Virtual bronchoscopy in the child using multi-slice CT: initial clinical experiences

PURPOSE: Virtual bronchoscopy of the pediatric patient has been reported to be more difficult because of artifacts due to breathing or motion. We demonstrate the benefit of the accelerated examination based on multislice spiral CT (MSCT) in the pediatric patient which has not been reported so far. MATERIAL AND METHODS: MSCT (tube voltage 120 kV, tube current 110 mA, 4 x 1 mm Slice thickness, 500 ms rotation time, Pitch 6) was performed on a CT scanner of the latest generation (Volume Zoom, Siemens Corp. Forchheim, Germany). In totally we examined 11 patients (median age 48 months, range 2-122 months) suspected of having tracheoesophageal fistula (n = 2), tracheobronchial narrowing (n = 8) due to intrinsic or extrinsic factors or injury of the bronchial system (n = 1). RESULTS: In all patients we obtained sufficient data for 3D reconstruction avoiding general anesthesia. 6/11 examinations were described to be without pathological finding. A definite diagnosis was obtained in 10 patients. Virtual bronchoscopy could avoid other invasive diagnostic examination in 8/11 patients (73%). CONCLUSION: Helical CT provides 3D-reconstruction and virtual bronchoscopy in the newborn as well as the infant. It avoids additional diagnostic bronchoscopy in a high percentage of all cases.     

Post-traumatic recto-spinal fistula

Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. Received: 7 December 1998; Revised: 10 May 1999; Accepted: 10 May 1999     

Osijek Health Center during the 1991-1992 war in Croatia

To assess the effectiveness of health services in the city of Osijek during the 1991-1992 war in Croatia, we followed the changes in the utilization of health services, morbidity and mortality, and completion of a vaccination plan during the 2 years of the war. We used a retrospective analysis of data from the Osijek Health Center and the Osijek County Institute of Public Health. The organization of health care during the war followed the concept of integrated health care and the instructions of the Ministry of Health. Visits to primary health care physicians decreased considerably, with a concomitant increase in disease and mortality. The plan for mandatory vaccination was not completed because of the evacuation of preschool and school children. The war changed the mode of health care use, the disease and mortality structure, and the implementation of mandatory vaccination. However, timely education and preparation of the health services to the war situation resulted in an adequate provision of health care to the population.     

Hematospermia—the added value of transrectal ultrasound to clinical evaluation: Is transrectal ultrasound necessary for evaluation of hematospermia?

Hematospermia is usually caused by nonspecific inflammation of the prostate and seminal vesicles. Transrectal ultrasound (TRUS) is a safe and inexpensive modality for evaluating patients with hematospermia. The aim of this study is to describe the findings of TRUS and its contribution to patients' management.A total of 115 consecutive patients presented with hematospermia and evaluated with TRUS between 2006 and 2012.All patients exhibited an abnormality in the TRUS examination. A 12-core TRUS-guided biopsy of the prostate was taken from 10 patients, but none of these samples were positive for tumor.In the vast majority of cases, a benign cause can be identified using TRUS. These causes usually do not require treatment.     

Plasma exchange for recurrent nephrotic syndrome following renal transplantation

Patients with steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis (FGS) who develop end-stage renal disease are at risk for recurrence of the disease following renal transplantation. Recurrence of the nephrotic syndrome in renal allografts of two children with primary FGS was successfully controlled by plasma exchange. This report suggests that plasma exchange instituted early in the course of recurrent nephrotic syndrome may be beneficial in some patients with steroid-resistant nephrotic syndrome and FGS.     

Biliary-bronchial fistula demonstrated by endoscopic retrograde cholangiography.

Endoscopic retrograde cholangiography is valuable in the evaluation of biliary tract disorders. A 50-year-old Italian woman developed biloptysis 1 year after cholecystectomy because of intrabiliary rupture of a hydatid cyst with secondary infection, which resulted in intrathoracic rupture and communication with the bronchial tree. Endoscopic retrograde cholangiography showed the cause and pathway of the fistulous tract by outlining the biliary tree, abscess cavity and communication with the right upper lobe bronchus. This technique appears to be well suited to the investigation of patients with biliary-bronchial fistula.     

Experimental photoablation of meniscus cartilage by excimer laser energy

Summary Excimer lasers have been demonstrated to provide a very precise and circumscribed ablation of synthetic polymers and biological tissues. We investigated in vitro the use of ultrashort pulsed ultraviolet excimer-laser energy for controlled removal of meniscus cartilage under the aspects of arthroscopic meniscectomy. A krypton-fluorine gas mixture was used to achieve laser emission of 248-nm wavelength. A total of 22 human menisci obtained either by operation or necropsy were irradiated over a range of energy fluence (2.15–3.07 J/cm²/pulse), repetition rates (5–20 Hz), and exposure time (15–60 s). Ablation rates of 4.00–5.76 m per pulse were obtained. Light-microscopic examinations demonstrated tissue ablation without any evidence of pathological changes associated with continuous-wave laser irradiation. Effects of laser energy were clearly limited to the target of the laser beam, and tissue removal proceeded without production of heat or smoke. Due to the lack of pathological alterations observed, excimer-laser irradiation of meniscus cartilage may prove to be advantageous for precisely cutting and removing menisci without injury to the surrounding normal tissue. Clinical application of excimer-laser irradiation includes the development of suitable fiberoptics and laser coupling, as well as modification of fiber tips.Funds were received from theFonds zur Förderung der wissenschaftlichen Forschung (Ministry of Science and Research, Austria)     

A Biomechanical Foot-Worn Device Improves Total Knee Arthroplasty Outcomes

Background

Biomechanics after total knee arthroplasty (TKA) often remain abnormal and may lead to prolonged postoperative recovery. The purpose of this study is to assess a biomechanical therapy after TKA.

New evidence for,and challenges in,linking small CGG repeat expansion FMR1 alleles with Parkinson's disease

We recently reported a significant increase in the frequency of carriers of grey zone (GZ) alleles of FMR1 gene in Australian males with Parkinson's disease (PD) from Victoria and Tasmania. Here, we report data comparing an independent sample of 817 PD patients from Queensland to 1078 consecutive Australian male newborns from Victoria. We confirmed the earlier finding by observing a significant excess of GZ alleles in PD (4.8%) compared to controls (1.5%). Although both studies provided evidence in support of an association between GZ‐carrier status and increased risk for parkinsonism, the existing evidence in the literature from screening studies remains equivocal and we discuss the need for alternative approaches to resolve the issue.