Ejection fraction and sizes of the left ventricle of the heart after intracoronary administration of autologous mononuclear cells of the bone marrow in patients with coronary artery disease with low ejection fraction

Since 2003 intracoronary administration of autologous bone marrow mononuclear cells has been performed in 119 patients with inoperable coronary artery disease, 53 of which had reduced ejection function that was gradually increased after injection of mononuclear bone marrow cells. By the 6th year the difference between the median of systolic and diastolic sizes of the left ventricle decreased by 12 and 14 mm respectively. In the control group the dynamics of changes of these indices at the same period was of negative character. The introduction of intracoronary bone marrow mononuclear cells is a safe and effective method of invasive therapy in patients with coronary artery disease to whom surgery is contraindicated.     

Burma revisited

The author, who had spent a year with a mobile field hospital in Burma in 1944 during World War II, was able to visit Rangoon for 5 days in 1977 with the assistance of a grant from the Association of Anaesthetists of Great Britain and Ireland. Some impressions of life in Burma today are given, especially in relation to the problem of providing an anaesthetic service for the main hospitals in Rangoon and the work of Professor Win Maung, FFARCS and his University department. The author also describes some of the aid which it has been possible to organise since his return to the United Kingdom and outlines requirements for the future.     

Chondrosarcomas revisited

Chondrosarcomas are malignant bone tumors with pure hyaline cartilage differentiation; myxoid changes, calcification, or ossification may be present. Several subtypes of chondrosarcomas exist. Behavior patterns vary, ranging from slow-growing nonmetastasizing lesions to aggressive metastasizing sarcomas. Symptoms are usually mild, with duration ranging from several months to years, and usually consist of persistent, dull, aching pain or palpable masses. Radiographic findings include bone expansion with cortical thickening, radiolucent areas with variably distributed punctate or ring-like matrix calcifications, cortical erosion or destruction, endosteal scalloping, and scant or absent periosteal reaction; extension into the soft tissue may be present. Histological differential diagnosis from benign cartilaginous lesions can be achieved by increased cellularity, enlarged plump nuclei, binucleated cells, hyperchromatic nuclear pleomorphism, and permeation of cortical or medullary bone. Atypia is usually mild to moderate; necrosis and mitoses can be seen, particularly in high-grade lesions. Adequate surgery is the mainstay of treatment. High-grade and pelvic chondrosarcomas are best managed with wide resection. Because of the low metastatic potential and low local recurrence rate noted with intralesional surgery, low-grade chondrosarcomas can be treated with curettage (with or without treatment of the defect cavity) with a local adjuvant, such as phenol or cryotherapy. Adjuvant chemotherapy may be considered for mesenchymal and dedifferentiated chondrosarcomas. Radiation therapy can be considered after incomplete resection or if resection is not feasible or would cause unacceptable morbidity.     

Etomidate revisited

The major advantage of etomidate is its lack of cardiovascular side effects. In addition, etomidate is supposed to be neuroprotective. The side effects of etomidate include adrenal suppression and myocloni. A review of the recent literature on etomidate, its clinical use, its side effects and its mechanism of action was performed. Among others, major recent advances include a new drug preparation devoid of propylene glycol and its side effects, a new pretreatment technique that may reduce the incidence of myocloni, and the identification of its site of action in the central nervous system.     

Rejuvenation revisited

Rejuvenation is a subject that has captured the imagination of the public as well as the interest of physicians. Long before plastic surgeons began performing operations, patients sought the help of reputable practitioners and charlatans alike to alleviate the outward manifestations of aging. This paper presents some of the men who offered remedies--some apparently ineffective or even potentially harmful--to those hopeful of restoring youth.     

PTH revisited

Recent investigations of parathyroid hormone (PTH) have advanced our understanding of its circulating forms as well as its action. It is now clear that first-generation immunoradiometric assays of so-called intact "PTH" not only measured full-length PTH(1-84) but also recognized large PTH fragments lacking the amino-terminus. New, second generation assays detect only full-length PTH. Under diverse pathological settings, second generation assays display lower levels of PTH (1-84). By measuring full-length PTH (bioactive PTH) and the combined full-length plus amino-terminal PTH fragments, the amount of non-PTH(1-84) in circulation can be estimated. The primary amino-terminal fragment is likely to be PTH(7-84). A considerable controversy surrounds the pathological significance of PTH(7-84) and its relation to adynamic bone disease. While these findings were emerging, other work uncovered the apparent basis by which PTH receptors signal through cAMP in some instances but through Ca/inositol phosphate in others. This signaling switch is dictated by the cytoplasmic adapter protein NHERF1 (EBP50), which is expressed in a cell-selective fashion. Other provocative findings may provide a means of unifying determinations of PTH(7-84) with the effects of NHERF1 on PTH receptor signaling. These latter studies reveal that in cells expressing NHERF1, PTH(7-84) has no effect on PTH receptor signaling or internalization. However, in cells lacking or expressing low levels of NHERF1, PTH(7-84) internalizes the PTH receptor without accompanying activation. Together, these findings suggest that the accumulation of PTH(7-84) in renal failure may lead to PTH resistance by internalizing and down-regulating PTH receptors.     

Mycophenolate revisited

The patent of mycophenolate mofetil (MMF) has expired, and for enteric‐coated mycophenolate sodium (EC‐MPS), this will happen in 2017. In the twenty years these drugs have been used, they have become extremely popular. In this review, the reasons for the popularity of mycophenolate are discussed, including the benefits compared to azathioprine. MMF and EC‐MPS are therapeutically equivalent. Although neither is considered to be a narrow therapeutic index drug, this should not lead to careless switching between the innovator drug and generic formulations, or between one generic formulation and another. The pipeline of new immunosuppressive drugs is dry, and it is very likely that we will be using mycophenolate for many more years to come as a first‐line immunosuppressive drug in our transplant population. Whether or not the development of donor‐specific anti‐HLA antibodies is related to drug exposure (mycophenolic acid concentrations) remains to be investigated.