Surgical outcome in 85 patients with primary cardiac tumors

BACKGROUND: We present a large, single institution experience with adult cardiac tumors and address factors affecting outcome. METHODS: A retrospective review was made of all patients who underwent surgery for primary cardiac tumors from April 1975 through August 2002. RESULTS: Eighty-five patients (33 male and 52 female) with a mean age of 54 years were identified with follow-up available for 80 (94%) patients. There were 68 (80%) benign tumors and 17 (20%) malignant tumors. Three tumors recurred and were resected giving a total of 88 surgeries. All benign tumors were grossly resected and the extent of resection for malignant disease ranged from 14 (78%) gross resections and 3 (17%) debulkings to 1 (5%) biopsy. There were 4 (5%) early hospital deaths. Median survival was 9.6 months and 322 months for patients with malignant and benign diseases, respectively. Significant predictors of long-term mortality were malignant disease (P <0.0001) and New York Heart Association class (P <0.03). CONCLUSIONS: Surgical resection provides excellent outcome in patients with benign cardiac tumors. Malignant tumors continue to pose a challenge with good local tumor control but limited survival owing to metastatic disease.     

Long-term carcinogenicity of pan masala in Swiss mice.

Carcinogenicity of pan masala, a dry powdered chewing mixture of areca nut, catechu, lime, spices and flavoring agents was evaluated by means of the long-term animal bio-assay 6- to 7-week old male and female S/RVCri mice were divided randomly into intermediate and lifetime exposure groups and fed normal diet without pan masala-(zero dose) or diet containing 2.5% and 5% pan masala. Animals in the intermediate-exposure group (n = 10/gender/dose group) were killed after 6, 12 or 18 months of treatment, while those in the lifetime-exposure group (n = 54/gender/dose group) were killed when moribund or at the termination of the experiment at 24 months. Several tissues were processed for histopathological examination. The body weight and survival rate of mice fed pan masala were lower than that of the controls. Histopathological observations of tissues from control animals did not reveal any neoplastic alterations. However, lifetime feeding of pan masala induced adenoma of the liver, stomach, prostate and sebaceous glands, also forestomach papilloma, liver hamartoma, hepatoma and hemangioma, carcinoma of the forestomach, adenocarcinoma of the lung and liver, and testicular lymphoma. Neoplastic lesions appeared mainly in the liver (n = 13), stomach (n = 3) and lung (n = 8). Lung adenocarcinoma, the most frequent malignant tumor type, was observed in 2/120 mice in the intermediate-exposure group and in 8/216 animals in the lifetime-exposure group. Statistical analysis of tumor-induction data revealed a significant dose-related increase in lung adenocarcinomas but not in liver and stomach neoplasms indicating that lung is the major target tissue for the carcinogenic action of pan masala.     

Analysis of Patterns and Treatment Strategies for Mandibular Condyle Fractures: Review of 175 Condyle Fractures with Review of Literature

This study aims to evaluate incidence, patterns and epidemiology of mandibular condylar fractures (MCF) to propose a treatment strategy for managing MCF and analyze the factors which influence the outcome. One hundred and seventy-five MCF’s were evaluated over a four year period and their pattern was recorded in terms of displacement, level of fracture, age of incidence and dental occlusion. Of the 2,718 facial bone fractures, MCF incidence was the third most common at 18.39 %. Of 175 MCF 58.8 % were unilateral and 41.12 % were bilateral. 67 % of bilateral fractures and 43.8 % of unilateral fractures were associated with midline symphysis and contralateral parasymphysis fractures respectively. Most of the MCF was seen in the age group of above 16 years and 50 % of them were at subcondylar level (below the neck of the condyle). Majority of MCF sustained due to inter personal violence were undisplaced (72.7 %) and contrary to this majority of MCF sustained during road traffic accident were displaced. 62.9 % of total fractures required open reduction and rigid fixation and 37.1 % were managed with closed reduction. 80 % of MCF managed with closed reduction were in the age group of below 16 years. From this study it can be concluded that the treatment algorithm proposed for managing MCF is reliable and easy to adopt. We observed that absolute indication for open reduction of MCF is inability to achieve satisfactory occlusion by closed method and absolute contraindication for open reduction is condylar head fracture irrespective of the age of the patient.     

Dipeptide monoester ganciclovir prodrugs for treating HSV-1-induced corneal epithelial and stromal keratitis: in vitro and in vivo evaluations.

