Justification of CT scans using referral guidelines for imaging.

This study analyses the efficiency of the justification of individual computed tomography (CT) procedures using the good practice guide. The conformity of the CT scans with guide's recommendations was retrospectively analysed in a paediatric emergency hospital in Romania. The involved patient doses were estimated. The results show that around one-third of the examinations were not prescribed in conformity with the guide's recommendations, but these results are affected by unclear guide provisions, discussed here. The implications of the provisions of the revised International Atomic Energy Agency's Basic Safety Standards and of the Council Directive 2013/59/EURATOM were analysed. The education and training courses for medical doctors disseminating the provisions of the good practice guide should be considered as the main support for the justification of the CT scans at the individual level.

Differential diagnosis of abdominal wall defects - omphalocele versus gastroschisis.

A newborn with abdominal wall defect is one of the most dramatic cases in neonatology, but also a challenge for pediatric surgeons. This article describes the fundamental concepts of two major abdominal wall defects - gastroschisis and omphalocele - including options and principles of prenatal and postnatal care. Although these birth defects of the abdominal wall are always grouped together, they are two separate and distinct entities, with many differences in terms of pathology and associated anomalies; this explains the different therapeutic approach and results. For a correct management of the newborn with this anomaly, it is essential to understand the similarities and differences between gastroschisis and omphalocele. This article emphasises the similarities between these two parietal defects, highlighting the differences as well.

[Prevention of venous thromboembolic disease in the critical patient: an assessment of clinical practice in the Community of Madrid]. / Profilaxis de la enfermedad tromboembólica venosa en el paciente crítico: aproximación a la práctica clínica en la Comunidad de Madrid.

OBJECTIVE: To analyze measures referred to venous thromboembolic prophylaxis in critically ill patients. DESIGN: An epidemiological, cross-sectional (prevalence cut), multicenter study was performed using an electronic survey. Comparison of results with quality indexes of the Spanish Society of Intensive Care Medicine, the American College of Chest Physician guidelines and international studies. SETTING: Intensive Care Units (ICUs) in the Community of Madrid (Spain). PATIENTS: All patients admitted to the ICU on the day of the survey. VARIABLES OF INTEREST: General aspects of venous thromboembolic prophylaxis and protocols used (risk stratification and ultrasound screening). A descriptive analysis was performed, continuous data being expressed as the mean or median, and categorical data as percentages. RESULTS: A total of 234 patients in 18 ICUs were included. Eighteen percent (42/234) received no prophylaxis, and 55% had no contraindication to pharmacological prophylaxis. Of the 192 patients receiving prophylaxis, 84% received pharmacological prophylaxis, 14% mechanical prophylaxis and 2% combined prophylaxis. Low molecular weight heparin was the only pharmacological prophylaxis used, with a majority use of enoxaparin (17 of 18 ICUs). In patients with mechanical prophylaxis (31/192), antiembolic stockings were the most commonly used option (58%). Pharmacological prophylaxis contraindications were reported in 20% of the patients (46/234), the most frequent cause being thrombocytopenia (28% of the cases). Fifty percent of the ICUs used no specific venous thromboembolic prophylaxis protocol. CONCLUSIONS: Pharmacological prophylaxis with low molecular weight heparin was the most frequently used venous thromboembolic prophylactic measure. In patients with contraindications to pharmacological prophylaxis, mechanical measures were little used. The use of combined prophylaxis was anecdotal. Many of our ICUs lack specific prophylaxis protocols.

Quantitative measurement of speech sound distortions with the aid of minimum variance spectral estimation method for dentistry use.

In this paper, we search an adequate quantitative method based on minimum variance spectral analysis in order to reflect the dependence of the speech quality on the correct positioning of the dental prostheses. We also search some quantitative parameters, which reflect the correct position of dental prostheses in a sensitive manner.

Beyond the magnetic domain matching in magnetic exchange coupling.

