Unexpected mortality in pediatric patients with postoperative Hirschsprung’s disease

Hirschsprungs disease is characterized by lower intestinal obstruction. In this retrospective study, we investigated the postoperative complications and the causes of death in pediatric patients with Hirschsprungs disease. Between January 1981 and June 1998, 147 patients with Hirschsprungs disease underwent surgical intervention (129 with both colostomy and Soaves pull-through procedures) at Mackay Hospital. Of 147 total patients, 83.67% had aganglionosis in the rectosigmoid, 5.44% had colon involvement, and 4.08% had total colon aganglionosis, documented pathologically after a Soaves pull-through procedure. Any post-pull-through patient who showed symptoms of fever, leukocytosis, diarrhea, and clinical sepsis was diagnosed with Hirschsprungs enterocolitis. Four patients died within 4.5 months of surgery, and one patient died more than 4 years after surgery; these five patients were positive for Thomsen (T-) antigen. One patient died soon after rectal irrigation was performed in preparation for the surgery. All five of these patients had sepsis clinically, and anaerobic sepsis was attributed as the main cause of their deaths. Of interest in these cases is the presence of T-antigen, a potentially useful marker for anaerobic bacterial infection that may not be well known to most pediatricians. We recommend (1) determining the presence of T-antigen in patients with recurrent Hirschsprungs enterocolitis, (2) administering empirical antibiotics with anti-anaerobic activity as soon as possible, and (3) irrigating the colon in those patients who develop sepsis after a pull-through procedure.     

Sequential assessment of urodynamic findings before and after tension-free vaginal tape (TVT) operation for female genuine stress incontinence

OBJECTIVES: To sequentially compare the urodynamic findings in patients with genuine stress incontinence (GSI) before and after tension-free vaginal tape (TVT) operation. PATIENTS AND METHODS: Between January 2001 and January 2002, 24 consecutive patients with GSI who completed multi-channel urodynamic study and 20-minute pad test before operation and at 3, 6, and 12 months after operation were enrolled. The sequential urodynamic findings of each case were compared and analyzed. RESULTS: The mean age of the 24 patients was 60.6+/-10.7 years with the parity of 3.5+/-1.4. No statistical differences in voiding and storage functions before and after TVT operation were noted. In contrast, significant changes of stress urethral pressure profile (sUPP) including maximal urethral pressure, maximal urethral closure pressure, functional urethral length, urethral closure area and continence area were observed at 6 and 12 months postoperatively ( p<0.03 ). The median pad weight test decreased from 72g (range 10-220) to 0g 3 months after operation and remained unchanged at 6 and 12 months postoperatively. CONCLUSIONS: This prospective study demonstrates that TVT operation, if done properly, does not significantly impair voiding and storage functions. The significantly increased sUPP parameters may contribute, at least in part, to the high cure rate of TVT operation.     

Ankle-brachial pressure index measured using an automated oscillometric method as a predictor of the severity of coronary atherosclerosis in patients with coronary artery disease

Ankle-brachial pressure index (ABI) measured using a conventional Doppler method is an independent predictor of the number of coronary vessels affected in coronary artery disease (CAD). Recently, a new clinical device has been developed to measure ABI using an oscillometric method. It is unclear whether ABI measured using this device is a significant predictor of the severity of coronary atherosclerosis. We retrospectively included 87 patients from our outpatient clinic who had ever undergone coronary angiography. ABI was determined in all subjects using the new ABI-form device. The lower value of ABI in either limb was used for analysis. We divided our subjects into two groups, with either ABI less than 0.9 or at least 0.9, and compared basal characteristics between groups. We analyzed the relationship between ABI and the severity of CAD. In addition, we calculated the sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel (two-vessel + three-vessel) involvement in our patients. There were 15 patients with ABI less than 0.9 and 72 with ABI at least 0.9. Patients with ABI less than 0.9 were older and had higher plasma levels of uric acid. The prevalence of diabetes mellitus, hypertension, smoking, and diuretic use was significantly higher in patients with ABI less than 0.9. In addition, the group with ABI less than 0.9 had a lower prevalence of one-vessel CAD and higher prevalence of three-vessel or multivessel CAD. The sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel CAD were 22%, 96%, 93%, and 34%, respectively. In conclusion, ABI measured using the automated oscillometric method can be used to predict the severity of coronary atherosclerosis in patients with CAD.     

