Hantavirus Pulmonary Syndrome Outbreak,Brazil, December 2009–January 2010

An outbreak of hantavirus pulmonary syndrome occurred in the Sobradinho Indian settlement of the Kayabí ethnic group in northern Mato Grosso during December 2009–January 2010. We conducted a retrospective study to clarify the outbreak’s epidemiologic and clinical characteristics. Results suggest a relationship between the outbreak and deforestation and farming expansion in indigenous areas.     

Sprunggelenkarthrodese nach gescheiterter Endoprothesenimplantation

Despite recent anatomical and biomechanical improvements the longevity of current total ankle replacements remains limited. Once total ankle replacement has failed conversion into ankle arthrodesis provides a viable option and should therefore be considered. However, due to the massive bone loss, precarious soft tissues and in order to preserve leg length, this kind of surgical treatment is considered to be technically demanding with potential impairment of the quality of life and decreased global foot and ankle function as well. The present article focuses on salvage ankle arthrodesis after failed total ankle replacement and seeks to provide a usable treatment algorithm.     

Insertion of the CCND1 gene into the IgH locus in a case of leukaemic small cell mantle lymphoma with normal chromosomes 11 and 14

The t(11;14)(q13;q32) translocation is considered to be the cytogenetic hallmark of mantle cell lymphoma. This report describes a case of leukaemic mantle cell lymphoma in which conventional cytogenetics on stimulated peripheral blood cells showed a 46,XY, t(1;12)(p21;q23)/46,XY karyotype. Fluorescence in situ hybridisation analysis using a dual colour immunoglobulin heavy chain (IgH)/CCND1 probe showed a fusion hybridisation signal on one normal chromosome 14, indicating that an insertion of the CCND1 gene into the 14q32/IgH locus had taken place. Overexpression of the cyclin D1 protein was demonstrated on bone marrow trephine by immunohistochemical staining.     

Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial

Background

A constructive safety culture is essential for the successful implementation of patient safety improvements.

Aim

To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture.

Design and setting

A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands.

Method

The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires.

Results

The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups.

Conclusion

Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety.     

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases

Aim

To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS).

A modified laparoscopic entry technique using a finger and rubber catheter.

Hasson and Grimes have developed the so-called open laparoscopy technique. Patients with surgical history and obese patients present a higher risk for laparoscopy. Since the development of laparoscopic cholecystectomy general surgeons have been able to obtain instruction in percutaneous and open techniques in various laparoscopic training centers throughout the United States. The percutaneous technique uses the Veress needle, while the open technique uses the Hasson cannula. We present a modification of the open technique using a finger and rubber catheter to thread the trocar cannula into the abdomen using standard disposable cannulas and avoiding the use of the Hasson cannula.     

Intraventricular endothelin-1 uncouples the blood flow: metabolism relationship in periventricular structures of the rat brain: involvement of L-type calcium channels.

Endothelin-1 (ET) produces contraction of cerebral resistance vessels in vitro and in situ, but also is neuroactive causing increases in tissue energy metabolism as measured by [14C]deoxyglucose autoradiography in the intact rat brain. ET may, therefore, disengage the normally tight linkage between cerebral blood flow and tissue metabolism. Using anatomically rigorous autoradiographic and imaging techniques to measure focal blood flow in anesthetized, ventilated rats, we found that intraventricular injection of 9 pmol of ET reduced rates of perfusion by an average of 29% (compared to a saline-injected condition) in 6 individual periventricular structures bordering the injected lateral ventricle. A significant vasoconstrictor effect (41% decrease in blood flow) also occurred in the ipsilateral choroid plexus after ET injection, despite its increased rate of glucose metabolism. We employed a hydrogen clearance method to monitor rates of blood flow serially within the periventricular margin of the caudate nucleus after intraventricular injection of the dihydropyridine calcium-channel antagonist, nimodipine (72 nmol), or 9 pmol ET, alone and in sequence. Nimodipine increased caudate blood flow (by 47%) and prevented the vasoconstriction produced by ET. The results indicate that ET causes vasoconstriction in penventricular brain structures and choroid plexus even in the presence of substantial increases in glucose metabolism. The simultaneous stimulation by intraventricular ET of tissue hypermetabolic and vascular constrictor mechanisms, leading to a net reduction of periventricular blood flow, is mediated, at least in part, by dihydropyridine-sensitive calcium L-channels.     

Prognosis of conventional root canal treatment reconsidered

Abstract— In endodontic literature, the so-called success rate of conventional root canal treatment is reported to range between 70% and 95%. This has been calculated as the percentage of successfully treated teeth of all teeth followed up or included in the clinical trial. This approach, however, does not allow for valid assertions on the prognosis of root canal treatment as the individual observation times are not considered. This article discusses some methodological and statistical aspects of how to design a prognostic study which focuses on the outcome of endodontic therapy and of how to analyse the data appropriately. Methodologically, the response variable should preferably be the individual time required for the occurrence of an event, e.g., success or failure of endodontic therapy, which should clearly be defined on the basis of widely accepted criteria in endodontology. Event times can appropriately be analysed by the Kaplan-Meier method, which estimates the probability that the event will not occur within a fixed time. This probability, together with the approximate 95% confidence interval (CI), permits an evaluation of the prognosis of a particular treatment. Two data sets were re-analysed to clarifj, the rationale behind the analysis of event times. Accordingly, the probability that an endodontically induced lesion will completely heal, e.g., within the first 3 years after root canal therapy ranges between 0,87 (CI: 0.74–1.00) and 0.89 (CI: 0.80–0.98). In this situation, the simple calculation of success rates would overestimate the chance of complete periapical healing within the first years after therapy but underestimate it over longer observation periods. Another example was used to analyse the time to occurrence of periapical pathosis associated with root canal treated teeth not diseased periapically. In this case the chance of recording a successful endodontic treatment is initially underestimated by the percentage of successful cases of all teeth integrated in the study but is markedly overestimated for longer observation periods. Potential risk factors affecting the outcome of the endodontic therapy and thereby the event times can adequately be determined by applying the Cox's or Aalen's regression model.     

Esophageal atresia and tracheoesophageal fistula in two infants born to hyperthyroid women receiving methimazole (Tapazol) during pregnancy.

We report on 2 newborn infants with esophageal atresia and tracheoesophageal fistula (EA + TEF) born to hyperthyroid mothers receiving methimazole (Tapazol) before and during their entire pregnancies. Both mothers were euthyroid during gestation and developed hydramnios diagnosed during weeks 34 and 33 of gestation. Premature delivery (36.2 weeks of gestation) occurred in one case, and both newborn infants were small for date with palpable goiter; one of them had other associated malformations. Hypothyroidism was diagnosed by laboratory tests in both cases. Corrective surgery was undertaken, but both newborn infants developed septicemia and renal insufficiency and died in the first week of life. The EA + TEF and a normally placed enlarged thyroid gland were confirmed at necropsy. These cases represent a previously unreported example of the association of maternal ingestion of methimazole during pregnancy and EA + TEF.