Fluctuations in relative humidity provided to extremely low‐birthweight infants (R1)

Background: In extremely low‐birthweight infants, the addition of relative humidity (RH) improves thermal stability, fluid and electrolyte balance. However, during routine care this microenvironment is frequently disturbed. The objective of this study was to determine the frequency, magnitude and direction of fluctuations in RH provided to extremely low‐birthweight infants. Methods: All infants in our study had ambient temperature and RH continuously recorded for 48 h using a datalogger device (RH32S‐C2). A clinically acceptable range for RH was defined as the set point ±10%. A secondary analysis was performed to compare outcomes between infants that spent > 50% of the time out‐of‐range (OOR) or inside the range (IR). A P‐value < 0.05 was significant. Results: A total of 20 infants were included. Important fluctuations were detected by the device with infants spending 40% and 14% of the time above and below the range, respectively. However, the RH set point did not differ from the mean levels measured over 48 h by the RH32S‐C2 or the incubator. Infants in the OOR group spent significantly more time at values higher than the planned range when compared to IR infants. Conclusion: Although significant fluctuations in RH above the desired range were detected in more than half of the infants, the average values were similar to the set points. Nevertheless, knowledge of these dynamic changes may help to optimize individualized care.     

Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed.     

Modular Training in Laparoscopic Colorectal Surgery Maximizes Training Opportunities without Clinical Compromise

Background  

Laparoscopic surgery is increasingly proposed as the gold standard technique for colorectal resections and is offered to greater numbers of patients. To meet the rising service demands, more trainees and established consultants need to learn the technique. We sought to establish whether it is feasible and safe to train on a large proportion of patients without adversely affecting clinical outcome or smooth running of clinical service.     

Hematometrocolpos associated with common cloacal anomaly

A rare case of hematometrocolpos is presented in a 14 years old female with known common cloacal malformation. It presented as a slowly growing tender pelvic mass. Ultrasound and CT scan of the pelvis revealed vagina and uterus filled with blood. A diagnosis of hematometrocolpos was made. Per-operatively multiple adhesions were found in the pelvis necessitating the removal of blood-filled uterus.     

CFSUM1 and CFSUM2 in urine from patients with chronic fatigue syndrome are methodological artefacts

McGregor et al. reported increased levels of an unidentified urinary compound (CFSUM1) in patients with chronic fatigue syndrome (CFS), with reduced excretion of another unidentified compound (CFSUM2), and suggested the possibility of chemical or metabolic 'markers' for CFS. The identity of CFSUM1 as reported was erroneous and the identities of these compounds have remained unknown until now. Urine samples were obtained from 30 patients with ME/CFS, 30 age- and sex-matched healthy controls, 20 control patients with depression and 22 control patients with rheumatoid arthritis. Samples were prepared using the published methods of McGregor et al. to produce heptafluorobutyryl-isobutyl derivatives of urinary metabolites. Alternative preparations utilised isopropyl, n-butyl and trifluoroacetyl derivatives. These were separated and identified using gas chromatography-mass spectrometry. CFSUM2 was identified as being partially derivatised [isobutyl ester-mono-heptafluorobutyryl (HFB)] serine. CFSUM1 was identified as partially derivatised pyroglutamic acid, being the isobutyl ester without formation of a HFB derivative. Both CFSUM1 and CFSUM2 are artefacts of the sample preparation procedure and previously reported quantitative abnormalities of CFSUM1 and CFSUM2 in urine from patients with ME/CFS are also artefactual. Pyroglutamic acid may be of primarily dietary origin. The methods used cannot provide reliable qualitative or quantitative data on urinary metabolites. No clinical or biochemical significance can be drawn between these compounds in ME/CFS or any other clinical conditions.