Cord blood serum in newborns of diabetic mothers

Serum cholesterol, triglycerides and lipoprotein cholesterol were measured in cord bloods from 117 newborns. Group I consisted of 39 infants of diabetic mothers and Group II (control) consisted of 78 newborns of non-diabetic mothers. The most significant difference in serum lipids between the two groups was the higher levels of LDL cholesterol and lower levels of HDL cholesterol in the newborns of diabetic mothers. Cord blood serum cholesterol was slightly, but not significantly, higher in children born of diabetic mothers. Serum triglycerides were also not significantly different between the groups. While it remains to be established whether elevated levels of LDL cholesterol and decreased levels of HDL cholesterol at birth in these infants represent a transient phenomenon, this study suggests that newborns of diabetic mothers may be predisposed early in life to LDL hypercholesterolemia and thus may be at a greater risk of developing coronary heart disease later in life.     

Reducing the risk of urgent revascularization for unstable angina: a randomized clinical trial

A prospective, randomized trial was instituted to determine whether blood cardioplegia (BC) could reduce the morbidity and mortality for patients undergoing urgent coronary bypass for unstable angina. One hundred forty patients who came to the hospital with prolonged angina at rest and who required urgent revascularization because their symptoms were resistant to medical therapy were randomized to receive BC (n = 70) or crystalloid cardioplegia (CC) (n = 70). The operative mortality rate was 2.8%, the incidence of myocardial infarction was 8.6%, the incidence of low output syndrome was 18% and morbidity (myocardial infraction or low output syndrome) was 23%. Patients who received BC had a significantly lower mortality rate (BC, 0%; CC, 5%; p less than 0.05) and incidence of myocardial infarction (BC, 4%; CC, 13.5%; p less than 0.05) or low output syndrome (BC, 10%; CC, 19%; p less than 0.05). The highest postoperative CK-MB level was less after BC (BC, 31 +/- 17 U/L; CC, 56 +/- 13 U/L; p less than 0.05). Preoperative predictors of postoperative morbidity in addition to the type of cardioplegia included the response to medical therapy, persistent ischemic electrocardiographic changes, left ventricular ejection fraction, and age. A multivariate analysis identified the type of cardioplegic protection (p = 0.008) and age (p = 0.05) as significant independent predictors of postoperative morbidity. BC reduced the risk of urgent revascularization for unstable angina.     

Laparoscopic Adrenalectomy for Conn's Syndrome is Beneficial to Patients and is Cost Effective in England

Purpose: Adrenalectomy has the potential to cure or improve the control of hypertension in patients with primary hyperaldosteronism due to unilateral adrenal adenoma (Conn's syndrome). This study assesses the patients' perception of, and costs associated with, laparoscopic adrenalectomy for Conn's syndrome. Materials and Methods: Clinical, radiological, operative, and pathological data were collected on patients undergoing adrenalectomy for Conn's syndrome over 8-years period in a UK tertiary referral center. Results: Thirty-eight patients (17M:21F, age 34–79 yrs, median 54 yrs) operated between Jan2005-Sept2012 had lateralization based on CT scans (n = 30) and/or MRI scans (n = 18) and confirmed on selective adrenal venous sampling (n = 25). Laparoscopic adrenalectomy was performed in all patients, with two cases requiring conversion to open operation. Median operative time was 105 min (range: 27–315). Costs were estimated as £19k for preoperative investigations, £20k for in-hospital stay, £53k for operating theatre use and £29k for disposable surgical instruments, with average £3499/patient (national tariff for adrenalectomy in 2015/2016 £3624). Follow-up at a mean of 30 months postoperatively using a visual analogue scale and a standardized questionnaire showed significantly improved quality of life (QoL) post-operatively. Majority of patients (85%) reported taking none or fewer anti-hypertensive medications (median reduction of 2 antihypertensive drugs). All patients stated that they would definitely have the operation again in preference to anti-hypertensive medications and they would recommend the operation to friends/relatives. Conclusions: Laparoscopic adrenalectomy for Conn's syndrome has a positive impact on hypertension control, leads to improved QoL and its costs are covered in the NHS financial model.     

A comparison of sickle cell syndromes in Northern Greece

Haematological and clinical characteristics have been examined in 30 patients with homozygous sickle cell (SS) disease, 28 with sickle cell-beta zero thalassaemia, and 21 with sickle cell-beta+ thalassaemia. The latter could be divided into three groups on their molecular basis and HbA levels, four subjects with an IVS-2 nt 745 mutation having 3-6% HbA (designated S beta+ thalassaemia type I), 14 subjects with an IVS-1 nt 110 mutation having 8-15% HbA (designated S beta+ thalassaemia type II), and three subjects with an IVS-1 nt 6 mutation having 20-25% HbA (designated S beta+ thalassaemia type III). Comparisons were conducted between SS disease, S beta zero thalassaemia, and S beta+ thalassaemia type II. Compared to SS disease, both thalassaemia syndromes had higher HbA2 levels and red cell counts and lower mean cell haemoglobin content (MCHC), mean cell volume (MCV) and MCH, and S beta zero thalassaemia had higher HbF and reticulocyte counts. Compared to S beta zero thalassaemia, S beta+ thalassaemia had a higher haemoglobin and MCHC. Clinically, persistence of splenomegaly was more common in S beta zero and S beta+ thalassaemia type II compared to SS disease. Few significant differences occurred between SS disease, S beta zero and S beta+ thalassaemia type II in Northern Greece suggesting that the 8-15% HbA in the latter condition was insufficient to modify the clinical course.     

