SAMAY S24: a novel wireless 'online' device for real-time monitoring and analysis of volumetric capnography

Volumetric capnography (VCap) provides information about CO2 exhaled per breath (VCO2br) and physiologic dead space (VDphys). A novel wireless device with a high response time CO2 mainstream sensor coupled with a digital flowmeter was designed to monitor all VCap parameters online in rabbits (SAMAY S24).Ten New Zealand rabbits were anesthetized and mechanically ventilated. VCO2br corresponds to the area under the VCap curve. We used the modified Langley method to assess the airway VD (VDaw) and the alveolar CO2 pressure. VDphys was estimated using Bohr's formula, and the alveolar VD was calculated by subtracting VDaw from VDphys. We compared (Bland-Altman) the critical VCap parameters obtained by SAMAY S24 (Langley) with the Functional Approximation based on the Levenberg-Marquardt Algorithm (FA-LMA) approach during closed and opened chest conditions.SAMAY S24 could assess dead space volumes and VCap shape in real time with similar accuracy and precision compared to the 'offline' FA-LMA approach. The opened chest condition impaired CO2 kinetics, decreasing the phase II slope, which was correlated with the volume of CO2 exhaled per minute.

[Endoscopic incision of intravesical ureteroceles in patients with duplex system]

PURPOSE

To evaluate the clinical status and renal function of pa- tients with duplex system and intravesical ureterocele after drainage by cystoscopy.

MATERIAL AND METHODS

In 9 patients with duplex system and intravesical ureterocele drainage was performed to present recurrent urinary tract infections (7 children with episodes of pyelonephritis and sepsis) or obstruction of the urinary drainage. The mean age was 33 months (range 8-108 months). The thecnique was done under general anesthesia in the operating room and puncture of the ureterocele was performed using cystourethroscopy with loop electrode. The minimum follow-up was 12 months (range 12-48 months) and includes renal ultrasound, renal isotopic study (Mag3 with furosemide) and-echocystography study in patients with preoperative vesicoureteral reflux or postoperative urinary tract infection.

RESULTS

The average operative time was 60 minutes. Mean hospital stay was 48 hours. There were no complications during the procedure. In five patients urinary infection episodes disappeared. Ultrasound demonstrated decreased hydronephrosis and megaureter. In two patients the differential renal function following the technique improved. One patient with preoperative split renal function of 14% required nephrectomy. One patient had postoperative vesicoureteral reflux.

CONCLUSIONS

The drainage of intravesical ureterocele in patients with duplex system reduces episodes of urinary tract infection and urinary tract dilation.

[First results of the orchiopexy via scrotal approach]

PURPOSE

We present our first results with the technique described by Bianchi and Squire in 1989 for the surgical treatment of undescended testis by scrotal incision as an alternative to the traditional inguinal approach.

MATERIALS AND METHODS

Prospective study of patients operated with the diagnosis of cryptorchidism with scrotal orchidopexy from October 2008 through July 2009.

INCLUSION CRITERIA

patients with inguinal palpable testis, scrotal orchidopexy, testicular position was assessed at 6 months and/or one year after surgery. All procedures were performed by the same surgeon. Retractile testes were excluded. We studied the preoperative localization of the testis, the average surgical time, presence or absence of the processus vaginalis, conversions to the traditional inguinal orchiopexy, complications and location of six months and one year after surgery.

RESULTS

A total of 50 orchidopexy were performed in 39 patients during this period. Aged between 1 and 12 years (mean 5 years, median 4 years). Were located in the intraoperative exam under anesthesia, fifteen testes in the inguinal canal and 35 in the external inguinal ring. Operative times ranged from 15 to 60 minutes (mean 34 minutes). The processus vaginalis was patent in 25 procedures (50%) and were ligated via the scrotal incision. Two patients required conversion to a traditional inguinal approach. All testes were satisfactorily positioned in the scrotum and there were no cases de testicular atrophy or ascent, hernia o hydrocele formation with followup that ranged from 6 months to 1 year.

CONCLUSIONS

The technique of orchiopexy with scrotal approach is a safe, well tolerated and reliable method.

