ETView SL versus Macintosh Direct Laryngoscope for Endotracheal Intubation Amid Simulated COVID-19 Cardiac Arrest: A Randomized Crossover Study

Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol-generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, randomized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView's performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.

A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings

BACKGROUND

Airway management in life-threatening emergencies is essential for children, and endotracheal intubation is the gold standard. It protects against regurgitation and enables mechanical ventilation. New types of airway management equipment are being developed and implemented to meet the needs of medical personnel.

RESEARCH DESIGN AND METHODS

This prospective, randomized, cross-over simulation trial evaluated the success of endotracheal intubation in three scenarios: normal airway (scenario-A), tongue edema (scenario-B), and continuous chest compression (scenario-C), using the bébé Vie Scope™ laryngoscope (VieScope) and the Macintosh blade laryngoscope (MAC) as a comparative tool performed by nurses with limited tracheal intubation experience.

RESULTS

The results of the study showed that in scenario-A, there were no significant differences in the first attempt success rate or endotracheal intubation time between VieScope and MAC. However, VieScope was associated with better visualization of the glottis. In scenarios B and C, VieScope was significantly more effective than MAC in terms of first-pass success rate, time to intubate, Cormack-Lehane grade, POGO score, and ease of endotracheal intubation.

CONCLUSIONS

Bébé VieScope may be useful for endotracheal intubation in pediatric patients, particularly in cases of tongue edema and ongoing chest compression, providing a higher first-pass success rate than conventional laryngoscopes.

Reference Ranges of Glycemic Variability in Infants after Surgery—A Prospective Cohort Study

We aimed to define reference ranges of glycemic variability indices derived from continuous glucose monitoring data for non-diabetic infants during post-operative intensive care treatment after cardiac surgery procedures. We performed a prospective cohort intervention study in a pediatric intensive care unit (PICU). Non-diabetic infants aged 0–12 months after corrective cardiovascular surgery procedures were fitted upon arrival to the PICU with a continuous glucose monitoring system (iPro2, Medtronic, Minneapolis, MN, USA). Thirteen glycemic variability indices were calculated for each patient. Complete recordings of 65 patients were collected on the first postoperative day. During the first three postsurgical days 5%, 24% and 43% of patients experienced at least one hypoglycemia episode, and 40%, 10% and 15%—hyperglycemia episode, respectively, in each day. Due to significant differences between the first postoperative day (mean glycemia 130 ± 31 mg/dL) and the second and third day (105 ± 18 mg/dL, 101 ± 22.2 mg/dL; p < 0.0001), we proposed two separate reference ranges—for the acute and steady state patients. Thus, for individual glucose measurements, we proposed a reference range between 85 and 229 mg/dL and 69 and 149 mg/dL. For the mean daily glucose level, ranges between 122 and 137 mg/dL and 95 and 110 mg/dL were proposed. In conclusion, rt-CGM revealed a very high likelihood of hyperglycemia in the first postsurgical day. The widespread use of CGM systems in a pediatric ICU setting should be considered as a safeguard against dysglycemic episodes; however, reference ranges for those patients should be different to those used in diabetes care.

Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I² = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I² = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I² = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I² = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I² = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.

P1816 Cerebral microembolism in low-risk patients with paroxysmal atrial fibrillation before and after pulmonary vein isolationCerebral microembolism in low-risk patients with paroxysmal atrial fibrillation

BACKGROUND

Invasive treatment of atrial fibrillation (AF) becomes more suitable and effective therapy. There are no consistent data describing the occurrence of potential neurological complications in low-risk patients with paroxysmal AF.

AIM

to determine the occurrence, consequences and risk factors for brain white matter hiperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients before and after pulmonary vein isolation (PVI) treatment.

METHODS

Eighty patients with symptomatic paroxysmal AF (median age: 58 years (IQR 50-63), K/M: 30/50), CHA2DS2-Vasc ≤ 3 (CHA2DS2-Vasc: 2 (IQR 1-2.5)) were included in the study. Before and after a minimum of 6-month period after PVI-RF treatment (med. 9,9 months, IQR 7.6-11.8 months) a clinical evaluation with brain MRI and Mini Mental State Examination (MMSE) test were determined. Severity of brain WMH in MRI was assessed in the Fazekas scale (pic 1). The efficacy of PVI-RF treatment analyzed in a 7-day Holter monitoring was confirmed in 43 (53.8%) patients.

