Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis

Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary artery disease. The routine management of hypertriglyceridemia is dietary restriction of fat and lipid-lowering medications to manage the secondary or precipitating causes of hypertriglyceridemia. However, in cases of AP with severe hypertriglyceridemia (SHTG) (triglycerides [TG] >1000 mg/dl) rapid reduction of TG levels to well below 1000 mg/dl can improve outcome and prevent further episodes of pancreatitis. Plasmapheresis is a therapeutic option in such medical emergencies. We discussed 2 cases of severe AP with SHTG where we used early plsmapheresis along with other supportive management.     

Ultrasound-Guided Femoral Dialysis Access Placement: A Single-Center Randomized Trial

Background and objectives: Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmark-guided technique (ALT) for the femoral vein (FV).Design, setting, participants, & measurements: This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.Results: Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P = 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P = 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P = 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).Conclusions: USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.Initiation of hemodialysis is an integral part of the management of patients with renal failure. This mandates the placement of a dialysis catheter (DC) in a central vein of sufficient caliber to permit the high blood flow rates required for successful dialysis. Common sites for DC insertion include the internal jugular vein (IJV), subclavian vein (SCV), and femoral vein (FV) (1). There is a higher incidence of thrombosis and higher rates of complications associated with SCV insertion, hence IJV and FV are generally preferred (2) The major deterrent to FV catheter placement was a high risk of infection, but recent data indicate that FV catheterization is not associated with any higher risk of infection than IJV catheterization (3).Hence, FV catheterization, especially with tunneled catheters, may become a more preferred site for catheterization because of its comparative ease of insertion and lower risk of complications (4). Although there are numerous studies proving the superiority of the ultrasonography-guided (USG) technique over the anatomical landmark-guided technique (ALT) for IJV catheter insertion, the same has not been conclusively demonstrated for FV catheterization. This prompted us to undertake this study.     

Modulation of allogeneic stimulation in man. I. Characterization of an in vitro induced suppressor macrophage population

Cultured human peripheral blood mononuclear cells suppressed the allogeneicresponse of fresh autologous lymphocytes. This suppressor activity developed gradually over a period of one week. The cells primarily responsible for this effect were enriched by Ficoll density gradient centrifugation. It was found that the suppressor cell is a large, low density nylon wool adherent, radioresistant, phagocytic, and nonspecific esterase positive mononuclear cell. Moreover, these cells did not form E rosettes and were Fc positive. Electron microscopy confirmed that suppressor cells were macrophagelike. Suppressor activity was not due to cytotoxicity, crowding, or steric hindrance by the cultured cells. The suppressor macrophage population did not appear to inhibit the allogeneic response via prostaglandin or arginase release, or interfere with the tritiated thymidine uptake by release of endogenous thymidine. The above system is viewed as an in vitro model of immune regulation by suppressor macrophages, in the context of allogeneic response.     

Parental occupational exposure to pesticides,animals and organic dust and risk of childhood leukemia and central nervous system tumors: Findings from the International Childhood Cancer Cohort Consortium (I4C)

Parental occupational exposures to pesticides, animals and organic dust have been associated with an increased risk of childhood cancer based mostly on case–control studies. We prospectively evaluated parental occupational exposures and risk of childhood leukemia and central nervous system (CNS) tumors in the International Childhood Cancer Cohort Consortium. We pooled data on 329,658 participants from birth cohorts in five countries (Australia, Denmark, Israel, Norway and United Kingdom). Parental occupational exposures during pregnancy were estimated by linking International Standard Classification of Occupations-1988 job codes to the ALOHA+ job exposure matrix. Risk of childhood (<15 years) acute lymphoblastic leukemia (ALL; n = 129), acute myeloid leukemia (AML; n = 31) and CNS tumors (n = 158) was estimated using Cox proportional hazards models to generate hazard ratios (HR) and 95% confidence intervals (CI). Paternal exposures to pesticides and animals were associated with increased risk of childhood AML (herbicides HR = 3.22, 95% CI = 0.97–10.68; insecticides HR = 2.86, 95% CI = 0.99–8.23; animals HR = 3.89, 95% CI = 1.18–12.90), but not ALL or CNS tumors. Paternal exposure to organic dust was positively associated with AML (HR = 2.38 95% CI = 1.12–5.07), inversely associated with ALL (HR = 0.55, 95% CI = 0.31–0.99) and not associated with CNS tumors. Low exposure prevalence precluded evaluation of maternal pesticide and animal exposures; we observed no significant associations with organic dust exposure. This first prospective analysis of pooled birth cohorts and parental occupational exposures provides evidence for paternal agricultural exposures as childhood AML risk factors. The different risks for childhood ALL associated with maternal and paternal organic dust exposures should be investigated further.     

