Lifetime Basilar Migraine: A Pontine Syndrome?

We describe the clinical and radiological findings of an 82-year-old woman patient with basilar type migraine attacks occurring over 70 years with a similar pattern of intensity and symptoms. We provide some evidence to suggest that gradual development of calcifications in the pontine tegmental nuclei can trigger attacks of basilar type migraine.     

Reliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer

The main aim of this study was to examine the absolute and relative reliability of some commonly used strength imbalance indices such as concentric hamstring-to-concentric quadriceps ratio, eccentric hamstring-to-concentric quadriceps ratio and bilateral concentric and eccentric strength ratios. An additional aim was to examine the reliability of the peak torque and work of the knee extensor and flexor muscles measured using the Cybex NORM dynamometer. Eighteen physically active healthy subjects (mean +/- standard deviation, age 23 +/- 3 years, height 176 +/- 5 cm, body mass 74 +/- 8 kg) were tested three times with 96 h between sessions. Peak torque, average work, unilateral and bilateral ratios were determined at 60, 120, 180 and -60 degrees s(-1). Low (0.34) to moderate (0.87) relative reliability (intraclass correlation coefficient, ICC) was found for strength imbalance ratios with eccentric hamstring-to-concentric quadriceps ratio showing the greater ICC (>0.80). High ICC values (0.90-0.98) were found for peak torque and average work. Absolute reliability (standard error of measurement) ranged from 3.2% to 8.7% for strength imbalance ratios and from 4.3% to 7.7% for peak torque and average work measurements. This study established the reliability of the most common strength imbalance ratios and of absolute isokinetic muscle strength assessed using the Cybex NORM.     

The critically ill injured patient

Patients admitted to the ICU after severe trauma require frequent procedures in the operating room, particularly in cases where a damage control strategy is used. The ventilatory management of these patients in the operating room can be particularly challenging. These patients often have severely impaired respiratory mechanics because of acute lung injury and abdominal compartment syndrome. Consequently, the pressure and flow generation capabilities of standard anesthesia ventilators may be inadequate to support ventilation and gas exchange. This article presents the problems that may be encountered in patients who have severe abdominal and lung injuries, and the current management concepts used in caring for these patients in the critical care setting, to provide guidelines for the anesthetist faced with these patients in the operating room.     

Identification of cytotoxic T-lymphocyte epitope(s) and its agonist epitope(s) of a novel target for vaccine therapy (PAGE4)

PAGE4 is an X chromosome-linked cancer testis antigen and is a potential new tumor-associated antigen that is overexpressed in prostate and uterine cancers. The purpose of this study was to identify a human CTL epitope and a corresponding agonist epitope of PAGE4 to determine if PAGE4 is a potential target for vaccine-mediated immunotherapy against PAGE4-expressing tumors. A class I PAGE4 epitope was identified with a high level of binding to HLA-A2. PAGE4 peptide-pulsed dendritic cells were then used to generate human PAGE4-specific T-cell lines. Further studies demonstrated the generation of an enhancer agonist epitope. Compared with the native peptide, the agonist (i) bound to HLA-A2 molecules at lower peptide concentrations, (ii) demonstrated a higher stability of the peptide HLA-A2 complex, (iii) induced higher levels of production of IFN-gamma, Granzyme B, TNF-alpha, IL-2 and lymphotactin by PAGE4-specific T-cell lines and (iv) T-cell lines generated against the agonist peptide were more efficient to lyse HLA-A2 human tumor cells expressing native PAGE4. The studies reported here are the first to describe a PAGE4 CTL epitope and its agonist epitope, and thus identify PAGE4 as a potentially useful target for vaccine-mediated therapy of prostate cancer.     

Clearance of Mucus from Endotracheal Tubes during Intratracheal Pulmonary Ventilation

Background: Intratracheal pulmonary ventilation (ITPV) is a form of tracheal gas insufflation in which all gas emerges in a cephalad direction from the tip of a reverse-thrust catheter positioned within an endotracheal tube. In vitro experiments have shown that this rapid gas flow, with 5 ml/h of normal saline added to the gas flow, continuously removes tracheal secretions from within the endotracheal tube. The authors evaluated its effectiveness to remove mucus in long-term studies in sheep.

Methods: Fourteen healthy sheep were tracheally intubated and ventilated for 3 days with ITPV or with volume-controlled ventilation. Measurements were made of the total amount of secretions within the endotracheal tubes (weight gain), the protein content within the endotracheal tubes, and the increase in resistance to constant air flow. The structure of the airways was examined grossly and histologically. Three additional sheep were ventilated for 24 h with ITPV, and Evans Blue dye was added to the saline to assess the distribution of the infused saline.

Results: There was significantly less mucus in endotracheal tubes of sheep ventilated with ITPV than with conventional ventilation, as shown by minimal weight gain (0.70 +/- 0.14 g vs. 2.44 +/- 0.81 g; P < 0.001), lower protein content (14.09 +/- 10.79 mg vs. 294.99 +/- 153.06 mg; P <0.001), and lower resistance to constant air flow (6.15 +/- 0.54 cm H2 O [center dot] l sup -1 [center dot] s sup -1 vs. 15.34 +/- 5.28 cm H2 O [center dot] l sup -1 [center dot] s sup -1; P < 0.001). Results of gross and histological examinations of the tracheas of animals in both groups were similar, and the tracheas were well preserved. More than 95% of the instilled saline was recovered during ITPV. Only traces of Evans Blue dye were found near the tip of the endotracheal tubes.     

A pseudo-outbreak of vancomycin-resistant Enterococcus faecium.

Five VRE isolates were reported from sterile samples. No infections were diagnosed among the patients, who were on different wards. PFGE showed that all five isolates were clonal. All samples were manipulated by the same worker, but the source could not be found. Contamination was probably related to manipulation of a source specimen in the laboratory.     

Assessing energy expenditure in cancer patients: a pilot validation of a new wearable device

BACKGROUND: Nutrition problems are common in cancer patients and are frequently due to metabolic derangements. Thus, accurately assessing energy expenditure (EE) is important in planning adequate nutrition support. Indirect calorimetry (IC) represents the gold standard method but is not always available or applicable to all settings. The purpose of this study was to preliminary compare a new wearable device, the SenseWear armband (SWA), to IC in cancer patients. METHODS: Ten (6 M, 4 F) subjects (mean +/- SD: 56.6 +/- 13.3 years) affected by newly diagnosed acute myelogenous leukemia, undergoing induction chemotherapy, were prospectively enrolled. Resting EE (REE) was measured simultaneously by SWA and IC on admission (day 0) and at discharge (end). Total daily EE (TDEE) was determined by SWA 4 times during the stay (days 0, 7, 14, and end) and predicted values were calculated according to IC REE estimates (TDEE = IC x correction factor 1.2). RESULTS: Mean length of stay was 27.1 +/- 6.2 days. Bland-Altman plots revealed no significant differences between overall REE estimates (day 0 + end) performed by IC and SWA (mean +/- SD; 1645 +/- 282 vs 1705 +/- 278 kcal/d) and the correlation was high (r = 0.84; p < .0001). SWA TDEE showed a progressive reduction during the stay. No bias was detected between overall SWA TDEE (1799 +/- 153 kcal/d) and IC predicted TDEE (1974 +/- 176 kcal/d), but there was a wide 95% confidence interval (-672; +321 kcal/d). Moreover, the correlation between these values was significant (r = 0.68; p = .001). CONCLUSIONS: SWA seems to provide accurate and reliable estimation of REE and useful information on TDEE also in cancer patients. Its use appears promising. Validation studies on larger samples and different cancer types should be considered.