Therapeutic monitoring of teicoplanin in a severely burned patient

It is now well documented that E-cadherin expression correlates inversely with tumor grade in various carcinomas including prostate cancer. We also demonstrated a statistically significant correlation between decreased E-cadherin expression and progression-free period in early stage patients treated by radical prostatectomy and decreased survival in patients with advanced stage disease. We now study the relationship between E cadherin and alpha-catenin expression, because in prostate cancer cell lines, mutational inactivation of the alpha-catenin gene can be the cause of the impaired E-cadherin function. Twenty patients treated by radical prostatectomy and 32 advanced stage patients were evaluated immunohistochemically for E-cadherin and alpha-catenin expression. The results were related to tumor grade and disease progression. Four patients in the radical prostatectomy group had aberrant E-cadherin and alpha-catenin expression and showed disease progression. The other 16 patients were free of progression and had normal E-cadherin and alpha-catenin expression. In the advanced stage group, 4 of 13 patients with normal E-cadherin staining showed aberrant alpha-catenin expression and 2 patients (50%) progressed, compared with only 22% progression in patients with both normal E-cadherin and alpha-catenin expression. The other 19 patients with aberrant E-cadherin and alpha-catenin staining had the poorest prognosis. Our results suggest that loss of alpha-catenin expression could be one of the mechanisms responsible for the loss of E-cadherin-mediated cell-cell adhesion in human prostate cancer and might in some cases provide prognostic information.     

Oxygen transport pattern in burned patient with sepsis under inotropic support

Hemodynamic and oxygen-kinetic data of 16 burn patients with sepsis were analysed to explore relationship between oxygen transport pattern and clinical outcome after dopamine and dobutamine therapy. Two patterns of oxygen transport were shown in the 16 patients. Of them, ten (62.5%) had optimal DO2 and VO2 values (model I), and six (37.5%) had lower DO2 and VO2 values than the optimal (model II). All of 6 patients with model II developed lactic acidosis, septic shock and MOF and died. Two of 10 patients in model I developed MOF, only one died. The results indicate that, in burn patient with sepsis, the decreased response of DO2 and VO2 to inotropic therapy suggests failure of tissue perfusion, oxygen extraction and utilization, and may possibly predict the outcome.     

Cerebral blood flow in the diabetic patient

Asthma affects about 1 in 10 children. The condition is characterized by acute respiratory distress brought on by environmental factors. The condition is treated with medications aimed to reduce reaction to stimulants by the airway. Dental management involves attention to the status of the patient and awareness of stimulants of the reactive airway. Clinical recommendations are provided.     

Variations in the intraoral electromotive force in the electrotherapy of the upper extremities]

We tested the intraoral microwaves under applied electrotherapy in cephalic neuralgia. The tests have been undertaken on 40 patients divided in 4 groups, according to the nature of the metallic components of the prosthetic appliances. There have been withdrawn practical conclusions regarding fixed prosthesis and the use of electrotherapy in the cephalic neuralgia.     

Variations in breast cancer treatment by patient and provider characteristics

PURPOSE: To create a simple and reproducible model of chromic thrombosis for the evaluation of thrombolytic agents and devices. MATERIALS AND METHODS: A stenosis was created in the superficial femoral artery of domestic swine, and autologous blood clot was deposited above the stenosis. Follow-up last for up to 3 months. Degree of clot organization was determined at histologic examination. Two thrombolytic agents, urokinase and collagenase, were used to test this model. RESULTS: There was a 27% delayed recanalization rate with this model. At histologic examination, early thrombus organization was seen at the vessel periphery after 10 days. One-month-old thrombus was substantial but variable in amount. Three-month-old thrombus was completely organized. Neither urokinase nor collagenase proved effective against chronic clot in the doses and time course of this study. CONCLUSION: This simple method yields a chronic porcine clot in a reliable number of domestic swine in 1 month.     

