Biocompatible implant mimicking cartilage: A new horizon for reconstructive facial field

Cartilage is avascular with limited to no regenerative capacity, so its loss could be a challenge for reconstructive surgery. Current treatment options for damaged cartilage are also limited. In this aspect there is a tremendous need to develop an ideal cartilage-mimicking biomaterial that could repair maxillofacial defects. Considering this fact in this study we have prepared twelve silicone-based materials (using Silicone 40, 60, and 80) reinforced with hydroxyapatite, tri-calcium phosphate, and titanium dioxide which itself has proven their efficacy in several studies and able to complement the shortcomings of using silicones. Among the mechanical properties (Young’s modulus, tensile strength, percent elongation, and hardness), hardness of Silicone-40 showed similarities with goat ear (P > .05). Silicone peaks have been detected in FTIR. Both AFM morphology and SEM images of the samples confirmed more roughed surfaces. All the materials were nonhemolytic in hemocompatibility tests, but among the twelve materials S2, S3, S5, and S6 showed the least hemolysis. For all tested bacterial strains, adherence was lower on each material than that grown on the plain industrial silicone material which was used as a positive control. S2, S3, S5, and S6 samples were selected as the best based on mechanical characterizations, surface characterizations, in vitro hemocompatibility tests and bacterial adherence activity. So, outcomes of this present study would be promising when developing ideal cartilage-mimicking biocomposites and their emerging applications to treat maxillofacial defects due to cartilage damage.     

Analysis of 88 nephrectomies in a rural tertiary care center of India

Nephrectomy is not an uncommon surgery in day-to-day practice of urology. Trauma is the most common cause of emergency nephrectomy. On the other hand, elective nephrectomy is done for both benign and malignant diseases of the kidney. This study has been performed to know the different causes of nephrectomy in a rural, tertiary care center of India. In our series, we have studied all the elective nephrectomies done in our hospital during a period of eight years. We have analyzed 88 cases of nephrectomies regarding their age, sex, laterality of disease, and histopathologic report of the nephrectomy specimens. Out of 88 cases, 61 were males and 27 were females. In our series, 62.5% cases of nephrectomies were done for benign causes and 37.5% cases for malignant causes. Among the benign causes, neglected pelviureteric junction obstruction was the leading cause, followed by calculus disease resulting in obstruction. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.     

Tuberculosis and its incidence, special nature, and relationship with chronic obstructive pulmonary disease

Tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) carry a significant burden in terms of morbidity and mortality worldwide. This review article focuses on different aspects of Tuberculosis in terms of the relationship with COPD such as in the development of chronic airflow obstruction as a sequel to active TB and reviewing the key role of cigarette smoking in the pathogenesis of both conditions. Patients diagnosed with TB may often have extensive co-morbidity such as COPD and the effect of an underlying diagnosis of COPD on outcomes in TB is also reviewed.     

Percutaneous ventricular assist device placement during active cardiopulmonary resuscitation for severe refractory cardiogenic shock after acute myocardial infarction

Cardiogenic shock after acute myocardial infarction is associated with a high mortality rate despite modern reperfusion methods and intra-aortic balloon pump support. For myocardial infarction patients in cardiogenic shock that is refractory to intra-aortic ballon pump counterpulsation and pressors (severe refractory cardiogenic shock), there are limited means to rapidly provide additional hemodynamic support. We present the case of a 49-year-old man who presented with an anterior wall acute myocardial infarction complicated by cardiogenic shock. After resuscitation and stabilization with intra-aortic balloon pump and pressor support, the patient underwent successful emergent percutaneous transluminal coronary angioplasty and stenting of the left anterior descending coronary artery. Forty-eight hours later, the patient again went into severe refractory cardiogenic shock; pulseless electrical activity arrest followed. Cardiopulmonary resuscitation was started, and the patient underwent urgent placement of a TandemHeart percutaneous ventricular assist device. The device enabled the reversal of terminal hemodynamic collapse during active cardiopulmonary resuscitation, subsequent stabilization of the patient, and discharge of the patient from the hospital after device removal. In this patient, the percutaneous ventricular assist device was successful in the treatment of severe refractory cardiogenic shock after acute myocardial infarction.     

