Clinical evaluation of a novel technology for non-invasive and continuous measurement of plasma haemoglobin concentration.

We undertook the first clinical evaluation of a novel, non-invasive device for the continuous measurement of plasma haemoglobin concentration in 25 patients undergoing elective cardiac surgery. At four pre-determined intervals, samples of blood were taken for plasma haemoglobin estimation on a blood gas analyser and a laboratory device and were compared with the plasma haemoglobin estimation on the novel device using the Bland-Altman method. The 95% limits of agreement for estimation of plasma haemoglobin concentration for the device vs. laboratory, the device vs. the blood gas analyser and the blood gas analyser vs. the laboratory were 101.3 g.l(-1) , 103.1 g.l(-1) and 14.5 g.l(-1) , respectively. The bias (mean difference) in each case was 27.4 g.l(-1) , 25.1 g.l(-1) and 2.4 g.l(-1) , respectively. We conclude that the novel device in its current form is not a suitable replacement for more invasive methods of determining plasma haemoglobin concentration in patients in the setting of cardiac surgery; however, lessons learnt from the study will help to improve the device's future performance.

Voriconazole in the treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis.

Allergic bronchopulmonary aspergillosis (ABPA) can cause a significant clinical deterioration in patients with cystic fibrosis. There is very little research in the current literature with regard to alternatives for treatment, apart from long courses of steroids. We conducted a retrospective review of all our patients with ABPA treated with the antifungal voriconazole and found there was a significant drop in IgE levels post treatment as well as a decrease in steroid dosing. The improvement in FEV was not statistically significant; however there was a very wide variation in pre-treatment levels.

Severe bone demineralisation is associated with higher mortality in children with cystic fibrosis.

Decreased bone mineral density (BMD) is an emerging problem for clinicians who care for children with Cystic fibrosis (CF). The aim of this study was to determine prevalence and assess risk factors for reduced BMD in our adolescent population with CF. All bone densitometry scans (n=99) performed on children (n=79) with a mean age 13.6 (10-19.2) years over a 7 year period (2000-2007) were reviewed. Patient records were reviewed for correlating clinical data. Low BMD is frequently present in adults and children with variable reports (36-66%). In our study, BMD expressed as z score of L2-L4 spine was reduced in a total of 50% children with a preponderance of males. Bone demineralization was strongly associated with increasing age (p=0.03), diminished lung function (p=0.027), reduced body mass index (p=0.001) and treatment with oral corticosteroids (p=0.02).

A review of recent advances in optical fibre sensors for in vivo dosimetry during radiotherapy.

This article presents an overview of the recent developments and requirements in radiotherapy dosimetry, with particular emphasis on the development of optical fibre dosemeters for radiotherapy applications, focusing particularly on in vivo applications. Optical fibres offer considerable advantages over conventional techniques for radiotherapy dosimetry, owing to their small size, immunity to electromagnetic interferences, and suitability for remote monitoring and multiplexing. The small dimensions of optical fibre-based dosemeters, together with being lightweight and flexible, mean that they are minimally invasive and thus particularly suited to in vivo dosimetry. This means that the sensor can be placed directly inside a patient, for example, for brachytherapy treatments, the optical fibres could be placed in the tumour itself or into nearby critical tissues requiring monitoring, via the same applicators or needles used for the treatment delivery thereby providing real-time dosimetric information. The article outlines the principal sensor design systems along with some of the main strengths and weaknesses associated with the development of these techniques. The successful demonstration of these sensors in a range of different clinical environments is also presented.

Peripheral muscle strength in young males with cystic fibrosis.

BACKGROUND: In children with cystic fibrosis there is a decrease in peak work capacity and oxygen consumption on maximal exercise testing when compared to controls. Previous studies have shown that peripheral muscle force is decreased in children with cystic fibrosis even in those with minimal changes in lung function. However, no studies have examined peripheral muscle strength using isokinetic dynamometry which permits measurement of muscle strength throughout range and is considered the gold standard in orthopaedics and sports medicine. METHODS: Isokinetic muscle strength was measured in the knee flexors and extensors and shoulder flexors and extensors at two speeds of movement in children with cystic fibrosis and matched controls. Activity levels in both groups were calculated. RESULTS: Thirteen subjects and 13 age and height matched controls were assessed. Average peak torque was calculated and expressed in terms of body weight. There was a significant difference in peak torque/body weight in children with cystic fibrosis when compared to controls. FEV1 was significantly correlated with knee muscle strength and shoulder flexion at 90 degrees /s in subjects with CF. CONCLUSION: Children with CF had lower muscle strength than control subjects. Airflow limitation was associated with decreased muscle strength. The relationship between muscle strength and exercise tolerance requires investigation.

Blood loss in prostatic resection after relief of acute retention of urine by prolonged catheter drainage.

Blood loss in transurethral resection of the prostate was measured in 31 patients and a comparison made between 12 who had required prolonged preoperative bladder drainage by indwelling urethral catheter and 19 who had not been catheterised. There was no difference in blood loss per gram weight of prostatic tissue resected per minute operating time between the two groups.

CT diagnosis of gall stone ileus.

We report a case of gall stone ileus in which only small bowel obstruction was seen on the conventional abdominal film and the diagnosis was made by computed tomography (CT). With the availability of CT and its increasing use in the investigation of the acute abdomen, CT examination will occasionally be performed on gall stone ileus patients. Awareness of the CT findings in gall stone ileus will result in early diagnosis leading to a reduction in the mortality rate.

Malignant mesothelioma presenting as stroke--a case report.

A case of a 64-year-old man with metastatic malignant mesothelioma is described in detail. When he presented to us he gave a history suggestive of transient ischaemic attack (TIA) 2 weeks before and 3 days after admission he developed weakness of the left upper limb. Computed tomographic scan of the brain revealed a solitary metastasis in the right cerebrum. A few days later, he developed subcutaneous metastasis in the chin. Malignant mesothelioma is considered to metastasize rarely and to spread locally. We suggest that distant metastasis in malignant mesothelioma is not uncommon and may be considered to behave like other forms of lung cancer. Treatment modalities should be studied in such patients.