Kaposi's sarcoma: the most common tumor after renal transplantation in Saudi Arabia

Between September 1975 and November 1986, 263 renal transplant recipients at the King Faisal Specialist Hospital and Research Center were followed; 82 procedures were done by the authors using live related donors. Among the 263 patients, 14 cases of Kaposi's sarcoma were identified, an incidence of 5.3 percent compared with an incidence of 0.4 percent in renal transplant recipients from Western countries. In addition, two more patients had other types of tumors. Thus, Kaposi's sarcoma represents 87.5 percent of tumors in the King Faisal Hospital renal transplant population, in contrast to 3.7 percent in the Cincinnati Transplant Tumor Registry. The mean period between transplantation and diagnosis of Kaposi's sarcoma was 12.5 months (range, one to 37 months). Eleven patients were Saudis and three were other Arab nationals. Seven of the 11 Saudi patients were from the southwestern region of the country. Cytomegalovirus titers were not elevated in six of 10 patients. Results of tests for human immunodeficiency virus were negative in seven of eight patients. HLA-A2 antigen frequency was significantly increased in the King Faisal Hospital renal transplant patients with Kaposi's sarcoma as compared with a control population (83.3 percent versus 43.6 percent, p value = 0.006 [P = 0.06 with Bonferroni adjustment]), and increased, though nonsignificantly, compared with the live related kidney transplant recipients without Kaposi's sarcoma (83.3 percent versus 49.4 percent, p value = 0.058 [P = 0.58 with Bonferroni adjustment]), suggesting a genetic predisposition to Kaposi's sarcoma in these patients.     

Distal myocardial protection with intracoronary beta blocker when added to a Gp IIb/IIIa platelet receptor blocker during percutaneous coronary intervention improves clinical outcome

Objective : The present study tested the hypothesis that intracoronary (IC) propranolol improves clinical outcomes with percutaneous coronary intervention (PCI) when used with background Gp IIb/IIIa receptor blockade. Background : We have previously shown that administration of a relatively large weight‐based IC dose of the beta blocker propranolol before PCI decreases the incidence of post‐PCI myocardial infarction (MI) and improves short‐ and long‐term outcome. It has previously been shown that administration of a Gp IIb/IIIa receptor blocker decreases post‐PCI MI and improves short‐ and long‐term clinical outcome. Methods : Patients undergoing PCI (n = 400) were randomized in a prospective double‐blind fashion to IC propranolol (n = 200) or placebo (n = 200) with eptifibatide administered to all the patients. Myocardial isoform of creatine kinase was measured during the first 24 hr and clinical outcomes at 30 days and 1 year. Results : MI after PCI was seen in 21.5% of placebo and 12.5% of propranolol patients (relative risk reduction 0.42; 95%CI 0.09, 0.63; P = 0.016). At 30 days, the composite end point of death, post‐procedural MI, urgent target lesion revascularization, or MI after index hospitalization occurred in 22.5% of placebo vs. 13.5% of propranolol patients (risk reduction 0.43; 95%CI 0.08, 0.65; P = 0.018). Similar results were observed at 1 year with adverse outcomes in 21.5% of propranolol and 32.5% of placebo patients (P = 0.01). Conclusion : IC propranolol administration with the background Gp IIb/IIIa receptor blockade significantly reduces the incidence of post‐PCI MI and improves the short‐ and long‐term clinical outcome when compared with a Gp IIb/IIIa blocker alone. © 2008 Wiley‐Liss, Inc.     

Realistic dielectric response of high temperature sintered ZnO ceramic: a microscopic and spectroscopic approach

High temperature sintering (1200–1400 °C) has been performed on ZnO ceramics. An X-ray Absorption Fine Structure (XAFS) study shows that high sintering temperature introduces a constant amount of V_O and V_Zn defects without any significant effect on the crystal or electronic structure of Wurtzite ZnO. The combined effects of grain boundaries and voids are considered responsible for the apparent colossal dielectric constant (ε′) > 10⁴ at low frequency (∼10² Hz) for all the sintered ZnO ceramics. The superior contact among grains of the ZnO-1200 sample enhances both the interfacial and orientational polarization of the Zn²⁺–V_O dipoles, which results in the increase of low and high frequency dielectric constants (ε′) and the corresponding dielectric loss (tan δ) also increases. On the other hand, high temperature sintering of ZnO at 1300 °C and 1400 °C introduces voids at the expense of reduced grain and grain boundary contact areas, thus affecting both the interfacial and orientational polarization with corresponding reduction of dielectric constant (ε′) and dielectric loss. Orientational polarizations due to Zn²⁺–V_O dipoles are suggested to remain fixed and it is the microstructure which controls the dielectric properties of high temperature sintered ZnO ceramics.

Superior grain contacts of ZnO-1200 samples enhance low and high frequency dielectric constants (ε′) and dielectric loss (tan δ).     

Multiple volar dislocations of the carpometacarpal joints with an associated fracture of the first metacarpal base

Multiple pometacarpal （CMC） joints volar dislocations of car- are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clini- cal examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His ra- diographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with anextra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.     

Low pregnancy-associated plasma protein A level in the first trimester

Objective

To review the recent evidence behind the association of low levels (ie, below the fifth percentile) of pregnancy-associated plasma protein A (PAPP-A) with adverse perinatal outcomes and to integrate new findings with the recommendations made by the Society of Obstetricians and Gynaecologists of Canada in 2008.

Quality of evidence

A review of recently published articles revealed that current evidence is sparse and mixed for the association of low PAPP-A level with small size for gestational age, preterm delivery, hypertensive disorders of pregnancy, and stillbirth. There is limited evidence that suggests an association between low PAPP-A levels and spontaneous pregnancy loss. Recent studies suggest that low PAPP-A levels are associated with abnormal placentation, which might be the root cause of the adverse perinatal outcomes of interest.

Main message

The evidence behind the association of low PAPP-A levels with adverse perinatal outcomes is both lacking and mixed. However, recent data do suggest an association between low PAPP-A levels and abnormal placentation. This emerging topic currently lacks strong evidence-based guidelines, yet has potential important implications for perinatal outcomes. Collaboration with obstetric specialists regarding pregnant women who have low PAPP-A levels in the context of normal first-trimester aneuploidy screening results might aid clinical decision making about pregnancy and placental surveillance.

Conclusion

While the clinical meaning of a low PAPP-A level detected in the context of normal fetal aneuploidy screening remains under debate, pregnant patients with such results should be counseled that at present no strong evidence exists to justify an ongoing ultrasound surveillance program.     

Interventions for improving research productivity in clinical radiology

The purpose of this study was to evaluate the effects of research promotion activities on overall quality and quantity of research output in a clinical department of a teaching tertiary care hospital. Simple research enhancing strategies including regular journal club, research hour, basic research skills training, hiring of research faculty, research awards, and annual research retreat and research board to increase research production were implemented in the Department of Radiology of a teaching hospital in Pakistan. A total of 77 papers were produced by the Department of Radiology before the intervention, which increased to 92 after the introduction of research initiatives. There was a significant increase in the overall proportion of publications in the international journals after the intervention (p < 0.001) with an increasing trend towards indexed journals (p < 0.001). The research enhancing interventions had a positive effect on increasing clinical research output by the Department of Radiology. Such interventions can also be replicated in other clinical departments to increase their research productivity.