Electrocardiographic atrial complex and acute atrial myocardial infarction

The atrial complex was examined by use of standard and right atrial leads in 59 patients with acute myocardial infarction. Abnormal atrial complexes were found in standard leads in 17 patients, and in the right atrial lead in 29 patients. Abnormal atrial complexes were found more frequently in patients who had arrhythmias in the acute phase than in patients without arrhythmias. Ten patients died during the acute phase. Infarcts in the right atrium were found in all 7 patients whose right atrium was examined microscopically. Abnormal atrial complexes in the right atrial lead were found in patients with atrial infarcts, especially when the lateral atrial wall was involved.     

A nationwide cohort study of resection rates and short-term outcomes in open and laparoscopic distal pancreatectomy

BackgroundDistal pancreatectomy (DP) is increasingly done by laparoscopy but data from routine practise are scarce. We describe practise in a national cohort.MethodsData from the Norwegian Patient Register of all patients undergoing DP from 2012 to 2016. National resection rates were analysed. Short-term outcomes include length of stay, reoperation, readmissions and 90-day mortality. Risk is reported as odds ratio (OR) with 95% confidence interval (c.i.).ResultsOf 554 procedures, 327 (59%) were laparoscopic. Median age was 66 years (iqr 55–72) and 52% were women. Resection rates increased during the period for all DP (from 1.76 to 2.39 per 100.000/yr), and significantly for laparoscopic DP (adjusted R-square 0.858; P = 0.015). Elderly patients had more resection (r₂ = 0.11; P = 0.019). Splenectomy (n = 427; 77%) was less likely with laparoscopy (laparoscopy 72% vs open 84%, respectively; OR 0.64, 95% c.i. 0.42–0.97; P = 0.035). Multivisceral resections occurred more often in open DP (5.3% vs 1.2% for laparoscopy, OR 4.51, 1.44–14.2; P = 0.008). Reoperation occurred in 34 (6%), readmission in 109 (20%), and mortality in 8 (1.4%). Hospital stay was shorter for laparoscopic DP.ConclusionUse of DP increases in the population, particularly in the elderly, with use of laparoscopic access and an association with a reduced hospital stay.     

Use of the national electronic maternal and child health registry (MCH eRegistry) in primary care clinics in occupied Palestinian territory: a pilot time-motion study

Background

In primary care maternal and child health clinics in occupied Palestinian territory, documentation and reporting consume considerable time for care providers. An electronic maternal and child health registry (MCH eRegistry), with point-of-care clinical decision support, is being implemented nationally in governmental clinics. We conducted a pilot study of time spent by care providers on important tasks, in preparation for a trial to compare eRegistry and non-eRegistry clinics.

Mental distress and job satisfaction in Palestinian nurses exposed to workplace aggression: a cross-sectional study

Background

Nurses who are exposed to workplace aggression from patients, patient relatives, or colleagues are at risk for mental health disorders and job dissatisfaction. The aim of this study was to assess the prevalence of exposure to workplace aggression and the association between mental distress and job satisfaction in nurses working in the Hebron district of the occupied Palestinian territory.

Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture

Background

In 2016, the International Study Group of Pancreatic Fistula (ISGPS) proposed an updated definition for postoperative pancreatic fistula (POPF). Pancreas texture (PT) is an established risk factor of POPF. The definition of soft vs. hard texture, however, remains elusive.

Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden

Background

Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.

Survival and morbidity after diagnosis of occlusive thromboaortopathy (Takayasu's disease)

Eighty-one young Japanese patients with occlusive thromboaortopathy (Takayasu's disease), including nine men, were followed up prospectively for 7.4 +/- 5.8 years (mean +/- standard deviation) after the established diagnosis. These patients were classified according to the presence and severity of four major complications (Takayasu's retinopathy, secondary hypertension, aortic regurgitation and aortic or arterial aneurysm) attributed to Takayasu's disease at the time when the diagnosis was established: no complications (group I) or mild single complication (group IIa) and severe single complication (group IIb) or multiple complications (group III). When the data were analyzed with the left table method, severe events attributed to TAkayasu's disease, as well as death, were used as end points. Seven of the 81 patients were surgically treated; 2 of the 7 died and 1 had severe events postoperatively. In the remaining 74, the 10 year cumulative eventless survival rate after the diagnosis in combined groups I and IIa (44 patients) and combined groups IIb and III (30 patients) was 97.0 +/- 2.9 (mean +/- standard error of the mean) and 58.6 +/- 11.3 percent, respectively (p less than 0.002). These data are useful for predicting death or severe events, or both, and provide basic information regarding possible elective surgery for patients with this intractable disease.     

The effect of centralization on short term outcomes of pancreatoduodenectomy in a universal health care system

Background

Centralization of pancreatic resections is advocated due to a volume-outcome association. Pancreatic surgery is in Norway currently performed only in five teaching hospitals. The aim was to describe the short-term outcomes after pancreatoduodenectomy (PD) within the current organizational model and to assess for regional disparities.

