Anomaly of arch of atlas--a rare cause of symptomatic canal stenosis in children

Symptomatic canal stenosis at the level of atlas (C1) without atlantoaxial dislocation is thought to be very rare in children. Though common, anomalies of the arch of atlas are generally incidental findings in X-rays. High cord compression due to a narrow canal from a bifid posterior arch, or an absent posterior arch, is a very rare condition. We report 5 children with high cord compression from stenosis of C1 arch.     

Large-cell change of hepatocytes in cirrhosis may represent a reaction to prolonged cholestasis

The deaths of 10 heroin body packers are reported and contrasted to those of cocaine body packers. Only one was a woman, and all were traveling to or from Colombia. Drug packets deteriorated in the gastrointestinal tract and caused the deaths of eight victims. Accomplices removed drug packets from two of these smugglers after death occurred. One died of peritonitis stemming from a small-bowel obstruction caused by the drug packets, and one died from the recreational use of heroin (nasally ingested). The heroin recovered was < or = 881 g, and the drug purity of the contraband in three cases was between 65% and 73%. Blood concentrations of morphine were < 1.0 mg/L in four victims; no morphine was detected in the smuggler who died of peritonitis. However, two victims had blood morphine concentrations of 4.4 mg/L and 6.7 mg/L, respectively, and three had morphine concentrations of 35.8, 39.4, and 52.6 mg/L, respectively. Fatal heroin body packing differs from cocaine body packing in that individuals may have extremely high drug levels in their blood and their accomplices appear to be more likely to abandon them in a remote location after attempting to remove the drug packets after death has occurred.     

Prophylactic nefopam administration for post-anesthetic shivering

PURPOSE: Shivering is a frequent postanaesthetic complication. Its definite reason is unknown. Patients with cardiovascular or pulmonary diseases are endangered by postanaesthetic shivering. The aim of this study was to assess the efficacy of nefopam in prophylaxis of shivering. Additionally we investigated the influence of nefopam on haemodynamic parameters and on the time until extubation. METHODS: 30 patients (ASA I-II) were randomly allocated in a double-blind fashion to one of two groups to receive directly after the end of isoflurane application either nefopam (0.15 mg/kg) or placebo (0.9% saline). The period of anaesthesia had to be longer than 60 minutes. All patients received a premedication with lorazepam (0.02 mg/kg) 30-45 minutes prior to surgery. Induction of anaesthesia was standardised: fentanyl (3 micrograms/kg), thiopentone (5 mg/kg), atracurium (0.4 mg/kg). Intraoperatively a mixture of isoflurane, nitrous oxide (60%) and oxygen was used to maintain anaesthesia. The following parameters were evaluated: Age, sex, duration of operation and anaesthesia and the time between the end of application of volatiles and extubation. Heart rate (HR), mean arterial blood pressure (MAP), rectal temperature and O2-saturation were measured at predefined data points. Postoperatively the consumption of analgesic was documented. The severity of shivering was classified in five grades. RESULTS: In the control-group nine patients shivered (60%), whereas in the nefopam group only one patient (6.6%) shivered (p < 0.05). In comparison to the placebo group we observed in the nefopam group a significantly decreased HR 30 and 60 minutes postoperatively (p < or = 0.007 and p < or = 0.002). We did not observe prolonged awakening in the nefopam-treated patients. MAP and O2-saturation showed similar reactions in both groups. CONCLUSION: The data indicate that prophylactic administration of nefopam can suppress postanaesthetic shivering. Prolonged awakening was not observed.     

An orally administered growth factor extract derived from bovine whey suppresses breath ethane in colitic rats

The aim of the present study was to assess the in vivo error of the method as well as the effect of thresholding when obtaining and evaluating standardized periapical radiographs for computer-assisted densitometric image analysis (CADIA). Twenty healthy volunteers participated in an experimental gingivitis study in which neither mechanical nor chemical plaque control was performed for 21 days. Two pairs of standardized periapical radiographs were taken at days 0 (baseline) and 21 (follow-up), one from a maxillary area (15 volunteers) and one from a mandibular molar/premolar area (17 volunteers). Each baseline radiograph was digitized and its image displayed on a monitor. The follow-up radiograph was then superimposed and digitized as well. After gray level correction, subtraction radiographic images were produced. The difference in gray level between the baseline and the follow-up image was calculated within each region of interest (ROI) at each picture point (pixel). In bone ROI, changes in density reflected the amount of change due to methodological errors plus the basic bone remodeling over 3 weeks. For gingival ROI, changes in density reflected the methodological error plus a possible change in soft tissue density during the experimental gingivitis. Within all of the ROI, some pixels indicated a change in gray level. A change in gray level was then thresholded; i.e., only changes >5 and then >10 gray levels were registered and used for calculation of the CADIA values. With a threshold of 5, 44/45 maxillary bone ROI and 60/66 mandibular bone ROI showed a change in density, while 41/45 maxillary gingiva ROI and 26/66 mandibular gingiva ROI indicated a change in density. With a threshold of 10, 16/45 maxillary bone ROI and 12/66 mandibular bone ROI indicated a change in density, while 13/45 maxillary gingiva ROI and 1/66 mandibular gingiva ROI indicated a change. The amounts of changes in density calculated in the various ROI were low even when applying no threshold, ranging from -0.279 to 0.621. Applying a threshold of 5, the CADIA values ranged from -0.234 to 0.727. With a threshold of 10, the changes in density ranged from -0.318 to 0.133. In vivo, CADIA of standardized radiographs indicated change in density due to methodological errors. Application of thresholds may avoid false-positive diagnoses. When applying CADIA in clinical research, the range of change to be expected due to methodological limitations as well as the threshold for true change should be evaluated. These thresholds may differ in various areas of the mouth, i.e., bone or gingival, maxillary/mandibular, anterior/posterior ROI.     

Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode

RATIONALE AND OBJECTIVES: We sought to induce large zones of coagulation necrosis using radiofrequency (RF) with perfusion electrodes and to define optimal parameters for this system. METHODS: We developed RF electrodes with internal cannulas to enable tip perfusion. Lesions were created with monopolar RF in ex vivo and in vivo liver and muscle tissue with and without perfusion of the electrode tip using 0 degree C saline. In separate experiments, wattage, current, procedure duration, tip exposure, and perfused tip temperatures were studied. RESULTS: In ex vivo liver tissue, a maximum lesion diameter of 3.1 cm without charring occurred with perfusion at 12 min and 50 W. In in vivo liver tissue with perfusion (tip temperature = 25-35 degrees C) and a 3-cm tip exposure, 80 W were deposited in muscle tissue and 65 W in liver tissue for 12 min without inducing charring. Lesion diameters were 4.5 cm and 2.4 cm, respectively. By comparison, without perfusion a maximum of 20 W could be deposited into either tissue type, resulting in 1.8-cm muscle lesions and 1.2-cm liver lesions. Tip temperatures between 45 degrees C and 55 degrees C resulted in charring. Smaller but predictable lesion diameters were created with a lower power, a shorter tip exposure, or both. Of all the parameters, diameter correlated best with the current applied. CONCLUSION: Perfusion of RF electrodes with chilled saline allows for increased power deposition without tissue charring, increasing the volume of coagulation necrosis created with a single electrode insertion. Perfusion electrodes therefore might decrease the number of probe insertions required for percutaneous tumor ablation therapy or allow for the treatment of larger lesions.