Malaria among patients and aid workers consulting a primary healthcare centre in Leogane, Haiti, November 2010 to February 2011 - a prospective observational study.

Plasmodium falciparum malaria is endemic in Haiti, but epidemiological data are scarce. A total of 61 cases of malaria were diagnosed between November 2010 and February 2011 among 130 Haitian patients with undifferentiated fever. Three additional cases were diagnosed in expatriates not taking the recommended chemoprophylaxis. No cases were diagnosed among aid workers using chemoprophylaxis. In conclusion, malaria is a significant health problem in Leogane, Haiti. Aid workers and visitors should use chemoprophylaxis according to existing guidelines.

[Surgical strategy for the liver injury and developed abdominal complications].

The authors have analyzed results of treatment of 641 patients with the liver injury: blunt injury--209, penetrating--432. Surgical strategy depends on the condition of the patient on admission, severity of the liver injury and combined trauma. Suturing the rupture (wound) of the liver was the method of choice in the I-II degrees of the liver injury. If it was impossible to achieve hemostasis in the bottom of the wound in the III-IV degrees of the liver injury, package with gauze drain (7) and ligation of the hepatic artery (3) were used. Resection of the liver was performed in 22 patients. In the postoperative period the main complications were: peritonitis (22), subphrenic abscesses (13), hemobilia (7), subhepatic abscesses (6) and liver abscesses (5). Embolization of the hepatic artery branches was preferable in hemobilia. The mortality rate in blunt injuries of the liver was 28.2%, gunshot wounds--27.6% and knife injury--4%.

Clinical utility of serodiagnostic testing in suspected pediatric inflammatory bowel disease.

OBJECTIVES: Confronted with nonspecific symptoms, accurate screening tests would be useful to clinicians to distinguish between functional childhood disorders and inflammatory bowel disease (IBD), thus avoiding invasive diagnostic testing. Traditional ulcerative colitis-specific perinuclear antineutrophil cytoplasmic antibody (pANCA) and Crohn's disease-specific anti-Saccharomyces cerevisiae antibody (ASCA) serodiagnostic assays have recently been modified, with ELISA cut-off values recalculated to maximize sensitivity. The aim of this study was to determine whether the combination of these serodiagnostic tests could maximize diagnostic accuracy and minimize invasive investigations in pediatric patients presenting with nonspecific symptoms suggestive of IBD. METHODS: With investigators blinded to clinical diagnoses, ASCA, ANCA, and pANCA profiles were obtained prospectively from 128 patients undergoing complete diagnostic evaluation for IBD. In phase I, diagnostic accuracy and predictive values of the modified and traditional assays were compared for the IBD (n = 54) and non-IBD groups (n = 74). In phase II, the overall accuracy of a novel sequential diagnostic testing strategy was determined. Additionally, the potential number of invasive investigations avoided with the hypothetical application of this strategy to the cohort was determined. RESULTS: For phase I, the modified serodiagnostic assay was more sensitive (81 vs 69%), whereas the traditional assay had a higher specificity (96 vs 72%) for IBD (p < 0.05) For phase II, false-positive diagnoses would have been reduced by 81%, yielding an overall sequential testing strategy accuracy of 84%. CONCLUSIONS: The incorporation of sequential noninvasive testing into a diagnostic strategy may avoid unnecessary and costly evaluations and facilitate clinical decision making when the diagnosis of IBD in children is initially uncertain.

A membrane lipid imbalance plays a role in the phenotypic expression of cystic fibrosis in cftr(-/-) mice.

A deficiency in essential fatty acid metabolism has been reported in plasma from patients with cystic fibrosis (CF). However, its etiology and role in the expression of disease is unknown. The objective of this study was to determine whether alterations in fatty acid metabolism are specific to CF-regulated organs and whether they play a role in the expression of disease. A membrane lipid imbalance was found in ileum, pancreas, and lung from cftr(-/-) mice characterized by an increase in phospholipid-bound arachidonic acid and a decrease in phospholipid-bound docosahexaenoic acid (DHA). This lipid imbalance was observed in organs pathologically affected by CF including lung, pancreas, and ileum and was not secondary to impaired intestinal absorption or hepatic biosynthesis of DHA. As proof of concept, oral administration of DHA to cftr(-/-) mice corrected this lipid imbalance and reversed the observed pathological manifestations. These results strongly suggest that certain phenotypic manifestations of CF may result from remediable alterations in phospholipid-bound arachidonic acid and DHA levels.

