Digestibility, ruminal fermentation, blood metabolites and antioxidant status in ewes supplemented with DL-methionine or hydroxy-4 (methylthio) butanoic acid isopropyl ester.

The effects of supplementing ewe diets with either DL-methionine (DL-Met) or 2-hydroxy-4 (methylthio) butanoic acid isopropyl ester (HMBi) were investigated on ruminal in situ degradability of grain and forage diets, in vivo digestibility, rumen fermentation, blood metabolites and antioxidant status. Six ruminally cannulated ewes were used in a replicated 3 × 3 Latin square design with 28-day periods. The dietary treatments were as follows: (i) no supplemental Met (control; CON), (ii) DL-Met at 1.2 g/kg DM intake and (iii) HMBi at 1.8 g/kg dry matter (DM) intake. Corn grain, barley grain and alfalfa hay were evaluated for their ruminal degradability by both in situ incubation and effective degradability measurements of DM, neutral detergent fibre (NDF) and acid detergent fibre (ADF). Compared to other treatments, HMBi supplementation increased (p < 0.05) the digestibility of organic matter, crude protein and NDF and also tended (p = 0.08) to increase the digestibility of DM and ADF. Moreover, HMBi supplementation increased (p < 0.01) total VFA concentrations, the molar proportions of valerate and iso-butyrate in the rumen. Compared to the CON treatment, DL-Met and HMBi treatments tended (p = 0.08) to increase the molar proportion of acetate but decreased (p < 0.05) ruminal ammonia-N concentration. Ewes supplemented with HMBi and DL-Met recorded greater (p < 0.05) serum concentrations of glutathione peroxidase, total antioxidant capacity and superoxide dismutase than the CON treatment. Serum concentrations of glucose, total protein, albumin, high-density lipoprotein and very low-density lipoprotein were greater (p < 0.01) and serum urea nitrogen (p < 0.05), malonyl dialdehyde and triglyceride were lower (p < 0.02) in the HMBi and DL-Met animals than in the CON ewes. The results concluded that HMBi is a very effective form of dietary Met supplementation for ewes with a positive effect on digestion, rumen fermentation and serum antioxidant function.

EFFECT OF PROBIOTIC FERMENTED MILK (KEFIR) ON SERUM LEVEL OF INSULIN AND HOMOCYSTEINE IN TYPE 2 DIABETES PATIENTS.

BACKGROUND: Probiotic fermented milk is one of the most beneficial foods. The main purpose of this study was to investigate the effect of probiotic fermented milk on the serum level of insulin and homocysteine in the type 2 diabetes patients. METHODS: This study was done in 60 patients with type 2 diabetes. The intervention group received 600 mL of probiotic fermented milk (kefir) daily and control group received 600 mL of conventional fermented milk daily for 8 weeks. Food intake, anthropometric indices, serum parameters were assessed at the beginning and at the end of the study. The statistical analysis was done by the use of SPSS software (Ver.13). RESULTS: The mean of serum insulin level did not reduce significantly after the intervention in probiotic fermented milk group, and there was no significant difference between the two groups. The mean of HOMA-IR decreased significantly in probiotic fermented milk group after intervention and there was a significant difference between the two groups after intervention. The mean of quickie increased in probiotic fermented milk group, but this increase was not significant. Also, there was not significant difference between the two groups after intervention. The mean of homocysteine level decresead significantly in patients with probiotic fermented milk and conventional fermented milk consumption. CONCLUSIONS: By considering the effect of probiotic fermented milk on some risk factors of cardiovascular disease in diabetic patients, probiotic foods may be useful as an adjuvant therapy in diabetic patients.

Interactive effects of molasses by homofermentative and heterofermentative inoculants on fermentation quality, nitrogen fractionation, nutritive value and aerobic stability of wilted alfalfa (Medicago sativa L) silage.

