Major anomalies and birth-weight influence NICU interventions and mortality in infants with trisomy 13 or 18.

OBJECTIVE: To describe neonatal intensive care unit (NICU) medical interventions and NICU mortality by birth weight and major anomaly types for infants with trisomy 13 (T13) or 18 (T18). STUDY DESIGN: Retrospective cohort analysis of infants with T13 or T18 from 2005 to 2012 in the Pediatrix Medical Group. We classified infants into three groups by associated anomaly type: neonatal surgical, non-neonatal surgical and minor. Outcomes were NICU medical interventions and mortality. RESULTS: 841 infants were included from 186 NICUs. NICU mortality varied widely by anomaly type and birth weight, from 70% of infants <1500 g with neonatal surgical anomalies to 31% of infants ⩾2500 g with minor anomalies. Infants ⩾1500 g without a neonatal surgical anomaly comprised 66% of infants admitted to the NICU; they had the lowest rates of NICU medical interventions and NICU mortality. CONCLUSIONS: Risk stratification by anomaly type and birth weight may help provide more accurate family counseling for infants with T13 and T18.

Real time remote monitoring of air pollutants and their online transmission to the web using internet protocol.

Recent advances in both information and sensor technologies have enabled the development of Real Time Remote Monitoring (RTRM) capabilities for environmental management. An online and real time remote monitoring system for air pollution has been designed and installed at a traffic police station at Punjagutta in Hyderabad, India. The system is optimized using electrochemical sensors and a real time particulate matter analyzer. The system also monitors meteorological parameters such as temperature, humidity, rainfall, barometric pressure, wind speed and wind direction. The system periodically monitors both pollution and meteorological parameters at pre- programmed intervals of [Formula: see text] hr during peak periods and 1 hr during non peak periods of the day and continuously uploads to a predestinated web site (www.appcb.org/home.htm) using File Transfer Protocol. The web site renders a quick, simple and graphical display of air pollution levels and meteorological parameters and their significance to humans. The present paper highlights design considerations of a pollution monitoring system, system hardware and software requirements and practical limitations and future directions for real time remote monitoring of air pollution.

Intraoperative penile erection.

OBJECTIVE: Penile erection following epidural anesthesia is an infrequent occurrence of unclear etioogy. It is very troublesome to perform the procedure during penile erection and attempting it leads to various complications. Three such cases are reported herein. The literature on the pathophysiology and management of intraoperative penile erection is discussed. METHODS: Eighteen hundred patients who received epidural anesthesia for various transurethral procedures like cystoscopy, ureterorenoscopy, transurethral resection of prostate and bladder tumors form the clinical material. RESULTS: Out of 1800 cases, we have encountered penile erection only in three cases. Two cases were managed with local application of cold saline and cold sponging followed by terbutaline. The third case could be managed with local application of cold saline and cold sponging of scrotum and penis. Afterwards the procedure could be performed safely. CONCLUSION: The pathophysiology and management of intraoperative penile erection is poorly understood. With the onset of erection during an operative procedure, the anesthesiologist must quickly initiate the therapy, as duration of erection is the critical factor in the detumescence of the penis.

Conditions that mimic stroke in the emergency department. Implications for acute stroke trials.

OBJECTIVE: To determine if any clinical variables allow early discrimination between stroke and other conditions presenting with a strokelike picture. BACKGROUND: New therapeutic modalities for the treatment of acute ischemic stroke are under active investigation. Many of these treatments have potential adverse effects. It is well known that noncerebrovascular conditions can present with a clinical picture mimicking stroke, so early accurate differentiation of such "mimics" from true stroke is essential. METHODS: Consecutive patients who presented to the emergency department with an initial diagnosis of stroke between January 1990 and January 1992 were evaluated. Chart review allowed these patients to be classified into two final diagnostic groups: stroke mimic and true stroke. Logistic regression was used to estimate the effects of predictor variables measured at initial evaluation on the final diagnosis. RESULTS: There were 411 patients initially diagnosed as having stroke. Of these, 78 patients (19%) were eventually found to have mimics, the majority comprising postictal states, systemic infections, tumors, and toxic-metabolic disturbances. Univariate analysis showed that decreased level of consciousness and normal eye movements increased the odds of mimic, while abnormal visual fields, diastolic blood pressure greater than 90 mm Hg, atrial fibrillation on electrocardiogram, and history of angina decreased the odds of mimic. Multivariate analysis showed that decreased consciousness increased, while history of angina decreased, the odds of mimic. Sensitivity of this model for predicting mimics was only 21% while specificity was 96%. CONCLUSION: For the neurologist faced with an immediate decision as to whether to randomize a patient with probable stroke to an acute treatment protocol, these findings have some usefulness but mandate further research into conditions that mimic stroke in the emergency department.

Seizures and 'disappearing' brain lesions.