We report a new macroscopic first-field-induced magnetic anisotropy for Co/α-Fe2O3(0001) layers, a prototypical ferromagnetic-antiferromagnetic interface for which the antiferromagnetic film has small in-plane magnetic anisotropy as compared to the interface coupling. We demonstrate that the effect is due to a first-field-induced irreversible magnetic domain motion in the antiferromagnetic layer, dragged by the ferromagnetic Co one. Whereas the initial domain matching is lost, the macroscopic manifestations of the exchange coupling remain stable. Therefore, the initial domain matching probably has only a marginal role in the explanation of the magnetic exchange coupling.

[Treatment of acute peritonitis. Results in County Hospital Suceava with 317 cases ]. / Evaluari asupra rezultatelor obtinute în terapia peritonitelor acute. Experienta pe 317 cazuri clinice în Spitalul Judetean Suceava.

UNLABELLED: The aim of this study was to identify prognostic factors for morbidity, mortality and long term outcome and to analyze the different management modalities for acute diffuse peritonitis. MATERIAL AND METHOD: A clinical retrospective study was carried out on a series of 317 cases with acute peritonitis; admitted in the General Surgery Department, Hospital of Suceava, between 2006-2009. RESULTS: There were 212 men (67%) and 105 women (33%) aged between 1 and 89 years. Preoperative concomitant disease was present in 31% of patients: cardiac disease was most common. The most common etiology was acute appendicitis in children 74 of cases (27.6%). Overall, 44 patients died during hospitalization. The cause of death was sepsis and multiple organ failure in 30 patients; malignancy in 8 patients and cardiac failure in 6 patients. Source control at the initial operation was possible in 282 of the patients (89%), of those 28 patients (9%) needed re-intervention. In 32 patients (10%), source control was not possible at the initial operation. CONCLUSION: This study emphasis the importance of prompt surgical treatment and shows the impact of adapting antibiotic treatment.

[Importance of enteral nutrition support in necrotic hemorrhagic pancreatitis]. / Contributii la cunoasterea importantei suportului nutritional enteral în pancreatita acuta necrotico-hemoragica.

UNLABELLED: A clinical retrospec tive study was carried out on a series of 68 cases with acute pancreatitis, admitted in the General Surgery Department, Suceava County Hospital, between 2006-2009. RESULTS: A number of 50 men (73.5%) and 18 women (26.5%), aged between 29 and 69 was studied. Enteral nutrition (EN) with naso-jejunal tube placed by endoscopy was used in 55.8% of cases; naso-gastric tube in 20 patients; total parenteral nutrition (TPN) in 10 patients (14.7%). Average duration of nutrition was 15.5 days. Pancreatic complications were observed in 7 patients (70%) from the TPN group comparatively with only 11 (18.9%) in the EN group. There were no significant differences in mortality but significant in hospital costs. CONCLUSIONS: The EN support should be the preferred way of nutrition support in patients with acute pancreatitis, because it is associated with a lower incidence of infection and a reduced hospitalization.

Magnetic logic using nanowires with perpendicular anisotropy.

In addition to a storage function through the magnetization of nanowires, domain wall propagation can be used to trigger magnetic logic functions. Here, we present a new way to realize a pure magnetic logic operation by using magnetic nanowires with perpendicular anisotropy. Emphasis is given on the generation of the logic function 'NOT' that is based on the dipolar interaction between two neighbouring magnetic wires, which favours the creation of a domain wall. This concept has been validated on several prototypes and the results fit well with the expectations.

Continuous expression of the homeobox gene Pax6 in the ageing human retina.

