Comparative study between novel sedative drug (dexmedetomidine) versus midazolam–propofol for conscious sedation in pediatric patients undergoing oro-dental procedures

ObjectiveA comparative study to evaluate the effect of dexmedetomidine as a sedative in pediatric dental patients in comparison to the currently used combination of midazolam and propofol.MethodsSixty ASA I children (4–10 years old) referred from the outpatient clinic of the pediatric dentistry department for sedation for dental procedures. They were randomly classified into two groups, group I (dexmedetomidine group) was given as 2 μg/kg loading dose over 5 min followed by 0.4 μg/kg/h continuous infusion. Group II (midazolam–propofol group) midazolam was given as 0.05 mg/kg and propofol was given loading dose as 1 mg/kg over 5 min followed by 5 mg/kg/h continuous infusion. Heart rate, mean arterial blood pressure, oxygen saturation, respiratory rate were recorded every 5 min till discharge. The onset of sedation, procedure time, recovery time, discharge time and the need of analgesia were recorded. The incidence of occurrence of adverse effects was observed.ResultsIn group I, the mean onset of sedation was significantly longer than in group II, but recovery time was significantly shorter in group I than group II, there are significantly hemodynamics effects in the first 15 min and more incidence of occurrence of side effects in group II than group I. There are more analgesic effects of dexmedetomidine in group I than group II postoperatively.ConclusionDexmedetomidine is safe and effective when used for sedation in pediatric patients undergoing dental procedures.     

Native superficial femoral artery peripheral atherectomy site pseudoaneurysm: a case report

A 45-year-old woman who presented with blue toe syndrome was treated with atherectomy for a focal plaque located in the superficial femoral artery. She subsequently developed a large pseudoaneurysm at the atherectomy site requiring multiple sequential endovascular procedures in order to maintain in-line blood flow to the foot. Pseudoaneurysm formation at native peripheral artery atherectomy site has not been reported previously. We discuss possible complications of atherectomy and the possible mechanism of pseudoaneurysm formation after atherectomy. We address the importance of understanding risks of these minimally invasive procedures along with planning follow-up duplex and potential bail-out tactics.     

Systemic naloxone infusion may trigger spasticity in patients with spinal cord injury: case series

BACKGROUND/OBJECTIVE: Three patients with spinal cord injury (SCI) and 3 able-bodied (AB) patients were infused with naloxone during a study to examine their neuroendocrine function. An unanticipated side effect occurred during the naloxone infusion. All 3 patients with SCI, but none of the AB patients, experienced profoundly increased spasticity during the naloxone infusion. Our report describes this side effect, which has potential implications for the clinical treatment or scientific evaluation of individuals with SCI. METHODS: All patients were in good general health and medication free for 11 days or longer before the study. Each patient was placed on a 30-hour protocol to analyze pulsatile release of gonadotropins. Physiologic saline was intravenously infused on day 1 to serve as a control period for naloxone infusion on day 2. RESULTS: AB patients experienced no muscle spasm activity or any other side effects at any time during the study. In contrast, all 3 patients with SCI experienced a profoundly increased frequency and duration of spasticity in muscles innervated by the nerve roots caudal to their level of injury. In all 3 patients with SCI, spasticity increased only during the period of naloxone infusion. Within 1 hour of stopping naloxone, spasticity returned to baseline levels. CONCLUSIONS: Naloxone infusion produced a differential effect on the muscle activity of men with SCI compared to AB men with intact spinal circuits. Consistent with previous studies, the results of this study indicate a relationship between opioid neuromodulation and spasticity after SCI.     

The midterm results of stent graft treatment of thoracic aortic injuries

INTRODUCTION AND OBJECTIVES: Several publications document the technical feasibility of stent graft repair of aortic transection. We report our mid-term results of endovascular repair of thoracic aortic transections using covered stent grafts and compare this to a cohort undergoing open repair during the same time period to demonstrate the shift in practice pattern at our institution. MATERIALS AND METHODS: A retrospective review of patients who sustained blunt thoracic transection was undertaken. Medical records were examined to identify the clinical outcome of the procedure, and follow-up CT scans were reviewed to document adequate treatment of the transection. Outcome measures include procedure-related mortality, neurological morbidity, and successful immediate and mid-term coverage of the thoracic false aneurysm and absence of graft migration or endoleak. RESULTS: From July, 2000 to October, 2004, 27 patients were identified with descending thoracic aortic transection at our level I trauma center. Fourteen patients were managed nonoperatively, five patients underwent thoracotomy and direct aortic repair, and eight patients underwent endoluminal stent graft repair. Of the endovascular group (n=8), repairs were performed with stacked AneuRx aortic cuffs (Medtronic, Inc., Minneapolis, MN) (n = 6), a Gore thoracic aortic stent graft (Thoracic EXCLUDER; W.L. Gore, Flagstaff, AZ) (n=1), or a Medtronic Talent thoracic endograft (Medtronic, Inc.) (n=1). Access for stent graft deployment was the common femoral artery (n=2), iliac artery (n=4), or distal abdominal aorta (n=2). Completion arch aortography and postoperative CT scanning confirmed successful management of the aortic transection in each patient. There were no procedure-related deaths, paraplegia, or stroke. Postoperative complications included a brachial artery thrombosis in one patient as well as an external iliac artery dissection and acute renal failure in a second patient for a complication rate of 37.5%. Two patients died as a result of their injuries unrelated to the stent graft repair. Mean follow-up of 16.6 mo has shown no evidence of endoleak or stent graft migration. Of the open repair group (n=5), one patient died in the operating room during attempted aortic repair, and one patient had a postoperative stroke. CONCLUSIONS: Due to technical success and absence of delayed complications including endoleak and graft migration, stent graft repair of traumatic aortic transection has replaced open aortic repair as the primary treatment modality in the multiply injured trauma patient at our institution. The postoperative complication rate observed in this small series tempers the success to some degree, but the severity of the complications compares favorably with those observed in the open repair group.     

