Retroperitoneal seminoma with ''burned out'' phenomenon in the testis

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor without traces of neoplasm in the testis. This condition is different and less common from the primary extragonadal germ cell malignancies. These malignancies are treated surgically with or without adjuvant chemotherapy or radiotherapy and their prognosis is better than that of other types of primary extragonadal tumors.     

Rotablation in the Drug Eluting Era: Immediate and Long‐Term Results from a Single Center Experience

The aim of this study was to investigate the immediate and long‐term outcome of patients who were treated with rotational atherectomy (RA) to facilitate the delivery of drug eluting stents (DES) in heavily calcified lesions. We analyzed 150 consecutive patients who underwent RA and subsequently DES implantation in our institution. The patients had heavily calcified coronary artery lesions requiring plaque modification prior to conventional angioplasty and stent implantation. Rotational atherectomy was performed using the standard Boston Scientific Rotablator^® system. A 2‐burr stepped approach was selected in most of the cases. Following successful modification of the plaque, the angioplasty was performed with a balloon at low pressure to avoid dissection and a DES was implanted. The mean follow up period was 3 years (max. 78 months). Follow‐up data included all cause death, stroke, myocardial infarction (MI), recurrent angina, re‐hospitalization, target lesion revascularization (TLR), target vessel revascularization (TVR), and long‐term duration of dual antiplatelet therapy. The rate of recurrent angina and MI during follow up was low (3.3%) and the overall major adverse cardiac events (MACE) rate was 11.3%. No MACE occurred during hospitalization. There was no relationship between discontinuation of clopidogrel and occurrence of death or MI. The combined approach of RA‐DES has a favorable effect when dealing with heavily calcified lesions in both the angiographic and clinical outcomes. No safety concerns are observed up to 6 years. (J Interven Cardiol 2010;23:249–253)     

RIB CAGE CONTRIBUTION TO RESTING AND CARBON DIOXIDE STIMULATED VENTILATION DURING 1 MAC ISOFLURANE ANAESTHESIA

Using respiratory inductive plethysmography, we have measuredrib cage and abdominal motion during isoflurane anaesthesiain 16 healthy day-surgery patients. Anaesthesia was inducedwith propofol and maintained with 1 MAC isoflurane in air-oxygenvia a laryngeal mask. Measurements were taken during both restingventilation and hyperpnoea induced by rebreathing carbon dioxide.For resting ventilation, the rib cage contributed a mean (sd)of 33 (15) % of the total ventilation whilst awake, and 39 (12)% during anaesthesia (ns). With increasing end-tidal carbondioxide whilst awake, the subjects showed a mean increase inthe percentage rib cage contribution of 7.1 (12.5)%lkPa of carbondioxide. With isoflurane anaesthesia, there was significantdepression of this rib cage recruitment with the mean contributiondecreasing by 3.6 (7.4) % kPa^–1(P < 0.05). These resultsindicate that 1 MAC of isoflurane does not selectively depressrib cage motion, except during carbon dioxide stimulated hyperpnoea.     

External Characteristics of Unsteady Spray Atomization from a Nasal Spray Device

The nasal route presents an enormous opportunity to exploit the highly vascularized respiratory airway for systemic drug delivery to provide more rapid onset of therapy and reduced drug degradation compared with conventional oral routes. The dynamics of atomization at low injection pressure is less known as typical spray atomization studies have focused on industrial applications such as fuel injection that are performed at much higher pressure. An experimental test station was designed in house and an alternative method to characterize the external spray is presented. This involved the use of high-speed camera to capture the temporal development of the spray as it is atomized through actuation of the spray device. An image-processing technique based on edge detection was developed to automate processing through the large number of images captured. The results showed that there are three main phases of spray development (prestable, stable, and poststable) that can be correlated by examining the spray width. A comparison with a human nasal cavity is made to put into perspective the dimensions and geometry that the spray atomization produces. This study aimed to extend the current existing set of data to contribute toward a better understanding in nasal spray drug delivery.     

Oral ketamine

Four cases of severely mentally handicapped young adults requiring day care dental treatment are reported. All had required varying degrees of restraint during previous dental treatments, which had been distressing for the patient, the relatives and the ward staff. In all cases, administration of oral ketamine 10 mg/kg, 30-60 minutes before the procedure, facilitated subsequent induction of anaesthesia.     

Endothelin-1 in children with acute poststreptococcal glomerulonephritis and hypertension

BACKGROUND: Endothelin-1 (ET-1), the most potent vasoconstrictor peptide, is known to play a role in arterial hypertension. In patients with acute poststreptococcal glomerulonephritis (APSGN) an increase in the production of ET-1 is suspected due to damaged endothelium, platelet activation and increased thrombin production in the glomeruli. The aim of the present study was to investigate whether the levels of plasma ET-1 are elevated in children with APSGN. Furthermore, we examined the association between plasma ET-1 levels and blood pressure levels in the same children. METHODS: We studied 18 children (14 boys) with APSGN (mean age 7.44 to approximately 2.82 years). Fourteen healthy children served as controls. The following parameters were evaluated: plasma ET-1, plasma atrial natriuretic peptide (ANP), plasma renin (Rn), serum aldosterone (Aldo), creatinine clearance (Ccr) and fractional excretion of sodium (FENa). RESULTS: The mean plasma ET-1 concentrations were higher in patients with APSGN (3.39 to approximately 1.86 pg/mL) compared to controls (1.40 to approximately 0.15 pg/mL; P=0.0001). Patients with APSGN also had higher plasma ANP concentrations (41.67 to approximately 27.99 pg/mL) than the controls (22.80 to approximately 4.24 pg/mL; P=0.011). Plasma Rn concentrations were lower in patients (24.54 to approximately 16.34 microU/mL) compared to controls (56.76 to approximately 32.36 microU/mL; P=0.027). A positive correlation was found between ET-1 plasma concentrations and the height of systolic or diastolic blood pressure (r=0.57, P=0.013 and r=0.53, P=0.023, respectively). CONCLUSIONS: Our results suggest that increased plasma ET-1 concentrations may play an important role in the pathogenesis of hypertension in children with acute poststreptococcal glomerulonephritis.