The effect of adding molasses (0, UM or 50 g/kg on DM basis, M) and two types of inoculant including homofermentative (HO) and a combination of homofermentative and propionate-producing bacterial (HOPAB) inoculants on silage fermentation quality, nitrogen fractionation and aerobic stability of pre-bloom, wilted alfalfa (AS) was determined in laboratory silos. The HOPAB inoculant was more effective than HO in reducing the alfalfa silage pH but increased propionate content in the absence of M (p < 0.05). Inoculation of HOPAB reduced (p < 0.01) acid detergent fibre (ADF) and increased (p < 0.01) lactate to acetate ratio compared with uninoculated AS. Acetate concentration was lower (p < 0.01) in HOPAB-inoculated than other AS. This difference was more pronounced in M-added AS (inoculants × M interaction, p = 0.01). Both inoculants reduced (p < 0.01) ammonia-N content in AS added with M, whereas only HOPAB decreased (p < 0.01) ammonia-N concentration in silage without M. Inoculants increased (p < 0.01) B2 fraction in AS with M addition but had no effect on AS without M. Treating silages with HO-UM increased (p < 0.05) C fraction (acid-detergent insoluble-N) but HOPAB decreased C fraction at two levels of M. Treating alfalfa crop with M and HOPAB improved aerobic stability by increasing the concentration of acetate and propionate of AS respectively. Adding M tended (p < 0.10) to increase short-chain fatty acids (SCFA) and cumulative gas production (CGP). HOPAB alone increased DM disappearance at 24 h post-incubation and effective degradability assuming outflow rate of 8%/h relative to untreated AS (p < 0.05). It was concluded that adding M had no pronounced effects on AS fermentation quality, but increased aerobic stability. HOPAB-inoculated AS with no addition of M improved fermentation quality and increased DM degradability compared with HO.

Nutrient digestibility and evaluation of protein and carbohydrate fractionation of citrus by-products.

The protein and carbohydrate fractionation and nutrient digestibility of citrus by-products were determined. Ruminal, intestinal and total tract CP disappearance values were measured by a modified three-step (MTSP) method and in vitro CP disappearance method (IVCP). Test feeds were orange pulp (OP), lime pulp (LP), lemon pulp (LEP), grapefruit pulp (GP), sweet lemon pulp (SLP), bitter lemon pulp (BLP), bergamot orange pulp (BP) and tangerine pulp (TP). The rumen undegradable protein (RUP) fractions of the feedstuffs were obtained by ruminal incubation in three cannulated wethers and incubation in protease solution (protease type xiv, Streptomyces griseus). The data were analysed using completely randomized design. There were significant differences between the tested feeds in protein fractions and acid detergent insoluble nitrogen (ADIN; C fraction) was highest in GP (14.56%) (p<0.001). For carbohydrate fraction, the highest C fraction was also observed in GP (2.67%) and in relation to the other citrus pulps (p<0.001). Ruminal CP disappearance was highest in OP (71.89%) (p<0.001). The level of post-ruminal CP disappearance, measured by MTSP, was highest for BP (34.94%) (p<0.001). The highest in vitro dry matter digestibility (IVDMD) was found for TP (80.44%) followed by that estimated for BP (78.38%) (p<0.001). The estimated metabolizable energy (MJ/kg DM) varied from 9.77 for LP to 12.91 for BP. Tangerine pulp had the highest true rumen digestibility (TRD) (p<0.001). According to the results, it could be concluded that citrus by-products have high nutritive value and also, the in vitro techniques can be easily used to determine of the nutritive value of citrus by-products.

Repellent and fumigant toxicity of essential oil from Thymus persicus against Tribolium castaneum and Callosobruchus maculatus.

