Role of MDCT in evaluating prothesis size prior to percutaneous transcatheter closure of ostium secundum atrial septal defect

The International Journal of Cardiovascular Imaging - To investigate the feasibility and accuracy of cardiac multidetector computed tomography (MDCT) prosthesis sizing prior to ostium secundum...     

Prognostic histologic indicators of curatively resected hepatocellular carcinomas: a multi-institutional analysis of 425 patients with definition of a histologic prognostic index.

Despite growing information on the clinical behavior of hepatocellular carcinoma, the histologic features associated with survival are not well characterized. Clinical and pathologic data on 425 patients who underwent complete resection for hepatocellular carcinoma were reviewed. Six microscopic features, namely, microvascular invasion, nuclear pleomorphism, mitosis, tumor architecture, growth interface, and tumor necrosis, were examined. Independent predictors of survival were identified and combined into a simple prognostic index. By univariate analysis, microvascular invasion, seen in 51.3% of patients (p <0.001), nuclear grade 3, present in 42% of the cases (p <0.001), and mitosis (p <0.008) were significant predictors of poor survival. Hepatocellular carcinoma with a compact growth pattern had a better prognosis as compared with macrotrabecular (p = 0.014) and acinar (p = 0.051) patterns. By multiple regression analysis, only microvascular invasion (p <0.001) and nuclear grade 3 (p = 0.008) were independent predictors of poor survival. The predictive values of microvascular invasion and nuclear grade allowed the construction of a hepatocellular prognostic index (HPI) whereby HPI = (microvascular invasion status x 0.459) + (nuclear grade x 0.287), with microvascular invasion either absent (0) or present (1) and nuclear grade scored as 1, 2, or 3. Using a cut-off of 0.746 (corresponding to at least nuclear grade 2 with microvascular invasion), two groups could be segregated: fair prognosis (HPI < or = 0.746), with a 50% survival of 5.06 years, and poor prognosis (HPI >0.746) with a 50% survival of 2.71 years (p <0.001). HPI was more discriminating than Edmondson grade, with Edmondson II hepatocellular carcinomas dispersed in both fair and poor prognosis groups. Microvascular invasion and nuclear grade 3 emerge as strong prognostic indicators, and their combination provides adequate prognostic stratification. Practically, hepatocellular carcinoma can be stratified in two groups with regard to prognosis: 1) fair prognosis group (nuclear grade 1 with or without microvascular invasion and nuclear grade 2 without microvascular invasion), and 2) poor prognosis (nuclear grade 2 with microvascular invasion and nuclear grade 3 with or without microvascular invasion). The combination of these histologic parameters provides adequate prognostic stratification.     

Urinary tract infection and functional bladder sphincter disorders in children

This review article focuses on the frequent association between urinary tract infection and functional bladder sphincter disorders which were distributed by the International Children’s Continence Society in two main categories referred to as unstable bladder and dysfunctional voiding. Relevant examinations, including ultrasound, voiding cystourethrography, isotopic studies, and urodynamics, are described as well as their main advantages and drawbacks. Emphasis is put on the associated vesicoureteric reflux which should not be considered the central problem in those children. Reflux is induced by distortion of the ureteric meatus, a consequence of a long-standing high pressure in the bladder. Follow-up and treatment should aim to prevent renal damage and to protect the bladder function.     

Fenoldopam reverses cyclosporine-induced renal vasoconstriction in kidney transplant recipients.

Cyclosporine causes renal vasoconstriction and reduced renal blood flow that may contribute to chronic nephrotoxicity. This effect has not been consistently reversed by available pharmacologic agents. The efficacy of orally administered fenoldopam, a dopamine-1 (DA-1) agonist with renal vasodilator properties, was evaluated in six patients whose condition was stable 3 to 6 months following renal transplantation. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured by inulin and p-aminohippurate (PAH) clearances, respectively, at baseline, after the acute oral administration of 100 mg of fenoldopam, and following 3 weeks of chronic oral fenoldopam therapy (100 mg thrice daily). Mean ERPF increased from 3.15 +/- 0.17 mL/s/1.73 m2 (189 +/- 10 mL/min/1.73 m2) at baseline to 3.48 +/- 0.17 mL/s/1.73 m2 (209 +/- 10 mL/min/1.73 m2) 4 hours after acute administration of fenoldopam (P = 0.04). Urine flow rate and fractional excretion of sodium also increased after acute administration, but not significantly. Mean systolic (SBP) and diastolic blood pressure (DBP) decreased maximally by 18 and 6 mm Hg, respectively, and mean pulse rate increased maximally by 8 bpm between 75 and 90 minutes after both acute and chronic administration. GFR was unchanged following both acute and chronic administration. The increase in ERPF was not maintained to the end of the dosing interval during chronic administration, probably due to the short half-life of fenoldopam. However, the renal vasodilatory response was still observed 3 to 4 hours after readministration of the drug following 3 weeks of oral dosing. Thus, fenoldopam significantly reverses the renal vasoconstriction caused by cyclosporine in renal transplant recipients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Physiological changes associated with unilateral pulmonary ventilation during operations on the lung

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - No important changes in the respiratory parameters were observed during onelung anaesthesia. However, this kind of thoracic...     

A longitudinal study of the physical growth and health of postinstitutionalized Romanian adoptees

In the present longitudinal study, the physical growth and health of 36 early-deprived postinstitutionalized Romanian orphans (ROs; 17 boys) adopted by Canadian families are documented. Data were collected for each child at three time points: at 11 months postadoption, at 4.5 years of age and at 10.5 years of age. Data from the RO children were compared with those from children in two matched comparison groups (Canadian-born [CB] nonadopted children and early-adopted [EA] Romanian children without institutional experience).Results indicated that there was considerable growth retardation in the RO children at times 1 and 2. Nonsignificant differences in height and weight among the RO, CB and EA groups were obtained at time 3, indicating significant growth catch-up. Precocious puberty, a documented feature of some postinstitutionalized children, was not observed in the present study population. At time 3, the RO children did not differ from the CB or EA children on indicators of puberty. The poor physical health of the RO children at time 1 was no longer apparent at time 3. According to parent reports, the RO children were equally as healthy as the CB and EA children.