Introduction of a modified obstetric early warning system -(-MOEWS-)- at an Ethiopian referral hospital: a feasibility assessment.

Early warning scores are points-based or colour-coded systems used to detect changes in physiological parameters and prompt earlier recognition and management of deteriorating patients. Vital signs recorded within a coloured zone corresponding to degree of derangement ('trigger') should prompt an action. The report of the UK Confidential Enquiry into Maternal and Child Health recommends the use of modified versions in the obstetric population.

ECG in suspected pulmonary embolism.

Objective: To establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).

Methods: Retrospective case-control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available.

Simplified cerebral protection using unilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.

Background: Antegrade cerebral perfusion is one of the most reliable methods of organ protection during hypothermic circulatory arrest for aortic arch surgery. We used a simplified antegrade cerebral perfusion technique with low mortality and morbidity.

Methods: Between January 2005 and August 2008, 21 patients underwent aortic arch surgery with unilateral antegrade selective cerebral perfusion through the brachiocephalic artery and moderate hypothermic circulatory arrest.

Intravenous leiomyomatosis with intracardiac extension: first reported case in Australia.

Intravenous leiomyomatosis (IVL) with cardiac extension is a rare uterine tumour. We present an unusual case of uterine leiomyoma that progressed along the inferior vena cava into the right atrium. Complete one stage removal of the tumour was performed using cardiopulmonary bypass and circulatory arrest.

Molecular interactions of Escherichia coli ExoIX and identification of its associated 3'-5' exonuclease activity.

The flap endonucleases (FENs) participate in a wide range of processes involving the structure-specific cleavage of branched nucleic acids. They are also able to hydrolyse DNA and RNA substrates from the 5'-end, liberating mono-, di- and polynucleotides terminating with a 5' phosphate. Exonuclease IX is a paralogue of the small fragment of Escherichia coli DNA polymerase I, a FEN with which it shares 66% similarity.

Management of life-threatening subcutaneous emphysema using subcutaneous penrose drains and colostomy bags.

Subcutaneous emphysema is a common complication post cardiothoracic surgery. Severe subcutaneous emphysema may cause respiratory obstruction and sometimes tracheostomy or intubation is required. We report a case of massive subcutaneous emphysema following aortic valve replacement.

Mitral valve replacement in a severely calcified posterior annulus: a novel technique.

We describe a technique for insertion of a mitral valve prosthesis in the presence of severe posterior annular calcification by plicating the left atrial tissue over the sewing ring. Extensive calcification often creates the technical difficulty of seating the prosthetic valve resulting in peri prosthetic leakage. Extensive decalcification may weaken the annulus and result in prosthetic valve dehiscence and atrioventricular dissociation.

Prior elevation of IL-18 promotes rapid early IFN-gamma production during staphylococcal infection.

Systemic Staphylococcus aureus infection is associated with significant morbidity and mortality arising from both bacterial and host immune factors. IL-18 is a pro-inflammatory cytokine of the IL-1 superfamily that exhibits broad functional effects in innate and acquired immune responses and which has been found in high levels in several chronic inflammatory and autoimmune diseases. Over-expression of IL-18 may promote early resolution of infection or could promote a detrimental exaggerated immune response.

A new technique for repair of atrioventricular disruption complicating mitral valve replacement.

Atrioventricular disruption is an uncommon but often lethal complication in mitral valve replacement. We present the case of a 79-year-old woman in whom the disruption after mitral valve replacement was successfully repaired using BioGlue surgical adhesive, bovine pericardium, and polytetrafluoroethylene (Teflon) patch.

Median sternotomy and extended left anterior thoracotomy for repair of traumatic aortic transection with ruptured right atrium.

A 22-year-old man presented with traumatic aortic transtion associated with rupture of the right atrium and underwent urgent median sternotomy to repair the right atrium. A T-shaped extended left anterior thoracotomy was performed, and ruptured descending thoracic aorta was repaired under total bypass. A Y-shaped connector was inserted in the arterial catheter to allow cannulation of both ascending aorta and femoral arteries.

Nitric oxide preferentially induces type 1 T cell differentiation by selectively up-regulating IL-12 receptor beta 2 expression via cGMP.

Nitric oxide plays an important role in immune regulation. We have shown that although high concentrations of NO generally were immune-suppressive, low concentrations of NO selectively enhanced the differentiation of T helper (Th)1 cells but not Th2 cells. This finding provided an explanation for the crucial role of NO in defense against intracellular pathogens.