Complication after abdominoperineal resection of the rectum

Treatment of rectal cancer commonly involves pre-operative short-term external beam radiotherapy along with curative surgery. We describe a case that was treated with the standard multi-modality treatment but developed some very unusual complications.     

MicroRNAs: Novel Regulators of the Heart

MicroRNAs are approximately 22 nucleotides in length, and they play central roles in the regulation of gene expression. MicroRNAs participate in many essential biological processes, such as cell proliferation, differentiation, apoptosis and stress. Emerging evidence has indicated that microRNAs are novel regulators involved in cardiac physiology and pathophysiology, including the regulation of cardiac physiological function and participation in the genesis of cardiac diseases. Although several challenges remain, microRNAs might have a promising diagnostic and therapeutic potential in cardiac diseases.     

Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder

AIM:To investigate the preoperative factors that can predict neoplastic polypoid lesions of the gallbladder(PLGs) as well as malignant PLGs.METHODS:A retrospective analysis was conducted on the 210 consecutively enrolled patients who underwent cholecystectomy due to a PLG larger than 10 mm,as was determined by preoperative trans-abdominal ultrasonography or endoscopic ultrasonography.We ana-lyzed the medical,laboratory,radiologic data and the pathologic results.RESULTS:In 210 cases,146 had non-neoplastic po...     

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

Echocardiography is the most common imaging modality for the assessment of cardiovascular tumors, followed by more advanced imaging modalities, such as cardiac computed tomography or cardiac magnetic resonance imaging. Non‐neoplastic lesions that may simulate a true neoplasm on imaging are termed “cardiac pseudotumors.” As echocardiography is the initial imaging modality where pseudotumors are identified, it is imperative to have a fundamental understanding of pseudotumors evaluation using echocardiography. There is paucity of the literature describing the different kinds of pseudotumors. This review is an attempt to describe common cardiac pseudotumors and to classify them based on their origin. The tumors arising from cardiac structures, such as epicardium, endocardium, or myocardium, were termed as “intrinsic” while the pseudotumors with no cardiac origin were termed as “extrinsic.” The more common pseudotumors are described in detail with pertinent echocardiographic features and examples.     

Protection of the Myocardium with Sodium-Hydrogen Exchange Inhibitors: A Cardiac Surgical Perspective

Strategies for myocardial protection in cardiac surgery are directed at the prevention of procedure-induced ischemia/reperfusion injury as well as metabolic resuscitation in acute ischemic syndromes. Postreperfusion myocardial dysfunction remains a significant clinical problem, most importantly in certain high-risk patient groups. The large body of experimental evidence demonstrating a significant role for sodium-hydrogen exchange activation in myocardial ischemia/reperfusion injury suggests that the ability to pharmacologically inhibit the exchanger presents a promising new approach to current myocardial preservation techniques.     

Controversies of cardiac glands in the proximal stomach: a critical review

Cardiac glands (CG), along with oxyntocardiac glands, in a normal human constitute cardiac mucosa (CM) that is positioned in the proximal stomach with a length of 10-30 mm, according to traditional teaching. This doctrine has been recently challenged. On the basis of studies on autopsy and biopsy materials in the esophagogastric junction region, some investigators have reported the presence of CG in only 50% of the general US population. They believed that CG were an acquired, metaplastic lesion as a result of gastroesophageal reflux disease. Subsequent recent study results from other research groups showed the presence of CG in the proximal stomach in embryos, fetuses, pediatric, and adult patients in most Europeans and Americans, and almost all Japanese and Chinese patients. These new data showed the following important findings: (i) CG are confirmed to be congenital in the proximal stomach; (ii) the length of CM is much shorter, approximately 5 mm in Caucasians in Europe and North America, and approximately 13 mm in Japanese and probably also in Chinese; (iii) CG are also present in the distal superficial esophagus underneath squamous mucosa in almost all Japanese and Chinese patients, but not so common in Caucasians in Europe, and not clear in Caucasians in North America. The recent data indicate a clear difference in the distribution of CG in the proximal stomach among different ethnic populations, and might explain different disease pathogenesis mechanisms among various ethnic patient groups.     

High frame rate Doppler echocardiography in the rat: an evaluation of the method.

AIMS: In small animal models, two-dimensional (2D) and Doppler echocardiography should provide more information than M-mode, especially in animals with infarcted and distorted left ventricles, but has been limited by low frame rates and poor near field resolution. New, high frame rate echo-Doppler equipment with digital processing was tested for accuracy of measurements. METHODS AND RESULTS: Fourteen normal Wistar rats (232-328 g) were examined under halothane anaesthesia. Pulsed Doppler recordings from both left ventricular outflow tract(LVOT) and right ventricular outflow tract (RVOT) cor-responded well with simultaneous ultrasound transit time measurements of aortic flow (LVOT: v=0.99x+4.8, min R=0.93. Standard error of estimate (SEE)=8.3 ml x min(-1), and RVOT: v=0.97x -4.3. R=0.93. SEE =8.4 ml x min(-1). No systematic differences were observed over a flow range of 20-90 ml x min(-1). Left ventricular (LV) dimensions assessed by 2D parasternal long-axis and short-axis views were equal to M-mode measurements with LV diameter 6.6 + 0.44 mm, anterior wall 1.8 +/- 0.18 mm, and posterior wall 1.5 + 0.56 mm. Mean absolute difference 4.4-8.5%. Intra- and interobserver variability was 4.6 +/- 4.1% and 6.7 +/- 7.0% for Doppler measurements, and 4.3 +/- 3.8% and 3.8 +/- 4.6% for dimensions, respectively. CONCLUSION: High frame rate Doppler echocardiography provides accurate non-invasive measurements of cardiac structure and function in the rat.     