Distribution and determinants of intraocular pressure in a normal pediatric population

PURPOSE: To examine the intraocular pressure (IOP) of a normal pediatric population under topical anesthesia without sedation and its correlation with other ocular parameters. SUBJECTS AND METHODS: The IOP of 810 eyes of 405 patients with ages ranging from 0 to 12 years was measured using the Perkins applanation tonometer. Cooperative patients also underwent pachymetry, refraction, and biometry measurements. RESULTS: The mean (+/- standard deviation) age was 6.68 (+/- 3.28) years, with a mean (+/- standard deviation) IOP of 12.02 (+/- 3.74) mm Hg. IOP showed an increasing trend with age (correlation coefficieit [r] = 0.49) and tended to approach adult levels by 12 years of age. The IOP correlated directly with refraction (r = 0.69) and pachymetry (r = 0.39) and inversely with axial length (r = -0.1). CONCLUSIONS: The IOP in children is much lower than that in adults. It was noted to increase with age, hyperopia, and corneal thickness and was inversely proportional to axial length.     

Current role of high dose vitamin C in sepsis management: A concise review

Sepsis and septic shock are common diagnoses for patients requiring intensive care unit admission and associated with high morbidity and mortality. In addition to aggressive fluid resuscitation and antibiotic therapy, several other drugs have been tried as adjuvant therapies to reduce the inflammatory response and improve outcomes. Vitamin C has been shown to have several biological actions, including anti-inflammatory and immunomodulatory effects, which may prove beneficial in sepsis management. Initial trials showed improved patient outcomes when high dose vitamin C was used in combination with thiamine and hydrocortisone. These results, along with relative safety of high-dose (supra-physiological) vitamin C, encouraged physicians across the globe to add vitamin C as an adjuvant therapy in the management of sepsis. However, subsequent large-scale randomised control trials could not replicate these results, leaving the world divided regarding the role of vitamin C in sepsis management. Here, we discuss the rationale, safety profile, and the current clinical evidence for the use of high-dose vitamin C in the management of sepsis and septic shock.     

Antagonist muscle activity during stretching: a paradox re-assessed

The purpose of this investigation was to examine and compare the simultaneous electromyographic activity from surface and implanted wire electrodes of an antagonist pair of muscles during a reversal stretching technique. Previous studies reported increased electromyographic activity of a muscle being stretched during antagonist muscle activation. Five male subjects performed a stretching method which consisted of active plantarflexion, followed by active dorsiflexion. Adjacent surface and implanted wire electrodes were applied to the soleus and tibialis anterior muscles. Comparison of the surface electrode recordings showed apparent cocontraction during dorsiflexion. However, no activity was observed on the soleus wire electrode trace during the dorsiflexion phase of the stretching method. Power spectral analysis showed a significant (P less than 0.001) frequency shift between plantarflexion (91.9 V2.Hz-1) and dorsiflexion (66.1 V2.Hz-1) from the surface electrode recordings. Cross-correlation between tibialis anterior and surface soleus activity during dorsiflexion provided strong evidence that the apparent electromyographic soleus signal originated in the tibialis anterior muscle with an average of 8.7 ms delay of the surface soleus signal. Although not generalizable to other studies, it was concluded that in this study the tracings from the surface electrodes, which gave the appearance of co-contraction between antagonist muscles, were actually cross-talk between the electrodes. The rationale for antagonist contraction during stretching in order to inhibit contraction of the muscle being stretched is supported with this evidence and is consistent with those studies which show greater range of motion gains using the reversal technique.     

Evaluation of aggressive pulp therapy in a population of vitamin D-resistant rickets patients: a follow-up of 4 cases

This investigation collected clinical and radiographic data from a retrospective chart review of 4 patients receiving prophylactic formocresol pulpotomies and stainless steel crowns following a dental abscess associated with a medical diagnosis of vitamin-D resistant rickets (VDRR) at Texas Scottish Rite Hospital for Children in Dallas, Tex. Clinical and radiographic data were available for 29 primary teeth in 4 children, with follow-up times ranging from 2 years, 1 month to 5 years, 6 months. Based on available recalls of 29 teeth treated following the prophylactic formocresol pulpotomy, 22 failed clinically. The earliest failure occurred at 3 months; the longest time to failure was 3 years, 9 months. No trends were discernable between tooth type and failure rate, although the shorter the time between eruption of the tooth and pulpotomy treatment, the greater the chance of success. Presently, there is not enough evidence to suggest that prophylactic pulpotomy therapy in VDRR patients is beneficial in preserving their primary dentition.