Anaesthesia for paediatric cardiac MRI

Background: General anaesthesia (GA) for cardiac magnetic resonance imaging (MRI) in patients with congenital heart disease (CHD) is challenging for the anaesthesiologist.     

Long-gap oesophageal atresia

The various options for the management of long-gap oesophageal atresia are discussed. Of 89 infants treated, 27 had isolated atresia, 6 distal atresia with proximal fistula, and 56 atresia with distal fistula. The preferred approach for the former two groups was oesophageal replacement via gastric transposition. Recently, delayed primary anastomosis has been attempted after 6–12 weeks. For wide-gap atresia with distal fistula, primary anastomosis under marked or extreme tension with elective paralysis and mechanical ventilation for 5 days postoperatively achieved highly successful results in 39 infants. There were no major anastomotic disruptions and only 7 minor leaks. Strictures developed in 72% of cases and gastro-oesophageal reflux in 54%, 66% of whom required antireflux surgery. There was only 1 death in the 43 patients undergoing oesophageal replacement (none after gastric transposition, n = 34). A highly satisfactory outcome was achieved in 85%–90% of infants undergoing a replacement procedure.     

Maternal sociodemographic characteristics as risk factors for preterm birth in twins versus singletons

Many studies have examined associations between sociodemographic variables and preterm birth in singletons. However, almost no research has been published on whether variables such as maternal age, race, ethnicity, level of education and smoking are associated with preterm birth among twins in the same way. The purpose of this study was to examine such associations in twins and singletons comparatively. The study population consisted of all 567796 twins and 23297909 singleton births recorded in the US birth records for 1990-95. Gestational age data were rigorously 'cleaned' to solve the problem of biologically implausible birthweight/gestation combinations in vital records. Preterm birth was defined as gestational age < 35 weeks. Some 25.8% of twins and 3.2% of singletons were preterm by this definition. Crude and adjusted relative risks (RR) were estimated using a modified Mantel-Haenszel procedure. We found several characteristics associated with preterm birth in both twins and singletons, e.g. for twins: race (black adjusted RR = 1.30 compared with white non-Hispanic); marital status (unmarried adjusted RR = 1.15 compared with married); and age (< or = 17 years adjusted RR = 1.39 compared with 20-29 years). A similar analysis of singletons revealed stronger associations between the same characteristics and preterm birth, e.g. the adjusted RR for black race was 2.3. These differences in RRs suggest that sociodemographic characteristics have weaker effects on preterm birth among twins than among singletons. Care must be taken in interpreting differences in preterm birth in twins and singletons, as their gestational age distributions differ so markedly.     

Muscular sufficiency, serum protein, enzymes and bioenergetic studies (31-phosphorus magnetic resonance spectroscopy) in chronic malnutrition

Muscle sufficiency was significantly lower in 1336 children with chronic malnutrition of moderate to severe degree. Eighteen children with a chronic moderate degree of malnutrition and 8 well-nourished, age-matched controls were selected for biochemical and 31-phosphorus magnetic resonance spectroscopy (31 -P MRS) studies. The results showed that: (a) serum total protein, albumin, iron, calcium and inorganic phosphate were similar in both groups; (b) serum enzyme levels were significantly increased in the malnourished group; (c) 31-P MRS showed significantly higher means for total ATP, β-ATP, a-ATP and inorganic phosphate for the malnourished compared to the control group. In chronic malnutrition, proteins are maintained by degradation in muscle resulting in release of amino acids and enzymes. 31-P MRS studies showing increases in total ATP, β-ATP and inorganic phosphate and a decrease in phosphocreatine suggest that ATP is maintained at the cost of phosphocreatine.     

The development of competency-based assessment for the profession of optometry

Background : In 1993, the Australian Optometrical Association developed competency standards for entry-level to the profession.¹ These competencies were the basis for the development of an assessment process to determine suitability for entry to the profession. Methods : The competency standards were ranked in order of importance for assessment. Methods were developed to assess the competencies with a number of methods used to assess more highly ranked competencies. A pilot examination was conducted to test the process. Passes were awarded if the performance of the candidate was suitable for entry-level to the profession. Results : The final examination consisted of: Two written papers (six hours), containing a number of case histories and requiring short answers, were used to assess knowledge in basic and clinical science and application of this knowledge clinically. A ‘diagnosis and management’ paper (two hours), containing photographic information accompanied by case histories, was used to assess ability to interpret information and offer diagnoses and management options. Skills station assessment (three and one-half hours) was used to assess the performance of 21 clinical skills. Clinical examinations were used to assess the performance during a full optometric examination, with the interpretation of results and determination of management plans.     

高效液相色谱法测定血浆中洛美沙星浓度及其在人体内药代动力学

建立了人血浆洛美沙星的反相离子对高效液相色谱测定方法。该法简便易行,精密度好,方法回收率95～102%,日内、日间RSD为2.1～7.8%,血药浓度在0.125～5.012 μg/ml范围内呈线性关系,相关系数0.9998,当S/N=2时,最小检测浓度为25 ng/ml。健康志愿者口服400 mg洛美沙星,药代动力学过程符合一室模型,消除相半衰期为5.5 h。     

Neuroendocrine hepatic metastases: does aggressive management improve survival?

OBJECTIVE: The aim of this study was to determine whether aggressive management of neuroendocrine hepatic metastases improves survival. SUMMARY BACKGROUND DATA: Survival in patients with carcinoid and pancreatic neuroendocrine tumors is significantly better than adenocarcinomas arising from the same organs. However, survival and quality of life are diminished in patients with neuroendocrine hepatic metastases. In recent years, aggressive treatment of hepatic neuroendocrine tumors has been shown to relieve symptoms. Minimal data are available, however, to document improved survival with this approach. METHODS: The records of patients with carcinoid (n = 84) and pancreatic neuroendocrine tumors (n = 69) managed at our institution from January 1990 through July 2004 were reviewed. Eighty-four patients had malignant tumors, and hepatic metastases were present in 60 of these patients. Of these 60 patients, 23 received no aggressive treatment of their liver metastases, 19 were treated with hepatic resection and/or ablation, and 18 were managed with transarterial chemoembolization (TACE) frequently (n = 11) in addition to resection and/or ablation. These groups did not differ with respect to age, gender, tumor type, or extent of liver involvement. RESULTS: Median and 5-year survival were 20 months and 25% for the Nonaggressive group, >96 months and 72% for the Resection/Ablation group, and 50 months and 50% for the TACE group. The survival for the Resection/Ablation and the TACE groups was significantly better (P < 0.05) when compared with the Nonaggressive group. Patients with more than 50% liver involvement had a poor outcome (P < 0.001). CONCLUSIONS: These data suggest that aggressive management of neuroendocrine hepatic metastases does improve survival, that chemoembolization increases the patient population eligible for this strategy, and that patients with more than 50% liver involvement may not benefit from an aggressive approach.