Doppler echocardiography of 119 normal-functioning St Jude Medical mitral valve prostheses: a comprehensive assessment including time-velocity integral ratio and prosthesis performance index.

The purpose of this study was to provide, in a large number of patients, comprehensive Doppler echocardiographic assessment of normal St Jude Medical mitral valve prosthesis function using Doppler-derived hemodynamic variables, including the mitral valve prosthesis-to-left ventricular outflow tract time-velocity integral ratio and prosthesis performance index. The pressure half-time was less than 130 milliseconds in all patients, and all but one patient had either a peak early mitral diastolic velocity of 2 m/s or less or a mitral valve prosthesis-to-left ventricular outflow tract time-velocity integral ratio of less than 2.2. There was a significant (P < .001) negative correlation between the prosthesis performance index and prosthesis size. This negative correlation suggests that there is more efficient use of the in vitro geometric orifice area with smaller prostheses.     

Incisor trauma in an adolescent Arab population: prevalence, severity, and occlusal risk factors.

INTRODUCTION: Incisor trauma is a significant clinical problem in children and adolescents. The purposes of this study were to report on the prevalence and severity of incisor trauma in a large population-based sample of adolescent Kuwaiti residents in the early permanent dentition, to determine the ages of and reasons for the injuries, and to test for any effects of sex, incisor occlusion, and lip coverage on the prevalence of incisor trauma. METHODS: Presence and type of traumatic injury were scored according to the National Institute of Dental Research index in a population-based sample of 795 girls and 788 boys with a mean age of 13.24 years (SD 0.42). RESULTS: Trauma prevalence was higher (P < .001) in boys (19.3%) than in girls (9.7%), and in the maxilla (13.6%) than in the mandible (1.5%). Most (77.3 %) of the affected subjects had only 1 injured tooth, and most (83.7%) of the traumatized teeth were maxillary central incisors. A total of 90.3% of the injuries were unrepaired enamel or enamel/dentin fractures. The major reasons for the injuries were falls and blows indoors (48.4%) or outdoors (41.6%). Nearly two-thirds (63.0%) of the traumas occurred at age 10 years or later. Mean overjet (OJ) was larger (3.9 v 3.0 mm, P < .01), and lip incompetence more frequent (12.7% v 7.3%, P < .01) among the subjects with injured maxillary incisors than among those without. Logistic regression showed that the odds of maxillary incisor trauma were 2.8 times higher in subjects with OJ between 6.5 and 9.0 mm, and 3.7 times higher in subjects with OJ > or = 9.5 mm than in subjects with OJ < or = 3.5 mm. CONCLUSIONS: Multiple logistic regression showed that the risk of maxillary incisor trauma was about 2 times higher in boys than in girls, and that the risk increased by 13% for every millimeter of increase in OJ. Lip competence was not included in the model. No associations were found between occlusion and mandibular incisor trauma.     

Granulomatous jellyfish dermatitis

The induction of a granulomatous inflammation by jellyfish toxins is rare. More typically, acute toxic and urticarial reactions are seen. An 11-year-old boy developed a striated urticarial erythema on the left cheek after contact with a gelatinous mass while swimming in the sea in Croatia. After initial erosion, a striated induration developed in the area of contact. Histological examination revealed a granulomatous inflammation with some eosinophils. While topical steroid-based antiinflammatory and antibacterial therapy over several weeks was not effective, topical therapy with tacrolimus 0.1% for two two-week treatment periods led to healing of the skin changes with a slight scar. There was no clinical recurrence after 5 month of follow-up.     

Safety of the use of Tissucol Duo S in cardiovascular surgery: retrospective analysis of 2149 patients after coronary artery bypass grafting.

