Carbon dioxide gas as a perfusion medium for the sapphire probe in laser ablation of human atheromatous plaques: comparison study with saline

The effectiveness of CO2 gas as a perfusion medium was compared to that of saline in laser ablation of human atheromatous plaque. In an experimental circulation-occlusion model using flowing whole blood, human cadaveric arterial samples were irradiated by a sapphire probe with the Nd-YAG laser. The following experiments were performed: 1) lasing without perfusion, 2) lasing with saline perfusion of the probe, and 3) lasing with CO2 perfusion. Different perfusion flow rates of saline and CO2 were used. Results showed that the mean ablation area was 1.6-fold larger with CO2 than with saline perfusion (P less than 0.05, Student's t test). The mean lateral injury at the site adjacent to the ablation crater and at the area directly facing the probe was not significantly different with either perfusion medium. The larger ablation area with CO2 was probably due to the fact that CO2 is a good insulator for maintaining a higher probe temperature and keeps the probe free of blood debris. In conclusion, our results show that CO2 perfusion facilitates more effective laser ablation of atheromatous plaque than saline perfusion by the sapphire probe with the continuous wave Nd-YAG laser.     

Cutaneous focal mucinosis with spontaneous healing

A case of extensive cutaneous focal mucinosis is described. The patient had insulin-dependent diabetes mellitus with complications in the peripheral circulation. No thyroid abnormality was found. The diagnosis was confirmed by typical clinical appearance, by light and electron microscopy. Shortly after the biopsies were taken, clinical healing became evident - a phenomenon which was clearly seen at the ultramicroscopic level. On the basis of the present case, supported by sparse evidence from the literature, it seems probable that cutaneous focal mucinosis does not present a real neoplasm, but a reactive condition with a possibility of spontaneous healing.     

The analgesic efficacy of acetaminophen, ketoprofen, or their combination for pediatric surgical patients having soft tissue or orthopedic procedures

The combined use of acetaminophen and a nonsteroidal antiinflammatory drug has been shown to provide better postoperative analgesia than either drug alone in several adult studies. However, there are no pediatric studies analyzing similar effects when the currently recommended doses of acetaminophen are used. In a double-blind, placebo-controlled design we randomized 120 children, aged 1-9 yr, undergoing orthopedic or soft tissue surgery, into 3 groups to receive either acetaminophen 60 mg/kg rectally and 40 mg/kg orally, ketoprofen 2 mg/kg IV twice, or the combination of the active drugs. The first drug doses were given at anesthetic induction and the second doses 8 h thereafter. During anesthesia all children received sevoflurane and a continuous infusion of remifentanil. Postoperative pain was evaluated by the behavioral objective pain scale (0-9) for 24 h. The rescue medication was morphine 0.05 mg/kg IV. The primary outcome variable was morphine consumption. For statistical analysis, analysis of variance, chi2 test and Kaplan-Meier survival analysis were used. Morphine requirement was less in the combination than in the acetaminophen group both in the postanesthesia care unit (2.5 +/- 1.7 versus 3.9 +/- 2.1 morphine doses) and during the 24-h postoperative follow-up (4.1 +/- 2.5 versus 5.9 +/- 2.9 morphine doses) (P < 0.05). No differences existed between the ketoprofen and the acetaminophen groups. The objective pain scale scores were lowest in the combination group both in the postanesthesia care unit and in the postoperative ward (P < 0.05). When children were divided based on their surgery, opioid requirement and pain scores were less in the combination than in the parent drug groups only after orthopedic surgery. The combination of acetaminophen 100 mg/kg and ketoprofen 4 mg/kg in a day provided better analgesia and lower pain scores after orthopedic, but not soft tissue, surgery in children.     

Erythrocyte and liver characteristics in low and high glutathione Finn sheep

Selenium-uptake, glutathione peroxidase (GSH-Px), hepatic microsomal cytochrome P-450 and hepatic glutathione contents were studied in Finnsheep. The erythrocytes of low-GSH sheep had higher Selenium uptake and GSH-Px activity than did those in high-GSH animals. The low Se uptake in high-GSH sheep could be due to continuous pumping of Se from the cells into the erythrocytes, which reflects the active role of these cells, compared to those in low-GSH sheep. Significant differences in hepatic microsomal cytochrome P-450 content were found in the two groups of sheep. The greater activity among the low-GSH sheep suggests that they may have more active detoxification mechanisms than the high-GSH animals. The glutathione content in the liver was similar in both high and low-GSH sheep.     