[A case of papilledema and Arnold-Chiari type I malformation]

CLINICAL CASE

A 12-year old girl was brought to the emergency ward because of headache and diplopia for 4 days. Bilateral papilledema was observed. Ancillary studies showed Arnold-Chiari Type I malformation without hydrocephalia. Cranial decompression treatment was performed but papilledema persisted and a progressive visual field deterioration was assessed. One month later, an optic nerve sheath fenestration was performed.

DISCUSSION

Arnold-Chiari I malformation is characterized by downward displacement of cerebellar tonsils below the foramen magnum plane. It usually remains asymptomatic or appears in adulthood with brainstem compression-related symptoms. Surgical decompression of the posterior cranial fossa is mandatory in symptomatic cases. In our case, intracranial hypertension persisted because of postoperative subdural hygromas. Visual field deterioration was resolved by optic nerve sheath fenestration (Arch Soc Esp Oftalmol 2002; 77: 449-454).

Molecular evidence for the existence of two species of Marteilia in Europe

Marteilia refringens is one of the most significant pathogens of bivalve molluscs. Previous sequencing of the small subunit ribosomal RNA gene of M. refringens isolates derived from the infected mussels (Mytilus edulis and Mytilus galloprovinciallis) and the oyster (Ostrea edulis) in Europe did not reveal genetic polymorphisms despite indications from epizootiological data that distinct types may exist. We investigated the existence of polymorphisms in the internal transcribed spacer region of the ribosomal RNA genes. The sequences of this region proved to be clearly dimorphic among Marteilia from five sampling sites. The distribution of the two genetic types, named "O" and "M", appeared to be linked to the host species, oysters and mussels, respectively. We therefore support the recognition of two species of Marteilia in Europe and propose that the "O" type corresponds to M. refringens and the "M" type to M. maurini.

A mitochondrial tRNA(Lys) gene mutation (T8316C) in a patient with mitochondrial myopathy, lactic acidosis, and stroke-like episodes

We studied a patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes who had morphologically and biochemically abnormal muscle mitochondria. Molecular analysis revealed a T8316C transition in the mitochondrial DNA tRNA(Lys) gene. The mutation was homoplasmic in muscle from the proposita, heteroplasmic in her blood, and still less abundant in blood from her asymptomatic maternal relatives. The T8316C mutation affects a highly conserved base pair and was not found in controls, thus satisfying the accepted criteria for pathogenicity. Our data document the genetic heterogeneity in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome, underlining that the same syndrome may be associated with mutations of different genes.

Mapping of linear antibody epitopes of the glycoprotein of VHSV, a salmonid rhabdovirus

Antibody linear epitopes of the glycoprotein G (gpG) of the viral haemorrhagic septicaemia virus (VHSV), a rhabdovirus of salmonids, were mapped by pepscan using overlapping 15-mer peptides covering the entire gpG sequence and ELISA with polyclonal and monoclonal murine and polyclonal trout antibodies. Among the regions recognized in the pepscan by the polyclonal antibodies (PAbs) were the previously identified phosphatidylserine binding heptad-repeats (Estepa & Coll 1996; Virology 216:60-70) and leucocyte stimulating peptides (Lorenzo et al. 1995; Virology 212:348-355). Among 17 monoclonal antibodies (MAbs), only 2 non-neutralizing MAbs, 110 (aa 139-153) and IP1H3 (aa 399-413), could be mapped to specific peptides in the pepscan of the gpG. Mapping of these MAbs was confirmed by immunoblotting with recombinant proteins and/or other synthetic peptides covering those sequences. None of the neutralizing MAbs tested reacted with any of the gpG peptides. Previously mapped MAb resistant mutants in the gpG did not coincide with any of the linear epitopes defined by the pepscan strategy, suggesting the complementarity of the 2 methods for the identification of antibody recognition sites.

[Low grade disseminated astrocytoma in childhood]

INTRODUCTION

Leptomeningeal dissemination is a common event in some kinds of cerebral tumours, but in low-grade astrocytomas who classically have been conferred a benign course. However, multifocal affectation is described each time more frequently in these group of tumours.

