The anatomical basis for ultrasonography of the lateral pterygoid muscle and the infratemporal fossa

Summary The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.Communication presented at the French Section of the European Association of Clinical Anatomy meeting, Bobigny, France, June 20, 1992     

Laboratory diagnosis and molecular epidemiology of an outbreak of hepatitis C virus infection among recipients of human intravenous immunoglobulin in Spain

BACKGROUND: Passive transfer of antibody to hepatitis C virus (HCV) has been thought to occur after infusion of human intravenous immunoglobulin (IVIG), as anti-HCV and/or HCV RNA was commonly found in that product. Recently, however, HCV RNA was detected in the serum of recipients of IVIG. Establishment of a causal relationship between IVIG therapy and HCV infection in recipients was attempted. STUDY DESIGN AND METHODS: Anti-HCV and HCV RNA sequences were investigated in serum samples from 39 persons who received a human IVIG product in seven different hospitals in Spain. HCV RNA was also investigated in two batches of the IVIG shared by some recipients. All the viral RNA detected were characterized with a line probe assay, restriction fragment length polymorphism analysis of the 5'-noncoding and core regions, and sequencing of the nonstructural 5 region. RESULTS: On the basis of both clinical and laboratory data, a relationship could be established between the IVIG therapy and the acquisition of the HCV infection by the recipients. Several HCV strains were detected among the recipients, with most of the recipients coming from the same hospital presenting with closely related strains. Moreover, an HCV strain almost identical to the main strain detected among the recipients was found in one batch of the IVIG that probably was shared by most of them. Follow-up studies and evaluation of low-avidity anti- HCV IgG suggested that both acute primary infections and reinfections were produced. In one case, direct evidence of reinfection by a different HCV strain was obtained. CONCLUSION: The results did not exclude the possibility that a second HCV strain associated with a further, unidentified batch of the IVIG could have contributed to this outbreak.     

Neurodevelopmental outcome of hypoglycaemia in healthy, large for gestational age, term newborns

AIMS: To evaluate the effects of transient hypoglycaemia on the first day of life in 75 healthy term large for gestational age (LGA) infants, born to non-diabetic mothers, on their neurodevelopmental outcome at the age of 4 years. METHODS: Screening for hypoglycaemia was performed 1, 3, and 5 hours after birth, and continued if blood glucose levels were low. Treatment with intravenous glucose for hypoglycaemia was started if hypoglycaemia was severe or symptomatic. Patients' development and behaviour was examined at the age of 4 years by the Denver Developmental Scale, a non-verbal intelligence test, and the Child Behaviour Check List. RESULTS: There were no significant differences between children with neonatal normoglycaemia (n = 15) and hypoglycaemia (plasma glucose <2.2 mmol/l 1 hour after birth, or <2.5 mmol/l subsequently; n = 60) in Denver developmental scale scores and child behaviour checklist scores. Although total IQ did not differ between hypoglycaemic and normoglycaemic children, one subscale (reasoning) did (mean difference 9.3, 95% CI 1.3 to 17.2). The correlation between reasoning IQ and neonatal blood glucose levels was weak and not statistically significant. When other definitions for hypoglycaemia were applied, the difference in reasoning IQ was not found. There were no differences in any of the test scores between hypoglycaemic children who had and who had not been treated with intravenous glucose. CONCLUSION: Transient mild hypoglycaemia in healthy, term LGA newborns does not appear to be harmful to psychomotor development at the age of 4 years.     

von Hippel-Lindau disease: inadequacy of angiography for identification of renal cancers

Selective renal angiograms were retrospectively evaluated for the identification of renal cell cancers in patients with von Hippel-Lindau disease (VHL). Seven patients underwent angiography and surgery because of solid or complex renal masses identified at cross-sectional imaging. Nine kidneys underwent detailed examination by the surgeon and by a pathologist. There were 31 renal cancers. Angiography had enabled identification of only five cancers (16%), and six others (19%) had been suspected. Cancers detected angiographically were larger than those not detected (P less than .05). Solid tumors tended to appear less hypervascular than expected and occasionally had the angiographic appearance of atypical cysts. There were no false-positive angiograms. Angiography revealed only one cancer not previously suspected and changed the surgeon's approach for only one kidney (11%). The sensitivity and specificity of angiography were 35% and 100%, respectively. In these patients, selective renal angiography is not helpful for the detection or exclusion of cancer in a kidney. It does not have a limited role for vascular mapping prior to partial nephrectomy or tumor enucleation.     

Efficacy of Nebulised Epinephrine versus Salbutamol in Hospitalised Children with Bronchiolitis

Background

The use of bronchodilators in bronchiolitis lacks consensus. The efficacy of nebulised epinephrine versus salbutamol in bronchiolitis and the safety profile of the bronchodilators was studied.

Methods

Effects of nebulised epinephrine and salbutamol were compared in children with moderate to severe acute bronchiolitis. Thirty children between 2 to 24 months of age were recruited, 15 in each treatment group. Children received periodic (0,30,60 minutes followed by 4 hourly) doses of either 1:1000 laevo- epinephrine (0.5ml/kg subject to a maximum of 2.5ml with 3ml saline) or salbutamol (0.15mg/kg with 3ml saline) via nebuliser with oxygen. Changes in heart rate (HR), respiratory rate (RR), respiratory distress assessment instrument (RDAI), oxygen saturation (SpO2), oxygen requirement, duration of hospital stay and the side effects were studied.

Results

The respiratory status was better with significant improvement in RR, RDAI score and SpO2, decreased oxygen requirement and shorter hospital stay in the epinephrine group. There were no significant side effects in either group.

Conclusion

Nebulised epinephrine is a useful and safe drug for moderate/severe bronchiolitis and is superior to salbutamol.Key Words: Bronchiolitis, Nebulised bronchodilators, Epinephrine, Salbutamol