RESULTS

Baseline WMH lesions were found in 55 (68.8%) patients. Patients with baseline WMH lesion obtained similar results in the MMSE test, compared to patients with a normal brain image in the MRI study. There was a statistically significant more frequent occurrence of cerebral WMH lesions among older patients, with a higher CHA2DS2-Vasc score, with left atrial (LA) dilatation and dysfunction. Factors affecting the severity of the WMH were: the co-occurrence of the patent foramen ovale (PFO) and coronary artery disease (CAD).

After PVI-RF treatment there were no significant changes in the presence and severity of WMH lesions. Similarly, there were no significant changes in the cognitive abilities assessed with MMSE test compared to the pre-procedural evaluation. There were also similar factors predisposing to brain WMH changes: older age, higher CHA2DS2-Vasc score and higher BMI. In turn, the degree of the brain WMH severity after observation period was dependent on age, higher CHA2DS2-Vasc score, presence of PFO and CAD and the initial LA function.

CONCLUSIONS Cerebral microembolism assessed in MRI is often found in low-risk patients with paroxysmal AF, and its presence and severity are associated with LA dilatation and dysfunction, age and higher CHA2DS2-Vasc score. Additional factors affecting the severity of WMH lesions are: the co-occurrence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In the population of relatively young AF patients with no significant cardiovascular disease burden, cerebral microembolism is not related to cognitive impairment.

Abstract P1816 Figure. pic 1

Determination of Glyphosate and Aminomethylphosphonic Acid in Crops by Capillary Gas Chromatography with Mass-Selective Detection: Collaborative Study

A collaborative study was conducted to validate a method for the determination of glyphosate and aminomethylphosphonic acid (AMPA) in crops. The analytes are extracted from crops with water, and the crude extracts are then subjected to a cation exchange cleanup. The analytes are derivatized by the direct addition of the aqueous extract into a mixture of heptafluorobutanol and trifluoroacetic anhydride. The derivatized analytes are quantitated by capillary gas chromatography with mass-selective detection (MSD). The collaborative study involved 13 laboratories located in 5 countries 12 laboratories returned valid data sets. The crops tested were field corn grain, soya forage, and walnut nutmeat at concentrations of 0.050, 0.40, and 2.0 mg/kg. The study used a split-level pair replication scheme with blindly coded laboratory samples. Twelve materials were analyzed, including 1 control and 3 split-level pairs for each matrix, 1 pair at each nominal concentration. For glyphosate, the mean recovery was 91%, the average intralaboratory variance, the repeatability relative standard deviation (RSDr), was 11%, and the interlaboratory variance, the reproducibility relative standard deviation (RSDR), was 16%. For AMPA, the mean recovery was 87%, the RSDr was 16%, and the RSDR was 25% at mg/kg levels.

Residual defects after repair of obstetric anal sphincter injuries and pelvic floor muscle strength are related to anal incontinence symptoms

INTRODUCTION AND HYPOTHESIS

The aim was to analyze the correlation between residual anal sphincter (AS) defects and pelvic floor muscle (PFM) strength on anal incontinence (AI) in patients with a history of obstetric AS injuries (OASIS).

METHODS

From September 2012 to February 2015, an observational study was conducted on a cohort of females who underwent repair of OASIS intrapartum. The degree of OASIS was scored intrapartum according to Sultan's classification. Participants were assessed at 6 months postpartum. Incontinence symptoms were evaluated using Wexner's score and PFM strength using the Modified Oxford Scale (MOS). 3D-endoanal ultrasound was performed to classify AS defects according to Starck's system. Correlation between Sultan's and Starck's classifications was calculated using Cohen's kappa and Spearman's rho (R_s) test. The impact of residual AS defects and PFM strength on AI was analyzed using a multiple regression model.

RESULTS

A total of 95 women were included in the study. Good correlation (κ= 0.72) was found between Sultan's and Starck's classifications. Significant positive correlation was observed between Wexner's score and both Sultan's (p = 0.023, R_s =0.212) and Starck's (p < 0.001, R_s =0.777) scores. The extent of the residual AS defect was the most relevant factor correlating with AI symptoms. In patients with severe AS injuries, higher MOS values were associated with lower Wexner's score.

