Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury

Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.     

Intraoperative navigation in surgery of paranasal sinus and anterior skull base

BACKGROUND AND OBJECTIVE: Based on physical laws, stage of technical development and the user's individual skills a number of possible errors have to be considered for the application of CAS in paranasal sinus and anterior skull base surgery. PATIENTS/METHODS: Based on our experiences of 436 navigated cases hard- and software errors, errors of image acquisition and transfer, errors of patient registration, user related errors as well as strategic errors are analyzed. RESULTS: Any hindrance of the camera field leads to a limitation of functionality of optical systems in the same extent as electromagnetic systems can be affected by ferromagnetic materials. The mode of image acquisition is dependent from the CAS-system involved. The reconstruction algorithm requires particular attention. The patient registration based on the headset proved to be reliable for endonasal sinus surgery. CONCLUSIONS: In dealing with navigation devices in paranasal and anterior skull base surgery the user must pay critical attention to possible malfunction in order to guarantee a successful image guided surgical procedure.     

Origin of left main and right coronary arteries from right aortic sinus of Valsalva

Coronary anomalies may be a part of complex congenital malformations of the heart or be an isolated defect. Anomalous coronary arteries are associated with a higher incidence of congenital heart diseases, but do not appear to be associated with an increased risk for development of coronary atherosclerosis. Coronary anomalies are recognized readily on angiography. Unexpected findings during invasive procedures would suggest a possibly existing coronary anomaly, especially when main branches cannot be opacified by selective contrast medium injection. This case report illustrates the clinical and angiographic findings of a patient undergoing coronary angiography for evaluation of ischemic heart disease with an unexpected presence of anomalous origin of the left coronary artery from the right aortic sinus.     

Rosacea: a cutaneous marker of Helicobacter pylori infection? Results of a pilot study

Given the long purported anecdotal association between rosacea and gastrointestinal disease, the discovery that Helicobacter pylori causes gastritis and duodenal ulcer disease has led to a hypothesized role for this organism in the aetiology of rosacea. We conducted a case-series study of 49 patients to assess the potential association between severity of rosacea and direct and serological evidence of H. pylori infection. Patients were classified by severity into non-inflammatory erythematotelangiectatic or inflammatory/papulopustular rosacea and were tested for current H. pylori infection and evidence of previous exposure. Positive 13C-urea breath test and ELISA tests were more likely to be observed in patients with inflammatory rosacea, although not statistically significantly so (OR = 3.0, p = 0.15 and OR = 2.9, p = 0.16, respectively). However, the proportion of patients who tested positive in both assays (versus negative in at least one) was even higher in the inflammatory rosacea group and neared statistical significance (OR = 4.5, p = 0.06). This pilot study provides sufficient evidence suggestive of a positive association between the severity of rosacea and the presence of H. pylori to warrant further research.     

Fibroblast migration on fibronectin requires three distinct functional domains

Mesenchymal cell movement is normally constrained; however, fibronectin can provide a pathway for stromal cell migration during embryogenesis, morphogenesis, and wound healing. Cells can adhere to fibronectin via integrin and nonintegrin receptors, which bind multiple unique peptide sequences. Synthetic peptides and recombinant proteins were used to delineate the functional domains needed for human fibroblast migration over fibronectin. The 9th and 10th fibronectin type III repeats, which contain RGD and PHSRN synergy cell attachment sequences, support almost maximal fibroblast attachment, but not migration of primary dermal fibroblasts. Specific sequences within the heparin domain and the IIICS region are also required for migration. These findings predict and additional data confirm the necessity for the cooperation of multiple integrin and nonintegrin receptors for fibroblast migration on fibronectin. Such stringency of migration most likely imposes an immense constraint on normal mesenchymal cell mobility in unperturbed tissue. Loss of such restraint may be critical for the migration cancer cells through the extracellular matrix.     

Dentistry as a possible route of hepatitis C transmission in Pakistan

AIMS AND OBJECTIVES: To identify the role of dental surgical procedures in contributing to the transmission of hepatitis C. DESIGN: Prospective observational pilot study. SETTING: Shaikh Zayed Federal Postgraduate Medical Institute Lahore, Pakistan. METHODS: Exposure to dental procedures, injections, tattooing, surgical intervention, blood transfusions, family history of hepatitis, diabetes mellitus and contact with jaundiced patients was evaluated in 78 consecutive adult patients of both sexes suffering from chronic hepatitis C. MAIN OUTCOME MEASURES: Distribution of risk factors for acquiring hepatitis C with emphasis on role of dentistry as a possible route of transmission. RESULTS: Dental procedures were the major source of exposure (39.7%) followed by injections (16.6%), surgical procedures (16.6%), diabetes (12.8%), family history of hepatitis (9%), blood transfusions (7%), tattooing (5.1%) and history of contact with a jaundiced patient (2.6%). There was a statistically significant difference in distribution of risk factors, with dental procedures being the commonest factor (p < 0.001). CONCLUSIONS: The high prevalence of dental procedures in patients with chronic hepatitis C stresses the importance of ineffective infection control methods practiced by dental surgeons as a risk factor for acquiring hepatitis C and which were probably the source of infection. Large epidemiological studies are needed to elucidate the role of dentistry in transmitting hepatitis C.     

