Rupture of a concealed aneurysm after intravenous thrombolysis of a thrombus in the parent middle cerebral artery.

BACKGROUND: Management of ischemic stroke in the presence of aneurysmal brain disease is controversial. Recent retrospective evidence suggests that in selected patients, intravenous thrombolysis (IVT) remains a safe approach for reperfusion. METHODS: We document a case of post-thrombolysis aneurysmal rupture. Supported by additional scientific literature we postulate that acute aneurysmal thrombosis leading to stroke in the culprit artery may be an ominous sign of rupture and should be considered separately from fortuitously discovered distant aneurysmal disease. RESULTS: A 71-year-old female presented with an acute right middle cerebral artery stroke syndrome. IVT allowed vessel reperfusion and revealed a previously concealed, juxtaposed non-giant M1 segment saccular aneurysm. Secondary aneurysmal rupture ensued. The aneurysm was secured by surgical clipping. Postoperative course was uneventful. CONCLUSIONS: This case shows that despite reports of thrombolysis safety in the presence of brain aneurysms, thrombolysis remains potentially hazardous and hints toward an increased risk when the stroke arises on the parent vessel itself.

The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: a single-blind randomised controlled trial.

AIMS: To evaluate the effect of a structured preoperative preparation on child and parent state anxiety, child behavioural change and parent satisfaction. BACKGROUND: It is estimated that around 50-70% of hospitalised children experience severe anxiety and distress prior to surgery. Children who are highly anxious and distressed preoperatively are likely to be distressed on awakening and have negative postoperative behaviour. Although education before surgery has been found to be useful mostly in North America, the effectiveness of preoperative preparation programme adapted to the Australian context remains to be tested. DESIGN: This single-blind randomised controlled study was conducted at a tertiary referral hospital for children in Western Australia. METHODS: Following ethics approval and parental consent, 73 children and one of their carers (usually a parent) were randomly assigned into two groups. The control group had standard practice with no specific preoperative education and the experimental group received a preoperative preparation, including a photo file, demonstration of equipment using a role-modelling approach and a tour. RESULTS: The preoperative preparation reduced parent state anxiety significantly (-2·32, CI -4·06 to -0·56, p = 0·009), but not child anxiety (-0·59, CI -1·23 to 0·06, p = 0·07). There was no significant difference in child postoperative behaviour or parent satisfaction between the groups. There was a significant two-point pain score reduction in the preoperative preparation group, when compared with the control group median 2 (IQR 5) and 4 (IQR 4), respectively (p = 0·001).¦CONCLUSIONS: Preoperative preparation was more efficient on parent than child. Although the preoperative preparation had limited effect on child anxiety, it permitted to decrease pain experience in the postoperative period.¦RELEVANCE TO CLINICAL PRACTICE: Parents should be actively involved in their child preoperative preparation.

Novel Approach Identifies SNPs in SLC2A10 and KCNK9 with Evidence for Parent-of-Origin Effect on Body Mass Index.

The phenotypic effect of some single nucleotide polymorphisms (SNPs) depends on their parental origin. We present a novel approach to detect parent-of-origin effects (POEs) in genome-wide genotype data of unrelated individuals. The method exploits increased phenotypic variance in the heterozygous genotype group relative to the homozygous groups. We applied the method to >56,000 unrelated individuals to search for POEs influencing body mass index (BMI). Six lead SNPs were carried forward for replication in five family-based studies (of ∼4,000 trios). Two SNPs replicated: the paternal rs2471083-C allele (located near the imprinted KCNK9 gene) and the paternal rs3091869-T allele (located near the SLC2A10 gene) increased BMI equally (beta = 0.11 (SD), P<0.0027) compared to the respective maternal alleles. Real-time PCR experiments of lymphoblastoid cell lines from the CEPH families showed that expression of both genes was dependent on parental origin of the SNPs alleles (P<0.01). Our scheme opens new opportunities to exploit GWAS data of unrelated individuals to identify POEs and demonstrates that they play an important role in adult obesity.

