One-stage versus two-stage Soave pull-through for Hirschsprung's disease in the first year of life

Several investigators have reported good results after a one-stage Soave procedure without a stoma for infants with Hirschsprung's disease. The authors reviewed their concurrent experience with the one- and two-stage approaches, comparing the two groups with respect to rate of complications and clinical outcome. Over a 3-year period, 36 infants with colonic Hirschsprung's disease presenting in the first year of life were treated with a Soave pull-through. Thirteen had a one-stage pull-through, and 23 had a two-stage procedure using an initial stoma. There was no difference with respect to median age at time of diagnosis, median follow-up period, length of aganglionosis, or male:female ratio between the groups. The incidences of major complications such as small bowel obstruction, segmental or acquired aganglionosis, anastomotic leak, and malabsorption were equal between the two groups. However, 13% of the two-stage patients required revision of the stoma. All major complications in the one-stage group were in those who weighed less than 4 kg at the time of surgery. Minor complications such as wound infection, perianal excoriation, and need for repeated dilatation were similar between the groups, but minor stoma-related complications (prolapse or retraction) occurred in 26% of the two-stage infants. When complications were stratified using a more sophisticated scale of severity, no significant difference was found between the groups. The overall complication rate was 1.5 events per patient in the one-stage group and 2.0 events per patient in the two-stage group. This small difference was related to the presence of a stoma in the two-stage group. Overall, 10 of 12 survivors in the one-stage group and 22 of 23 in the two-stage group were doing well, with normal bowel function noted on long-term follow-up (mean period, of 14 and 19 months, respectively). Both one- and two-stage approaches were associated with a significant complication rate, although long-term outcome was excellent in both groups. The higher complication rate in the two-stage group was attributable to the presence of a stoma. For small infants, it may be beneficial to delay the one-stage pull-through until weight exceeds 4 kg.     

Interactions of alpha-lactalbumins with lipid vesicles studied by tryptophan fluorescence

Complexes of alpha-lactalbumin (alpha-LA)1 with dimyristoylphosphatidylcholine (DMPC) or dipalmitoylphosphatidylcholine (DPPC) liposomes at pH 8 and at pH 2 have been obtained by means of gel filtration. Thermal denaturation of alpha-LA complexes of DMPC or DPPC at pH 8 was found to depend on the saturation of protein by metal cations. The intrinsic fluorescence of DMPC-alpha-LA and DPPC-alpha-LA was sensitive to two thermal transitions. The first transition corresponded to the Tc of the lipid vesicles, while the second transition arose from the denaturation of the protein. Fluorescence spectrum position suggested that at low temperature tryptophan accessibility increases upon protein-DMPC or protein-DPPC association. At temperatures above the protein transition (70 degrees C) tryptophan appears to interact significantly with the apolar phase of DMPC and DPPC, evidenced by spectral blue shifts. Whereas the free protein at pH 2 adopts the molten globule (MG) state and is characterized by the absence of a thermal transition, the rapidly-isolated DMPC-alpha-LA complex was characterized by the appearance of a distinct fluorescence thermal transition between 50 and 60 degrees C. This result is consistent with a model of a partially-inserted form of alpha-LA which may possess some degree of tertiary structure and therefore unfolds cooperatively.     

Warfarin and aspirin as thromboprophylaxis in atrial fibrillation

1. Anticoagulant therapy with warfarin is now established as effective thromboprophylaxis against stroke in atrial fibrillation, in high-risk persons. Aspirin is indicated in moderate-risk persons or if warfarin is contraindicated. 2. Risk stratification is suggested, using clinical factors supplemented by echocardiography, to aid choice of prophylaxis. 3. Further studies are required to establish how best to identify undiagnosed patients who have atrial fibrillation; to develop new therapeutic strategies; and to refine risk stratification to define which patients with atrial fibrillation are at the highest risk of stroke.     

Salivary duct carcinoma (clinicopathologic study of 11 cases)

Eleven cases of salivary duct carcinoma were studied clinicopathologically. The clinical features are as follows: men outnumber women; arise most frequently within the parotid glands; rapidly enlarging mass; obvious symptoms of invading nerves; high rates of cervical lymph node and distant metastases; poor patient's prognosis. Its histologic features were shown by the various stages of development of duct carcinoma including dysplasia, carcinoma in situ, papillary, cribriorm, solid and commedo patterns. In addition to the intraductal carcinoma, there is the invasive carcinoma with obvious infiltration into the surrounding tissues. Its treatment requires the combination of radical surgery with postoperative radiotherapy.     

Shortwave infrared hyperspectral imaging for detecting sour skin (Burkholderiacepacia)-infected onions

Sour skin (Burkholderiacepacia) is a major postharvest disease for onions and causes substantial production and economic losses in onion postharvest. In this study, a shortwave infrared hyperspectral imaging system was explored to detect sour skin. The hyperspectral reflectance images (950-1650 nm) of onions were obtained for the healthy and sour skin-infected onions. Principal component analysis conducted on the spectra of the healthy and sour skin-infected onions suggested that the neck area of the onion at two wavelengths (1070 and 1400 nm) was most indicative of the sour skin. Log-ratio images utilizing the two optimal wavelengths were used for two different image analysis approaches. The first method applied a global threshold (0.45) to segregate the sour skin-infected areas from log-ratio images. Using the pixel number of the segregated areas, Fisher’s discriminant analysis recognized 80% healthy and sour skin-infected onions. The second classification approach used three parameters (max, contrast, and homogeneity) of the log-ratio images as the input features of support vector machine (Gaussian kernel, γ = 1.5), which discriminated 87.14% healthy and sour skin-infected onions. The result of this study can be used to further develop a multispectral imaging system to detect sour skin-infected onions on packing lines.