Long-term symptomatic relief following surgical sphincteroplasty for sphincter of Oddi dysfunction

INTRODUCTION

Surgical sphincteroplasty (SS) for sphincter of Oddi dysfunction (SOD) can be performed primarily or following failed endoscopic therapy. The role of SS in an era of endoscopic management is unclear. This study presents long-term follow-up of patients who had undergone SS at a tertiary referral unit.

METHODS

Patients were identified from a departmental database and sent post-operative questionnaires to review pain scores and satisfaction with the procedure. Indications, pre-operative interventions and complications were recorded.

RESULTS

Seventeen patients underwent SS over 13 years. Thirteen patients had objective features of biliary obstruction (delayed excretion of isotope or elevated sphincter pressures). The positive predictive value, sensitivity and specificity of morphine 99mTc-TBIDA in this series was 100, 100 and 92%, respectively. There were 12 responders of whom all but one had symptomatic improvement. Median follow-up was 5.1 years. Pain was significantly lower following SS (16 ± 9 vs. 67 ± 11; p = 0.003) and median satisfaction with the procedure was high (95%).

CONCLUSIONS

Excellent symptomatic pain relief following SS can be achieved in carefully selected patients. Manometry does not appear to be essential for diagnosing SOD and morphine provocation hepatic scintigraphy was used to reliably identify patients who would benefit from SS.

Global oral health inequalities: dental caries task group--research agenda

The IADR Global Oral Health Inequalities Task Group on Dental Caries has synthesized current evidence and opinion to identify a five-year implementation and research agenda which should lead to improvements in global oral health, with particular reference to the implementation of current best evidence as well as integrated action to reduce caries and health inequalities between and within countries. The Group determined that research should: integrate health and oral health wherever possible, using common risk factors; be able to respond to and influence international developments in health, healthcare, and health payment systems as well as dental prevention and materials; and exploit the potential for novel funding partnerships with industry and foundations. More effective communication between and among the basic science, clinical science, and health promotion/public health research communities is needed. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. Recommendations are made for both clinical and public health implementation of existing research and for caries-related research agendas in clinical science, health promotion/public health, and basic science.

Effects of Cu-doping on the magnetic state of Zn(0.9-x)Fe0.1Cu(x)O

Magnetization measurements were performed on a series of Zn(0.9-x)Fe0.1Cu(x)O samples (0 < x approximately 0.1) prepared using solid state reaction and sol-gel methods. Although Cu is nonmagnetic, we found that increasing Cu content increases the saturation magnetization and enhances the hysteresis losses. Curie behavior of the susceptibility at high temperature indicates the presence of ferromagnetic exchange interaction. Moreover, we found that the exchange interaction and the molecular field coefficient are both ferromagnetic and greatly enhanced with Cu-doping; however, the Arrott-Belov-Kouvel plot did not reveal the presence of spontaneous magnetization down to 4.2 K.

Multiwavelength Brillouin-erbium fiber laser with double-Brillouin-frequency spacing

We demonstrate a multiwavelength Brillouin-erbium fiber laser with double-Brillouin-frequency spacing. The wider channel spacing is realized by circulating the odd-order Stokes signals in the Brillouin gain medium through a four-port circulator. The circulated odd-order Stokes signals are amplified by the Brillouin gain and thus produce even-order Stokes signals at the output. These signals are then amplified by erbium gain block to form a ring-cavity laser. Ten channels with 0.174 nm spacing that are generated at 0.5 mW Brillouin pump power and 150 mW pump power at 1480 nm can be tuned from 1556 nm to 1564 nm. The minimum optical signal-to-noise ratio of the generated output channels is 30 dB with maximum power fluctuations of ±0.5 dB.

End of life decisions and care of the adult burn patient

INTRODUCTION

Despite advancements in the provision of burn care, there is still a significant cohort of patients who fail to respond to therapy or for whom treatment is deemed futile. The decision to withdraw support from, or to implement a Do-Not-Resuscitate (DNAR) order in, such patients can be challenging. Our aims were to review the withdrawal of life-sustaining treatment, issuing of DNAR orders and end of life care in burn patient deaths.

