Successful treatment of refractory ascites in a child with transjugular intrahepatic portosystemic shunt

A 16-y-old boy who had undergone bone marrow transplantation for relapsed acute lymphoblastic leukaemia developed liver cirrhosis and refractory ascites, which did not respond to salt restriction, diuretics and abdominal paracentesis. Liver transplantation was not feasible because of poor nutritional status, pre-existing renal dysfunction and uncertainty about the prognosis of his leukaemia. The patient underwent a successful transjugular intrahepatic portosystemic shunt (TIPS), with immediate resolution of ascites, enabling cessation of diuretics and improvement in nutritional status. At 24 mo following TIPS there has been no re-accumulation of ascites. CONCLUSION: TIPS may have a role in the management of refractory ascites secondary to liver cirrhosis in selected children.     

Reinfection in erythema migrans disease

Summary Two patients received oral penicillin for erythema migrans disease (EMD) in 1973 and 1977. Five and seven years later, respectively, they developed EMD for a second time after being bitten by ticks. The first and second erythema migrans lesions appeared in different places. Tests of sera evaluated for antibodies toBorrelia burgdorferi before (in one case), during and after the second episode of EMD remained negative (patient 1) or yielded an at least four-fold rise of IgG antibody titers, but did not become positive (patient 2). These cases provide evidence that reinfection in EMD may occur without a significant elevation of specific antibody titers.

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Reinfektion bei Erythema-migrans-Krankheit

Zusammenfassung Zwei Patienten mit Erythema-migrans-Krankheit (EMK) wurden in den Jahren 1973 bzw. 1977 mit oralem Penicillin behandelt. Fünf und sieben Jahre später trat in beiden Fällen nach Zeckenstich eine EMK zum zweiten Mal auf. Die ersten und zweiten Erythema-migrans-Herde waren jeweils an verschiedenen Lokalisationen zu beobachten. Die Testungen auf Antikörper gegenüberBorrelia burgdorferi an Hand von Seren, die vor (in einem Fall), während und nach der zweiten EMK entnommen wurden, waren negativ (Patient 1) oder ergaben einen Anstieg der IgG-Titer um mindestens vier Stufen, ohne jedoch positiv zu werden (Patient 2). Diese Beobachtungen weisen darauf hin, daß eine Reinfektion bei der EMK ohne signifikant erhöhte Antikörpertiter möglich ist.

     

Nanoindentation of orthodontic archwires: The effect of decontamination and clinical use on hardness,elastic modulus and surface roughness

ObjectivesThe purpose of this research was to investigate the effects of decontamination and clinical exposure on the elastic moduli, hardness and surface roughness of two frequently used orthodontic archwires, namely 0.020 in. × 0.020 in. heat activated (martensitic active) nickel titanium archwires and 0.019 in. × 0.025 in. austenitic stainless steel archwires.MethodThis study was a prospective clinical trial in which 20 consecutive patients requiring an archwire change as part of their course of orthodontic fixed appliance therapy, had either a nickel titanium or stainless steel archwire fitted as deemed clinically necessary. The effect of clinical use was determined by comparing distal end cuts of the “as received” archwires before and after decontamination, with the same retrieved archwires following clinical use and decontamination. Hardness, elastic modulus and surface roughness were determined using an atomic force microscope (AFM) coupled with a nanoindenter.ResultsThe results showed that the decontamination regimen and clinical use had no statistically significant effect on the nickel titanium archwires, but did have a statistically significant effect on the steel archwires. Decontamination of the steel wires significantly increased the observed surface hardness (p = 0.01) and reduced the surface roughness (p = 0.02). Clinical use demonstrated a statistically significant increase in the observed elastic modulus (p < 0.001) and a decrease in surface roughness (p = 0.001).SignificanceAt present it is difficult to predict the clinical significance of these statistically significant changes in archwire properties on orthodontic tooth movement.     

The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament

Objective  

The objective of this study was to evaluate the incidence of radiographic osteoarthritis in the operated knee in comparison with the contralateral knee ten years after a bone-tendon bone patellar autograft ACL-reconstruction and to evaluate to which level patients regain activity ten years after reconstruction.     

Suprapancreatic biliary obstruction: CT evaluation

In a 5-year period, 92 patients with biliary obstruction proximal to the pancreatic segment were evaluated with computed tomography (CT). Seventy-three were judged to have technically optimal studies. Observations of the level of obstruction were compared with data from 50 percutaneous transhepatic cholangiograms; CT data enabled the level of obstruction to be correctly predicted in 46. CT enabled correct prediction of the distribution of obstructing lesions in all 18 patients with intrahepatic obstruction. Forty-four of the 73 patients had pathologic examination of the porta hepatitis. CT findings of obstructing mass and lesser omental nodes resulted in correct prediction of malignancy in 25 (92%) of 27 patients; the absence of such findings enabled correct prediction of benign disease in 13 (77%) of 17 individuals. CT is most valuable as a noninvasive means of planning surgical or radiologic drainage procedures in patients with biliary obstruction.     

Coagulation parameters of CPD fresh-frozen plasma and CPD cryoprecipitate-poor plasma after storage at 4 degrees C for 28 days

A pilot study was performed on the storage of plasma and cryosupernatant plasma at 4 degrees C for up to 28 days. Eight bags, four of CPD fresh-frozen plasma (FFP) and four of CPD cryosupernatant plasma (CSP, plasma without cryoprecipitate), were sampled during storage for assays of pH; factors V, VIII, IX, and XI; fibrinogen; prothrombin time; activated partial thromboplastin time (APTT); plasma protein electrophoresis; viscosity; and C1q binding. No changes were found in viscosity or the plasma protein electrophoretic pattern, and there was no detectable immune complex formation. The fibrinogen concentration remained constant, and the prothrombin time showed a gradual increase of 2.5 seconds for both groups of plasma. The labile coagulation factor V decreased gradually for FFP and CSP to 58 and 64 percent of its initial value, respectively (51 +/− 8% and 54 +/− 6% of the value of fresh pooled plasma). Factor VIII decreased to 36 percent of its initial value in FFP (48 +/− 14% of fresh pooled plasma). In CSP, factor VIII decreased after 28 days to 7 percent of its initial value (7 +/− 1% of fresh pooled plasma). The APTT increased for FFP from 28 to 35.8 +/− 1.1 seconds and for CSP from 36 to 49.5 +/− 4.9 seconds. The only chemical change observed for both plasmas was a rise in pH, from 7.27 to 7.56, after 28 days. The results of this pilot study indicate that FFP can be stored at 4 degrees C for 28 days with sufficient recovery of coagulation factors to maintain hemostasis.(ABSTRACT TRUNCATED AT 250 WORDS)