Who needs the surgical headlight?

OBJECTIVE: The use of surgical headlights may lead to awkward posture and limit the mobility and visibility of the operating team. Despite the vast availability of fiber-optic instruments, many surgeons continue to use the surgical headlight, which may be harmful to their health and career. We report the use of the Lumitex LightMat surgical illuminator instead of the conventional surgical headlight in cleft palate surgery. METHODS: The LightMat is a disposable single-use device that is bright, flexible, and malleable and attaches easily to most retractors. Twenty cleft palate and five pharyngeal flaps cases were performed in which the LightMat was attached to the Dingman mouth retractor with biocompatible two-sided adhesive tapes. RESULTS: The LightMat was successfully used in all 25 cases. No cases required the surgeon to put on additional lighting such as a headlight. In addition, no cases required the LightMat surgical illuminator to be replaced. CONCLUSION: The LightMat provides excellent surgical light for cleft palate surgery and pharyngeal procedures. It affords the surgeon several advantages: it provides a cool operative light, flexibility in surgical position, and improved visibility and mobility; the surgeon avoids the delay in obtaining an appropriate working headlight; and, more importantly, it may prevent postural problems that could lead to spinal sprain and disability.     

Can LDH activity in spermatic vein indicate testicular damage? A preliminary report

We aimed to investigate the relationship between varicocele and lactic dehydrogenase (LDH), an intracellular enzyme that indicates cellular damage. LDH levels were measured in the blood samples of 17 oligoasthenospermic infertile patients with varicocele which were obtained synchronously from spermatic and peripheral veins during operation. Sperm counts ranged from 1 to 74 million/ml, while motility ranged from 10% to 60%. LDH level in spermatic vein was found statistically higher than the level in peripheral vein (p=0.042). There was no correlation between sperm counts and LDH level in spermatic vein. We found a significant increase in spermatic vein LDH level in varicocele. We think that further studies are needed to reveal the relationship between spermatic vein LDH level and varicocele.     

Measurement of urea nitrogen and creatinine concentrations in peritoneal dialysate and other body fluids using the Vitros analyzer

OBJECTIVES: A majority of chemistry analyzers have separate modes for estimating urea nitrogen and creatinine in serum and urine because of significant differences in their concentration. As there is no defined mode for other biological fluids such as dialysis fluid, these can be run on either of the two modes. On Vitros (Clinical Ortho-Diagnostics, Rochester, NY) chemistry analyzer, we observed an overestimation in calculated creatinine clearance (CrCl) and Kt/V(urea) in some children that led us to investigate into methodology used for these assays. DESIGN AND METHODS: We measured urea nitrogen and creatinine on peritoneal dialysate effluent, pleural fluid and hemofiltration effluent on serum and urine modes of Vitros analyzer. RESULTS: Vitros chemistry analyzer significantly overestimated urea nitrogen and creatinine in 'urine' mode on samples with low urea nitrogen and creatinine. CONCLUSIONS: Since peritoneal dialysate effluent has concentrations of urea nitrogen and creatinine comparable to serum; hence, it should be analyzed on 'serum' mode.     

Miniaturization and automation of an ubiquitin ligase cascade enzyme-linked immunosorbent assay in 1,536-well format

Enzyme-linked immunosorbent assays (ELISAs) are a long established and widely used assay format for drug discovery and diagnostics. They offer many advantages over homogeneous assay formats, including high sensitivity and separation (wash) steps that remove detection-interfering compounds. Many high-throughput screening assays are now performed in miniaturized formats (1,536- and 3,456-well plates) for higher throughput and lower reagent consumption. With miniaturization, separation steps in assays such as ELISA can become difficult to implement. Here we report on the implementation of the Kalypsys, Inc. (San Diego, CA) 1,536-well plate washer to enable the successful miniaturization and full automation of an ELISA that monitors ubiquitin ligase activity. The 1,536-well plate ELISA was robust and used for the high-throughput screening of a large screening collection (>1 million compounds).     

Stage I vitamin D-deficiency rickets mimicking pseudohypoparathyroidism type II

The clinical presentation and biochemical features of stage I vitamin D-deficiency rickets (VDR) and pseudohypoparathyroidism (PHP) type II are quite similar. These 2 entities have therefore often been mistaken for one another. We report our experience with 2 cases of stage I VDR that were originally diagnosed as PHP type II. The report provides an insight into the pathophysiology of VDR and PHP and thus allows for better differentiation between the 2 disease entities. It has become essential for pediatricians to recognize VDR owing to its resurgence in developed countries.     

Triglycerides predict plasma fibronectin in children with type I diabetes mellitus rather than diabetes

Fibronectins are adhesive proteins considered as markers of endothelial activation. Plasma fibronectin levels in diabetes mellitus (DM) have been found to be associated with atherosclerotic risk factors. This study was carried out to investigate plasma fibronectin and its relation with serum lipids, apolipoproteins AI, B100 and lp(a) in diabetic children. 35 children (19F/16M) with type I DM and 30 non-diabetic age and gender-matched controls were enrolled. Apolipoprotein and fibronectin concentrations were determined with nephelometric methods. Plasma fibronectin levels of the children with type I DM and the control group are not statistically different. HbA1c and triglycerides concentration are found to be significant predictors of plasma fibronectin in diabetic children, while effect of plasma cholesterol, apolipoprotein AI, B100 and lp(a) are insignificant. Diabetic children with triglycerides 1.13 mmol/l have elevated plasma fibronectin (median, 25th-75th percentiles; 29.6, 8.3-40.8 mg/dL) compared to the diabetic > or = 19.9, 8.6-30.7 mg/dL, p < 0.05) and non-diabetic children (16.6, 12.7-32.4 mg/dL, p < 0.01) with triglycerides < 1.13 mmol/L. On the other hand plasma fibronectin concentrations of diabetic and non-diabetic children with high triglycerides are not significantly different. In conclusion our data does not support the concept that plasma fibronectin is elevated in type I diabetes mellitus at least in children, but high plasma triglycerides secondary to diabetes or not is associated with higher FNp concentrations which may have implications on atherogenesis. Plasma cholesterol, apolipoproteins AI, B100 and lp(a) are not significant determinants of FNp in type I diabetic children.     