Repellent and insecticidal activity of the essential oil extracted from Thymus persicus (Roniger ex Reach. F.) Jalas was evaluated against two stored-product beetles Tribolium castaneum (Herbst) and Callosobruchus maculatus (F.). Dry flowering aerial parts of the plant were subjected to hydro distillation using a modified Clevenger-type apparatus. The repellent and fumigant toxicity were tested against 1-7 days old adult beetles at 27 +/- 1 degrees C and 65 +/- 5% RH in dark condition. The repellency on C. maculatus and T. castaneum at highest concentration (2 microL/mL acetone) was 82.40% and 70.40% respectively. Fumigation bioassays showed that C. maculatus adults were significantly more susceptible (LC50 = 2.39 microL/L air) to the essential oil than T. castaneum adults (LC50 = 234.42 microL/L air). It could be concluded that T. persicus may have potential for applications in management of stored-product pests because of its safety, strong repellency and fumigant toxicity.

Preliminary report of a nationwide case-control study for identifying risk factors of tuberculosis following renal transplantation.

BACKGROUND: Tuberculosis (TB) is an important infection encountered posttransplantation, especially among patients in developing countries, where there are high incidences of morbidity and mortality. MATERIALS AND METHODS: One hundred and twenty subjects (1%) from 15 major kidney transplantation centers in Iran from 1984 to 2003 were compared with 440 controls who were matched for operative time, treatment center, and surgical team. RESULTS: Mean ages of research subjects and controls were 38.6 and 36.6 years (P = .04), respectively. The mean duration of pretransplantation hemodialysis was 29 months (range, 2 to 192 months) in research subjects and 20 months (range, 1 to 180 months) in controls (P = .003). Positive past history of tuberculosis was detected in 4 (3.3%) research subjects and in 7 (1.5%) controls (P = .2). Fifty-two research subjects (43.3%) and 241 controls (54.8%) had pretransplantation purified protein derivative of tuberculin less than 5 mm (P = .02). Mean dosages of initial and maintenance immunosuppressive drugs in research subjects and in controls were not significantly different. Sixty research subjects (50%) and 152 controls (34.5%) had rejection prior to diagnosis of TB (P = .03). CONCLUSION: To our knowledge, this is the first study that demonstrates an increased risk of posttransplant TB by prolonged duration of pretransplant hemodialysis and number of posttransplant rejection episodes. Further study is needed to clarify these findings specifically with respect to various immunosuppressive regimens.

The relationship between isokinetic muscle strength and spasticity in the lower limbs of stroke patients.

OBJECTIVE: In this study the relationship between degree of spasticity and strength of knee extensor and ankle plantar flexor muscles of post stroke hemiparetic patients has been investigated. MATERIALS & METHODS: The participants of this study were 40 stroke patients whose elapsed time of stroke onset was at least 3 months. Their age averaged 59 years. Spasticity was measured with the Modified Ashworth Scale. Isokinetic muscle strength was measured with an isokinetic dynamometer. Two methods of torque normalization - subtractive and weight based normalization - were used for comparing torques among participants. RESULTS: Kendall's tau-b coefficient was calculated for investigating this relationship. This coefficient was not significant for the relationship between weight based normalized data and modified Ashworth scale (MAS) in any of each muscle groups (α = 0.05). This coefficient was significant for the relationship between the subtractive normalization method and MAS in knee extensors (P = 0.005, α = 0.01) and ankle plantar flexors (P = 0.002, α = 0.01). CONCLUSION: This study suggests a negative relationship between spasticity and muscle strength and provided evidence that spastic muscles are weaker.

Supplementation of herbal plants differently modulated metabolic profile, insulin sensitivity, and oxidative stress in transition dairy cows fed various extruded oil seeds.