CONCLUSIONS

The degree of AS tear measured intrapartum was the most important factor related to AI after primary repair of OASIS. PFM strength was associated with lower incontinence symptoms in the postpartum period.

A survey of pyrethroid-resistant populations of Meligethes aeneus F. in Poland indicates the incidence of numerous substitutions in the pyrethroid target site of voltage-sensitive sodium channels in individual beetles

The pollen beetle (Meligethes aeneus F.) is the most devastating pest of oilseed rape (Brassica napus) and is controlled by pyrethroid insecticides. However, resistance to pyrethroids in Europe is becoming widespread and predominant. Pyrethroids target the voltage-sensitive sodium channel (VSSC), and mutations in VSSC may be responsible for pyrethroid insensitivity. Here, we analysed individual beetles that were resistant to esfenvalerate, a pyrethroid, from 14 populations that were collected from oilseed rape fields in Poland. We screened the VSSC domains that were presumed to directly interact with pyrethroids. We identified 18 heterozygous nucleic acid substitutions, amongst which six caused an amino acid change: N912S, G926S, I936V, R957G, F1538L and E1553G. Our analysis of the three-dimensional structure of these domains in VSSC revealed that some of these changes may slightly influence the protein structure and hence the docking efficiency of esfenvalerate. Therefore, these mutations may impact the susceptibility of the sodium channel to the action of this insecticide.

First Report of Potato mop-top virus on Potato in Poland

Potato mop-top virus (PMTV) is a serious pathogen occurring in Northern Europe, North and South America, and Asia that significantly reduces potato (Solanum tuberosum) production. PMTV is transmitted by Spongospora subterranea, the casual agent of potato powdery scab, and causes the characteristic brown arcs and circles (spraing symptoms) in potato tubers, stunting of stems, shortening of internodes, and mosaic patterns (V-shaped) on leaves as well as leaf necrosis (2). S. subterranea and PMTV are mainly associated with cool, humid environments. Between 2005 and 2009, extensive surveys for PMTV were conducted in Polish potato fields with an emphasis on areas neighboring countries where the virus had previously been reported. Approximately 18,000 tubers from 39 cultivars from different regions of Poland were collected. Tubers were first visually inspected for symptoms within the flesh and then selected tubers were analyzed by double-antibody sandwich (DAS)-ELISA (3). Symptomatic samples tested by ELISA gave A₄₀₅ values approximately threefold higher than negative controls and approximately two- to fivefold lower than PMTV-positive controls (supplied by J. Valkonen). Total RNA was isolated (1) from tubers testing positive for PMTV by DAS-ELISA. cDNA synthesis and subsequent PCR amplification of the CP region were carried out using primers located in RNA2: PMTV1 5'GGTTTGTTTACCACCCTTGG3' (3) and PMTV2 5'AAAAGCCTGAGCGGTTAATTG3' (courtesy of E. Savenkov), which amplified a 530-bp product. No PMTV was detected in Poland between 2005 and 2007. In 2008, one tuber (cv. Inwestor) from central Poland (Łódź County) tested positive for PMTV. The RT-PCR products were sequenced and the sample from 2008 was submitted to GenBank (PMTV-Pl CP, Accession No. GQ503252). In 2009, additional infected tubers were found in three Polish cultivars (Bartek, Glada, Ruta) from the same county. Sequence comparisons of PMTV-Pl revealed 99% nucleotide identity and approximately 98% amino acid identity to Czech, Swedish, and Finnish PMTV isolates. To our knowledge, this is the first report of PMTV in Poland. Poland is one of the major potato-producers in Europe with the 2008 crop around 10 million t. If PMTV spreads in Poland, the virus could threaten potato production. References: (1) S. Chang et al. Plant Mol Biol Rep. 11:113, 1993. (2) A. Germundsson et al. J. Gen. Virol. 83:1201, 2002. (3) S. Latvala-Kilby et al. Phytopathology 99:519, 2009.

