Factor VII Deficiency: A Rare Case Report

Factor VII deficiency is a rare congenital coagulopathy. Prolonged prothrombin time with normal partial thromboplastin time indicates factor VII deficiency. For the definitive diagnosis, the specific factor VII level should be investigated. We report a 20 day old, baby girl, born full-term who was admitted with the diagnosis of sepsis. Hematological tests revealed prolonged prothrombin time and a factor VII level of nine percent. After antibiotic therapy and fresh frozen plasma replacement, her clinical status improved but the prothrombin time continued to be prolonged. On the seventh day of discharge the baby died due to sudden intracranial hemorrhage.     

Bicuspid aortic valve replacement with stentless autologous pericardial valve

Bicuspid aortic valve is a common congenital cardiac anomaly that poses a surgical challenge in young patients. We describe replacement of a bicuspid aortic valve with a stentless glutaraldehyde-treated autologous pericardial prosthesis in a 16-year-old girl.     

Investigation and structural elucidation of a process related impurity in candesartan cilexetil by LC/ESI-ITMS and NMR

Four impurities were detected in candesartan cilexetil bulk drug samples by HPLC and LC/MS. These impurities were marked as CDC-I, II, III and IV. One of the impurities CDC-II was unknown and has not been reported previously. An optimized method using liquid chromatography coupled with electrospray ionization ion trap mass spectrometry (LC/ESI-ITMS) in positive ion mode has been developed to carry out structural identification of unknown impurity. Based on mass spectrometric data and synthetic specifics the structure of CDC-II was proposed as 2-ethoxy-1-[[2′-(1-ethyl-1H-tetrazol-5-yl)biphenyl-4-yl]methyl]-1H-benzimidazole-7-carboxylic acid ethyl ester. The impurity was isolated by semi-preparative HPLC and structure was confirmed by NMR spectroscopy. The plausible mechanism for the formation of impurities is also discussed.     

Bone remodeling around the tibial component of distal femoral expandable endoprosthesis

Radiographs of 33 patients who had an expandable prosthesis inserted after tumor resection in the distal femur were evaluated. We hypothesized that, when a sleeve was present, there was greater stem migration and cortical reaction. The thickness of medial and lateral cortices of the tibia was measured at 6 months and on the last follow-up radiograph. The distance from the edge of the prosthesis to the cortical edge was also compared. When a sleeve was present, there was greater stem migration (P < .001) and a greater increase in lateral cortical thickness (P < .001). There was a higher revision rate when a sleeve was used, but this was not statistically significant. There was no difference in function according to the Toronto Extremity Salvage Score (TESS) between the 2 groups. This is the first study to demonstrate that the presence of a polyethylene sleeve is associated with a tendency for the tibial prosthesis to migrate laterally and cause a greater sclerotic reaction.     

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones

Background:

In cases with infected non-union, the primary step is eradication of the infection before attempting to achieve union. Release of antibiotics from the bone cement at a high concentration and its penetration to the surrounding tissues, including cortical and cancellous bone, prompted the use of antibiotic cement in the control of bone infection. The aim of this study is to summarize our experience with the use of antibiotic cement-impregnated intramedullary nail (ACIIN) for control of infection in cases of infected non-union with bone defect.

Materials and Methods:

We prospectively studied 25 cases of infected non-union (23 femora and two tibiae). There were 24 males and one female, with the mean age being 33 years (range, 21–58 years). All patients had high-velocity road traffic accidents except one patient who had farmland injury. There were seven closed fractures, one grade I compound, two grade II compound fractures, five grade IIIA compound fractures, and 10 grade IIIB compound fractures. ACIIN was used in all cases after adequate debridement. Patients were classified according to the amount of bone defect present after debridement: group 1 with bone defect <4 cm (n=13), group 2 with bone defect ≥4–<6 cm (n=7), and group 3 with bone defect ≥6 cm (n=5). Infection control was judged on the basis of discharge through the wound and laboratory parameters. All patients were followed-up, with an average follow-up time of 29 months (range, 18–40 months). The mean duration of retention of the intramedullary rod was 8 weeks (range, 6–12 weeks).