OBJECTIVE: Fibrin sealant is widely used in almost all fields of surgery and has proved to be an effective therapeutic tool in cardiothoracic surgery. Nevertheless, there have been concerns about early bypass graft occlusion associated with the use of fibrin glue. This analysis has been performed to assess the risks and benefits of Tissucol Duo S in coronary artery bypass grafting (CABG) surgery. METHODS: Two thousand one hundred forty-nine patients were included in this retrospective study, 879 (40.9%) were intra-operatively treated with Tissucol Duo S fibrin glue, 1270 (59.1%) did not receive fibrin glue (control group). Patient characteristics were documented according to the EuroScore. Intra- and postoperative data were collected. Primary endpoint of this study was the 30-day all-cause mortality rate in the Tissucol Duo S treated group compared to the control group. RESULTS: Mean age was 66.6+/-9.4 years, 76.3% of the patients were male. There was an increased 30-day-mortality rate in the Tissucol Duo S group compared to the control group (8.5 vs 3.5%, p<0.001). In order to determine if and to what extent the apparent fibrin effect might be due to confounding effects from covariates, an adjustment for potential confounding was done. However, multivariable adjustment did not reduce the risk of fibrin glue below an odds ratio of 2.2. CONCLUSION: Although the apparent increase in mortality risk associated with the use of fibrin glue could not be eliminated statistically, we consider Tissucol Duo S fibrin glue a safe and effective therapeutic tool in CABG surgery when it is applied correctly. Due to the retrospective character of this study some detailed information about the indication for the use of fibrin glue and its application is missing which may be important cofactors for mortality. For further clarification a prospective randomized study may be useful.     

Genomic DNA fingerprinting by restriction fragment end labeling.

A typing method for bacteria was developed and applied to several species, including Escherichia coli and Actinobacillus actinomycetemcomitans. Total genomic DNA was digested with a restriction endonuclease, and fragments were enabled with [alpha-32P]dATP by using the Klenow fragment of DNA polymerase and separated by electrophoresis in 6% polyacrylamide/8 M urea (sequencing gel). Depending on the restriction endonuclease and the bacterium, the method produced approximately 30-50 well-separated fragments in the size range of 100-400 nucleotides. For A. actinomycetemcomitans, all strains had bands in common. Nevertheless, many polymorphisms could be observed, and the 31 strains tested could be classified into 29 distinct types. Furthermore, serotype-specific fragments could be assigned for the three serotypes investigated. The method described is very sensitive, allowing more distinct types to be distinguished than other commonly used typing methods. When the method was applied to 10 other clinically relevant bacterial species, both species-specific bands and strain-specific bands were found. Isolates from different locations of one patient showed indistinguishable patterns. Computer-assisted analysis of the DNA fingerprints allowed the determination of similarity coefficients. It is concluded that genomic fingerprinting by restriction fragment end labeling (RFEL) is a powerful and generally applicable technique to type bacterial species.     

The lived experience of home total parenteral nutrition: an online qualitative inquiry with adults, children, and mothers.

BACKGROUND: The purpose of this study was to access a sample of short-bowel patients receiving home total parenteral nutrition (HTPN) in their home environment and describe their HTPN experience using qualitative methodology. METHODS: Three semistructured, open-ended, in-depth interviews were conducted online over a 5-month period with 6 adults (aged 27 to 45 years) who received HTPN for 2 to 8 years, 3 children (aged 8 to 10 years) receiving HTPN since birth, and the children's mothers. The constant comparison method was used to code and categorize data, inductively develop themes, and create a taxonomy (flow chart) of themes from the data. Credibility of data analysis and themes was established by the prolonged engagement with subjects and subject review of themes identified. RESULTS: Six major themes emerged: affirmation of life, infusion-related complications, lifestyle adaptations, self-worth, isolation, and food intake. Within most themes, subjects described similar concerns and reactions. A clear difference occurred within the theme of food intake. Adults reported feeling constantly hungry and challenged with resisting temptation to eat restricted foods. They admitted to lack of consistency in following dietary restrictions and repeated attempts to consume contraindicated foods. Children expressed lack of desire for food and mothers complained of their children's refusal to eat. CONCLUSIONS: Using qualitative methods allowed insight into the HTPN experience and depiction of the daily challenges of being total parenteral nutrition-dependent from patients' and caregivers' perspectives. It provides insight into their reactions and behaviors. By gaining this type of awareness and understanding, clinical protocols and services can be planned that are more likely to derive successful outcomes.     

