Retrograde Inversion Stripping as a Complication of the Clarivein? Mechanochemical Venous Ablation Procedure

The endovenous revolution has accelerated the development of new techniques and devices for the treatment of varicose veins. The ClariVein^® mechanochemical ablation device offers tumescentless treatment with a rotating ablation tip that can theoretically become stuck in tissue. We present the first report of retrograde stripping of the small saphenous vein without anaesthesia following attempted use of the ClariVein^® device, without adverse sequelae.     

Admission inflammatory markers and isolation of a causative organism in patients with spontaneous spinal infection

Introduction

The purpose of this study was to investigate the significance of the inflammatory markers on admission in the isolation of a causative pathogen in patients with spinal infection. Spinal infection is treated frequently at spinal units and can encompass a broad range of clinical entities. Its diagnosis is often delayed because of the difficulty of identifying the responsible pathogen.

Methods

Patients with spinal infection treated in our institution over a period of eight years were identified and their notes studied retrospectively. Admission C-reactive protein (CRP), white cell count (WCC) as well as co-morbidities and mode of pathogen identification were recorded. Overall, 96 patients were included in the study.

Results

The CRP levels on admission were correlated significantly with the overall potential for isolation of a pathogen (p<0.0001) and positive biopsy cultures (p=0.0016). Admission WCC levels were associated significantly with the overall potential for isolation of a pathogen (p=0.0003) and positive biopsy cultures (p=0.0023). Both CRP and WCC levels were significantly negatively correlated with the duration of the preceding symptoms (p=0.0003 and p<0.0001 respectively). Delay in presentation was significantly negatively correlated with organism isolation (p=0.0001). Multivariate analyses identified the delay in presentation as the strongest independent variable for organism isolation (p=0.014) in cases of spontaneous spinal infection when compared with the admission CRP level (p=0.031) and WCC (p=0.056).

Conclusions

In spontaneous spinal infection, delay in presentation is the strongest independent variable for organism isolation. High inflammatory marker levels on admission are a useful prognostic marker for the overall potential of isolating a causative organism either by blood cultures or by biopsy in patients with negative blood cultures. Furthermore, the admission inflammatory marker levels allow for treating surgeons to counsel their patients of the likelihood of achieving a positive microbiological yield from biopsy.     

Pelvic ultrasound findings in different forms of sexual precocity

Recently produced reference curves for various ultrasound dimensions were used to retrospectively assess 67 pelvic ultrasound scans carried out at the initial presentation in girls with sexual precocity. At presentation the group with precocious puberty had significantly increased uterine lengths and ovarian volumes compared with the normal population, and a significantly increased fundal–cervical ratio. Ovarian volume was also significantly increased in thelarche and thelarche variant. The fundal–cervical ratio was significantly increased in thelarche variant. There was considerable overlap between individuals with sexual precocity and normal subjects. The ultrasound findings that best discriminated early or precocious puberty from other forms of sexual precocity were the presence of a midline endometrial echo, and a uterine length above the 97th centile for age. An entirely normal pelvic ultrasound at presentation did not rule out the possibility of precocious puberty.     

The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients

Transesophageal echocardiography (TEE) is an invaluable intraoperative diagnostic monitor that is considered to be relatively safe and noninvasive. Insertion and manipulation of the TEE probe, however, may cause oropharyngeal, esophageal, or gastric trauma. We report the incidence of intraoperative TEE-associated complications in a single-center series of 7200 adult cardiac surgical patients. Information related to intraoperative TEE-associated complications was obtained retrospectively from the intraoperative TEE data form, routine postoperative visits, and cardiac surgical morbidity and mortality data. The overall incidences of TEE-associated morbidity and mortality in the study population were 0.2% and 0%, respectively. The most common TEE-associated complication was severe odynophagia, which occurred in 0.1% of the study population. Other complications included dental injury (0.03%), endotracheal tube malpositioning (0.03%), upper gastrointestinal hemorrhage (0.03%), and esophageal perforation (0.01%). TEE probe insertion was unsuccessful or contraindicated in 0.18% and 0.5% of the study population, respectively. These data suggest that intraoperative TEE is a relatively safe diagnostic monitor for the management of cardiac surgical patients. IMPLICATIONS: The overall morbidity (0.2%) and mortality (0%) rates of intraoperative transesophageal echocardiography (TEE) were determined in a retrospective case series of 7200 adult, anesthetized cardiac surgical patients. The most common source of TEE-associated morbidity was odynophagia (0.1%), which resolved with conservative management. These results suggest that TEE is a safe diagnostic tool for the management of cardiac surgical patients.     