PURPOSE: In the past few years, the essential role of the homeobox gene Pax6 for eye development has been demonstrated unambiguously in a variety of species including humans. In humans, Pax6 mutations lead to a variety of ocular malformations of the anterior and posterior segment. However, little is known about PAX6 expression in the adult human retina. We have therefore investigated PAX6 levels and localization in the human retina at various ages. METHODS: Adult human eyes of various ages (17-79 years) were obtained from the Zurich Eye Bank. PAX6 expression levels and patterns were analysed by Western blot analysis of total retinal protein and by immunohistochemistry on paraffin sections, respectively. RESULTS: PAX6 expression in the retina was detected up to 79 years of donor age and was predominantly localized to the ganglion cell layer and the inner part of the inner nuclear layer. CONCLUSIONS: PAX6 remains distinctly expressed throughout the lifespan of the human retina suggesting a role for PAX6 in the retina after completion of eye morphogenesis.

Laparoscopic subtotal splenectomy in hereditary spherocytosis : to preserve the upper or the lower pole of the spleen?

BACKGROUND: Clinical manifestations of hereditary spherocytosis can be controlled by splenectomy. The use of this procedure has been restricted due to concerns regarding exposure of patients to a lifelong risk of overwhelming infections. Subtotal splenectomy, which removes 85-90% of the enlarged spleen, is a logical alternative. In the first cases performed by laparoscopy we have chosen to preserve the upper pole. However, this technique showed some disadvantages, especially concerning the correct intraoperative evaluation of the splenic remnant volume. Therefore, we developed a new variant of the procedure by preserving the lower pole of the spleen. METHODS: Based on the authors' experience in laparoscopy (176 laparoscopic splenectomies), 10 laparoscopic subtotal splenectomies were performed in patients with hereditary microspherocytosis, preserving either the upper or the lower splenic pole. RESULTS: Patient age ranged between 5 and 35 years. The mean volume of the remnant spleen was 41.4 cm3. There were no complications, and no transfusions were needed. Follow-up for 1-30 months was available. CONCLUSIONS: Subtotal splenectomy appears to control hemolysis while maintaining splenic function. The laparoscopic approach is safe and effective and should be considered the procedure of choice in hereditary microspherocytosis. Laparoscopic subtotal splenectomy presents an advantage over open subtotal splenectomy, resulting in decreased blood loss, shorter hospital stay, no conversions, fewer operative and postoperative complications, and excellent remission rates. On the basis of our experience, the preservation of the lower pole of the spleen seems to be a first-line option for the optimal evaluation of the residual splenic mass.

[Feeder vessel treatment of choroidal neovascularization in age-related macular degeneration]. / Traitement des vaisseaux nourriciers de la néovascularisation choroïdienne rétrofovéale dans la DMLA.

INTRODUCTION: To report on the results of feeder vessel treatment for choroidal neovascularization in age-related macular degeneration (AMD). MATERIAL AND METHODS: Retrospective study of 40 patients presenting subfoveal classic choroidal neovascularization (CCNV) and/or occult choroidal neovascularization (OCNV) with or without fibrovascular pigment epithelium detachment (PED), based on fluorescein angiography (FA) and indocyanine green angiography (ICG). Visual acuity was measured using Snellen lines and/or ETDRS. The feeder vessels were visualized with high-speed ICG angiography (confocal scanning laser ophthalmoscope, Heidelberg HRA, Heidelberg, Germany). Feeder vessels were identified as very thin vessels with early filling and rapid emptying. Feeder vessel closure was achieved by laser photocoagulation treatment with either minipulse infrared laser therapy (810 nm), microburst, or yellow laser (568 nm). Post-treatment high-speed ICG angiography follow-up was recommended to the patient immediately or the day after the treatment. The number of treatments and location of the feeder vessels in relation to the macula as well as FA, ICG, and visual acuity results were assessed. If necessary, other treatment techniques such as photodynamic therapy (PDT) or transpupillary thermotherapy (TTT) were offered to the patient when leakage was still present. RESULTS: The patients were followed for an average of 6.2 months (2-9 months). Twenty-six women and 14 men (mean age, 72 years; range, 51-95) were included. Eight patients demonstrated classic neovascularization, 32 presented occult neovascularization, including 17 cases of vascularized PED and 15 retrofoveal plaques. The average number of treatments was 1.8 (range, 1-4 treatments). Location of feeder vessels were as follows: nine superior-macular, 18 inferior-macular, six nasal-macular and 11 temporal-macular. Visual acuity improved two lines or more in nine patients (22.5%), decreased 2 lines or less in five patients (12.5%) and was stable in 26 patients (65%). After feeder vessel treatment, seven patients showed improvement of the anatomical aspect of the AMD lesions, with a reduction in leakage. Except for one subretinal hemorrhage, no complications after feeder vessel treatment were observed. CONCLUSION: Feeder vessel treatment is a technique requiring high-speed ICG angiography to detect the feeder vessels located at a distance from the subfoveal OCNV, CCNV, and PED. Although the final visual acuity result was for the most part stabilization, the technique appeared to be safe and reproducible. In patients who were not eligible for other therapies such as PED, feeder vessel treatment seemed to be a reasonable alternative.

