Standard operating procedure of image-guided intervention during the COVID-19 pandemic: a combined tertiary musculoskeletal oncology centre experience.

AIM: To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. MATERIALS AND METHODS: This study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (US) rooms from 24 March 2020 to 24 May 2020 (during the COVID-19 pandemic peak) at Royal National Orthopaedic Hospital, London, and Royal Orthopaedic Hospital, Birmingham, UK. Measures were put in place to address air pressures, airflow direction, aerosol generation, and the safe utilisation of existing scanning rooms and work lists for interventional procedures. RESULTS: Three hundred and thirty-one patients (164 at Royal National Orthopaedic Hospital and 167 at Royal Orthopaedic Hospital) underwent image-guided procedures at both sites in the CT and US rooms. At the Royal National Orthopaedic Hospital, 40% of all procedures were performed under general anaesthesia. These consisted of 47 CT biopsies, 7 CT radiofrequency ablations (RFAs), and 12 US biopsies. At the Royal Orthopaedic Hospital, 86% of all procedures were performed under local anaesthetic, with no general anaesthetic procedures. These consisted of 61 CT biopsies and 83 US biopsies. All 256 patients having procedures in the CT room had no post-procedural complications or COVID-19-related symptoms and morbidity on follow-up. CONCLUSION: By adopting a pragmatic approach with meticulous planning, a limited, but fully functional image-guided interventional list can be run without any adverse patient outcomes.

N-Hexyl-3-(4-hy-droxy-3,5-dimeth-oxy-phen-yl)propanamide.

In the title compound, C(17)H(27)NO(4), which is an hydro-sinapic acid derivative with increased lipophilicity conferred by an additional alkyl chain, the central and the hexyl linear chains contain slightly shorter bond lengths [C-N = 1.316 (2) Å; average linear chain C-C = 1.487 (6) Å] than reported average values [Csp(2)-N = 1.334, C-C for CH(2)-CH(2) = 1.524 and 1.513 Šfor CH(2)-CH(3)]. The 4-hy-droxy-3,5-dimeth-oxy-phenyl plane [r.m.s. deviation 0.055 (12) Å] makes an angle of 59.89 (5)° with the central plane of the mol-ecule (composed of the N atom, the carbonyl group and the two methyl-ene C atoms linking the carbonyl group and the ring, [r.m.s. deviation 0.0026 (10) Å], which, in turn, makes an angle of 64.24 (13)° with the essentially planar hexyl chain [r.m.s. deviation 0.035 (18) Å]. The N-H group of the amide group is involved in a bifurcated hydrogen bond towards the hy-droxy and one of the meth-oxy O atoms of the 4-hy-droxy-3,5-dimeth-oxy-phenyl substituent of a neighbouring mol-ecule, forming a two-dimensional network in the (100) plane. In addition, the same hy-droxy group acts as a donor towards the carbonyl O atom of another neighbouring mol-ecule, forming chains running along the b axis.

6-Methyl-ideneandrost-4-ene-3,17-dione.

In the title compound, C(20)H(26)O(2), which is the 6-methyl-ene derivative of androstenedione and a synthetic percursor of exemestane, the steroid A ring approximates to a sofa (or envelope) conformation, with the methyl-ene group adjacent to the link to the B ring lying out of the plane of the other atoms. The B and C rings have slightly flattened chair conformations and the D ring is an envelope, with the CH group forming the flap. In the crystal, mol-ecules are linked by two distinct C-H⋯O hydrogen bonds, involving acidic H atoms close to C=C and C=O double bonds.

In vitro performance of a new non-invasive extracorporeal saturation monitor.

A simulated cardiopulmonary bypass circuit was constructed in the laboratory to compare the accuracy and precision of a new non-invasive extracorporeal oxygen saturation monitor-- the M3 monitor (Spectrum Medical LLP, Gloucester, UK) against the Siemens RAPIDLab(®) blood gas analyser (Siemens AG, Munich, Germany). Comparisons were made across a range of oxygen saturations and at different temperatures and different haemoglobin concentrations. Results showed that under all conditions, when recording oxygen saturation, the M3 monitor achieved a mean (SD) bias of -0.9 (1.7)% with limits of clinical agreement of -4.2 to 2.5. However, the difference between the two monitors was larger at lower saturation levels (p < 0.001), lower haemoglobin levels (p = .002) and lower temperatures (p = 0.013). The mean (SD) haemoglobin concentration was 15.4 (0.6) when recorded by the M3 monitor, compared to 15.4 (0.5) g.dl(-1) measured by the blood gas analyser The M3 monitor compares favourably with the gold standard of the blood gas analyser and has the advantage of giving a continuous reading. You can respond to this article at http://www.anaesthesiacorrespondence.com.

5α-Androst-3-en-17ß-yl acetate.

In the crystal structure of the title compound, C(21)H(32)O(2), ring A is highly distorted, with a conformation inter-mediate between 10ß-sofa and 1α,10ß-half chair; rings B and C have slightly flattened chair conformations. Ring D assumes an unusual 13ß-envelope conformation, probably induced by the acet-oxy substituent. Cohesion of the crystal structure is due only to weak van der Waals inter-actions.