Clomiphene citrate and dexamethazone in treatment of clomiphene citrate-resistant polycystic ovary syndrome: a prospective placebo-controlled study

BACKGROUND: The aim of this work was to evaluate the efficacy of adding dexamethazone (DEX) (high dose, short course) to clomiphene citrate (CC) in CC-resistant polycystic ovary syndrome (PCOS) with normal dehydroepiandrosterone sulphate (DHEAS) in induction of ovulation. METHODS: Eighty infertile women with CC-resistant PCOS were randomly assigned into two groups. Group I: Clomiphene citrate 100 mg/day was given from day 3 to day 7 of the cycle and DEX 2 mg/day from day 3 to day 12 of the cycle. Group II: Same protocol of CC combined with placebo (folic acid tablets) was given from day 3 to day 12 of the cycle. The main outcome was ovulation. Secondary measures included number of follicles >18 mm endometrial thickness and pregnancy rate. Ovarian follicular response was monitored by transvaginal ultrasound. HCG 10,000 U was given when at least one follicle measured 18 mm, and timed intercourse was advised. RESULTS: There were no statistically significant differences between groups as regards age, duration of infertility, BMI, waist-hip ratio (WHR), menstrual pattern, hirsutism, serum DHEAS or day of HCG administration. The mean number of follicles>18 mm at the time of HCG administration and the mean endometrial thickness were significantly higher in the DEX group than in the placebo group (P<0.05). Similarly, there were significantly higher rates of ovulation (75 versus 15%) (P<0.001) and pregnancy (40 versus 5%) (P<0.05) in the DEX group. Dexamethazone was very well tolerated as no patients complained of any side effect. There was a significant difference between the responders and non-responders in the presence of oligomenorrhea, amenorrhea or hirsutism. CONCLUSION: Induction of ovulation by adding DEX (high dose, short course) to CC in CC-resistant PCOS with normal DHEAS is associated with no adverse anti-estrogenic effect on the endometrium and higher ovulation and pregnancy rates in a significant number of patients. Induction with DEX appears to be independent on age, period of infertility, BMI or WHR.     

Chromosome 16 tumor-suppressor genes in breast cancer

Loss of heterozygosity on the long arm of chromosome 16 is one of the most frequent genetic events in breast cancer, suggesting the presence of one or more classic tumor-suppressor genes (TSGs). It has been shown that E-cadherin is the TSG on 16q in lobular tumors. In a search for the target genes in more frequently occurring low-grade nonlobular tumors, the smallest region of overlap (SRO) in this area of the genome has been exhaustively searched for. However, the results have demonstrated remarkable complexity, and so a clear consensus on identification of the SRO boundaries has not been reached. Several genes in the vicinity of these SROs have been scrutinized as putative TSGs in breast cancer, but so far, none has fulfilled the criteria for target genes. This review discusses the complexity of the 16q region and the different approaches that have been, are being, and will be used to detect the target genes in this area.     

��3, a transposable element that promotes host sexual reproduction

Theoretical models predict that selfish DNA elements require host sex to persist in a population. Therefore, a transposon that induces sex would strongly favor its own spread. We demonstrate that a protein homologous to transposases, called α3, was essential for mating type switch in Kluyveromyces lactis. Mutational analysis showed that amino acids conserved among transposases were essential for its function. During switching, sequences in the 5′ and 3′ flanking regions of the α3 gene were joined, forming a DNA circle, showing that α3 mobilized from the genome. The sequences encompassing the α3 gene circle junctions in the mating type α (MATα) locus were essential for switching from MATα to MATa, suggesting that α3 mobilization was a coupled event. Switching also required a DNA-binding protein, Mating type switch 1 (Mts1), whose binding sites in MATα were important. Expression of Mts1 was repressed in MATa/MATα diploids and by nutrients, limiting switching to haploids in low-nutrient conditions. A hairpin-capped DNA double-strand break (DSB) was observed in the MATa locus in mre11 mutant strains, indicating that mating type switch was induced by MAT-specific DSBs. This study provides empirical evidence for selfish DNA promoting host sexual reproduction by mediating mating type switch.     

