The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

Objective

This study assessed whether immediate postpartum insertion of levonorgestrel contraceptive implants is associated with a difference in infant growth from birth to 6 months, onset of lactogenesis, or breastfeeding continuation at 3 and 6 months postpartum compared to delayed insertion at 6 to 8 weeks postpartum.

MRI of the fingers in patients with systemic scleroderma. Early results of contrast-enhanced examinations on a dedicated MRI system

Purpose. To estimate disease activity in patients with systemic sclerosis using contrast-enhanced MRI of the skin. Material and Methods. In a pre-study, sequences of a low-field (0.2 T) scanner (Artoscan, Esaote, Genova, Italy) were optimized for detection of intravenous contrast (0.1 mmol/l Gd-DTPA) in six patients with the autoimmune disease systemic scleroderma. Based on the results of the pre-study, 17 patients with scleroderma (7 sclerotic/10 active inflammatory disease) were scanned using gradient-spoiled 3D GRE sequences (FA 90 °, TR 100 ms, TE 18 ms), which had been established as most sensitive for intravenous contrast. Contrast enhancement of the skin was determined quantitatively by contrast-to-noise ratios (CNR), comparing post- to pre-contrast and dynamic scans (for 6 min, 1 acquisition/min). Patients in the chronic state with sclerodactylia and active inflammation of the hands were considered separately and compared to a control group (n = 10) matched according to age. Results. CNR increase after intravenous contrast was significantly higher in patients with active disease (86 ± 16 % increase) than sclerosing disease (29 ± 3 %, p < 0.05) and the control group (4 ± 2 %, p < 0.05). The dynamic examination showed a significantly slower decrease after the peak rise in the first minute in patients with active disease (CNR 15.4 ± 0.7 to 14.2 ± 1.4) than in those with chronic disease (14.1 ± 0.5 to 11.3 ± 0.9, p < 0.05). Discussion. Capillary leakage is the most likely explanation for the increased enhancement in patients with active scleroderma. Using sequences optimized for contrast detection, disease activity in the course of scleroderma and response to therapy can be determined by MRI in the future.      

Temporal lobe dual pathology in malignant migrating partial seizures in infancy.

A child had the characteristic clinical and EEG pattern of migrating partial seizures in infancy with left temporal lobe atrophy, hippocampal sclerosis and cortical-subcortical blurring.Seizures were drug-resistant, with recurring episodes of status epilepticus. The child developed microcephaly with arrest of psychomotor development. Focal brain lesions, in the context of migrating partial seizures, have not been previously reported.[Published with video sequences].     

Risk factors of system clotting in heparin-free haemodialysis

Heparin-free haemodialysis must be considered for all dialysis patients with a risk of haemorrhage. This technique is associated with increased danger of system coagulation with a blood loss of up to 250 ml. In 84 patients with a risk of haemorrhage, 296 heparin-free haemodialyses were recorded prospectively. First signs of coagulation were found very much more frequently in the venous airtrap than in the dialyser (146 vs 42). System coagulation occurred in 13 of the 296 dialyses (4%) and was prevented by prophylactic switching of the system and dialyser in 140 dialyses (47%). The time of system coagulation was on average 1.8 hours (+/- 0.2) after the beginning of dialysis. The 13 patients with system coagulation had a reduced blood flow on dialysis (217 +/- 52 vs 240 +/- 36 ml/min). Their initially normal clotting time (12 +/- 5 vs 14 +/- 4 min) was more significantly shortened after 2 h (4 +/- 3 vs 8 +/- 3 min). The activities of antithrombin III (87 +/- 34% vs 88 +/- 39%) and protein C (66 +/- 45% vs 59 +/- 37%) do not differ from those of 47 other patients, even at the time of system coagulation, as measured in five patients (92 +/- 34% for antithrombin III, 51 +/- 29% for protein C). System coagulation and shortening of clotting time thus cannot be regarded as a consequence of absorption of these inhibitory factors of plasmatic coagulation. The danger of system coagulation in heparin-free haemodialysis could probably be further reduced by an improvement of the biocompatibility of systems (airtrap) and dialysers (less activation of thrombocytes).     