BACKGROUND--Patients with seizures may have abnormal brain imaging. Lesions demonstrated on computerized tomography or magnetic resonance imaging often suggest the underlying cause of the seizures, and may prompt an invasive investigation for diagnosis and treatment. In an increasingly recognized subset of patients however, the imaged lesions spontaneously resolve. While poorly understood, these 'disappearing' lesions may in fact be the consequence of seizures, rather than the cause. Two patients with 'disappearing' lesions are presented: the first patient had a proven cause, the second a probable one. Case 1. A patient with new onset seizures had an abnormal MRI. An angiogram confirmed thrombosis of the straight sinus. On follow-up, she was doing well; repeat imaging was normal with resolution of the lesion. Case 2. A patient with a long seizure history had been well controlled on medications, and had no change in frequency of her seizures. She was found to have a left homonymous hemianopsia. MRI revealed a right parieto-occipital lesion. The patient refused further work-up and was lost to follow-up. She returned almost a year later; repeat imaging was normal. CONCLUSION--Patients with seizures and abnormal imaging suggestive of structural lesions may occasionally have lesions that resolve spontaneously. While some diagnoses remain elusive, an important consideration to exclude in these patients is venous thrombosis.

When is isolated vertigo a harbinger of stroke?

Isolated vertigo is usually a distressing though benign clinical entity. Recently, however, it has been recognized that in a subset of patients isolated vertigo may be a harbinger of vertebrobasilar stroke. Recognition of this "at risk" subgroup may be difficult. Brainstem auditory evoked potentials (BAEPs) are usually normal in patients with vertigo from labyrinthine disease. We describe a patient with isolated vertigo, in whom BAEPs were abnormal, and who subsequently developed an anterior inferior cerebellar artery territory infarct. BAEP testing might lead to early recognition of those patients at risk for catastrophic stroke, and prompt appropriate investigation and treatment to prevent this outcome.

Central retinal artery occlusion from carotid dissection diagnosed by cervical computed tomography.

BACKGROUND: Carotid dissection may lead to many different types of neurological deficits, both transient and permanent. CASE DESCRIPTION: We present a patient with an isolated central retinal artery occlusion who was found to have an ipsilateral carotid dissection by neck computed tomographic scan, later confirmed by angiography. CONCLUSIONS: This is the first reported case of carotid dissection causing central retinal artery occlusion without any other neurological deficits. It demonstrates the diagnostic usefulness of computed tomographic imaging in such cases.

Dynamic coating ion-interaction chromatographic separation of some trace impurities in oxygen-free electronic copper (OFEC) by pre-column chelation with 4-(2-thiazolylazo)resorcinol.

Deleterious trace impurities like Mn, Fe, Co, Ni, Zn, Bi and Pb in oxygen-free electronic copper (OFEC) were separated and determined by dynamic coating ion-interaction chromatography (IIC) with spectrophotometric detection using pre-column reaction methods. 4-(2-Thiazolylazo)resorcinol (TAR) was used as pre-column chelating agent. The requirements for sample preparation and the conditions for pre-column chelation reaction are discussed. The optimum conditions for the sensitive detection of these trace metal ions after ion-chromatographic separation are set. The ph of the chelating medium and the eluent, the concentration of TAR and the composition of the eluent were investigated. The detection limits achieved were 2.0, 2.8, 0.6, 0.8, 1.2, 2.6 and 3.0 ng for Mn, Fe, Co, Ni, Zn, Bi and Pb, respectively. The results obtained by IIC methods compare well with those of graphite furnace atomic-absorption spectrometry and the certified values of Mur Bundy Hamil (MBH Analytical Ltd, U.K.).

Studies on thio-substituted polyurethane foam (T-PUF) as a new efficient separation medium for the removal of inorganic/organic mercury from industrial effluents and solid wastes.

Novel thio-substituted flexible polyurethane foam (T-PUF) was synthesised by addition polymerisation of mercaptan with the precursors of an open-cell polyurethane foam, which can be used as a highly selective sorbent for inorganic and organic mercury from complex matrices. The percentage extraction of inorganic mercury was studied at different flow-rates, over a wide pH range at different concentrations ranging from 1 ppm, to 100 ppm. The break-through capacity and total capacity of unmodified and thio-foams were determined for inorganic and organic mercurials. The absorption efficiency of thio-foam was far superior to other sorbent media, such as activated carbon, polymeric ion-exchange resins and reagent-loaded polyurethane foams. It was observed that even at the 1000 ppm level, divalent ions like Cu, Mg, Ca, Zn do not appreciably influence the per cent extraction of inorganic mercury at the 10 ppm level. These matrix levels are the most concentrated ones which are likely to occur, both in local sewage and effluent waters. Further, the efficiency of this foam was sufficiently high at 10-100 ppm levels of Hg, even from 5-10 litres of effluent volumes using 50 g of thio-foam packed into different columns in series. Thio-foams were found to possess excellent abilities to remove and recover mercury even at low levels from industrial effluents and brine mud of chlor-alkali industry after pre-acid extraction. This makes it a highly efficient sorbent for possible application in effluent treatment. Model schemes for the removal and recovery of mercury from industrial effluents and municipal sewage (100-1000 litre) by a dynamic method are proposed and the costs incurred in a full-scale application method are indicated to show that the use of thio-foam could be commercially attractive.