Effects of vitamin D3 metabolites on production of prolactin and growth hormone in rat pituitary cells

Recent animal studies and tissue-culture studies have led to the suggestion that prolactin (PRL) and growth hormone (GH) are involved in the regulation of 25-hydroxyvitamin d-1α-hydroxylase activity. This study was undertaken to investigate the effects of vitamin D on the production of PRL and GH. A clonal strain of rat-pituitary tumor cells (GH₃) that spontaneously synthesize and secrete PRL and GH was used as model system. The hormones were measured by radioimmunoassay, and the amount of hormones that accumulated in the medium during 24 h was used as a measure of prolactin.Treatment of the GH₃ cells with 1α, 25-dihydroxyvitamin D₃ (1α, 25-(OH)₂D) caused a parallel and dose-dependent decrease in the production of both PRL and GH, and the effects were significant at 10^?11 and 10^?10 M, respectively. The maximal inhibition (20–40% of controls) by 1α, 25-(OH)₂D was obtained at 10^?6 M after 6 days of treatment, and the effect was detectable after 2 days. Similar effects were observed with 25-hydroxy-vitamin D₃ (25-OHD) and the synthetic analog 1α-hydroxyvitamin D₃ (1α-OHD), but the ED₅₀ for these substances were more than 10³ times higher than the corresponding concentration of 1α, 25-(OH)₂D. In contrast, there was no effect of 24,25-dihydroxyvitamin D₃ (24,25-(OH)₂D) (10^?11?10^?6M) on the production of PRL and GH. None of the vitamin D analogs affected cell growth measured as total cell protein. Equimolar concentrations (10^?7M) of 25-OHD, 1α-OHD and 24,25-(OH)₂D slightly reduced the inhibitory effect of 1α,25-(OH)₂D when used in combination.The stimulatory effects of thyroliberin (TRH) and estrogens on PRL production were partly inhibited by treatment with 1α,25-(OH)₂D. GH₃ cells pre-treated with 1α,25-(OH)₂D had similar TRH and 17β-estradiol-binding characteristics as untreated control cells.We conclude that, in GH₃ cells, 1α,25-(OH)₂D reduces the production of PRL and GH and strongly counteracts the actions of TRH and estrogens without affecting receptor affinity and concentration. Our results suggest a feed-back loop between the renal tubular cells and the anterior pituitary.     

Clinical and hemodynamic results after combined aortic and mitral valve replacement with the Lillehei-Kaster pivoting disc valve.

Combined mitral and aortic valve replacement with the Lillehei-Kaster pivoting disc valve prosthesis was performed in 23 patients. Hospital mortality rate was 8.3 per cent. Detailed postoperative clinical and hemodynamic studies were performed after a mean follow-up period of 24.4 months. Replacement of both valves had resulted in a marked symptomatic and hemodynamic improvement with a normal or nearly normal resting value of cardiac output, pulmonary arterial pressure, and pulmonary vascular resistance while left ventricular end-diastolic pressure (LVEDP) had increased significantly. The rise in left ventricular end-diastolic pressure most probably might be related to the simultaneous rise in cardiac output (Starling mechanism), reflecting the severity and irreversibility of the underlying myocardial disease. Most patients also had systolic gradient across the aortic prosthesis, as well as diastolic gradient across the mitral prosthesis. The gradients across the mitral prosthesis were approximately the same as seen after single valve replacement, while the pressure gradients across the aortic prosthesis were somewhat smaller than previously reported. Angiographic studies of the aortic valve movement indicated that the opening angle of the disc was approximately 60 degrees, and thus less than according to the valve specifications.     

First results from the Swedish National Pancreatic and Periampullary Cancer Registry

Background

Despite improvements in therapy regimens over the past decades, overall survival rates for pancreatic and periampullary cancer are poor. Specific cancer registries are set up in various nations to regional differences and to enable larger prospective trials. The aim of this study was to describe the Swedish register, including possibilities to improve diagnostic work-ups, treatment, and follow-up by means of the register.

High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based,propensity score adjusted analysis

Background

Current consensus guidelines suggest that gallbladder cancer (GBC) patients with resected T1a disease can be observed while patients with T1b or greater lesions should undergo lymphadenectomy (LNE). The primary aim of this study was to critically explore the impact of LNE in early-stage GBC on overall survival (OS) on a population-based level.

Trichosporon capitatum: thrush-like oral infection, local invasion, fungaemia and metastatic abscess formation in a leukaemic patient

A thrush-like oral infection with subsequent alveolar abscess formation and a positive blood culture due to Trichosporon capitatum developed in a patient with acute myelogenous leukaemia. Later T. capitatum was identified by indirect immunofluorescence in multiple splenic abscesses. The infection was controlled by immediate aggressive treatment with amphotericin B, flucytosine and rifampicin and by splenectomy. This case of systemic T. capitatum infection resembles somewhat the invasive mycosis due to candida.     

Carbohydrate intolerance associated with reduced hepatic glucose phosphorylating and releasing enzyme activities and peripheral insulin resistance in alcoholics with liver cirrhosis

Carbohydrate intolerance was investigated in 8 alcoholics with liver cirrhosis and in controls. Indices of carbohydrate metabolism, glucose and insulin levels after glucose loading, were compared with glucose phosphorylating (glucokinase, hexokinase) and releasing (glucose-6-phosphatase) enzymes. Comparison was also made with pericellular collagen in liver biopsies and with insulin sensitivity assessed by the euglycemic clamp technique and with conventional liver function tests including oral antipyrine test. Glucokinase activity was low or absent, hexokinase activity increased and the GK/HK ratio reduced. Glucose-6-phosphatase activity was lowered and insulin sensitivity decreased. Pericellular collagen was increased (P less than 0.001) and related to the fasting glucose (r0.593) and insulin levels (r0.526). Blood glucose was related to antipyrine metabolism (r-0.727) but not to the other liver tests. Glucose intolerance in cirrhosis seems to be associated with reduced glucose phosphorylating and liberating enzyme activities. Hyperinsulinaemia, developing secondarily, may then lead to insulin resistance.