Urolithiasis in adolescent children

Idiopathic urolithiasis in children has become more frequent in the past few decades as a result of increasing affluence and rapid change in our society's dietary habits. In Western societies, calcium stones in the kidney and ureter predominate. Pediatric urolithiases, unlike the adult form, require a comprehensive metabolic evaluation, because metabolic and enzymatic derangements play an important role in their pathogenesis. The recent advancements in endoscopic procedures, interventional radiology, and lithotripsy have allowed children to be managed effectively without open surgery. Pediatric urolithiasis requires a close working relationship between the urologist for acute surgical management of urolithiasis and the nephrologists for prevention of stone formation. In many children and adolescents with urolithiasis, a nonpharmacologic approach involving the adoption of healthy nutrition habits may suffice.     

Effects of fasudil, a Rho-kinase inhibitor, on myocardial preconditioning in anesthetized rats

The aim of this study was to examine the effects of fasudil, a Rho-kinase inhibitor, on ischemic preconditioning and carbachol preconditioning in anesthetized rats. The total number of ventricular ectopic beats was markedly augmented with fasudil at 0.3 mg/kg and depressed with fasudil at 10 mg/kg. Fasudil at 10 mg/kg also markedly decreased the ventricular tachycardia incidence. Ischemic preconditioning, induced by 5 min coronary artery occlusion and 5 min reperfusion, decreased the incidence of ventricular tachycardia and abolished the occurrence of ventricular fibrillation. The incidences of ventricular tachycardia and ventricular fibrillation in the fasudil (10 mg/kg) + ischemic preconditioning group were found to be similar to the ischemic preconditioning group. However, low doses of fasudil (0.3 and 1 mg/kg) appeared to prevent the antiarrhythmic effects of ischemic preconditioning. Carbachol (4 microg/kg/min for 5 min) induced marked reductions in mean arterial blood pressure, heart rate and abolished ventricular tachycardia. Marked reductions in ventricular ectopic beats and ventricular tachycardia were noted in the fasudil (10 mg/kg) + carbachol preconditioning group. Lactate levels were markedly reduced in the ischemic preconditioning group and this reduction was prominently inhibited with fasudil at 1 mg/kg. Ischemic preconditioning caused a marked decrease in plasma malondialdehyde levels. Fasudil (10 mg/kg), ischemic preconditioning and carbachol preconditioning each generated marked reductions in ischemic myocardial malondialdehyde levels. Decreases in infarct size were observed with fasudil (10 mg/kg) treatment, ischemic preconditioning and carbachol preconditioning when compared to control. These results suggest that low doses of fasudil (0.3 and 1 mg/kg) appeared to prevents the effects of ischemic preconditioning and carbachol preconditioning, but a high dose of fasudil (10 mg/kg) was able to produce cardioprotective effects on myocardium against arrhythmias, infarct size or biochemical parameters and mimic the effects of ischemic preconditioning in anesthetized rats.     

Constitutively active HIF-1alpha improves perfusion and arterial remodeling in an endovascular model of limb ischemia

OBJECTIVE: Hypoxia-inducible factor 1 (HIF-1) regulates the expression of angiogenic growth factors. We analyzed the effect of intramuscular (i.m.) delivery of AdCA5, an adenovirus encoding a constitutively active form of the HIF-1alpha subunit, in a novel model of limb ischemia. METHODS: AdCa5 or AdLacZ (6 x 10(8) pfu) was injected into male New Zealand White rabbits that were untreated or subjected to occlusion of the left superficial femoral artery by endovascular coils. Expression of mRNAs was quantified 1, 3, and 7 days after adenovirus injection into rabbits without occlusion. Calf blood pressure (BP), angiography, and immunohistochemical analyses were performed 14 days after arterial occlusion and adenovirus injection. RESULTS: AdCA5 increased the expression of HIF-1alpha, monocyte chemotactic protein-1, placental growth factor, platelet-derived growth factor B, stromal-derived factor 1alpha, and vascular endothelial growth factor (VEGF) mRNA as well as HIF-1alpha and VEGF protein. On day 14, AdCA5-injected limbs showed improved calf BP ratios (0.89+/-0.13 vs. 0.51+/-0.05, p=0.02), angiographic perfusion scores (3.50+/-0.56 vs. 8.33+/-1.31, p=0.007), and distal deep femoral artery diameter ratio (1.84+/-0.25 vs. 0.93+/-0.22, p=0.02) relative to those receiving AdLacZ. The capillary/myocyte ratio (0.93+/-0.03 vs. 0.78+/-0.06, p=0.04) and arterial luminal area (0.32+/-0.05 mm2 vs. 0.21+/-0.03 mm2, p=0.04) were significantly increased in the AdCA5 group. CONCLUSION: In a model that resembles atherosclerotic obstruction of peripheral arteries in patients, the i.m. administration of AdCA5 promoted arteriogenic and angiogenic responses.