Nitinol stents in the treatment of benign proximal tracheal stenosis or tracheomalacia.

Nitinol stents have been used in the treatment of benign tracheal stenosis. A retrospective review of five patients treated at Stobhill Hospital over the last six and a half years is presented. Age at presentation ranged from 17 to 76 years. The minimum follow-up period was 23 months and the maximum was 78 months. All our patients were successfully decannulated, with none requiring recannulation. Four patients developed granulation tissue related to the stent at intervals ranging from three weeks to 41 months post stenting. Topical mitomycin C application has been useful after resection of granulations using the carbon dioxide (CO2) laser. Stent migration occurred in one patient three weeks after insertion. Nitinol stents are easy to insert and effective in the treatment of tracheal stenosis, but can have associated morbidity. Their use should be considered carefully, as insertion should be regarded as permanent. Publications reporting experience and outcome with the use of Nitinol stents in the trachea are reviewed.

Congenital anomalies in Canada 2013: a perinatal health surveillance report by the Public Health Agency of Canada's Canadian Perinatal Surveillance System.

Congenital Anomalies in Canada 2013: A Perinatal Health Surveillance Report is the second national surveillance report from the Public Health Agency of Canada dedicated to congenital anomalies. It provides comprehensive data on congenital anomalies in Canada, focussing on 6 categories of congenital anomalies: Down syndrome, neural tube defects, congenital heart defects, orofacial clefts, limb deficiency defects and gastroschisis. The report presents national-level birth prevalence data and temporal trends, provincial and territorial estimates, and international comparisons. Known risk factors, prevalence-related impacts of prenatal diagnosis and preventative measures are also discussed.

TITRE: Note de synthèse - Anomalies congénitales au Canada 2013 : Rapport de surveillance sur la santé périnatale du Système canadien de surveillance périnatale de l'Agence de la santé publique du Canada. INTRODUCTION: Anomalies congénitales au Canada 2013 : Rapport de surveillance sur la santé périnatale est le deuxième rapport national de surveillance des anomalies congénitales publié par l'Agence de la santé publique du Canada. Il dresse un portrait d'ensemble des anomalies congénitales au Canada en utilisant principalement six grandes catégories : le syndrome de Down, les anomalies du tube neural, les cardiopathies congénitales, les fentes labio-palatines, les malformations des membres et le gastroschisis. Le rapport fournit des données et des tendances à l'échelle nationale concernant la prévalence à la naissance, des estimations par province et par territoire et des comparaisons internationales. Sont également abordés les facteurs de risque connus, les effets du diagnostic prénatal sur la prévalence à la naissance et les mesures de prévention.

Perinatal health indicators 2013: a surveillance report by the Public Health Agency of Canada's Perinatal Surveillance System.

The Canadian Perinatal Surveillance System (CPSS) is a national health surveillance program of the Public Health Agency of Canada. The CPSS mandate is to monitor and report on key indicators of maternal, fetal and infant health. These indicators include both determinants and outcomes of perinatal health. Perinatal Health Indicators 2013 reports on 13 priority indicators using the most recent data from vital statistics, hospitalizations, the Canadian Community Health Survey and the National Longitudinal Survey of Children and Youth.

TITRE: Note de synthèse - Rapport de surveillance Indicateurs de la santé périnatale au Canada 2013 du Système canadien de surveillance périnatale de l'Agence de la santé publique du Canada. INTRODUCTION: Le Système canadien de surveillance périnatale est un programme national de surveillance de la santé géré par l'Agence de la santé publique du Canada. Il a pour but de surveiller les principaux indicateurs de la santé maternelle, foetale et infantile et d'en diffuser les tendances observées. Ces indicateurs sont constitués à la fois des déterminants et des résultats en santé périnatale. Le rapport Indicateurs de la santé périnatale au Canada 2013 présente 13 indicateurs prioritaires utilisant les plus récentes données issues de l'état civil, des hospitalisations, de l'Enquête sur la santé dans les collectivités canadiennes et de l'Enquête longitudinale nationale sur les enfants et les jeunes.

Electronic detection of nucleic acids: a versatile platform for molecular diagnostics.

A novel platform for the electronic detection of nucleic acids on microarrays is introduced and shown to perform well as a selective detection system for applications in molecular diagnostics. A gold electrode in a printed circuit board is coated with a self-assembled monolayer (SAM) containing DNA capture probes. Unlabeled nucleic acid targets are immobilized on the surface of the SAM through sequence-specific hybridization with the DNA capture probe. A separate signaling probe, containing ferrocene-modified nucleotides and complementary to the target in the region adjoining the capture probe binding site, is held in close proximity to the SAM in a sandwich complex. The SAM allows electron transfer between the immobilized ferrocenes and the gold, while insulating the electrode from soluble redox species, including unbound signaling probes. Here, we demonstrate sequence-specific detection of amplicons after simple dilution of the reaction product into hybridization buffer. In addition, single nucleotide polymorphism discrimination is shown. A genotyping chip for the C282Y single nucleotide polymorphism associated with hereditary hemochromatosis is used to confirm the genotype of six patients' DNA. In addition, a gene expression-monitoring chip is described that surveys five genes that are differentially regulated in the cellular apoptosis response. Finally, custom modification of individual electrodes through sequence-specific hybridization demonstrates the potential of this system for infectious disease diagnostics. The versatility of the electronic detection platform makes it suitable for multiple applications in diagnostics and pharmacogenetics.

