The Impact of Preload Alteration on the Myocardial Performance Index through Implementing Positive End Expiratory Pressure

Load independent methods should be used for the assessment of ventricular function. Debate still exists regarding whether tissue Doppler imaging (TDI) indices are influenced by preload. Here, we evaluated the effect of positive end expiratory pressure (PEEP) related preload reduction on both conventional pulsed Doppler (PD) and TDI myocardial performance index (MPI). Thirty-eight mechanically ventilated patients of 3 months to 12 years old (mean ± SD age of 30 ± 11months) without overt heart disease were enrolled. Doppler mitral inflow velocities, isovolumetric contraction and relaxation times and aortic ejection time in addition to TDI peak systolic, early and late diastolic velocities from the basal segment of left ventricular lateral wall were determined for each patient before and after applying high PEEP (10 cmH(2) O).PD-MPI was load dependent (0.61 ± 0.22 vs. 0.78 ± 0.25, P = 0.002). However, TDI-MPI did not significantly change after the use of high PEEP declining the left ventricular volume loading (0.78 ± 0.21 vs. 0.84 ± 0.22, P = 0.23). Hence, regarding various interfering pathophysiologic factors particularly preload reduction, it seems that TDI-MPI would be a more reliable index for the assessment of ventricular function.     

Clinical spectrum of 15 patients with HIV-related ocular involvement in Tehran

AIM: To determine the frequency of HIV-related ocular involvement and to describe the characteristics of involvement in a special clinic in Tehran. METHODS: In this cross sectional study, 141 patients (125 male and 16 female, 282 eyes) of HIV-infected patients with various stages of HIV infection that were referred to Center of behavioral diseases were evaluated during a period of 7 months. Every patient had a complete profile including demographic data, method of HIV transmission, recent CD4 T cell lymphocyte count, serological studies for common sexual or blood-born viruses and toxoplasmosis, history of antiretroviral therapy, and associated systemic disease. RESULTS: A total of 141 patients were evaluated. HIV-related ocular involvement was detected in 15 patients (10.6%), including 3 mycobacterium tuberculosis-related choroiditis, 2 cytomegalovirus retinitis, 2 retinal toxoplas- mosis, 2 herpes simplex virus-related lesions, 1 HIV- associated retinopathy, 1 herpes zoster ophthalmicus, 1 undetermined vitritis, and 3 cases of cranial nerve involvement including 2 cases of gaze palsy and 1 case of papilitis. In our study, mean CD4 T cell lymphocyte count was fewer in patients with ocular involvement than in patients without ocular involvement (204.7±123.8 vs 403.7±339.7, P=0.029), but there was no difference in other possible associated factors between two groups. CONCLUSION: Mycobacterium tuberculosis-related choroiditis and neurophthalmic lesions are the most common HIV-related ocular involvements in Tehran that is different from those of recent publications in developed countries.     

德黑兰15例HIV患者眼部病变的临床特点

目的:探讨德黑兰HIV患者眼部病变的发生频率及其特点。方法:采用横向研究,选取7个月间收录的141例(282眼,其中男性125例,女性16例)不同程度的HIV患者,每位患者拥有全部的个人资料,包括人口统计信息、HIV传播途径、最近CD4淋巴细胞计数、普通性/血源性病毒和弓形虫病的血清学研究、抗逆转录病毒治疗史以及相关的全身性疾病。结果:患者141例中,HIV涉及眼部病的为15例(10.6%),包括3例结核性脉络膜炎,2例巨细胞病毒性视网膜炎,2例单纯疱疹病毒相关病变,1例HIV相关的视网膜病变,1例眼带状疱疹,1例待定为玻璃体炎以及3例涉及颅神经损伤包括2例凝视麻痹和1例视乳头炎。CD4淋巴细胞计数在涉及眼部病变的患者中比没有涉及眼部病变的患者低(204.7±123.8vs403.7±339.7,P=0.029),但两组间其他相关因素没有差异。结论:在德黑兰,结核性脉络膜炎和神经性眼科疾病损伤是HIV患者最常见的眼部损伤,这与最近发表在发达国家的不一致。     

p16 expression in colorectal adenocarcinoma: marker of aggressiveness and morphological types