Perceptions of cannabis effects a qualitative study among adolescents

The aim of the study was to compare perceptions of cannabis use effects and risks of tolerance effect, withdrawal syndrome, dependence and repercussions on school, social, and familial functioning among adolescent cannabis users and non users. Subjects were 210 adolescents (121 boys, 89 girls; mean age=16.3 1.3) from the department of Pyrénées-Orientales, France. Subjects completed a questionnaire assessing the frequency of cannabis use, the method of using cannabis, and including open-ended questions (What are the different methods of cannabis use? What are their pleasant and unpleasant or negative effects? What are their risks? Do you think that cannabis effects decrease in intensity when you are used to it? When someone is used to cannabis and stop using it (or has no more of it), does she experience craving for cannabis and withdrawal symptoms? What do you think of cannabis use?). Among the subjects, 118 (56.2%) were cannabis users and 92 (43.8%) were non-users. Among users, 27% used cannabis once a Month or less than once a Month, 21%, more than once a Month; 24%, more than once a weeks; 6%, every day; 20%, more than once a day. The methods of using cannabis were joints (76%), bong (40%), pipe (23%), and ingestion (18%). Knowledge of methods of using cannabis was higher in users than non-users: joint (87% vs 64%, p<0.0001), bong (69% vs 21%, p<0.0001), pipe (38% vs 7%, p<0.0001), ingestion (41% vs 13%, p<0.0001). Fifty-four per cent of users reported that cannabis use induces pleasant affects versus 30% of non-users (p=0.0006). They were exhilaration (47% vs 9%), relaxation (40% vs 23%), cheerfulness (21% vs 10%). Twenty-seven percent of users reported that cannabis use reduces negative feelings versus 14% of non-users (p=0.02). To be more open to social relationships was mentioned by 13% of users versus 1% of non-users (p=0.0001). The negative effects that were reported were attention and cognitive impairment (13% of users vs 5% of non users, p=0.05), irritability (8% vs 8%), loss of control (8% vs 8%) and feeling faint (13% vs 6%, p=0.09). Users reported than bong has much quicker and stronger effects than joints. The effects of bong class cannabis as a hard drug. Physical negative effects or risk were reported by 35% of users versus 30% of non-users (p=0.44). Bong users described specific physical risks such as respiratory problems and fainting. No subjects reported the risk of road accidents. Most users and non-users considered that cannabis use causes dependence (60% vs 74%, p=0.03), tolerance (68% vs 60%, p=0.23), and withdrawal symptoms (76% vs 52%, p<0.001). A minority of users and non-users reported that cannabis use causes a deterioration in school functioning (42% vs 20%, p=0.69), in social activities (23% vs 14%, p=0.10) and in family relationships (29% vs 20%, p=0.14). Most of users (56%) had a global positive opinion of cannabis use whereas most non-users (66%) had a global negative opinion of cannabis use. The frequency and methods of use reported in this study compare with the results of a recent study carried out in another town of the south of France. These results suggest that a high proportion of French adolescents are using cannabis and that a high proportion of users utilize bongs. Perception of cannabis effects and risks of tolerance effect, withdrawal syndrome, dependence and repercussions on school, social, and familial functioning differed between users and non-users. Users have more positive beliefs and less negative beliefs about cannabis than non-users. Users reported more frequently pleasant effects and less frequently unpleasant or negative effects, physical risks, risks of dependence, deterioration in school, social, and familial functioning than non-users. However, only a minority of non-users reported negative effects or consequences of cannabis use. None subjects reported a risk of road accident. These results suggest that information on negative effects, risks and repercussions of cannabis use may be a target for prevention intervention.     

Influence of caloric restriction on the development of atherosclerosis in nonhuman primates: progress to date

Caloric restriction (CR) has been observed to retard aging processes and extend the maximum life span in rodents. In an effort to evaluate the effect of this nutritional intervention on physiologic variables in higher species, several nonhuman primate trials are ongoing. In particular, a study evaluating the independent effect of CR on the extent of atherosclerosis was initiated in 1993 in 32 adult cynomolgus monkeys. Therefore, the trial was designed to achieve identical cholesterol intake after animals were randomized to a control group or a calorie-restricted group (30% reduction from baseline caloric intake). The animals were routinely evaluated for glycated proteins, plasma insulin and glucose levels, insulin sensitivity, and specific measures for abdominal fat distribution by CT scans over a 4-year interval. The results from 4 years of intervention demonstrate that CR improves cardiovascular risk factors (such as visceral fat accumulation) and improves insulin sensitivity. In contrast to other primate studies with normolipidemic animals, CR had no independent effects on plasma lipid levels and composition in the presence of equivalent amounts of dietary cholesterol intake. Preliminary analysis of atherosclerotic lesion extent in the abdominal aorta has failed to demonstrate differences between control animals and CR animals. Follow- up studies are being conducted to determine the effect of CR on atherosclerosis extent in coronary and carotid arteries.      

Rectourethral fistula: a rare cause of infertility

Rectourethral fistulas are rare, and infertility due to rectal ejaculation is extremely rare. We report a case of congenital rectourethral fistula presenting as infertility due to rectal ejaculation.