Cross-sectional study of kidney stones by laser-induced breakdown spectroscopy.

We performed laser-induced breakdown spectroscopy (LIBS) for the in situ quantitative estimation of elemental constituents distributed in different parts of kidney stones obtained directly from patients by surgery. We did this by focusing the laser light directly on the center, shell, and surface of the stones to find the spatial distribution of the elements inside the stone. The elements detected in the stones were calcium, magnesium, manganese, copper, iron, zinc, strontium, sodium, potassium, carbon, hydrogen, nitrogen, oxygen, phosphorus, sulfur, and chlorine (Cl), etc. We optimized the LIBS signals by varying the laser energy from 10 mJ to 40 mJ to obtain the best signal-to-background and signal-to-noise ratios. We estimated the quantities of different elements in the stones by drawing calibration curves, plotting graphs of the analyte signal versus the absolute concentration of the elements in standard samples. The detection limits of the calibration curves were discussed. The concentrations of the different elements were found to be widely different in different stones found in different age groups of patients. It was observed that stones containing higher amounts of copper also possessed higher amounts of zinc. In general, the concentrations of trace elements present in the kidney stones decreased as we moved from center to shell and surface. Our results also revealed that the concentrations of elements present in the stones increased with the age of the patients. The results obtained from the calibration curves were compared with results from inductively coupled plasma mass spectrometry (ICP-MS). We also used the intensity ratios of different elemental lines to find the spatial distribution of different elements inside the kidney stones.

Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy.

OBJECTIVES: The influenza vaccination rate is very low among children with moderate to severe asthma. This may be partly because of poor patient motivation and failure to visit clinics for vaccination. Another important factor may be health care providers' deferral of vaccination because of concern about the efficacy and safety of influenza vaccination during asthma exacerbations and concurrent prednisone therapy. We therefore examined the safety and immunogenicity of influenza vaccination during acute asthma exacerbation with concomitant prednisone therapy. SETTING: A pediatric allergy and pulmonology clinic and a pediatric emergency department. DESIGN: Children (n = 109) with a known diagnosis of asthma 6 months to 18 years of age were recruited. All participating patients, 59 without asthma symptoms (no prednisone, control group) and 50 with acute asthma exacerbation requiring prednisone burst therapy (prednisone group) received trivalent subvirion influenza vaccine. Fifteen children in the control group and 12 in the prednisone group received a booster dose according to American Academy of Pediatrics guidelines. Serum antibody titers to influenza A/Beijing/32/92 (H3N2), influenza A/Texas/36/91 (H1N1), and influenza B/Panama/45/90 were measured before and 2 weeks after vaccination. Adverse effects noted within 48 hours after vaccine dose were ascertained during the follow-up visit. RESULTS: The antibody response was analyzed by comparing mean postvaccine titers, the percentage of patients achieving protective antibody levels (> or = 5log2), and the percentage of patients achieving rises in titers of 2log2 or greater. Antibody responses to influenza A/Beijing/32/92 (H3N2) and influenza A/Texas/36/91 (H1N1) in the prednisone-treated and control groups were not different. A significantly better response to the influenza B/Panama/45/90 antigen was seen in the prednisone group for all three parameters. Children who received a booster dose and the subgroup of children with low prevaccination titers (< or = 3log2) showed similar patterns. Adverse effects, including asthma exacerbation, local swelling at the injection site, fever, rash, and headache, were not different in the two groups. CONCLUSIONS: Influenza vaccination can be given safely and effectively to asthmatic children regardless of asthma symptoms or concurrent prednisone therapy when necessary. Vaccination of all moderate to severe asthmatic patients visiting clinics or emergency departments would improve the overall vaccination rate significantly.

Power output of pericardium-lined skeletal muscle ventricles, left ventricular apex to aorta configuration: up to eight months in circulation.

