Point of Care Ultrasound in the Diagnosis and Management of Severe Ovarian Hyperstimulation Syndrome

Presentation A 32year old woman, presented with a 5-day history of non-productive cough, chest pain, shortness of breath andabdominal bloating. She had undergone Embryo Transfer Treatment 6 days previously. Diagnosis A point of care ultrasound (POCUS) exam was performed as part of her initial investigations which showed right pleuraleffusion, ascites and cystic ovaries. Treatment She received Oxygen, IV Fluids and Antibiotics and was referred to the Obstetricians. Discussion Point of care ultrasound (POCUS) aided the prompt diagnosis of ovarian hyperstimulation syndrome (OHSS) in thispatient, making it possible for her to receive appropriate resuscitation and referral and an excellent outcome despitethis being a case of severe ovarian hyperstimulation syndrome.

The genetic architecture of sexually selected traits in two natural populations of Drosophila montana

We investigated the genetic architecture of courtship song and cuticular hydrocarbon traits in two phygenetically distinct populations of Drosophila montana. To study natural variation in these two important traits, we analysed within-population crosses among individuals sampled from the wild. Hence, the genetic variation analysed should represent that available for natural and sexual selection to act upon. In contrast to previous between-population crosses in this species, no major quantitative trait loci (QTLs) were detected, perhaps because the between-population QTLs were due to fixed differences between the populations. Partitioning the trait variation to chromosomes suggested a broadly polygenic genetic architecture of within-population variation, although some chromosomes explained more variation in one population compared with the other. Studies of natural variation provide an important contrast to crosses between species or divergent lines, but our analysis highlights recent concerns that segregating variation within populations for important quantitative ecological traits may largely consist of small effect alleles, difficult to detect with studies of moderate power.

Practice makes perfect, but only with the right hand: sensitivity to perceptual illusions with awkward grasps decreases with practice in the right but not the left hand

It has been proposed that the visual mechanisms that control well-calibrated actions, such as picking up a small object with a precision grip, are neurally distinct from those that mediate our perception of the object. Thus, grip aperture in such situations has been shown to be remarkably insensitive to many size-contrast illusions. But most of us have practiced such movements hundreds, if not thousands of times. What about less familiar and unpracticed movements? Perhaps they would be less likely to be controlled by specialized visuomotor mechanisms and would therefore be more sensitive to size-contrast illusions. To test this idea, we asked right-handed subjects to pick up small objects using either a normal precision grasp (thumb and index finger) or an awkward grasp (thumb and ring finger), in the context of the Ponzo illusion. Even though this size-contrast illusion had no effect on the scaling of the precision grasp, it did have a significant effect on the scaling of the awkward grasp. Nevertheless, after three consecutive days of practice, even the awkward grasp became resistant to the illusion. In a follow-up experiment, we found that awkward grasps with the left hand (in right handers) did not benefit from practice and remained sensitive to the illusion. We conclude that the skilled target-directed movements are controlled by visual mechanisms that are quite distinct from those controlling unskilled movements, and that these specialized visuomotor mechanisms may be lateralized to the left hemisphere.

Left handedness does not extend to visually guided precision grasping

In the present study, we measured spontaneous hand preference in a "natural" grasping task. We asked right- and left-handed subjects to put a puzzle together or to create different LEGO models, as quickly and as accurately as possible, without any instruction about which hand to use. Their hand movements were videotaped and hand preference for grasping in ipsilateral and contralateral space was measured. Right handers showed a marked preference for their dominant hand when picking up objects; left handers, however, did not show this preference and instead used their right hand 50% of the time. Furthermore, compared to right handers, left handers used their non-dominant hand significantly more often to pick up objects in ipsilateral as well as contralateral space. Our results show that handedness in left handers does not extend to precision grasp and suggest that right handedness for visuomotor control may reflect a universal left-hemisphere specialization for this class of behaviour.