Variations in the postoperative length of stay according to patient characteristics in a general surgery service

With the purpose of identifying factors that explain variations in length of postoperative stay in a general surgery unit, information from 666 clinical records of discharged alive patients was collected. Factors related to the surgical procedure, the severity of the disease and the medical team together with sociodemographic characteristics of the patients were analyzed. Statistical analysis was based on analysis of variance and multiple linear regression. Variables with statistically significant regression coefficients (p < 0.001) were in this order: severity of complications, type of intervention, need for reintervention and severity of diagnosis. Sixty-seven percent of length of stay variation was explained by the included variables. Results allow to suggest an evaluation procedure which takes into account patient and operation characteristics.     

Implantable patient chip]

Currently, enormous innovative developments are taking place in the area of micro-electronics. In particular, advances in the sector of chip card controller ICs make it appear possible to quickly implement theoretical applications which, only just a few months ago would have been considered utopian and would have ended up gathering dust in the developer's drawer. The present paper describes a technical possibility, so far not implementable in practice, for always having personal emergency data available. Only a year or two ago any idea of implanting electronic circuitry employing memory modules would have been immediately dropped again. At the present state of development in the area of microelectronics, however, structures measuring less than 5 microns in length have become a matter of routine, and a personal memory chip in biotolerable packaging and measuring no more than about (5 x 5 x 1) mm3 can now be implanted subcutaneously. At the present time, further application based on the use of the same technological facilities, such as, for example, the cyclic recording and storage of the heart rate, are under discussion.     

Fluid resuscitation in the burned child--a reappraisal

Recent reports have suggested that burned adults may be resuscitated with one half the volumes of Ringer's lactate recommended by the popular Parkland formula (4 ml/kg/% burn). Forty children studied with a mean burn size of 45% were initially estimated to require 3 ml/kg/% (modified Brooke formula) but the actual requirement was greater. Burns of 25%-35% required 3 ml/kg/% but those in excess of 35% required 4 ml/kg/% or more in order to achieve adequate cardiac output. It is likely that this apparent increased need in children as compared to adults is the result of greater metabolic rate and insensible water loss.     

Micrografting in the treatment of severely burned patients

The micrografting technique, employed to treat patients with extensive TBSA burns and reduced areas of healthy donor skin, was assessed simultaneously with traditional mesh grafts (STSG) or Tiersch grafts in the treatment five severely burned subjects (average TBSA burned 35.6 per cent; average per cent of full thickness wounds 32.6 per cent). At the first clinical control on day 6 post-surgery, 93 per cent of the micrografted area was in situ and health; epithelialization of the wound sites was complete at day 21. Meshed STSG yielded 90 per cent attachment at day 6 post-surgery, with epithelialization complete at 12 +/- 2 days post-surgery. Functional results were equivalent no matter what technique was used, while aesthetic results were better in the areas where micrografting was carried out. Although the micrograft technique is labour-intensive, if the expansion needed is at least 1:6, the aesthetic and functional results obtained are comparable to, or better than, those with meshed grafts. Also, large segments of micrograft are not compromised if a small area of mesh becomes detached, and epithelialization is faster and more uniform, enabling a reduction in both infection and length of hospital stay.     

Inhibition of neutrophil chemotaxis by plasma of burned patients: effect of blood transfusion practice

In an ultrasonographic screening study at 11 to 14 weeks' gestation involving 9885 singleton pregnancies, the prevalence of exomphalos was 0.11% (11 cases) and the prevalence of trisomy 18 or 13 was 0.35% (35 cases). The mean maternal age of the screened population was 35 years (range, 15 to 47 years) and a significant association was found between maternal age and both the prevalence of trisomies and the prevalence of exomphalos. Because the frequency of exomphalos in fetuses with trisomy 18 or 13 was 17% and in those with no evidence of these trisomies it was 0.05%, the risk for trisomies in fetuses with exomphalos is 340 times higher than in those without exomphalos.     

Therapy with blood and blood products]

Rare musculoskeletal tumors can be difficult to diagnose by light microscopy or immunohistochemistry. Electron microscopy can be of diagnostic assistance especially if histotype specific ultrastructural features exist. In particular, electron microscopy for uncommon sarcomas such as alveolar soft part sarcoma, parachordoma, atypical Ewing's sarcoma and epithelioid sarcoma may be the diagnostic modality of choice.