Sonographic and computerized tomography study of congenital choledochal cyst

In the neonatal period ultrasound and hepatobiliary functional scintigraphy are used to diagnose choledochal cysts. Initial sonography demonstrates hepatobiliary anatomy, hepatobiliary function is assessed by subsequent scintigraphy. The diagnosis can be confirmed by additional computed tomography as shown in this case report.     

Gastric outlet obstruction after long-term prostaglandin administration mimicking hypertrophic pyloric stenosis.

Prostaglandin E1 (PGE1) is widely used in neonates with cyanotic congenital heart disease who depend on the patency of the ductus arteriosus for oxygenation. Side effects of prostaglandin therapy are common and include respiratory depression, generalized flushing, and cardiovascular and neurological effects. Little is known about the complex effects on the gastrointestinal tract. We report on an infant with gastric outlet obstruction after long-term prostaglandin administration. At the age of 1 month, feeding problems developed with projectile vomiting. Ultrasonography showed progressive elongation of the antropyloric channel without wall thickening, which was causing gastric outlet obstruction. Three days after cardiac surgery and cessation of prostaglandin therapy, the infant fed normally and rapidly gained weight. The clinical signs in such patients can mimic hypertrophic pyloric stenosis. Therefore, the sonographic findings should not be confused with pyloric wall thickening to avoid a false diagnosis and unnecessary surgery. The symptoms diminish with cessation of the prostaglandin therapy after a corrective cardiac operation.     

Intraabdominal pressures during natural activities in patients treated with continuous ambulatory peritoneal dialysis

Intraabdominal pressures were measured during natural activities in 6 men, age 24-62 years, treated with continuous ambulatory peritoneal dialysis. The pressures were measured with a pressure transducer secured at the level of the umbilicus in the supine, sitting, and upright positions with 0-3 liters intraperitoneal fluid during talking, coughing, straining, changing position, walking, jogging, exercycling, jumping and weight lifting. Coughing and straining generated the highest intraabdominal pressures in every position. The pressures with weight lifting were proportional to the magnitude of the weight lifted up to 50 lbs, but were lower than those during coughing and straining. The pressures were generally higher with greater intraabdominal fluid volumes, especially with jumping and coughing. Exercycling was associated with lower intraabdominal pressure than was jogging, and the pressures were only minimally influenced by intraperitoneal fluid volumes. The results of this study can be used as a guide in establishing preventive measures in patients with intraperitoneal fluid to decrease complication rates related to raised intraabdominal pressures such as dialysate leaks, hernias and hemorrhoids.     

Recombinant interferon alfa-2a with or without vinblastine in metastatic renal cell carcinoma: results of a European multi-center phase III study.

A total of 178 patients with metastatic renal cell cancer were randomized to receive interferon alfa-2a (rIFN alfa-2a) or interferon alfa-2a+vinblastine (VLB). IFN alfa-2a was injected intramuscularly at a dose of 18 MIU 3 times a week and VLB was given intravenously at a dose of 0.1 mg/kg once every 3 weeks. The response rate was 11% for patients on monotherapy and 24% for those on combination treatment. The 5-year survival for 145 eligible patients was 9%, independently from the treatment arm. The performance status was significantly related to long-term prognosis, and 13% of the patients with performance status 0 were alive at 5 years, as compared to 6% and 0% for patients with a WHO grade of 1 and 2, respectively. The most frequent adverse events in both treatment arms were flu-like symptoms (95%), fatigue (70%) and gastrointestinal disturbances (68%). Leukopenia was observed more frequently with combination treatment (53%) than with IFN alfa-2a alone (30%). In conclusion, rIFN alfa-2a monotherapy at this dose and schedule has modest antitumor activity in metastatic renal cell cancer. The combination of rIFN alfa-2a+VLB results in a doubling of the response rate, but this does not translate into prolonged survival. Toxicity (except leukopenia) and tolerance were similar in both treatment arms.     

Biomagnetic multi-channel systems. Principles and application in cardiology.

The non-invasive measurement of the extremely weak magnetic fields generated by heart and brain is motivated by the possibility of obtaining quantitative diagnostic information about electric function. Magnetic signals (MCG, MEG) are significantly less influenced by body tissue than the corresponding electric signals (ECG, EEG). Measurement of biomagnetic signals is performed by superconducting sensors, consisting of pickup coils and SQUIDs (superconducting quantum interference device) operating in liquid Helium. For clinical investigations a biomagnetic multi-channel system (KRENIKONR) has been designed. It uses a flat array of 37 magnetic field sensors and is operated inside a shielded room. Evaluation of biomagnetic signals by use of simple source and body models and in combination with anatomical data from 3D MR- or CT-images yields sequences of locations of electrical function with a spatial resolution of some millimeters and a time resolution better than one millisecond. More than three years of clinical studies have demonstrated the value of the method primarily in cases with localized functional pathologies. In cardiology this is pathologies of the cardiac conductive pathway, ectopies, and arrhythmias. Validation has been performed by catheter stimulation in volunteers, and by catheter mapping and nuclear medical methods in patients. Extension of modelling and evaluation to cases with distributed activity, e.g. ventricular excitation, is under investigation.     

Systemic endotoxin and gastric mucosal pH are the best parameters to predict lethal outcome in a porcine model of abdominal sepsis according to multivariate analysis.

