Abdominal Stab Wounds in Children: an 18-Year Experience

Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms. Received: November 2, 2001; revision accepted: February 15, 2002     

18F]-Dopa positron emission tomography imaging in early-stage, non-parkin juvenile parkinsonism.

There are few reports of positron emission tomography (PET) in juvenile parkinsonism (JP). We report on the results of (18)F-6-fluoro-L-dopa (FD) PET in a 14-year-old patient with JP of 5 years duration associated with atypical features. This is the youngest subject to be investigated to date. There was a severe asymmetric reduction in striatal FD uptake, with a rostrocaudal gradient in the putamen similar to that seen in adult-onset idiopathic parkinsonism. Extensive DNA analysis in this patient did not show mutations in the parkin gene.     

The use of autogenous costal cartilage graft in septorhinoplasty

INTRODUCTION: Reconstructive septorhinoplasty in complex nasal deformities often requires harvesting a large amount of tissue for grafting. Autogenous septal cartilage has generally been considered the gold standard grafting material. The aim of this paper was to report our experience with the use of costal cartilage grafts in cases with significant structural deformities and insufficient septal cartilage. DESIGN: Retrospective chart review. PATIENTS: Between 1998 and 2006, 37 patients underwent septorhinoplasty using costal cartilage as the primary source for grafting. Twenty-two men and 14 women with a median age of 42 were enrolled in the study. Patient demographics, indications for surgery, and immediate and late complications were reviewed. The follow-up range was 3 to 72 months. CONCLUSIONS: Autogenous costal cartilage graft is a viable option in reconstructive septorhinoplasty. We advocate the use of this graft in septorhinoplasty cases requiring a large volume of tissue and insufficient septal cartilage.     

Laboratory and field efficacy of Bacillus thuringiensis var. Israelensis and Bacillus sphaericus against Anopheles gambiae s.l. and Culex quinquefasciatus in Ouagadougou, Burkina Faso

Two wettable powders (Bactimos and Vectobac) and one flowable concentrate (Teknar) of Bacillus thuringiensis var. israelensis (B.t.i.) and primary powders of Bacillus sphaericus isolates 1593 and 2362 were evaluated (laboratory) against field-collected larvae of Anopheles gambiae s.l. and Culex quinquefasciatus in Ouagadougou, Burkina Faso. Bactimos, Vectobac and a Corn-cob B.t.i. formulation (ABG-6138G) were field tested against Cx. quinquefasciatus and An. gambiae s.l. The isolates of B. sphaericus were also tested against An. gambiae s.l. in artificial ponds. Both wettable powders of B.t.i. showed superior activity than the flowable concentrate formulation against An. gambiae s.l. in the laboratory. Culex quinquefasciatus was more susceptible (3-4X) to B.t.i. (Bactimos) than An. gambiae s.l. The isolates of B. sphaericus were more effective (2-3X) against both mosquito species than Bactimos. In a ditch and two channels, Bactimos, Vectobac and ABG-6138G at 0.65, 1.5 and 5.6 kg/ha, respectively, gave 91-100% control of Cx. quinquefasciatus within 3 days of treatment. The same formulations at rates ranging from 0.25 to 5.6 kg/ha, produced 82-97% control of An. gambiae s.l. in rainwater pools 24 h after treatment. Isolates 1593 and 2362 at 0.12 and 0.24 kg/ha gave excellent control of An. gambiae s.l. in artificial ponds.     

Incidence of the retroaortic left renal vein in patients with varicocele.

OBJECTIVE: The purpose of this study was to investigate the incidence of the retroaortic left renal vein (RLRV) in patients with varicocele. METHODS: The left renal vein was ultrasonographically investigated for the presence of the RLRV in 140 patients with varicocele and a control group of 137 age-matched patients. The main diagnostic criteria for varicocele were the presence of a varicose vein with a diameter of 3 mm or larger at rest and with a reflux lasting more than 2 seconds during the Valsalva maneuver. The RLRV was defined as a posterior course of the left renal vein to the aorta at the level of the origin of the superior mesenteric artery. RESULTS: The RLRV was observed in 13 (9.3%) of the 140 patients with varicocele and 3 (2.2%) of the control patients. The incidence of the RLRV was found to be significantly higher in patients with varicocele compared with the control patients (P = .018, Fisher exact test). In 13 patients with the RLRV, left varicocele and bilateral varicocele were detected in 10 and 3 cases, respectively. CONCLUSIONS: In this study, the incidence of the RLRV was found to be significantly higher in patients with varicocele compared with control patients. Thus, we suggest that the presence of the RLRV may be considered one of the etiologic factors in the development of varicocele.     

