The role of Doppler studies in predicting individual intrauterine fetal demise after laser therapy for twin-twin transfusion syndrome

OBJECTIVE

To investigate the role of Doppler studies in predicting individual fetal demise in patients scheduled for selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS).

METHODS

Doppler studies of the umbilical artery, umbilical vein, ductus venosus, tricuspid valve regurgitation and middle cerebral artery were performed in the donor and recipient twins before and 24 hours after SLPCV. Results were analyzed cross-sectionally and longitudinally. As multiple comparisons were made, an a priori alpha rejection was set at P < 0.001.

RESULTS

One hundred and ten consecutive patients were available for analysis. Overall fetal survival was 68.6% (151/220) with at least one survivor in 88.2% (97/110) of cases. Absent or reversed end-diastolic velocity in the umbilical artery of the donor twin was the only preoperative Doppler result predictive of intrauterine fetal demise (IUFD) (10/15, 66.7%, P < 0.001). Postoperatively, reversed flow during atrial contraction in the ductus venosus of the donor twin showed a trend towards prediction of IUFD of this fetus (4/5, 80%, P = 0.007). No other Doppler studies, including the longitudinal analyses, were predictive of IUFD.

CONCLUSIONS

Our data suggest that preoperative absent or reversed end-diastolic velocity in the umbilical artery may be useful in predicting individual fetal demise of the donor twin in TTTS patients scheduled for SLPCV. This may reflect the role of decreased individual placental mass that may be associated with some donor twins. The inability of other Doppler studies to predict individual IUFD may be explained preoperatively by the effect of the interfetal vascular connections on the individual Doppler signals and postoperatively by the effect of surgery or the timing of the assessment. Our findings may be important in patient counseling, in furthering understanding of the disease, and perhaps in improving surgical technique.

[Bone mineral density in children with osteogenesis imperfecta]

OBJECT

Osteogenesis imperfecta is the term used for a group of disorders of collagen synthesis which cause increased bone fragility. The aim of our study was to evaluate the BMD in patients with OI.

MATERIAL AND METHODS

We used dual-energy x ray absorptiometry, Hologic QDR 4500W (DEXA), to compare the bone mineral density (BMD) of 8 patients aged from 3 years to 20 years who had osteogenesis imperfecta with an age and sex matched control group.

RESULTS

DEXA detected highly significant differences in BMD respecting control group. The mean BMD in the patients with osteogenesis imperfecta was 62.6 % of normal in lumbar spine (p < 0.01) and 63.01 % of normal in the femoral neck (p < 0.01) using Wilcoxon test.

CONCLUSION

DEXA is an objective, reproductible and sensitive method of measurement of BMD in children. It may help to stablish the diagnosis, to asses prognosis and possibly to monitor the response to different types of treatment.

Critical steps in the early evolution of the isocortex: insights from developmental biology

This article proposes a comprehensive view of the origin of the mammalian brain. We discuss i) from which region in the brain of a reptilian-like ancestor did the isocortex originate, and ii) the origin of the multilayered structure of the isocortex from a simple-layered structure like that observed in the cortex of present-day reptiles. Regarding question i there have been two alternative hypotheses, one suggesting that most or all the isocortex originated from the dorsal pallium, and the other suggesting that part of the isocortex originated from a ventral pallial component. The latter implies that a massive tangential migration of cells from the ventral pallium to the dorsal pallium takes place in isocortical development, something that has not been shown. Question ii refers to the origin of the six-layered isocortex from a primitive three-layered cortex. It is argued that the superficial isocortical layers can be considered to be an evolutionary acquisition of the mammalian brain, since no equivalent structures can be found in the reptilian brain. Furthermore, a characteristic of the isocortex is that it develops according to an inside-out neurogenetic gradient, in which late-produced cells migrate past layers of early-produced cells. It is proposed that the inside-out neurogenetic gradient was partly achieved by the activation of a signaling pathway associated with the Cdk5 kinase and its activator p35, while an extracellular protein called reelin (secreted in the marginal zone during development) may have prevented migrating cells from penetrating into the developing marginal zone (future layer I).

[Renal lithiasis due to indinavir]

Indinavir sulphate is a protease inhibitor that has been found to be extremely effective in increasing CD4+ cell counts and in decreasing HIV-RNA titers in patients with HIV and AIDS. However, patients receiving indinavir also have been noted to have a significant risk of developing urolithiasis. Indinavir has high urinary excretion with poor solubility in a physiologic pH solution. The typical symptoms of indinavir urolithiasis are similar to other forms of urolithiasis. Indinavir urolithiasis is unique in that computed tomography, which was once thought to be efficacious in identifying all urinary calculi, is not useful in imaging stones that are composed of pure indinavir. Indinavir urolithiasis generally responds to a conservative regimen of hydration, pain control, and temporary discontinuation of the medication. Only a minority of patients need surgical intervention.

Delayed acute capture myopathy in three roe deer

Delayed acute capture myopathy is the term used to describe the clinical syndrome observed in three roe deer captured by drive-nets and transported to an enclosure for scientific purposes. The animals died 48 h, 60 h and 8 days after being captured. The simultaneous deaths coincided with a previous episode of deliberate human disturbance. The histopathological findings were indicative of acute myopathy and myoglobinaemic nephrosis. These could be related to an ataxic myoglobinuric syndrome brought on by capture and transport operations. The lack of clinical signs and negative prognosis indicators in the period between capture and just before death. the absence of gross muscular lesions in the animal that died after 8 days post-capture, the simultaneous deaths of animals captured at different times and the evidence of deliberate human disturbance in the enclosure are suggestive of death triggered by a second stress episode.

