Febrile complications following insertion of 100 double-J ureteral stents

BACKGROUND AND PURPOSE: Implanted foreign bodies are associated with a higher risk of infection. Little has been published on infectious complications associated with ureteral double-J stents. The aim of this study was to define risk factors and characterize the febrile complications of the insertion of double-J stents. PATIENTS AND METHODS: One hundred consecutive cases of retrograde stent insertion (55 men and 45 women) were evaluated retrospectively. Eighty-one patients had an obstructing stone, either in the ureter or at the ureteropelvic junction; 10 had an obstructing tumor; and 9 had hydronephrosis and pain without calculi. Risk assessment was calculated for two major categories: urgent (N = 47) and elective (N = 53) insertion. Potentially confounding factors such as age, sex, accompanying medical problems, and types of prophylaxis were assessed. All but six patients received prophylactic antibiotics prior to stent insertion. RESULTS: All thirteen patients who had fever at the initial evaluation underwent urgent stent insertion. Of the 87 afebrile patients (53 elective and 34 urgent insertions), 22 (25%) developed fever (> or = 38 degrees C) after the procedure. Fever developed in 19 (56%) of the 34 urgent-insertion group who were not originally febrile as opposed to 3 (6%) of the elective-insertion group (P < 0.001). Six of these 22 patients (27%) had a positive urine culture after insertion. None had a positive blood culture, including the 13 patients who underwent the procedure while febrile. CONCLUSIONS: Urgent insertion of a double-J stent is associated with a high risk of fever but a favorable outcome.     

Genetik des Silver-Russell-Syndroms

Zusammenfassung Beim Silver-Russell-Syndrom (SRS) handelt es sich um ein meist sporadisch auftretendes Kleinwuchssyndrom mit charakteristischen Dysmorphien. Bei etwa 7–10% der Patienten liegt eine materne uniparentale Disomie von Chromosom 7 (matUPD7) vor. Auch mehrere andere strukturelle Aberrationen dieses Chromosoms wurden berichtet. Veränderungen auf Chromosom 7 scheinen eine wesentliche Rolle in der Ätiologie des Syndroms zu haben, u.a. solche, die mit elterlicher Prägung einhergehen. Zytogenetische Befunde sprechen für eine Beteiligung weiterer chromosomaler Regionen, insbesondere von Faktoren, die auf den Chromosomen 11, 15 und 17 lokalisiert sind. Der funktionelle Zusammenhang zwischen den nachgewiesenen genetischen Veränderungen bei SRS-Patienten und den Ausprägungen des Syndroms ist noch unklar. Nichtsdestotrotz kann auf der Basis des derzeitigen Wissens eine Labordiagnostik angeboten werden, die eine zytogenetische und molekulargenetische Untersuchung im Hinblick auf Umbauten und eine uniparentale Disomie von Chromosom 7 umfasst. Im vorliegenden Beitrag werden der Stand des Wissens zu genetischen Grundlagen des SRS und die Schlussfolgerungen für den genetisch-diagnostischen Ablauf dargestellt.     

Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants

BACKGROUND: Normal brain and visual development is thought to require exogenous docosahexaenoic acid (DHA; 22:6n-3) intake, but the amount needed is debatable. Because the supplementation of breastfeeding mothers with DHA increases the DHA content of their infants' plasma lipids, we hypothesized that it might also improve brain or visual function in the infants. OBJECTIVE: The objective was to determine the effect of DHA supplementation of breastfeeding mothers on neurodevelopmental status and visual function in the recipient infant. DESIGN: Breastfeeding women received capsules containing either a high-DHA algal oil ( approximately 200 mg DHA/d) or a vegetable oil (no DHA) for 4 mo after delivery. Outcome variables included the fatty acid pattern of maternal plasma phospholipid and milk lipids 4 mo postpartum, the fatty acid pattern of plasma phospholipids and visual function in infants at 4 and 8 mo of age, and neurodevelopmental indexes of the infants at 12 and 30 mo of age. RESULTS: Milk lipid and infant plasma phospholipid DHA contents of the supplemented and control groups were approximately 75% and approximately 35% higher, respectively, at 4 mo postpartum. However, neither the neurodevelopmental indexes of the infants at 12 mo of age nor the visual function at 4 or 8 mo of age differed significantly between groups. In contrast, the Bayley Psychomotor Development Index, but not the Mental Development Index, of the supplemented group was higher (P < 0.01) at 30 mo of age. CONCLUSION: DHA supplementation of breastfeeding mothers results in higher infant plasma phospholipid DHA contents during supplementation and a higher Bayley Psychomotor Development Index at 30 mo of age but results in no other advantages either at or before this age.     

One-Year Experience with Tantalus™: a New Surgical Approach to Treat Morbid Obesity

Background: Increased caloric density in modern processed foods may be an important factor underlying the prevalence of obesity, because low-volume, high-caloric food intake may delay activation of volume-dependent gastric mechanical activity known to induce the feeling of fullness. We therefore hypothesized that enhancement of gastric contractions by electrical stimulation at an early stage of the meal will reduce food intake and body weight in morbidly obese subjects. Methods: The study was a prospective, non-randomized, open-label, single-center trial. 12 subjects (age 36.1 ± 2.8 years, BMI 43.2 ± 2.7 kg/m², weight 128.8 ± 5.2 kg, means±SEM) underwent laparoscopic implantation with the Tantalus^™ system. A pulse generator with 3 bipolar leads was implanted: 2 pairs in the antrum and a 3rd pair in the fundus. The system was activated at week 6. All subjects were followed for 20 weeks and 9 of them for 52 weeks. Results: All subjects finished the initial 20-week observation period. Following activation of the Tantalus^™ System, a reduction (P<0.05) in hunger and an increase in cognitive control (P<0.05) as assessed by the Three-Factor Eating Questionnaire (TFEQ) could be observed. Body weight decreased (P<0.05) from 128.8±5.2 to 119.9+5.9 (17.6+4.3% EWL, N=12) after 20 weeks (14 weeks of treatment). In the 9 subjects continuing for 52 weeks (46 weeks of treatment), body weight further decreased to 112.4 ± 3.8 kg (26.6 ± 8.5 %EWL, N=9). Blood pressure decreased (P<0.05) from 142 ± 6.1/91 ± 3.2 to 125.5 ± 4.0/83 ± 2.6 mmHg by week 20 and 128.8 ± 3.8 / 86.3 ± 3.6 mmHg after 1 year. The frequency and severity of device and/or procedure-related adverse events indicate that the method is safe and well-tolerated. Conclusion: This data suggests that gastric stimulation by the minimally invasive Tantalus^™ System is safe and leads to favorable changes in eating behavior, clinically significant weight loss and reduction in blood pressure. Treatment with the Tantalus^™ System is therefore a promising minimally invasive treatment for obesity.