The efficacy and limitations of percutaneous endoscopic gastrostomy.

We analyzed 64 percutaneous endoscopic gastrostomy procedures performed by us between 1986 and 1990. Thirty patients had neurologic disease; 16 had head and neck cancers; eight had other malignancies; two had acquired immunodeficiency syndrome; and eight had other problems. Seven patients died within 30 days of complications (n = 4) or the primary illness (n = 3). Mean follow-up was 6 months; an additional patient died of aspiration and eight others died of their underlying illness. There were 19 complications (32%). Four wound complications occurred. Nine patients developed aspiration pneumonia within 3 days of the procedure, four of whom died in the hospital. Of the 24 patients with a history of aspiration, nine experienced aspiration during or after percutaneous endoscopic gastrostomy. Patients with a history of aspiration were more likely to have perioperative aspiration pneumonia, and patients who experienced aspiration were more likely to die.     

Mortality and survival of the Down's syndrome population in Western Australia

ABSTRACT. From 1976 to 1984, there were 149 Down's syndrome live births in Western Australia. Where previously the coexistence of congenital heart disease was a major determinant of early mortality, current survival rates do not reflect this. Survival rates have significantly increased over the last decade: particularly so for those with coexistent congenital heart disease. Projected frequencies for Down's syndrome persons in Western Australia are expected to significantly increase. This rise in prevalence will have major economic effects on the planning and delivery of health care for this population.     

The effects of hyperthyroidism on oesophageal motility.

This study, evaluating the effects of hyperthyroidism (HT) in oesophageal motility, depended on an oesophageal radionuclide transit test. A modified standard method was used to calculate: (a) total mean transit time (MTT), (b) residual fraction (RF) and (c) retrograde index (RI) in a supine position. Eighteen untreated patients with HT and 25 normal volunteers (NV) with a similar age distribution were included in this study. The results showed that oesophageal motility in patients with HT was worse than in the normal controls (P < 0.05 by Student's t-test). The correlation of MTT, RF and RI with size and function of thyroid glands in the patients with HT were calculated to explain the effects of HT in oesophageal motility. The results showed that neither the size nor the function of the thyroid glands in HT affected oesophageal motility.     

The evolution of ischemic cerebral infarction in infancy: a sonographic evaluation

Cranial sonography provides a noninvasive, portable method for imaging the infant brain. This study describes the time-dependent, sonographic findings of infantile cerebral infarction, as well as computed tomographic (CT) scan and neuropathologic confirmation. Three hundred ninety-five infants under 18 months of age were sonogrammed over a period of 18 months. Three infants were diagnosed by cranial sonography and confirmed by CT scan and/or autopsy to have acute ischemic cerebral infarcts. The cases were followed with serial cranial sonograms for up to 18 months of age. The acute sonographic findings included a hyperechoic zone around the infarcted tissue. The subacute infarct had a checkerboard pattern, while the chronic infarcts were anechoic.     

Expression of tyrosine hydroxylase and neuropeptide tyrosine in mouse sympathetic airway-specific neurons under normal situation and allergic airway inflammation

BACKGROUND: The traditional neurotransmitter catecholamine and the neuropeptide tyrosine in sympathetic airway nerves have been proposed to be involved in the pathogenesis of airway diseases. OBJECTIVE: The aim of the present study was to investigate the effect of allergic airway inflammation on the expression of catecholamine enzyme tyrosine hydroxylase (TH), neuropeptide tyrosine (NPY) and tachykinins in mouse sympathetic airway ganglia. METHODS: Using neuronal tracing in combination with immunohistochemistry, the present study was designed to characterize TH, NPY and tachykinin profiles of superior cervical (SCG) and stellate ganglia after allergen challenge. RESULTS: The vast majority of fast blue-labelled SCG neurons (allergen: 97.5+/-1.22% (mean+/-SEM) vs. controls: 94.5+/-1.48%, P=0.18) and stellate neurons (allergen: 95.3+/-1.01% vs. controls: 93.6+/-1.33%, P=0.34) were immunoreactive for TH. Of the TH immunoreactive and fast blue-labelled SCG neurons, 52.0+/-1.01% allergen vs. 51.2+/-3.58% controls (P=0.83) and stellate neurons, 57.3%+/-0.97 allergen vs. 56.4+/-1.65% controls (P=0.64) were positive for TH only but not NPY, whereas 45.3+/-1.05% allergen vs. 43.3+/-1.18% controls (P=0.47) of fast blue-labelled SCG neurons and 37.9+/-0.86% allergen vs. 37.1+/-1.24% controls (P=0.62) of fast blue-labelled stellate neurons were immunoreactive for both TH and NPY immunoreactivities. There was a trend of an increase, but not significant one, in the percentage of TH-/NPY-immunoreactive and fast blue-labelled neurons in allergen-treated animals in comparison with the controls. Tachykinins, however, were not expressed by sympathetic neurons and were also not induced in sympathetic neurons after allergen challenge. CONCLUSION: The present study indicates that allergic airway inflammation does not alter the expression of noradrenalin and NPY in sympathetic ganglia and also shows that sympathetic neurons do not respond to allergic airway inflammation with tachykinins induction. However, a participation of catecholamine and NPY in the pathogenesis of allergic airway inflammation cannot be excluded in the present study as a higher neurotransmitter output per neuron following allergen challenge could be possible.     

Intraoperative Awareness in a Regional Medical System: A Review of 3 Years' Data

Background: Intraoperative awareness in patients undergoing general anesthesia is an infrequent but well-described adverse outcome. The reported incidence of this phenomenon is between 0.1% and 0.9%.

Methods: With institutional review board approval, the authors reviewed continuous quality improvement data from 3 yr (2002-2004) at the locations where the physician group provided anesthesia. Board-certified anesthesiologists supervising certified registered nurse anesthetists in the anesthesia care team model of practice delivered all anesthetics. Brain function monitors were not used in the operating room setting. Patients were interviewed twice during a 48-h postoperative period and, as part of that process, underwent a modified Brice interview to determine intraoperative awareness. All cases that met the criteria for awareness were examined by the continuous quality improvement committee to modify anesthetic practice and were included in this study.

Results: Data from 211,842 patients undergoing anesthesia were considered. Of these, the continuous quality improvement process followed up 177,468 (83.1%). Cases were not included in the study if the patient was younger than 18 yr, did not have a general anesthetic, or had a terminal event during the hospital course. By these criteria, a total of 87,361 patients followed by the continuous quality improvement process were at risk for awareness. Six patients reported instances of recall.     

Health-Related Quality of Life in Children with Asthma from Different Ethnic Origins

This study aimed to identify and explain differences in health-related quality of life (QoL) between immigrant and non-immigrant children with asthma. In 274 children (7-17 years of age) generic and asthma-related QoL were assessed. The association between ethnicity and QoL was studied in linear regression model analyses. For the asthma-related QoL, unadjusted analyses showed significant ethnic differences. The non-immigrant children had the highest scores, which implies a better QoL. After adjusting for asthma control and socioeconomic status (SES), ethnic differences disappeared. These results suggest that immigrant children have a similar QoL to that of non-immigrant children from a comparable SES, when their asthma is under control.     

Announcement

The name of one of the contributing authors to this paper was omitted from the list of authors that appeared on page 373. The correct list of authors and affiliations are printed below: