Adenomatoid tumor of the tunica albuginea

Adenomatoid tumors are benign mesothelial tumors most commonly found in the paratesticular structures, especially the epididymis. Herein, we report a case of adenomatoid tumor originating in the tunica albuginea and mimicking an intratesticular neoplasm. We review the ultrasonographic presentation and literature regarding adenomatoid tumors originating in the tunica albuginea and testicular parenchyma.     

Enzyme-linked immunosorbent assay (ELISA) of changes in specific IgG antibodies to five venoms during venom immunotherapy

An enzyme-linked immunosorbent assay (ELISA) was developed that could measure titres of human IgG antibodies to five different venoms (honeybee, yellow jacket, yellow hornet, white-faced hornet, and wasp), and to honeybee phospholipase A. Changes in specific IgG anti-venom titres were measured in twenty patients that had systemic anaphylactic reactions to insect stings, and ten non-allergic controls. After being stung and prior to treatment all patients had anti-venom IgG titres greater than controls. Treatment with small doses of venom over 1–2 months resulted in prompt rises in anti-venom IgG titres that may represent secondary anemnestic responses primed by prior slings. All patients undergoing venom immunotherapy showed at least 2-fold increases in IgG antibody lo the venoms they were treated with by the time maintenance doses of 100 meg were achieved, with one exception. Significant cross-reactive increases in anti-vespid IgG antibodies to venoms not used for treatment occurred in nine of eighteen treated patients. Overall, ELISA of IgG antibodies lo five venoms allowed clear evaluation of the considerable variation of IgG responses among different patients. We conclude that serial determination of venom-specific IgG titres by ELISA offers an important adjunct to evaluating the results of venom immunotherapy.     

Noninvasive Measurement of Blood Pressure in Conscious Cynomolgus Monkeys

Systolic (SP), diastolic (DP), and mean arterial blood pressures(MAP) and pulse rate (PR) were recorded on treated and untreatedconscious cynomolgus monkeys by the oscillometric method (Dinamap1846SX/P). Each monkey was placed in a restraining tube withthe cuff placed on the base on the shaved tail. Measurementswere taken on untreated animals once or twice a day for 4 weeks.The mean and standard deviations for SP, DP, MAP, and PR wereapproximately 121 ± 17, 60 ± 14, and 84 ±17 mm Hg and 193 ± 18 pulses/min, respectively. One maleand one female cynomolgus monkey were treated with isoproterenol,norepinephrine, and nitropmsside. Blood pressure was measuredindirectly with the cuff on the tail and directly with an indwellingcatheter in the descending thoracic aorta. Although the oscillometricmethod was not as sensitive as the catheter, the oscillometricmethod detected a change in the same direction of SP, DP, MAP,and PR compared with the direct method for all drugs administered.The monitor was reliable and sufficiently accurate to concludethat it may be useful in toxicology studies for evaluation ofblood pressure parameters in Conscious Cynomolgus monkeys.     

Characteristics and management of prisoners at risk of suicide behaviour

This study provides data on the characteristics and management of all prisoners identified at risk of suicidal behaviour over a 12 month period in all Scottish prisons. From a total of 44,093 admissions, 1,984 (4.5%) prisoners were identified at time of reception as at risk while 857 (1.9%) inmates were classified as at risk at some other point during custody. Of those identified at risk at time of reception, 19.1% were retained on suicidal supervision, while 58.2% of those identified at risk during custody were maintained on some form of suicidal supervision. Average length of time kept on strict suicidal supervision for those identified at time of reception was 1.87 days, and for those identified at some other point during custody was 2.59 days. Results are discussed in relation to the problems associated with suicide prediction and prevention in prison settings and the tendency for risk assessment to create significant numbers of false positives at time of reception.     

Effects of 1,1-Dichloroethene and of Some of Its Metabolites on the Functional Viability of Mouse Hepatocytes

1,1-Dichloroethene (DCE) is hepatotoxic in rodents, and theexpression of its toxicity involves probably its metabolism.In this study the role of DCE metabolites in the generationof the hepatotoxic lesion was investigated. Hepatocytes frommale BALB/c mice in suspension were used as the experimentalmodel. Cells were incubated with DCE for up to 5 hr and cellularviability was assessed by measurement of the release of lactatedehydrogenase into the medium and by alterations in the reductionof the dye 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazoliumbromide. After incubation for 3 hr DCE at 0.5 mM caused maximaltoxicity, whereas at 0.1 mM DCE was only marginally toxic. Cytotoxicitywas exacerbated by pretreatment of mice with buthionine sulfoximine(1.6 g/kg), an inhibitor of glutathione biosynthesis, given4 hr prior to hepatocyte isolation. Inclusion of N-acetylcysteine(10 mM) into the incubate protected cells against DCE-inducedcytotoxicity. Coincubation with octylamine (0.5 mM), an inhibitorof cytochrome P450, abolished the cytotoxic potential of 0.5mM DCE during incubation for 3 hr. DCE toxicity was increasedin hepatocytes from mice which had received ethanol or acetonein their drinking water, both of which induce levels of thehepatic cytochrome P450 isozyme P450 2E1. Incubation of cellswith the P450 2E1 inhibitors N,N-dimethylformamide (10 mM) ordiethyldithiocarbamate (100 µM) protected liver cellsagainst the detrimental effect of DCE. Pretreatment of animalswith phenobarbital, which induces the P450 2B subfamily, or3-methylcholan-threne, which induces P450 1A1, did not affectthe degree of hepatocytotoxicity elicited by DCE. The DCE metaboliteschloroacetic acid and dichloroacetaldehyde at 0.75 mM were toxictoward the cells; however, their toxic potency was inferiorto that of DCE. Dichloroacetic acid, another product of metabolicDCE oxidation, and S-(chloroacetyl)glutathione and glutathionylacetylglutathione,both of which are generated by conjugation of DCE metaboliteswith glutathione, at concentrations of up to 5 mM did not interferewith hepatocyte viability. The results suggest that (i) DCEundergoes metabolic toxification in mouse hepatocytes, (ii)P450 2E1 is responsible for the metabolic activation of DCE,and (iii) conjugation with glutathione is a detoxification step.     

Reversion Mode Activation by Myopotential Sensing in a Ventricular Inhibited Demand Pacemaker

Pacemaker follow-up in a 72-year-old woman revealed occasional failure to sense and pace, which was confirmed by Holter monitor. Neither reprogramming the pacemaker sensitivity nor repositioning the lead resolved the problem. A recheck of the Holter recordings revealed pacing and sensing failures were concurrent with "baseline artifact," suggestive of myopotentials. Furthermore, the inappropriate pacing spikes occurred at a rate of 90 pulses per minute (ppm). It was theorized that myopotential sensing was alternately inhibiting the pacer and activating the reversion mode, an asynchronous rate of 90 ppm. Reprogramming the unit to a lower sensitivity restored normal pacer function.     

How do pediatric anesthesiologists define intraoperative hypotension?

Introduction: Although blood pressure (BP) monitoring is a recommended standard of care by the ASA, and pediatric anesthesiologists routinely monitor the BP of their patients and when appropriate treat deviations from ‘normal’, there is no robust definition of hypotension in any of the pediatric anesthesia texts or journals. Consequently, what constitutes hypotension in pediatric anesthesia is currently unknown. We designed a questionnaire‐based survey of pediatric anesthesiologists to determine the BP ranges and thresholds used to define intraoperative hypotension (IOH). Methods: Members of the Society of Pediatric Anesthesia (SPA) and the Association of Paediatric Anaesthetists (APA) of Great Britain and Ireland were contacted through e‐mail to participate in this survey. We asked a few demographic questions and five questions about specific definitions of hypotension for different age groups of patients undergoing inguinal herniorraphy, a common pediatric surgical procedure. Results: The overall response rate was 56% (483/860), of which 76% were SPA members. Majority of the respondents (72%) work in academic institutions, while 8.9% work in institutions with fewer than 1000 annual pediatric surgical caseload. About 76% of respondents indicated that a 20–30% reduction in baseline systolic blood pressure (SBP) indicates significant hypotension in children under anesthesia. Most responders (86.7%) indicated that they use mean arterial pressure or SBP (72%) to define IOH. The mean SBP values for hypotension quoted by SPA members was about 5–7% lower across all pediatric age groups compared to values quoted by APA members (P = 0.001 for all age groups). Conclusions: There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20–30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have implications for patient care as well as future clinical research.     

Osteoporosis in adults with cerebral palsy

Life expectancy for the 400 000 adults with cerebral palsy (CP) in the USA is increasing. Although there is a perception of increased fractured rate in the adult with CP, it has not been well studied. Low bone mineral density is found in more than 50% of adults with a variety of disabilities, including CP. Dual-energy X-ray absorptiometry scanning is commonly used to assess bone mineral density, but is limited by positioning and other artifacts in adults with CP. Novel scanning regions of interest, such as the distal femur, are not yet standardized in adults. Nutritional assessment and physical activity, the basis of most fracture prevention programs, are difficult to do in the adult with CP. A better understanding of the 'muscle-bone unit' physiology and its exploitation may lead to better treatment modifications. Clinical research trials with bisphosphonates (e.g. pamidronate), estrogen, selective estrogen receptor modulators, parathyroid hormone analogs, and growth hormone need to be targeted to the adult with CP. Longitudinal studies of fracture risk factors, genetic research in bone and neuromuscular biology, and the development of treatment surrogates for physical activity are additional areas of needed expertise. This could be facilitated by an adult CP registry and the centralization of clinical research efforts.