Extracorporeal Membrane Oxygenation Using the Tandem Heart System's Catheters

We describe the initial—and successful—use of the TandemHeart System''s catheters to provide extracorporeal membrane oxygenation (ECMO), in 2 patients. In 1 patient, who was experiencing severe primary respiratory failure, the catheters provided a standard venovenous ECMO circuit. In the other patient, who had severe, acute pulmonary hypertension and right-heart failure, the catheters enabled a novel right atrial-to-left atrial circuit for ECMO. We discuss the potential of the TandemHeart System''s catheters to provide novel and possibly superior vascular routes for the delivery of ECMO in different types of cardiopulmonary failure.Key words: Extracorporeal circulation, extracorporeal membrane oxygenation/instrumentation/methods, heart failure/therapy, heart-assist devices, hemodynamics, methods, pneumonia/complications, respiratory insufficiency/therapy, technology assessment, biomedical, treatment outcomeExtracorporeal membrane oxygenation (ECMO) first came into wide clinical use as a tool to enable open-heart surgery through cardiopulmonary bypass (CPB) in the 1960s.^1,2 By the 1970s, there was hope that ECMO technology could provide effective temporary oxygenation in patients who had a major, yet reversible, lung injury but in whom mechanical ventilation was not completely effective.³ A generation later, ECMO technology is a well-established, widely used method of support in neonatal and pediatric patients who experience severe respiratory failure.⁴ In contrast, progress in the application of ECMO to improve outcomes of respiratory failure in adults has been much slower. A large National Institutes of Health-sponsored trial of ECMO use in severe respiratory failure of various causes⁵ failed to show a benefit and thereby dampened enthusiasm for this application for more than a decade. New technology and implementation methods, however, have reinvigorated interest in the use of ECMO when severe respiratory failure occurs in adults.^6,7 Indeed, data from the recently completed, large, prospective CESAR trial suggest that ECMO may already be of great usefulness in patients who are experiencing severe respiratory failure.^8–10There have also been encouraging reports of the successful use of ECMO to support patients who are experiencing acute right-heart failure,¹¹ acute refractory left-heart failure,¹² postcardiotomy heart failure,¹³ prolonged cardiac arrest,¹⁴ and postoperative cardiogenic shock.¹⁵ In these circumstances, ECMO has served temporarily (sometimes along with mechanical hemodynamic support) until heart recovery, or as a bridge to heart transplantation, heart–lung transplantation, or the placement of a left ventricular (LV) assist device.The TandemHeart® PTVA® System (CardiacAssist, Inc.; Pittsburgh, Pa) is a new, percutaneously placed, ventricular assist device that has proved to be effective in the short-term management of acute heart failure.¹⁶ The system features innovative vascular-access catheters that enable a minimally invasive approach to mechanical LV assistance. We report here the 1st experience of using these catheters to perform ECMO, in 2 patients. One patient had severe primary respiratory failure, and the other had respiratory failure and right-heart failure caused by severe pulmonary hypertension. The TandemHeart catheters were placed in different intravascular locations in each patient. Our experience suggests that the TandemHeart catheter system can offer innovative and superior options for ECMO delivery to different populations of patients who experience cardiopulmonary failure.     

Cell therapy and satellite centers: The cardiovascular cell therapy research network experience

Due to the changing population in patients with myocardial infarction, recruiting patients in clinical trials continues to challenge clinical investigators. The Cardiovascular Cell Therapy Research Network (CCTRN) chose to expand the reach and power of its recruitment effort by incorporating both referral and treatment satellite centers. Eight treatment satellites were successfully identified and they screened patients over a two year period. The result of this effort was an increase in recruitment, with these treatment satellites contributing 30% of the patients to two of the three Network studies. The hurdles that these satellite treatment centers faced and how they surmounted them provide instruction to clinical research groups eager to expand to satellite systems and to health care practitioners who are interested in taking part in multicenter clinical trials.     

Clear cell carcinoma of exocrine pancreas: a rare tumor with an unusual presentation

Metastatic clear cell carcinomas are relatively common from primary tumors arising in the kidney, female genital tract, adrenal cortex, and lung, but they rarely occur from primary tumors of the pancreas. We report a case of metastatic pancreatic tumor with marked clear cell changes in a 46-year-old white man presenting with a pseudocyst of the pancreas. At laparotomy, there was a hard area in the head of the pancreas and another hard nodule was present in the omentum. The histologic and immunohistochemical test of the excised omental nodule exhibited features consistent with clear cell carcinoma from pancreatic primary. To our knowledge, this is the first report of a metastatic clear cell pancreatic tumor with such an unusual presentation.