Gastroschisis: a radiological and clinical review

The paediatric patient we are describing suffered a scald injury covering 83 per cent of the total body surface area (TBSA). This injury was complicated by Klebsiella pneumoniae septicaemia resulting in multiorgan failure (MOF). Acute respiratory distress syndrome (ARDS), gastrointestinal insufficiency, hepathopathy and wound conversion to full thickness posed the main problems. The boy was ventilated with pressure-controlled mechanical ventilation. The concept of permissive hypercapnia (PHC) resulted in a complete resolution of ARDS within 4 weeks. From our experience, further lung injury among infants and children suffering from severe ARDS can be avoided by using controlled mechanical hypoventilation. It is a simple and safe technique that allows adequate oxygenation.     

Outcome in elderly injured patients: injury severity versus host factors

To evaluate the differences between the outcome of elderly patients with severe injuries and that of their contemporaries with a less severe injury, we reviewed 42 severely injured elderly patients and compared them with 76 patients with a femoral neck fracture. We analysed the influence of injury severity and host factors (age, sex and pre-injury medical status) on outcome. The in-hospital mortality rate was 31 per cent in the severely injured patients and 3 per cent in those with a femoral neck fracture. Home was the main discharge destination in the severely injured elderly (34 per cent) and a nursing home in patients with a femoral neck fracture (65 per cent). Functional outcome 1 year after injury was better in the severely injured elderly group. Long-term survival was mainly determined by host factors and not by injury severity. Physicians and policy makers should be careful in predicting the outcome of elderly injured patients merely on the basis of injury severity, because host factors are of greater importance.     

Validation of multifrequency bioelectrical impedance analysis in monitoring fluid balance in healthy elderly subjects

BACKGROUND: Multifrequency Bioelectrical Impedance Analysis (MFBIA) is a novel method to assess body composition in elderly subjects. However, it is unclear whether MFBIA can detect changes in body water compartments in elders. We aimed to determine the within-subject variability of MFBIA and the responsiveness to a diuretic intervention in aged subjects with a stable fluid balance. METHODS: We selected 12 healthy active elderly subjects (5 male, 7 female) with a mean age of 75 years. Total body water and extracellular fluid (ECF) were measured by deuterium oxide- and potassium bromide-dilution techniques. Within-subject variability in total body MFBIA was assessed by performing four measurements at 1, 5, 50, and 100 kHz within a 2-month period. Subsequently, responsiveness of MFBIA to the ECF loss caused by oral administration of 40 mg of furosemide was determined. RESULTS: Within-subject variability in MFBIA at 1, 5, 50, and 100 kHz expressed as standard deviations was 21, 19, 14, and 14 Ohm (omega), respectively. Furosemide caused a mean weight loss of 1.8 +/- 0.6 kg, which resulted in significant increases in impedance of 57 +/- 24 omega at 1 kHz and 37 +/- 12 omega at 100 kHz (p < .001). The responsiveness of MFBIA for the diuretic intervention was best at 5 kHz (responsiveness index = 1.98). CONCLUSIONS: Within-subject variability of MFBIA was small in healthy elderly subjects with stable fluid balance. Responsiveness of MFBIA to 9% furosemide-induced ECF loss was excellent. These data support the necessity for further clinical assessment of the value of MFBIA in monitoring fluid balance in geriatric patients.     

Reattachment of coronal fragments: operative considerations for the repair of anterior teeth

The maxillary incisors occupy an extraordinary position in the dental arch. They set the aesthetic tone, and their influence on the overall well-being of the individual cannot be overemphasized. However, their eruptive pattern and dominance carries a significant risk for trauma, particularly in childhood. More than half of all traumatic dental injuries involve the central incisors. In the past, fractured teeth were either extracted, trimmed and leveled, or restored with cast restorations. The learning objective of this article is to stimulate a shift in treatment strategy towards aesthetic reattachment of fractured segments. Indications and limitations for reattachment are outlined, including the primary and secondary restorative efforts. Innovative operative techniques that improve the aesthetic, biologic, and mechanical variables of the reattachment treatment option are presented.     

Hypertension in the elderly

Elevated blood pressure, especially isolated systolic hypertension, is increasingly frequent with advancing age, affecting 1/4 of all 80-year-olds. Systolic hypertension is associated with increased cardiovascular morbidity and mortality. Recent studies have clearly demonstrated that antihypertensive treatment in the elderly decreases cardiovascular morbidity and mortality (in absolute numbers several times more than in younger patients), without more frequent side effects or a decrease in quality of life. Hypertension in the elderly thus deserves proper attention and should be taken seriously.     

Major histocompatibility complex class I presentation of exogenous soluble tumor antigen fused to the B-fragment of Shiga toxin

Targeting exogenous antigen into the MHC class I-restricted presentation pathway is a prerequisite for the induction of cytotoxic T lymphocytes (CTL) which have been shown to represent an important component of the protective and therapeutic immune response to viral infections and tumors. In this study, we produced recombinant proteins composed of the receptor-binding non-toxic B-fragment of bacterial Shiga toxin derived from Shigella dysenteriae associated with an epitope from a model tumor antigen, Mage 1. We show that Shiga B-Mage 1 fusion proteins carrying an active or inactive endoplasmic reticulum retrieval signal (the C-terminal peptides KDEL or KDELGL, respectively) could be presented by peripheral blood mononuclear cells in an MHC class I-restricted manner to Mage 1-specific CTL. After pulsing B lymphoblastoid cells or dendritic cells with Shiga B-Mage 1 fusion protein, activation of the MHC class I-restricted Mage 1-specific CTL was also demonstrated. In further analysis, we showed that treatment with brefeldin A or paraformaldehyde fixation of Epstein-Barr virus-transformed B cells prevented the presentation of the Mage 1 T cell epitope, which excluded extracellular processing of the antigen. Immunofluorescence analysis also revealed that the Shiga B-Mage 1 fusion protein was largely excluded from Lamp-2-positive lysosomal structures. Therefore, the ability of Shiga toxin B-fragment to target dendritic cells and B cells and to direct antigen into the exogenous class I-restricted pathway makes it an attractive non-living and non-toxic vaccine vector.     

Stimulus duration, neural adaptation, and sweep visual evoked potential acuity estimates

PURPOSE: Results in several studies have suggested that the visual evoked potential (VEP) amplitude can vary with stimulus duration. The purpose of this study was to determine whether acuity estimates obtained by extrapolation of the sweep VEP are altered by this adaptation effect. METHODS: Sweep VEP data were obtained from 16 healthy observers under binocular viewing conditions. Data were acquired with a commercially available VEP unit using standard electrode recording techniques. Three sweeps (high spatial frequencies, medium spatial frequencies, and low spatial frequencies) were run. The subjects' visual acuity at the monitor distance was 6/6 for the high spatial frequency sweep. For the medium and low spatial frequency sweeps, the subjects were dioptrically blurred to 6/15 (medium spatial frequencies) or 6/30 (low spatial frequencies) at the monitor distance. Each sweep consisted of six spatial frequencies (contrast 80%; temporal frequency (TF) = 7.5 Hz; screen luminance = 100 candela [cd]/m2). For each spatial frequency, the stimulus duration was 8 seconds, partitioned into 1-second bins. A minimum of eight sweeps were obtained per subject. An acuity estimate was obtained for each second's data by fitting a line to the high spatial frequencies (excluding noise) and extrapolating this line to the x-axis. With this technique, estimates could not be obtained for 29 of 384 possible acuities. RESULTS: The sweep VEP acuities for the 16 subjects did not change significantly over the 8 seconds of data collection for the high, medium, or low spatial frequency sweep (repeated measures analysis of variance [ANOVA]: high, P = 0.25; medium, P = 0.50; low, P = 0.23). In any given subject, there was a 1- to 2-octave range in acuity estimates over the 8 seconds of stimulus presentation (high, 1.23+/-0.417 octaves; medium, 1.41+/-0.593 octaves; low, 1.52+/-0.475 octaves; mean +/- SD). CONCLUSIONS: These results suggest that there is not a significant change in sweep VEP acuity estimates over an 8-second stimulus presentation. Thus, neural adaptation does not significantly affect the clinical use of the sweep VEP.