A set of double-angled needle holders and long,angled tissue forceps for use in surgery of the abdomen

A set of double-angled needle holders and long, angled tissue forceps have been designed and presented for use in surgery of the abdomen. The problems of passage and control of curved needles in all directions is well recognized. The marriage of design and presentation addresses the mechanical and anatomic needs of surgeons in the pelvis, subdiaphragmatic area, and in large and obese patients. Multiple variables in use provided by these instruments, particularly when used together, enhance surgical control at problem sites.     

Anakinra treatment for systemic onset juvenile idiopathic arthritis (SOJIA)

SIR, Systemic onset juvenile idiopathic arthritis (SOJIA) accountsfor 10–20% of all patients with JIA, but it accounts forincreased morbidity and mortality compared with other formsof JIA [1]. A significant number of patients have ongoing diseaseactivity despite aggressive treatment. A follow-up study foundthat the probability of disease remission 10 yrs after onsetwas only 37% [2]. Despite a variety of treatments some childrenwith SOJIA have a refractory course with significant morbidity.Pasqual et     

Usefulness of adenosine in augmenting ventricular preexcitation for noninvasive localization of accessory pathways.

Adenosine was administered to test the hypothesis that it would maximize preexcitation and facilitate noninvasive localization of accessory pathways in 22 patients with suspected accessory pathway-mediated tachycardias. Twelve-lead electrocardiograms and 2-dimensional echocardiograms were recorded at baseline and during adenosine-augmented ventricular preexcitation to localize the accessory pathway. Phase analysis was performed on digitized 4-chamber and short-axis views using a first harmonic Fourier transformation. At baseline, 15 patients had manifest preexcitation. In 14 of these patients (93.3%), preexcitation became more prominent after adenosine. Four patients without preexcitation at baseline clearly had it after adenosine. In patients who had preexcitation in response to adenosine, the electrocardiogram correctly identified the accessory pathway locations in 18 of 19 patients at a regional level and was incorrect in 1 of 19 patients. Echocardiographic phase analysis correctly identified the accessory pathway location in all 17 patients, who had technically adequate studies, at a regional level. In conclusion, administration of adenosine accentuates preexcitation, allowing for more accurate electrocardiographic and echocardiographic accessory pathway localization.     

Evaluation of functional capacity during exercise radionuclide angiography

This study compared functional capacity during treadmill exercise testing and during bicycle exercise radionuclide angiography. 262 patients performed maximal upright bicycle exercise and also performed maximal graded exercise testing using either the Bruce (n = 158) or Naughton (n = 104) treadmill protocols. The functional capacity was well correlated between bicycle and treadmill for Bruce (r = 0.89), Naughton (r = 0.93), or combined treadmill (r = 0.90) protocols. However, the functional capacity was significantly lower during bicycle than during treadmill testing for Bruce (8.3 vs. 10.5 METs), Naughton (7.8 vs. 8.7 METs), or combined treadmill (8.1 vs. 9.8 METs) protocols. Treadmill functional capacity could be predicted from bicycle functional capacity using the following equations: Bruce METs = 1.00 X (bike METs) + 2.23, Naughton METs = 0.94 X (bike METs) + 1.40, and combined treadmill METs = 0.98 X (bike METs) + 1.85.     

Luteinizing hormone release after two injections of synthetic luteinizing hormone releasing hormone in the ewe.

Anoestrous ewes were given two injections of 30 mug synthetic luteinizing hormone releasing hormone (LH-RH) separated by one of the following intervals: 1-5, 3, 6, 12 or 24 h. The first injection caused an increase in the plasma LH concentration in each animal. The response to the second injection was dependent on the interval between the injections. When the second injection was administered 1-5 h after the first it caused a further increase in the LH concentration to maximal levels which were significantly greater than those induced in the other anoestrous groups. When the second injection was administered 3 h after the first, there was no significant difference between the responses to the two injections although the time to reach the maximal LH concentration was shorter and the height of the LH peak was greater in each animal following the second injection. When the second injection was administered 6, 12 or 24 h after the first, the LH response was significantly less, in terms of height and area of the induced peak, than following the first injection. The LH response to the second injection was particularly low in the 12 and 24 h groups. Two injections of 30 mug synthetic LH-RH were also administered at 1-5 h intervals to ewes on either day 10 of the oestrous cycle or at onset of oestrus. The pattern of LH responses in all these animals was similar to that observed in anoestrous ewes injected at 1-5 h intervals. The total LH release, as assessed in terms of the induced peaks, was significantly greater in the onset of oestrus group than in the day 10 group or any of the anoestrous groups. Presumably the sensitization-desensitization sequence of the pituitary gland to LH-RH which has been demonstrated, together with the effects of sex steroid hormones, must play an important part in the development and decay of the natural preovulatory LH peak.