[Isovolemic hemodilution--a treatment method for central retinal vein obstruction]. / Hemodilutia izovolemica--metoda de tratament a obstructiei de vena centrala a retinei.

OVCR--is a vascular disease of the posterior pole of the eye, witch leads usually, to a significant decrease of the visual acuity. The actual management of the disease is still inefficient of the functional recovery of those patients. Among the medical treatment methods, is also the isovolemic hemodilution, witch must be established only after a thorough cardio-vascular and renal examination. The present study shows an increase of the visual acuity in the patients treated with isovolemic hemodilution followed by LASER Argon photocoagulation.

Maximal inspiratory flow rates in patients with COPD.

OBJECTIVES: To assess the relevance of maximal inspiratory flow rates (MIFR) in the assessment of airway obstruction in COPD. SETTING: University teaching hospital. PARTICIPANTS: Ten consecutive COPD patients (O group; mean [+/- SD] age, 58.5+/-8.3 years) and 10 matched healthy subjects (H group; mean age, 58.7+/-7.4 years). MEASUREMENTS: Lung volumes, FEV(1), specific airway conductance, single-breath lung diffusing capacity, MIFR, and maximal expiratory flow rates (MEFR). RESULTS: Mean FEV(1)/vital capacity (VC) was 74.7% in the H group and 37.8% in the O group (p<0.001). Total lung capacity was higher (p<0.001) in the O group compared with the H group. Lung diffusing capacity was less than half in the O group compared with the H group (p<0.001). MEFR at all lung volumes were lower in the O group (p<0.001). MIFR were comparable in the two groups, except at 25% inspired VC, where MIFR were lower in the O group (p< 0.05). CONCLUSION: MIFR are less sensitive than MEFR to detect airway obstruction in COPD patients. Yet, the interest of MIFR lay in the possibility to separate intrinsic from extrinsic involvement of airways. A normal MIFR associated with low MEFR, as in the present study, suggests either a lack of parenchymal support, an increased collapsibility of the airways, or a reversible peripheral airway narrowing. A fixed, generalized airway narrowing would be associated with a decrease of both MIFR and MEFR.

Lung function study and diffusion capacity in anorexia nervosa.

STUDY OBJECTIVES: In humans, malnutrition alters the respiratory system in different ways. It impairs the ventilatory drive, decreases respiratory muscle strength and reduces immune competence. In addition, typical emphysema-like changes were demonstrated in starved animals. The presence of emphysema has never been demonstrated in starved humans. Our objective was to investigate whether pulmonary emphysema occurs in anorexia nervosa by means of a pulmonary function study. POPULATION AND METHOD: We examined 24 women aged between 14 and 38 years (nine smokers). We studied the lung function including lung volumes, ventilatory capacity, maximal respiratory pressures and transfer factor, as well as PaO2. RESULTS: All respiratory tests were within normal limits with the exception of decreased maximal inspiratory (59% of predicted values) and expiratory pressures (35%), and increased residual volume (162%). Diffusion capacity (98.1 +/- 16.2%) and transfer coefficient (98.4 +/- 16.2%) were also normal. The diffusion coefficient was lower in current smokers than in those who had never smoked (P < 0.01), a difference similar to that calculated from existing reference values for transfer factor for smokers and nonsmokers. CONCLUSION: In anorexia nervosa, pulmonary function tests are within normal limits with the exception of maximal pressures and residual volume. Diffusion capacity is not decreased. The present results within the limitations of the used method are not compatible with the hypothesis of starvation-induced pulmonary emphysema.

