Herniation of the caecum and ascending colon through the foramen of Winslow: a case report and review.

Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.

The first case of the Reveal LINQ™ Insertable Cardiac Monitor implanted in a child in Malta.

BACKGROUND: The Reveal LINQ™Insertable Cardiac Monitor (ICM) or Implantable Loop recorder (ILR), is a miniaturized, subcutaneous, single lead, electrocardiographic monitoring device which has been extensively used in the differential diagnosis of unexplained syncope and palpitations in adults. PATIENT DESCRIPTION: We describe an asymptomatic 20-month-old boy, noted to have incidental bradycardia on routine examination and in whom Holter monitoring revealed complete heart block (CHB). Over 1 year, the longest recorded pause lengthened from 1.8 seconds to 3.6 seconds. RESULTS: The Reveal LINQ™ ICM was inserted for long-term monitoring of the CHB. The device will record the electrocardiogram (ECG) continuously for up to 3 years, freezing in its memory any significant arrhythmic events. This will enable the diagnosis of the longest pauses, confirm whether they are lengthening over time and assist with the decision of pacemaker implantation. CONCLUSION: The Reveal LINQ™ ICM is much smaller than the conventional loop recorder and has been shown to be ideal for close monitoring of asymptomatic yet potentially dangerous arrhythmias in young children.

Speciation of Cd and Pb in dust emitted from sinter plant.

Many studies have provided evidence of the impact of heavy metals in atmospheric emission. Sinter plants represent the first step in steel production, and are important emitters of Cd and Pb. The toxicity of these two metals depends above all on their speciation. Particles collected before and after the filtration system were analysed to determine the Cd- and Pb-bearing phases, using analytical tools such as XRF, EXAFS or ICP-AES and chemical leaching (sequential extractions adapted to steel dusts). Results show that Pb is associated with carbonate and Cd with chloride. These two types of speciation lead to high solubility under common environmental conditions, which may produce impacts on the environment and health.

Determination of zinc speciation in basic oxygen furnace flying dust by chemical extractions and X-ray spectroscopy.

There is a growing concern regarding the environmental and public health risks associated with airborne particulate matter (PM). The basic oxygen furnace is one of the most important atmospheric dust sources of the steel manufacturing process. It emits dust enriched in heavy metal such as Zn, which is assumed to contribute to the toxic potential of atmospheric PM. Dust collected before and after the filtration system was analyzed to determine Zn speciation. To this end, a variety of analytical tools were used and a sequential extraction protocol has been specifically developed for iron and steel dust. The Zn speciation results obtained by EXAFS and sequential extraction were in excellent agreement. Before filtration, the speciation of Zn in BOF was 43% ZnFe(2)O(4), 23% ZnCO(3) and 16% ZnO. The same species were detected after filtration with different proportions. BOF dust after filtration contains more soluble Zn phases which may play a role in the toxic effects of the emissions.

Healthy diet in primary care: views of general practitioners and nurses from Europe.

BACKGROUND: Most of the national colleges of general practitioners (GPs) do not have their own dietary/nutritional tools, and GPs and nurses do not have the time, knowledge, or skills to advise their patients about desirable dietary practices. OBJECTIVE: To assess the usefulness of a simple and practical guide on healthy diet to be used by European GPs and nurses. DESIGN: A postal survey was mailed to 171 GPs and nurses from 12 European countries to obtain information about the usefulness of a guide on healthy diet developed by EUROPREV. RESULTS: The perception of health professionals is that the main source of information on healthy diet for the population was the media. In all, 95% of GPs and nurses reported that the guide was useful; 93, 95, and 82% reported that the concepts were concise, easy to understand, and realistic, respectively. Also, 77% reported that the type of counselling recommended was feasible and could be applied, 94% reported that the implementation measures proposed could be effective and 88% reported that the Traditional Mediterranean Diet Pyramid is useful, but some concerns about the content were mentioned. CONCLUSIONS: GPs and nurses from Europe think that a practical guide on healthy diet developed by EUROPREV could be used to advise patients in primary care, although the Traditional Mediterranean Diet Pyramid should be modified.

Lead and other metals in gestational hypertension.

OBJECTIVES: To identify any effects that lead, calcium, magnesium, and zinc may have on the development of gestational hypertension. METHODS: Third-trimester 110 normotensive and 33 gestational hypertension cases were assayed for various metal levels, using standard techniques, including atomic absorption spectrometry. RESULTS: Gestational hypertension cases showed significantly higher blood lead levels than normotensives. No differences were noticed regarding calcium (ionized and total), magnesium, and zinc levels. Blood lead was significantly related with blood pressure, even after correcting for the body mass indices and age. Blood pressure levels showed no relation to the other analyzed metals. However, the lead:ionized calcium ratio showed a stronger association with blood pressure, than lead alone. Blood lead showed a significant negative relationship with ionized calcium, but none with the other metals. CONCLUSIONS: Blood lead evidently influenced blood pressure increments and gestational hypertension development. This implies that all efforts should be made to reduce the population's exposure.

Evaluation of environmental levels and biological impact of TBT in Malta (central Mediterranean).

