Embolization of bronchial arteries with N-butyl cyanoacrylate for management of massive hemoptysis: a technical review

N-butyl cyanoacrylate (NBCA) is an adhesive material, which has been used as an embolic agent in various vascular beds. Its role in the management of patients with acute massive hemoptysis has not been reported. In this article we report our experience with 12 such patients who underwent bronchial artery embolization using NBCA and compare the results with 36 procedures using polyvinyl alcohol (PVA) particles. As compared with PVA, NBCA embolizations appear more durable, leading to fewer rebleeds. There were 12 episodes of recurrent hemoptysis after 36 procedures using PVA (33%) with 8 being due to bleeding from a previously embolized vessel. Conversely, there were only 2 of the 12 patients who were treated by NBCA who experienced rebleed (16.6%). In this article, we describe the technical nuances of NBCA embolization of bronchial arteries and review potential pitfalls.     

Generation of motor neurons by coculture of retinoic acid-pretreated embryonic stem cells with chicken notochords

Understanding neuroectoderm formation and its subsequent diversification to functional neural subtypes remains elusive. We have shown here for the first time that embryonic stem cells (ESCs) can differentiate into neurons and motor neurons (MNs) by using a coculture embryonic notochord model in vitro. Mouse ESCs were induced to form neural precursors via timed exposure to retinoic acid (RA) using the 4-/4+ RA protocol. These cells were then cocultured with alginate bead-encapsulated notochords isolated from Hamburger and Hamilton stage 6-10 chick embryos. The use of notochord alone was not able to induce neural differentiation from ESCs, and, therefore, notochord does not possess neural inducing activity. Hence, the most successful neuronal cells and MN differentiation was only observed following the coculture of RA-pretreated ESCs with notochord. This resulted in a significantly greater number of cells expressing microtubule-associated protein-2 (MAP2), HB9, choline acetyltransferase (ChAT) and MN-specific genes. While further characterization of these differentiated cells will be essential before transplantation studies commence, these data illustrate the effectiveness of embryonic notochord coculture in providing valuable molecular cues for directed differentiation of ESCs toward an MN lineage.     

Comparison of the cardiovascular effects of isoflurane and sevoflurane as measured by magnetic resonance imaging in children with congenital heart disease

STUDY OBJECTIVE: To compare the cardiovascular effects of isoflurane and sevoflurane at minimum alveolar concentration (MAC) = 1 in children with congenital heart disease using cardiac magnetic resonance imaging. DESIGN: Randomized, crossover, single-blinded study. SETTING: Tertiary-care teaching hospital. PATIENTS: 10 pediatric patients with congenital heart diseases scheduled to undergo cardiac magnetic resonance studies. INTERVENTIONS: Patients were randomized to receive either isoflurane or sevoflurane as the "first inhalation agent." After a period or more than 20 minutes, they were crossed over to receive the "second inhalation agent." MEASUREMENTS: Heart rate, mean arterial pressure (MAP), cardiac index, stroke volume index, and ejection fraction (EF) at one MAC for both agents were all recorded. MAIN RESULTS: Both isoflurane and sevoflurane caused a significant decrease in MAP from the baseline (P = 0.013). The mean values (+/-SD) of stroke volume (mL), cardiac index (L min(-1) m(-2)), and EF (%) for isoflurane versus sevoflurane were 21.5 (+/-9.2) versus 19.6 (+/-6.2), 4.1 (+/-1.2) versus 3.7 (+/-0.87), and 64.2 (+/-14.5) versus 62.5 (+/-13.8), respectively. CONCLUSION: Both isoflurane and sevoflurane were found to be comparable in terms of cardiovascular effects.     

Viral hepatitis elimination challenges in low- and middle-income countries—Uzbekistan Hepatitis Elimination Program (UHEP)

Background & Aims

Chronic infection with hepatitis B and C viruses (HBV & HCV) is a major contributor to liver disease and liver-related mortality in Uzbekistan. There is a need to demonstrate the feasibility of large-scale simplified testing and treatment to implement a national viral hepatitis elimination program.

Methods

Thirteen polyclinics were utilized to screen, conduct follow-up biochemical measures and treat chronic HBV and HCV infection in the general adult population. Task shifting and motivational interviewing training allowed nurses to provide rapid screening and general practitioners (GPs) to treat individuals on-site. An electronic medical system tracked individuals through the cascade of care.

Results

The use of rapid tests allowed for screening of 60 769 people for HCV and HBV over 6 months and permitted outdoor testing during the COVID-19 pandemic along with COVID testing. 13%–14% of individuals were lost to follow-up after the rapid test, and another 62%–66% failed to come in for their consultation. One stop testing and treatment did not result in a statistically increase in retention and lack of patient awareness of viral hepatitis was identified as a key factor. Despite training, there were large differences between GPs and patients initiating treatment.

Conclusions

The current study demonstrated the feasibility of large-scale general population screening and task shifting in low- and middle-income countries. However, such programs need to be proceeded by awareness campaign to minimize loss to follow up. In addition, multiple trainings are needed for GPs to bolster their skills to talk to patients about treatment.     

Ameloblastic fibrosarcoma of the maxillary sinus in an infant: a case report with long-term follow-up

Ameloblastic fibrosarcoma (AFS) or ameloblastic sarcoma is an extremely rare odontogenic neoplasm. The authors report AFS in the maxillary sinus of a 4-month-old boy. The tumor was composed of odontogenic epithelium, resembling that of ameloblastoma, and a mesenchymal part exhibiting features of fibrosarcoma. We also found some areas with deposition of dentinoid material closely adjacent to the ameloblastic epithelium. Although AFS has occurred in a wide age range, this is the first report of this tumor in infancy with long-term follow-up.     

Herpes Simplex Encephalitis – An Atypical Case

Herpes simplex virus (HSV) is a common cause of viral encephalitis. Herpes simplex encephalitis (HSE) typically presents with acute neurologic changes and the initial cerebrospinal fluid examination is nearly always abnormal. We report a case of a patient with HSE and normal initial CSF analysis. This resulted in delayed diagnosis and therapy with subsequent severe neurolgical sequelae. Herpes simplex infection should be included in the differential diagnosis of encephalopathic patients and a normal CSF examination. Received: August 16, 2000 · Revision accepted: August 27, 2001