An Ozone-Generating System and Chamber for Testing Injury to Cultured Cells

A system was constructed which alternately exposed cultured cells to specific concentrations of ozone in the gas phase and then to cell culture medium. It was designed to produce a constant mass transfer between the gas phase and the exposed cell phase. Monolayers of neonatal rat lung fibroblasts cultured in miniature glass dishes were used to test for ozone toxicity. The cells were alternately exposed to ozone (0.05, 0.15, 0.45, 1.35, and 4.05 ppm) for 30 sec and then to culture medium for 30 sec over a 1-hr period. Toxicity was measured as inhibition of cell growth 4 days after exposure to ozone. Growth was significantly inhibited at all concentrations with a 50% inhibitory concentration of 0.8 ppm. The system described was effective for quantifying ozone toxicity for cultured lung cells.     

Pulse Oximetry Screening in Wisconsin

Introduction. Pulse oximetry can be used as a screening tool to detect critical congenital heart disease (CCHD) in neonates prior to hospital discharge and the development of symptoms. Newborns suspected of having CCHD based on pulse oximetry screening should have the diagnosis excluded or confirmed with echocardiography. However, echocardiography is not immediately available in all settings in which newborns are delivered and the best course of action in these settings remains to be determined. The purpose of this study was to evaluate the resources available to diagnose and treat newborns with CCHD born in the state of Wisconsin. Methods. We surveyed the nurse managers or administrators of the 99 Wisconsin hospitals in which babies are routinely delivered in the state of Wisconsin. A telephone survey was performed in February and March 2011. The number of births per facility was estimated from the most recent available data (2010). Results. There were 66 179 total births occurring in 106 hospitals in the state of Wisconsin in 2010, with 99 hospitals routinely delivering newborns. Surveys were completed in 88/99 (88.9%), representing 95% of the state's in‐hospital births. All responding hospitals had pulse oximetry available in the nursery. Twenty‐five of 88 (28.4%) of responding hospitals routinely use pulse oximetry to screen for CCHD, representing 35.2% of surveyed hospital births. Same‐day neonatal echocardiography was available at 33/88 (37.5%) of the responding hospitals, representing 74.4% of surveyed hospital births. The average distance to the higher‐level care facility of choice from the hospitals without neonatal echocardiography is 53.1 miles. Conclusion. Pulse oximetry is universally available in Wisconsin newborn nurseries, and pulse oximetry screening for CCHD is currently being performed for many of Wisconsin's newborns. The majority of births in Wisconsin occur in hospitals where same‐day neonatal echocardiography is available for confirmatory diagnosis of CCHD when necessary.     

Acute cholestatic hepatitis caused by amoxicillin/ clavulanate

Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.     

Efficacy of infliximab in acute severe ulcerative colitis:A single-centre experience

AIM:To suggest infliximab(IFX) is effective for acute severe ulcerative colitis,from real-life clinical practice.METHODS:All patients receiving IFX for the treatment of acute severe ulcerative colitis in a single centre were included.Data were extracted from clinical records in order to assess response to IFX therapy.The primary endpoint was colectomy-free survival,and secondary outcomes included glucocorticosteroid-free remission and safety,which was evaluated by recording deaths and adverse events.Demographic and clinical characteristics of those who underwent colectomy and those who were colectomy-free,both at discharge from their index admission,and during follow-up after an initial response to IFX were compared.RESULTS:Forty-four patients(16 females,mean age 36 years) received IFX between May 2006 and January 2012 for acute severe ulcerative colitis.The median duration of follow-up post-first infusion was 396 d(interquartile range = 173-828 d).There were 21(47.7%) patients with < 1 year of follow-up,10(22.7%) with 1 years to 2 years of follow-up,and 13(29.5%) with > 2 years of follow-up post-first infusion of IFX.Overall,35(79.5%) responded to IFX,avoiding colectomy during their index admission,29(65.9%) were colectomyfree at last point of follow-up(median follow-up 396 d),and 25(56.8%) were in glucocorticosteroid-free remission at end of follow-up.There was one death from post-operative sepsis,20 d after a single IFX infusion.Colectomy rates were generally lower among those "bridging" to thiopurine.Of 18 patients "bridged" to thiopurine therapy,17(94.4%) were colectomyfree,and 15(83.3%) were in glucocorticosteroid-free remission at study end.No predictors of response were identified.CONCLUSION:IFX is effective for acute severe ulcerative colitis in real-life clinical practice.Two-thirds of patients avoided colectomy,and more than 50% were in glucocorticosteroid-free remission.     

The saphenous nerve in foot and ankle surgery: Its variable anatomy and relevance

BackgroundSeveral studies have raised doubt regarding the role of the saphenous nerve (SN) in the foot, and some authors omit the SN from ankle blocks. Our aim was to assess the SN anatomy with reference to foot and ankle surgery.MethodsIn 29 cadaveric feet the SN was traced to its termination. At the ankle, the distances from the SN to the tibialis anterior tendon (TAT) and the long saphenous vein (LSV) were recorded.ResultsIn 24 specimens, a SN was present at the ankle, and in 19 specimens extended to the foot. The mean distances from the nerve to the TAT and LSV were 15 mm and 4 mm respectively. The nerve reached the first metatarsal (MT) in 28% of specimens.ConclusionAlthough the SN anatomy is less extensive than previously described, it often reaches the first MT and therefore should routinely be included in ankle blocks for forefoot surgery.