PURPOSE: The aim of this study was to evaluate a series of dipeptide monoester ganciclovir (GCV) prodrugs with the goal of improving ocular bioavailability of GCV from topical ophthalmic solutions. METHODS: Solubility, logP, pH-stability profile, permeability, interaction with corneal peptide transporter, and in vivo efficacy against herpes simplex virus type 1 (HSV-1) ocular disease in the rabbit model were studied. RESULTS: Val-Val-GCV, Tyr-Val-GCV, and Gly-Val-GCV were more stable in aqueous solution than Val-GCV, showing no measurable degradation even after 7 d at 37 degrees C, within the pH range of 1.4-5.4. Tyr-Val-GCV and Val-Tyr-GCV were the most lipophilic among the prodrugs synthesized and were predicted to have an n-octanol/water partition coefficient 33 times greater than that of GCV. All of the prodrugs had a much higher aqueous solubility than the parent drug. Transcorneal permeability of Val-GCV and Val-Val-GCV was seven- to eightfold greater than that of GCV, in the presence of a proton gradient, and was significantly decreased in the presence of Gly-Pro. Val-Val-GCV (1% w/v) provided significantly better therapeutic activity than trifluorothymidine (1% w/v) against HSV-1 epithelial keratitis and equivalent therapeutic activity against stromal keratitis in the rabbit eye model. CONCLUSIONS: Val-Val-GCV demonstrates excellent corneal permeability and chemical stability, high aqueous solubility, and substantial in vivo antiviral activity against the HSV-1.     

Distinguishing features of delayed-onset posttraumatic stress disorder

The author identifies common themes in the clinical presentations of war veterans who experienced a delayed onset of posttraumatic stress disorder. These patients appear to share the characteristics of (1) long periods of good postwar adjustment, (2) guilt about a relatively circumscribed act of omission or commission during combat, and (3) similar defense mechanisms. The author explores the implications of these findings for the understanding of posttraumatic stress disorder.     

Estimation of stature from cranial sutures in a South Indian male population

The aim of this study was to investigate the possibility of estimating height from length of coronal and sagittal sutures of the skull for the positive identification of the height in forensic investigations concerned with fragmentary skeletal remains. The study was conducted on 87 male bodies subjected to medicolegal autopsy in the Department of Forensic Medicine, Kasturba Medical College, Manipal, South India and the Department of Forensic Medicine, Kasturba Medical College, Mangalore, South India. Length of coronal suture was measured from left pterion at the junction of sphenoparietal with the sphenofrontal suture, along the coronal plane, over the coronal suture to the pterion on the right side. Length of sagittal suture was measured from bregma along the sagittal plane over the sagittal suture to the lambda. The data collected were subjected to statistical methods. Significant correlation was found between height and coronal suture length in males, when compared to sagittal suture. The correlation coefficient between height and coronal suture was 0.363. The correlation coefficient between height and sagittal suture was 0.090. Linear regression equations for stature estimation were derived from coronal suture length in male population. Coronal suture length gives more accurate results in estimating stature than sagittal suture. However, in cases where identification is required by means of only skull, this method could prove useful.     

Autonomous Purkinje cell axonal dystrophy causes ataxia in peroxisomal multifunctional protein‐2 deficiency

Peroxisomes play a crucial role in normal neurodevelopment and in the maintenance of the adult brain. This depends largely on intact peroxisomal β‐oxidation given the similarities in pathologies between peroxisome biogenesis disorders and deficiency of multifunctional protein‐2 (MFP2), the central enzyme of this pathway. Recently, adult patients diagnosed with cerebellar ataxia were shown to have mild mutations in the MFP2 gene, hydroxy‐steroid dehydrogenase (17 beta) type 4 (HSD17B4). Cerebellar atrophy also develops in MFP2 deficient mice but the cellular origin of the degeneration is unexplored. In order to investigate whether peroxisomal β‐oxidation is essential within Purkinje cells, the sole output neurons of the cerebellum, we generated and characterized a mouse model with Purkinje cell selective deletion of the MFP2 gene. We show that selective loss of MFP2 from mature cerebellar Purkinje neurons causes a late‐onset motor phenotype and progressive Purkinje cell degeneration, thereby mimicking ataxia and cerebellar deterioration in patients with mild HSD17B4 mutations. We demonstrate that swellings on Purkinje cell axons coincide with ataxic behavior and precede neurodegeneration. Loss of Purkinje cells occurs in a characteristic banded pattern, proceeds in an anterior to posterior fashion and is accompanied by progressive astro‐ and microgliosis. These data prove that the peroxisomal β‐oxidation pathway is required within Purkinje neurons to maintain their axonal integrity, independent of glial dysfunction.