Transjugular intrahepatic portosystemic shunts (TIPS) in children

The transjugular intrahepatic portosystemic shunt procedure is an accepted treatment for adults with complications of portal hypertension. We performed a retrospective review of all pediatric TIPS placements performed at the University of California, San Francisco between 1990 and 1996. Twelve procedures were attempted in nine children, with a mean age (+/- SD) of 9.4 +/- 3.9 years (range, 5 to 15 years) and a mean weight of 31 +/- 18 kg (range, 16 to 70 kg). The indications for TIPS placement were portal hypertension complicated by chronic variceal hemorrhage not controlled with sclerotherapy (n = 7) and hypersplenism with thrombocytopenia (n = 2). TIPS placement was successfully completed initially in seven of nine (78%) patients. Unfavorable vascular anatomy was the cause of failure in two cases. The seven patients who underwent successful TIPS placement were followed up for an average of 136 days (range, 1 to 800 days); two still have patent shunts, three underwent liver transplantation, one had a splenorenal shunt after stenosis, and one died of underlying liver disease. Variceal bleeding was controlled in four of five patients who successfully underwent TIPS placement. Shunt occlusion occurred in four patients; patency was restored by transjugular shunt revision in three, and a splenorenal shunt was performed in one.     

Dissolved organic carbon dynamics in the upper rhone: The influence of side-arms?

Dissolved organic carbon (DOC) dynamics were investigated over a two year period in the Upper Rhǒne River to examine the role of side-arms in providing DOC to the main channel in relation to discharge fluctuations, especially floods. Concentrations of DOC are shown to remain low in space and in time (average 1.5 mg ^?1) and to be more related to global hydrological events (precipitation) than to any local flushing for backwaters during floods. The results do not support the general assumption that side-arms are the providers of DOC to the main channel.     

Traumatic vertebral arterial dissection and vertebrobasilar arterial thrombosis successfully treated with endovascular thrombolysis and stenting

A case of traumatic extracranial vertebral arterial dissection leading to vertebrobasilar thrombosis and respiratory compromise requiring mechanical ventilation was managed with intraarterial thrombolysis and stenting of the vertebral intimal dissection. In contrast to similar, previously reported cases, this critically ill patient made a full recovery, returning to his job as a secondary school teacher.     

Principles of lymphogenic and hematogenous metastasis and metastasis classification

A subpopulation of rabbit polyclonal anti-idiotypic antibody (anti-Id) was previously produced to a murine monoclonal antibody (mAb) (M1875) specific for the bluetongue virus core protein VP7. In this report, mimicry of VP7 by this anti-Id (designated RAb2-A) was functionally analyzed through immunization of Balb/c mice with RAb2-A or purified VP7. Animals immunized with RAb2-A were able to produce an M1875-like Ab3 antibody response with idiotype and epitope specificity resembling that of M1875 without subsequent exposure to the nominal antigen. This conclusion was supported by experiments showing that the RAb2-A-induced Ab3 antibodies (i) reacted specifically with the immunizing anti-Id; (ii) were capable of binding VP7; (iii) inhibited M1875 from binding to VP7; and (iv) inhibited M1875 from binding to RAb2-A. Similarly, mice immunized with purified VP7 also produced antibodies that exhibited characteristics such as idiotype and epitope specificity in common with M1875. No antibody response to VP7 was detected in control groups of mice immunized with either normal rabbit IgG or BHK-21 cell components. Therefore, it can be concluded that rabbit anti-Id RAb-2-A mimics an M1875-defined VP7 epitope sufficiently to function as a surrogate antigen for inducing an anti-bluetongue virus response.     