CLINIC CASES

We present three patients aged respectively 8 and 10 months and 10 years, who were diagnosed of low-grade astrocytoma with multicentric spread. They were treated with systemic chemotherapy and controlled with MRI. At the end of the treatment an important reduction in tumours' size was observed in the three cases.

DISCUSSION

Biological behaviour of low-grade astrocytoma as been reviewed in last years. By one side, it has been seen that certain histological characteristics are associated with an aggressive behaviour: on the other hand, long-term evolution of these tumours can be complicated with tumoral recurrence, malignization and leptomeningeal dissemination. This last one is observed each time more frequently since the use of MRI in the diagnose of cerebral tumours has become routine. From the therapeutic point of view, chemotherapy represents an effective choice for these patients' management, when surgery is not possible and radiotherapy not advisable, allowing in many cases to stop tumoral growth and sometimes to reduce it's size strongly.

Fast neutralization/immunoperoxidase assay for viral haemorrhagic septicaemia with anti-nucleoprotein monoclonal antibody

An enzyme-immunohistochemical procedure was employed to facilitate neutralization/diagnostic tests for viral haemorrhagic septicaemia virus (VHSV), a significant pathogen in trout farms throughout Europe. The method described can be used for trout or mice antibodies; increases speed (1 day), simplicity, and minimizes the use of reagents compared to other neutralization assays. Furthermore, the test requires a minimum handling of the cell cultures under sterile conditions, decreasing frequent contamination due to the non-sterile conditions of the fish pathological samples. Foci of 5-20 infected epithelioma papillosum carp (EPC) cells are detected and counted with an inverted microscope in under 16 h after infection of EPC monolayers using a high titre anti-N VHSV monoclonal antibody (MAb) 2C9. MAb 2C9 recognizes different viral haemorrhagic septicaemia virus serotypes and VHSV isolates from different host species (trout, salmon and barbel) and Spanish geographical locations. The high titre and specificity of MAb 2C9 favour its conjugation to peroxidase and also make it possible to use in direct immunoperoxidase staining of the VHSV infected EPC monolayers. This neutralization/immunoperoxidase assay should improve diagnostics that use currently agarose or methylcellulose plaque reduction neutralization assays.

Sporadic MERRF/MELAS overlap syndrome associated with the 3243 tRNA(Leu(UUR)) mutation of mitochondrial DNA

We studied a patient with a mitochondrial encephalomyopathy characterized by the presence of all the cardinal features of both myoclonic epilepsy and ragged-red fibers (MERRF) and mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes (MELAS) syndromes. Muscle biopsy showed ragged-red fibers (RRF). Some RRF were cytochrome c oxidase (COX)-negative while some others stained positive for COX. Muscle biochemistry revealed defects of complexes I and IV of the respiratory chain. Both muscle and blood mitochondrial DNA from the patient showed the presence of the mutation at nucleotide position 3243 in the tRNA(Leu(UUR)) gene and the absence of point mutations related to MERRF syndrome. The proportions of mutant mtDNA were 70% in muscle and 30% in blood. The mutation was absent in blood from all maternal relatives, in hair follicles from the mother, and in muscle from one sister of the proband. Therefore, there was no evidence of maternal inheritance.

Variable clinical and biochemical presentation of seven Spanish cases with glutaryl-CoA-dehydrogenase deficiency

In this report, we describe seven new patients with a severe deficiency of glutaryl-CoA dehydrogenase in cultured skin fibroblasts. Three of the patients studied excreted high levels of glutaric acid. The remaining four patients presented a lack of significant glutaric aciduria. However, glutaric acid was found in increased levels in CSF. In both groups of patients, the urine glutaric acid levels were not related to their metabolic condition at the time of sampling. Hypocarnitinemia was a common finding. Some patients also showed defects on respiratory chain complexes in muscle biopsy. Only one patient has a normal psychomotor development. The other six patients are severely handicapped despite the attempts of different therapies. In patients with progressive neurological deterioration with dystonia and cerebellar signs associated with temporal lobe atrophy and bilateral basal ganglia damage on MRI, a glutaric aciduria type I (GA I) should always be investigated. The presence of glutaric acid in body fluids, especially in CSF, as well as plasma carnitine levels, should be determined. These procedures can lead to the diagnosis of glutaric aciduria type I.

