Deficiencies in selenium and/or vitamin E lower the resistance of mice to Heligmosomoides polygyrus infections

Previous studies have shown that deficiencies in selenium (Se) and/or vitamin E (VE) can exacerbate the infectivity and pathogenesis of coxsackievirus B3 and influenza. Both Se and VE play a role in immune function and antioxidant defense. To determine whether these deficiencies would affect the normal course of infection with a metazoan parasite, mice were made deficient in Se and/or VE and inoculated with the gastrointestinal nematode parasite Heligmosomoides polygyrus. Both primary and secondary infections were assessed. Although the course of a primary infection with H. polygyrus was unaffected by diet, diets deficient in Se, VE, and both Se and VE (Se/VE double-deficiency) all caused delayed adult worm expulsion and increased fecundity during a secondary infection; suggesting an impaired intestinal response. H. polygyrus-induced IL-4 levels were diet-independent; but Se/VE double-deficiency blocked the H. polygyrus-induced IL-4 receptor-associated decrease in sodium-dependent glucose absorption in the jejunum that contributes to worm expulsion. In contrast, Se/VE double-deficiency had no effect on the infection-induced, IL-4R-associated increase in epithelial cell permeability that accompanies the infection. These results suggest that both Se and VE are required for specific IL-4-related changes in intestinal physiology that promote host protection against H. polygyrus.     

Training of a Minimally Invasive Bariatric Surgeon: Are Laparoscopic Fellowships the Answer?

Background: Fellowships in advanced laparoscopy with emphasis in laparoscopic gastric bypass (LGBP) are available for obtaining experience in performing LGBP. The following is the first report in the literature prospectively documenting a single surgeon's experience with LGBP outcomes following completion of an advanced laparoscopic surgical fellowship. Methods: Outcomes measured prospectively included length of stay, length of operation, complications, reduction in obesity-related co-morbidities, and percentage excess weight loss. Outcomes were analyzed by quartile to see if there was a difference over time. Complications were also compared to outcomes in the literature. Results: 175 patients (147 female, 28 male) underwent LGBP. The mean BMI was 49.2. Mean operative time was 123 minutes, and mean length of stay was 2.2 days. The percentage excess weight loss at 1 year was 73% (n = 79). One patient developed an internal hernia (0.6%) and 1 patient developed an anastomotic leak (0.6%). Postoperative transfusion rate was 4.6%. There were no deep venous thromboses or pulmonary emboli detected. There were no conversions to open, and there was no mortality. Upon quartile analysis, there was no difference in complication rates. Complication rates were comparable to published outcomes in the literature. Conclusion: Fellowships in advanced laparoscopy with emphasis on LGBP provide the optimal training environment for acquisition of skills necessary to safely and effectively perform LGBP. With fellowship training, complication rates were comparable to published outcomes in the literature without a period of higher complications (the learning curve).     

Fertility Enhancing Hysteroscopic Surgery: Our Experience

690 hysteroscopies done over a period of four and a half years for infertility were evaluated. 85 therapeutic hysteroscopic procedures like hysterscopic metroplasty, lysis of intrauterine adhesions, electroresection of fibroids, removal of foreign bodies and cornual cannulation were carried out. These minimally invasive procedures were associated with satisfying results, least morbidity, shorter hospital stay and high patient satisfaction.Key Words: Cornual cannulation, Electroresection, Hysteroscopy, Intrauterine adhesions, Metroplasty, Submucus fibroids     

Clinical review of patients with fixed bridges (2). A study of deviations between observers

