Transvaginal cervico-isthmic cerclage: a simple approach

In this article, we describe a relatively simple surgical option that we believe is indicated for use in cases of cervical incompetence. We discuss the advantages of this procedure to the surgeon and patient, and give details of 59 patients who have undergone this procedure one or more times over a 13-year period. A short review of the history of treatment of cervical incompetence and of recent trends for its management is also presented.     

Principles and practice of HIV-protease inhibitor pharmacoenhancement

Continually maintaining maximally suppressive drug concentrations represents a key defence against the emergence of resistance. If drug levels fall and replication occurs, the opportunity for mutant virus to be selected occurs. It has been increasingly recognized that variability in the pharmacokinetics of antiretrovirals, particularly protease inhibitors (PIs), means that drug exposure is not always optimal, giving the virus a chance to replicate. A significant number of patients receiving PIs two or three times daily will have trough (C_trough or C_min) plasma concentrations, which are close to, or below, the plasma protein binding‐corrected inhibitory concentration (IC₅₀ or IC₉₅) during the dosing interval. It is primarily in this context that therapeutic drug monitoring of PIs has been proposed as an aid to patient management, to ensure that patients maintain adequate drug concentrations throughout the dosing interval. Ideally, an antiretroviral drug will have a pharmacokinetic (PK) profile that maintains drug levels well above the viral inhibitory concentration throughout the entire dosing interval. Beneficial drug–drug interactions have been shown to improve PI pharmacokinetics. Ritonavir (RTV) inhibits the key enzymes that limit the bioavailability or speed the metabolism of other PIs. It is therefore increasingly used for boosting and maintaining PI plasma concentrations. At low (100 mg twice a day) doses it acts as a pharmacoenhancer of indinavir (IDV), amprenavir, saquinavir, lopinavir and to a more limited degree nelfinavir. Using a pharmacoenhancer with a PI results in increased exposure to the PI, higher C_min levels, and in most cases prolonged elimination half‐lives. The long‐term clinical benefits of PK enhancing are unknown as are the long‐term toxicities, although the incidence of nephrolithiasis with IDV appears increased when IDV is combined with low‐dose RTV in HIV‐infected patients. Head‐to‐head clinical comparisons of boosted PI regimens will help answer some of the questions that remain with regard to PK enhancement.     

Intraoperative ultrasound examination of the brain

In a preliminary demonstration of cranial intraoperative real-time ultrasound, both supratentorial and posterior fossa scans displayed the pertinent anatomy. A grade III astrocytoma was visualized on the supratentorial scan as well. Ultrasound may be valuable for surgical planning and biopsy procedures because of its reliable depiction of intracranial anatomy and ease of use.     

Is permanent congenital facial palsy caused by birth trauma?

OBJECTIVE: To study the relation between traumatic birth and the development of permanent facial palsy in the newborn. DESIGN: Retrospective case control study of children with 'congenital' facial palsy. SETTING: Two tertiary referral centres for patients with facial palsy. SUBJECTS: 61 children with established facial palsy. MAIN OUTCOME MEASURES: Odds ratios of recognised factors for birth injury: maternal primiparity, high birth weight, and the use of obstetric forceps at delivery. RESULTS: 13.2% of those studied had forceps assisted delivery compared to 10.2% in the normal population (odds ratio 1.34; 95% confidence intervals 0.61 to 2.97) 39.6% were born to primiparae compared to a national rate of 36.7% (1.13; 0.65 to 1.96) and only 18.9% weighed more than 3500 g at birth (0.37; 0.19 to 0.74). CONCLUSIONS: There is no association between the development of permanent 'congenital' facial palsy and recognised risk factors for birth injury. These data suggest an intrauterine rather than a traumatic aetiology.     

核磁共振法测定喃氟啶温度敏感性脂质体的相转变温度

用核磁共振法测定了喃氟啶温度敏感性脂质体的相转变温度。此法与经典的差热分析法不同,有灵敏度高、准确性好、提供信息全面等优点。用该法测得的DPPC-脂质体和DSPC-脂质体的相转变温度分别为36℃和48℃;DPPC-DSPC-脂质体的相转变温度与DPPC和DSPC的含量有关,随DPPC含量的增加而降低,随DSPC含量的增加而增加;药物的加入及含量不影响相转变温度。同时,制得可供临床前研究用相转变温度为41℃的喃氟啶温度敏感性脂质体。     

Nance-Horan syndrome: a contiguous gene syndrome involving detetion of the ametogenin gene? A case report and molecular analysis

DESIGN: A case of Nance-Horan syndrome in a male is presented, with some features of the condition in his carrier mother and her mother. It is proposed that Nance-Horan syndrome might be a contiguous gene syndrome mapping to chromosome Xp21.2–p22.3.
SETTING: The proband had congenital cataract micro-phthalmia and dental abnormalities including screwdriver shaped incisors and evidence of enamet pitting hypoplasia. The region Xp2I.2–p22.3 also contains the tooth enamet protein gene, ametogenin (AMGX).
RESULTS: Using molecular genetic techniques, we have shown that there is no evidence that the AMGX gene is deteted in this case of the Nance-Horan syndrome.     

Transrectal US as an adjunct in the diagnosis of rectal and extrarectal tumors

Transrectal ultrasound (US; also called endosonography) was used to evaluate known or suspected rectal and perirectal masses. Thirty-one patients were examined with commercially available endosonographic probes. Those who obtained and interpreted the sonograms had no knowledge of other diagnostic studies, which included digital rectal and sigmoidoscopic examinations, conventional US, and computed tomography (CT). All but one patient underwent surgical exploration for diagnoses that included rectal cancers, perirectal abscesses, presacral endometriosis, intramural dermoid of the rectum, and intramural venous angioma. Transrectal US was able to image all masses situated within 12 cm of the anus. Malignant infiltration of perirectal fat and perirectal node involvement were detected at least as accurately with US as with CT, suggesting that this technique is a cost-effective, reliable adjunct for staging rectal cancers.