Quantitation of HBV DNA in human serum using a branched DNA (bDNA) signal amplification assay.

The aim of this study was to establish the performance characteristics of a nonradioisotopic branched DNA (bDNA) signal amplification assay for quantitation of hepatitis B virus (HBV) DNA in human serum. Quantitation was determined from a standard curve and expressed as HBV DNA equivalents/mL (Eq/mL; 285,000 Eq = 1 pg of double stranded HBV DNA). The bDNA assay exhibited a nearly four log dynamic range of quantitation and an analytical detection limit of approximately 100,000 Eq/mL. To ensure a specificity of 99.7%, the quantitation limit was set at 700,000 Eq/mL. The interassay percent coefficient of variance for quantification values ranged from 10% to 15% when performed by novice users with different sets of reagents. Using the bDNA assay, HBV DNA was detected in 94% to 100% of hepatitis B e antigen-positive specimens and 27% to 31% of hepatitis B e antigen-negative specimens from chronic HBV-infected patients. The bDNA assay may be useful as a prognostic and therapy monitoring tool for the management of HBV-infected patients undergoing antiviral treatment.

Comparison of hepatitis C virus markers in patients with NANB hepatitis.

10 different HCV-specific assays and RT-PCR of the 5' untranslated region of HCV RNA were used to analyze sixty-four patients with chronic NANB liver disease. Po, CP-9 and C22 antigens are located in the putative core; C33c in the putative NS3; C100-3 in the putative NS3/4; KCL in the putative NS4/5 and C825 is located in the putative NS5. GOR protein is not part of the HCV genome, but antibodies to it appear to be present in response to a hepatitis C infection. Positive rates were 91% for Po, 89% for CP-9, 94% for C22, 97% for C33c, 88% for C100-3 (Ortho, EIA), 86% for C100-3 (Abbott, EIA), 84% for C100-3 (Ohtsuka, RIA), 88% for KCL, 59% for C825, 58% for GOR, and 83% for RT-PCR. There were 8 cases which were negative by all anti-C100 tests. 7 of these cases were positive by other anti-HCV markers and/or PCR suggesting the need for improved blood screening assays. There is a variation in the relative reactivity for different markers with different samples. Of the tests employed, anti C33c shows the highest positivity rate.

Bone metastases in carcinoma of the rectum: a clinical and pathological review.

Bone metastases were confirmed in 48 patients after treatment of rectal cancer and occurred predominantly in the lumbar spine and pelvis. Most of the deposits were lytic and coexisted with widespread metastatic disease. Correspondingly, the median survival from diagnosis was only 4 months. The new prognostic classification for rectal cancer was applied to the original tumour specimens and categorized 23 of these tumours into group IV which confidently predicts a poor outcome compared with only eight by the method of Dukes.

Bioelectronic detection of point mutations using discrimination of the H63D polymorphism of the Hfe gene as a model.

BACKGROUND: A bioelectronic detection platform has recently been developed that facilitates the detection and characterization of nucleic acids. The DNA chip platform is compatible with homogeneous assays because separate labeling and wash steps are not required. A one-step, bioelectronic detection assay was developed to genotype patient samples with respect to the H63D polymorphism of the Hfe gene, associated with hereditary hemochromatosis. METHODS AND RESULTS: Electrode arrays were modified with DNA capture probes that were perfectly matched to the wild-type or mutant allele of H63D. Amplicons containing the polymorphic site were hybridized with the capture probes on the electrode arrays in the presence of electronically labeled reporter (signaling) probes. Voltammetric analysis of the electrode arrays was conducted first at ambient temperature and then at elevated temperature. The electronic signal was preferentially diminished at elevated temperature from electrodes that hybridized with mismatched target amplicons. CONCLUSION: An assay for bioelectronic genotyping of the H63D polymorphism was developed and used with six patient specimens to show the feasibility of this system as a model for point mutation detection.

Assessment of intramuscular emulsified disulfiram in alcoholics by estimation of urinary diethylamine.