Organophosphonate Utilization by the Wild-Type Strain of Penicillium notatum

We studied the biodegradation of compounds containing phosphorus-to-carbon bonds by using a wild-type strain of Penicillium notatum. The substrate specificity of this strain was studied, and we found that it is able to utilize structurally diverse organophosphonates as sole sources of phosphorus. This ability seems to be inducible, as indicated by the presence of a lag phase during growth. A popular herbicide, glyphosate, inhibited fungal growth, but it was also degraded by the fungus if it was applied in sublethal doses. This indicates that P. notatum may play an important role in biodegradation of organophosphonates. The strain which we used did not metabolize any of the phosphonates which we tested when they were used as sole carbon or nitrogen sources.

Cervical lymphadenopathy in children--incidence and diagnostic management

OBJECTIVE

Palpable lymph nodes are common due to the reactive hyperplasia of lymphatic tissue mainly connected with local inflammatory process. Differential diagnosis of persistent nodular change on the neck is different in children, due to higher incidence of congenital abnormalities and infectious diseases and relative rarity of malignancies in that age group. The aim of our study was to analyse the most common causes of childhood cervical lymphadenopathy and determine of management guidelines on the basis of clinical examination and ultrasonographic evaluation.

MATERIAL AND METHODS

The research covered 87 children with cervical lymphadenopathy. Age, gender and accompanying diseases of the patients were assessed. All the patients were diagnosed radiologically on the basis of ultrasonographic evaluation.

RESULTS

Reactive inflammatory changes of bacterial origin were observed in 50 children (57.5%). Fever was the most common general symptom accompanying lymphadenopathy and was observed in 21 cases (24.1%). The ultrasonographic evaluation revealed oval-shaped lymph nodes with the domination of long axis in 78 patients (89.66%). The proper width of hilus and their proper vascularization were observed in 75 children (86.2%). Some additional clinical and laboratory tests were needed in the patients with abnormal sonographic image.

CONCLUSIONS

Ultrasonographic imaging is extremely helpful in diagnostics, differentiation and following the treatment of childhood lymphadenopathy. Failure of regression after 4-6 weeks might be an indication for a diagnostic biopsy.

Supported liquid membrane extraction of peptides

The application of supported liquid membrane (SLM) extraction for the enrichment of short peptides is presented. The extraction efficiency is dependent on the pH of donor phase and salt concentration in acceptor phase. Moreover, the extraction efficiency is also influenced by the peptide amino-acid sequence and hydrophobicity.

Ultrasound images of thrombosis of caval vein inferior--three selected cases

Thrombosis of vena cava inferior can occur as complication of numerous diseases. Because of a variety of causes, the clinical signs accompanying thrombosis are often ambiguous, which is the cause of delay in initiation of appropriate treatment. This article presents three interesting cases of thrombosis of vena cava inferior in children accompanying extensive burn, the Budd-Chiari syndrome, and prolonged presence of catheters in vessels. The use of ultrasound in B presentation, Color Doppler and Power Doppler has enabled early diagnosis and application of appropriate treatment.

Supported liquid membrane extraction of peptides

The application of supported liquid membrane (SLM) extraction for the enrichment of short peptides is presented. The extraction efficiency is dependent on the pH of donor phase and salt concentration in acceptor phase. Moreover, the extraction efficiency is also influenced by the peptide amino-acid sequence and hydrophobicity.

Abdominal aortic aneurysm: association between haptoglobin phenotypes, elastase activity, and neutrophil count in the peripheral blood

To investigate the role of genetic factors on susceptibility to atherosclerotic arterial disease, the influence of haptoglobin phenotypes (Hp) on serum elastase activity, neutrophil count, and elastin concentration in the aorta was measured in patients with abdominal aortic aneurysm (AAA; n=52) and aortoiliac atherosclerotic occlusive disease (AOD; n=37). Findings (serum elastase activity, peripheral blood neutrophil count) were compared to a control group (CG) of 37 subjects without atherosclerosis. Hp phenotyping performed by starch-gel electrophoresis produced a haptoglobin-hemoglobin complex of three phenotypes: Hp1-1, Hp2-2, and Hp2-1. Distribution of Hp phenotypes was similar in the three study groups (AAA, AOD, CG). Significant increases in serum elastase activity and neutrophil count was measured in Hp2-1 phenotype of AAA patients. Although the aorta wall of aneurysm patients contained less (p<0.001) elastin than that of AOD patients, no significant difference of aorta elastin concentration between the three Hp phenotypes, including Hp2-1, was measured. The postulated association of AAA susceptibility with Hp2-1 phenotype was supported by the study data that demonstrated an increase in serum elastase activity in patients undergoing AAA repair.

