Paediatricians' perception of the use of extracorporeal membrane oxygenation to treat meconium aspiration syndrome

This questionnaire study was designed to determine how consultant paediatricians perceived the value of extracorporeal membrane oxygenation (ECMO) in the treatment of meconium aspiration syndrome (MAS). A significant number believed that the survival of infants with MAS who received ECMO was lower than reported. Early discussion with an ECMO centre will ensure appropriate timing of referral.     

Intact skin--an integrity not to be lost

Maintaining skin integrity can be challenging but it is vital to overall health, particularly in elderly patients. In this population, skin integrity is frequently compromised as a result of under- or over-hydration, which may cause serious complications. Plans of care must include preventive efforts such as the use of barriers and protectants including zinc oxide preparations, petrolatum- and silicone-based ointments and creams, liquid-forming products, adhesive dressings, fluid managers, skin cleansers, and moisturizers. A team approach that includes the patient, caregivers, and healthcare professionals is needed to address patient concerns regarding independence/dependence, utilization of support systems and services, pain, and control of body fluids. The healthcare provider's role in this team should emphasize continuity of care, patient satisfaction, and product selection - all vital to protecting skin integrity.     

Hyperperfusion syndrome: toward a stricter definition

OBJECTIVE: Hyperperfusion syndrome is a rare and potentially devastating complication of carotid endarterectomy or carotid artery angioplasty and stenting. With the advent of new imaging techniques, we reviewed our experience with this phenomenon. METHODS: This report is a retrospective review of 129 consecutive cases of carotid endarterectomy performed between June 1, 2000, and May 31, 2002, and 44 consecutive cases of carotid artery angioplasty and stenting performed between January 1, 1997, and May 31, 2002. We specifically searched for examples of patients who developed postprocedural nonthrombotic neurological deficits that typified the hyperperfusion syndrome. RESULTS: Seven cases of hyperperfusion syndrome occurred, four after endarterectomy (3.1% of carotid endarterectomy cases) and three after stenting (6.8% of stenting cases). The cases of hyperperfusion were classified as presenting with 1). acute focal edema (two cases with stroke-like presentation, attributable to edema immediately after revascularization), 2). acute hemorrhage (two cases of intracerebral hemorrhage immediately after stenting and one case immediately after endarterectomy), or 3). delayed classic presentation (two cases with seizures, focal motor weakness, and/or late intracerebral hemorrhage at least 24 hours after endarterectomy). CONCLUSION: Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.     

Nutrition and the life cycle. 1: Maternal nutrition and pregnancy

Babies who are smaller than average at birth are more likely to face health problems during their adult life. A major influence on the size of the baby is maternal nutrition. Maternal energy requirements are not greatly increased, but other nutrients have been shown to influence fetal wellbeing; these include folate, riboflavin and some polyunsaturated fatty acids. Other nutrients that may enhance fetal welfare are ascorbic acid, zinc, and magnesium, and there are probably many more. Nurses, midwives, and health visitors need to be aware of the nutritional needs of pregnant women, and of the need to assist women to meet these needs. This is the first in a series of articles reviewing nutritional needs to maintain health during progressive stages of the life-cycle. This article discusses issues surrounding nutrition in pregnancy. Subsequent articles will review nutritional needs in young children, school-age children, adults, and older adults.     

Rib perichondrial grafts for the repair of full-thickness articular-cartilage defects. A morphological and biochemical study in rabbits

The purpose of this study was to investigate the use of perichondrial grafts in articular cartilage defects and to characterize the newly formed cartilage. In a rabbit model, rib perichondrium was used to repair full-thickness defects in the femoral condyle. The quality of repair was then evaluated histologically and biochemically at six and twelve weeks after grafting. Unacceptable results were obtained in 50 per cent of the rabbits. These failures were due to condylar fracture in 20 per cent, failure of graft attachment in 20 per cent, and infection in 10 per cent. The technique of grafting must be improved to increase the percentage of successful grafts in which neocartilage with a relatively normal chemical composition fills the articular cartilage defect. Successful grafts proliferate to fill the full-thickness defect with neocartilage, which has biochemical characteristics that are similar to those of hyaline cartilage.     

Preimplantation genetic diagnosis using combined strategies on a breast cancer patient with a novel genomic deletion in BRCA2

Purpose

To perform Preimplantation Genetic Diagnosis (PGD) on a paternal Brca2 unknown mutation carrier with early-onset breast cancer, whose paternal grandmother and mother had breast cancer at 60s.

Method

Elucidating the linkage via single sperm haplotyping on patient''s carrier brother, and identifying the genomic deletion via BLAST followed by PCR screening. PGD was subsequently conducted.

Result

The mutant allele was found by using 4 microsatellite and 2 intragenic SNP markers. Recombination was detected in 8 % of sperms. BLAST was utilized to locate putative hairpin structure(s), followed by PCR screening with seven sets of primers. A novel 2,596 bp deletion containing exon 15 ~ 16 was identified. Due to the severity of phenotype and the integrity of exon 11 encoding RAD51 binding domain, and the fact that the patient''s mother also had breast cancer at her 60s, we speculate a possible coexistence of maternal breast cancer risk allele(s). Embryo biopsy was performed on day 3. Unaffected morula and blastocyst were replaced on day 5, resulting in a singleton livebirth. A breast lump appeared in the patient after delivery without the presence of malignant cells.

Conclusion

Concerning the assisted reproductive option for breast cancer patients, the possibility of coexistence of multiple familial risk alleles and the significance of each mutation to the phenotype should be evaluated. To eliminate misdiagnosis resulting from recombination and/or allelic drop-out, both direct mutation detection and linkage analysis approaches may be necessary. BLAST is a very useful and cost-effective tool for identifying large genomic deletion.