Aim: The aim of the present study was to investigate the clinicopathological roles of p16 expression in a large cohort of patients with colorectal adenocarcinoma with tight methodology and close follow-up. Methods: p16 protein expression was investigated in 194 patients (102 men, 92 women) with colorectal adenocarcinomas by immunohistochemistry. The findings were correlated with their clinicopathological features. Results: p16 protein was detected in 80% (155 of 194) of patients with colorectal carcinoma. The p16 protein was more often detected in male patients with colorectal cancers (86% versus 73%, p = 0.03). p16 protein expression was more often seen in carcinomas in the rectum, sigmoid and descending colon compared with more proximal colon (90% versus 61%, p = 0.001). The p16 protein was more often detected in well or moderately differentiated colorectal adenocarcinoma than poorly differentiated colorectal adenocarcinoma (84% versus 63%, p = 0.009). The level of expression of p16 protein is related to the lymph nodal status (p = 0.004) and the TNM staging of the colorectal carcinoma (p = 0.008). Conclusion: p16 protein expression was common in colorectal adenocarcinomas. The expression correlated with gender of the patient, distal location, differentiation and staging of the tumour. The findings suggest that p16 plays an important role in cancer pathogenesis and has implications for improving the clinical management.     

Augmentation of Left Atrial Contractile Function: A Herald of Iron Overload in Patients with Beta Thalassemia Major

Early detection of myocardial iron overload is crucial for optimal management of patients with beta thalassemia major, which could lead to intensification of iron chelating therapy. In this study, we evaluate the conventional echocardiography and tissue Doppler imaging measurements in patients with beta thalassemia major and further introduce the assessment of atrial ejection force as a feasible price-saving approach for early detection of myocardial iron overload. During a 1-year period, 42 cases of beta thalassemia major aged <21 years and with preserved systolic function were evaluated with magnetic resonance T2* imaging (MRI T2*), conventional echocardiography, and tissue Doppler imaging techniques. Patients were classified into two groups according to their myocardial MRI T2* values, with and without critical iron loading. All patients with echocardiographic evidence of moderate and severe stages of diastolic dysfunction showed critical iron loading in their MRI T2*. After excluding those patients with severe and moderate ventricular diastolic filling abnormality, the atrial ejection force index (P = 0.002) and a number of volume indexes of the left atrium showed a significant difference between the two groups. None of the tissue Doppler imaging measurements showed a statistically significant difference between the two groups. The atrial ejection force index of 7.41, with a sensitivity of 93% and a specificity of 74%, was suggested to detect critical cardiac iron loading. These results imply that combining the atrial ejection force index with the transmitral-derived echocardiographic assessment is a feasible way to detect early stages of myocardial iron overload in patients with beta thalassemia major.     

Upper Endoscopic Findings in Children with Recurrent Abdominal Pain: High Prevalence of Hiatus Hernia

Objective

Recurrent abdominal pain (RAP) by itself is one of the common reasons in child-aged patients to refer to a clinician. Some of these patients are presented with more serious features, so-called the “red flag”. The most important issue in management of RAP is to distinguish the type of it, whether it is functional or organic. In this study we aimed to assess the redundancy of red-flagged RAP with findings of esophago-gastro-deudonoscopy.

Methods

In a 2 year prospective study 150 consecutive children with RAP who showed red flags underwent esophago-gastro-deudonoscopy. The prevalence of each finding was recorded. Overall positive predictive value of predicting an endoscopic finding while having a red-flag was calculated.

Findings

Among all the patients, 126 cases showed at least a positive finding in their endoscopy that corresponded to the positive predictive value of 84% for predicting the presence of an endoscopic finding according to red flags. Interestingly, 20% of patients showed hiatus hernia when surveyed.

Conclusion

Comprehensive physical examination is needed to avoid performing esophago-gastro-deudonoscopy without indication in patients with recurrent abdominal pain.     

Concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis for synchronous carcinoma

An extensive large bowel resection with a single anastomosis is the accustomed management option for widely spaced synchronous colorectal neoplasms. We report a successful case of concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis in an 85-year-old man with synchronous cancers of the hepatic flexure and lowrectum. This surgical technique is advantageous for elderly patients as it provides the benefits of multiple segmental resection and laparoscopic surgery while potentially reducing mortality, time of procedure, postoperative pain, ileus, length of hospitalization and direct cost of care, and improving independence at discharge. The technique for efficient multiple extractions of specimens and effective reconstitution of pneumoperitoneum for a multistaged procedure is discussed.