Streptococcus milleri and Recurrent Intra-Abdominal Abscesses: A Case Report and Literature Review.

We report a case of recurrent intra-abdominal abscesses as a postoperative complication following diverticular perforation in which Streptococcus milleri (SM) was isolated. SM is evaluated here as a potent pyogenic organism commonly associated with intra-abdominal abscess especially in the postoperative setting. With the commonly adopted conservative management, the challenges of recurrence and prolonged hospital stay experienced in the indexed case as well as many other previous reports are highlighted. We also present a recommendation of the need for a more intensive approach of SM-related abscess drainage along with areas that would benefit further research.

Acute rectal ischaemia following emergency abdominal aortic aneurysm surgery.

We present a case of isolated rectal ischaemia, a rare complication after emergency surgery for a ruptured abdominal aneurysm. We discuss the possible aetiology of this condition and how this rare condition may be missed unless care is taken at the time of reoperation.

Inversion, hydration and diuresis during extracorporeal shock wave lithotripsy: does it improve the stone-free rate for lower pole stone clearance?

OBJECTIVE: It was the aim of this study to assess the efficacy and safety of combined forced hydration and diuresis with limited inversion during shock wave lithotripsy (SWL) by comparing this treatment modality with conventional SWL for lower calyceal nephrolithiasis. PATIENTS AND METHODS: In this prospective, non-randomized study, we included 100 patients with lower calyceal calculi 0.05). Complications were minimal and not statistically significant. CONCLUSIONS: Forced diuresis and inversion therapy is very well tolerated; however, the stone-free rate was not significantly improved.

Appropriate cutoff for treatment of distal ureteral stones by single session in situ extracorporeal shock wave lithotripsy.

OBJECTIVES: To determine an appropriate cutoff for treatment by single session in situ extracorporeal shock wave lithotripsy for a prevesical stone by determining the differences in the efficiency quotient (EQ). METHODS: This was a review of a series of patients who underwent shock wave lithotripsy for a primary, single, prevesical stone from January 1995 to June 2003. All 153 patients were treated using a Dornier MPL 9000 lithotripter in the prone position under intravenous sedation. The stone size was measured in two dimensions (parallel and perpendicular to the long axis of the ureter). The EQ was calculated using a standard formula. RESULTS: Of the 153 patients, 141 (92.2%) were stone free within a mean period of 12.2 +/- 12.2 days (EQ 68.8). No significant complications occurred, and none of the patients required admission. The treatment failed in 10 patients (6.5%), who subsequently required an ancillary procedure (ureteroscopy). Statistically, we found 7 mm to be an appropriate cutoff for treatment using in situ shock wave lithotripsy. The EQ for stones greater than 7 mm and those 7 mm or smaller was 58 and 81, with a stone-free period of 13.6 +/- 12.9 and 10.9 +/- 11.6 days, respectively. CONCLUSIONS: Ultrasound-guided shock wave lithotripsy is an efficient and safe modality for the treatment of prevesical stones 7 mm or less. Using an echo-guided lithotripter, the treatment was a radiation-free, day care procedure performed under intravenous sedation. Only 11% of our patients required repeat treatment.

Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

BACKGROUND: An intravenous urogram (IVU) has traditionally been considered mandatory before treating renal and ureteric stones by extracorporeal shock wave lithotripsy (ESWL). This study was designed to see whether there is a difference in complications and the need for ancillary procedures in patients managed by ESWL for renal and ureteric calculi, according to preoperative imaging technique. METHODS: This retrospective study compared 133 patients undergoing ESWL from January 2001 to July 2002. Patients were divided into three groups according to the preoperative imaging technique used: i) IVU; ii) non-contrast enhanced helical computed tomography (UHCT); and iii) ultrasound (US) + X-ray kidney, ureter and bladder (KUB). The groups were matched in terms of age and gender, as well as location, side and size of stones. RESULTS: There was no statistically significantly difference for number of ESWL sessions, number of shock waves and use of ancillary procedures between the three groups. The stone-free rate was 98% for the IVU and UHCT groups, and 97% for the US + X-ray KUB group. CONCLUSIONS: The complication rate and need for ancillary procedures was comparable across the three groups. Patients imaged by UHCT or US + X-ray KUB prior to ESWL for uncomplicated renal and ureteric stones do not require IVU.

