Is fasting necessary for elective cerebral angiography?

BACKGROUND AND PURPOSE: In order to prevent unexpected events such as aspiration pneumonia, cerebral angiography has been performed under fasting in most cases. We investigated prospectively the necessity of fasting before elective cerebral angiography. MATERIALS AND METHODS: The study is an open-labeled clinical trial without random allocation. In total, 2554 patients who underwent elective cerebral angiography were evaluated on development of nausea, vomiting, and pulmonary aspiration during and after angiography. Potential risks and benefits associated with fasting were provided in written documents and through personal counseling to patients before the procedure. The patients chose their fasting or nonfasting option. No restriction in diet was given after angiography. The patients were observed for 24 hours. Nausea and vomiting during and within 1 hour after angiography was considered as a positive event associated with cerebral angiography. RESULTS: The overall incidence of nausea and vomiting during and within 1 hour after angiography was 1.05% (27/2554 patients). There was no patient with pulmonary aspiration. No statistical difference in nausea and vomiting development between the fasting and the diet groups was found. CONCLUSIONS: The incidence of nausea and vomiting associated with cerebral angiography is low and not affected by diet or fasting. Pulmonary aspiration had no difference between the diet and the fasting group. Our study suggests that fasting may not be necessary for patients who undergo elective cerebral angiography.

The removal of residual organic matter from biologically treated swine wastewater using membrane bioreactor process with powdered activated carbon.

The objective of this study was to characterize the mechanisms of the COD removal in the membrane bioreactor (MBR) process with powdered activated carbon (PAC) addition and to determine its optimal operation, for the removal of residual organic matters (ROM) from biologically treated swine wastewater. The MBR process with PAC showed higher removal efficiency of chemical oxygen demand (COD(Mn)) than that without PAC. When the average COD(Mn) concentration of the influent was 217 mg/L, the average COD(Mn) concentration of the permeate from the MBR with PAC was about 41.5 mg/L, indicating an approximate removal efficiency of 81%. On the other hand, the average COD(Mn) concentration of the permeate from the MBR without PAC was 172 mg/L. The PAC dosage estimated to obtain the above removal efficiency was about 0.74 g per litre of influent. Among the total residual organics removed by PAC-added MBR, 46.5% was removed by PAC adsorption, 20.8% by biodegradation, 4.4% by membrane separation, and 9.3% by enhanced microorganism activity. From these results, the MBR process with PAC was considered as a very useful treatment process for the reduction of COD(Mn) in biologically treated swine wastewater.

Multiple meningiomas of different pathological features: case report.

Meningioma is a common intracranial tumour and it may occur not infrequently as one of the multiple tumours, especially in patients with neurofibromatosis. The incidence of multiple meningiomas (MMs) without the stigmata of neurofibromatosis is rare, ranging from 1 to 9% of all meningiomas in the literature. Multiple meningiomas with different pathologic features are even rarer, and most of them are benign histologies. The authors report an extremely rare case of MMs which were presented with malignant and benign histological features simultaneously. The underlying mechanism of MM formation is still unclear, however, subarachnoid spread was thought to be the most likely mechanism. The findings of most of MMs showed identical histopathological features and several molecular biologic studies provided evidence for the monoclonal origin of MMs to back up the above hypothesis. However, different histological features among the reported multiple meningioma cases including our particular one, suggests their origin from multicentric neoplastic foci activated by a supposed tumour-producing factor. However, we cannot completely exclude the possibility of independent progression from monoclonal origin.

Technetium-99m-ECD brain SPECT in cerebral palsy: comparison with MRI.

UNLABELLED: Hypoxic brain injury is one of the major causes of cerebral palsy. Therefore, this study was performed to evaluate cerebral perfusion impairments in these patients using 99mTc-ECD brain SPECT. METHODS: Fifty-one patients (31 boys, 20 girls; age range 6 mo to 6 yr, 11 mo) with clinical manifestations of cerebral palsy underwent brain SPECT after intravenous injection of 99mTc-ECD. The clinical subtypes of cerebral palsy were spastic diplegia (n = 35), spastic quadriplegia (n = 11), spastic hemiparesis (n = 2), choreoathetoid (n = 2) and mixed (n = 1). Transaxial, coronal and sagittal images obtained with a brain-dedicated annular crystal gamma camera were qualitatively analyzed and compared with the findings of magnetic resonance imaging (MRI). RESULTS: In SPECT, thalamic hypoperfusion was seen in all patients except one (98%), followed by hypoperfusion in the temporal lobe (52.9%, n = 27), basal ganglia (41.2%, n = 21), cerebellum (39.2%, n = 20) and extratemporal cortices (21.6%, n = 11). However, MR imaging demonstrated thalamic abnormality in seven (13.7%), basal ganglia in two (3.9%), extratemporal cortical defect in five (9.8%) and cerebellar atrophy in one (1.9%). Instead, white matter changes such as periventricular leukomalacia or ischemia (56.9%, n = 25) and thinning of corpus callosum (49%, n = 25) were the major findings. CONCLUSION: Brain SPECT is useful in the diagnosis of cerebral palsy and is more sensitive in the detection of cortical, subcortical nuclei and cerebellar abnormalities. MRI is superior in the detection of white matter changes.

Laparo-vaginal treatment of uterine procidentia.

The following is a description of a combined vaginal and laparoscopic repair of vaginal eversion with uterine prolapse (procidentia). There are few procedures that seek to correct the condition while preserving vaginal function. Among them are (1) vaginal approach for sacrospinous fixation, (2) abdominal sling procedures, and (3) abdominal and laparoscopic approaches for promontorial fixation. We are presenting a technical report of a modified sling procedure done via laparoscopy. This technique achieves the functional vaginal reconstruction and avoids the potentially dangerous bleeding associated with the sacral fixation. It has also been our experience that the sacrospinous fixation technique affords limited visual exposure, and henceforth the laparoscopic vaginal sling procedure may be a better alternative.