[Comparison of the efficacy of treatment by two laparoscopic techniques combined with medical treatment of endometriosis stage three and four]

20 patients were treated for endometriosis with combined treatment, we have divided prospectively our patients on the 2 groups. One group was operated by laparoscopic marsupialisation of endometrial cyst and coagulation. The second group was operated by stripping of lining. Second-look laparoscopy was performed after six month medical treatment. Two techniques laparoscopic was very efficacy (decrease of AFS score). The difference between them wasn't significant.

[Ultrasonographic diagnosis of Meckel's diverticulum--case report]

Meckel's diverticulum is the congenital anomaly of the gastrointestinal tract affecting about 2% of the population. It is a true diverticulum containing all layers of the ileum wall. Heterotopic tissue is frequently present (25%): gastric mucosa, duodenal mucosa, jejunal mucosa and pancreatic tissue. Meckel's diverticulum is localized about 50 cm from the ileo-colic valve on the external border of the ileum. Most of Meckel's diverticula are clinically silent; clinical symptoms (19%) are in cases of complications such as: strangulation of the bowel in a ring formed by the diverticulum, intussusception of the diverticulum into the ileum, volvulus, incarceration of the diverticulum in hernia, tumour originating in the diverticulum. The diagnosis of Meckel's diverticulum is very difficult. The most useful in the diagnosis are plain abdominal radiographs, barium studies, CT, sonography and scintigraphy Abdominal sonography shows a tubular fluid structure localized far from the coecum. The wall of the diverticulum is swollen and in the lumen are chyme or fat.

Determination of optical purity of phosphonic acid analogues of aromatic amino acids by capillary electrophoresis with alpha-cyclodextrin

A simple and efficient method for the determination of enantiomeric purity of structurally diverse phosphonic and phosphinic acid analogues of phenylalanine and phenylglycine using capillary electrophoresis is presented. These preliminary studies indicated that the enantiomer separation is strongly dependent on the structure of the aminophosphonic acid.

[Mutations of genes coding collagen type I--biochemical and clinical effects]

Type I collagen is the most abundant structural protein of human body. In this paper the effects of mutations in COL1A1 and COL1A2 genes on biochemical properties of this protein and clinical manifestations are described.

Extraction of glyphosate by a supported liquid membrane technique

The possible application of the supported liquid membrane (SLM) technique for the extraction of glyphosate is presented. For the extraction of this compound the SLM system has been applied with utilisation of Aliquat 336 as a cationic carrier incorporated into the membrane phase. The extraction efficiency of glyphosate [N-(phosphonomethyl)glycine] is dependent on the donor phase pH, carrier concentration in the organic phase and NaCl concentration in the acceptor phase. The optimal extraction conditions are: donor phase pH>11, acceptor phase of 2 M NaCl solution and the organic phase composed of 20% (w/w) Aliquot 336 solution in di-hexyl ether. Counter-coupled transport of chloride anions from the acceptor phase to the donor phase is a driving force of the mass transfer in this system.

[Influence of immediate newborn care on infant adaptation to the environment]

The indicators of newborns' adaptation during 75 min after birth were compared in three randomised groups of full-term newborns: skin-to-skin contact (group I), swaddled newborns beside the mother (group II), swaddled and separated from the mother (group III). The changes in skin temperature, blood glucose, pH, heart rate, respiration rate and crying time were studied. All the above characteristics but pH were significantly the most favourable for infants in the skin-to-skin group. The analysis of individual trends of changes in skin temperature indicated that for all but two newborns not separated from the mother (skin-to-skin or lying besides) the temperature was growing during the observation period, whereas in the separated group, six newborns (27%) had unstable not growing temperature. The mean level of blood glucose was the highest in skin-to-skin group (60.1 mg/dl), lower in group of swaddled and lying beside mother (52.5 mg/dl) and the lowest (49.6 mg/dl) in the separated group. The mean duration of crying time in the skin-to-skin contact was a little shorter than in the group of newborns lying besides the mother and more than three times shorter than in the separated group. The observed number of episodes of crying were 7, 17 and 38 in the three groups respectively. All results indicated that skin-to-skin contact is optimal for newborns', adaptation after birth especially as a protection against hypothermia and hypoglycaemia.

