Type A behavior pattern and blood glucose control in diabetic children

We studied the relationship between presence of Type A behavior pattern and glycemic response to stress in children with insulin dependent diabetes mellitus (IDDM). Twelve male (six Type A and six Type B) and nine female (four Type A and five Type B) insulin-dependent diabetic patients between the ages of 8 and 16 years received a standard meal and blood glucose values were assessed two hours later. All subjects then played a competitive videogame for 10 minutes following which blood glucose was assessed again. Preprandial and postprandial blood glucose values did not differ between the groups. However, only Type A subjects showed a hyperglycemic response to the videogame stress. Type A subjects also demonstrated significantly higher glycohemoglobin values. In order to assure that this effect was due to a differential response to stress and not simply a difference in metabolic response to a meal, a second study was conducted in which blood glucose values were assessed at one, two and three hours following a standard meal. No significant differences in postprandial blood glucose values were observed between Type A and Type B subjects. These data support previous research which has suggested that some but not all patients with IDDM show a hyperglycemic response to stress.     

Serum gastrin concentrations in colorectal cancer patients.

Fasting serum gastrin concentrations were shown to be elevated in colorectal cancer patients compared with controls (P = 0.0037), which was mainly accounted for by a subgroup of patients who had significantly elevated levels. In cancer patients there was no difference in gastrin concentrations in blood taken from a tumour-draining mesenteric vein and from a peripheral vein at the time of colonic resection. Serum gastrin concentrations were significantly lower after apparently curative resection for colorectal cancer (P = 0.028), suggesting that the elevated serum gastrin seen in these patients may be due, at least in part, to secretion of gastrin by the tumour.     

The relationship among receptive and expressive vocabulary, listening comprehension, pre-reading skills, word identification skills, and reading comprehension by children with reading disabilities.

PURPOSE: Some researchers (F. R. Vellutino, F. M. Scanlon, & M. S. Tanzman, 1994) have argued that the different domains comprising language (e.g., phonology, semantics, and grammar) may influence reading development in a differential manner and at different developmental periods. The purpose of this study was to examine proposed causal relationships among different linguistic subsystems and different measures of reading achievement in a group of children with reading disabilities. METHODS: Participants were 279 students in 2nd to 3rd grade who met research criteria for reading disability. Of those students, 108 were girls and 171 were boys. In terms of heritage, 135 were African and 144 were Caucasian. Measures assessing pre-reading skills, word identification, reading comprehension, and general oral language skills were administered. RESULTS: Structural equation modeling analyses indicated receptive and expressive vocabulary knowledge was independently related to pre-reading skills. Additionally, expressive vocabulary knowledge and listening comprehension skills were found to be independently related to word identification abilities. CONCLUSION: Results are consistent with previous research indicating that oral language skills are related to reading achievement (e.g., A. Olofsson & J. Niedersoe, 1999; H. S. Scarborough, 1990). Results from this study suggest that receptive and expressive vocabulary knowledge influence pre-reading skills in differential ways. Further, results suggest that expressive vocabulary knowledge and listening comprehension skills facilitate word identification skills.     

Laser-assisted transluminal angioplasty of the superficial femoral and popliteal arteries

During an initial 1-year experience with percutaneous laser-assisted balloon angioplasty at the Vancouver General Hospital, 9 of 61 patients considered suitable for intervention because of arterial occlusive disease were selected for laser treatment. The neodymium-YAG laser with a contact sapphire tip was chosen because the probes and tips are reusable, thereby reducing the cost per patient. The patients had either severe limiting claudication or pain at rest, involving the superficial femoral or popliteal artery. One of the patients had lesions in both legs, making a total of 10 lesions. In 8 of the 10 lesions, treatment initially was successful. In the other two instances, the laser perforated the arterial wall, but the patients suffered no ill effects; repair by bypass surgery was uncomplicated. Another patient had distal thrombosis at the time of angioplasty of the popliteal artery; this responded to fibrinolytic therapy and subsequent balloon angioplasty of the peroneal artery. The initial 80% success rate was reasonable, considering that all these patients would otherwise have undergone bypass surgery. One patient had recurrent stenosis 5 months after the procedure. The other seven had good results with relief of symptoms. However, follow-up has been short (mean 4.9 months), the longest being only 11 months.     

Meningiomas presenting with paranasal sinus involvement

Extracranial paranasal spread of meningiomas is uncommon. We describe the management of four cases, all of which first presented to an oto-rhino-laryngologist for an opinion. We suggest that greater use of modern imaging techniques could lead to earlier diagnosis. The natural history of extracranial spread is relatively benign but the management of regrowth of residual disease is difficult. We therefore suggest radical surgery in the first instance provided that the patients general health and configuration of the tumour allow.     

Leukocyte Depletion of Blood Cardioplegia Attenuates Reperfusion Injury

Background. Leukocytes are associated with myocardial injury during reperfusion after ischemia. Short periods of leukocyte depletion during reperfusion result in persistent attenuation of postischemic myocardial dysfunction.

