Real-time dynamics of single vortex lines and vortex dipoles in a Bose-Einstein condensate.

Understanding the behavior of quantized vortices is essential to gaining insight into diverse superfluid phenomena, from critical-current densities in superconductors to quantum turbulence in superfluids. We observe the real-time dynamics of quantized vortices in trapped dilute-gas Bose-Einstein condensates by repeatedly imaging the vortex cores. The precession frequency of a single vortex is measured by explicitly observing its time dependence and is found to be in good agreement with theory. We further characterize the dynamics of vortex dipoles in two distinct configurations: (i) an asymmetric configuration, in which the vortex trajectories are dynamic and nontrivial, and (ii) a stable, symmetric configuration, in which the dipole is stationary.

The effectiveness of aerosolized intraperitoneal bupivacaine in reducing postoperative pain in children undergoing robotic-assisted laparoscopic pyeloplasty.

OBJECTIVE: To assess the effectiveness of aerosolized intraperitoneal bupivacaine in reducing postoperative pain in children. Laparoscopic surgery has decreased the severity of postoperative pain in children. However, children often experience abdominal and shoulder pain requiring significant amounts of opioids, potentially prolonging their hospitalization. METHODS: Forty-one consecutive patients undergoing unilateral robotic-assisted pyeloplasty between December 2005 and December 2007 were retrospectively reviewed to assess perioperative opioid requirements and length of hospitalization. RESULTS: In addition to standard-of-care perioperative analgesia, five patients received intraperitoneal aerosolized bupivacaine just prior to trocar removal, 17 patients received aerosolized bupivacaine just prior to incising the perirenal fascia, and 19 patients received no intervention. There was a significant reduction in postoperative opioid utilization when bupivacaine was administered at the beginning of the surgery (0.1mg/kg vs 0.4mg/kg, P=0.04), but not at the end (0.3mg/kg, P=0.25), as compared to controls. All patients receiving aerosolized bupivacaine had a significantly shorter time in hospital (2.4 vs 1.4 days, P=<0.01). CONCLUSIONS: The administration of intraperitoneal aerosolized bupivacaine just prior to incising the perirenal fascia appears to be a simple, effective and low-cost method to reduce postoperative pain in children undergoing laparoscopic pyeloplasty.

Immune effects of decreasing low-molecular weight hemoglobin components of hemoglobin-based oxygen carriers (HBOC) in a swine model of severe controlled hemorrhagic shock.

Hemoglobin-based oxygen carriers (HBOCs) show potential as safe, efficacious, pre-hospital resuscitation fluids. The major criticism of HBOC-201 is its vasoactive property, attributed partially to low-molecular weight (low-MW) tetrameric/dimeric (TD) hemoglobin (Hb) in HBOC solution. Here we sought to determine whether resuscitation with decreasing concentrations of low-MW Hb component of HBOC affects immune responses in hemorrhagic swine. 28 anesthetized swine underwent a soft muscle crush and controlled hemorrhage of 55% blood volume, followed by resuscitation with HBOC containing 31%, 2%, or 0.4% low-MW Hb in four 10 ml/kg infusions at 20, 30, 45 and 60 minutes before hospital arrival at 75 minutes. IL-10, cell activation and adhesion markers and CD4:CD8 ratio remained unchanged in all 3 groups compared to baseline. Leukocyte apoptosis was equally elevated across all groups. Purification from 31% to 0.4% low-MW Hb in HBOC solution did not alter immune effects in a swine model of severe controlled hemorrhagic shock.

Innate immune responses in Swine resuscitated from severe traumatic hemorrhagic shock with hemoglobin-based oxygen carrier-201.

