Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates

Air enema was used for exclusion, diagnosis, initial movement, and complete reduction of intussusception in 186 pediatric patients. Average pressure needed for initial movement of intussusception was 56.5 mm Hg; average maximum pressure of 97.8 mm Hg was required for complete reduction. Average fluoroscopy time required for intussusception reduction was 94.8 seconds; an average of 41.8 seconds was required to exclude intussusception. Intussusception was diagnosed in 75 patients, and reduction was accomplished in 65 (87%). Of 100 consecutive patients that underwent hydrostatic reduction of intussusception at the authors' institution, reduction was successful in 55. Compared with hydrostatic enema, air enema involves shorter fluoroscopy time and lower radiation dose to the patient. Air enema is safe and effective for diagnosis and treatment of intussusception in infants and children and has replaced hydrostatic enema for such procedures at the authors' institution.     

Oxygenation remains unaffected by increased inspiration-to-expiration ratio but impairs hemodynamics in surfactant-depleted piglets

Objectives Prolongation of inspiratory time is used to reduce lung injury in mechanical ventilation. The aim of this study was to isolate the effects of inspiratory time on airway pressure, gas exchange, and hemodynamics, while ventilatory frequency, tidal volume, and mean airway pressure were kept constant.Design Randomized experimental trial.Setting Experimental laboratory of a University Department of Anesthesiology and Intensive Care.Animals Twelve anesthetised piglets.Interventions After lavage the reference setting was pressure-controlled ventilation with a decelerating flow; IE was 11, and PEEP was set to 75% of the inflection point pressure level. The IE ratios of 1.51, 2.31, and 41 were applied randomly. Under open lung conditions, mean airway pressure was kept constant by reduction of external PEEP.Measurement and results Gas exchange, airway pressures, hemodynamics, functional residual capacity (SF₆ tracer), and intrathoracic fluid volumes (double indicator dilution) were measured. Compared to the IE of 11, PaCO₂ was 8% lower, with IE 2.31 and 41 (p0.01) while PaO₂ remained unchanged. The decrease in inspiratory airway pressure with increased inspiratory time was due to the response of the pressure-regulated volume-controlled mode to an increased IE ratio. Stroke index and right ventricular ejection fraction were depressed at higher IE ratios (SI by 18% at 2.31, 20% at 41; RVEF by 10% at 2.31, 13% at 41;p0.05).Conclusion Under open lung conditions with an increased IE ratio, oxygenation remained unaffected while hemodynamics were impaired.This study was supported by the Swedish Medical Research Council (project 4252), the Swedish Heart-Lung Foundation, Stockholm, Sweden, and the Laerdal Foundation for Acute Medicine, Stavanger, Norway     

Immunological response and overall survival in a subset of advanced renal cell carcinoma patients from a randomized phase 2/3 study of naptumomab estafenatox plus IFN-α versus IFN-α

Naptumomab estafenatox/ABR-217620/ANYARA (Nap) has been evaluated in clinical phase 1 and 2/3 studies. RCC patients in the phase 2/3 trial were randomized 1:1 in an open label study to receive Nap+IFN-α or IFN-α. In this study, we analyzed the UK patients for their immunological response in relation to prolonged overall survival (OS). We found that Nap-specific T cells were reduced after 3 treatment days in patients'' peripheral blood. Levels of both Nap-specific CD4⁺ and CD8⁺ T cells were significantly higher 8 days after the first treatment. Patients with such pattern of reduction and expansion of Nap-binding T cells also showed increased levels of IL-2 and IFN-γ in plasma 3 hours after the first Nap treatment. In addition, Nap caused an increase of IL-6, IL-10 and TNF-α. The patients in the UK subset showed a tendency of OS benefit after Nap treatment. Most Nap treated patients with long OS had low baseline IL-6 and normal levels of anti-SEA/E-120 antibodies. Furthermore, patients with pronounced Nap induced IL-2 and T cell expansion had long OS. In conclusion, patients with low baseline IL-6 and normal anti-SEA/E-120 may respond well to Nap by T cell activation and expansion paving the way for anti-tumour effects.     

Pedicle subtraction osteotomy in degenerative scoliosis

European Spine Journal -     

Increased expression of nestin in the major pelvic ganglion following cavernous nerve injury

In an effort to identify neuronal repair mechanisms of the major pelvic ganglion (MPG), we evaluated changes in the expression of nestin, an intermediate filament protein and neural stem cell marker following cavernous nerve crush injury (CNI). We utilized two groups of Sprague Dawley rats: (i) sham and (ii) bilateral CNI. Erectile responses to cavernous nerve stimulation (CNS) were determined at 48?h in a subset of rats. The MPG was isolated and removed at 48?h after CNI, and nestin immunolocalization, protein levels and RNA expression were evaluated. At 48?h, erectile responses to CNS in CNI rats were substantially reduced (P<0.05; ～70% decrease in intracavernous pressure/mean arterial pressure) compared with sham surgery controls. This coincided with a dramatic 10-fold increase (P<0.05) in nestin messenger RNA expression and protein levels in the MPG of rats with CNI. Immunoflourescence microscopy demonstrated that nestin upregulation after CNI occurred within the ganglion cell bodies and nerve fibers of the MPG. In conclusion, CNI induces nestin in the MPG. These data suggest that nestin may be involved in the regenerative process of the cavernous nerve following crush injury.     

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.     

Visualization of defective measles virus particles in cerebrospinal fluid in subacute sclerosing panencephalitis

Measles virus particles were visualized in the CSF of two patients with verified subacute sclerosing panencephalitis (SSPE) by using scanning electron microscopy. Immunologic identification of the accumulated particles was performed with monoclonal antibodies, directly conjugated to carboxylated microspheres, specific for different measles virus antigens. The beads were amassed on the filter surface after a 1-hr incubation in the CSF. Spherical particles with a diameter ranging between 150 and 500 nm were detected. Such particles bound specifically to latex beads covered by monoclonal antibodies to measles virus hemagglutinin but not to beads conjugated with monoclonal antibodies specific for nucleoprotein. Adding the two monoclonal antibodies to measles virus hemagglutinin to the CSF agglutinated the virus particles in a dose-dependent way. Further, no particles in the CSF bound to microspheres conjugated with monoclonal antibodies to non-related antigens of Sendai virus, cytomegalovirus, or human immunodeficiency virus. Similarly sized particles were also identified by transmission electron microscopy after concentrating the CSF.     

Recurrent encephalitis due to trimethoprim intake

We wish to report a 76-year-old woman with 2 episodes of meningitis related to the intake of trimethoprim. On both occasions the patient demonstrated encephalitic symptoms and a pathological electroencephalogram with cerebral function disturbances. A similar case with encephalitic symptoms due to trimethoprim has not been reported earlier.