Monitoring detrital input and resuspension effects on sediment trap material using mineralogy and stable isotopes (δ18O and δ13C): the case of Lake Neuchatel (Switzerland)

Isotopic analyses on bulk carbonates are considered a useful tool for palaeoclimatic reconstruction assuming calcite precipitation occurring at oxygen isotope equilibrium with local water and detrital carbonate input being absent or insignificant. We present results from Lake Neuchatel (western Switzerland) that demonstrate equilibrium precipitation of calcite, except during high productivity periods, and the presence of detrital and resuspended calcite. Mineralogy, geochemistry and stable isotope values of Lake Neuchatel trap sediments and adjacent rivers suspension were studied. Mineralogy of suspended matter in the major inflowing rivers documents an important contribution of detrital carbonates, predominantly calcite with minor amounts of dolomite and ankerite. Using mineralogical data, the quantity of allochthonous calcite can be estimated by comparing the ratio ankerite + dolomite/calcite + ankerite + dolomite in the inflowing rivers and in the traps. Material taken from sediment traps shows an evolution from practically pure endogenic calcite in summer (10-20% detrital material) to higher percentages of detrital material in winter (up to 20-40%). Reflecting these mineralogical variations, delta(13)C and delta(18)O values of calcite from sediment traps are more negative in summer than in winter times. Since no significant variations in isotopic composition of lake water were detected over one year, factors controlling oxygen isotopic composition of calcite in sediment traps are the precipitation temperature, and the percentage of resuspended and detrital calcite. Samples taken close to the river inflow generally have higher delta values than the others, confirming detrital influence. SEM and isotopic studies on different size fractions (<2, 2-6, 6-20, 20-60, >60 mu m) of winter and summer samples allowed the recognition of resuspension and to separate new endogenic calcite from detrital calcite. Fractions >60 and (2 mu m have the highest percentage of detritus, Fractions 2-6 and 6-20 mu m are typical for the new endogenic calcite in summer, as given by calculations assuming isotopic equilibrium with local water. In winter such fractions show similar values than in summer, indicating resuspension. Using the isotopic composition of sediment traps material and of different size fractions, as well as the isotopic composition of lake water, the water temperature measurements and mineralogy, we re-evaluated the bulk carbonate potential for palaeoclimatic reconstruction in the presence of detrital and re-suspended calcite. This re-evaluation leads to the following conclusion: (1) the endogenic signal can be amplified by applying a particle-size separation, once the size of endogenic calcite is known from SEM study; (2) resuspended calcite does not alter the endogenic signal, but it lowers the time resolution; (3) detrital input decreases at increasing distances from the source, and it modifies the isotopic signal only when very abundant; (4) influence of detrital calcite on bulk sediment isotopic composition can be calculated. (C) 1998 Elsevier Science B.V. All rights reserved.

Performance of a chromatographic procedure used in the certification of reference material for polycyclic aromatic hydrocarbons in sewage sludge

Semi-automatic capillary gas chromatographic method with classical flame ionization detection, which satisfies the conditions for required performance and gave acceptable results within the framework of an interlaboratory certification programme for PAHs in sewage sludge, is described. The interesting feature of the procedure is that it incorporates automatic operations such as sample fractionation by semi-preparative HPLC, fraction collection at signal level recognition and evaporation under nitrogen flow. Multiple injections in the GC capillary column are performed in the on-column mode via an autosampler with temperature-programmable injector. Automatic data acquisition and chromatogram treatment are made via computer software. This partially automatic procedure releases personnel from tedious and time-consuming tasks and its robust character was validated through the certification of reference material for PAHs in sewage sludge, demonstrating its reliable performance.

Allergic reactions following contrast material administration: nomenclature, classification, and mechanisms

In forensic pathology routine, fatal cases of contrast agent exposure can be occasionally encountered. In such situations, beyond the difficulties inherent in establishing the cause of death due to nonspecific or absent autopsy and histology findings as well as limited laboratory investigations, pathologists may face other problems in formulating exhaustive, complete reports, and conclusions that are scientifically accurate. Indeed, terminology concerning adverse drug reactions and allergy nomenclature is confusing. Some terms, still utilized in forensic and radiological reports, are outdated and should be avoided. Additionally, not all forensic pathologists master contrast material classification and pathogenesis of contrast agent reactions. We present a review of the literature covering allergic reactions to contrast material exposure in order to update used terminology, explain the pathophysiology, and list currently available laboratory investigations for diagnosis in the forensic setting.