The epidemiologic necropsy for abdominal aortic aneurysm

The epidemiologic necropsy measures the occurrence of unsuspected disease through the examination of necropsy records. The estimates of unsuspected disease should approximate what occurs in the living population. The necropsy records of the University of Kansas Medical Center (Kansas City) from 1950 to 1984 were examined for the occurrence rate of abdominal aortic aneurysms. Each adult patient was categorized as (1) without abdominal aortic aneurysm, (2) abdominal aortic aneurysm discovered as a necropsy surprise, or (3) abdominal aortic aneurysm diagnosed or suspected during life. Necropsy detection rates of unsuspected abdominal aortic aneurysms were compared with those found in five published screening surveys. The necropsy detection rate in men was 81 (0.019) of 4155 and was 28 (0.009) of 3142 in women, a difference that was statistically significant. When the necropsy series was adjusted to reflect the same demographic composition as the screening surveys, the results from necropsy and screening were statistically similar. In particular, two surveys from the United Kingdom showed screening detection rates among white men of 0.072 compared with a necropsy detection rate of 0.058. These results further support the use of the epidemiologic necropsy as a research tool for estimating the reservoir of disease in the population.     

Isoflurane for removal of chest drains after cardiac surgery

Thirty-five patients who had undergone uncomplicated cardiac surgery were randomly allocated to receive either Entonox or isoflurane 0.25% in Entonox as inhalational analgesia for the removal of their two chest drains. The gases were presented premixed in high-pressure cylinders and were self-administered by means of a demand valve. The removal of the second drain was more painful than the first but that pain was better controlled by isoflurane 0.25% in Entonox than by Entonox alone.     

Prediction of a small internal jugular vein by external jugular vein diameter

The relationship between internal jugular vein diameter as measured with an ultrasound imaging machine (SiteRite, Dymax) and external jugular vein diameter was studied in 50 anaesthetised patients undergoing elective cardiac surgery. There was an inverse correlation between external jugular vein diameter and internal jugular vein diameter ( r  = −0.47, p < 0.001). All patients with an external jugular vein diameter of 7 mm or greater had an internal jugular vein diameter of less than 15 mm. No patient with an external jugular vein diameter of less than 7 mm had an internal jugular vein diameter of less than 20 mm. No other patient dimension (height, weight, body mass index, neck circumference) predicted internal jugular vein size. These results suggest that a large external jugular vein (i.e. 7 mm or greater in external diameter) may be associated with a small internal jugular vein. A size 5.0-mm internal diameter tracheal tube may be used to provide a rapid assessment of external jugular vein diameter.     

Battered and pregnant: a prevalence study.

We interviewed 290 pregnant women randomly selected from public and private prenatal clinics, 80 per cent of whom were at least five months pregnant (ages 18-43, 42 per cent Latino, 22 per cent Black). Twenty-four women reported physical battering during this pregnancy (44 reported physical battering before the current pregnancy). Eight of the 24 pregnant women had sought medical treatment for injuries sustained; none reported having been assessed by prenatal care providers for abuse.     

Experimental hydranencephaly in the ovine fetus

Hydranencephaly is defined as the replacement of a previously normal brain, in whole or in part, by membranous fluid-filled sacs. The etiology is not well understood, and the time course of development is unknown. Fifteen ovine fetuses were chronically cannulated and had both carotid arteries ligated at 100 days of gestation (term is 145–150 days). They were killed at 1 (n = 4), 2 (n = 6) and 4 (n = 5) weeks post-surgery, and the findings compared with those of 25 age-matched controls. By 2 weeks post-surgery the entire cerebral hemispheres and diencephalon had been replaced by fluid closely resembling cerebrospinal fluid. The choroid plexus, pituitary and brain stem remained outwardly normal, but the cerebellum showed signs of damage. Fetuses maintained normal values for blood gases and hematocrit up to 4 weeks post-surgery, and grew normally. Light microscopy of the brain stem showed significant losses of cell populations in the medulla by 4 weeks. Vascular casting and acute blood flow studies in an additional group of fetuses showed that the entire brain was perfused via the vertebral-occipital anastomosis immediately after acute bilateral carotid clamping, but that the blood flow rate was insufficient to maintain adequate oxygen delivery. Received: 4 August 1995 / Revised, accepted: 30 November 1995     

Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure [published erratum appears in Hum Reprod 1998 Mar;13(3):780]

The aim of the study was to determine whether a prior diagnostic testicle biopsy can predict success or failure of testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) in patients with non-obstructive azoospermia caused by testicular failure, and what is the minimum threshold of sperm production in the testis which must be surpassed for spermatozoa to reach the ejaculate. Forty- five patients with non-obstructive azoospermia caused by testicular failure underwent diagnostic testicle biopsy prior to a planned future TESE-ICSI procedure. The diagnostic testicle biopsy was analysed quantitatively, and correlated with the quantitative findings of spermatogenesis in patients with normal spermatogenesis, as well as with the results of subsequent attempts at TESE-ICSI. Men with non- obstructive azoospermia caused by germinal failure had a mean of 0-6 mature spermatids/seminiferous tubule seen on a diagnostic testicle biopsy, compared to 17-35 mature spermatids/tubule in men with normal spermatogenesis and obstructive azoospermia. These findings were the same for all types of testicular failure whether Sertoli cell only, maturation arrest, cryptorchidism, or post-chemotherapy azoospermia. Twenty-two of 26 men with mature spermatids found in the prior testis biopsy had successful retrieval of spermatozoa for ICSI, 12 of their partners became pregnant, and are either ongoing or delivered. The study suggests that 4-6 mature spermatids/tubule must be present in the testis biopsy for any spermatozoa to reach the ejaculate. More than half of azoospermic patients with germinal failure have minute foci of spermatogenesis which are insufficient to produce spermatozoa in the ejaculate. Prior diagnostic testicle biopsy analysed quantitatively (for the presence of mature spermatids) can predict subsequent success or failure with TESE-ICSI. Incomplete testicular failure may involve a sparse multi-focal distribution of spermatogenesis throughout the entire testicle, rather than a regional distribution. Therefore, it is possible that massive testicular sampling from many different regions of the testes may not be necessary for successful TESE-ICSI.      

Adhesion inhibitory activity of β-lactoglobulin isolated from infant formulae

β-Lactoglobulin was isolated from infant formulae that were ultra high temperature (UHT) -treated, sterilized or spray-dried. The effect of the isolated β-lactoglobulin on SfaII-fimbriae-mediated adhesion of Escherichia coli to human ileostomy glycoproteins was studied in vitro. β-Lactoglobulin isolated from sterilized formulae was found to perform significantly less well than preparations from spray-dried formulae (p = 0:05). Great heterogeneity was observed in the adhesion inhibitory capacity of β-lactoglobulin isolated from UHT-treated formulae. Therefore, no significant difference was observed between UHT-treated and sterilized formulae or spray-dried formulae (p < 0:10). It can be hypothesized that β-lactoglobulin from spray-dried and some UHT-treated infant formulae may affect the colonization of mucous membranes by E. coli strains causing neonatal septicaemia and meningitis.