Short- and intermediate-term follow-up results of percutaneous transluminal balloon valvuloplasty in adolescents and young adults with congenital pulmonary valve stenosis

Percutaneous pulmonary balloon valvuloplasty (PBV) is a well-established treatment alternative to surgery in many cardiology centers. We described our experience with PBV in 25 adolescent and young adult patients with isolated pulmonary valve stenosis (PVS). Among 20 successful PBVs, there was a significant immediate decrease in right ventricular systolic pressure from 116.9 32.4 mmHg to 60.5 18.7 mmHg (p < 0.0001) and a decrease in transpulmonary valve pressure gradient from 93.5 32.8 mmHg to 33.5 9.7 mmHg (p < 0.0001) was noted. The follow-up period was 1-5 years (mean = 3.2 1.2 years), during which patients were periodically assessed by Doppler echocardiogram. During follow-up, the transpulmonary valve pressure gradient further decreased from 33.5 9.7 mmHg to 18.6 3.4 mmHg (p < 0.0001) mainly due to regression of infundibular hypertrophy. Thus, the study showed excellent short-term and intermediate-term results of PBV.     

Outcome evaluation of early discharge from hospital with asthma

OBJECTIVE: The aim of the study was to determine whether it was safe to discharge children with asthma from hospital when stable on 3-hourly rather than 4-hourly doses of salbutamol. METHODOLOGY: A retrospective study of 419 individual admissions of 359 children with asthma was undertaken. We defined a theoretical 'time ready for discharge' (TRD) for asthmatic admissions based on: (i) at least two doses of 3-hourly salbutamol and due for the third dose, (ii) no oxygen supplementation, (iii) no intravenous fluid or therapy, and (iv) time of discharge should be either before 17:30 hours or after 07:30 hours. Each admission was analysed using appropriate parameters to assess for risks and benefits of using this theoretical TRD as a guide for discharging asthmatic children from hospital. RESULTS: A total of 116 (27.7%) children were discharged before our theoretical TRD, including 11 children who received salbutamol no less often than 2-hourly and 37 who had a single dose of 3-hourly salbutamol before discharge. Re-admission to hospital and representation to the Emergency Department without re-admission within 1 week of discharge were less common in the group who were discharged before they had achieved theoretical TRD than in those who were discharged at or after the theoretical TRD, although the numbers were too small to reach statistical significance. Between our theoretical TRD and actual time of discharge two children who received supplemental oxygen and more frequent salbutamol may have required re-admission. CONCLUSIONS: From the medical viewpoint discharge when the child is stable on 3-hourly rather than 4-hourly doses appears safe. This can be expected to shorten length of stay by an average of 5.5 h (P < 0.001).     

Myocardial stunning in man

Myocardial stunning refers to the contractile dysfunction that occurs following an episode of acute ischaemia, despite the return of normal blood flow. The phenomenon was initially identified in animal models, where it has been very well characterised, and there was initial doubt about whether a similar syndrome occurred in humans, and if it did, whether it was of any clinical relevance. This article outlines the conditions that must be met to diagnose myocardial stunning and why it has been difficult to confirm its presence in humans. The clinical scenarios where it has now been clearly identified and those others where it may also occur and be of clinical importance are also reviewed.     

High-resolution voxelation mapping of human and rodent brain gene expression

Voxelation allows high-throughput acquisition of multiple volumetric images of brain gene expression, similar to those obtained from biomedical imaging systems. To obtain these images, the method employs analysis of spatially registered voxels (cubes). For creation of high-resolution maps using voxelation, relatively small voxel sizes are necessary and instruments will be required for semiautomated harvesting of such voxels. Here, we describe two devices that allow spatially registered harvesting of voxels from the human and rodent brain, giving linear resolutions of 3.3 and 1 mm, respectively. Gene expression patterns obtained using these devices showed good agreement with known expression patterns. The voxelation instruments and their future iterations represent a valuable approach to the genome scale acquisition of gene expression patterns in the human and rodent brain.