Live Three‐Dimensional Transesophageal Echocardiography in an Unusual Case of Aorto‐Left Ventricular Tunnel with a Large Interventricular Septal Aneurysm

Aorto‐left ventricular tunnel (ALVT) is a rare congenital malformation. We report an unusual case of ALVT with a large interventricular septal aneurysm causing severe aortic regurgitation and left ventricular outflow obstruction diagnosed with real time three‐dimensional transesophageal echocardiography (3D TEE). Real time 3D TEE allows for assessment and novel views of complex cardiac abnormalities and can aid in perioperative monitoring. (Echocardiography 2011;28:E12‐E15)     

Incidence of methemoglobinemia in patients receiving cerium nitrate and silver sulfadiazine for the treatment of burn wounds: A burn center's experience

In 1976, the combination of cerium nitrate and silver sulfadiazine was introduced as a topical therapy for burn wounds. Experience with a locally prepared combination agent has shown physical change of the eschar and delayed subeschar bacterial colonization. A potential systemic complication of this treatment is the development of methemoglobinemia (Met‐Hba) due to the oxidizing nature of Ce(NO₃)₃. Met‐Hba has a spectrum of clinical consequences, ranging from headache and cyanosis to cardiac ischemia, hypotension, and even death. Given the frequent use of this combination agent at our burn center, a retrospective review was conducted to evaluate the incidence of Met‐Hba. A query of pharmacy records revealed 170 patients from January 2005 to October 2009 that had received this treatment. Eighteen patients (～10%) developed Met‐Hba as noted on arterial blood gas (methemoglobin>3%) and only three patients (～2%) had methemoglobin levels >10%. In the majority of cases, there were no clinical symptoms of Met‐Hba. Most patients' relative hypoxia resolved with cessation of treatment; however, five patients required treatment with methylene blue. The presence of Met‐Hba associated with this topical therapy can be diagnosed early by vigilant monitoring, thereby reducing morbidity and mortality. In our experience, cerium combined with silver sulfadiazine is a valuable and safe treatment for deep partial and full‐thickness burn wounds.     

Life‐threatening anaphylactic reaction after the administration of airway topical lidocaine

A 9‐year‐old boy who developed a life‐threatening anaphylaxis reaction of the airway and subsequent dyspnea and circulation collapse because of instilled the topical lidocaine into the airway within 2 min before performing flexible bronchoscopy (FB). FB revealed swollen airway mucosa and extensive foamy secretion that severely compromised the ventilation lumen. Rapid detection with FB and immediate resuscitation, including prompt administration of epinephrine, volume expander, and positive pressure ventilation with pure oxygen via an endotracheal tube, were successfully save the patient's life. Pediatr. Pulmonol. 2011; 46:505–508. © 2010 Wiley‐Liss, Inc.     

Simultaneous Bilateral Carotid Stenting in One Session in High‐Risk Patients

The authors report their experience in treating a group of 6 high‐risk patients with severe bilateral carotid disease by carotid artery stenting in a single session. The patients were men aged 53 to 83 years. All had bilateral, synchronous, symptomatic ischemic disease. Five of the 6 patients had severe bilateral carotid stenoses due to atherosclerotic disease: the sixth had a dissecting aneurysm on one side. All were treated with self‐expandable stents: a distal protection device was used. All stenting procedures were technically successful. Stenoses averaged 84 ± 8% before the procedure and 10 ± 7% after. No procedure‐related complications occurred and no 30‐day postoperative complications were found. One patient experienced bradhycardia and hypotension for 1 day and was treated medically. After careful preparation and perioperative procedures in a selected group of patients, simultaneous bilateral carotid stenting procedures are feasible when required and appear to be relatively safe.     

Combinations of physiologic estrogens with xenoestrogens alter calcium and kinase responses,prolactin release,and membrane estrogen receptor trafficking in rat pituitary cells

Background  

Xenoestrogens such as alkylphenols and the structurally related plastic byproduct bisphenol A have recently been shown to act potently via nongenomic signaling pathways and the membrane version of estrogen receptor-α. Though the responses to these compounds are typically measured individually, they usually contaminate organisms that already have endogenous estrogens present. Therefore, we used quantitative medium-throughput screening assays to measure the effects of physiologic estrogens in combination with these xenoestrogens.     

Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children.

BACKGROUND AND PURPOSE: To evaluate clinical variables for diagnosing childhood acute pyelonephritis (APN) when technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy is not available. METHODS: We retrospectively reviewed the records of 590 children with febrile UTI seen from January 1999 to February 2004. On the basis of DMSA scintigraphy performed within 7 days after admission, they were divided into APN (n = 237) or non-APN (n = 353) groups. Gender, age, clinical presentation, absolute neutrophil count, C-reactive protein (CRP), urinalysis, culture, and sonographic findings were recorded from charts. RESULTS: A CRP level of > or =66.4 mg/L, in patients with >2 days prior to admission had a sensitivity of 71.6% and a specificity of 72.5% for APN. Similarly, a CRP of >27.3 mg/L in patients with < or =2 days prior to admission and a white cell count of >14,990/mm3 had sensitivities of 68.6% and 62.0% and specificities of 66.1% and 63.0%, respectively. Combining two or more variables did not result in better discrimination. CONCLUSIONS: If a DMSA scan is not available, it is reasonable to treat a febrile UTI as APN if the CRP is >66.4 mg/L in a patient with >2 days of fever or if the CRP is >27.3 mg/L in a patient febrile for < or =2 days.     

Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong

We conducted a cross-sectional survey using a self-administered questionnaire among attendees of a well women clinic in Hong Kong during June and July 1998. The study aimed to examine the factors associated with the past and future use of screening services among Chinese women in Hong Kong and their perception of service providers. Of the 430 respondents (64% response rate), 87% were aged 31-50 y, 85% married, 93% attained education to upper secondary school level, and 96% were non-smokers. Nearly all respondents (99%) reported having sexual experience and most of them (87%) had such experience with only one partner; 59% reported having a pap-smear test, 28% a mammogram and 44% a breast self-examination. Women who were health conscious (ate a lower fat diet and performed regular exercise) were more likely to have used the screening service (mammogram and pap-smear test) and performed breast self-examination. Staff manner, privacy and cost were the most common contributing factors for respondent's desire for future use of the screening service. Respondents showed a preference for doctors (70%) over nurses (30%), and females (80%) over males (20%) as their service providers. The findings suggest the need to disseminate appropriate information on screening services among the public to dispel misconceptions about the preference for doctors over nurses and females over males. Improving clinician- and other staff-patient communication would be important for breast and cervical screening programs in Hong Kong.     

The role of endothelin in mediating virus-induced changes in endothelinB receptor density in mouse airways.

Emerging evidence supports a mediator role for endothelin (ET)-1 in airway diseases including asthma. Respiratory tract viral infections, are associated with increased levels of ET and altered ET receptor density and function in murine airways. To determine whether these virus-induced effects are causally linked, perhaps involving ET-1-induced ET(B) receptor downregulation, the current study investigated the influence of in vivo administration of CGS 26303, an ET-converting enzyme inhibitor, on virus-induced changes in ET-content and ET(B) receptor density. CGS 26303 (5 mg x kg(-1) x day(-1)) or placebo was administered to mice via osmotic minipumps implanted subcutaneously. Two days after implantation, mice were inoculated with influenza A/PR-8/34 virus or sham-infected, and all measurements were performed on tissue obtained on the fourth day post-inoculation. Viral infection was associated with elevated levels of immunoreactive ET and decreased densities of ET(B) receptors in murine airways. Both of these effects were attenuated in virus-infected mice that had received CGS 26303. Virus-induced increases in wet lung weight were also inhibited by CGS 26303. Importantly, administration of CGS 26303 had no effect on the titres of infectious virus in the lungs and similarly, viral infection had no effect on the plasma levels of free CGS 26303. In summary, CGS 26303 inhibited the virus-induced changes in both immunoreactive endothelin content and endothelinB receptor density. These findings are consistent with the postulate that the elevated epithelial expression of endothelin-1 during respiratory tract viral infection is a contributing factor in the downregulation of endothelinB receptors in airway smooth muscle. Whether inhibitors of endothelin synthesis attenuate virus-induced exacerbations of asthma or airways hyperresponsiveness remains to be established.