Five alcoholics administered 1 g of disulfiram in soybean emulsion by deep intramuscular injection were found to have insignificant urinary levels of disulfiram metabolites compared with five patients on oral disulfiram. Disulfiram administered in this way is unlikely to produce a significant reaction with ethanol, but its value as a placebo should not be discounted. In this pilot trial, the technique caused moderate local and systemic reactions and possible hepatic toxicity. Although in other respects the method is superior to surgical implants, modification of dosage and vehicle will be necessary, and the high incidence and severity of side effects preclude further clinical use of disulfiram in this form. Based on the work of Gordis and Peterson, a qualitative and quantitative thin-layer chromatographic urine assay method for the disulfiram metabolite diethylamine, measured as cupric diethyldithiocarbamate, was developed. This is practicable in a hospital laboratory situation and has application for compliance testing in patients on oral disulfiram.

Reducing sediment inputs to Scottish streams: a review of the efficacy of soil conservation practices in upland forestry.

The historical process by which a soil conservation strategy has evolved within the UK forestry industry is briefly reviewed. Particular attention is given to the development of practical and effective guidelines to prevent both soil damage and sediment entering water courses. It is concluded that the 'Forest and Water Guidelines', together with other forest industry manuals, largely provide adequate protection for aquatic habitats from pre-afforestation cultivation and from harvesting activities. The problem of soil erosion owing to ploughing of open furrows has largely been obviated by improved drainage network design coupled with the use of vegetated buffer strips and sediment catchpits. Alternative site preparation techniques, such as 'moling' or 'dolloping' of afforestation sites, are now preferred. However, the effects on slope hydrology and the improved soil conservation associated with these methods require quantifying. Additional understanding of effective buffer strip function, for example, on a variety of slope angles, soil types and vegetation associations would be beneficial. The design of forest roads and the associated network of drains, culverts and sediment catchpits is addressed in forestry guidelines. Future potential in this area may involve the use of Geographical Information Systems in the effective design of road networks which minimise adverse effects on slope hydrology. Similarly computer simulation of flow routing might aid in the design of road drain networks. At the more local scale there remains scope for further research aimed at minimising soil disturbance by machinery. Consideration should also be given to the long-term sustainability of the soil structure through second and subsequent crop rotations.

Effect of sheep and human follicular fluid on the maturation of sheep oocytes in vitro.

This study examines the effect of sheep and human follicular fluid on the in vitro maturation (IVM) of sheep follicular oocytes. Oocyte cumulus complexes recovered post mortem were matured for 24 to 26 h at 38.6 degrees C, 5% CO(2) in air, in TCM-199 bicarbonate medium supplemented with 20% fetal calf serum (FCS) and, where stated, with maturation hormones, including FSH (5.0 microg/ml), LH (5.0 microg/ml) and estradiol (1 microg/ml), or with sheep follicular fluid recovered from large (>5 mm) or small (2 to 5 mm) ovarian follicles post mortem, or with human periovular follicular fluid obtained during routine IVF procedures. The matured oocytes were then denuded, and their maturation stage and developmental capacity were assessed by in vitro fertilization (IVF) and culture (IVC). It was found that inclusion of sheep or human follicular fluid or hormone supplements in the IVM media more than doubled the number of oocytes completing maturation (FCS alone 33%, compared with 76.2% for maturation hormones, 84.2% for fluid from large and 69.6% for fluid from small sheep follicles and 82.6% for human follicular fluid), and significantly increased fertilization rates (FCS alone 51.6%, compared with 71.9% for maturation hormones, 78.4% for fluid from the large and 75.7% for fluid from small sheep follicles and 73.1% for human follicular fluid) without discernible adverse effects on the development of the cleaving embryos to the morula or blastocyst stage in culture. Omission of FCS and supplements from the IVM medium resulted in a marked reduction (56%) in the number of oocytes maturing. This reduction could be offset to a large part, but not completely, by inclusion of human follicular fluid or human follicular fluid plus LH (5 microg/ml) in the medium. The results of this study show that addition of sheep or human follicular fluid to maturation medium can enhance rather than inhibit the maturation and fertilizability of sheep follicular oocytes in vitro.

Gonadotropin stimulation regimens for follicular aspiration and in vitro embryo production from calf oocytes.

