Aggressive Approach in a Case of Cancer Cervix with Uremia

Carcinoma of cervix is the most common cancer in developing countries. Majority of them present in locally advanced stages. A 36-year-old lady presented with bleeding and white discharge per vagina since four months, vomiting and reduced urine output since two weeks. Patient had an exophytic cervical growth. Investigation revealed elevated serum creatinine. Patient received single fraction radiation and underwent percutaneous nephrostomy. At one month follow-up, serum creatinine returned to almost normal level. Patient underwent bilateral ante grade stenting and completed concurrent chemoradiotherapy. In selected subsets of patients, aggressive management offered longer palliation and good quality of life.     

Psychometric evaluation of the myasthenia gravis composite using Rasch analysis

Introduction: The MG Composite (MGC) is a validated outcome measure of the clinical manifestations of myasthenia gravis. Methods: We performed Rasch analyses of the MGC to investigate additional properties, including its unidimensionality and the appropriateness of the weights assigned to the response categories for the MGC items. Results: The fit statistics indicated that the 10 items belong together and can be summated for a total score. There was an overall absence of item order distortion between response categories. The Rasch model's expected category response values were compatible with item weights previously assigned. Conclusions: Our analysis suggests that: (1) the score can be summated to estimate an overall disease severity score; (2) the response options of the 10 items are not significantly distorted; and (3) the assigned weights of the response options are appropriate. Muscle Nerve 45: 820–825, 2012     

Endocardial laser ablation for the treatment of atrial fibrillation in an acute sheep model

BACKGROUND: The purpose of this study was to test the feasibility, effectiveness, and safety of the use of a new laser energy catheter for linear endocardial ablation in an acute sheep model. METHODS: Bipolar pacing electrodes were positioned on the left atrial appendage (LAA) and the pulmonary veins (PVs). Laser ablation within the left atrium was performed around the LAA and PVs in six sheep. The temperature in the esophagus was measured continuously during ablation. The animals were weaned from cardiopulmonary bypass (CPB) and were sacrificed two hours after ablation. The heart, lungs, and esophagus were retrieved for histological examination. RESULTS: Aortic cross clamp time was 26.2 +/- 6.1 minutes and CPB time was 81 +/- 29 minutes. Electrical isolation of the LAA and PVs was confirmed in all sheep. On histological analysis, there was an extensive transmural alteration of the left atrial tissue including vascular lesions, myocardial degeneration, and necrosis, and epi- and endocardial necrosis. In six out of six cases, extensive lesions of the esophagus (muscular layer) were also found. Significant changes in esophageal temperature were observed, reaching up to 70 degrees C. The epithelial layer of the esophagus was not affected by the laser energy, but mild focal degeneration of the subepithelial connective tissue was observed in all sheep. There were no injuries to the circumflex coronary artery. CONCLUSIONS: Laser is an effective tool in endocardial ablation, resulting in electrical isolation and transmurality. Future studies should more completely assess the safety of laser ablation, especially with regards to the nearby esophagus, as well as examine the results of epicardial application.     

银杏叶提取物对体外循环细胞因子的干预作用

目的：探讨体外循环脑损伤的发生机制及银杏叶提取物的干预作用．方法：选择44例心脏病需体外循环手术的风湿性心脏瓣膜病患者,随机分为观察组和对照组,每组22例．观察组在体外循环予充液中加入银杏叶提取物2mg／kg体质量,对照组应用常规予充液．分别在术前、主动脉阻断后1h,术后6,12,24和48h抽取静脉血标本,检测血清IL-1β,IL-18和S100蛋白水平．结果：对照组自CPB结束即刻开始,血清IL-1β显著升高,观察组血清IL-1β自主动脉阻断1h开始升高,持续至术后48h,自主动脉阻断1h开始,对照组显著低于观察组．对照组自术后6h开始,血清IL-18持续升高至术后48h,观察组血清IL-18主动脉阻断1h开始,血清IL-18持续升高至术后48h,主动脉阻断1h,对照组血清IL-18低于观察组,但术后6,12,24,48h显著高于观察组．对照组S100蛋白自CPB结束开始升高,持续至实验结束,自主动脉阻断1h开始至术后48h血清S100蛋白水平对照组均显著高于观察组．结论：体外循环心脏直视手术细胞因子IL-18参与脑组织损伤过程,GBE可调节细胞因子,使血清S100蛋白显著降低．