Evaluation of the ventriculocholecystic shunt—an overview of present practice in adult and pediatric hydrocephalus

Neurosurgical Review - In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the...     

Microbial life at ?13 °C in the brine of an ice-sealed Antarctic lake

The permanent ice cover of Lake Vida (Antarctica) encapsulates an extreme cryogenic brine ecosystem (−13 °C; salinity, 200). This aphotic ecosystem is anoxic and consists of a slightly acidic (pH 6.2) sodium chloride-dominated brine. Expeditions in 2005 and 2010 were conducted to investigate the biogeochemistry of Lake Vida’s brine system. A phylogenetically diverse and metabolically active Bacteria dominated microbial assemblage was observed in the brine. These bacteria live under very high levels of reduced metals, ammonia, molecular hydrogen (H₂), and dissolved organic carbon, as well as high concentrations of oxidized species of nitrogen (i.e., supersaturated nitrous oxide and ∼1 mmol⋅L⁻¹ nitrate) and sulfur (as sulfate). The existence of this system, with active biota, and a suite of reduced as well as oxidized compounds, is unusual given the millennial scale of its isolation from external sources of energy. The geochemistry of the brine suggests that abiotic brine-rock reactions may occur in this system and that the rich sources of dissolved electron acceptors prevent sulfate reduction and methanogenesis from being energetically favorable. The discovery of this ecosystem and the in situ biotic and abiotic processes occurring at low temperature provides a tractable system to study habitability of isolated terrestrial cryoenvironments (e.g., permafrost cryopegs and subglacial ecosystems), and is a potential analog for habitats on other icy worlds where water-rock reactions may cooccur with saline deposits and subsurface oceans.     

Regional anaesthesia for circumcision in adults: a comparative study

Penile block (PB) in adults is not a well-recognized technique. The aim of this study was to compare, in a randomized prospective manner, five different techniques of PB in 250 adults undergoing circumcision with regard to anaesthetic quality, complications and postoperative analgesia. Patients were divided into five groups (50 per group) according to the technique used: Group A — “10, 30–13, 30” approach; Group B — the subpubic approach; Group C — subcutaneous ring block; Group D — a combination of frenulum infiltration and the “10, 30–13, 30” approach; Group E — a combination of frenulum infiltration and the subpubic approach. The number of failed blocks in Groups A and B (41 and 43 respectively) was greater than in Groups C, D and E (2, 3 and 5 respectively) (P < 0.001). The five groups did not differ with regard to adverse effects or time until the onset of postoperative pain when the blocks were successful. It is concluded that good surgical anaesthesia, a low rate of adverse effects and prolonged postoperative analgesia can be achieved by the use of either subcutaneous ring block or a combination of dorsal nerve block (using the “10, 30–13, 30” or the subpubic approach) and infiltration of the frenulum. These approaches to the PB are effective anaesthetic techniques for circumcision in adults.     

The infantile chronic-visceral form of niemann-Pick diseases (author's transl)

A report was made of three patients who exhibited pronounced heptosplenomegaly at the time of hospital admission: a six-year-old girl and two brothers, 1 year 4 months and 4 years 4 months of age. As is typical for Niemann-Pick disease, foam cells were found in the bone marrow and the liver biopsy specimens for the three patients. Since, however, none of the children had syptoms involving the central nervous systems, the disease must have been the rare B form of Niemann-Pick disease, the infantile chronic-visceral form. In all three patients, laboratory findings indicated a disturbance in hepatic function. The characteristic pulmonary involvement associated with the infantile form was found only in the two brothers, and then in a follow-up examination one year later. The reduced speed of nerve conduction established in the two brothers suggested subclinical involvement of the peripheral nervous system in the disease process. Electron-microscopic examinations of liver biopsies showed various forms of lipoid storage: lipoid bodies with loose, membranous structures and bodies with dense, concentrically arranged lamellae.