Crystallization and preliminary X-ray analysis of pseudo-merohedrally twinned crystals of the full-length beta(2) subunit of the Kv1 K(+) channel from Rattus norvegicus.

The eukaryotic Kv1 voltage-gated K(+) channel is composed of four alpha subunits and four beta subunits. The full-length beta(2) subunit from Rattus norvegicus has been expressed in Esherichia coli, purified and then crystallized. A careful molecular-replacement study using the structure of the truncated beta(2) subunit reveals that the crystals are perfectly pseudo-merohedrally twinned. While the apparent space group of the crystals was P42(1)2, the real space group was shown to be P2(1)2(1)2, with unit-cell parameters a = 222.6, b = 222.6, c = 82.3 A. An asymmetric unit of the crystal contains two beta(2) tetramers (MW = 340 kDa). A data set was collected from a crystal to 2.0 A resolution, with 266 659 independent observations (93.0% complete) and R(merge) = 0.06. Although the crystals are perfectly twinned, they are still suitable for structural determination by molecular replacement using the truncated beta(2)-subunit structure.

Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave lithotripsy - the controversy continues.

BACKGROUND: To determine factors influencing the clearance of fragments after extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC) stones. METHODS: In the period between July 1998 and Oct 2001, 100 patients with isolated lower polar calyceal calculi or= 14 years, were included in the study. Intravenous urograms (IVU) were reviewed to define the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end points i.e. stone free status; number of shock waves used and number of sessions were correlated with variables like LPC anatomy, body mass index and stone size. RESULTS: At three months follow up the clearance for stone size 90 degrees ) had stone clearance of 94 and 100% respectively. For the infundibular width of < 4 mm, the stone clearance was 93% were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30 kg/m2, the stone clearance was 92 and 95% respectively. CONCLUSIONS: There is a trend towards more ESWL sessions and shock wave requirement in patients with acute pelvi-calyceal angle and narrow infundibulum but it is not statistically significant. Size (

Characteristics of brain Kv1 channels tailored to mimic native counterparts by tandem linkage of alpha subunits: implications for K+ channelopathies.

Most neuronal Kv1 channels contain Kv1.1, Kv1.2 alpha, and Kvbeta2.1 subunits, yet the influences of their stoichiometries on properties of the (alpha)(4)(beta)(4) variants remain undefined. cDNAs were engineered to contain 0, 1, 2, or 4 copies of Kv1.1 with the requisite number of Kv1.2 and co-expressed in mammalian cells with Kvbeta2.1 to achieve "native-like" hetero-oligomers. The monomeric (Kv1.1 or 1.2), dimeric (Kv1.1-1.2 or 1.2-1.2), and tetrameric (Kv1.1-(1.2)(3)) constructs produced proteins of M(r) approximately 62,000, 120,000, and 240,000, which assembled into (alpha)(4)(beta)(4) complexes. Each alpha cRNA yielded a distinct K(+) current in oocytes, with voltage dependence of activation being shifted negatively as the Kv1.1 content in tetramers was increased. Channels containing 1, 2, or 4 copies of Kv1.1 were blocked by dendrotoxin k (DTX)(k) with similarly high potencies, whereas Kv(1.2)(4) proved nonsusceptible. Accordingly, Kv1.2/beta2.1 expressed in baby hamster kidney cells failed to bind DTX(k); in contrast, oligomers containing only one Kv1.1 subunit in a tetramer exhibited high affinity, with additional copies causing modest increases. Thus, one Kv1.1 subunit largely confers high affinity for DTX(k), whereas channel electrophysiological properties are tailored by the content of Kv1.1 relative to Kv1.2. This notable advance could explain the diversity of symptoms of human episodic ataxia I, which is often accompanied by myokymia, due to mutated Kv1.1 being assembled in different combinations with wild-type and Kv1.2.