Upregulation of nitric oxide synthase in mice with severe hypoxia-induced pulmonary hypertension

BACKGROUND

The importance of nitric oxide (NO) in hypoxic pulmonary hypertension has been demonstrated using nitric oxide synthase (NOS) knockout mice. In that model NO from endothelial NOS (eNOS) plays a central role in modulating pulmonary vascular tone and attenuating hypoxic pulmonary hypertension. However, the normal regulation of NOS expression in mice following hypoxia is uncertain. Because genetically engineered mice are often utilized in studies of NO, we conducted the present study to determine how hypoxia alters NOS expression in wild-type mice.

METHOD

Mice were exposed to sea level, ambient conditions (5280 feet) or severe altitude (17,000 feet) for 6 weeks from birth, and hemodynamics and lung NOS expression were assessed.

RESULTS

Hypoxic mice developed severe pulmonary hypertension (right ventricular systolic pressure [RVsP] 60 mmHg) as compared with normoxic mice (27 mmHg). Using quantitative reverse-transcription PCR, it was found that expressions of eNOS and inducible NOS (iNOS) increased 1.5-fold and 3.5-fold, respectively, in the lung. In addition, the level of lung eNOS protein was increased, neuronal NOS (nNOS) protein was unchanged, and iNOS was below the limit of detection. Immunohistochemistry demonstrated no change in lung iNOS or nNOS staining in either central or peripheral areas, but suggested increased eNOS in the periphery following hypoxia.

CONCLUSION

In mice, hypoxia is associated with increases in lung eNOS, possibly in iNOS, but not in nNOS; this suggests that the pattern of lung NOS expression following hypoxia must be considered in studies using genetically engineered mice.

Fumigant-related illnesses: Washington State's five-year experience

OBJECTIVE

Exposure to fumigants may have severe or persistent health effects. Washington State's fumigant-related illnesses were reviewed to better understand the circumstances surrounding exposure and resultant health effects.

METHODS

Fumigant-related illnesses reported to and investigated by the Washington State Department of Health were reviewed. Illnesses considered by Department of Health to be definitely, probably, or possibly related to pesticide exposure were then analyzed.

RESULTS

From 1992-1996, 39 (3.3%) of 1192 definite, probable, or possible cases of pesticide-related illnesses involved exposures to fumigants. Fumigant exposures during this period were to aluminum phosphide (15), methyl bromide (12), metam-sodium (9), and zinc phosphide (3). Symptoms included respiratory problems and eye and/or skin irritation for the majority of exposures, and no deaths were reported. The nature of exposure for these cases included exposure to applicators (17), reentry into a fumigated structure (9), improper storage or disposal (6), reentry into treated agricultural fields (4), drift from treated fields (2), and other (1).

CONCLUSIONS

Review of fumigant exposures should be used to prevent future events through continued enforcement of established regulations and training of applicators.

Effectiveness of the A-V impulse hand pump

Acute swelling of the hand is a common problem after trauma or surgery and is associated with both pain and loss of function. We describe a prospective study of 47 patients in which we assessed the effects of a pneumatic compression device (A-V impulse hand pump) on the swollen hand. The pump reduced swelling by increasing the velocity of venous return as demonstrated by Duplex scanning of the median cubital vein. Continuous use of the pump for 48 hours gave a reduction of 78.6% in swelling of the injured hand compared with the opposite, uninjured side. Even when used intermittently, with the pump on for 12 hours out of 24, a statistically significant effect was seen. There was a subjective reduction in pain and an objective improvement in function of the hand. Use of the pump resulted in a nearly normal hand by the time of discharge from hospital after, on average, 48 hours.

MRI of recurrent rectosigmoid carcinoma

BACKGROUND

A prospective study was performed to determine the most reliable MRI criteria to distinguish recurrent rectosigmoid carcinoma from benign postoperative fibrosis.

METHODS

Twenty-two consecutive patients who were suspected to have recurrent rectosigmoid carcinoma were examined by T2 and precontrast and contrast enhanced T1 weighted images. The prospective interpretations, the presence of high signal on T2 weighted images, the shape of the margins of a mass and the degree of contrast enhancement were correlated with histology and follow up to determine their respective accuracies, sensitivities and specificities.

