In-111-labeled white blood cell uptake in noninfected closed fracture in humans: prospective study

Since indium-111 white blood cell (In-111 WBC) scintigraphy is often used to evaluate for osteomyelitis in bone fractures, it is important to know if noninfected fractures have In-111 WBC uptake. Twenty-seven noninfected closed fracture sites in 19 patients were prospectively evaluated with technetium-99m methylene diphosphonate bone scintigraphy and In-111 WBC scintigraphy. In-111 WBC uptake was present in 41% of the 27 sites. In the 11 positive sites, the In-111 WBC uptake was 1+ (definite but minimal) in 55%, 2+ (moderate) in 36%, and 3+ (marked) in 9%. The visual intensity of the radioactive uptake on In-111 WBC scintigrams relative to that on bone scintigrams was less in 82%, equal in 9%, and greater in 9%. The visual size of the area of uptake on In-111 WBC scintigrams and bone scintigrams was smaller in 36%, equal in 55%, and greater in 9%. Factors that may help distinction of In-111 WBC uptake due to fracture alone from infection associated with fracture are discussed.     

Outcomes of split versus reduced-size grafts in pediatric liver transplantation

BACKGROUND: Split-liver transplantation, where two grafts are created from a single donor organ, is a means of overcoming donor organ scarcity. There are few data comparing outcomes of split with reduced-size liver grafts, which is the most common type of cadaveric graft in pediatric liver transplantation. The aims of the present paper were to compare survival and complication rates between split and reduced-size cadaveric grafts in pediatric patients receiving a liver transplant in Brisbane. METHODS: Review of the Queensland Liver Transplant Service database was undertaken. All pediatric patients who received either a cadaveric split or reduced-size graft between 1985 and 2000 were examined. The incidence of patient and graft survival, vascular complications and biliary complications were identified. RESULTS: A total of 251 liver transplants were performed of which 138 were reduced-size grafts and 30 were split grafts. There were no differences in etiology of liver disease, mean age, weight, and urgency of transplant between the two groups. One-year patient and graft survivals were comparable at 73% and 67%, respectively, in both groups. There was no difference in the incidence of vascular complications between groups. Biliary complications were significantly more common after split grafts when compared with reduced-size grafts (21%vs 4%, P < 0.0001) but did not affect patient or graft survival. CONCLUSIONS: Survival and vascular complications after split-liver grafts were comparable to outcomes after reduced-size grafts. Biliary complications occur more commonly with split-liver grafts but did not affect patient or graft survival. It is recommended that every pediatric recipient be considered for a split-liver graft.     

Analysis of P Wave and P Dispersion in Children with Secundum Atrial Septal Defect

Background: P maximum and P dispersion are evaluated as predictors of paroxysmal atrial fibrillation in adults. In this study, these variables are being investigated in children with secundum ASD in comparison with that of normal controls and in relation to size of ASD and the presence or absence of atrial dilation. Methods: Ninety‐four children with isolated secundum ASD (33 boys, 60 girls; mean ± SD age at diagnosis 2.9 ± 4.1 years) and 65 age‐matched controls (mean ± SD age 4.2 ± 4.2 years) were evaluated. Resting 12‐lead ECG was used to measure P waves from which P maximum and P dispersion (difference between maximum and minimum P‐wave duration) were derived. ASD children were arbitrarily subgrouped according to ASD sizes (small: 1–3 mm, moderate: 4–7 mm, large: 8 mm). The presence of right atrial dilation was noted from echocardiography. Results: Children with ASD had significantly longer mean P dispersion compared to controls (P dispersion: 30.2 ± 11.1 vs 26.4 ± 6.6 ms, P = 0.008). Mean P maximum and P dispersion were significantly prolonged with increasing ASD size (P < 0.001). Children with right atrial dilation had significantly longer P maximum (102.3 ± 15.2 vs 82.8 ‐13.4 ms, P < 0.001) and larger P dispersion (36.1 ± 12.5 vs 27.6 ± 9.4 ms, P = 0.003) compared to those without right atrial dilation. Conclusion: Prolonged atrial conduction time and inhomogeneity of atrial conduction may possibly be present in children with moderate to large sized ASD and in those with atrial dilation. A.N.E. 2001;6(4):305–309     

PAX4 R192H is associated with younger onset of Type 2 diabetes in East Asians in Singapore

Aims

Young-onset T2D (YT2D) is associated with a more fulminant course and greater propensity for diabetic complications. The association of PAX4 R192H (rs2233580) variation with YT2D was inconsistent partly because of its Asian-specificity and under-representation of Asians in international consortiums. Interestingly, in our preliminary YT2D (mean?=?25?years old) cohort, the prevalence of PAX4 R192H variant was remarkably higher (21.4%) than the general population. Therefore, we sought to determine whether PAX4 R192H is associated with younger onset of T2D in our East Asian (Chinese) population.

Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring in adolescents with type 1 diabetes

OBJECTIVE

To determine whether real-time continuous glucose monitoring (CGM) with preset alarms at specific glucose levels would prove a useful tool to achieve avoidance of hypoglycemia and improve the counterregulatory response to hypoglycemia in adolescents with type 1 diabetes with hypoglycemia unawareness.

RESEARCH DESIGN AND METHODS

Adolescents with type 1 diabetes with hypoglycemia unawareness underwent hyperinsulinemic hypoglycemic clamp studies at baseline to determine their counterregulatory hormone responses to hypoglycemia. Subjects were then randomized to either standard therapy or real-time CGM for 4 weeks. The clamp study was then repeated.

RESULTS

The epinephrine response during hypoglycemia after the intervention was greater in the CGM group than in the standard therapy group.

CONCLUSIONS

A greater epinephrine response during hypoglycemia suggests that real-time CGM is a useful clinical tool to improve hypoglycemia unawareness in adolescents with type 1 diabetes.Hypoglycemia unawareness is defined as the onset of neuroglycopenia before autonomic activation (1). Patients have defective symptomatic and counterregulatory responses, in particular impaired epinephrine response to hypoglycemia. Both defective counterregulatory responses and hypoglycemia unawareness constitute the hypoglycemia-associated autonomic failure associated with recurrent iatrogenic hypoglycemia (2–4).In adults, it has been demonstrated that as little time as 2 to 3 weeks of avoidance of hypoglycemia reverses hypoglycemia unawareness and improves the attenuated epinephrine component of defective counterregulation in affected patients (5–7). Although strict avoidance of hypoglycemia can restore autonomic symptoms of hypoglycemia and improve counterregulatory responses to hypoglycemia, this is difficult to achieve in practice. Real-time continuous glucose monitoring (CGM) allows patients to view their blood glucose levels almost instantaneously and offers potential to reduce hypoglycemia frequency.This study was designed to determine whether real-time CGM with preset alarms at specific glucose levels would prove a useful tool to achieve avoidance of hypoglycemia and therefore improve the counterregulatory response to hypoglycemia in adolescents with type 1 diabetes with hypoglycemia unawareness.     

无牙颌颞下颌关节紊乱病患者总义齿修复前后咬合垂直距离改变与髁状突在关节凹内位置的关系

目的:观察咬合垂直距离改变对无牙颌颞下颌关节紊乱病患者两侧颞颌关节髁状突位置的影响。方法:于1994-01/1997-12选择本院口腔修复门诊收治的无牙颌患者中符合颞下颌关节紊乱病诊断标准,同时垂直距离减低的患者48例。实验方案经医院伦理委员会审批,患者均知情同意。将48例无牙颌颞下颌关节紊乱病患者根据垂直距离减低程度的不同分为3组:减低1.8～6.0mm组18例,减低6.1～10.0mm组20例,减低10.1￣14.0mm组10例。通过重新制作一副全口义齿的方法治疗,咬合垂直距离恢复在合适的范围内,3组全口义齿的咬合垂直距离恢复前分别平均为63.4,60.6,54.2mm,恢复后咬合垂直距离分别平均为67.8,68.4,66.4mm,平均抬高4.4,7.8,12.2mm。通过拍摄正中颌位时颞下颌关节薛氏位X射线片测量各组前、后、上关节间隙。结果:垂直距离恢复前,减低1.8～6.0mm组关节后间隙,减低6.1～10.0mm组关节前、后间隙、减低10.1￣14.0mm组关节上、后间隙左右侧相比较,差异有显著性意义(P<0.05)。垂直距离恢复后,3组关节间隙左右侧差异无显著性意义。结论:无牙颌咬合垂直距离减低后可以导致两侧髁状突位置发生不对称改变。