This study was devised to identify sepsis-relevant parameters that early and reliably predict a lethal outcome in intra-abdominal sepsis. In 18 Duroc pigs, peritonitis was induced through standardized gastrotomy. Twelve hours later the defect was oversewn and the abdominal cavity lavaged thoroughly. Sepsis relevant parameters were measured before initiating therapy, and 30 min later animals were extubated and observed for a period of 6 days under adequate analgesia with free access to water and food. All parameters were correlated with survival postoperatively. In the treatment group, 7 out of 18 pigs (39%) died within the observation period. Endotoxin level at 30 min after initiation of therapy [17.9 EU/mL (+/- 12.1) vs. 110.9 EU/mL (+/- 21); p <.001] and Delta pHi [0.015 (+/- 0.011) vs. -0.039 (+/- 0.013); p =.016] were identified as the two parameters with highest predictive power regarding mortality in a multivariate analysis. In conclusion measurement of endotoxin and gastric tonometry should gain wider clinical application in septic patients.     

Thromboembolieprophylaxe bei minimal-invasiven Eingriffen und kurzstationärer Behandlung Ergebnisse einer multicentrischen, prospektiven, randomisierten, kontrollierten Studie mit einem niedermolekularen Heparin

Zusammenfassung. Mit dem Ziel, die Incidenz tiefer Venenthrombosen bei selektierten Patienten nach laparoskopischer Cholecystektomie und anderen minimal-invasiven chirurgischen Eingriffen zu bestimmen, sowie die Sicherheit und Wirksamkeit eines niedermolekularen Heparinpr?parats (NMH) in der postoperativen Thromboseprophylaxe zu belegen, wurde eine prospektive, randomisierte, kontrollierte klinische Studie durchgeführt. Dabei wurden 718 Patienten nach Randomplan einer von 2 Prüfgruppen zugeordnet: Eine Gruppe erhielt physikalische Ma?nahmen zur Thromboseprophylaxe, wie Kompressionsstrümpfe mit graduiertem Andruck (n = 359), die 2. Gruppe erhielt ebenfalls physikalische Ma?nahmen und zus?tzlich ein NMH (Reviparin-Natrium, Clivarin) s. c. einmal t?glich (n = 359). Aus Sicherheitsgründen mit Hinblick auf die medikament?s unbehandelte Kontrollgruppe wurden Patienten mit 3 oder mehr Risikofaktoren für eine ven?se Thromboembolie nicht in die Studie aufgenommen. Die Diagnostik tiefer Beinvenenthrombosen erfolgte mittels Duplexscan. In dieser, eher künstlichen Niedrigrisikoselektion war die Gesamtincidenz thromboembolischer Ereignisse überraschend gering: 5 Verdachtsf?lle einer Lungenembolie, von denen nur 1 Lungenembolie szintigraphisch verifiziert werden konnte, sowie eine phlebographisch best?tigte Unterschenkelthrombose. Die Anwendung von Reviparin zur Prophylaxe ven?ser Thromboembolien war sicher und anwenderfreundlich – die Incidenz postoperativer Blutungskomplikationen betrug nur 2,3 % in der NMH-Gruppe und war somit sogar geringfügig niedriger als in der Kontrollgruppe (3,2 %). Die tats?chliche Incidenz tiefer Venenthrombosen bei Patienten nach laparoskopischer Cholecystektomie bleibt jedoch nach wie vor unklar. Weitere klinische Studien müssen in einem unselektierten Patientengut durchgeführt werden.      

Plasmodium falciparum andP. berghei: detection of sporozoites and the circumsporozoite proteins in the saliva ofAnopheles stephensi mosquitoes

Sporozoites and free circumsporozoite (CS) protein were stained immunoenzymatically in 1-min saliva samples collected fromAnopheles stephensi mosquitoes infected with eitherPlasmodium berghei orP. falciparum. The number of sporozoites in 1-min saliva-streak samples significantly increased as the salivary gland index rose from 3+ to 4+. ForP. berghei-infected mosquitoes from which saliva had been collected before 30 days postfeed, the median sporozoite counts for 3+ and 4+ gland indexes were 4.5 and 116, respectively. ForP. falciparum-infected mosquitoes, the median counts obtained in two experiments were 4.5 and 14.5 (3+) and 97 and 107 (4+), respectively. The frequency of sporozoite detection in the saliva of mosquitoes containing <100 salivary-gland sporozoites was low (0.1), whereas that in the saliva of mosquitoes with >100 sporozoites was high (0.96). In highly infected 4+P. berghei-infected mosquitoes from which saliva had been collected after 30 days postinfection, both the volume of saliva collected and the median number of sporozoites recovered decreased significantly.     

Early life experiences linked to diabetes mellitus: a study of African-American migration.

African Americans experienced massive internal migrations that shifted more than 6 million Southern-born blacks to other sections of the United States over the past century, a trend that only recently has been reversed. Whenever mass migration takes place, there is an opportunity to examine the role of the native and relocated environments in the development of disease. This article examines those relationships for diabetes mellitus, a group of diseases that disproportionately affect African-Americans relative to other racial and ethnic groups in the United States. Age-specific and age-adjusted rates with 95% confidence intervals were calculated for males and females for combinations of five regions of birth and four regions of residence at time of death. Southern-born males had statistically significantly higher death rates from diabetes than did their counterparts who died in the same regions in 9 of 16 comparisons. For females, those born in the South had statistically significantly higher rates in 15 of 16 comparisons. The results of this study indicate that place of birth and early life experiences are statistically associated with diabetes mortality among African Americans regardless of place of residence at time of death.