Intussusception in Children: A Clinical Review.

Intussusception is the most common cause of small bowel obstruction in young infants. Therefore a high index of suspicion and thorough knowledge of this condition is of major importance to be able to diagnose and treat this potentially life threatening condition. In this review we describe epdidemiology, etiology and clinical symptoms of intussuception. Furthermore, we describe diagnostic modalties, especially ultrasonography as the primary choice for diagnosis. In addition, non-operative treatment with different types of enema reduction techniques, and operative treatment by laparotomy and laparoscopy, and outcomes have been reviewed.

Social environment and HIV risk among MSM in Hanoi and Thai Nguyen.

Little is known about the effect of the social environment on HIV risk in gay men in northern Vietnam, particularly in rural areas. This qualitative research study conducted 4 key informant interviews and 30 in-depth interviews of men in two northern Vietnamese cities: Hanoi, a large city, and Thai Nguyen, a smaller town. Hanoi has experienced a growth in the number of places where gay men can socialize, access HIV prevention services, and discuss health issues. Thai Nguyen lacks these open venues. However, homosexuality is still highly stigmatized in the general population in both cities. This stigma affects the number of partners and level of sexual risk of participants. Also, men generally reported little communication between partners about sexual risk. While stigma in the general community is difficult to change, social environments where gay men can openly communicate creates an opportunity for HIV prevention and social support.

Surgical management of concurrent, coeliac and bilateral iliac artery aneurysms.

A 76-year-old man was admitted with bilateral common iliac artery aneurysms found incidentally on computed tomography. Transfemoral digital subtraction arteriography demonstrated atherosclerotic plaques in the aorta with bilateral common iliac artery aneurysms and a coeliac axis aneurysm. The coeliac artery aneurysm was resected and an aortobifemoral bypass performed with reimplantation of the inferior mesenteric artery into the prosthesis. The patient was well when discharged 2 weeks after operation. The incidence, natural history and management of coeliac axis and iliac artery aneurysms are reviewed.

Path of electron transfer in photosystem 1: direct evidence of forward electron transfer from A1 to Fe-Sx.

Pulsed EPR spectroscopy and selective removal of the iron-sulfur centers in photosystem 1 have been used to study forward electron transfer from the secondary electron acceptor A1. At cryogenic temperatures where forward electron transfer is inhibited, we have observed a g = 2.003 electron spin-echo signal presenting a characteristic phase shift. This out-of-phase signal is attributed to the electron spin-polarized pair P700+/A1-, it decays with t1/e = 23 microseconds, reflecting the recombination reaction. At room temperature the out-of-phase signal is also observed, but it decays with t1/c = 200 ns in untreated photosystem 1, due to forward electron transfer from A1- to one of the iron-sulfur centers. This rate is unchanged in Fe-SA/B-depleted PS1 but is lost when the iron-sulfur center Fe-Sx is removed. In the preparations depleted of all iron-sulfur centers the out-of-phase signal decays with t1/c = 1.3 microseconds, reflecting either the back reaction or the decay of polarization. These results demonstrate that the electron transfer pathway in photosystem 1 is P700-->A1-->Fe-SX-->Fe-SA/B.

Infected false aneurysm after puncture of an aneurysm of the deep femoral artery.

Pseudoaneurysm of the femoral artery is a well known complication after diagnostic and therapeutic catheterisation. We report a case of voluminous postcatheterisation false aneurysm, which developed on a pre-existing deep femoral artery aneurysm. Infection by Staphylococcus aureus was demonstrated. After surgical exploration, rupture and external haemorrhage occurred before reconstructive surgery was possible. Due to the septic conditions only a lateral aneurysmorraphy was performed. Postoperative angiogram showed an acceptable result. An aneurysm of the deep femoral artery was also demonstrated on the contralateral side. This was scheduled for elective surgery. In conclusion, this complication could have been avoided by accurate puncture technique. Surgical exploration under local anaesthesia is ill-advised. Especially in patients with advanced vascular disease, non-invasive studies of the puncture site is recommended.

Oral amoxicillin as prophylaxis for endocarditis: what is the optimal dose?

We compared serum levels and tolerability of oral amoxicillin in 30 healthy adults who each received 2.0 g of amoxicillin and, 1 week later, 3.0 g of the same preparation. Serum levels of amoxicillin were determined at 1, 2, 4, and 6 hours following its ingestion. Mean serum levels of amoxicillin were significantly higher after 3.0-g doses than after 2.0-g doses. Levels in females were higher than in males; this was a reflection of differences in body weights. Food intake had no effect on serum levels. The 2.0-g doses resulted in adequate serum levels; 6 hours after dosing levels were still substantially higher than the MICs for oral streptococci. Three individuals (10%) experienced mild gastrointestinal side effects after they received the 3.0-g doses; no side effects were noted after the 2.0-g doses. We propose that to prevent bacterial endocarditis in adults who are at risk, a single 2.0-g dose of oral amoxicillin may be adequate prophylaxis for dental, oral, or upper respiratory tract procedures.

Resurgence of congenital syphilis.

As a result of the alarming increase in primary and secondary syphilis in the United States, congenital syphilis has resurged in many areas, including Detroit. Several maternal risk factors have been identified as contributing to the increase in congenital syphilis, the most important of which are poor prenatal care and the trading of sex for illicit drugs, specially "crack" cocaine. Contact tracing programs are currently ineffective. To prevent the continuing increase in congenital syphilis, a comprehensive prenatal care program starting in early pregnancy is essential. STS should be determined during pregnancy and may be required more than once in high-risk mothers. Results of STS must be verified before infants are discharged from nurseries. Obstetricians, neonatologists, pediatricians, and general practitioners should be more aware of the problem of congenital syphilis and the need for early intervention and treatment.