Impact of radical hysterectomy for cervical cancer on urodynamic findings

To elucidate the impact of radical hysterectomy upon the urodynamic findings of patients with cervical cancer, 20 patients with cervical cancer at stage IB to IIA who underwent radical hysterectomy were recruited. Each patient underwent a 20-min pad test and urodynamic study prior to and 3 months after radical hysterectomy. ANOVA, Bonferroni test and paired t -test were utilized for analysis. The mean age of the 20 patients was 50.2±8.7 years with a mean parity of 3.5±1.5. Four (20%) of the 20 cases revealed normal urodynamic findings preoperatively, and the urodynamic findings became abnormal after surgery. Comparing the urodynamic parameters of both bladder voiding and storage functions pre- and post-surgery, we found significant impairments postoperatively in all 20 cases. Our data demonstrate that abnormal urodynamic findings may pre-exist for some patients with cervical cancer prior to surgical treatment. These findings may worsen, and/or additional abnormal states may arise subsequent to radical hysterectomy.Abbreviations GSI Genuine stress incontinence - MUCP Maximal urethral closure pressure - MUP Maximal urethral pressure Editorial Comment: This paper is interesting because of the attempt at getting longitudinal urodynamic data on patients undergoing radical hysterectomy. All diagnosis and data are based on urodynamic findings. The patients serve as their own controls and only 20% were normal before surgery. Urodynamic data are useless in the absence of clinical correlation, and only provide a photographic and not cinematic view of bladder function. I believe it to be critical to include such information to evaluate the value of the information presented if it were to add to our knowledge of bladder dysfunction following radical hysterectomy. Further studies with control groups with no surgery and with regular hysterectomy would add worthwhile information regarding the true impact of radical hysterectomy for cervical cancer on the lower urinary tract function.     

Biomedical informatics: development of a comprehensive data warehouse for clinical and genomic breast cancer research

The Windber Research Institute is an integrated high-throughput research center employing clinical, genomic and proteomic platforms to produce terabyte levels of data. We use biomedical informatics technologies to integrate all of these operations. This report includes information on a multi-year, multi-phase hybrid data warehouse project currently under development in the Institute. The purpose of the warehouse is to host the terabyte-level of internal experimentally generated data as well as data from public sources. We have previously reported on the phase I development, which integrated limited internal data sources and selected public databases. Currently, we are completing phase II development, which integrates our internal automated data sources and develops visualization tools to query across these data types. This paper summarizes our clinical and experimental operations, the data warehouse development, and the challenges we have faced. In phase III we plan to federate additional manual internal and public data sources and then to develop and adapt more data analysis and mining tools. We expect that the final implementation of the data warehouse will greatly facilitate biomedical informatics research.     

Determination of hydroquinone in cosmetic emulsion using microdialysis sampling coupled with high-performance liquid chromatography

A method based on microdialysis sampling combined with high-performance liquid chromatography (HPLC) has been developed for the determination of hydroquinone in cosmetic emulsion. In microdialysis sampling, using deionized water as perfusate, a probe length of 10mm and dialysis flow-rate of 5 microl min(-1) were found to be the optimum conditions for the analysis. The accuracy (% bias) for intra-day (n=3) and inter-day (n=12, four consecutive days) ranged from -9.5 to 13.0% with a precision less than 7.55% relative standard deviation (R.S.D.). Recovery obtained between 89 and 112% by adding hydroquinone standards into medicated cosmetics and the coefficients of variance between 0.5 and 3.3%. The linearity of calibration curve is in the range of 2 microM-2 mM with an R(2) value for the linear regression of 0.9981. The detection limit is 0.2 microM derived from the three times of signal-to-noise ratio. This method has been applied to determine the hydroquinone content in medicated and non-medicated cosmetics. The contents of hydroquinone in the medicated cosmetics are 5.36% (0.12% R.S.D., n=3) and 3.85% (0.26% R.S.D., n=3), respectively; in contrast to the percentages given by the manufacturer are 5 and 4%, the accuracy (% bias) are 7.20 and 3.75%, respectively. No hydroquinone was detected in non-medicated cosmetics. The proposed method has the advantages of easy sample pretreatment, rapid isolation and lower organic solvent consumption than in other methods for the determination of hydroquinone in cosmetics.     

Cytotoxic flavonoids and new chromenes from Ficus formosana f. formosana

Two new chromenes, ficuformodiol A and ficuformodiol B, and nine known compounds including one chromene, spatheliachromen, six flavonoids, obovatin, carpachromene ( 5), apigenin ( 6), norartocarpetin ( 7), steppogenin, 6-prenylpinocembrin, one benzopyran, chromenylacrylic acid, and one isocoumarin, ( R)-(-)-mellein, were obtained from the cytotoxic chloroform-soluble fraction of the stems of Ficus formosana f. formosana (Moraceae). Their structures were determined by means of spectroscopic analyses. Compounds 5, 6 and 7 exhibited significant cytotoxicity against HepG2, PLC/PRF/5 and Raji cancer cell lines in vitro.     

A Rasch Analysis of a Self-perceived Change in Quality of Life Scale in Patients with Mild Stroke

A Rasch analysis was used to assess the unidimensionality and appropriateness of the scoring level of a 13-item self-perceived change in quality of life scale (CQOL) for stroke patients. A total of 158 patients with mild stroke completed the CQOL themselves at home. The results showed that a unidimensional CQOL can be created by deleting the three items related to speaking, vision, and thinking. The 4 scoring categories of the shortened scale were deemed appropriate from the analysis. These results provide preliminary evidence of the 10-item CQOL in assessing self-perceived change in quality of life in stroke patients. Further studies are needed to examine the test-retest reliability, criterion validity, and responsiveness of the 10-item CQOL in stroke patients.