Improvements in quality of life in children after surgical therapy for sinonasal disease.

OBJECTIVES: To study changes in quality of life in children with chronic sinonasal disease after surgical therapy. STUDY DESIGN AND SETTING: Prospective, nonrandomized quality of life study of children with sinonasal disease who undergo adenoidectomy or functional endoscopic sinus surgery (FESS) at an academic institution. Caregivers completed a preoperative SN-5 quality of life survey and a second survey within 6 months after surgery. RESULTS: Twenty-two children were enrolled in the study (mean, 6.5 years; range, 1.4 to 15.9). The majority (59%) of children underwent adenoidectomy. The mean total score was 25.8 at initial presentation and 12.0 at follow-up (P>0.001). Postoperative scores for all domains were significantly different from preoperative scores. The domains with the greatest change in mean score were nasal obstruction and emotional distress. There were no significant differences in outcome between children who underwent adenoidectomy and those who underwent FESS. CONCLUSIONS: After either adenoidectomy or FESS, caregivers report a dramatic improvement in the quality of life of children with sinonasal disease. EBM rating: B-3b.     

Transabdominal sonography before uterine exploration as a predictor of retained placental fragments.

OBJECTIVE: To evaluate the diagnostic accuracy of sonography in postpartum patients thought to have retained placental fragments. METHODS: The study group consisted of 39 postpartum women in whom inspection of the placenta brought up suspicion of retained placental fragments. All these women underwent manual exploration of the uterine cavity. Before the procedure, all patients had two-dimensional sonographic imaging, after which they were divided into 2 groups. The first group comprised women who were judged to have had an empty uterus or nothing but intrauterine fluid collection. The second group consisted of those in whom sonography showed echoes of what might appear as residual trophoblastic tissue, that is, echogenic, hypoechoic, or mixed echo intracavitary patterns. The sonographic patterns were then correlated with the presence or absence of retained placental fragments as found on uterine manual exploration and pathologic examination. RESULTS: In 18 patients, no suspected contents were observed on sonography. In 17 of these patients, the uterus was empty on manual uterine exploration. One of these patients had residual trophoblastic tissue, which was of minimal quantity and clinically unimportant. In 21 patients, sonography suggested retained placental tissue. In 15 of these patients, pathologic examination confirmed residual trophoblastic tissue, and in the remaining 6, the uterus contained blood clots, decidua, or both. CONCLUSIONS: Sonography is an effective tool for evaluating postpartum patients thought to have retained placental fragments. Normal sonographic findings might obviate the need for manual exploration of the uterine cavity. A questionable sonographic result is not an effective tool for distinguishing between placental fragments and blood clots.     

Preprocedure hyperglycemia is more strongly associated with restenosis in diabetic patients after percutaneous coronary intervention than is hemoglobin A1C.

BACKGROUND: Although more frequent in diabetic patients, restenosis after percutaneous coronary intervention (PCI) is less common in those with good glycemic control. High circulating insulin levels may also be associated with more frequent restenosis. METHODS: Fasting blood samples were obtained from 162 diabetic patients immediately prior to the PCI and analyzed for glucose, hemoglobin A1C, and insulin. Nine-month follow-up information was obtained in 145 (89.5%) patients. Target vessel revascularization (TVR) was the surrogate for restenosis. RESULTS: Patients were divided into quartiles with regard to their blood levels. Insulin, calculated insulin resistance, and hemoglobin A1C were not associated with increased TVR rates. Glucose level was significantly associated (P=.02). Patients in the two lower quartiles (glucose < or = 128 mg/dl) had a 9-month TVR rate of 12.7% while those in the two higher quartiles (>128 mg/dl) had a rate of 33.8% (P=.005). Level of glucose was independent of hemoglobin A1C. In patients whose A1C level was < or = 7%, the TVR rate was greater in those with a glucose level >128 mg/dl (39.1% vs. 10.6%, P=.009). Similarly, in patients with a hemoglobin A1C level >7%, the TVR rate was lower in patients with a glucose level < or = 128 mg/dl, but this difference did not reach statistical significance (16.6% vs. 31.3%, P=.3). CONCLUSIONS: Hemoglobin A1C, insulin, and insulin resistance at the time of the PCI are not associated with restenosis. Periprocedural hyperglycemia may promote restenosis in diabetics.     

Analysis of Acanthurus triostegus for marine toxins by the stick enzyme immunoassay and mouse bioassay.

