Post-Partum Spontaneous Coronary Artery Dissection with Occluded Left Anterior Descending Artery.

Presentation We present a case of spontaneous coronary artery dissection (SCAD) in a 35-year-old lady who was 4 months post-partum. Despite a lack of typical risk factors, initial presentation and investigations were strongly suggestive of ACS. Diagnosis Coronary angiography revealed an occluded proximal left anterior descending (LAD) artery with TIMI 0 flow. Angiographic appearances and intravascular ultrasound (IVUS) were consistent with SCAD. Treatment A single drug-eluting stent was deployed, successfully restoring good flow, without extending the dissection flap. Discussion SCAD should be considered as an important and underdiagnosed cause of ACS, predominantly in young women without other apparent risk factors.

Pond walls: inclined planes to improve pathogen removal in pond systems for wastewater treatment?

Attenuation of sunlight in wastewater treatment ponds reduces the depth of the water exposed to disinfecting irradiances. Shallow pond depth with paddlewheel rotation increases exposure of pathogens to sunlight in high rate algal ponds. Generation of thin films, using pond walls as inclined planes, may increase inactivation of pathogens by increasing sunlight exposure. The performance of a laboratory based model system incorporating an inclined plane (IP) was evaluated. F-RNA bacteriophage, in tap water or wastewater, was exposed to sunlight only on the IP with the bulk water incubated in the dark. MS2 inactivation was significantly higher when the IP was present (P < 0.05) with a 63% increase observed. Prolonged exposure increased MS2 die-off irrespective of IP presence. Versatility of the IP was also demonstrated with faster inactivation observed in both optically clear tap water and wastewaters. IPs of different surface areas produced similar inactivation rates when operated at similar hydraulic loading rates regardless of slope length.

Impact of heparan sulfate chains and sulfur-mediated bonds on the mechanical properties of bovine lens capsule.

We assessed the importance of glycosaminoglycans and sulfur-mediated bonds for the mechanical properties of lens capsules by comparing the stress-strain responses from control and treated pairs of bovine source. No significant change in mechanical properties was observed upon reduction of disulfide bonds. However, removal of glycosaminoglycan chains resulted in a significantly stiffer lens capsule, whereas high concentrations of reducing agent, which is expected to reduce the recently reported sulfilimine bond of collagen IV, resulted in a significantly less stiff lens capsule. A comparison of the diffraction patterns of the control and strongly reduced lens capsules indicated structural rearrangements on a nanometer scale.

Lymph node localisation of biodegradable nanospheres surface modified with poloxamer and poloxamine block co-polymers.

Studies were performed to develop a sub-100 nm biodegradable colloidal system for the efficient delivery of drugs and diagnostic agents to the lymphatic system. Nanospheres of poly(lactide-co-glycolide) were prepared by interfacial polymer deposition. The nanospheres were coated with block co-polymers in order to modify their surface characteristics. Radiolabelling of the nanospheres for in vivo tracing was achieved by the incorporation of the lipophilic complex 111In-oxine during nanosphere preparation. In vitro stability of the radiolabelled nanospheres was determined in rat serum at 37 degrees C. The lymphatic distribution of the nanospheres was determined after subcutaneous administration to the rat. Lymphatic uptake of all coated systems was enhanced compared to the uncoated nanospheres, and a maximal uptake of 17% of the administered dose in the regional lymph nodes was achieved. These observations suggest that the nanospheres are suitable for diagnostic and therapeutic applications in clinical and experimental medicine.

Surface engineered nanospheres with enhanced drainage into lymphatics and uptake by macrophages of the regional lymph nodes.

The concept of steric stabilization as used in colloid science is applied to carefully manipulate the drainage and lymphatic distribution of subcutaneously administered model polystyrene nanospheres. A wide range of synthetic polyoxyethylene (POE)/polyoxypropylene (POP) block co-polymers of poloxamine and poloxamer series have been used to produce sterically stabilized nanospheres. We have found a correlation between the length of the stabilizing POE chains of the block co-polymers and nanosphere drainage and passageway across tissue lymph interface in dermal lymphatic capillaries in the rat footpads; the longer the POE chains, the faster the particle drainage. Nanospheres conditioned with block co-polymers of POE chains of 5-15 ethylene oxide units are effectively opsonized in lymphatics; a process which dramatically enhances sequestration (up to 40% of the administered dose) by macrophages of the regional lymph nodes. If the dimensions of the stabilizing POE chains of the poloxamines and poloxamers exceed the range of the Van der Waals force of attraction, opsonization fails to occur and rapidly drained engineered vehicles escape clearance by macrophages of the regional nodes, reach the systemic circulation and remain in the blood for prolonged periods. These observations suggest that a lymphatic delivery composition based on polymer-coated particles will be advantageous for many applications in clinical and experimental medicine.

