Reduction of CO2-pneumoperitoneum-induced metabolic hypoxaemia by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. A preliminary study

Dear Sir, We read with great interest the recent paper (Mynbaev et al.,2002) on the reduction of CO₂-pneumoperitoneum-induced metabolichypoxaemia by the addition of small amounts of O₂ to the CO₂in a rabbit ventilated model. In the     

Valproate-associated reproductive and metabolic abnormalities: are epileptic women at greater risk than bipolar women?

OBJECTIVE: Evidence indicates that valproate (VPA) may have an adverse impact on reproductive endocrine and metabolic functions in women with epilepsy. This study explores whether the association of VPA with reproductive endocrine abnormalities is applicable to women with bipolar disorder (BD) or is unique to women with epilepsy. METHODS: Thirty female patients aged 18-40 years with a DSM-IV diagnosis of BD (15 on lithium monotherapy and 15 on VPA monotherapy or VPA in combination with lithium therapy) and 15 with idiopathic generalized epilepsy (IGE) on VPA monotherapy were evaluated for reproductive endocrine functioning and metabolic parameters. RESULTS: The menarche age, mean length of menstrual cycle and mean length of menses were not significantly different between groups. None of the bipolar patients on lithium, three (20%) of the bipolar patients on VPA and seven (47%) of the epileptic patients on VPA reported menstrual disturbances. Hirsutism scores of the epilepsy group were significantly higher than those bipolar women, regardless of treatment. Serum total testosterone levels were significantly higher in patients (both with BD and with IGE) treated with VPA than in those treated with lithium. Serum FSH levels were significantly lower and LH-to-FSH ratio was significantly higher in patients with epilepsy than in patients with BD, regardless of treatment. The weight parameters and lipid values investigated did not differ significantly between the groups. CONCLUSION: The study supports the conclusion that VPA may be associated with menstrual abnormalities and increased total testosterone levels in both bipolar and epileptic patients although women with BD did not show clinical features of hyperandrogenism (menstrual abnormalities, hirsutism and truncal obesity) as did frequently as women with epilepsy.     

Endovascular treatment of Behçet's disease-associated intracranial aneurysms: report of two cases and review of the literature

Behçet's disease (BD) is a well-known multisystem inflammatory disorder of unknown etiology. Aneurysms of the cerebral arteries are not commonly described in patients with BD. There are few cases of intracranial aneurysms with BD reported in the literature. In this study, we report endovascular treatment of BD-related ruptured intracranial aneurysms in two cases, and present a wide literature review of intracranial arterial aneurysms related to BD.     

Power spectral analysis of heart rate variability in children with aortic stenosis

Aortic stenosis is a progressive disorder and can be the cause of serious arrhythmias and possibly sudden death. Evaluation and follow-up of the autonomic nervous system may provide some useful information for management of the disease. Our study aimed to examine heart rate variability in children with aortic stenosis in the supine position and to detect the changes in autonomic activity during head-up tilt testing. Sixteen patients and 11 healthy controls participated in the study. In the supine position, seven minutes of continuous echocardiographic (ECG) recording was performed, followed by four consecutive ECG recordings, each consisting of seven minutes in 70 degrees tilt position. To obtain power spectrums, the tachograms were taken on the autoregressive mode. The mean RR interval duration, standard deviation of RR interval, central frequencies of low and high frequency oscillations, their powers, total power and percents of normalized low and high frequency powers were accepted for statistics. There were no significant differences between the groups in the supine position. In tilt position, mean RR interval and its standard deviation were decreased in both groups. The central frequency of low freuquency power significantly (p<0.05) shifted to left, normalized low frequency power increased and normalized high frequency power decreased in the control group at the beginning of tilt position, but at the second phase of tilt position in the patient group. We conclude from the results that children with mild-to-moderate aortic stenosis reflect delayed response to sympathetic provocation.     

