No abstract

SUMMARYThe deleterious effects of free radicals in acute myocardial ischaemia/reperfusion are rather well known. However, the possibility that thrombolysis positively affects the recovery of blood antioxidant capacity in the later postinfarction period, and thus contributes to the better overall outcome of these patients, has not yet been investigated.We followed the time course of erythrocyte antioxidant activity in 45 patients with first acute myocardial infarction (AMI), who were treated with streptokinase. Success of thrombolysis was evaluated by noninvasive clinical signs of reperfusion using continuous vector cardiography. The patients were divided into two groups according to successful or unsuccessful reperfusion. The control group consisted of 24 healthy subjects. Glutathione peroxidase (GPX) and superoxide dismutase (SOD) were determined immediately after admittance to the hospital (0 hours) and after subsequent thrombolytic therapy (1.5, 6, 12, and 24 hours after initiation of infusion of streptokinase), and 2, 4, and 8 days after AMI.Patients with AMI had decreased antioxidant enzyme activity at the time of admittance to the hospital, showing that the oxidative/antioxidative balance is disturbed early during the ischemic phase of AMI. In AMI patients without successful reperfusion, erythrocyte antioxidant enzyme activity remains low during the postinfarction period of 7 days. It can be concluded that prolonged ischemia reduces antioxidant enzyme activity. AMI patients with successful reperfusion have a significant rise in the activity of antioxidant enzymes within the first hours after thrombolysis, followed by a decrease until the third postinfarction day. During the subsequent postinfarction period, erythrocyte antioxidant activity gradually recovered and reached control levels. These beneficial effects of reperfusion on erythrocyte antioxidant status might contribute to the better overall prognosis of these patients. (Jpn Heart J 2003; 44: 823-832)

No abstract

Lower pole heminephroureterectomy is a common paediatric urology procedure with few reported complications. We report a case of possible vascular ischemic injury to the normal remaining ureter following a lower pole heminephroureterectomy, probably due to both ureters sharing a common blood supply. Extra caution in such procedures is therefore warranted.

Britain has the highest rate of pregnancies in Europe among young women aged 15–19 years. In girls under 16, the rates of pregnancy are rising: in 2006, there were 7.8 conceptions per 1000 girls; in 2007, there were 8.3 conceptions per 1000 girls. Where babies are born with conditions requiring treatment, the clinician may be faced with the task of obtaining consent from a parent who is also a minor. These situations present potential pitfalls. Guidance from legislative acts and case law is sparse. For example, the Children Act 1989 does not specify age limits for the assumption of parental responsibility. Legal precedents for assessing competence and capacity may not apply to minors. The Gillick principle for assessing competence does not extend to the competence of minors to take decisions as responsible parents. The Mental Capacity Act 2005 prescribes the limits of capacity but only in those aged over 16 years. Lastly, although a minor's parents will bear responsibility for the minor, this responsibility does not extend to the minor's child. This article explores these controversies through four case scenarios. These scenarios are loosely based on the authors' prior experiences as paediatric surgeons. In light of current statutory guidance, and the paucity of legal precedent, there are few answers to be offered. However, exploring the issues, enabling them to be thoughtfully considered by health professionals, is in itself valuable.