The study investigated the effects of a mixture of herbal plants (HM) and two sources of unsaturated fatty acids (FA), extruded linseed (LS) and soybean (SB), on metabolic profile, insulin sensitivity, and oxidative status of transition dairy cows. Thirty-two prepartum Holstein cows, blocked by parity and calving day, were randomly assigned to 1 of 4 treatments, in a 2×2 factorial design, starting from 25 days before the expected calving date to 26 days postpartum. The supplementation rates of HM were 150 and 170 g/animal/day at pre- and postpartum, respectively. Blood samples were analyzed for metabolites on day 7.15±1.70 prepartum and on days 1 and 21 postpartum. An intravenous glucose tolerance test (IV-GTT) was conducted on day 25 postpartum. Data showed that cows supplemented with HM had lower serum concentration of NEFA (0.395 vs. 0.602±0.044 mmol/L; P<0.01) and NEFA to insulin ratio (P<0.01) postpartum. Compared to animals fed SB-based diets, cows fed the LS-based diet had greater serum glucose concentration during prepartum (80.7 vs. 71.3±3.32 mg/dL; P=0.06) and postpartum period (86.3 vs. 73.5±3.35 mg/dL; P=0.01), as well as lower NEFA (0.425 vs. 0.572±0.044 mmol/L; P=0.03) and insulin to glucose ratio (P<0.01) postpartum. Revised quantitative insulin-sensitivity check index revealed that supplementing HM in LS-based diet improved insulin sensitivity (0.45 vs. 0.41±0.013; P=0.03) prepartum, whereas after parturition, the HM addition was effective for both oil seeds (0.40 vs. 0.37±0.008; P=0.06) in enhancing insulin sensitivity. Result of IV-GTT indicated that cows fed LS-based diets had higher basal glucose concentration (63.7 vs. 55.7±2.37; mg/dL; P=0.02) and lower glucose area under the curve (995.8 vs. 1529.5±100.7; mg/dL×45 min; P<0.01). Supplementing HM resulted in greater total antioxidant capacity prepartum (0.55 vs. 0.48±0.017 nmol/L; P=0.01) and lower malondialdehyde concentration at prepartum (1.03 vs. 1.96±0.140 µmol/L; P<0.01) and postpartum (1.32 vs. 1.88±0.178 µmol/L; P=0.04). Although feeding LS ameliorated insulin resistance, this feeding strategy lowered total antioxidant capacity prepartum (0. 48 vs. 0.55±0.017 nmol/L; P<0.01) and increased malondialdehyde concentration postpartum more than the SB diet (1.91 vs. 1.28±0.172 µmol/L; P=0.02). Overall, both HM supplementation and LS feeding improved metabolic profile and insulin response following glucose infusion, although feeding of LS-based diets induced an increased oxidative stress.

Conservative management of splenic trauma.

conservative approach to splenic trauma has been practised in many countries. Haemodynamically stable patients who have been carefully assessed clinically and radiographically may safely be treated non-operatively. In those patients who require surgery the spleen may be preserved by splenorrhaphy or partial splenectomy. This approach has been practised at our hospital and we present our experience over seven years to show that expectant treatment of splenic injury following trauma is safe.

School fire in Iran: simple actions save lives.

On December 5, 2012 a fire broke out in a primary school in Iran, causing injuries to 26 children and two deaths. The fire came from an oil stove. Rather than evacuate the classroom and use the fire extinguisher, the teacher attempted to remove the stove itself from the classroom. During this process an explosion occurred resulting in a haphazard attempt at evacuation. This tragedy highlights gaps in both the policy and practice of fire safety. From 2005 to 2012, Iran experienced six large school fires that led to 67 injuries and five deaths. Five events were related to oil stoves. About 30% of Iran's classrooms use oil stoves for heating during the winter with 3.4 million students and 150,000 teachers at risk. Iran's Ministry of Education has mandated that regular training of school personnel in fire safety measures should be organized but no safety officer is tasked to prepare and conduct this training. Instead, the task is delegated to the Fire Departments, which fall under municipal administrations; however, such departments do not exist in 93% of the rural areas of Iran. School fires are not unique to Iran. Similar tragic events have occurred in several middle-income countries (India, Kenya, Russia) over the last decade. This article presents an overview of school fires in Iran and proposes preventive strategies through a reform in policy making and practice, including education of students and school personnel along with regular drills, designation of a fire safety officer, and development of a countrywide school fire registry.