Position-sensitive superheated-liquid-droplet neutron dosimeter

The one-dimensional (1D) position-sensitive superheated-liquid-droplet dosimeter (SLDD) has been fabricated and tested in the laboratory. The 1D SLDD is fabricated from a 9.525-mm OD, 6.35-mm ID, 20-cm long, Plexiglas-walled tube filled with a mixture of superheated-liquid Freon droplets and host medium glycerol. Washer-shaped piezoelectric acoustic transducers are positioned at both ends of the tube; they determine the number and positions of the acoustic events when the superheated-liquid droplets evaporate upon neutron irradiation. The SLDD is irradiated with the ¹³⁷Cs and ⁶⁰Co γ-sources, as well as ²⁵²Cf neutron source to test for its radiation response and spatial resolution. The SLDD based on the Freon-134a superheated-liquid droplets operating at 20°C and 1 atm is found to be ideal for measuring absorbed neutron dose. This study also proves that the positions of the radiation-induced nucleation acoustic events can be linearly determined from the differences in the transmission times received by the acoustic transducers on the 1D SLDD. The spatial resolution of the neutron depth-dose is 1 mm due the finite response time (1 μs) of the piezoelectric acoustic transducers.     

The road to maturity: navigating between craft and science

C. Ebert presents his views on the state of software engineering as a field, its roots and inherent conflicts, its relationship to other engineering disciplines, where it is headed, and what we can do to influence that direction. T. Matsubara, T. Webb, M. Pezze, and O.W. Bertelsen offer a spectrum of further insights     

Effect of hygiene measures, water sanitation and oral rehydration therapy on diarrhea in children less than five years old in the south of Ivory Coast

BACKGROUND: Gastric sucrose permeability is a noninvasive marker that reliably increases in association with gastrointestinal injury due to use of nonsteroidal antiinflammatory drugs. Despite the effect of Helicobacter pylori infection on the gastric mucosa, in a previous study we were unable to demonstrate that H. pylori infection was associated with abnormal gastric sucrose permeability. Our goal in this study was to explore further whether H. pylori infection changed gastric permeability; therefore, we evaluated the effect of treatment of H. pylori infection on gastric permeability to sucrose and the relation of sucrose permeability to density of polymorphonuclear leukocytes. MATERIALS AND METHODS: Five hundred milliliters of a solution containing 100 gm of sucrose was ingested by the subject at bedtime. Overnight urine was collected and assayed for sucrose by high-performance liquid chromatography. Sucrose permeability was assessed both before and approximately 4 weeks after anti-H. pylori therapy. RESULTS: Seventeen asymptomatic H. pylori-infected volunteers participated; 8 were cured. Sucrose permeability was in the range commonly found in normal controls both before and after anti-H. pylori therapy (mean excretion, 76.3 mg; range, 13-171 mg). Gastric sucrose permeability correlated with the density of polymorphonulcear cell infiltration of the mucosa. Cure of the H. pylori infection was associated with a small but significant decrease in sucrose permeability (98.8 +/- 18 mg to 51.7 +/- 9.8 mg (p = .01). Sucrose permeability was greater in those with a high density of mucosal polymorphonuclear cells compared to those with lower scores (119.5 +/- 4 vs 71.4 +/- 13 for those with scores > or = 5 compared to scores < or = 4; p = .023). Failed therapy resulted in an increase in the mucosal density of polymorphonuclear infiltration and sucrose permeability (56.4 +/- 13 mg-99.7 +/- 19 mg pretreatment vs posttreatment, respectively; p = .031). CONCLUSION: H. pylori gastritis causes a small but measurable increase in gastric permeability to sucrose that may reflect epithelial transmigration of neutrophils.     

Study of the heart rate and energy expenditure of ponies during transport

The energy expenditure and heart rate of five Shetland ponies were measured during transport and compared with the values recorded while they were at rest and walking. Secondary aims of the study were to investigate whether there was any correlation between heart rate and energy expenditure and whether different orientations affected the values to different degrees. The measurements were recorded at one-minute intervals while the ponies were at rest, walking and being transported in four different orientations, on journeys lasting 30 minutes. There were significant increases (P < 0.001) in both heart rate and energy expenditure during transport which were similar to those associated with walking, and there was a strong correlation between the two measurements. There was no conclusive evidence that orientation affected the measurements, but it appeared that rear facing transport might have had the least effect.     

Peer evaluation. A visual picture

To meet the criteria of role accountability, nursing competence and ongoing staff development, an improved peer-evaluation system was designed to continuously monitor these new roles. This peer-evaluation process converts evaluation input into data, giving staff a visual picture of how their performance compares within their peer group. This peer-evaluation process was designed as a tool to assist in staff growth and development, not as a punitive system.