Carcinoma of the maxillary antrum — A 10 year experience

A retrospective analysis was performed of 250 cases of carcinoma of the maxillary antrum seen over a 10 years period (1975–1984). 98.24% patients were seen in T3 and T4 stages (UICC 1985). 40.7% patients presented with clinically palpable nodes. 42.9% patients were treated by radical radiation and 18.6% by a combination of preoperative radiation followed by surgery. Rest 38.5% patients were treated with palliative intention. Three year disease free survival was 39.58% with radiation alone and 51.91% with combined modality treatment which includes patients salvaged by surgery. Failures were mainly at the local site, 75.86% with radiation alone and 60% with combined modality treatment. Combined modality treatment, preferably preoperative radiation followed by radical surgery, gives the best results in the management of carcinoma of the maxillary antrum. Based upon paper read at 8th Congress of Association of Radiation Oncologists of India, Bombay, December 5–8, 1986.     

Simple tests in amniotic fluid for evaluation of gestational age

Amniotic fluid was collected from 105 pregnant mothers without any obstertrical or medical complications between 13–41 weeks of gestation. Simple tests viz. Nile blue sulphate test for cytology and shake test were performed in 92 cases. The study has revealed that more than 20 percent of orange cells were found above 36 weeks of gestation in most of the cases (92%) and the cells were in clusters. The shake test positive results increased with the increasing gestational age and were seen in majority of cases (82.5%) above 36 weeks of pregnancy. The cell was found to be a better parameter as compared to shake test. However, based on the results of study both the tests are recommended for routine use in ward side laboratories.     

Infection scoring in early neonatal infection

This study reports the usefulness of infection scoring system, comprising of maternal and neonatal high risk factors for infection. The score was applied on 947 neonates at birth who were followed up for superficial and deep infections in postnatal wards or neonatal nursery. Total score consisted of 10 points. A high association was observed between increasing score and total and deep infections. Incidence of infections was 0, 5.0, 10.5, 20.9, 61.8 and 95.4 percent respectively with infection scores of 0, 1, 2, 3, 4 and 5 and above respectively. For term infants, cut off point for infection was at score 3, while for low birth ones this was lower at 2. This study, therefore, shows the utility of this practical scoring system in prediction of early neonatal infections.     

Difficult cases in heart failure: chemotherapy-related cardiomyopathy--all that glitters is not gold

As long-term morbidity with chemotherapeutic exposure becomes a clinical reality, the development of cardiomyopathy with heart failure is rapidly growing. The type of chemotherapy agent, dose, rate of administration, use of combination chemotherapy, and concomitant radiation therapy are major factors that define the propensity to cardiotoxicity. Chemotherapy-related cardiomyopathy is multifactorial in origin and requires a diligent etiologic survey to arrive at the appropriate diagnosis. A contemporary discussion of chemotherapy-related cardiomyopathy with particular emphasis on the pathogenesis and ameliorative targets of this unique clinical disorder are described in this report.     

Revascularization in severe ventricular dysfunction (15% < OR = LVEF < OR = 30%): a comparison of bypass grafting and percutaneous intervention

BACKGROUND: We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction. METHODS: We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% < OR = LV ejection fraction < OR = 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997. RESULTS: The CABG group was younger (62 versus 67 years, p = 0.026), and fewer previous bypasses (7% versus 40%, p < 0.0001) and fewer prior percutaneous revascularizations (16% versus 42%, p = 0.0019) were noted. More vessels were revascularized (3 +/- 0.8 versus 1.5 +/- 0.7, p < 0.0001), and revascularization was more complete by CABG (84% versus 48%, p < 0.0001). Morbidity and mortality at 30 days were similar, and there was no significant difference in 3-year survival (73% versus 67%), although 3-year cardiac event-free survival (52% versus 25%, p = 0.0011) and 3-year target vessel revascularization-free survival (71% versus 41%, p < 0.0001) were significantly better in the CABG group, and LV ejection fraction was significantly improved after CABG. In the subgroup of patients 65 years of age or older and those without proximal left anterior descending coronary artery lesions, significant benefit of CABG in cardiac event-free and target vessel revascularization-free survival disappeared. CONCLUSIONS: We found that in clinically selected patients with severe ventricular dysfunction, CABG compared with percutaneous revascularization achieves more complete revascularization, improved LV function, fewer cardiac events, and fewer target vessel revascularizations, but does not affect mid-term survival. A prospective controlled trial with defined criteria for treatment assignment is warranted to confirm our results regarding the two revascularization strategies in patients with severe LV dysfunction.     

Revascularization in severe ventricular dysfunction (15% ≤ LVEF ≤ 30%): a comparison of bypass grafting and percutaneous intervention

Background

We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction.

Methods

We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% ≤ LV ejection fraction ≤ 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997.

Results

The CABG group was younger (62 versus 67 years, p = 0.026), and fewer previous bypasses (7% versus 40%, p < 0.0001) and fewer prior percutaneous revascularizations (16% versus 42%, p = 0.0019) were noted. More vessels were revascularized (3 ± 0.8 versus 1.5 ± 0.7, p < 0.0001), and revascularization was more complete by CABG (84% versus 48%, p < 0.0001). Morbidity and mortality at 30 days were similar, and there was no significant difference in 3-year survival (73% versus 67%), although 3-year cardiac event-free survival (52% versus 25%, p = 0.0011) and 3-year target vessel revascularization-free survival (71% versus 41%, p < 0.0001) were significantly better in the CABG group, and LV ejection fraction was significantly improved after CABG. In the subgroup of patients 65 years of age or older and those without proximal left anterior descending coronary artery lesions, significant benefit of CABG in cardiac event-free and target vessel revascularization-free survival disappeared.

Conclusions

We found that in clinically selected patients with severe ventricular dysfunction, CABG compared with percutaneous revascularization achieves more complete revascularization, improved LV function, fewer cardiac events, and fewer target vessel revascularizations, but does not affect mid-term survival. A prospective controlled trial with defined criteria for treatment assignment is warranted to confirm our results regarding the two revascularization strategies in patients with severe LV dysfunction.     

Is heart failure with preserved systolic function an overlooked enigma?

Heart failure with preserved systolic function, or diastolic heart failure, represents the neglected other half of the pandemic of heart failure. Unlike previously held beliefs, diastolic heart failure carries with it the same connotation of morbidity and mortality as systolic heart failure, particularly in the elderly. Due to lack of standards in application of the diagnosis of diastolic heart failure, studies are difficult to interpret due to heterogeneity in the clinical criteria applied to the patient enrollment. It is imperative that preventive efforts be implemented in high-risk groups, and screening measures with newer biomarkers be considered for identifying underlying structural heart disease in order to employ preventive therapy early in the course of illness. No evidence-based therapeutic strategy to reduce morbidity and mortality has been established, even after the diagnosis of diastolic heart failure is manifest. Current therapy targets lusitropic abnormalities in the realm of impaired relaxation, abnormal diastolic compliance, avoidance of tachycardia, and restoration of atrial booster pump function. Outcomes-based placebocontrolled clinical trials are currently underway to define appropriate therapeutic strategies in diastolic heart failure.