唐氏综合征和脓毒症患儿的死亡风险

目的：明确唐氏综合征（DS）患儿与一般儿童在致命性疾病方面的差异。试验设计：利用儿童健康信息系统（PHIS）数据库，该数据库包括来自于独立的儿童医院人口统计学和诊断学资料。在控制潜在的混杂因素后，作者应用Poisson回归分析法来确定DS患儿合并脓毒症时死亡的风险性。结果：总共有35645例患者符合纳入标准，其中3936（11％）例在住院期间死亡。在所纳入的病例中总共有620例被诊断为DS；其中106（17％）患者住院期间死亡。校正潜在的混杂因素，包括人口统计学因素、病原学因素和其他伴随条件后，DS患儿的死亡率明显较高（死亡率RR 1．30，95％CI 1．06～1．59）。     

Hemodynamic and myocardial metabolic consequences of PEEP

The cardiac effects of positive end expiratory pressure (PEEP) were examined in 50 patients six hours after elective coronary bypass surgery. Increasing the level of PEEP from 5 to 10 to 15 cm H2O decreased cardiac index (evaluated by thermodilution), stroke index and left ventricular end diastolic volume index without a change in left ventricular ejection fraction (evaluated by nuclear ventriculography). Right ventricular end diastolic volume index remained unchanged. Coronary sinus blood flow (measured by the continuous thermodilution technique) and myocardial oxygen and lactate consumption were unchanged with the application of 15 cm H2O PEEP. In 21 patients, volume loading (250 ml [mL] of plasma) was performed at 5 cm, and again at 15 cm H2O PEEP. Volume loading produced a similar increase in cardiac volumes and cardiac index at 5 and 15 cm H2O PEEP. Right and left ventricular performance and left ventricular systolic function were not altered by PEEP (by analyses of covariance). Coronary sinus blood flow and myocardial oxygen consumption increased with volume loading at 5 and 15 cm H2O of PEEP, but myocardial lactate utilization tended to increase at 5 cm, and decrease at 15 cm H2O PEEP (p = 0.08). Of the 33 patients who underwent complete hemodynamic and metabolic measurements, 16 increased cardiac lactate utilization at 15 cm H2O PEEP and 17 decreased cardiac lactate utilization at 15 cm H2O PEEP. PEEP decreased cardiac index, perhaps by reducing left but not right ventricular volumes. Volume loading during PEEP restored cardiac index and revealed no depression in myocardial performance or systolic function. With the application of PEEP, myocardial metabolism was maintained in half the patients, but ischemic metabolism was observed in the other half.     

MRI-compatible positioning device for guiding a focused ultrasound system for transrectal treatment of prostate cancer

Background   

High-intensity focused ultrasound (HIFU) is a promising treatment method for many common cancers, including prostate cancer. Magnetic resonance image (MRI) guidance of HIFU permits targeting and monitoring of therapy. A prototype MRI-compatible positioning device that navigates a HIFU transducer was designed, fabricated and tested.

Materials and methods   

The positioning device has two PC-controlled and one manually driven stage that allow endorectal access to the prostate. The positioning device was constructed using a 3-D rapid prototype manufacturing device. Software was developed that controls the motion of the positioning device and enables activation of a HIFU transducer. In vitro testing of the system was performed in a 1.5T MRI scanner using ex vivo turkey tissue. Optical encoders were employed to enhance the accuracy of this positioning device.

Result   

The positioning device was successfully tested for MRI compatibility. The movement error of the positioning device is approximately 20 \(\upmu \) m. The robot has the ability to accurately move the transducer for creation of discrete and overlapping lesions.

Conclusion   

An MRI-compatible HIFU positioning system was developed that has the ability to create thermal lesions with MRI guidance for endorectal treatment of prostate cancer.     

Use of intraluminal stapler device for creation of a permanent colostomy

We present our experience with the use of the intraluminal stapler device for the purpose of creating of a dermal permanent colostomy, in cases of acute emergency operations and of regular programmed operations. The advantages of this method for those surgeons who use stapling devices are: controlled safety of the colostomy, shorter operation time and the creation of a stable diameter of the colostomy. All patients of this category as well as those having been operated on for colon cancer have been placed on a protocol follow up for three years and are closely monitored. This has allowed us to closely follow these patients in cases of complications.     

MR monitoring of focused ultrasonic surgery of renal cortex: Experimental and simulation studies

The aim of the study was to test the hypothesis that magnetic resonance (MR) imaging-guided and -monitored noninvasive ultrasonic surgery can be performed in highly perfused tissues from outside the body. A simulation study was performed to evaluate the optimal sonication parameters. An MR-compatible positioning device was then used to manipulate a focused ultrasound transducer in an MR imager, which was used to sonicate kidneys of five rabbits at various power levels and different durations. Temperature elevation during sonication was monitored with a T1- weighted spoiled gradient-echo sequence. The simulation study demonstrated that a sharply focused transducer and relatively short sonication times (30 seconds or less) are necessary to prevent damage to the overlying skin and muscle tissue, which have a much lower blood perfusion rate than kidney. The experiments showed that the imaging sequence was sensitive enough to show temperature elevation during sonication, thereby Indicating the location of the beam focus. Histologic evaluations showed that kidney necrosis could be consistently induced without damage to overlying skin and muscle. The study demonstrated that highly perfused tissues such as the renal cortex can be coagulated from outside the body with focused ultrasound and that MR imaging can be used to guide and monitor this surgery.