METHODS

A retrospective case notes review was undertaken, for all burn in-patient deaths from 1st April 2001 to 31st December 2007.

RESULTS

Following exclusions, 63 patients were included in our study, with a median age of 56 years (21-94). End of life decisions in younger patients (under 65 years) were more often due to burn severity. In those over 65 years, reasons were due to co-morbidities, and these decisions were made late in the patient's admission. In 34% of patients, end of life care was not comprehensively documented.

CONCLUSION

A coherent, decisive approach should be adopted and adhered to by all members of the multi-disciplinary team, with clear, standardised documentation in place.

Distribution and normalization of some metals in surface sediments from South Caspian Sea

Surface sediments along the south of Caspian Sea were collected to evaluate the contamination of heavy metals. The result ranged (μg/g, Fe% dw): Pb(13.06-33.48); Ni(18.01-69.63); Cd(0.62-1.5); Zn(30.11-87.88); Cu(5.86-26.37) and Fe(1.8-4%) respectively. Cadmium showed higher EF when compared to other sites. Geoaccumulation Index value for Cd in most stations was classified as moderately contaminated and moderately to strongly contaminated, as well as the average of I(geo) of Cd (1.77 ± 0.35) suggested that surface sediments of Caspian coast were moderately polluted by this metal. The result of the Pearson correlation showed that there were significant positive associations between Ni, Cd and Zn (r = 0.44-0.76; p < 0.01).

Prospective surveillance of nosocomial device-associated bacteremia in three adult intensive units in Malaysia

Nosocomial blood stream infection (or nosocomial bacteremia) is a common problem in hospitals worldwide, including Malaysia. A three-year prospective cohort study (October 2003-March 2007) of the incidences, risk factors, and patterns of the microorganisms causing bacteremia was conducted using a validated surveillance form in three intensive care units (ICUs) in Malaysia. Center for Disease Control criteria were used to diagnose bacteremia. Patients were monitored from admission until the end point of study, which was the first detection of bacteremia in the blood in each patient. The frequency of occurrence of bacteremia with clinical symptoms was 10.7% (n=23). Bacteremia was observed to occur within a mean length of stay of 10 days in ICU. The rate of device-related infection was 10.4% per device utilization days with a device utilization rate of 95.9%/1000 patient days. The total number of patient days was 2309 and the period of device utilization was 2211 days. The common bacteria detected were extended-spectrum beta-lactamases (ESBLs) Klebsiella pneumoniae (n=6); Pseudomonas aeruginosa (n=6); Acinetobacter species (n=5); Methicillin-resistant Staphylococcus aureus (MRSA)(n=3); and (non- ESBL) Klebsiella pneumoniae (n=2). Multivariable analysis using Cox Proportional Hazard Model showed that the predictors for developing bacteremia were cancer, MRSA carriage, duration of central venous catheter (CVC) infusion, frequency change of CVC, and the administration of hydrocortisone drugs. These results indicate that a combination of nursing and medical interventions as well as patients' severity of illness could lead to bacteremia in ICU. Strategic implementation of quality assurance measures in ICUs could help to control this problem.

All-optical generation of a 21 GHz microwave carrier by incorporating a double-Brillouin frequency shifter

An all-optical generation of a microwave carrier at 21 GHz that incorporates a double-Brillouin frequency shifter is presented. The frequency shift of approximately 21 GHz is achieved by generating the second-order Brillouin Stokes signal from the Brillouin pump. This is accomplished through the circulation and isolation of its first-order Stokes signal in the optical fiber. The Brillouin pump signal is heterodyned with its second-order Brillouin Stokes signal at a high-speed photodetector, and the output beating frequency is equal to the offset between these two signals. The generated microwave carrier is measured at 21.3968 GHz, and the carrier phase noise as low as -58.67 dBc/Hz is achieved.