OBJECTIVE: The purpose of this experiment was to evaluate the potential for a skeletal muscle ventricle connected to the circulation between the left ventricle and the aorta to provide effective, long-term cardiac assist. METHODS: Skeletal muscle ventricles were constructed from the latissimus muscle in 10 dogs. After conditioning, the skeletal muscle ventricles were connected to the left ventricle and the aorta with 2 valved conduits. The skeletal muscle ventricle was programmed to contract during diastole. RESULTS: At time of implantation, skeletal muscle ventricles stimulated at 33 Hz and in a 1:2 ratio with the heart significantly decreased left ventricular work by 56% (P <.01) and at 50 Hz by 65% (P <.01). At a 1:2 ratio, the power output of the skeletal muscle ventricles was 59% of left ventricular power output at 33 Hz (P <. 01) and 93% at 50 Hz (P <.01). Animals survived 7, 11, 16, 17, 72, 99, 115, 214, and 249 days. Three deaths were directly related to the skeletal muscle ventricle. One animal is alive at 228 days. In the animal that survived 249 days, skeletal muscle ventricle power output at 8 months with a 33 Hz stimulation frequency and a 1:2 contraction ratio was 57% of left ventricular power output and 82% at 50 Hz. At a 1:1 ratio, skeletal muscle ventricle power output was 97% and 173% of the left ventricle at 33 and 50 Hz, respectively. CONCLUSIONS: Left ventricular assist with a skeletal muscle ventricle connected between the left ventricle and the aorta is the most hemodynamically effective configuration we have tested and can maintain significant power output up to 8 months.

Predilection of occlusive disease for the left iliac artery.

Eighty-six consecutive patients operated on for atherosclerotic occlusion of the aortoiliac segment were examined regarding the severity of the disease in the left or right iliac arteries. Sixty-nine percent of 78 patients were found to have predominantly more severe lesions on the left side. A study of the geometric anatomy of the aortoiliac region in 14 male and 12 female cadavers revealed that the right common iliac take-off angle was wider than the left and the radius of curvature of the right osculating circle at the aortoiliac bifurcation was smaller than the left, with the asymmetry of the region being much more marked in males than in females. The predilection of occlusive disease for the left iliac artery is explained on the basis of these differences in local geometric anatomy and their effect on the local hemodynamics.

Can self assessment of communication predict hearing loss?

A total of 120 subjects with hearing loss (75 men, 45 women), within the age range 18-70 years (mean, 38 years), and 15 normal subjects were administered a modified Hindi adaptation of the 'self assessment of communication' hearing loss inventory. The study aimed to determine whether there was any correlation between subjects' average pure tone thresholds and their inventory scores. Data was analysed using the Pearson coefficient of correlation and regression analysis. A negative correlation was obtained stating that the greater the hearing loss, the lower the inventory score. An equation could also be derived for the bilateral symmetrical sensorineural hearing loss group and the bilateral symmetrical conductive hearing loss group to enable calculation of patients' average hearing loss from their inventory scores, in the absence of an audiogram. This could aid rehabilitation in cases with either type of hearing loss (in which no medical intervention was required) when pure tone audiometry is not possible.

Placental pathology of recurrent spontaneous abortion: the role of histopathological examination of products of conception in routine clinical practice: a mini review.

BACKGROUND: Histopathological examination of products of conception from miscarriages is part of routine clinical practice. The extent of additional clinically relevant information provided by this investigation in the setting of recurrent spontaneous abortion remains uncertain. METHODS: Review of the literature was performed to identify studies reporting on findings of histological examination of routinely obtained products of conception in the setting of recurrent spontaneous abortion. The initial search identified 312 potential references, but 300 were excluded on further examination due to lack of data on specific histopathological findings in routine products of conception specimens from patients with recurrent spontaneous abortion. The 12 included studies indicated that such examination may identify hydatidiform moles, villous dysmorphic features suggesting fetal aneuploidy, chronic histiocytic intervillositis (CHI) and massive perivillous fibrin deposition and impaired trophoblast invasion. However, in most cases, morphological assessment cannot reliably determine the cause of the miscarriage or distinguish recurrent from sporadic miscarriage. Studies reporting on the use of additional immunohistochemical methods do not currently provide additional clinically useful diagnostic or prognostic information. CONCLUSION: Routine histological examination of products of conception in the setting of recurrent spontaneous abortion can provide important clinical information in a minority of cases.

Ulnar nerve compression in Guyon's canal caused by calcinosis in scleroderma.

Calcium deposits in Guyon's canal secondary to scleroderma caused low ulnar nerve paralysis in a 70-year-old white woman. Excision of calcium deposits resulted in rapid alleviation of pain. After nerve regeneration, the patient's clawing disappeared, and she was able to abduct and adduct all digits.

Advanced prostatic carcinoma in a 19-year-old male.

We report a case of poorly differentiated carcinoma of the prostate with lymph node metastasis in a 19-year-old male. He was managed with bilateral orchiectomy, flutamide and recombinant interferon alfa-2b therapy. He showed subjective improvement for 2 months. However, during the 3rd month of treatment there was global deterioration which progressed further till his demise during the 4th month. The beneficial role, if any, of combined hormonal and immunotherapy in advanced prostatic carcinoma is discussed as also the natural history and prognosis of prostatic carcinoma in men under 20 years of age.