Prediction of oesophageal varices in patients with compensated cirrhosis: A novel scoring system

Background and study aimsPatients with liver cirrhosis are recommended to undergo an evaluation of oesophageal varices to assess their risk of bleeding. Predicting the presence of oesophageal varices through non-invasive means may reduce the number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Child-Pugh A liver cirrhosis.Patients and methodsRetrospective analysis was performed on 70 patients with compensated cirrhosis. Clinical and laboratory parameters Child-Pugh class and platelet count were assessed. Ultrasonographic characteristics of splenic axis and portal vein diameter were noted. The data were assessed by univariate analysis and a multivariate logistic regression analysis.ResultsWe found the prevalence of oesophageal varices in patients with child A liver cirrhosis to be 64.3%. Platelet count, splenic axis, portal vein diameter, platelet count/splenic axis ratio, portal vein congestive index, and renal resistive index were found to be significantly associated with the presence of oesophageal varices on univariate analysis. A platelet count of 100,000, platelet count/splenic axis ratio <900, renal resistive index ?0.68, and a portal vein congestive index of ?0.07 had the highest discriminating value, at which the number of true positive patients was highest and the number of false positive patients was lowest (50% and 3%, 63% and 13%, 41% and 0%, 57% and 1%, respectively). Multivariate analysis identified platelet count, platelet count/splenic axis ratio, renal resistive index, portal vein congestive index as independent factors for the presence of oesophageal varices.ConclusionOur data suggest that a new score system composed of some laboratory and ultrasonographic parameters may predict the presence of varices in patients with Child-Pugh A cirrhosis, and that the score system may help physicians to identify patients who would most likely benefit from screenings for oesophageal varices.     

Efficacy of surgical treatment of de novo, adult-onset, cryptogenic, refractory focal status epilepticus

BACKGROUND: There have been few published reports of successful surgical treatment of focal status epilepticus. Surgical intervention is considered a last resort after medical strategies have been exhausted. OBJECTIVE: To report a case of an adult who was initially seen with de novo, medically refractory, cryptogenic focal status epilepticus and underwent resection of an electrographically defined portion of the left middle frontal gyrus with multiple subpial transections of the adjacent cortex resulting in termination of the electroclinical seizure activity. DESIGN: Report of a case of successful surgical treatment of cryptogenic focal status epilepticus. INTERVENTION: After an initial 35 days of oral antiepileptic drug therapy and subsequent 16 days of continuous electroencephalography-guided intravenous antiepileptic drug therapy in an intensive care unit setting, and after extensive preoperative and intraoperative characterization of the epileptogenic zone, a tailored resection of the left middle frontal gyrus with multiple subpial transections of the surrounding cortex was performed. RESULTS: The restricted surgical resection and multiple subpial transections terminated the seizure activity. Neuropathological examination of the resected tissue revealed moderate inflammatory changes and a few abnormally located neurons without any definitive evidence of dysplasia, which was suspected preoperatively. CONCLUSIONS: We suggest that focal cortical resection may be an appropriate intervention in medically refractory focal status epilepticus even when an overt structural etiology is not evident preoperatively and should be considered as an option at the onset of intractability.     

Agricultural and horticultural pesticides fatal poisoning; the Jordanian experience 1999-2002

A prospective autopsy study addressing fatal poisoning with agricultural and horticultural pesticides was undertaken in Jordan over a 4 year period. A total number of 140 deaths occurred during 1999-2002. The mean fatality rate was 0.68 case per 100,000 population and the age range was 2-55 years; mean 28.3 years with male to female ratio 1.03. The largest number of cases occurred in those 20-29 years (n=69, 49.3%) followed by the age group 30-39 years (n=34, 24.3%) and 40-49 years (n=17, 12.1%). Less than 3.0% of the total fatal poisoning was noticed in both children younger than 9 years of age and those in the age group 50-59 years, with no fatal poisoning in adults at the age 60 years and above. At least 64.3% of all pesticide fatalities were due to suicide with male: female ratio (1.37:1). Accidental and homicide poisoning resulted in 24.3% and 7.9% of the total fatalities, respectively; however, only five cases 3.6% of fatal poisoning were due to unknown pesticides. The main pesticide used was carbamates with 110 cases 78.6% followed by organophosphorus 23 cases 16.4%. The study showed that the present legislation on pesticides availability in Jordan failed to reduce the number of fatal pesticides poisoning since the number of fatal pesticides poisoning was increased from 25.3 to 35 cases per year over a 20 years period. Enforcement of a new legislation addressing the availability of agricultural and horticultural pesticides for self-harm, especially carbamates and organophosphorus, is the most important strategy in the long term to prevent fatal pesticides poisoning in Jordan.