RESULTS

The best criteria for recurrent tumor was the combination of high signal on T2 weighted images, round margins and > 40% contrast enhancement, which had an accuracy of 92%, sensitivity of 100% and specificity of 85%. In patients who were more than one year postoperative the specificity was 100%.

CONCLUSIONS

The most reliable MRI criteria for distinguishing recurrent rectosigmoid carcinoma from benign postoperative fibrosis are the combination of the signal intensity on T2 weighed images, the shape of the margins of a mass and the presence of greater than 40% contrast enhancement.

Percutaneous needle biopsy of the mediastinum: review of 94 procedures

BACKGROUND

A number of reports of radiologically guided percutaneous biopsy of mediastinal masses have been described but techniques have varied, particularly the type of needle used. In this study mediastinal biopsies with fine aspiration needles and cutting needles have been compared, sometimes in the same patient. The results are reviewed with particular emphasis on the choice of biopsy needle and its influence on pathological diagnosis.

METHODS

A retrospective review was undertaken of radiologically guided mediastinal biopsies performed between 1981 and 1991.

RESULTS

Sixty fine needle aspiration biopsies (FNA) and 34 Tru-Cut biopsies of mediastinal masses were performed in 75 patients with fluoroscopic or computed tomographic guidance. Overall sensitivity and specificity in terms of diagnosis of malignant disease were 90% and 100% respectively for FNA biopsies, and 96% and 100% for Tru-Cut biopsies. Diagnostic accuracy in terms of precise diagnosis of the malignant or benign nature of a mass and its origin was 77% for FNA biopsies and 94% for Tru-Cut biopsies. For FNA biopsies sensitivity and accuracy were higher for carcinomatous lesions (96% and 88%) than for noncarcinomatous lesions (81% and 69%). The only significant complication encountered was a pneumothorax following a biopsy which required intercostal drainage.

CONCLUSIONS

Radiologically guided percutaneous needle biopsy is a safe procedure which provides useful diagnostic information in the majority of cases. Fine needle aspiration techniques usually suffice for carcinomatous lesions but a cutting needle biopsy should be performed whenever possible when lymphoma, thymoma, or neural masses are suspected to obtain larger specimens for more accurate histological diagnosis.

The computed tomographic appearances in pulmonary artery atresia

Isolated pulmonary artery atresia is an uncommon congenital abnormality. Plain radiography and ventilation/perfusion lung scintigraphy may suggest the diagnosis but pulmonary angiography has traditionally been recommended for confirmation. The computed tomographic (CT) appearances of four patients with isolated atresia of a pulmonary artery are described. In each case the atretic segment of the abnormal vessel could be identified. Other CT findings included reduction of volume of the involved hemithorax, increased density of the affected lung, a small hilum, and an abnormal pulmonary vascular pattern thought to be due to the collateral systemic arterial supply to the intrapulmonary branches of the atretic pulmonary artery. The diagnosis of isolated pulmonary artery atresia can be made using dynamic, contrast enhanced CT without recourse to more invasive procedures.

Arterial blood gas standards for healthy young nonsmoking subjects

Arterial blood gas analysis has become indispensable for precise physiologic assessment of many lung and heart conditions. Previous studies have related the level of arterial oxygenation to age, smoking habits, and the severity of lung or heart dysfunction. However, no study has reported complete normal blood gas values under all conditions most commonly used by cardiopulmonary laboratories to assess patients. Therefore, we assessed blood gas values in 20 nonsmoking volunteers (ten men, ten women) between 20 and 28 years of age who were healthy (negative heart-lung history and normal results on physical examination, chest radiography, and lung function testing). Blood samples were drawn from the radial artery and measured immediately on a blood gas analyzer. The findings were no significant different (P less than 0.05) in blood gas values among rest (supine), rest (sitting), and exercise (supine) conditions within sex groups; significantly lower mean PCO2 for women than for men under all conditions (except for subjects breathing 100% O2), and a higher pH for women in the rest (supine) position than under other conditions; and a lower mean PCO2 and higher pH for both groups breathing 100% O2. This study provides valid normal arterial blood gas reference standards for routine cardiopulmonary function testing.