The accuracy of three-dimensional echocardiography with multiplanar reformatting in the assessment of the aortic valve annulus prior to percutaneous balloon aortic valvuloplasty in congenital heart disease.

Objective: To review the use of three-dimensional echocardiography (3DE) with multiplanar reformatting (MPR) in children with congenital aortic stensosis undergoing percutaneous balloon aortic valvuloplasty to assess its accuracy in measuring the aortic valve annulus and any influence it may have on balloon sizing.

Methods: All percutaneous aortic balloon valvuloplasties performed from 01/01/2009 to 01/09/2011 were included in the study. All imaging performed for the procedure to determine the size of the aortic valve annulus and aid in balloon sizing was reviewed.

What is the educational value of ward rounds? A learner and teacher perspective.

Ward rounds (WRs) have been a valuable resource in medical education for both learners and teachers since first recorded in 1660. Previous studies have shown that over 50% of junior doctor learning occurs on WRs. However, postgraduate medical education in the UK has changed significantly over recent years with the adoption of the foundation programme and the application of the European Working Time Directive (EWTD).

MicroRNAs: critical regulators of epithelial to mesenchymal (EMT) and mesenchymal to epithelial transition (MET) in cancer progression.

MicroRNAs (miRNAs) are a class of small highly conserved RNAs that provide widespread expressional control through the translational repression of mRNA. MiRNAs have fundamental roles in the regulation of intracellular processes, and their importance during malignant transformation and metastasis is becoming increasingly well recognized. An important event in the metastatic cascade is epithelial to mesenchymal transition (EMT), a reversible phenotypic switch over, which endows malignant epithelial cells with the capacity to break free from one another and invade the surrounding stroma.

Restoring anterior leaflet continuity: the Spinnaker repair of Ebstein's anomaly.

Several repair techniques for Ebstein's anomaly include aggressive mobilization of the anterior leaflet and the construction of a monobicuspid valve coapting against the interventricular septum. This can prove difficult when leaflet tissue is of poor quality or several fenestrations reduce leaflet surface. We present a simple and highly reproducible technique for restoring tissue continuity of the anterior leaflet that could represent a possible addendum to the existing array of surgical solutions.

Prevalence of deep venous incompetence and microvascular abnormalities in patients with diabetes mellitus.

The involvement of venous disease in the diabetic neuropathic foot is widely accepted. This article reports the result of prevalence of venous incompetence, impaired calf vein hemodynamics, and loss of microvascular control in the skin over the dorsum of the foot in an effort to document whether increased retrograde pressure caused by venous incompetence or loss of sympathetic regulation of the microcirculation is present in the diabetic patient who is at risk of foot disease. It was found that 64% and 70.

Advances in defibrillation.

Purpose Of Review: The place of defibrillation in the chain of survival is paramount and this review covers advances in this aspect of resuscitation over the past 18 months.

Recent Findings: The main advance is the publication of 2010 European Resuscitation Council guidelines of which defibrillation is a key aspect. Additionally, there have been a number of important articles discussing safety issues with defibrillation, the occurrence of refibrillation following successful cardioversion, prediction of shock success and changes in transthoracic impedance with sequential defibrillation shocks.

Acute urinary retention following percutaneous interventions in individuals with congenital heart disease.

Though frequently reported following surgical procedures, urinary retention after cardiac catheterization is rare and has not previously been documented in the literature. We reported 4 cases of acute retention over a 1-year period encountered in patients with congenital heart disease undergoing interventional percutaneous procedures. We also review the literature.

Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis.

Objective: To examine the long-term oncological impact of anastomotic leakage (AL) after restorative surgery for colorectal cancer using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival.

Background: Recurrence after potentially curative surgery for colorectal cancer remains a significant clinical problem and has a poor prognosis.

Concise guidance: diagnosis, management and prevention of occupational contact dermatitis.

Occupation is an important risk factor for contact dermatitis that presents in adulthood. Occupational contact dermatitis often has significant adverse effects on quality of life and the long-term prognosis is poor unless workplace exposures are addressed. The condition often presents to general practitioners, physicians or dermatologists who will be responsible for facilitating management of the workplace issues in the event that an occupational health service is not accessible.

Dislocation of large diameter metal-on-metal bearings an indicator of metal reaction?

We report 3 patients who underwent total hip arthroplasty (THA) using large diameter metal-on-metal bearing. These patients initially presented with pain but went on to develop dislocation of the THA while awaiting investigations. Any pain following metal-on-metal bearing THA should be taken seriously and should trigger investigations to identify a metal reaction.

