Patency of permanent vascular access creation in paediatric patients with end stage renal disease.

Renal transplant is the first-line therapy in paediatric patients with end-stage renal disease (ESRD). Wong HS and Goh BL reported up to 79% of 1061 paediatric patients still require long-term haemodialysis (HD).1 The lack of deceased and living donors is attributable to the poor awareness, cultural and religious grounds. Permanent vascular access (PVA) in paediatrics therefore, serves more as a long term treatment rather than a bridging therapy. We observed 5 children and an adolescent, all with previous indwelling catheters, who underwent arteriovenous fistula (AVF) creation and report the outcomes. The aim of this report is to determine the factors that influence the longterm patency of paediatric AVF. Factors such as body weight, vessel diameter, preoperative preparations, microsurgical technique and postoperative maintenance are discussed. In addition, considerations on the choice and timing of PVA is highlighted.

[Approach to tumors of the chiasm-sellar region with preservation of the olfactory tracts]. / Dostup k opukholiam khiazmal'no-selliarnoi oblasti s sokhraneniem oboniatel'nykh traktov.

Mobilization of the olfactory tract in mono- and bifrontal approach to the chiasmal-sellar region with preservation of its own vascular network down to the olfactory trigone on the side of the approach and for a distance of 20 mm from the other side creates adequate conditions for the operation. According to the EEG values, the degree of the operative trauma does not increase essentially and the prognosis of vision restoration is no worse. The olfactory function is restored immediately after surgery in most cases.

Venipuncture versus heel prick for blood glucose monitoring in neonates.

INTRODUCTION: The aim of this study was to determine whether there was a difference in the pain indicators and effectiveness between venipuncture (VP) and heel prick (HP) for blood glucose monitoring in term neonates (recently, venipuncture was shown superior for the Guthrie test). METHODS: 66 term neonates undergoing blood glucose monitoring underwent VP or HP. Primary outcome measures included the Neonatal Facial Scoring System (NFCS) score, duration of the first cry, total duration of cry and duration of procedure. Secondary outcome measured was the number of skin punctures needed to obtain blood. RESULTS: The NFCS score was not significantly different between the two groups and the duration of the procedure was significantly longer for the VP than the HP group (median 27 s vs. 7 s; p-value is less than 0.001). The differences between the two groups in the duration of the first cry, total duration of cry and number of skin punctures needed to obtain blood were not statistically significant, but these parameters displayed a trend, favouring the HP. CONCLUSION: The HP is still the preferred method of drawing blood in neonates for blood glucose monitoring, as only one drop of blood is required.

Syphilis d'emblée due to blood transfusion. Case report.

A 58-year-old Chinese woman presented with syphilis d'emblée. Seven weeks after a blood transfusion lesions appeared on the palms of her hands and the soles of her feet. These gradually increased in number and other lesions developed on the scalp and palatal mucosa. One of the blood donors was found to have had positive serological test results for syphilis but no clinical symptoms or signs. This case illustrates the danger inherent in the use of whole fresh blood for transfusion purposes.

Penicillinase-producing Neisseria gonorrhoeae isolated in Surabaya.

Although penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) were discovered in 1976 in neighbouring countries, not until 1980 were such strains isolated and identified in Indonesia. In that year PPNG were detected in three male patients with gonococcal urethritis in Surabaya. The minimum inhibitory concentration of penicillin G for all three strains was 12 . 5 microgram/ml.

Blood flow velocity in cutaneous lesions of leprosy.

The velocity of blood flow in the cutaneous lesions of leprosy was measured by the noninvasive technique of laser-Doppler velocimetry in nine male patients, all under treatment with World Health Organization multidrug regimens. In three patients with stable borderline tuberculoid (BT) lesions, the blood-flow velocity was slightly faster over the lesion than that in adjacent uninvolved skin. There was no substantial difference between different sites at the center and edge of individual lesions in each patient, but there was some variation between subjects. In one other BT patient with a reversal reaction, blood-flow velocity was 20-fold greater than in adjacent uninvolved skin. In four patients with stable borderline lepromatous/lepromatous (BL/LL) disease, the blood-flow velocity was 3 to 9 times faster over the plaques than in adjacent skin. There was relatively little difference between measurements over comparable points at the edge and center of individual plaques, or between plaques in the same patient, but there were considerable differences between patients. A fifth BL patient in reversal reaction showed generally similar results to those found in the stable BL/LL patients. Histometric study of the biopsies taken immediately after blood-flow measurement from two different plaques on each of four BL patients showed a clear relationship between the granuloma fraction measured by planimetry and the blood-flow velocity. This finding suggests that laser-Doppler velocimetry might prove to be a useful, clinically acceptable, noninvasive technique for monitoring the severity of hyperemia as an early indication of reversal reaction during chemotherapy trials in leprosy patients.

The cellular responses of tuberculosis and leprosy patients and of healthy controls in skin tests to 'new tuberculin' and leprosin A.

The density and distribution of T4 and T8 lymphocytes and of monocyte/macrophages at the site of skin tests with mycobacterial antigens was studied in pulmonary tuberculosis and leprosy patients and in healthy controls. Most of the inflammatory cells were located in perivascular and periappendicular foci in the dermis: the percentage of the dermis occupied by focal infiltrate was unrelated to the clinical measurement of the area of induration. There was a less intense diffuse infiltrate in the dermis between the foci, most marked in the papillary dermis and lessening progressively in deeper layers. In patients, diffusely infiltrating lymphocytes were more numerous (mainly due to an excess of T8 cells) in relation to extracts of the pathogen causing their disease than to extracts of the other organism: T8 cells were particularly numerous in reactions to Leprosin A in three of four partly treated leprosy patients who had been classified as tuberculoid at the time of diagnosis. The density of diffusely infiltrating macrophages showed a similar density gradient and selective concentration in response to active disease pathogens. However these cells were less numerous in partly treated leprosy patients than in controls and most frequent in untreated pulmonary tuberculosis patients. Selective migration of monocyte/macrophages and, to a lesser extent T8 cells, appears to be a prominent feature in the reaction of patient with active mycobacterial disease to antigens derived from the causative organisms: this suggests that it might become possible to distinguish direct reactions from cross-reactions in human delayed hypersensitivity reactions by identification of these histological features.