Deletion of the carboxy-terminus of herpes simplex virus type 1 (HSV-1) glycoprotein B does not affect oligomerization,heparin-binding activity,or its ability to protect against HSV challenge

Summary A recombinant vaccinia virus designated VgBt which expresses a truncated secreted herpes simplex virus gB (gBt) was constructed and compared to V11gB, a vaccinia recombinant previously studied which expresses gB exclusively on the surface of infected cells. Indirect immunofluorescence assay (IFA) revealed that gBt was strongly associated with the surface of infected cells despite being released slowly into the cell culture medium. Both gB and gBt existed as oligomers, and both membrane bound and secreted forms of gBt exhibited heparin-binding activity. In protection studies VgBt and V11gB conferred equivalent protection against both homologous (HSV-1) and heterologous (HSV-2) challenge with HSV.     

An Alternative Surgical Technique in Orthotopic Cardiac Transplantation

A bstract Forty patients underwent orthotopic cardiac transplantation at Wythenshawe Hospital between May 1991 and November 1992. Twenty patients had transplantation using an alternative technique that preserves the shape of the left atrium and leaves the right atrium intact (group A). The remaining twenty had conventional transplantation using the technique described by Lower and Shumway (group B). The patients were randomized to either the new or the conventional technique on an alternate basis. There was no mortality in group A, but two patients in group B developed right ventricular failure and died. Two patients in each group developed nodal rhythm and all four recovered sinus rhythm. Echocardiography and Doppler velocimetry at the transvalvular level confirmed normal atrial function in group A with erratic atrial contraction wave in group B. There was also slightly lower incidence of mitral and tricuspid valve regurgitation in group A than in group B. The improved atrial function in group A may play a part in the prevention of right sided failure following cardiac transplantation.     

Demethylpeceyline, A New Dimeric Indoline Alkaloid from Petchia ceylanica

A new dimeric indoline alkaloid has been isolated from the leaves of PETCHIA CEYLANICA. Its structure has been assigned as 1 on the basis of spectral studies. Its stereochemistry has been established by NOE difference measurements.     

Benzodiazepine-like behavioral effects following withdrawal from chronic delta-9-tetrahydrocannabinol administration in rats

Chronic exposure to cannabis extract or delta-9-tetrahydrocannabinol (THC) has been reported to produce hippocampal neuropathology in rats, as well as classical "hippocampal" behavioral deficits. In an attempt to replicate and extend these findings, male rats were exposed to THC for 13 consecutive weeks, beginning in early adolescence. Drugs were administered five consecutive days a week (Monday through Friday). There were five dose levels: vehicle control, 5, 10, or 20 mg/kg, p.o., and 20 mg/kg THC four days a week (Monday-Thursday), followed by 60 mg/kg on Friday. Following THC exposure, all animals were withdrawn from drugs for seven weeks prior to behavioral testing. Three behavioral tasks previously shown to be sensitive to hippocampal damage were assessed. These were habituation of open-field activity, 24-hr passive avoidance response retention, and complex maze performance. A fourth task, emergence latency, was also included because it has been determined to be sensitive to "anxiety" levels. To facilitate interpretation of the complex maze data, two additional experiments are also reported. One experiment tested rats exposed to trimethyltin (TMT, a potent hippocampal neurotoxicant) on the complex maze. The second assessed the affects of chronic/acute benzodiazepine (BZ) exposure upon maze performance. Test results did not suggest that chronic THC exposure produced behavioral deficits resembling those seen following hippocampal damage. Habituation rates in an activity monitor were identical for all exposure groups, and there was no passive avoidance retention deficit. Further, while TMT caused pronounced abnormalities in the complex maze, chronic THC exposure at the two highest dose levels significantly improved maze performance, similar to BZ effects on this task. Chronic THC also appeared to reduce freezing on the emergence task, another anxiolytic-like effect. These results support other reports of persistent long-term behavioral effects of chronic THC exposure. However, they suggest that some behavioral effects may more closely resemble the effects of minor tranquilizers rather than hippocampal damage.     

Communicating with tribals on health and nutrition

Health and nutrition education involves not only conveying new information and concepts, but also persuading the target population to engage in innovative action and direct participation. This process can be thwarted if cultural factors are ignored, particularly in dealing with a tribal population. In a country like India, communication with tribals is influenced by ethnic and cultural diversities, different types of ecological settings, a low literacy level, geographic isolation, the lack of development infrastructure, language barriers, health taboos and problems, a lack of access to modern media forms, and food availability and use. Most suitable for working with tribal populations appear to be the media of the spoken work, song and drama, games, exhibitions at the weekly market and yearly festivals, and pictorial aids. Since communication is a 2-way process, there must be a shared frame of reference among scientists, communicators, and receivers. Moreover, even when health education messages are delivered through culture-specific entertainment programs, they must be part of a comprehensive health and development package in which extension workers are backed up by health professionals and integrated programs.