Chemical monitoring for butyltins in bulk seawater, surface microlayer and superficial sediments determined that the two main local sources of marine contamination by tributyltin (TBT) compounds in Malta are ship-repairing dockyards and marinas. In bulk seawater, TBT values ranged from below the detection limit of 5 ng Sn l(-1) to 300 ng Sn l(-1); in sediments derived from the most polluted areas, TBT concentrations as high as 1500 ng Sn g(-1) were measured. At TBT levels found in local harbours, several sublethal biological responses are possible and were observed, including a significant reduction in MFO enzyme system activities of fish; digestive cell atrophy in the oyster Ostrea edulis; and induction of imposex in the snail Hexaplex trunculus. The latter two responses are evident at TBT concentrations below the environmental quality standard (20 ng TBT l(-1)). The ecological implications of these results are discussed and it is concluded that exposure of marine organisms to TBT in local harbours may be expected to lead to a reduction in the long-term survival of a number of such organisms. For these reasons, both the use of TBT-based antifouling paints for pleasure boats as well as drydock practices need to be controlled by appropriate regulations and their enforcement.

Anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome.

We describe the management of a patient with Eisenmenger's syndrome presenting for laparoscopic cholecystectomy. Of prime concern was maintenance of systemic vascular resistance and this was achieved using infusion of noradrenaline started before induction of anaesthesia and continued after operation. Avoidance of other factors that could potentially increase right to left shunt flow contributed to the successful outcome.

Petrol lead in a small island environment.

The Maltese population has been repeatedly shown to have high mean blood lead levels irrespective of age. This study confirms that these higher levels also occur in Maltese children. A definite correlation is shown between high blood lead levels and the environment of the subjects studied, being statistically higher in individuals living on the urbanized larger island. A statistical correlation has been shown between hand-wipe specimens taken from children playing in a playground and the traffic density of the area. A similar statistical correlation between playground, street and household dust to traffic density has also been identified.

Chronic lead exposure and pregnancy.

The objective of the study was to determine the effect of chronic lead exposure on pregnancy and the newborn. Cord blood was assayed for blood lead levels (PbB) in a randomly selected group of 82 Maltese newborns. Twenty-eight (34.1%) neonates had a PbB level greater than 200 µg/l. Two trends appeared with increasing blood lead levels suggesting a decrease in newborn birth weight (r=-0.1445, P=0.207) and an increase in the duration of the first stage of spontaneous labour (r=0.1385, P=0.3043). There appeared to be no mean differences in maternal third trimester haemoglobin, duration of gestation, and previous pregnancy loss in infants with high PbB levels compared to infants with low PbB. Through its properties of inhibiting enzymatic function and its competitiveness with other minerals, calcium and zinc, chronic sub-toxic lead exposure during pregnancy may cause adverse effects on the neonate and pregnancy.

Improvements in immunostaining samples embedded in methacrylate: localization of microtubules and other antigens throughout developing organs in plants of diverse taxa.

Microtubules are important in plant growth and development. Localizing microtubules in sectioned material is advantageous because it allows any tissue of interest to be studied and it permits the positional relations of the cells within the organ to be known. We describe here a method that uses semi-thin (0.5-2 µm) sections of material embedded in butyl-methylmethacrylate, to which 10 mM dithiothreitol was added. After removing the embedding material and using indirect immunofluorescence staining, we obtain clear images of microtubules, actin microfilaments, callose and pulse-fed bromodeoxyuridine. This method works on the root tissues of Arabidopsis thaliana(L.) Heynh, Pinus radiataD. Don, Zamia furfuraceaAit., Azolla pinnataR. Br. and on sporophytic tissues of Funaria hygrometricaHedw. In general, most of the cells in the organs studied are successfully stained. Using this method, we find that interphase meristematic cells in all of these species have microtubules not only in the usual cortical array but also throughout their cytoplasm. The presence of the calcium chelator ethylene glycol-bis(ß-aminoethyl ether)N,N,N',N'-tetraacetic acid EGTA in fixation buffers led to some tissue damage, and did not enhance the preservation of microtubules. The common assumption that EGTA-containing buffers stabilize plant microtubules during fixation appears unwarranted.

Pethidine blood concentrations at time of birth.

Pethidine levels in maternal and fetal blood were estimated at birth after variable periods of intramuscular administration--delivery intervals in forty pregnant women. The results suggest that maternal--fetal equilibrium occurs at a fast rate with a regression coefficient initially of 0.54. There appeared to be a tendency towards trapping of the drug in the fetal circulation resulting in a rise in the regression coefficient after 3 h reaching 0.85. The pharmacokinetics and the clinical significance of these observations are discussed.

Rearrangements of Microtubules Involved in Establishing Cell Division Planes Start Immediately after DNA Synthesis and Are Completed just before Mitosis.

This work concerns an aspect of spatial regulation of cell division, the development of the preprophase band (PPB) of microtubules. The PPB is significant in plant development because its position in the dividing cell indicates where the new cell wall will be inserted[mdash]an important site for control of histogenesis. We have categorized and determined the durations of stages in the development of PPBs, and have established their timing relative to the S-, G2-, and mitotic phases of the cell cycle. Roots of wheat seedlings were supplied with bromodeoxyuridine in continuous and pulse-chase treatments. Cells that were in the S-phase were identified and changes in their microtubule arrays were monitored by double immunolabeling. PPB initiation was detectable as early as the end of the S-phase as a narrowing of the preceding interphase array of microtubules. Development continued throughout G2 to a mature, narrow PPB, which existed only briefly and then eroded during the transition to the prophase mitotic spindle. The microtubule rearrangements of PPB development showed that preparation of the future site and plane of division in higher plant cells begins just after DNA replication and is completed just before mitosis.