Cannabis cookies: A cause of coma

Despite the prevalence of cannabis use in the community, reports of adverse effects in young children are rare. Two cases of cannabis-induced coma are reported following accidental ingestion of cannabis cookies. The possibility of cannabis ingestion should be considered in cases of unexplained coma in a previously well young child if signs of conjunctival hyperaemia, pupillary dilatation and tachycardia are present and other causes such as CNS infection or trauma are unlikely. Specific screening for cannabinoids should be undertaken.     

Early and late surgical treatment of orbital dystopia in craniofacial malformation.

Orbital dystopia is one of the most frequent clinical signs of craniofacial malformation. The term dystopia indicates the mono- and bilateral asymmetry of the orbits at least in one of the three-dimensional planes. The diagnosis is based on the clinical test of the patient with the support of diagnostic instruments such as teleradiography in both standard projections, axial computed tomographic (CT) scans at a rate of 1:1 through the neuro-orbital plan, and the three-dimensional CT. Good results of the surgical treatment depend on the patient's age and on adequate programming, which should consider the anomalies in the three spatial planes. The VTO is obtained through a protocol of analysis on cephalometric graphics of the teleradiographics on the CT at a rate of 1:1. The surgical treatment of orbital dystopia is different depending on the age of the patient and the cause of the orbital anomaly. In the case of growing patients, it is preferable to use the fronto-orbital bandeau technique so as not to damage the dental buds, whereas in grown patients Tessier's orbital quadrant technique is used. Even the fixation is quite different between patients who are growing and those who are already grown. In still-growing patients, rigid internal fixation is used only in some cases to avoid the interference with the growth mechanisms.     

Educating nurses--the assisted conception nursing care course of the RCN Institute

The Assisted Conception Nursing Care course of the Royal College of Nursing Institute is approaching its 5 yearly review. This professionally and academically validated course was designed in collaboration with the Fertility Nurses Group to meet the needs of those in specialist practice who are taking an increasingly significant role in the care of those needing support and treatment for fertility problems. The 6 month part-time course addresses areas as diverse as physiology and pharmacology, behavioural sciences and ethical, legal and cultural issues. There is also an emphasis on research awareness and the analysis of nursing and social policy. The course draws nurses from a wide area within the UK who particularly value the opportunity to share ideas and construct ongoing networks.      

Proton magnetic resonance relaxation behavior of whole muscle with fatty inclusions

This in vitro proton study of spin lattice (T1) and spin spin (T2) relaxation of muscle with storage-fat inclusions demonstrates slow exchange and lack of cross-relaxation between fat and water. Slow exchange causes biphasic T1 relaxation, but T2 relaxation is paradoxically uniphasic due to the nearly equal T2 values for both fractions. By careful dehydration and fat extraction, the relaxation information was deconvolved into water, fat, and protein contributions. The biphasic T1 decay has a short component due to lipid and a long component due to the water-protein combination. The fat content of muscle can be measured from the relative amplitude of the two T1 components or directly from the T2 relaxation time.     

Nasofrontal duct: CT in frontal sinus trauma

Radiologic evaluation of frontal sinus fractures is instrumental in determining the need for surgery. Computed tomography (CT) is an excellent modality for evaluation of frontal sinus trauma, particularly for anterior and posterior wall fractures. However, fractures of the nasofrontal duct are more difficult to delineate, and judgments about operating for this problem are often made on less than concrete evidence of duct trauma. To evaluate the usefulness of CT in identifying nasofrontal duct trauma, a two-part study was done. First, CT was performed on cadavers to study the anatomic relationship of the nasofrontal duct to midface anatomy. Then, a retrospective study was performed in 19 patients with suspected frontal sinus fractures who underwent frontal sinus surgery. Findings at surgery were compared with preoperative evaluation with CT. Correlations were identified and criteria developed that can be used to identify patients needing surgical intervention in frontal sinus trauma. These criteria include findings of either a fracture involving the base of the frontal sinus or a fracture of the anterior ethmoid complex, or both.     

(-)棉酚和(+)棉酚对蛋白激酶C及蛋白激酶A活力影响的比较

部分纯化的大鼠肝脏蛋白激酶C和蛋白激酶A,在体外与棉酚的旋光异构体分别温育,结果(--)棉酚和(+)棉酚对蛋白激酶C活力均有剂量依赖性的抑制作用;(-)棉酚对Ⅰ型蛋白激酶A活力的抑制作用明显比(+)棉酚强,而(-)棉酚和(+)棉酚在高浓度时对Ⅱ型蛋白激酶A才显示抑制作用。结果提示棉酚在体内可能干扰细胞信息的传递过程。     

Nonfebrile seizures after febrile convulsions: possible role of chronic cytomegalovirus infection

Twelve hundred children with convulsions when feverish were studied during a period of five years. Among them 52 subjects (4.33%) developed nonfebrile seizures after a period of eight months to five years from the first febrile convulsion (group A). Twenty-three children had neither afebrile seizures nor EEG abnormalities during the period of observation (group B). The two groups were comparable for age of the first febrile convulsion onset, sex, and socioeconomic status. None had risk factors for subsequent epilepsy or clinical signs of congenital cytomegalovirus infection. The isolation rate of CMV from urine was 53.84% in patients of group A, 26.09% in children of group B, and 26.83% in healthy control children. Twelve CMV-positive children from group A were followed for one to more than three years. In five of seven children with persisting EEG abnormalities, cytomegaloviruria was still present 13 to 41 months after the first isolation, whereas none of five patients with normal electroencephalograms had viruria after a comparable period. We found that CMV-positive children generally lacked cell-mediated immunity to the virus, whereas CMV-negative patients had positive reactions. Our data suggest a correlation between persistence of neurologic abnormalities and CMV excretion in children with nonfebrile seizures and CMV infection.     

ototoxicity after high-dose chemotherapy with cyclophosphamide, thiotepa and carboplatin followed by stem cell transplantation in patients with breast cancer

Our purpose was to determine the risk of ototoxicity in breast cancer patients receiving a myeloablative regimen consisting of cyclophosphamide 6000 mg/m², thiotepa 500mg/m² and carboplatin 800mg/m² (CTCb) followed by stem cell transplantation. Fourteen consecutive patients with breast cancer were treated with high dose chemotherapy consisting of the CTCb regimen followed by stem cell transplantation. A pretransplant complete hearing study was obtained which consisted of hearing case history, audiometry and tympanometry. In addition, DPOAE (Distortion Product Otoaccoustic Emissions) was done to evaluate measurable changes in the cochlear (outer hair cell) functioning. Pre-transplant, all patients had no clinical evidence of hearing impairment and hearing studies were normal. Eleven patients had hearing studies and a telephone interview posttransplant. One patient was lost to follow-up and two patients died. One of the 11 patients tested had an abnormal post-transplant hearing study but none of them had clinically detectable hearing impairment. In our prospective study of breast cancer patients treated with the CTCb regimen, we did not observe clinically detectable hearing impairment in any of the patients tested.