Retroperitoneoskopie – Erfahrungen mit den ersten 200 Fällen

Zusammenfassung. Der retroperitoneale Zugang findet breite Anwendung bei offenen Operationen in der Urologie. Mit Einführung der Ballondissektionstechnik konnte dieser anatomische Zugang auch für laparoskopische Operationen genutzt werden. Material und Methode: Zwischen 12/1992 und 10/1997 wurden 200 retroperitoneale Operationen an 197 Patienten (Alter 4–82 Jahre) durchgeführt: 78 Nephrektomien, 50 Nierencystenresektionen, 14 Nephropexien, 11 Ureterolysen, 8 retroperitoneale Lymphadenektomien, 8 Nierenbiopsien, 6 Adrenalektomien, 6 Heminephrektomien, 6 Pyeloplastiken, 5 Ureterolithotomien, 6 Ureterocutaneostomien sowie 2 andere. 38 Patienten (19 %) waren bereits abdominell , 22 (11 %) an Niere und Ureter voroperiert. Die Pr?paration des Retroperitonealraums erfolgte in 14 F?llen mit Hilfe eines Ballonkatheters, in 93 F?llen mittels eines Ballontrokarsystems, w?hrend in den letzten 93 F?llen eine Pr?paration des Retroperitoneums mit dem Zeigefinger sich als ausreichend erwies. Ergebnisse: Die Eingriffe wurden wie folgt klassifiziert: 76 einfache Operationen (z. B. Nierenbiopsie, Nierencystenresektion, Ureterocutaneostomie), 102 schwierige (z. B. Adrenalektomie, Nephrektomie, Nephropexie) und 22 sehr schwierige Eingriffe (z. B. Pyeloplastik, Heminephrektomie, Lymphadenektomie). W?hrend der ersten 50 F?lle zeigte sich eine signifikante Lernkurve, welche sich in einer h?heren Operationszeit und Komplikations- sowie Konversionsrate widerspiegelte. Abh?ngig vom Schwierigkeitsgrad des Eingriffs betrugen die mittlere Operationszeiten 45–100 min bei leichten Eingriffen, 95–185 min bei schwierigen und 185–240 min bei sehr schwierigen Operationen. In den letzten 50 F?llen war die Komplikations-, Konversions- sowie Reinterventionsrate mit offenen Eingriffen vergleichbar (2, 4 und 2 %). Schlu?folgerung: Nach mehr als 200 retroperitoneoskopischen Eingriffen wurde die Zugangstechnik bedeutend vereinfacht, so da? das Verfahren heute standardisiert, sicher und reproduzierbar ist.      

CD1a and antitumour immune response

Primary immune response is based on the capacity of local professional antigen-presenting cells (whose prototype is represented by dendritic cells, DCs) to take up and present antigens to selected clones of T cells, but also to non-specific effector cells such as macrophages or natural killer cells. The four CD1 proteins, all of which share a limited homology to class I MHC proteins, are differently expressed in various cell types, of both mesenchymal and, as recently described, epithelial lineage. Regarding the role of CD1 molecules in the anti-tumour response, it has been reported that CD1+ dendritic cells are involved in the first steps of the primary immune response in a number of malignancies. Moreover, the presence of a high number of DCs in the tumoral or peritumoral area, as well as in the draining lymph nodes, has been shown to correlate with a better prognosis. A recent report on the presence of CD1a in metaplastic epithelial cells of Barrett esophagus introduced new questions about CD1a expression patterns. Moreover, the strong correlation between the lack of CD1a+ cells and the malignant evolution of the lesion may indicate a possible role of non-professional APCs in mediating and/or potentiating immune responses to tumours.