Reconstitution of a hyperinflammatory prostaglandin E2 response to Porphyromonas gingivalis challenge in severe combined immunodeficient mice

BACKGROUND: The purpose of this study was to determine whether lymphocytic cells regulate the monocytic hyperinflammatory trait (MO+) in chronic periodontitis patients. Using a P. gingivalis challenge model in severe combined immunodeficient (SCID) mice, we tested the effects of adoptively transferred human peripheral blood leukocytes from gingivitis and chronic periodontitis diabetic and non-diabetic individuals on monocytic responses. METHODS: This response was examined using the subcutaneous tissue chamber infection model. Three weeks following cell reconstitution, all SCID mice were challenged with 10(9) colony forming units of live P. gingivalis HG405. Chamber contents were collected at day 7 after bacterial challenge for prostaglandin E2 (PGE2) analysis and chamber rejection monitored up to day 30. Gingival crevicular fluid (GCF) samples were collected from all patients for PGE2 analysis. Both chamber fluid- and GCF-PGE2 levels were determined by enzyme-linked immunosorbent assays (ELISA). RESULTS: Significantly elevated GCF-PGE2 levels were found in diabetic as well as in non-diabetic patients with moderate/advanced periodontitis compared to diabetic and non-diabetic subjects with gingivitis/mild periodontitis at P= 0.01 and P= 0.001, respectively. As reflected in chamber fluid PGE2 levels and percentage chamber rejection, lymphocytic sensitization to P. gingivalis occurred in both diabetics and non-diabetics with moderate/advanced periodontitis, but not in diabetics and non-diabetics with gingivitis/mild periodontitis. CONCLUSIONS: These results suggest that the exaggerated monocytic inflammatory response trait (MO+) associated with moderate/advanced chronic periodontitis is due, at least in part, to lymphocytic modulation, while the directional findings for lymphocytes from diabetic subjects deserve further investigation. Our findings further demonstrate that the SCID mouse model is a useful animal model to study human immune responses to periodontal microorganisms.     

Development and psychometric properties of the Individualized Care Scale

RATIONALE, AIMS AND OBJECTIVES: In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients' views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization. METHOD: Three different data sets were collected among patients being discharged from hospital (n1 = 203, n2 = 279, n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view. RESULTS: The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85-0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB. CONCLUSIONS: The ICS has demonstrated promise as a tool for measuring patients' evaluations of their hospital experience and individuality in care.     

Parental alcohol misuse is a powerful predictor for the risk of traumatic brain injury in childhood

Background: Although the positive relationship between parental alcohol use and children's injuries is well established, it is not known whether parental alcohol misuse is a risk factor for traumatic brain injuries (TBIs) of their children and whether subjects with childhood TBI have hazardous drinking habits in adolescence.

Methods: The authors conducted a longitudinal cohort study at Oulu University Hospital. The cohort consisted of 12 058 subjects born in 1966, of which 207 had sustained TBI before the age of 14 years. Data on parental alcohol problems were obtained from the Finnish Hospital Discharge Register and the adolescents' drinking habits were analysed based on a postal inquiry at the age of 14 years.

Results: Parental alcohol misuse (RR 1.99, CI 1.19-3.33) and male gender (RR 1.53, CI 1.12-2.08) significantly predicted the risk of childhood TBI. Drinking to intoxication at the age of 14 was significantly associated with parental alcohol misuse (RR 1.62, CI 1.34-1.96), belonging to a one-parent family (RR 1.80, CI 1.61-2.02) and mild TBI (RR 1.67, CI 1.20-2.33).

Conclusions: It was observed that parental alcohol misuse is a major risk factor for TBI in children and drinking to intoxication is a common drinking pattern of adolescents who have sustained TBI in childhood.     

Sleep disturbances in aspartylglucosaminuria (AGU): A questionnaire study

Summary Sleep disturbances are common in many progressive metabolic encephalopathies. The possible presence of disturbed sleep–wake behaviour in the lysosomal storage disorder aspartylglucosaminuria, has not been previously studied, however. The sleep–wake behaviour of 81 patients with aspartylglucosaminuria (AGU, age 3–55 years, median 22 years; 42 female and 39 male) and 49 controls (age 2–57 years, median 18 years; 25 female and 24 male) was assessed through a postal survey. A slightly modified version of the validated Basic Nordic Sleep Questionnaire was used. Fifty-eight per cent of the AGU patients were reported to suffer daily from a sleep-related problem (controls 31%, p < 0.01). In AGU adults (age >17 years) and children (age ≤17 years), the corresponding figures were 52% and 61%, respectively (control children 22%, p < 0.05 and control adults 38%, p = 0.06). In AGU children, settling difficulties were reported to occur significantly more commonly than in control children. Children with AGU were also reported to snore more often than were the controls. Adults with this disorder were found to suffer from severely fragmented night-time sleep, which was experienced as highly distressing by the parents and other caregivers. A long night sleep period was reported to be common in the ageing AGU patients (AGU 9.5 ± 1.7 vs controls 7.2 ± 1.0 h, mean ± SD, p < 0.001). Parents and caregivers also often complained about disturbing movements during sleep in AGU patients. In conclusion, both children and adults with aspartylglucosaminuria were reported to display several types of sleep disturbances significantly more commonly than healthy controls. Competing interests: None declared