Congenital visceral malformations--role of perinatal autopsy in diagnosis

OBJECTIVES: Congenital malformations are one of the leading causes of perinatal deaths and infant mortality. The objective of the present study is to detect visceral malformations in perinatal autopsies. DESIGN: A retrospective analysis of perinatal autopsies performed between 1998 and 2001 was done. Various visceral malformations were noted and categorized as urologic, cardiac, respiratory, gastrointestinal and miscellaneous. RESULTS: Out of a total of 62 perinatal autopsies performed, congenital malformations were present in 38.7% of cases. Visceral malformations were observed in 24.1% of cases. Urologic malformations were the commonest (14.1%), followed by cardiac (8%) malformations. Associated external malformations were present in 6/15 cases, cardiac malformations being commonly associated with skeletal malformations. CONCLUSIONS: In all the cases, internal malformations were not suspected clinically. Thus, autopsy is an invaluable tool for detecting visceral malformations, adding to the clinical diagnosis and providing a feedback to the parents.     

Comparison of ondansetron with ondansetron plus dexamethasone for antiemetic prophylaxis in children undergoing strabismus surgery

BACKGROUND: Children undergoing strabismus surgery have a high incidence of postoperative nausea and vomiting. Ondansetron plus dexamethasone is effective in reducing its incidence in many surgical procedures. PURPOSE: To examine the efficacy of ondansetron plus dexamethasone in children undergoing strabismus surgery. PATIENTS AND METHODS: A randomized, placebo-controlled, double blind study of 100 children 2 to 12 years old, in American Society of Anesthesiologists classes I and II, and undergoing strabismus surgery with the use of general anesthesia was conducted. Children received normal saline (n = 31), an injection of 0.15 mg/kg of ondansetron (n = 39), or an injection of 0.15 mg/kg of ondansetron and 0.2 mg/kg of dexamethasone (n = 30). Postoperatively, children were monitored for the number of emetic episodes, Steward recovery score, and need for a rescue antiemetic. RESULTS: The incidence of vomiting was 64.5% in the group receiving saline, 33.3% in the group receiving ondansetron, and 10% in the group receiving ondansetron plus dexamethasone (P < .001). The incidence of early vomiting (0 to 4 hours) and the need for a rescue antiemetic were significantly lower in the groups receiving ondansetron (P < .01) and ondansetron plus dexamethasone (P < .001) compared with the group receiving saline; however, the former two groups were comparable in this regard. In the late postoperative period (4 to 24 hours), the incidence of vomiting and the need for a rescue antiemetic were not significantly different among the groups. Vomiting was significantly more severe in the group receiving saline compared with the groups receiving ondansetron and ondansetron plus dexamethasone at all times (P < .01 and P < .001, respectively). However, the latter two groups were comparable in this regard. CONCLUSION: Ondansetron and ondansetron plus dexamethasone were equally effective in preventing early nausea and vomiting in children following strabismus surgery. However, the efficacy of dexamethasone in late postoperative nausea and vomiting could not be demonstrated. Further studies with a large population and different doses of dexamethasone may be warranted.     

Radiation effect on poly(vinylbenzyltrimethylammonium chloride) in aqueous solution: pulse radiolysis and steady-state study

Poly(vinylbenzyltrimethylammonium chloride) (PVBT) has been synthesized by radiation-induced polymerization of Vinylbenzyltrimethylammonium chloride (VBT). The viscosity average molecular weight of synthesized polymer was estimated to be approximately 10(5) by viscosity measurements. The radiation-induced affects on PVBT have been investigated by steady-state and pulse radiolysis (PR) techniques. The reactions of primary radicals (*)OH, e(aq)(-), and H(*) generated by the radiolysis of water with PVBT were studied. The reactions of some other species such as N(3)(*), Cl(2)(*-), Br(2)(*-), SO(4)(*-), and CO(2)(*-) with PVBT were also investigated. The results indicate that the reactivity of these species toward PVBT is lower then that with the monomer VBT. The rate constants for the reactions of OH radical and H atom with PVBT were evaluated both by competition kinetics and by direct observation of the buildup of transient species. The difference in the rate constant values evaluated by the two methods indicated that (*)OH and H(*) react with PVBT to give more than one species. It was observed that the OH radical and H atom react with PVBT in different manners. Near neutral pH, the OH radicals react to form an adduct and to generate a radical by abstracting methylenic H atom. The H atom, however, also abstracts the H atom from the PVBT backbone. The rate constant value for the reaction of hydrated electron with PVBT was found to be 3.1 currency 10(9) dm(3) mol(-1) s(-1). Steady-state irradiation studies of the aqueous PVBT solution indicated that PVBT predominantly undergoes cross-linking on irradiation. Cross-linking is a function of dose rate, concentration, and ambient of irradiation. At concentrations < 2%, only intramolecular cross-linking takes place, whereas beyond this concentration, the intermolecular cross-linking of polymer chains takes place to form a soft gel. The gel dose (D(gel)) is a function of the ambient of irradiation.     

Primary angiosarcoma of the spleen--a case report

Primary splenic angiosarcomas are rare neoplasms. They have aggressive behavior that frequently present with hematological abnormalities and metastatic disease. The diagnosis can only be made at surgery. Prognosis of this disease is poor. We present a rare case of primary splenic angiosarcoma with metastases in liver.     

Active Immunization of Humans with Dendritic Cells

Dendritic cells (DCs) are potent antigen-presenting cells specialized to initiate T-cell immunity. The development of methods to generate large numbers of DCs has facilitated their application for immunotherapy. Recent studies have demonstrated the safety and immunogenicity of DCs in humans and have begun to outline the durability, kinetics, and nature of the elicited T-cell responses. However, DC-based immunotherapy remains a challenge and several parameters need to be examined to optimize immune responses, in order to maximize clinical efficacy against cancer and infectious diseases.     

更换胰岛素注射笔后出现的复发性糖尿病酮症酸中毒

糖尿病酮症酸中毒是由于胰岛素严重缺乏所致的糖尿病未经控制的严重状态，其特征为高糖血症、高酮血症以及代谢性酸中毒。在I型糖尿病儿童患者中，糖尿病酮症酸中毒为其发病和死亡的主要原因。，在西方国家中，其总死亡率为5％-10％。糖尿病酮症酸中毒的常见诱因包括感染和胰岛素剂量不足，后者是由于治疗无持续性、未能遵循“发病期”原则（在并发其他疾病时增加胰岛素用量的建议）和注射技术不佳所导致的‘。最近，我们遇到2例复发性糖尿病酮症酸中毒患者，是由于在更换预填充胰岛素注射装置过程中，未认识到其中的差异造成的。