The authors have made a study of observer deviations in the re-examination of patients with fixed bridges. The material consisted of eighteen patients who have had their bridges for about 2 years. The total number of bridge-elements was 126, including eighty-three abutment teeth and forty-three politics. Nine observers have taken part. Of these, three have been teachers and six post-clinical students, so that it has been possible to say that the observers had more, and lesser, experience of routine observation. The recorded factors have been: (1) primary contact; (2) the general status of the marginal periodontium; (3) calculus; (4) caries; (5) periapical status; (6) attrition facet; (7) abrasion in the opposing jaw; (8) crown margin excess; (9) crown margin deficit; (10) exposed crown margin; (11) pocket formation; (12) discolouration of gold. The examinations have been carried out in a conventional milieu with the usual instruments for examination and with access to orthopantomograms. The recordings have been made after independent as well as cumulative and simultaneous examination. In the last two cases the observers have been divided into three groups. A very simple account of the results regarding the first five factors is given. It is quite clear, however, that the nine observers record different totals and that positive finds are at the same time seldom reported by all. Each of the seven remaining factors has given rise to a larger number of (positive) recordings, so that a more detailed processing has been meaningful. Within each factor (with a certain exception for abrasion) considerable deviations are found between the nine independent observers in the matter of totals. It has been possible with analysis of variance to confirm, to a great extent, these deviations as significantly systematic. In connection with the change to cumulative and simultaneous observer strategy it has been possible to note certain improvements. It has not, however, been possible to designate the agreement between the three observer groups as appreciable. On the other hand, the number of positive recordings increases most frequently in connection with the changes to (Cum) and still more with the change to (Sim). The nine observers change level in relation to one another on moving from the one factor to the other. Within a certain factor they sometimes vary also between different patients, though a certain logical pattern appears. Through comparisons in pairs and the calculation of the correlation (expressed through the coefficient r) it has been possible to show that the correlation between the recordings of two observers is not always satisfactory. However, the conventional limit + 0.70 is exceeded in the majority of cases. The two groups of observers do not differ characteristically from each other factor by factor, (the factors ‘general status of the periodontium’ and ‘crown margin excess’ constitute exceptions). Both teachers and students change position in an irregular way. Each one of the nine observers may occur alternately as a high and a low recorder. The authors recommend further studies in this field with the aim of throwing light upon the homogenization of observers and becoming better informed concerning the precise significance of utilizing different observer strategies.     

Radionuclide venography in iliac and inferior vena caval obstruction

Thirteen cases are presented to demonstrate normal and various abnormal radionuclide venographic patterns following obstruction of the inferior vena cava or common iliac veins. In these patients, obstruction was due to surgery, thrombosis, or neoplasm. Contrast venography was also performed in seven patients to confirm the radionuclide findings. Radionuclide venograms did not visualize the same collateral patterns that contrast venograms did. Most notably, the anterior parietal vessels were seen in many cases with radionuclide venography, and the paraspinal veins were seen more commonly with contrast venography.     

Caffeine and Pregnancy Outcome

Caffeine is a drug which easily crosses the placental barrier and enters the fetal circulation. To date, most studies that demonstrate caffeine's teratogenic potential have been conducted in animal models. Although no definite relationship in humans has been confirmed, it is suggested that a pregnant woman should limit or discontinue her intake of caffeine.     

A PROSPECTIVE STUDY ON THE INCIDENCE AND SIGNIFICANCE OF CONGENITAL CYTOMEGALOVIRUS INFECTION

Abstract. Screening of 3060 neonates for congenital cytomegalovirus (CMV) infection by virus excretion in the urine showed an overall incidence of 0.4%. The incidence was about 1 % for mothers between 16 and 25 years and only 0.2% for mothers between 25 and 35. No mothers over 35 years of age gave birth to congenitally infected infants. The percentage of women in the child-bearing age susceptible to CMV infection was estimated by the absence of CMV complement-fixing antibodies in cord sera and ranged from 48% to 33% with increasing age. None of the infected infants showed obvious signs of congenital CMV infection at birth. At follow-up, two infants showed slight, but transient symptoms compatible with a foetal infection; a pair of premature twins exhibited retarded physical and psychomotor development, but this could just as well be ascribed to the prematurity itself. None of the infants had detectable CMV-IgM antibodies in cord sera, but a trend towards elevated total IgM concentration in cord sera and elevated virus excretion titres appeared in the infants with symptoms. With the very low incidence and no signs of sensomotor sequelae the preliminary conclusion is that foetal CMV infection in our population by no means has a significance to deserve routine screening or a vaccination programme.