Le 5 décembre 2012, un incendie dans une école primaire en Iran a causé des lésions à 26 enfants et deux décès. Le feu provenait d'un poêle à pétrole. Plutôt que d'évacuer la classe et utiliser l'extincteur, l'enseignant a tenté de porter le poêle audehors de la salle de classe. Pendant ces moments une explosion s'est produite, suivie par des tentatives hasardeuses à l'évacuation. Cela met en évidence les lacunes à la fois politiques et pratiques de la sécurité anti-incendie. De 2005 à 2012, il y a eu six grands incendies en Iran avec cinq décès et 67 blessés. Cinq de ces événements étaient liés à des poêles à pétrole. Environ 30% des salles de classe en Iran utilisent les poêles à mazout pour le chauffage pendant l'hiver, avec 3,4 millions d'élèves et 150.000 enseignants à risque. Le Ministère iranien de l'Education a insisté sur la formation régulière du personnel scolaire pour ce qui concerne les mesures de protection contre les incendies, mais les agents de sécurité chargés de préparer et de diriger cette formation n'existent pas. Au lieu de cela, la tâche est déléguée aux services d'incendie qui relèvent des administrations municipales, mais ces services n'existent pas dans 93% des zones rurales de l'Iran. Les incendies dans les écoles évidemment ne se produisent pas seulement en Iran. Des événements tragiques similaires ont eu lieu dans plusieurs pays à revenu intermédiaire comme l'Inde, le Kenya et la Russie au cours de la dernière décennie. Cet article présente une vue d'ensemble des incendies dans les écoles iraniennes et propose des stratégies de prévention basées sur une réforme dans l'élaboration des politiques d'action et des pratiques, y compris l'éducation des élèves et du personnel scolaire ainsi que des exercices réguliers, la désignation d'un agent de sécurité anti-incendie, et la compilation d'un registre national de tous les incendies qui se vérifient dans les écoles iraniennes.

ABCD2 score and BNP level in patients with TIA and cerebral stroke.

Scoring systems have been designed to help physicians in early prediction of cerebral stroke following Transitional Ischemic Attack (TIA). ABCD2 system is one of these scoring systems. Considering increase of brain natriuretic peptide following cerebral ischemic stroke, BNP level may be associated with incidence of ischemic stroke following TIA. The present study evaluates ABCD2 score, BNP level in patients with TIA and incidence of cerebral stroke. This cross sectional-analytical study evaluated 78 patients with TIA. ABCD2 score was calculated for all patients based on some criteria including age, blood pressure, clinical manifestations (speech/motor disorder), symptoms duration and diabetes. BNP level was measured at the reference laboratory when the patient referred to the treatment center. The patients were followed up for 6 months considering incidence of cerebral stroke and TIA. Mean age of the patients was 66.53 +/- 13.08 years and the sample was consisted of 62.8% male and 37.2% female patients. Mean BNP level and mean ABCD2 score was 611.31 +/- 125.61 and 4.61 +/- 10.99 in all patients, respectively. During follow-up period, TIA recurrence and cerebral stroke were, respectively seen in 11.5 and 3.8% of cases. Mortality was reported in 5.1% of the patients. BNP was significantly higher in cases with recursive TIA (p = 0.03). But, there was not any difference considering ABCD2 score (p = 0.38). BNP is capable of predicting TIA recurrence following first TIA and it can be used in this case.

Restoring hindgut continuity in cloacal exstrophy: a valuable method of optimising bowel length.