[Porencephaly in infants and children imaged with tomography]

On the basis of current bibliography verum and spurum porencephaly have been distinguished. Verum porencephaly originates in prenatal life and is defined as disorder of brain tissue development. Its main characteristic is that cave borders are covered with grey matter often connected with lateral ventricle. Spurum porencephaly is term for lack of brain tissue caused by its disintegration. Five cases of cysts in infants and children diagnosed in CT examination were presented with the description of the patients' clinical condition. 3 cases were diagnosed as verum porencephaly, the remaining 2 cases turned out to be spurum porencephaly.

[A case of developmental cerebral cortex disorder with epilepsy resistant to treatment]

Developmental disorders of the cerebral cortex were described as a local lesion in the right frontal lobe. Wide gyruses with increased density of cortical brain were observed. Changes in the cerebral cortex were correlated with clinical symptoms and EEG results and were responsible for the epilepsy resistant to any treatment. CT examination made possible the precise localisation of the lesion and then proper conservative or operative therapy.

Ectopic pregnancy diagnosis in very high risk patients

The authors analyse the effectiveness of ectopic pregnancy diagnosis in women with clinical history and high psychological motivation for treatment. The effectiveness of the diagnostic algorithm was studied in 21 women with previous history of infertility treatment (including 15 who had undergone tube surgery). The diagnostic process was begun between 20th and 25th days after the suspected conception. The only clinical symptom that the patients complained of was spotting (7 cases). The algorithm used serum HCG determination (EIA); in cases of HCG ranging between 2 mIU/ml and 1500 mIU/ml (or clinical uncertainty)-transvaginal sonography (with colour Doppler) was used. If ectopic pregnancy was suspected, laparoscopy was done. It was found that in 15 cases laparoscopic images agreed with diagnostic results; in 5 cases, the image obtained was false negative; in 1 case it was false positive. The diagnostic efficiency of sonography alone was higher than if it was correlated with HCG, but it, too, did not secure against false positive and false negative results. The conclusion was drawn that despite very high sensitivity (70%) and specificity (93%) of the diagnostic procedures used, in high-risk patients the diagnosis should be verified by laparoscopy.

The ability of soil-borne fungi to degrade organophosphonate carbon-to-phosphorus bonds

The ability of a wide variety of soil-borne fungal strains to degrade four structurally different compounds containing P-C bonds, namely the naturally occurring amino acid ciliatine, the popular herbicide glyphosate, phosphonoacetic acid and 2-amino-3-phosphonopropionic acid, was studied in order to show that soil fungi may play an important role in the biodegradation of organophosphonates. Most of the strains appeared to utilize ciliatine as the sole source of phosphorus for growth. Only a limited number of strains were able to grow on the other phosphonates used in this work. The strains of Trichoderma harzianum, Scopulariopsis sp. and Aspergillus niger chosen for more detailed study show the ability to degrade ciliatine, glyphosate and also amino(3-methoxyphenyl)methylphosphonic acid effectively.

[Endometrial changes in the ovaries during full-term pregnancy: a case report]

The authors described case of 27 years old female patient treated due to infertility of unknown etiology. The female was pregnant after series of intrauterine insemination. During caesarean section due to pelvic longitudinal lie the chocolate cyst and endometriosis of the ovary were found. The authors did not find any information in the literature about coincidence of endometriosis of female reproductive organs and full-term pregnancy.