Elimination of cutting oil wastes by promoted hydrothermal oxidation

Cutting oils are emulsionable fluids widely used in metalworking processes. Their composition is normally oil, water, and additives (fatty acids, surfactants, biocides, etc.) generating a toxic waste after a long use. Generally, it is a waste too dilute to be incinerated and it is difficult to treat biologically. Other conventional treatment methods currently used are not satisfactory from the environmental point of view. Wet air oxidation (WAO) and supercritical water oxidation (SCWO) are two forms of hydrothermal oxidation that have been proved to be effective processes to treat a wide variety of industrial wastes, but hardly tested for oily wastes. In the case of refractory wastes, WAO process is not efficient enough due to the moderate temperatures used. SCWO is a more powerful process since operating temperatures are usually around 600 degrees C, but the use of severe conditions leads to major disadvantages in the commercialization of the technology. In order to enhance WAO and SCWO efficiency at mild conditions, the use of free radical promoters has been studied in this work. Both normal and promoted hydrothermal oxidation have been tested to treat cutting oil wastes in a continuous flow system operating at 300-500 degrees C. Hydrogen peroxide has been used both as a source of oxygen and as a source of free radicals by introducing it into the reactor with or without previous thermal decomposition, respectively. Organic material is easily oxidized in both cases, obtaining more than 90% TOC reduction in less than 10s at 500 degrees C. At lower temperatures, the use of promoters clearly enhances the oxidation process. Activation energies have been estimated for normal and promoted oxidation processes.

Application of the sequential elution technique to determine Cd and Cu cellular location in Ulva lactuca Linnaeus

The sequential elution technique, used to determine the cellular location of metals in nonvascular plants, was adapted to the seaweed Ulva lactuca Linnaeus for the heavy metals Cu and Cd. The optimum conditions for the extraction of extracellular Cu and Cd were determined using specimens previously loaded with these metals. The best extracellular metal extraction media and the number of extracellular metal extraction steps obtained were the following: Two steps (1 h + 40 min) in a filtered sea water-20 mM Ni solution for Cd and two steps in a filtered sea water-50 mM Co solution for Cu. To find these extraction conditions the extracellular metal extraction capacity of the different media used as well as the alteration provoked in plasmalemma permeability were compared. The concentrations of the incubation solutions of Cd and Cu that allowed reliable comparisons between the different extracellular metal extraction media used were previously determined.

Evolution of the need for operation for peptic pyloric stenosis over a period of 24 years (1976-1999)

OBJECTIVE

To analyse the need for operation for pyloric stenosis caused by duodenal ulcer over a period of 24 years (1976-1999).

DESIGN

Retrospective study.

SETTING

University hospital, Spain.

SUBJECTS

156 patients operated on for peptic pyloric stenosis.

MAIN OUTCOME MEASURES

The number of patients operated on yearly were grouped into 4-year periods for statistical comparison.

RESULTS

The number of cases operated on each year steadily decreased between 1976 and 1999. In the 1988-1991 period there was a significant reduction (p <0.05), which continued over the next two 4-year periods, particularly the last (p <0.01).

CONCLUSION

Although we cannot use this study to establish a direct relation between the decrease in the indication for operations for peptic pyloric stenosis and the use of H2 antagonists, proton pump inhibitors, or treatment to eradicate Helicobacter pylori, we did find a significance difference between the years before and after the introduction of these drugs.

Multiple bilateral fractures of the lumbar transverse processes in a roe deer (Capreolus capreolus)

Multiple bilateral fractures of the lumbar transverse processes were radiographically identified postmortem in a recently captured roe deer (Capreolus capreolus). These fractures were probably caused by an avulsion of the psoas major occurring during introduction into the transport box. The deer probably died from shock caused by the fractures, muscle damage, and subsequent hemorrhage. Although easily overlooked, fractured lumbar transverse processes may indicate inadequate postcapture management practices.

[Socio-economic costs of road traffic accidents in the Canary Islands, Spain, in 1997]

OBJECTIVE

To evaluate the economic impact in terms of direct and indirect costs road traffic accidents in Canarias Islands (Spain) in 1997.

METHOD

The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 1997. Direct costs were divided into health services costs, insurance administration costs and the costs of material damage to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory.

RESULTS

The total cost of road traffic accidents was 39,887.16 million pesetas, equivalent to 24,470 for each inhabitant of the Canary Islands and representing 1.3% of the GNP in this region. The total direct cost was 32,559.67 million pesetas, constituting 82% of the total, which was distributed according to the different concepts analyzed: health service costs: 2,407.40 million pesetas; insurance administration costs, 13,415.89 million pesetas and the costs of material damages to the vehicles: 16,736.38 million pesetas. The total indirect costs was 7,327.49 million pesetas, accounting for 18% of the total costs, which was distributed in premature mortality (6,884.88 million pesetas) and absenteeism from work (442.61 million pesetas).

CONCLUSIONS

Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the hight socio-economic cost of road traffic accidents clearly indicates the need for the different administrations of the Canary Islands to collaborate in implementing preventive measures.