MRI of pseudoaneurysm of a brachial venous coronary bypass graft.

Coronary artery bypass grafting (CABG) is being performed all over the world, with major success in the management of ischemic heart disease and angina pectoris. Complications of bypass grafting include partial or total graft reocclusion, and less common entities such as aneurysm or pseudoaneurysm formation. Noninvasive imaging procedures exist which can help include or exclude the presence of these unusual types of complications when mass-like abnormalities are seen on a chest X-ray following coronary artery bypass grafting. This case specifically illustrates the usefulness of ultrafast magnetic resonance imaging techniques in the evaluation and diagnosis of pseudoaneurysm formation at the site of coronary artery bypass graft.

Two-dimensional coronary MR angiography: analysis of initial clinical results.

PURPOSE: To assess the diagnostic value of two-dimensional coronary magnetic resonance (MR) angiography in patients evaluate for ischemic heart disease. MATERIALS AND METHODS: Twenty patients who underwent elective cardiac catheterization with coronary angiography were evaluated with two-dimensional coronary MR angiography. Coronary MR angiography was performed with a fat-suppressed electrocardiographically gated gradient-echo sequence with k-space segmentation with a 1.5-T imager. RESULTS: Seventeen of the 20 patients had a hemodynamically significant coronary artery lesion (> or = 50% reduction in luminal diameter), with a total of 27 proximal lesions. The sensitivity for detection of hemodynamically significant lesions was 62% for the right coronary artery, 50% for the left main artery, 73% for the left anterior descending artery, and 0% for the left circumflex artery, with an overall sensitivity of 63%. Corresponding specificities were 56%, 84%, 37%, and 82% respectively. CONCLUSION: Although in an early stage of development, two-dimensional coronary MR angiography can depict 63% of hemodynamically significant coronary artery lesions.

The role of bone scintigraphy in the evaluation of talar dome fractures.

We undertook a retrospective study of 122 patients with ankle pain to determine the accuracy of bone scintigraphy using 99mTc-methylene diphosphonate (MDP) for detection of osteochondral talar dome fractures (OCTDF). Plain radiographs, which were available in 97 patients, had not revealed any abnormality in the talar dome. Bone scintigraphy was followed by CT, which was considered to be the reference test in diagnosing OCTDF. Analysis of our data showed that when the bone scan findings in the two highest confidence categories (high and moderate probability) were accepted as abnormal, the sensitivity and the specificity of the test were 0.94 and 0.76, respectively. Although CT is mandatory to establish the stage of OCTDF, it cannot be used routinely due to its high cost. Bone scintigraphy appears to be a good screening procedure that will identify patients who are likely to benefit from further radiographic studies such as CT. These findings are subject to further confirmation in a prospective study.

Intracranial extramedullary hematopoiesis. CT and bone marrow scan findings.

This case concerns a patient with intracranial extramedullary hematopoiesis (EH) suspected on a CT scan and subsequently confirmed with In-111 chloride and Tc-99m SC bone marrow scans. The bone marrow scans also provided additional information by demonstrating other sites of EH in the paravertebral tissues and bone marrow expansion into the distal extremities.

[The system of evaluation of the severity of injuries (status and prospects of the problem)]. / Sistema otsenki tiazhesti travm (sostoianie i perspektivy problemy).

The authors have substantiated the necessity of elaboration and introduction of a single all-state++ system of objective quantitative evaluation of the severity of the injuries. A brief comparative characteristic of the most popular Soviet and foreign systems of the severity of the injuries is presented. The synthesized scales (elaborated at the prognosis laboratory of the Central Institute of Traumatology and Orthopedics ) for a quantitative evaluation of the character and the localization of the fractures are presented.

[Duodenal injuries]. / Povrezhdeniia dvenadtsatiperstnoi kishki.

Experience with the treatment of 33 patients with injuries of the duodenum is presented: 17 patients with ruptures of the duodenum, 16 patients with wounds. Post-operative complications were developed in 21 patients, 13 patients died. The two-row suture of the wound and decompression by nasogastroduodenal probe are considered by the authors to be the adequate operation for most of the patients.