Evaluation of O6-methylguanine DNA methyltransferase activity in patients with gastric cancer

O6-Methylguanine DNA methyltransferase (O6-MGMT) reverses DNA alkylation damage produced alkylating agents. O6-MGMT is also a major determinant of cellular resistance to adjuvant chemotherapy with alkylating drugs. O6-MGMT activity was measured in samples from patients with gastric cancer, including tumor, adjacent normal appearing mucosa, and peripheral blood leukocytes (PBL). O6-MGMT activity of PBL from healthy individuals was evaluated as control. There was no significant difference between controls and patients for O6-MGMT activity in PBL. O6-MGMT activity was significantly increased in tumor tissue. Tumor O6-MGMT activity was found to be independent from tumor subgroups and tumor grade. A positive correlation was determined between O6-MGMT activity in tumor and in circulating PBL. The results indicate that O6-MGMT, a defense protein against alkylating agent-mediated carcinogenesis, increased in gastric tumors. This may explain the low response rate to drug combinations, including chloroethylnitrosoureas, exhibited by patients with gastric cancer.     

Genital injuries in boys and abuse.

AIMS: To describe a cohort of boys with genital injuries in whom child abuse was suspected. METHODS: Boys with genital injury (penile and/or scrotal) and referred to paediatricians in Leeds, population 750 000, with concerns regarding possible abuse from 1983 to 2003 were identified from medical reports. RESULTS: 86 boys (average age 62.7 months, median age 48 months) were referred between 1983 and 2003. The injury was judged inflicted in 63, unexplained, suspicious or inconsistent with the history given in 17 and accidental in six. The number of discrete injuries ranged from one in 57, two in 15, three in 12, to more than three in two cases. Genital injuries included burns in seven boys, bruises in 27, incised wounds, lacerations or scars in 39, and other traumatic lesions in 27. Non-genital findings included anal findings in 28, >10 bruises in 17, fractures in three, burns in 12, mouth injuries in four, brain and retinal haemorrhages in one, and poor nourishment or underweight in 14. The categories of abuse were physical (eight), sexual (19), both physical and sexual (eight), physical and neglect (four), and physical, sexual and neglect (one). The category of abuse was unspecified in 39 children. CONCLUSIONS: Genital injury in boys may be the result of abuse which may be physical or sexual in nature.     

Pleural flap for treating perigraft leak after a modified Blalock-Taussig shunt

Plasa oozing through the graft after a modified Blalock-Taussig shunt is a troublesome complication. We encountered a massive leak following a modified Blalock-Taussig shunt in a 2 1/2 year-old-girl which required reexploration. The leak was treated by wrapping the polytetrafluoroethylene shunt with the parietal pleura flap harvested from the adjacent chest wall. The patient had an uneventful recovery. Covering of the polytetrafluoroethylene shunt with parietal pleura appears to stop plasma leak through the graft following a modified Blalock-Taussig shunt.     

A randomised trial of self-management planning for adult patients admitted to hospital with acute asthma

BACKGROUND: There is still debate over the benefit of self-management programmes for adults with asthma. A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission. METHOD: A randomised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months. Patients on the self-management programme (SMP) received 40-60 minutes of education supporting a written self-management plan. Control patients received standard care (SC). RESULTS: One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze (OR 2.6, 95% CI 1.5 to 5.3), no night disturbance (OR 2.0, 95% CI 1.2 to 3.5), and no activity limitation (OR 1.5, 95% CI 0.9 to 2.7). Over 12 months 17% of SMP patients were re-admitted compared with 27% of SC patients (OR 0.5, 95% CI 0.3 to 1.0). Among first admission patients, OR readmission (SMP v SC) was 0.2 (95% CI 0.1 to 0.7), p<0.01. For patients with a previous admission, OR readmission was 0.8 (95% CI 0.4 to 1.6), p=0.6. SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge (99% v 92%, p=0.03), oral steroids (98% v 90%, p=0.06), and to have hospital follow up (98% v 84%, p<0.01) but adjustment for these differences did not diminish the effect of the self-management programme. CONCLUSIONS: A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients. The benefit of the programme may have been greater for patients admitted for the first time. The programme also had a small but significant effect on medical management at discharge.     

Idiopathic penile mondors' disease: A case report

A 34-year old man was admitted to us with a mild painful cord-like induration on the left dorsal side of the penis extending from corona of the glans to the base of the penis. The patient was treated with anti-inflammatory and anticoagulan agents. Cord-like-induration resolved and recanalized in 4th week, and venous flow was detected in Doppler examination.