The herbivorous convict tang or surgeon fish, Acanthurus triostegus, collected at different locations in the Hawaiian islands, was analyzed for toxicity using a mouse bioassay and a stick enzyme immunoassay (S-EIA) developed to detect ciguatoxin and closely related polyethers. Results of the S-EIA test indicated that about 94% of the samples gave negative readings, while 6% of the fish were positive and thus considered toxic. Fish samples from each location were pooled and the flesh and viscera were successively extracted with hexane, methanol, and water and tested in a mouse bioassay. About one-third of the methanol soluble fractions killed mice within 20 min, 70% killed within 4 hr, and 85% killed within 48 hr. About 40% of the hexane-soluble fractions killed mice within 24 hr and 55% killed within 48 hr. The water-soluble extracts of the flesh and viscera of fish taken from three locations showed relatively high toxicity. Common symptoms for all fractions included convulsions and jumping (especially just prior to death), respiratory distress, hind leg to complete paralysis, loss of body tone, and tremors. Analysis of the data suggests that in the flesh and viscera of A. triostegus there are at least three different nervous system-type toxins, most of which did not appear to react to the S-EIA test.     

Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study

BACKGROUND: Patients with a normal stress technetium 99m sestamibi study were shown to have a favorable outcome at intermediate-term follow-up. However, long-term survival has not been studied. The aim of this study was to evaluate the incidence and predictors of mortality and cardiac events at long-term follow-up after a normal exercise stress sestamibi study.Methods and results We studied 218 patients (mean age, 53 +/- 10 years, 108 men) who had normal myocardial perfusion assessed by Tc-99m sestamibi single photon emission computed tomography at rest and during symptom-limited bicycle exercise stress test. Endpoints during a follow-up period of 7.4 +/- 1.8 years were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all-cause mortality. During follow-up, 13 patients died of various causes (cardiac death in 1 patient). Ten patients had nonfatal myocardial infarction (a total of 11 hard cardiac events). By multivariate analysis, independent predictors of cardiac events were history of coronary artery disease (chi(2) = 5, P =.03) and lower exercise heart rate (chi(2) = 12, P =.001). Independent predictors of all-cause mortality were age (chi(2) = 4, P =.05) and exercise heart rate (chi(2) = 5, P =.03). The annual mortality rate was 0.6% in the first 5 years and 1.8% between the sixth and eighth years. The annual hard cardiac event rate was 0.7% in the first 5 years and 1.5% between the sixth and eighth years. Receiver operating characteristic curves identified an exercise heart rate lower than 130 beats/min as the cutoff value that separated patients with regard to their risk for mortality and hard cardiac events. CONCLUSIONS: It is concluded that the annual mortality and cardiac event rate is less than 1% during 5-year follow-up after a normal exercise sestamibi study. Therefore repeated testing would not be required unless there is a change in symptoms. Follow-up should be closer in patients with a history of coronary artery disease and in those who fail to achieve an exercise heart rate of 130 beats/min or greater.     

Metabolic rates in small brain nuclei determined by high-resolution PET.

Identification of small nuclei in the brain by PET has been limited by the spatial resolution of conventional scanners. The new detector technology and advanced signal analysis of a high-resolution research tomograph (HRRT) has improved 3-dimensional spatial resolution to 2.2 mm at sufficient efficiency and permitted the quantification of tracer concentrations in small volumes. METHODS: In 9 healthy volunteers, cerebral glucose metabolism was investigated after intravenous injection of 370 MBq of (18)F-FDG, and regional cerebral metabolic rates for glucose (rCMRGlc) were determined in various structures of the brain identified on coregistered MR images using stereotactic and topographic anatomic information. RESULTS: rCMRGlc values (in mumol/100 g/min) were higher in the cerebral cortex (33.5 +/- 2.98), the basal ganglia (32.6 +/- 3.04 in the nucleus caudatus and 40.2 +/- 3.50 in the putamen), the thalamus (36.6 +/- 4.72), and the cerebellum (29.8 +/- 2.20) and were lower in the cerebral white matter (12.3 +/- 1.45) than those reported previously with conventional scanners. This resulted in an increased ratio of cortical values to white-matter values. Various nuclei in the basal frontal lobe (21.4 +/- 3.19 in the basal forebrain and 32.3 +/- 2.39 in the nucleus accumbens), the temporal lobe (22.2 +/- 1.74 in the corpus amygdalae), the hippocampus (25.7 +/- 2.11), the diencephalon (23.1 +/- 3.33 in the corpus geniculatum laterale, 20.2 +/- 2.87 in the corpus geniculatum mediale, and 25.2 +/- 3.29 in the nucleus subthalamicus), and the brain stem (24.4 +/- 2.47 in the colliculus superior, 31.4 +/- 3.63 in the colliculus inferior, 31.0 +/- 3.10 in the nucleus ruber, and 22.8 +/- 2.35 in the substantia nigra) could be identified, and the metabolic rate was assessed in these structures. The effect of improved spatial resolution on quantified metabolic rates could directly be demonstrated in a few cases investigated on scanners of different generations. CONCLUSION: The improved spatial resolution of the HRRT decreased partial-volume effects in the quantification of metabolic rates in the brain and increased the accuracy of rCMRGlc values in large structures. For the first time, this scanner has permitted the determination of metabolic rates in small nuclei that are involved in various neurodegenerative disorders.