CGA for the prediction of preterm delivery <37 weeks.     

Ultimate doctor liability: A myth of ignorance or myth of control?

Ultimate medical doctor responsibility for the care delivered to patients by all professionals is a myth. Legally Lord Denning dismissed the myth in the mid-20th century in England. The assumption that a medical doctor is responsible for the care delivered by nurses has not existed in English and Australian law since that time, and it has been actively refuted. Yet it is a myth that continues to circulate influencing health service, state and federal health policy. For some it is a myth of ignorance and for others it is a means of control. This paper outlines the relevant case law to debunk the myth of ultimate medical doctor control.     

O等位基因引起ABO基因型与表现型定型差异

保证输血时血清学方面的安全,首要的是对受血者与献血者ABO血型定型,血清学检查通常分两个步骤.正定型通常使用鼠源单克隆抗体检测红细胞表面是否存在A或B抗原.互补的实验即反定型,利用当红细胞上缺乏A或B抗原时,人群可天然产生相对应的抗体的原理,检测血清中是否存在抗-A或者抗-B抗体.确定了受血者红细胞表面的ABO抗原以及血浆中的抗体,便能确定血型,为其提供相合的血液.     

Neuronal and nonneuronal quantitative BACE immunocytochemical expression in the entorhinohippocampal and frontal regions in Alzheimer's disease

In this study, we quantitatively investigated the expression of beta-site amyloid precursor protein cleaving enzyme (BACE) in the entorhinohippocampal and frontal cortex of Alzheimer's disease (AD) and old control subjects. The semiquantitative estimation indicated that the intensity of BACE overall immunoreactivity did not differ significantly between AD and controls, but that a significantly stronger staining was observed in the hippocampal regions CA3-4 compared to other regions in both AD patients and controls. The quantitative estimation confirmed that the number of BACE-positive neuronal profiles was not significantly decreased in AD. However, some degeneration of BACE-positive profiles was attested by the colocalization of neurons expressing BACE and exhibiting neurofibrillary tangles (NFT), as well as by a decrease in the surface area of BACE-positive profiles. In addition, BACE immunocytochemical expression was observed in and around senile plaques (SP), as well as in reactive astrocytes. BACE-immunoreactive astrocytes were localized in the vicinity or close to the plaques and their number was significantly increased in AD entorhinal cortex. The higher amount of beta-amyloid SP and NFT in AD was not correlated with an increase in BACE immunoreactivity. Taken together, these data accent that AD progression does not require an increased neuronal BACE protein level, but suggest an active role of BACE in immunoreactive astrocytes. Moreover, the strong expression in controls and regions less vulnerable to AD puts forward the probable existence of alternate BACE functions.     

Seronegative and seropositive rheumatoid arthritis: radiographic differences

Patients with seronegative and patients with seropositive rheumatoid arthritis (RA) have clinical, genetic, and immunologic differences. This study was undertaken to determine whether the two populations differ radiologically. Seventeen patients with seronegative RA were closely matched with seropositive control subjects. Radiographs of the hands and wrists were studied blindly, and disease severity was quantified with use of a modification of the Beaver Creek grading sheet. The following distinguishing features were also evaluated: osteosclerosis, new bone formation, carpal predominance, ankylosis (fusion), symmetry, and classical erosions. Seropositive patients had more severe disease, with larger and more numerous erosions, while the seronegative group had more osteosclerosis, carpal predominance, fusion, and new bone formation. Symmetry was equal in both groups. Although there were definite quantitative and qualitative differences between the two populations, radiologists should be cautious in using these criteria because of the great deal of overlap between the two groups.