Marfan's syndrome and surgical repair of ascending aortic aneurysms

Marfan's syndrome is an inherited, degenerative connective tissue disorder that affects many body systems (eg, skeletal, ocular, cardiovascular, cutaneous, pulmonary, abdominal, neurologic). The cause of Marfan's syndrome is unknown, but recent genetic studies have linked this disorder to chromosome 15q15-q21.3. The characteristics associated with Marfan's syndrome require a multidisciplinary approach to patient care. This article discusses one serious complication of Marfan's syndrome-aortic root dilatation- and composite graft repairs of ascending aortic aneurysms. Physicians and nurses must be more aware of Marfan's syndrome so that life-threatening medical conditions can be evaluated and followed by health care providers.

Developing critical pathways for the operating room

Case management and managed care systems are emerging in the 1990s as ways to deliver quality, cost effective patient cae. The essential tool of managed care systems is a critical pathway, which is developed through the collaboration of health care team members. The critical pathway is an abbreviated version of the patients hospital course according to his or her medical diagnosis or case type and it allows health care team members to continually evaluate the patients care. It has helped team members at Johns Hopkins Hospital, Baltimore, identify more effective and cost-efficient ways to deliver patient care.

[Ultrasound images of prostate and seminal vesicles in infertile male patients]

The results of clinical examinations, semen analysis and endosonographic examinations of prostate and seminal vesicles were analysed in 172 male patients treated due to infertility. Ultrasound equipment with transrectal multiplane transducers 6.5 and 7.0 MHz frequency has been used to the evaluation of size, symmetry and echostructure of prostate and the seminal vesicles. In 62% patients pathological changes have been displayed in the prostate and 32% in the seminal vesicles.

[Usefulness of diagnostic ultrasonography for evaluation of scrotal organs]

Scrotal sonography was performed on 172 patients treated for infertility ranging 1-10 years. The results of the sonographic examinations were compared with palpations. Pathological deviations were found in 71.5% of patients using sonography and ony 53.5% of patients examined clinically. Our study found varicocele in 55.2% of patients, spermatoceles in 6.4% of patients and pathological amount of fluid surrounding the testicles in 15.1% of patients. The results of our study show that sonography should be used for more exact and more correct findings in the examination of scrotal organs and accurate monitoring of applied treatment.

[Observation of some semen parameters in men with varicocele]

Among 172 examined male patients varicoceles have been found in 57.6% patients. The frequency of varicocele appearance increased according to the fall of sperm concentration. Simple relations between sperm motility and varicocele have not been observed. Larger per cent of pathological sperm forms in patients with varicoceles has been shown. In patients with varicoceles three times as frequent appearance of richer periprostatic and periseminnal blood vessels have been observed in comparison with patients without varicocele.

[Varices of the spermatic cord and endo-sonographic changes of urogenital organs in men with decreased values of certain sperm parameters]

A comparative analysis was carried out of sperm cell density, proportion of mobility and viability, and the proportion of morphologically abnormal sperm cells in 80 (74.6%) men with varices of the spermatic cord and 88 (52.4%) men without the varices. A significant shortening was observed of the viability time od the sperm cells, measured by the ability to maintain motion, in 57.5% of sperm samples from men with varices of the spermatic cord and in 39.8% of sperm samples from men without the varices. The shorter viability time was correlated with lower sperm cell density (20 million/ml) in the sperm samples. In endosonographic examinations performed at the same time, a coexistence was observed of varices and endosonographic changes in the prostate, seminal vesicles, and in a small proportion in the testicles. The coexistence of endosonographic changes and the varices was more frequently associated with decreased sperm cell density. The usefulness was demonstrated of sonographic examinations in the diagnosis and treatment of impaired fertility in men.

[Coexistence of sertolioma with borderline (adenoma-cystoma-fibroma) tumor in the ovaries of a 69 year old patient]

A rare case of coexistence of gonadal neoplasm Sertolioma with boundary line tumor with epithelial fill in ovaries in 69 old patient was described. Current diagnostic and prognostic possibilities in such cases were discussed.

Interaction of sodium, lithium, caesium, and potassium ions with ascorbyl radicals

The influence of the concentration of sodium, lithium, caesium, and potassium ions as well as of the ionic strength of the solutions used on the dismutation rate of ascorbyl radicals has been investigated. While the dismutation rate was not influenced by Li+, it decreased, however, with increasing concentrations of the other ions investigated. The largest effect was obtained with Na+. This change in dismutation rate indicates a stabilizing effect on ascorbyl radical by these ions.