Methods. Leukocyte depletion was examined in a canine model of regional myocardial ischemia and reperfusion. The extracorporeal circuit and cardioplegia circuits underwent leukocyte depletion by mechanical filtration. Animals were instrumented for baseline global function before 90-minute occlusion of the left anterior descending coronary artery. Global function during ischemia and at 5, 30, 60, and 90 minutes after a 60-minute cardioplegic arrest using continuous blood cardioplegia was assessed in leukocyte-depleted (n = 9) and control (n = 10) groups.

Results. No significant difference between groups was seen for systemic leukocyte counts, global function, or water content. Endothelial function was significantly protected as assessed by response to both calcium ionophore (endothelial-dependent, receptor-independent relaxation: leukocyte-depleted, 72% ± 19% of endothelin-induced constriction versus control, 46% ± 14%; p < 0.05) and acetylcholine (endothelial-dependent, receptor-dependent relaxation: leukocyte-depleted, 83% ± 11% versus control, 44% ± 15%; p < 0.05).

Conclusions. Leukocyte-mediated endothelial reperfusion injury can be attenuated by leukocyte depletion during reperfusion.     

Acute Cholecystitis and Severe Ischemic Cardiac Disease: Is Laparoscopy Indicated?

BACKGROUND AND OBJECTIVES: Laparoscopy in patients with poor cardiac function has been the subject of controversy and is considered by many surgeons a relative contraindication. METHODS: We report the case of a patient who presented with acute cholecystitis and choledocholithiasis concurrent with unstable angina. Our experience in laparoscopic management of patients with calculous biliary disease and severe coronary artery disease is examined. RESULTS: The patient was managed by coronary angioplasty and stenting immediately followed by laparoscopic cholecystectomy and common bile duct exploration under close invasive hemodynamic monitoring and low-pressure pneumoperitoneum. Between 1996 and 2001, 39 patients with coronary artery disease and an ASA class of III or IV underwent laparoscopic cholecystectomy. Eight of these patients (20.5%) had common bile duct stones necessitating laparoscopic common bile duct exploration. No conversions were necessary, and no major morbidity or mortalities occurred. CONCLUSIONS: Laparoscopic cholecystectomy and common bile duct exploration can be safely performed in patients with severe ischemic cardiac disease under close hemodynamic monitoring and a low-pressure pneumoperitoneum (10 to 12 mm Hg).     

Safety and efficacy of radiofrequency ablation of brain: a potentially minimally invasive treatment for brain tumours.

INTRODUCTION: Cerebral metastases are associated with a very poor prognosis. The best survival results are seen after surgical resection. However this involves a relatively invasive procedure and many patients are not suitable for surgical resection. We have evaluated the safety and efficacy of radiofrequency ablation of the brain in a sheep model. METHODS: We produced ablations of 1 - 3 cm diameter in the brain of sheep using the RITA starburst XL probe and RITA 1500 generator. We varied the time of RF application between 1 minute and 5 minutes and observed the animals for between 24 hours and 3 weeks for short-term and long-term effects and measured the intracranial pressure (ICP) in 2 animals following RFA. RESULTS: A total of 8 ablations were produced in 8 sheep. There was no change in the ICP measurements and there were no neurological complications in the 5 sheep with superficial ablation of up to 2 cm. Three sheep failed to regain consciousness due to large ablations near the brain stem and cerebellum. The sizes of the ablations were confirmed on necropsy and there was no other evidence of damage to the surrounding brain. Satisfactory ablation of brain was achieved at 70 degrees C and an ablation time as short as 3 minutes produced a 1.5 - 2.0 cm diameter of ablation. CONCLUSION: Cerebral RFA is a relatively safe and effective technique capable of producing a predictable ablation with no damage to surrounding brain. The potential of this technique requires further evaluation but likely advantages include the ability to treat multiple tumours and perform repeated treatment with a minimally invasive approach.     

Early experience with minimally invasive esophagectomy in head and neck surgical patients

BACKGROUND: Minimally invasive esophagectomy (MIE) via thoracoscopy and laparoscopy have reduced the morbidity and mortality of total esophagectomy at experienced centers. MIE has not been evaluated in combination with major head and neck surgery, or in the otolaryngology literature. METHODS: Case series of 11 consecutive patients undergoing either open or MIE with an ablative neck procedure. RESULTS: Comparing 4 MIEs and 7 open operations, similar operative time, blood loss, and ICU and hospital length of stay were observed. There was one mortality in the open group. A 100% rate of major complications was observed in the MIE group. CONCLUSION: Our multidisciplinary team was unable to achieve improved outcomes in a series of head and neck surgical patients undergoing MIE. This result may represent an early stage of the learning curve for MIE, but may also be attributed to the escalated surgical requirements of head and neck patients.