Echinococcal disease and the provision of humanitarian surgical aid in Bosnia

The Canadian Armed Forced have been deployed to the republics of the former Yugoslavia since 1992 as part of the United Nations Protection Force and the NATO-led Implementation Force. Most of the combat arms units have been supported by small, self-contained surgical teams for essential surgery. Considerable benefit is gained by cooperating with civilian surgeons. The experience of treating five patients with complicated hydatid disease endemic to the area is examined. Treatment of these patients requires performing major surgical procedures under austere conditions and must be undertaken with care. Careful selection and communication with the surgical nursing team and civilian surgeons is essential. Well selected cases can also pay tremendous dividends in terms of maintaining the skills of personnel who must be prepared for any emergency in addition to providing vital surgical assistance to these patients.     

Clostridium tertium bacteremia: 2 cases and review

Clostridium tertium bacteremia is unusual, seen most often with gastrointestinal disease and/or neutropenia. Two cases are described. The first was a 19-yr-old female with acute leukemia, who developed gastrointestinal symptoms and C. tertium bacteremia while neutropenic. The second was a 57-yr-old female with quiescent ulcerative colitis, who presented with fever, rigors and epigastric pain. Four organisms including C. tertium were isolated from blood cultures. This patient responded to broad spectrum antimicrobial therapy, whereas the first patient required the addition of specific agents to recover. C. tertium is aerotolerant and thus can be misidentified as a Bacillus or Corynebacterium spp. Our isolates had a distinctive Gram stain morphology, were catalase negative and failed to sporulate aerobically--this aided in the recognition of this significant Gram-positive bacillus.     

Endothelial selectins and vascular cell adhesion molecule-1 promote hematopoietic progenitor homing to bone marrow

The adhesive mechanisms allowing hematopoietic progenitor cells (HPC) homing to the bone marrow (BM) after BM transplantation are poorly understood. We investigated the role of endothelial selectins and vascular cell adhesion molecule-1 (VCAM-1) in this process. Lethally irradiated recipient mice deficient in both P-and E-selectins (P/E-/-), reconstituted with minimal numbers (相似文献   

Efficacy of silicone punctal plugs as adjuncts to topical pharmacotherapy of glaucoma--a pilot study. Punctal Plugs in Glaucoma Study Group

BACKGROUND: The concept of enhancing the ocular hypotensive effects of topical antiglaucoma medications by impeding lacrimal drainage of medication has been insufficiently studied. This investigation sought to evaluate the effect of bilateral inferior punctal occlusion using silicone punctal plugs on the ocular hypotensive effect of topically applied timolol. METHODS: A randomized, double-masked, cross-over clinical trial was conducted, comparing the ocular hypotensive effect of timolol maleate 0.25 percent, both with and without occlusion of the inferior punctum with the Freeman silicone punctal plug. Following a 2-week washout of topical medication, 17 subjects with early primary open-angle glaucoma or ocular hypertension received one drop of timolol 0.25 percent in each eye with or without punctal plugs in place. Blood pressure, resting pulse rate, and intraocular pressure were measured both before timolol instillation and at intervals of 1, 2, 4, 8, and 12 hours following drop instillation. Following a 2-week washout period, the subjects were evaluated with the alternative treatment. RESULTS: There was no statistically significant difference (p = 0.648) in IOP levels between treatment groups. CONCLUSIONS: This pilot suggests that need for a longer-term study with larger numbers of subjects to evaluate the potential role of silicone punctal plugs to enhance the ocular bioavailability of topically applied antiglaucoma medications.     

Ultrasonography of the fetal neck in the first and early second trimesters. Part 1. Normal appearance

The soft tissues of the neck of 196 normal fetuses were examined with ultrasonography during the first and early second trimesters, and the criteria for normality are described here. The dorsal pseudomembrane is the most important feature of this area in a normal fetus. This feature appears as a single echogenic line lying parallel to the occiput and the upper cervical spine but separated from them by an anechoic area, which should be less than 2.8 mm deep before 18 weeks gestational age. The membrane is best observed when the fetus is in the "neck-up" position with the neck flexed. Although the superior-inferior extent of the membrane is variable, the occurrence of lateral extension, septations or hydrops or a bulbous appearance indicates abnormality. The membrane should move freely with the motion of the neck, which allows it to be differentiated from the normal amnion, amniotic bands or synechiae.     

Dynamics of glucose-induced insulin release from mouse islets transplanted under the kidney capsule

Mouse pancreatic islet grafts under the kidney capsule of syngeneic hosts were removed and perifused in vitro 1-40 weeks after the transplantation. In comparison with fresh islets, 12- to 40-week-old grafts exhibited an attenuated first phase of glucose-stimulated insulin release. In grafts 1, 12, 28, or 40 weeks old, but not in fresh islets, the mean secretory rate during the initial 10 min of stimulation was significantly lower than that during the subsequent 15 min. When expressed in relation to insulin content, the insulin output in response to 11 mmol/L glucose was no less from grafts than from fresh islets; in grafts 12 or 40 weeks old at 16.7 mmol/L glucose, the fractional output above baseline was significantly diminished during the initial 10 min, but not subsequently. Immediately on switching from basal to stimulatory glucose concentration, there was a transient drop in insulin secretion from the grafts, especially after more than 12 weeks of transplantation and in response to 16.7, as compared with 11, mmol/L glucose. When glucose was switched back from stimulatory to basal concentration, grafts also frequently exhibited a transient increase in the insulin secretory rate. Neither initial drops nor "off responses" were seen in untransplanted islets. The modifications of the secretory dynamics in islet grafts suggest that transplantation influences the balance between the stimulatory and inhibitory influences of glucose on the beta-cell's secretory machinery.     

Titanium diffusion in shinbone of rats with osseointegrated implants

Dental implants are composed of commercially pure Ti (which is actually an alloy of titanium, and minor or trace components such as aluminium and vanadium). When the implant is inserted, its surface undergoes a number of chemical and mechanical processes, releasing particles of titanium to the medium. The metabolism of free ions of titanium is uncertain; the uptaking processes in the body are not well known, nor their toxic dose. In addition, physical properties of newly formed bone, such as diffusivity and activation energy, are scarce and rarely studied. In this study, we analysed the diffusion of titanium in the titanium‐implanted shinbones of six adult male Wistar rats by spatially resolved micro x‐ray fluorescence. The measurements were carried out at the microfluorescence station of the x‐ray fluorescence (XRF) beamline of the Brazilian synchrotron facility LNLS (from Portuguese ‘Laboratorio Nacional de Luz Sincrotron’). For each sample, XRF spectra were taken by linear scanning in area near the new bone formed around the Ti implant. The scanning line shows a clear effect of titanium diffusion whereas calcium intensity presents a different behaviour. Moreover, a clear correlation among the different structures of bones is observed in the Ti and Ca intensities. The results obtained in these measurements may allow determining quantitatively the parameters of diffusion rates and other physical properties of new bone like diffusion coefficients.     

Myocardial rupture during exercise ECG

We report a case of heart rupture in connection with a stress test performed nine days after an otherwise uncomplicated myocardial infarction. The Danish Association of Cardiologists recommend stress testing 5-20 days after myocardial infarction. We question whether this timing is appropriate considering the vulnerability of the myocardium at that time.