Hemoglobin-based oxygen carrier-201 transports oxygen and improves survival in swine with hemorrhagic shock, but has potential to be immune activating. Herein, we evaluated HBOC-201's immune effects in swine with more severe hemorrhagic shock due to soft tissue injury and 55% blood volume catheter withdrawal over 15 minutes followed by fluid resuscitation at 20 minutes with HBOC-201, Hextend, or no treatment (NON) before hospital arrival. Survival rates were similar with HBOC-201 and Hextend (p > 0.05), but were higher than in (p = 0.007). There were no significant group differences in blood cell count, percentages of leukocyte sub-populations and immunophenotype (CD4:CD8 ratio), adhesion markers expression (neutrophil CD11b; monocyte or neutrophil CD49d) and apoptosis. There was a trend to higher plasma IL-10 in HBOC-201 and groups vs. Hextend. We conclude that in swine with severe controlled HS and soft tissue injury, immune responses are similar with resuscitation with HBOC-201 and Hextend.

Coagulation patterns following haemoglobin-based oxygen carrier resuscitation in severe uncontrolled haemorrhagic shock in swine.

Massive blood loss due to penetrating trauma and internal organ damage can cause severe haemorrhagic shock (HS), leading to a severely compromised haemostatic balance. This study evaluated the effect of bovine polymerized haemoglobin (Hb) (Hb-based oxygen carrier, HBOC) resuscitation on haemostasis in a swine model of uncontrolled HS. Following liver injury/HS, swine received HBOC (n= 8), Hextend (HEX) (n= 8) or no resuscitation (NON) (n= 8). Fluids were infused to increase mean arterial pressure above 60 mmHg and to reduce heart rate to baseline. At 4 h, the animals were eligible for blood transfusions. Prothrombin time (PT), activated partial thromboplastin time, fibrinogen, thromboelastography (TEG) and platelet function analyser closure time (PFA-CT) were compared by using mixed statistical model. At 4 h, blood loss (% estimated blood volume) was comparable for HBOC (65.5 +/- 18.5%) and HEX (80.8 +/- 14.4%) and less for NON (58.7 +/- 10.1%; P < 0.05). Resuscitation-induced dilutional coagulopathy was observed with HBOC and HEX, as indicated by reduced haematocrit, platelets and fibrinogen (P < 0.05). At 4 h, PT was higher in HEX than in HBOC groups (P < 0.01). In the early hospital phase, a trend to increased TEG reaction time and PFA-CT indicates that dilutional effects persist in HBOC and HEX groups. PFA-CT returned to baseline later with HBOC than with HEX (48 vs. 24 h) following blood transfusion. At 4 h, all surviving HEX animals (n= 3) required transfusion, in contrast to no HBOC (n= 7) or NON (n= 1) animals. In this severe uncontrolled HS model, successful resuscitation with HBOC produced haemodilutional coagulopathy less than or similar to that produced by resuscitation with HEX.

16alpha-bromoepiandrosterone, a dehydroepiandrosterone (DHEA) analogue, inhibits Plasmodium falciparum and Plasmodium berghei growth.

Dehydroepiandrosterone (DHEA) and its analogue, 16alpha-bromoepiandrosterone (alpha-epi-Br), may have activity against viral and parasitic infections, including human immunodeficiency virus (HIV) and Cryptosporidium parvum. Therefore, we evaluated its antimalarial effects on Plasmodium falciparum and Plasmodium berghei. In vitro, chloroquine (CQ)-sensitive and resistant strains of P. falciparum parasitized red blood cells were incubated with escalating doses of alpha-epi-Br or CQ. In vivo, 62 rats were infected with P. berghei and treated with CQ or alpha-epi-Br. At the highest doses tested against a CQ-sensitive strain, parasitemias decreased from 25.4% in the saline control group to 4.3% and 4.8% in the alpha-epi-Br and CQ groups, respectively (P < 0.05). Against two CQ-resistant strains, parasitemias decreased from 22.3-28.8% and 24.8-30% in the CQ and saline groups, respectively, to 2.5-2.7% in the alpha-epi-Br groups (P = 0.003). In vivo, on Day 4, parasitemias decreased from 23% in the saline group to 9-12% and 12% in the in alpha-epi-Br and CQ groups, respectively (P < 0.05). These data demonstrate that alpha-epi-Br shows activity against CQ-sensitive and resistant strains of P. falciparum in vitro. At the doses tested against P. berghei in vivo in rats, alpha-epi-Br is comparable to CQ.