Quantifying human susceptibility to contact sensitization; risk assessments now and in the future.

Assessment and quantification of the risk that a chemical will induce allergic contact sensitization presently depend heavily on background data from animal tests. Following the banning of animal testing of chemicals used in cosmetics and personal products in Europe after 2013, alternative approaches will be required. The chemical properties likely to make a given compound a sensitizer can be determined in vitro with reasonable certainty, but confirmation that it is a sensitizer comes only from in vivo exposure to it.

Ezetimibe as a potential treatment for non-alcoholic fatty liver disease: is the intestine a modulator of hepatic insulin sensitivity and hepatic fat accumulation?

Non-alcoholic fatty liver disease (NAFLD) is the hepatic component of the metabolic syndrome and is known to be associated with marked insulin resistance and increased risk of cardiovascular disease. Ezetimibe, an inhibitor of intestinal cholesterol absorption, inhibits Niemann-Pick C1-like 1 (NPC1L1). Interestingly, NPC1L1 is abundantly expressed in human liver, as well as in the intestine.

Non-Alcoholic Fatty Liver Disease (NAFLD): new challenge for general practitioners and important burden for health authorities?

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of hepatic dysfunction encountered in general practice. A large proportion of individuals with type 2 diabetes and the metabolic syndrome develop NAFLD. NAFLD is associated with severe insulin resistance and increased risk of cardiovascular disease and can progress to non-alcoholic steato-hepatitis, liver cirrhosis and cancer.

Does an advanced life support course give non-anaesthetists adequate skills to manage an airway?

Introduction: Traditionally, anaesthetists have provided airway management skills on resuscitation teams. Because advanced life support (ALS) courses teach practical airway management, some UK hospitals have dropped anaesthetists from cardiac arrest teams. Does the ALS course give non-anaesthetists adequate skills to manage an airway during a cardiac arrest?

Methods: We recruited adult surgical patients undergoing general anaesthesia and laryngeal mask airway (LMA) insertion as part of their routine care.

Educational article: The Mitrofanoff procedure.

The management of urinary incontinence has been revolutionized by the introduction of intermittent catheterization by Lapides in 1972, and later, by the description of the 'trans-appendicular continent cystostomy' by Mitrofanoff in 1980. Mitrofanoff launched a new concept whereby the bladder could be emptied by a route other than the urethra. This concept led to the publication of a plethora of alternatives to the appendix conduit, including the transverse ileal (Yang-Monti) tube, and conduits constructed from ureter, Fallopian tube, tubularized preputial transverse island flap, and longitudinally tubularized ileal and gastric segments.

Recognition and treatment of genitourinary complications in paediatric Crohn's disease using Infliximab.

Unlabelled: Although genitourinary complications of Crohn's are well recognized, available information regarding their clinical course and management is sparse especially in the paediatric population. We report a myriad of urological complications in five paediatric cases, our experience from a tertiary paediatric urological and gastroenterological centre. All children with urological complications had severe Crohn's disease which necessitated the use of immuno-suppressants including Infliximab.

Pulmonary artery diverticulum: an angiographic marker for Williams syndrome.

We evaluated the presence of pulmonary artery diverticulum in patients with Williams syndrome in comparison with other conditions causing peripheral pulmonary artery stenosis (PPS). Angiographic characteristics of patients with a definitive diagnosis of Williams syndrome, by fluorescence in situ hybridization, between 1990 and 2008 were reviewed. These data were compared with those diagnosed with those for patients with PPS without Williams syndrome.

An update on the use of ultrasound imaging in oral and maxillofacial surgery.

Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5-12 MHz) produces high definition multi-planar images.

Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery.

Aim: Robotic colorectal surgery is an emerging field and may offer a solution to some of the difficulties inherent to conventional laparoscopic surgery. The aim of this review is to provide a comprehensive and critical analysis of the available literature on the use of robotic technology in colorectal surgery.

Method: Studies reporting outcomes of robotic colorectal surgery were identified by systematic searches of electronic databases.

Iatrogenic pseudoaneurysm of internal mammary artery: case report and literature review.

Pseudoaneurysms of the internal mammary artery (IMA) following median sternotomy are very uncommon and were first reported in 1973. Presentation and treatment of such a complication has been variable. We are presenting a case of a patient with pseudoaneurysm of IMA after mitral valve replacement.