Long circulating biodegradable poly(phosphazene) nanoparticles surface modified with poly(phosphazene)-poly(ethylene oxide) copolymer.

The biodistribution of biodegradable poly(organo phosphazene) nanoparticles surface modified by adsorption of a novel poly(organo phosphazene)-poly(ethylene oxide) copolymer with a 5000 M(W) PEO chain (PF-PEO[5000]), following intravenous administration in rats and rabbits, is described. The data are compared to the biodistribution of poly(organo phosphazene) and poly(lactide-co-glycolide) nanoparticles coated with a tetrafunctional copolymer of poly(ethylene oxide)-poly(propylene oxide) ethylenediamine, commercially available as Poloxamine 908. This copolymer has a PEO chain of the same size as the poly(organo phosphazene)-PEO derivative used. The results in the rat model reveal that poly(organo phosphazene) nanoparticles with a Poloxamine 908 coating were mainly captured by the liver, although a retardation in clearance from the systemic circulation was seen. In contrast, the poly(organo phosphazene) nanoparticles coated with PF-PEO(5000) showed a prolonged blood circulating profile, with only a small amount of the nanoparticles sequestered by the liver. This indicates the importance of the nature of both the anchoring group and the particle surface on the biological performances of the system. Study of the biodistribution of the PF-PEO(5000)-coated poly(organo phosphazene) nanoparticles in the rabbit model also indicated a prolonged systemic circulation lifetime and reduced liver uptake, whereby a significant amount of the administered nanoparticles was targeted to the bone marrow.

Effects of ration, season and animal handling on composition of bison and cattle blood.

Composition of ration and season of sampling markedly affected the composition of blood in six tamed bison (Bison bison) steers and eight Hereford cattle (Bos taurus) steers. Observed values extended reported ranges for albumin, phosphorus and blood urea nitrogen (BUN) in bison serum. There were several differences between species in blood composition. In particular, erythrocytic and BUN values were higher in bison than in cattle. Overall mean values for bison and cattle receiving experimental rations were, respectively: BUN, 17.1 mg/dl and 14.1 mg/dl; hemoglobin, 17.8 g/dl and 13.3 g/dl; packed cell volume (PCV), 47.6% and 35.6%; red blood cells, 9.3 x 10(6)/mm3 and 8.2 x 10(6)/mm3; mean corpuscular volume (MCV), 51.3 mean 3; mean corpuscular hemoglobin, 18.9 pg and 16.1 pg. The significant changes in blood composition associated with changes in ration composition support the use of blood composition as an index of nutritional status. There were no sex-specific differences in blood of 20 bison from Elk Island National Park and 34 bison from Wood Buffalo National Park, Alberta. Alkaline phosphatase (ALP) level was higher in juvenile than in adult bison. Impoundment of wild bison for 24 hr was accompanied by a decrease in BUN and an increase in PCV. Wild bison that were killed during handling had significantly higher blood levels of ALP, glutamate oxaloacetate transaminase, MCV and phosphorus.

A form of human intercourse?

The philosophical basis of military medicine needs to be understood fully before progress can be made in doctrine, organization, training, and resourcing. During a time of increased resource constraint and radical restructuring of the military, an opportunity arises for a fundamental reexamination of the nature and philosophy of military medicine. In order to be effective in the role, a military physician needs to fully understand the obligations of the two professions that he or she straddles. The military physician needs to be fully conversant with the profession of arms as well as being a medical professional. The obligations of the two may occasionally be divergent, but the physician has an important role to play in reconciling them. This action may act synergistically and produce a maximally effective military system.

Biodosimety Assessment Tool: a post-exposure software application for management of radiation accidents.

The Biodosimetry Assessment Tool software application under development will equip health care providers with diagnostic information (clinical signs and symptoms, physical dosimetry, etc.) germane to the management of human radiation casualties. Designed primarily for prompt use after a radiation incident, the user-friendly program facilitates collection, integration, and archiving of data obtained from exposed persons. Data collected in templates are compared with established radiation dose responses obtained from the literature to provide multiparameter dose assessments. The program archives clinical information (e.g., extent of contamination, wounds, infection, etc.) useful for casualty management, displays relevant diagnostic information in a concise format, and can be used to manage both military and civilian radiation accidents. In addition, monitoring of diagnostic information of individuals using this program could potentially minimize the severity of psychological casualties by making a marked impact on the way that both radiation casualties and the worried well view their exposure, dose, and future risk for the development of disease.

Long-gap oesophageal atresia: a nursing perspective.

Oesophageal atresia (OA) is a congenital anomaly in which the oesophagus ends in a blind upper pouch. Specialised family-centred nursing care is required for the neonate/infant with 'long-gap' OA. Goals of preoperative nursing care focus on prevention of aspiration, optimising nutrition and thus growth of the baby and supporting parents. Primary repair is delayed to enable further growth of the infant and additional oesophageal growth. Additional nursing and medical research needs to be undertaken in a number of areas relating to the management of infants with long-gap OA.