Decreased lactic acidosis and anemia after transfusion of o-raffinose cross-linked and polymerized hemoglobin in severe murine malaria.

Severe anemia is a major cause of death in falciparum malaria. Blood transfusion increases survival in humans and in animal models of this disease. Because of logistic constraints and viral contamination of the blood supply, transfusions are frequently not practical in endemic regions. Modified hemoglobin is an effective O2 carrier in hemorrhagic shock. It is free of infectious contamination, may not require refrigeration, and because of its nitric oxide scavenging and small size, may have pharmacologic benefits in malaria. The effects of transfusions of modified hemoglobin in rats with high-grade parasitemia were evaluated. Modified hemoglobin decreased lactic acidosis and corrected anemia as well as transfusions with red blood cells; these findings may correlate with improved survival and suggest a possible proerythropoietic effect. Further study of this novel therapy is warranted.

Is it migraine?

BACKGROUND: Migraine is a common disorder affecting 8-10% of the population. It results in significant morbidity and has social and economic consequences. Vascular and neurogenic mechanisms are involved in the genesis of migraine. Serotonin plays an important part. Attacks are brought on by internal (not identified) and external (identified) trigger factors in people predisposed to the condition, often on an hereditary basis. OBJECTIVE: The diagnosis of migraine depends on the recognition of the features specific to the condition. This article aims to define these features. DISCUSSION: There are diagnostic criteria which define the two main types of migraine--migraine with aura and migraine without aura. The variants of migraine need to be recognised and migraine needs to be distinguished from cluster headache. It is also important to recognise and exclude sinister causes of headache. Treatment is not discussed.

Time course of alpha-1-acid glycoprotein and its relation to myocardial enzymes after acute myocardial infarction.

The acute phase reactant, alpha-1-acid glycoprotein, binds to a number of basic antiarrhythmic drugs, including lidocaine, quinidine, propranolol, imipramine and disopyramide. Binding to alpha-1-acid glycoprotein accounts for a decrease in free drug fraction and may alter the expected concentration: response relation of drugs particularly when there are unpredictably large or rapid changes in alpha-1-acid glycoprotein. To determine the time course and magnitude of alpha-1-acid glycoprotein for 1 month after acute myocardial infarction (AMI), blood samples were collected from 27 patients, 14 with AMI and 13 with a chest pain syndrome but no AMI. Patients with AMI had a significant increase in alpha-1-acid glycoprotein after 72 hours (mean 153 +/- 35 mg/dl) (p less than 0.05), and the maximum was observed on day 7 (mean 165 +/- 53 mg/dl) (p less than 0.05), returning to baseline by 28 days. There was no significant change in alpha-1-acid glycoprotein in patients with chest pain but no AMI. Regression analysis showed a significant relation between creatine kinase (p less than 0.005) and lactic dehydrogenase (p less than 0.001) vs alpha-1-acid glycoprotein indicating alpha-1-acid glycoprotein concentration is high in patients with large AMI. Changes in binding resulting from alpha-1-acid glycoprotein during AMI could account for misinterpretation of total drug concentration and response to antiarrhythmic drugs acutely, during convalescence and at discharge.

Choroidal (subretinal) neovascularization secondary to choroidal nevus and successful treatment with argon laser photocoagulation. Case reports and review of literature.

Retinal detachment secondary to choroidal nevus may be caused by subretinal fluid accumulation or neovascularization. Foveal subretinal fluid or leakage of choroidal neovascularization may impair visual acuity. 10 cases of nevus with serous sensory retinal detachment successfully treated with laser photocoagulation are reviewed. 2 additional cases of successful laser therapy for retinal detachment secondary to choroidal neovascularization with nevus of the choroid are presented.

Imipramine binding to alpha-1-acid glycoprotein in normal subjects and cardiac patients.