Moment-to-moment dynamics of ADHD behaviour in South African children

Background  

The behaviour of children with Attention-Deficit/Hyperactivity Disorder is characterized by low predictability of responding. Low behavioural predictability is one way of operationalizing intra-individual ADHD-related variability. ADHD-related variability may be caused by inefficient behavioural selection mechanisms linked to reinforcement and extinction, as suggested by the recently published dynamic developmental theory (DDT) of ADHD. DDT argues that ADHD is a basic neurobehavioural disorder, caused by dysfunctioning dopamine systems. For establishing ADHD as a neurobehavioural disorder, findings from studies conducted in Western countries should be replicated in other cultural populations. The present study replicated the study conducted in Norway, with children from the Limpopo province in the Republic of South Africa.     

The significance of an isolated central nervous system relapse, occurring as first relapse in children with acute lymphoblastic leukemia

In a retrospective study, which comprised the whole Dutch childhood population of approximately 3 million children, the authors assessed the influence of an isolated meningeal relapse, occurring as first relapse, together with some patient and treatment characteristics on prognosis in 142 children with acute lymphoblastic leukemia (ALL). Until their first relapse, patients were initially treated according to standard protocols, whereas the treatment for relapse was heterogeneous. Concerning the probability of achieving a second complete remission (CR) it appears that the duration of the first CR is the single most important prognostic factor. The duration of the first CR is also the most important factor with regard to the duration of the second CR, upon which also age and sex have a significant influence. Concerning the survival from the time of central nervous system (CNS) relapse, again the duration of the first CR appears to be the most important prognostic factor, followed by age and the institution of systemic reinduction treatment. Other factors, such as initial leukocyte count, attainment of first CR within 48 days, type of reinduction treatment, and the cerebral spinal fluid (CSF) blast count at the time of relapse, have a less important, but nevertheless significant influence on survival. The median survival from the time of CNS relapse is 25 months, the 5-year survival is 25%, whereas the ultimate survival will be less than 20%. From 90 patients who developed second or subsequent relapses, 75% experienced a bone marrow relapse during the follow-up period. From this study the authors conclude that CNS relapse in children with ALL carries a grave prognosis, which requires the institution of intensive retreatment programs.     

Eosinophilic granuloma of the head and neck: CT and MRI features in three cases

We report the radiological findings and more specifically the MRI features in three typical cases of Langerhans' cell histiocytosis of the head and neck. All three cases were of solitary eosinophilic granuloma of bone: two mandibular and one temporal bone lesion. Reports on the MRI features of head and neck eosinophilic granulomas are rare.     

Lack of association between cytomegalovirus infection, HLA matching and the vanishing bile duct syndrome after liver transplantation.

In this study we evaluated the association between cytomegalovirus infection alone or in relation to human leukocyte antigen matching and the development of vanishing bile duct syndrome, a form of chronic hepatic allograft rejection. A total of 81 consecutive liver transplant recipients were studied. Cytomegalovirus infection developed in 46 recipients (57%), and vanishing bile duct syndrome occurred in 9 recipients (11%). Cytomegalovirus infection developed in only five of the nine patients with vanishing bile duct syndrome. Univariate analysis of pretransplant recipient/donor cytomegalovirus serological tests and human leukocyte antigen typing showed they were not significant risk factors for the development of vanishing bile duct syndrome. Time-dependent analysis of cytomegalovirus infection after transplantation as a risk factor for vanishing bile duct syndrome, in a multivariate analysis with human leukocyte antigen match, showed no statistical significance. In our study, no association was found between cytomegalovirus infection alone or in relation to class I or II human leukocyte antigen match and the subsequent development of vanishing bile duct syndrome.