Rwanda 1994: a study of medical support in military humanitarian operations.

The deployment of British Contingent (BRITCON) to United Nations Force in Rwanda (UNAMIR) on Operation GABRIEL in 1994, proved to be a successful deployment on humanitarian operations. Many of the lessons have been successfully incorporated into training, equipment and organisational structures since the deployment. Others require further work to develop and assimilate. The essential issue concerning principles of humanitarian relief doctrine, mission definition, understanding the Disaster-Development continuum, capability mix, spectrum of military utility and the importance of force maintenance were all highlighted by the Rwanda deployment. Implications for future humanitarian operations include a co-operative approach to pre-deployment training with the Non-Governmental Organisation (NGO) community. This will help to promote understanding between the 2 arms of the humanitarian effort and will exploit the strengths of both sides. Equally, the military medical services have to be fully aware of mission definition and its centrality to planning, execution and audit of performance.

Trauma management on the battlefield: a modern approach.

With the development of British Army doctrine it is necessary to review the concepts underlying medical support to the modern battlefield. In particular, the provision of timely and balanced resuscitation to the high intensity battle is an issue requiring an understanding of both the tactical and the clinical demands. The wholesale application of civilian techniques and approaches to trauma management is not possible given the austerity of the battlefield clinical environment. The commitment to excellence and quality of care implicit in modern mainstream practice is of continuing relevance to the battlefield. A doctrinal approach involving the definition of desired clinical outcome and the constraints of operational feasibility, is proposed. Specifically, the introduction of a triad approach to trauma management is offered. The triad comprises readily available Battlefield Advanced Trauma Life Support (BATLS) skills, Surgical Resuscitation deployed forward and the provision of Field Intensive Care. Such an approach would marry together the clinically ideal with the tactically.

Adder bites in Aldershot.

Each summer cases of adder bite occur in Aldershot and its surrounding areas. Many of these are brought to the Cambridge Military Hospital. This paper reports three cases that together illustrate the commonest clinical signs and symptoms. These include rapid swelling, malaise and anxiety. An important diagnostic indication is an early and marked leucocytosis. Treatment regimes are also reviewed with the advice ultimately being to "admit and monitor". The danger of early resort to antivenom is also examined and the principles of both treatment and first aid are developed.

Health surveillance: an operational imperative?

Many recent operations have highlighted the problem of hazard exposure in troops. This is a difficult area since it depends upon both post-deployment and possibly mid-deployment health surveillance and crosses the traditional limits of occupation and public health medicine. Health surveillance is itself a term which straddles occupational and public health medicine. For the military population at risk on operations, a combined approach is required incorporating the separate activities of needs and risk assessments. There is an existing vehicle to develop this approach using the new J95 methodology. Equally, a system of data access crossing medical and personnel records is necessary. The important requirement is that health surveillance is included in pre-deployment planning. Only by this method can adequate resources and significance be accorded to appropriate health surveillance strategies both during and following an operation as required.

Adder bite in the British Army 1979-1988: a decade of experience.

The results of hospital admissions for adder bite suffered by British Army personnel were reviewed over a ten year period. They confirmed the low bite rate and the risk factors previously demonstrated in earlier studies. In particular, the dangers of handling and attempting to catch the snake were highlighted. Also illustrated was a general ill-preparedness by clinicians to manage the condition. In this connection, the use of specific Zagreb anti-venom preparation for cases of severe poisoning is advocated, as is admission to hospital for assessment and appropriate monitoring. Adder bite is both unusual and unpredictable so caution needs to be exercised in the initial clinical appraisal.

Rosuvastatin reduced deep vein thrombosis in ApoE gene deleted mice with hyperlipidemia through non-lipid lowering effects.

INTRODUCTION: Statins, particularly rosuvastatin, have recently become relevant in the setting of venous thrombosis. The objective of this study was to study the non-lipid lowering effects of rosuvastatin in venous thrombosis in mice with hyperlipidemia. MATERIALS AND METHODS: An inferior vena cava ligation model of venous thrombosis in mice was utilized. Saline or 5mg/kg of rosuvastatin was administered by gavage 48hs previous to thrombosis. Blood, the inferior vena cava, thrombus, and liver were harvested 3, 6hours, and 2days post-thrombosis. Thrombus weight, inflammatory markers, and plasminogen activator inhibitor-1 expression and plasma levels were measured. Also, neutrophil migration to the IVC was assessed. RESULTS: Rosuvastatin significantly decreased thrombus weight, plasminogen activator inhibitor-1 expression and plasma levels, expression of molecules related to the interleukin-6 pathway, and neutrophil migration into the vein wall. CONCLUSIONS: This work supports the beneficial effects of rosuvastatin on venous thrombosis in mice with hyperlipidemia, due to its non-lipid lowering effects.