Prolongation of pregnancy following eclampsia

Eclampsia is a serious complication of preeclampsia with high maternal and perinatal mortality and morbidity rates. The recommended management is induction of labour when convulsions are controlled and the women's condition is stabilised. Here, we report about stabilisation after eclampsia followed by prolongation of a preterm pregnancy for 11 days within early gestational weeks.     

Detection of brain oedema using magnetic induction tomography: a feasibility study of the likely sensitivity and detectability

The detection and continuous monitoring of brain oedema is of particular interest in clinical applications because existing methods (invasive measurement of the intracranial pressure) may cause considerable distress for the patients. A new non-invasive method for continuous monitoring of an oedema promises the use of multi-frequency magnetic induction tomography (MIT). MIT is an imaging method for reconstructing the changes of the conductivity deltakappa in a target object. The sensitivity of a single MIT-channel to a spherical oedematous region was analysed with a realistic model of the human brain. The model considers the cerebrospinal fluid around the brain, the grey matter, the white matter, the ventricle system and an oedema (spherical perturbation). Sensitivity maps were generated for different sizes and positions of the oedema when using a coaxial coil system. The maps show minimum sensitivity along the coil axis, and increasing values when moving the perturbation towards the brain surface. Parallel to the coil axis, however, the sensitivity does not vary significantly. When assuming a standard deviation of 10(-7) for the relative voltage change due to the system's noise, a centrally placed oedema with a conductivity contrast of 2 with respect to the background and a radius of 20 mm can be detected at 100 kHz. At higher frequencies the sensitivity increases considerably, thus suggesting the capability of multi-frequency MIT to detect cerebral oedema.     

Human medial intraparietal cortex subserves visuomotor coordinate transformation

In the macaque, the posterior parietal cortex (PPC) integrates multimodal sensory information for planning and coordinating complex movements. In particular, the areas around the intraparietal sulcus (IPS) serve as an interface between the sensory and motor systems to allow for coordinated movements in space. Because recent imaging studies suggest a comparable functional and anatomical organization of human and monkey IPS, we hypothesized that in humans, as in macaques, the medial intraparietal cortex (area MIP) subserves visuomotor transformations. To test this hypothesis, changes of neural activity were measured using functional magnetic resonance imaging (fMRI) while healthy subjects performed a joystick paradigm similar to the ones previously employed in macaques for studying area MIP. As hypothesized, visuomotor coordinate transformation subserving goal-directed hand movements activated superior parietal cortex with the local maximum of increased neural activity lying in the medial wall of IPS. Compared to the respective visuomotor control conditions, goal-directed hand movements under predominantly proprioceptive control activated a more anterior part of medial IPS, whereas posterior medial IPS was more responsive to visually guided hand movements. Contrasting the two coordinate transformation conditions, changing the modality of movement guidance (visual/proprioceptive) did not significantly alter the BOLD signal within IPS but demonstrated differential recruitment of modality specific areas such as V5/MT and sensorimotor cortex/area 5, respectively. The data suggest that the human medial intraparietal cortex subserves visuomotor transformation processes to control goal-directed hand movements independently from the modality-specific processing of visual or proprioceptive information.     

Mycobacterium marinum causing tenosynovitis. 'Fish tank finger'

Mycobacterium marinum is an unusual atypical mycobacterium with low pathogenicity for humans in comparison with Mycobacterium tuberculosis. Among the non-tuberculous mycobacterial pathogens, Mycobacterium marinum is the most common pathogen to cause skin infections. Mycobacterium marinum infection causes chronic cutaneous lesions and in some cases deeper infections such as tenosynovitis, septic arthritis and rarely osteomyelitis. We report the case of a male patient presenting with tenosynovitis of the distal upper extremity secondary to Mycobacterium marinum infection.     

Total hip replacement in younger patients: survival rate after avascular necrosis of the femoral head

BACKGROUND: A high risk of loosening has been reported in replacements performed because of avascular necrosis. PATIENTS AND METHODS: To study cementless total hip replacement (THR) in younger patients with avascular necrosis (AVN), we analyzed retrospectively the outcome in 129 cases: 46 Mittelmeier monobloc ceramic hips (22 cases with AVN), and 83 Zweymüller total hip systems (35 cases with AVN) clinically and radiographically. RESULTS: At follow-up, 17 Mittelmeier prostheses (10 AVN) and 4 Zweymüller prostheses (none with AVN) had been revised. The diagnosis did not affect the implant survival, but the Zweymüller THR fared better than the Mittelmeier system. The main reason for revision of Mittelmeier implants was aseptic loosening, 3 of 4 Zweymüller revisions were necessary due to polyethylene wear. This difference was confirmed by the radiographic evaluation of the still intact implants: Zweymüller THR showed better values for signs of osseointegration, radiolucent lines around the implants and migration, but more acetabular wear. None of these differences was affected by the AVN diagnosis. INTERPRETATION: We could not confirm that AVN is a risk factor in total hip replacement.     