Results:

In group 1, all cases achieved infection control, with three patients achieving bone union without any need of secondary procedure. In group 2, all cases achieved infection control but the time taken was significantly longer than for group 1 (P value 0.0002). All the cases required a secondary procedure in the form of either interlocking intramedullary nailing with iliac crest bone graft or Ilizarov ring fixator application to achieve union. None of the cases in group 3 achieved infection control.

Conclusion:

ACIINs are useful for infection control in cases of infected non-union with bone defect <6 cm. In cases with defect >6 cm, other alternatives should be used.     

Psychological functioning and health-related quality of life in adulthood after preterm birth

The aim of this study was to determine if preterm birth is associated with socioeconomic status (SES), psychological functioning, and health-related quality of life (HRQoL) in adulthood. We used prospective follow-up of 192 adult offspring of mothers who took part in a randomized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (66 born at term [33 males, 33 females] 126 born preterm [66 males, 60 females]). Cognitive functioning was assessed using the Wechsler Abbreviated Scale of Intelligence. Working memory and attention was assessed using the Benton Visual Retention Test, the Paced Auditory Serial Addition Test, and the Brown Attention Deficit Disorder Scale. Psychiatric morbidity was assessed using the Beck Depression Inventory II, the State-Trait Anxiety Inventory, and the Schizotypy Traits Questionnaire. Handedness was assessed using the Edinburgh Handedness Inventory. HRQoL was assessed using the Short Form-36 Health Survey. Moderately preterm birth (median gestation 34wks, mean birthweight 1946g [SD 463g]) was not related to later marital status, educational attainment, SES, cognitive functioning, working memory, attention, or symptoms of anxiety or schizotypy at 31 years of age. Preterm birth was associated with fewer symptoms of depression and higher levels of satisfaction in three of the eight HRQoL domains measured (bodily pain, general health perception, and social functioning). Adults who were born moderately preterm have SES, psychological functioning, and HRQoL consistent with those who were born at term. This good long-term outcome cannot be extrapolated to those with early childhood disability or very low birthweights.     

Exercise pre-conditioning ameliorates blood-brain barrier dysfunction in stroke by enhancing basal lamina

OBJECTIVE: We investigated whether exercise pre-conditioning ameliorates stroke-induced blood-brain barrier (BBB) dysfunction by strengthening basal lamina. METHODS: Adult male Sprague-Dawley rats were subjected to a 30 minute exercise program on a treadmill each day for 3 weeks. Stroke was induced by a 2 hour middle cerebral artery (MCA) occlusion using an intraluminal filament in the exercised and non-exercised groups. BBB dysfunction was then determined by brain edema. Expression of collagen IV, the major component of basal lamina essential for maintenance of the endothelial permeability barrier, was quantitatively detected by Western blot and immunocytochemistry. Ex vivo techniques were used to compare collagen IV-labeled vessels in response to ischemic insult. RESULTS: Brain edema was significantly (p<0.05) reduced after stroke in the exercised group. Western blot analysis indicated that exercise pre-conditioning enhanced collagen IV expression and reduced the loss after stroke. Immunocytochemistry demonstrated that collagen IV-positive vessels were significantly (p<0.01) increased in exercised rats. In ex vivo study, after exercised brain was incubated with ischemic brain tissue, a significantly (p<0.01) higher expression of collagen IV in cortex and striatum was observed compared to non-exercised brain following the same treatment. The ex vivo study also revealed that matrix metalloproteinase (MMP)-9 plays a key role in exercise-strengthened collagen IV expression against ischemia/reperfusion injury. DISCUSSION: Our results indicate that exercise pre-conditioning improved BBB function and enhanced basal lamina, which involved MMP-9.     

Chorioangioma of placenta: sonographic features

Chorioangioma is a benign vascular tumor of the placenta arising from primitive chorionic mesenchyme. Large (>4 cm) chorioangiomas are much rarer and are often associated with maternal and/or fetal complications. We describe the sonographic features of a large placental chorioangioma with normal outcome.