3α,4α-Ep-oxy-5α-androstan-17ß-yl acetate.

The title compound, C(21)H(32)O(3), results from modifications of the A and D rings of the aromatase substrate androstenedione. Ring A adopts a conformation between 10ß-sofa and 1α,10ß half-chair. Rings B and C are in slightly flattened chair conformations. Ring D approaches a 13ß-envelope conformation, probably due to the acet-oxy substituent, and shows a very short Csp(3)-Csp(3) bond next to the epoxide ring, which is characteristic of 3-4 epoxides. .

5alpha-Androst-3-en-17-one oxime.

The title compound, C(19)H(29)NO, is a C17-oxime derivative of a potent aromatase inhibitor, which surprisingly has been found to have no inhibitory power. It crystallizes with two independent molecules in the asymmetric unit. C=N-O-H...N hydrogen bonds link pairs of molecules to form dimers almost parallel to the bc plane. Cohesion of the structure is also due to another three C-H...O hydrogen bonds directed along the a axis. This hydrogen-bonding scheme can be correlated to the almost complete loss of inhibitory power of the title compound.

3,17-Dioxoandrost-4-en-4-yl acetate.

The title compound, C(21)H(28)O(4), has a 4-acetoxy substituent positioned on the steroid alpha face. The six-membered ring A assumes a conformation intermediate between 1alpha,2beta-half chair and 1alpha-sofa. A long Csp(3)-Csp(3) bond is observed in ring B and reproduced in quantum-mechanical ab initio calculations of the isolated molecule using a molecular-orbital Hartree-Fock method. Cohesion of the crystal can be attributed to van der Waals interactions and weak C-H...O hydrogen bonds.

17-Oxo-5alpha-androstane-3alpha,4beta-diyl diacetate and 17-oxo-5beta-androstane-3alpha,4beta-diyl diacetate.

The title compounds, both C23H34O5, are the 5alpha and 5beta configurations of two diacetate epimers. The 5beta-diacetate crystallizes in an hexagonal structure, unusual for steroid molecules. The unit cell has an accessible solvent volume of 358 A(3), responsible for clathrate behaviour. The 5beta-epimer also features some shorter than average bond lengths in the 3alpha,4beta-acetoxy groups. The conformations of the molecules of both epimers are compared with those obtained through ab initio quantum chemistry calculations. Cohesion of the crystals can be attributed to van der Waals and weak molecular C-H...O interactions.

3 beta,7 alpha,12 alpha-triformyloxy-24-nor-5 beta-chol-22-ene.

The title compound, alternatively called 24-nor-5 beta-chol-22-ene-3 beta,7 alpha,12 alpha-triyl triformate, C(26)H(38)O(6), has a cis junction between two of the six-membered rings. All three of the six-membered rings have chair conformations that are slightly flattened and the five-membered ring has a 13 beta,14 alpha-half-chair conformation. The 3 beta, 7 alpha and 12 alpha ring substituents are axial and the 17 beta group is equatorial. The 3 beta-formyloxy group is involved in one weak intermolecular C-H...O bond, which links the molecules into dimers in a head-to-head fashion.

An unusual foreign body in the tongue.

A T-shaped metal object from an umbrella embedded in the tongue of a 4-year-old male child is described, along with its subsequent removal. The types of foreign bodies reported in this area are also mentioned.

[Clinical profile of cytomegalovirus (CMV) enterocolitis in acquired immunodeficiency syndrome]. / Perfil clínico da Enterocolite por Citomegalovírus (CMV) na síndrome da imunodeficiência adquirida (Aids).

OBJECTIVE: To determine the clinical profile of CMV colitis in AIDS patients, comparing clinical, endoscopic parameters and survival time between 2 groups of AIDS patients having chronic diarrhea. Group A being CMV colitis and group B without CMV colitis. METHODS: 48 patients with diarrhea that lasted more than 30 days, being 27 in Group A and 21 in Group B, were studied. Age, risk factors, interval time between the diagnosis of HIV infection and the beginning of diarrhea, hematochesia, the endoscopic findings and life table in both groups, were analysed. All of them were diagnosed by stool culture and stools for ovum and parasites, along colonoscopy with biopsies. The unpaired t test was used to assess statistical significance of differences observed in the means of continuous and the chi-square with Yates correction for non-parametric variables. The survival curves were assessed by the Kaplan-Meier and the Mantel-Haenszel's tests. A P value of less than 0,05 was considered to indicate statistical significance. RESULTS: The mucosal lesions associated with the CMV infection are typically ulcerative on a background of hemorrhagic erythema 14 (51,8%) p < 0,01. The life table analysis disclosed shorter survival time in the CMV colitis group 0,005> P>0,001. The others studied data did not achieve statistical significance. CONCLUSIONS: AIDS patients with CMV colitis have a poorer long-term survival. Among the colonoscopic findings, ulcerations with hemorrhagic background were the most common lesions.