Crossbred beef x dairy calves were randomly allocated at 3 wk of age to different gonadotropin treatment regimens for stimulation of follicle development and induction of oocyte maturation in vivo. Follicular responses were assessed laparoscopically, and oocytes were aspirated for assessment of maturational state or for in vitro fertilization (IVF) and culture to determine developmental capacity. Follicle-stimulating Hormone (FSH), administered in a single subcutaneous injection together with a low dosage of PMSG, was as effective as the same total dosage of FSH administered in 6 injections over a 3-d period. Without accompanying PMSG, this dose of FSH was ineffective in stimulating follicle development. The mean number of preovulatory follicles (> 5mm, with hyperemic appearance) doubled with each successive stimulation at 3-wk intervals, reaching 35 follicles per calf at 9 wk of age. Oocyte yields ranged from 55 to 81% of follicles aspirated, and did not differ significantly among age, FSH regimen and oocyte maturation stimulus. A combination of LH + FSH was more effective in stimulating cumulus cell expansion than LH by itself (73 vs 22% of recovered oocyte-cumulus cell complex (OCC) respectively; P<0.05). Of 33 unselected immature oocytes (cumulus unexpanded) subjected to in vitro maturation (IVM) and IVF, 30% developed to blastocysts during co-culture with bovine oviduct epithelial cells, which was not significantly different from 25% of 36 oocytes from adult ovaries which reached the blastocyst stage under similar conditions. The results indicate that follicle responses of calf ovaries to FSH stimulation increase progressively from 3 to 9 wk of age, and that oocytes recovered laparoscopically from these follicles produce blastocysts in culture at rates similar to oocytes from adult cattle ovaries collected at slaughter. The approach offers promise for embryo production from donor calves of superior genetic merit for embryo transfer, thereby enhancing the rate of genetic gain above that attainable by conventional breeding or by embryo transfer in adult cattle.

Pregnancies and live birth from in vitro fertilization of calf oocytes collected by laparoscopic follicular aspiration.

Oocytes were recovered by laparoscopic aspiration from 3- to 8-week-old calves treated with follicle-stimulating hormone (FSH) followed by human chorionic gonadotropin (hCG) to induce follicular growth and oocyte maturation in vivo. Most of the recovered oocytes either had resumed meiotic maturation at the time of aspiration or were competent to undergo maturation during subsequent culture in vitro. Oocytes matured in vivo following FSH and hCG treatment underwent in vitro fertilization (70%) at rates not significantly different from those of control oocytes recovered from adult cow ovaries at abattoirs and matured in vitro (75%). Calf oocytes that were immature at aspiration exhibited lower fertilization rates after in vitro maturation (36%) but their rate of development to morulae and blastocysts did not differ from that of mature oocytes at aspiration. A total of 91% of the zygotes produced from calf oocytes developed to morula and 27% to blastocyst stages during 6 days of culture. The proportion developing to morulae was significantly higher (P<0.05) than that observed for zygotes resulting from in vitro maturation and fertilization of oocytes recovered from cow ovaries obtained at an abattoir and processed concomitantly (59% to morulae and 18% to blastocysts). Morulae or blastocysts developed from oocytes from 5 to 6-week-old calves, when transferred to synchronized recipient heifers, resulted in 2 confirmed pregnancies, one of which produced a single full-term live calf. The ability to produce embryos from oocytes recovered from newborn or prepubertal calves offers the potential for markedly reducing the generation interval in cattle, thereby substantially accelerating the rate of genetic gain that can be achieved through embryo transfer.

Primary extracranial meningioma of the soft palate.

Extracranial meningiomas comprise two per cent of all meningiomas. Primary extracranial meningiomas are even less common. The authors report the first case of a primary extracranial meningiomas of the soft palate, which presented as an intraoral mass. This was treated by surgical excision and there was no evidence of tumour recurrence at four years of follow-up.

Naso-labial flap in the reconstruction of floor of the mouth defects.

Defects caused by tumour excision in the floor of the mouth can be closed by different methods. We present thirteen cases treated in our department over the last seven years in whom naso-labial flaps were used. Twelve patients had squamous cell carcinoma of the floor of the mouth and one had fibro-sarcoma of the right lower mandible. Five received post-operative radiotherapy, one was resected following radiotherapy and seven were treated with surgery alone. Patient selection is important to give good functional results without compromising tumour clearance.

The Provox voice prosthesis and Candida albicans growth: a preliminary report of clinical, mycological and scanning electron microscopic assessment.

Provox voice prostheses are low-resistance speech values available since 1990 for post-laryngectomy voice rehabilitation. Candida spp. mycelial growth has always been a major problem in all prosthetic valves causing leakage and limiting valve life. We found that the Provox new valves were not exempt from the old problem. We performed a preliminary clinical, mycological and scanning electron microscopic assessment of Candida spp. growth on these valves. In contrast to studies done with other valves we found that the Candida mycelium on these new valves was a surface colony rather than growing into the valve substance, thus it might be feasible to control the mycelial growth by either mechanical cleansing or by using topical anti-fungal agents.

Developments in palliative nursing in and out of the hospital setting.

This article compares and contrasts the developments that have occurred in palliative nursing in the community (including the hospice movement) with those in acute hospitals. Symptom control, communication and family care are highlighted. The problems associated with caring for dying patients are considered and suggestions made for improving the present system.

Teaching palliative nursing to students.

This article explores some of the reasons why students need to learn about death and dying, and examines why students may be ill-prepared to deal with dying patients. It also outlines some innovative ways of teaching death and dying, including methods the author has used to teach students in her own practice.