The CD44-initiated pathway of T-cell extravasation uses VLA-4 but not LFA-1 for firm adhesion.

Leukocytes extravasate from the blood in response to physiologic or pathologic demands by means of complementary ligand interactions between leukocytes and endothelial cells. The multistep model of leukocyte extravasation involves an initial transient interaction ("rolling" adhesion), followed by secondary (firm) adhesion. We recently showed that binding of CD44 on activated T lymphocytes to endothelial hyaluronan (HA) mediates a primary adhesive interaction under shear stress, permitting extravasation at sites of inflammation. The mechanism for subsequent firm adhesion has not been elucidated. Here we demonstrate that the integrin VLA-4 is used in secondary adhesion after CD44-mediated primary adhesion of human and mouse T cells in vitro, and by mouse T cells in an in vivo model. We show that clonal cell lines and polyclonally activated normal T cells roll under physiologic shear forces on hyaluronate and require VCAM-1, but not ICAM-1, as ligand for subsequent firm adhesion. This firm adhesion is also VLA-4 dependent, as shown by antibody inhibition. Moreover, in vivo short-term homing experiments in a model dependent on CD44 and HA demonstrate that superantigen-activated T cells require VLA-4, but not LFA-1, for entry into an inflamed peritoneal site. Thus, extravasation of activated T cells initiated by CD44 binding to HA depends upon VLA-4-mediated firm adhesion, which may explain the frequent association of these adhesion receptors with diverse chronic inflammatory processes.

In long-term smokers and former smokers the bronchodilator response is not related to the fall in FEV.

BACKGROUND: Cigarette smoking is the cardinal cause of chronic obstructive pulmonary disease (COPD), but only a relatively small percentage of smokers are developing clinically overt disease, suggesting, therefore, that other risk factors than smoking are involved. Several studies have shown that the bronchodilator response (BR) is related to the progress of COPD, as assessed by the fall in forced expiratory volume in 1 s (FEV(1)). However, the relationship between BR and fall in FEV(1), is a disputed one. OBJECTIVE: To assess the relationship between BR and fall in FEV(1) in a group of long-term smokers and ex-smokers who were 60 years old on the average. METHODS: Questionnaire, spirographic tests and BR were assessed in 56 smokers and ex-smokers of mean age 62.5 +/- (SD) 2.7 years at the end of a 13-year follow-up period. BR was expressed as a percentage change of the prebronchodilator value ('% initial') and as a percentage change of predicted value ('% predicted'). RESULTS: The FEV(1)/VC vital capacity was 68.9 +/- 7.6% at the start and 64.5 +/- 11.3% at the end of the study. The average fall in FEV(1) over 13 years was 26 +/- 25 ml/year. The FEV(1) increased after albuterol on the average with 5.9 +/- 6.6%, 4.5 +/- 3.9% of predicted, and the vital capacity with 2.5 +/- 6.5%, 2.3 +/- 6.4% of predicted. BR and fall in FEV(1) were correlated: the greater the BR, the more rapid the fall in FEV(1) (r = 0.4 and p < 0.01 for FEV(1)% and r = 0.3 and p < 0.05 for FEV(1) predicted). However, when adjusting for prebronchodilator FEV(1), the BR was no more related to the fall in FEV(1) (r = 0.15, p > 0.05). CONCLUSIONS: In long-term smokers and ex-smokers, the BR measured at the end of the follow-up period was correlated with the fall in FEV(1). However, after adjusting for prebronchodilator FEV(1) values, BR was no more related to the decline in FEV(1). The BR appears not to be associated with the development of COPD.