BACKGROUND: In cloacal exstrophy the hindgut is typically a blind ending segment attached to the exstrophy plate. This section of bowel may be mobilized, its continuity restored with the rest of the bowel, and used to fashion an end colostomy. We review our results using this approach. PATIENTS AND METHODS: A retrospective review of the outcomes was carried out on the basis of the case notes of nine consecutive patients with cloacal exstrophy who had been treated by restoration of hindgut continuity and an end colostomy. RESULTS: The colostomy was fashioned at a median age of 17 days of life. The colostomy was formed as part of the primary repair in all but one patient in whom it was performed as a secondary procedure to treat a previously repaired, dehisced exstrophy repair where the hindgut had originally been left in situ. Seven patients had co-existing spinal anomalies and potentially neuropathic bowel. The median length of hindgut that was restored was 10 cm. Median interval until the stoma produced faeces was six days. There was stoma necrosis in one patient requiring early revision. Six patients underwent further subsequent bowel operations at a median interval of 9.1 months: four had colostomy revision but kept the hindgut, one had excision of the hindgut and a terminal ileostomy, and one had a pull-through operation that was subsequently further revised to an ileostomy. CONCLUSION: Use of the hindgut loop in cloacal exstrophy to form a distal terminal colostomy is effective. Although stoma complications are common, these may be offset against the benefits of: restoration of hindgut electrolyte and fluid absorption; easier to mange stoma effluent; and the siting of the stoma on the left providing greater flexibility for future bladder reconstruction.

Genitourinary tumor following kidney transplantation: a multicenter study.

Renal transplantation has been advocated as the treatment of choice for end-stage renal disease. Immunosuppression increases the incidence of cancer and promotes the growth of neoplasms in solid organ recipients. There have been a few reports on the incidence of cancer from transplant registries. It is difficult to precisely compare the incidence with that in the general population using data from small, single-center studies. Thus, we sought to study the prevalence of genitourinary cancer development in Iranian renal transplant recipients. We collected data from 5 kidney transplant centers in Iran between 1984 and 2008, seeking to detect the incidence, type, and outcome of cancers after kidney transplantation. Only histologically confirmed tumors, which occurred after renal transplantation, were included in the analysis. Of the 5532 patients who underwent kidney transplantation, genitourinary tumors were detected in 21 subjects (0.38%), namely, 12 males and 9 females. Transitional cell carcinoma (TCC) of the bladder, the most common genitourinary cancer (n = 7) was followed by renal cell carcinoma (RCC; n = 5), ovarian cancer (n = 3), breast cancer (n = 3), prostate cancer (n = 1), seminoma (n = 1), and uterine cancer (n = 1). The overall mean age of the patients was 46 +/- 12 years (range, 19-72 years) and the median time to diagnosis after transplantation was 72 months (range, 4-240 months). Seven patients died during the follow-up. There was a male predominance among TCC of the bladder and RCC (5:2 and 4:1, respectively). In conclusion, TCC of the bladder was the most common genitourinary tumor following kidney transplantation. It was predominant in male patients.

When does it hurt? Pain during flexible cystoscopy in men.

INTRODUCTION: In this observational study, pain was measured continuously in men undergoing flexible cystoscopy, in order to help to identify which parts of the procedure were the most painful. PATIENTS AND METHODS: Men who were to undergo flexible cystoscopy were recruited. Pain was measured continuously throughout flexible cystoscopy by asking the subject to squeeze a pressure-sensing rubber bulb in proportion to the amount of discomfort experienced giving a score of 0-10. RESULTS: The most painful part of the procedure was as the cystoscope passed through the membranous urethra with a median pain score of 2.82. The initial lidocaine administration gives a median pain score of 0.84. The other parts of the cystoscopy produced median scores of between 0.14 and 0.33. The difference in the pain scores was significant (p = 0.03). There was no statistically significant difference in the pain scores between those who were having their first cystoscopy and those who were having repeat cystoscopy. The subjects' age did not influence the degree of pain experienced. CONCLUSION: This study gives further understanding of how pain is experienced during flexible cystoscopy. It may help explain why previous studies have not reached a clear consensus on the value of lidocaine during flexible cystoscopy.

Digestion of feed amino acids in the rumen and intestine of steers measured using a mobile nylon bag technique.

