Neurologic eye signs following motorcycle accidents

A review of 96 consecutive patients who suffered neuro-ophthalmologic injuries in motorcycle accidents revealed a wide range of findings. These findings were similar to signs associated with other forms of closed-head trauma, aside from a higher incidence of trochlear nerve palsies.     

Clinical aspects of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a common and poorly managed condition. Untreated or inadequately treated, it leads to tubal infertility, ectopic pregnancy and chronic pelvic pain. Diagnostic difficulties are compounded by the wide variety of clinical presentations and the insensitivity and poor specificity of laboratory tests. Better recognition of mild and atypical disease needs a high index of suspicion whenever young, sexually active women present with gynaecological symptoms. Laparoscopy supplemented by microbiological tests and fimbrial minibiopsy should be regarded as the diagnostic 'gold standard' for research studies; new studies are required to identify techniques which might reduce under- and over-diagnosis. Early treatment reduces the risk of an adverse effect on fertility. Any therapeutic regimen selected should be effective against the common aetiological agents Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas and aerobic and anaerobic bacteria. Since at least 60% of cases of PID can be attributed to infection with a sexually transmitted organism, partner notification forms an essential part of management.      

Surgical treatment of urinary stress incontinence.

This article reviews traditional vaginal and suprapubic procedures as well as more recent advances such as urethral bulking agents and artificial sphincters. It illustrates how the chosen operation must be tailored to the individual patient and how the surgeon treating urinary incontinence requires a variety of procedures in his repertoire.     

Effect of growth hormone on human alveolar macrophage oxidative metabolism

BACKGROUND: Growth hormone (GH) has diverse immunological actions and has been shown to augment oxidative metabolism in rat peritoneal and porcine alveolar macrophages and both human and animal neutrophils. A study was performed to determine the effects of GH on human alveolar macrophages in vitro. METHODS: Macrophages were harvested from 10 patients undergoing bronchoalveolar lavage and incubated with 0, 10 and 100 nmol/ml GH for four hours. Oxidative metabolism was assessed by means of a fluorescent assay using FMLP and E coli as stimulants. Fluorescence was measured using flow cytometry. RESULTS: No difference in basal or stimulated oxidative metabolism was found between the GH and control groups. CONCLUSIONS: GH does not have a direct stimulatory action on human alveolar macrophages in vitro. However, this does not exclude an indirect effect in vivo. The results contrast with previous studies on animal alveolar macrophages.




     

The microbial flora of in-use blood pressure cuffs

The capacity of blood pressure cuffs to act as vehicles of hospital infection has been recognised. We describe the microbial flora of in-use DINAMAP blood pressure cuffs used in the operating theatres and one recovery room in a teaching hospital. Our results show significant microbial contamination of in-use blood pressure cuffs.     

Percutaneous balloon pericardiotomy in the management of recurrent malignant pericardial effusions

Two patients with recurrent symptomatic pericardial effusions secondary to malignant disease were successfully treated by percutaneous balloon pericardiotomy. Open surgery was avoided and the procedure was completed under local anaesthesia in less than 40 minutes. The first patient was free of recurrence at nine months but pericardial effusion recurred at two months in the second patient.Percutaneous balloon pericardiotomy offers a potentially important new means of relieving recurrent tamponade and substantially reduces trauma to the patient.     

Prevalence of asymptomatic bacteriuria in subjects with NIDDM in San Luis Valley of Colorado

This study examined whether non-insulin-dependent diabetic (NIDDM) subjects have an increased prevalence of asymptomatic bacteriuria compared with subjects with normal glucose tolerance. Diabetic (n = 206) and normal (n = 418) subjects were identified from a defined geographic area in the San Luis Valley of southern Colorado. Presence of asymptomatic bacteriuria was determined by testing the subjects' urine with a reagent-strip test for nitrite and leukocyte esterase (Chemstrip LN). The ability of the Chemstrip LN to detect bacteriuria was evaluated by comparing its results with those from urine culture on a subsample of subjects. There were 7 control and 12 diabetic subjects with bacteriuria as measured by the Chemstrip LN. The prevalence of urinary tract colonization among diabetic compared with control subjects was increased 3.5-fold (95% confidence interval 1.4-8.6). Adjustment for confounding by age, sex, ethnicity, and county of residence resulted in an adjusted prevalence ratio of 4.4 (95% confidence interval 1.1-17.4). Among diabetic subjects, prevalence of bacteriuria increased with longer disease duration but was not affected by measures of glucose control. We conclude that NIDDM increases the prevalence of bacterial colonization of the urine and, therefore, probably also increases the risk of symptomatic urinary tract infection.     

Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations.

OBJECTIVE: The aim of this study was to assess the significance of malperfusion syndromes in patients with acute type A aortic dissection following a contemporary surgical management algorithm and the effects on morbidity, hospital mortality, and long-term survival. We believe that obliteration of the primary tear site with restoration of flow in the true aortic lumen results in decreased need for revascularization of malperfused organ systems. METHODS: Our operative approach aims at replacing the entire ascending aorta, resuspension of the aortic valve with repair or replacement of the sinus segment, and routine open replacement of the arch under hypothermic circulatory arrest with retrograde cerebral perfusion with obliteration of false lumen at the distal arch/proximal descending thoracic aorta, thus reestablishing normal flow in the descending thoracic true lumen. From January 1993 to December 2004, 221 consecutive patients underwent repair of acute type A aortic dissection at our institution. Data were collected retrospectively and prospectively. Various types of malperfusion syndromes were present in 26.7% of patients. The organ systems with malperfusion were as follows: cardiac, 7.2%; cerebral, 7.2%; ileofemoral, 12.7%; renal, 4.1%; mesenteric, 1.4%; innominate, 5.4%; and spine, 2.2%. RESULTS: Coronary malperfusion required coronary revascularization in 62.5% of cases. Distal revascularization was needed in 42.9% of patients with ileofemoral malperfusion. Patients with malperfusion were more likely to suffer perioperative myocardial infarction (p<0.001), postoperative coma (p=0.012), delirium (p=0.011), sepsis (p=0.006), acute renal failure (p=0.017), dialysis (p=0.018), and acute limb ischemia (p<0.001). The in-hospital mortality was 30.5% in patients presenting with any malperfusion syndrome while only 6.2% in patients without malperfusion syndrome (p<0.001). Both cardiac (p=0.020) and cerebral malperfusions (p<0.001) were risk factors for in-hospital mortality. The actuarial long-term survival in patients with malperfusion syndrome was estimated by Kaplan-Meier methods to be 67.8%+/-6.1% at 1 year, 54.0%+/-7.0% at 5 years, and 43.1%+/-8.0% at 10 years and for patient without malperfusion 82.7%+/-3.0% at 1 year, 66.3%+/-3.9% at 5 years, and 46.1%+/-6.7% at 10 years (log rank 2.55, p=0.110). Cerebral malperfusion was a significant risk factor for decreased long-term survival (p=0.0002). CONCLUSIONS: The occurrence of malperfusion in patients with acute type A dissection is associated with significant increased risk of in-hospital mortality and complications. Additional revascularization is generally needed in patients with coronary malperfusion and ileofemoral malperfusion. Patients presenting with cardiac and cerebral malperfusions have a high hospital mortality and preoperative cerebral malperfusion is associated with dismal long-term survival.