Cardiac chloroma or cardiac myeloid sarcoma: Case Report

Chloroma or myeloid sarcoma is rare extramedullary tumor composed of immature myeloid cells that may occur in association with or during or even before the course of adult myelodysplastic or myeloproliferative diseases. It may involve different organs including the orbit, skin, lymph nodes, bone, gastrointestinal tract, breast, central nervous system, and lung. Cardiac involvement with MS is an exceedingly rare finding. We report a very rare case of left ventricular cardiac chloroma accidentally discovered by transthoracic echocardiography (TTE) and confirmed by cardiac magnetic resonance (CMR) in an old aged male patient with acute myeloid leukemia (AML) French‐American‐British (FAB)‐class M5. Unfortunately, shortly after a prompt start of AML palliative chemotherapy protocols, the patient died due to massive intracranial hemorrhage (ICH).     

多种肿瘤标志物在胰腺癌临床分期中的应用

目的探讨多种肿瘤标志物检测对胰腺癌的临床分期及术前评估的应用。方法45例胰腺癌,其中Ⅰ-Ⅱ期16例、Ⅲ期11例、Ⅳ期18例,检测其术前CA199、CA125、CEA等肿瘤指标,分析多种肿瘤标志物在胰腺癌临床分期及术前评估中的意义。结果不同分期胰腺癌之间CA199水平差异无显著性（P=0．381）,CA125、CEA的水平随着分期的递增而升高,但统计分析显示只有CA125组间差异有统计学意义（P〈0．05）。按照是否可切除分为两组,CA199水平在两组间差异无统计学意义（Z=1．045,P=0．296）,而CA125、CEA水平在两组间存在显著性差异（P=0．000、0．045）。多因素分析结果显示,胰腺癌的不同分期与有无黄疸、胆道疾病史、性别、体重减轻等之间存在显著统计学差异（P〈0．05）,而与术前胆红素水平、血糖、糖尿病史、年龄等之间无统计学差异。结论CA125和CEA可辅助用于胰腺癌患者临床分期及术前评估,具有无创性、病人依从性好等优点,具有较好的临床潜在应用价值。     

Pericardiocentesis: Insertion of a Pericardial Catheter

Pericardiocentesis is a lifesaving procedure in cardiac tamponade but is associated with significant and often life threatening complications. A patient is described in whom a catheter was inserted into the pericardium. This provided for prolonged pericardial drainage of purulent fluid and has the potential for decreasing the risk of this procedure.     

Intracardiac masses detected by echocardiography: case presentations and review of the literature

Intracardiac masses are often diagnosed by transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) improves overall visualization of masses, especially those located in the posterior cardiac structures. Masses in the heart are most commonly due to thrombi or valvular vegetations; however, a variety of tumors may also present as cardiac masses on echocardiography. Tumors of the heart most commonly occur in the setting of metastatic disease, usually from malignancies of the breast, lung, or from malignant melanoma. Primary cardiac tumors occur much less frequently and are usually benign. Atrial myxomas constitute nearly one-half of reported primary cardiac tumors. The following discussion details the findings of five cases that illustrate the spectrum of intracardiac tumors detected by echocardiography and reviews the relevant literature.     

Cardiac catheterization 1991: A report of the registry of the society for cardiac angiography and interventions (SCA&I)

This report summarizes the results of the 1991 Registry of the Society for Cardiac Angiography and Interventions in which 72 laboratories reported a total of 92,157 patients, including 17,073 coronary angioplasties, studied between January 1 through December 31, 1991. Complications were similar to previous reports of this Registry.     

Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponins

Despite the number of technologies used, the diagnosis of perioperative myocardial infarction is still a challenge. Studies conducted in surgical series have demonstrated that cardiac troponins (cTns) have both a superior diagnostic sensitivity and specificity, compared with other traditional techniques, and an independent power to predict short- and long-term prognosis. Nevertheless, some points need to be clarified. They include the usefulness of cTns in patients with end-stage renal failure; the standardization of the cTns cut-off for the diagnosis of myocardial injury; the timing of postoperative blood samplings; the cost-effectiveness of a screening in asymptomatic patients; and the possible therapeutic strategies.     

Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing

Gastroesophageal reflux disease (GERD) is one of the most commonly encountered digestive diseases in the world, with the prevalence continuing to increase. Many patients are successfully treated with lifestyle modifications and proton pump inhibitor therapy, but a subset of patients require more aggressive intervention for control of their symptoms. Surgical treatment with fundoplication is a viable option for patients with GERD, as it attempts to improve the integrity of the lower esophageal sphincter (LES). While surgery can be as effective as medical treatment, it can also be associated with side effects such as dysphagia, bloating, and abdominal pain. Therefore, a thorough pre-operative assessment is crucial to select appropriate surgical candidates. Newer technologies are becoming increasingly available to help clinicians identify patients with true LES dysfunction, such as pH-impedance studies and high-resolution manometry (HRM). Pre-operative evaluation should be aimed at confirming the diagnosis of GERD, ruling out any major motility disorders, and selecting appropriate surgical candidates. HRM and pH testing are key tests to consider for patients with GERD like symptoms, and the addition of provocative measures such as straight leg raises and multiple rapid swallows to HRM protocol can assess the presence of underlying hiatal hernias and to test a patient’s peristaltic reserve prior to surgery.