The disappearance of dry matter (DM), crude protein (CP), and amino acids (AA) in steers after rumen incubation and intestinal passage of alfalfa hay, barley hay, corn silage, barley grain, corn grain, wheat bran, meat meal, fish meal, cottonseed meal, and soybean meal were measured in 3 steers using a mobile nylon bag technique. Ruminal degradation of individual AA differed between feedstuffs. For barley hay and corn silage, the ruminal disappearance of total AA was higher and lower than the other feedstuffs, respectively. The intestinal digestibility of total AA in alfalfa hay was lower than the digestion of CP. The intestinal digestibility of Arg and His was higher than that of total AA in alfalfa hay, meat meal, cottonseed meal, soybean meal, barley hay, and wheat bran. In addition, the intestinal digestibility of Lys was higher than that of total AA in alfalfa hay, meat meal, cottonseed meal, soybean meal, barley hay, corn silage, and wheat bran. The intestinal disappearance of CP in most cases was higher than that of DM. The results indicated that feedstuffs with lower ruminal disappearance of DM, CP, total AA, essential AA, and nonessential AA generally had a higher intestinal disappearance, resulting in a relatively constant total tract disappearance. These results could be used to improve the current system of diet formulation in ruminants.

Pathogenesis of bronchopulmonary dysplasia following hyaline membrane disease.

The pathologic changes in the lungs of 112 infants dying from hyaline membrane disease (HMD) and 64 infants dying from other causes in the years 1967 to 1972 have been reviewed in order to obtain information about the pathogenesis of bronchopulmonary dysplasia (BPD). The results from the infants with HMD showed that: a) From the fourth or fifth day, the surface tension of lung extracts fell, inclusion bodies became more plentiful, and air saccules with patent airways could be inflated with air, even when severe changes due to BPD were present. b) There was a highly statistically significant correlation between the most serious lesions of BPD--damage to airways followed by excessive repair and fibrosis--and the use of high (greater than 35 cm H2O) peak airway pressures during mechanical ventilation in life. c) Damage due to oxygen breathing could not be reliably identified although some of the lesions, particularly edema and fibroplasia in intersaccular septa, may have been caused by oxygen. d) Evidence of pulmonary hypertension was present in infants surviving for more than a month with severe lung damage, and the ductus arteriosus was always open. We conclude that the most important factor in the pathogenesis of BPD following HMD is mechanical trauma to the lung from the use of excessively high peak airway pressures during mechanical ventilation.

Calcified epidermoid cyst in the testis: an unusual finding on ultrasound.

Epidermoid cysts of the testis are uncommon, benign testicular tumours. They are often seen on ultrasound as rounded, hypoechoic lesions due to high keratin contents. Calcification within epidermoid cysts is rare. We report a case of prominent calcifications within an epidermoid cyst. If a possible epidermoid cyst is identified with ultrasound, testis-sparing surgery should be considered.

Acute spontaneous haematoma of the rectum.

Gastrointestinal haematomata occur usually in the small intestine and may be secondary to anticoagulation. Spontaneous intramural haematoma of the rectum is rare. We report such a case which presented as acute abdominal pain and which was treated by simple drainage.

Long-term outcomes of brachiobasilic transposition fistula for haemodialysis.

OBJECTIVES: The transposed basilic vein to brachial artery arteriovenous fistula provides secondary vascular access for haemodialysis. The long-term results of such fistula are assessed in this retrospective series. MATERIAL AND METHODS: Over a 5-year period 75 brachiobasilic transposition fistulae were performed in 74 patients. There was a median follow up of 14 months. RESULTS: Primary patency was achieved in 69 (92%) of the fistulae, and secondary patency in 74 (99%) of the fistulae. Successful interventions included angioplasties in four, and saphenous vein interposition in one, whilst three patients had failed thrombectomies. Dialysis was performed using 69 (92%) of the fistulae while 6 (8%) were never used. Of the 75 fistulae 47 (63%) were patent at follow up. Cumulative secondary patency was 66% at 1 year, 52% at 2 years, and 43% at 3 years. Complications developed in 41 (55%), and included thrombosis, infection, stenosis, arm oedema, bleeding, steal syndrome and microaneurysm formation. CONCLUSIONS: Brachiobasilic transposition fistulae have good long-term patency rates. The complication rate, although high, is lower than that reported for PTFE grafts. Brachiobasilic fistulae should be used in preference to PTFE grafts for secondary access.