The relationship between binding ratio of imipramine and plasma alpha 1-acid glycoprotein (AAG) was determined in normal subjects, patients with chest pain syndrome, and patients after myocardial infarction. Binding ratio of imipramine was determined by equilibrium dialysis and plasma AAG concentration was determined by radial immunodiffusion. Plasma AAG concentrations ranged from 56 to 80 mg/dl (mean = 65 +/- 9 mg/dl) in 12 normal subjects, from 86 to 228 mg/dl (mean = 125 +/- 37 mg/dl) in 12 patients with chest pain syndrome, and from 78 to 350 mg/dl (mean = 181 +/- 69 mg/dl) in 12 patients after myocardial infarction. Plasma AAG concentrations in the three patient groups differed. Binding ratio ranged from 5.6 to 19.8 (mean = 12 +/- 3.5). Binding ratio of imipramine significantly correlated with plasma AAG concentration, but not with plasma albumin. In addition, binding ratio of imipramine and pure AAG was significantly related, indicating AAG is an important determinant for imipramine binding. If plasma AAG concentration increases or changes rapidly, plasma drug concentration and drug effect may be unpredictable. Under these circumstances an estimate of free drug fraction may be clinically helpful and can be estimated from the formula. y = 7.95 + 0.03 X AAG.

Branch retinal artery occlusion in patients with Hodgkin's disease.

Ocular involvement in Hodgkin's disease is relatively unusual. This report describes two cases of branch retinal artery occlusion in young patients with Hodgkin's disease. Both patients were thought to be in remission when the occlusions occurred. The possible etiology and relationship to drug therapy is discussed.

Cauda equina lesion due to thorotrast.

Thorotrast (Thorium dioxide) has been used in the past as a radiological contrast medium. Its use resulted in serious side-effects, often after a delay of many years. There was an increased incidence of tumours and blood dyscrasias. Meningeal fibrosis, hydrocephalus and progressive lesions of the cauda equina have followed its injection into the sub-arachnoid spaces. A patient with such a cauda equina lesion is reported.

Absorbable implants in nondrainage procedures for repair of retinal detachment.

Our experience in 1,700 consecutive cases of retinal surgery for the repair of nontraumatic, rhegmatogenous retinal detachments using a modified technique involving a nondrainage procedure with an absorbable implant was presented. We found that 228 of these 1,700 cases fell into our criteria for the use of this technique. We discussed the indications and contraindications for both the operative procedure and for the absorbable implant, and it is our belief that this technique is a valuable addition to the methods available to the retinal surgeon for the treatment of certain selected cases of retinal detachment.

Retinal injuries associated with cataract surgery.

Five patients had trauma to the retina that occurred during cataract surgery. In two of the cases the injury was caused by perforation of the globe by the retrobulbar injection needle and in one case the retinal injury occurred when the superior rectus muscle bridle suture perforated the sclera. A stab incision for release of blood in an expulsive choroidal hemorrhage caused a retinal dialysis. Another case of retinal dialysis was caused by aspiration of solid vitreous after vitreous loss.

Diagnosis and management of tuberculous paraplegia with special reference to tuberculous radiculomyelitis.

Paraplegia occurred in eight of 17 patients with central nervous system tuberculosis. In six of these paraplegia was the presenting feature. Paraplegia may complicate tuberculous meningitis, or vertebral tuberculosis, but it may also occur, as in three of our cases, as a primary localised spinal tuberculous radiculomyelitis. These cases are presented in relation to the concept that paraplegia complicating these forms of tuberculosis is caused by radiculomyelitis.

Long-term follow-up of scleral buckling procedures with sickle cell disease and retinal detachment treated with the use of hyperbaric oxygen.

We have presenteed a late follow-up study of 8 eyes previously presented which were treated with scleral buckling procedures under hyperbaric oxygen conditions for repair of rhegmatogenous retinal detachments complicating sickle cell disease. In addition, we have presented a patient treated under similar conditions with a scleral shortening procedure and drainage of subretinal fluid for repair of a non-rhegmatogenous traction detachment secondary to diabetic retinopathy and sickle disease. We feel that our successful results in these cases and our lack of the usually reported complications merits the continued use of this technique in these difficult cases of detachment of the retina.