Muscle carnitine deficiency and lipid storage myopathy in patients with mitochondrial myopathy

Abnormal carnitine distribution in muscle was found in 22 of 77 patients (29%), with mitochondrial myopathy. Furthermore, total (TC) and free (FC) carnitine levels in muscle were lower in patients than in controls (P < 0.01). Muscle long-chain acylcarnitines (LCAC) were significantly increased in these patients (P < 0.01). Muscle carnitine deficiency was found in 31.5% of patients with lipid storage myopathy (LSM) and in 25.6% of patients with ragged-red fibers (RRF). Therefore, carnitine deficiency can be found in patients with mitochondrial myopathy even in the absence of LSM. Muscle levels of TC and FC were lower in patients with respiratory chain defects than in those with normal respiratory chain (P < 0.01). In contrast, LCAC levels were significantly increased (P < 0.05). Carnitine levels did not differ significantly, among patients with different respiratory-chain defects. Consequently, these patients, owing to their biochemical block, reduce progressively the muscle carnitine pool and subsequent LCAC rise, due to long-chain fatty acid (LCFA) accumulation.

Plasma carnitine insufficiency and effectiveness of L-carnitine therapy in patients with mitochondrial myopathy

Plasma carnitine "insufficiency," (plasma esterified carnitine to free carnitine ratio above 0.25) was found in 21 of 48 (43.8%) patients with mitochondrial myopathy, of whom 4 also showed both total and free carnitine deficiencies in plasma. In addition, plasma levels of SCAC and LCAC were higher in patients with mitochondrial myopathy than in controls (P < 0.001 and P < 0.01, respectively). Patients diagnosed as having plasma carnitine insufficiency or deficiency were treated with L-carnitine (50-200 mg/kg per day in four daily doses). Muscle weakness improved in 19 of 20 patients, failure to thrive in 4 of 8, encephalopathy in 1 of 9, and cardiomyopathy in 8 of 8 patients. Plasma carnitine "insufficiency" provides an additional clue to the diagnosis of mitochondrial myopathy and an indication for L-carnitine therapy.

[Ewing's sarcoma in childhood: the therapeutic results]

We evaluated 27 patients with localized Ewing's sarcoma diagnosed in our hospital. In 9 cases the lesion was centroaxial and in 18 it was located in the limbs. The treatment consisted of: 1) chemotherapy with 6 drugs (vincristine, cyclophosphamide, methotrexate, bleomycin, actinomycin D and adriamycin) during one year in all patients, and 2) radiotherapy in 24 patients with a dose of 30-40 Gy in the involved bone with a 10-15 Gy superimpression on the tumor area. In 7 patients nonradical surgery followed by radiotherapy was carried out. In 2 cases with rib localization and in 1 with tibial localization and large bone destruction radical surgery was undertaken. One patient had a local relapse (femur) and six had distant metastases. The remaining 20 patients (74%) are alive and without evidence of disease, with follow-up periods ranging from 17 to 80 months (median 38 months). The estimated actuarial free from disease survival was 64% after 58 months. Sequelae of therapy were evaluated in the 12 survivors with primary localization in the limbs. In 7 cases (58%) there were minimal sequelae, in two moderate and in three there was a severe limitation, but amputation was not required in any patient. The results of our study show that the local control of the disease can be achieved in most cases without radical surgery and with an acceptable limb function.

Gastrocolic fistula

Peptic ulcer disease is a less common cause of gastrocolic fistula than either carcinoma of the stomach or colon. However, use of steroids or aspirin appear to make this a more common complication of benign disease. The typical symptoms are pain, diarrhea, weight loss, foul eructation, and feculent vomiting. The most accurate method of diagnosis is with barium enema. The treatment is surgical.

Heterotopic pancreas mimicking carcinoma of the head of the pancreas: a rare cause of obstructive jaundice

A 61-year-old man developed obstructive jaundice and had ultrasonographic and cholangiopancreatographic findings consistent with carcinoma of the pancreas. However, pathologically the obstruction proved to be from heterotopic pancreatic tissue compressing the common bile duct. This patient and eight previously reported patients with a similar problem are the subjects of this report.