Radio-guided occult lesion localization in patients undergoing breast-conserving surgery and sentinel node biopsy

BACKGROUND: The objective of the study was to evaluate the feasibility of radio-guided occult lesion localization (ROLL) in breast-conserving surgery for nonpalpable breast cancer. METHODS: Altogether 215 breast cancer patients were included in a prospective study. Ultrasonographically guided intratumoral injection of radioactive tracer was used for tumor localization in 64 patients with nonpalpable tumors, visible in breast ultrasonography (the ROLL group). Nonpalpable tumors, visible only in mammography, were localized with a help of a guidewire in 14 patients (the WGR group). The remaining 137 patients had palpable tumors. RESULTS: The proportion of specimens with close or involved margins (0 to 3 mm) was the same in the ROLL group (6%) and among cases with palpable tumors (5%). In addition the median length of the closest margin did not differ significantly between the groups. CONCLUSIONS: The results of ROLL for nonpalpable breast cancer are comparable with those for resection of palpable tumors.     

Management strategies for type A dissection complicated by peripheral vascular malperfusion

BACKGROUND: End-organ malperfusion is a dreaded complication of type A aortic dissections. Different strategies have been proposed to manage this complex cohort of patients. Ideal management includes the rapid restoration of organ perfusion while avoiding catastrophic rupture and tamponade. We present our experience with primary aortic repair as the optimal method of patient management. METHODS: From July 1997 until April 2003, 101 patients underwent dissection repair and were assessed for malperfusion of the central nervous system, renal, visceral or extremity circulation. Patients with coronary artery malperfusion were analyzed separately. Aortic repair was performed expeditiously utilizing femoral bypass, circulatory arrest, and antegrade perfusion after completion of the distal anastomosis. Persistent malperfusion led to additional procedures. In-hospital morbidity, end-organ salvage, and mortality were determined. Chi-square analysis defined variables contributing significantly to outcome. RESULTS: Twenty-three patients presented with malperfusion. The operative mortality for the entire cohort with malperfusion, 4.4% (n = 1), was not greater than those without it, 5.1% (n = 4). Five patients required additional procedures following aortic repair, a majority in patients with persistent extremity ischemia. All deficits resolved except for one patient with spinal ischemia and one with visceral ischemia. Visceral malperfusion was highly lethal with a mortality of 33% (n = 1). All other patients presenting with malperfusion survived to discharge. CONCLUSIONS: Patients with malperfusion in the setting of acute type A dissection should undergo immediate aortic reconstruction as the primary means of reestablishing end-organ perfusion. Early postoperative intervention for persistent deficits leads to a gratifyingly high rate of end-organ salvage.     

Preoperative brain injury in newborns with transposition of the great arteries

BACKGROUND: The objective was to determine the timing and mechanism of brain injury using preoperative and postoperative magnetic resonance imaging (MRI) and three-dimensional MR spectroscopic imaging (MRSI) in newborns with transposition of the great arteries (TGA) repaired with full-flow cardiopulmonary bypass. METHODS: Ten term newborns with TGA undergoing an arterial switch operation were studied with MRI, MRSI, and neurologic examination preoperatively and postoperatively at a median of 5 days (2 to 9 days) and 19 days (14 to 26 days) of age, respectively. Five term historical controls were studied at a median of 4 days (3 to 9 days). Lactate/choline (marker of cerebral oxidative metabolism) and N-acetylaspartate (NAA)/choline (marker of cerebral metabolism and density) were measured bilaterally from the basal ganglia, thalamus, and corticospinal tracts. RESULTS: Four TGA newborns had brain injury on the preoperative MRI. The only new lesion detected on the postoperative study was a focal white matter lesion in one newborn with a normal preoperative MRI. The MRSI of age-adjusted lactate/choline was quantitatively higher in newborns with TGA compared with those without heart disease (p < 0.0001), even in newborns without MRI evidence of preoperative brain injury. Lactate/choline decreased after surgery but remained elevated compared with controls. In newborns with TGA, those with preoperative brain injury on MRI had lower NAA/choline globally (p = 0.04) than those with normal preoperative MRI. Five newborns had a decline in NAA/choline from the preoperative to postoperative studies. CONCLUSIONS: Abnormal brain metabolism and injury was observed preoperatively in newborns with TGA. Brain injury is not solely related to the operative course.