The effect of single or multiple courses of antenatal corticosteroid therapy on neonatal respiratory distress syndrome in singleton versus twin pregnancies

Background: Antenatal corticosteroid (ACS) treatment is widely used for the prevention of respiratory distress syndrome (RDS) in preterm infants. However, the efficacy and safety of ACS treatment remains controversial in twin pregnancies.
Aims: To investigate the effect of ACS therapy, single or multiple courses, on the incidence of neonatal RDS in singleton and twin pregnancies.
Methods: We retrospectively evaluated the pregnancy and neonatal outcomes of 450 singleton and 117 twin pregnancies delivered at 24–34 weeks of gestation due to preterm labour or preterm premature rupture of membranes. The subjects were categorised into four groups according to ACS exposure: 0, 1, 2 and ≥ 3 courses.
Results: Overall, RDS occurred more frequently in twins compared to singletons (41.0% vs 25.3%, P  < 0.001). In singleton pregnancy, the incidence of RDS was significantly lower in the ACS user groups than in the non-user group, with the lowest incidence in the multiple course groups. An increase in the number of courses of ACS was associated with a reduction in the incidence of RDS (odds ratio 0.349, 95% confidence interval 0.226, 0.537, P  < 0.001) independent of confounding variables. In twin pregnancies, however, the incidence of RDS was not significantly different in comparisons among the four groups.
Conclusion: Multiple courses of ACS were associated with a significantly decreased risk of RDS in singleton pregnancies. However, the current standard dose or interval for ACS administration in singleton pregnancy, as either a single or multiple courses, did not reduce RDS in twins.     

White matter lesions on magnetic resonance imaging in late-life depression

Objectives: The aims of the present study were to identify the frequency and severity of white matter lesions on the magnetic resonance imaging (MRI) of major depressive disorders and depression caused by cerebrovascular diseases (CVD), to evaluate the relation with cerebrovascular risk factors, and finally to understand an important cause of late‐life depression. Methods: The MRI films of 32 patients over 50 years of age (15 men and 17 women) with major depressive disorders, 25 patients (17 men and eight women) with depression caused by CVD who had scores over 24 on the mini‐mental state examination, and 25 controls (six men and 19 women) were analyzed for white matter lesions according to the modified Fazekas criteria. The cerebrovascular risk factors including hypertension, arteriosclerosis, obesity, smoking, diabetes mellitus, thyroid function abnormalities, EKG abnormality and stroke were also assessed. Results: (i) The frequency of periventricular lesions or deep white matter lesions were significantly higher in patients with depression caused by CVD and major depressive disorders than in controls; (ii) the intracerebral hyperintensities or classical infarctions were prevalent in the frontal cortex (32.0%) and basal ganglia (40.0%); (iii) among cerebrovascular risk factors, stroke (P < 0.005), hypertension (P < 0.025), EKG abnormality (P < 0.005) and smoking (P < 0.05) were significantly prevalent in the patients with depression caused by CVD and major depressive disorders as compared with controls; and (iv) the severity of white matter lesions was significantly associated with the cerebrovascular risk factors (P < 0.005) in patients over 50 years of age with major depressive disorders. Conclusions: The white matter hyperintensities on brain MRI of patients with major depressive disorders over 50 years of age were significantly associated with cerebrovascular risk factors, which suggested a vascular origin of pathogenesis of late‐life depression.     

Chest radiography: a survey of techniques and exposure levels currently used

In diagnostic radiology, the routine measurement of exposure levels for a reference patient is an important part of an effective quality assurance program. In the United States, chest radiography is the most frequent examination and has the lowest exposure level of all radiologic examinations. We estimated the amount of exposure an average patient received from both manual and automatic exposure-controlled radiographic techniques by using a "patient-equivalent" chest phantom during measurements. A densitometric procedure was used to assess processor performance. The mean exposure from 194 chest systems was 20 mR (5.16 X 10(-5) C/kg); the mean film density, 1.38; and the mean processing speed, 108. It is interesting to note that a wide range of radiographic techniques, processing conditions, and screen-film speeds are currently being used. With the information given in our study, investigators can begin to identify the problems that lead to unusual exposure levels and, perhaps, poor image quality.     

Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy

The purpose of this study was to classify anatomical variations of the internal iliac vein (IIV) in relation to robotic or laparoscopic extended lymphadenectomy. Between March 2011 and July 2012, 60 consecutive patients underwent robotic or laparoscopic extended lymphadenectomy. We retrospectively reviewed surgical video clips and analyzed the pattern of the IIVs in the presacral area. IIV variations were classified into seven types: Type A, normal (n = 39, 65.0%); Type A with a dilated middle sacral vein (n = 5, 8.3%); Type B, left IIV connecting centrally to the left external iliac vein (n = 5, 8.3%); Type C, a separated trunk of the left IIV draining into the left central common iliac vein (CIV; n = 1, 1.7%); Type D, a separated trunk of the right IIV draining into the left central CIV (n = 8, 13.3%); Type E, a separated trunk of the right IIV draining into the right central CIV (n = 0, 0%); and Type F, separated trunks of the bilateral IIV connecting with each other before draining into the left central CIV (n = 2, 3.3%). The prevalence of IIV anomalies was 26.7%; the incidence of separated IIV trunks was 18.3%. To prevent life‐threatening IIV injury during extended lymphadenectomy or sacral colpopexy, the anatomical variations of the IIVs should be known exactly. Clin. Anat. 28:661–664, 2015. © 2014 Wiley Periodicals, Inc.     

Percutaneous endoscopic gastrostomy in children with cancer

We reviewed the clinical course of 32 children with cancer who received nutrition through a feeding tube placed percutaneously during gastroscopy (PEG). Their median age was 5.1 y (75%, range: 1.8-13.7 y, min: 3.5 mo) when the PEG was done 0.7-23 mo after diagnosis (median: 1.8 mo, 75%; range: 0.9-8 mo). Five of the children underwent bone marrow transplantation with the gastrostomy in place. There was a significant (p     

The Effects of Tadalafil on Axial-Pattern Skin Flap Survival in Rats

BACKGROUND Pharmacologic augmentation to mimic the delay phenomenon that increases skin flap survival has been studied extensively. Tadalafil is a phosphodiesterase V inhibitor that is used for treatment of erectile dysfunction by enhancing vascular smooth muscle relaxation.
OBJECTIVE The aim of this study was to investigate the effects of local injection of tadalafil in enhancing axial-pattern skin flap survival in rats.
MATERIALS AND METHODS Twenty Sprague-Dawley rats were used and a McFarlane-type caudally based axial-pattern skin flap was designed on the dorsum of the rat (2 × 9 cm). Rats were divided into two groups: the treatment group and the control group. Tadalafil 10 mg/kg/day was injected to the distal flap area of the treatment group for 3 days, and normal saline was injected for the control group. On Postoperative Day 7, necrotic flap area was measured and compared, and angiograms of the skin flaps were obtained in the two groups.
RESULTS In the treatment group, the mean necrotic area was 21.9±6.4%, and in the control group, 37.7±5.9%. There was a statistically significant increase of skin flap survival in the treatment group ( p =.001). Angiography also showed vasodilation of the choke vessels between adjacent angiosomes to form true anastomosis in the treatment group.
CONCLUSION The results demonstrate that the use of local injection of tadalafil to failing skin flaps increases the survival of axial-pattern flaps in rats.