Importance of preservation of chordal apparatus in mitral valve replacement

Mitral valve replacement often involves disruption of the chordal apparatus with disturbance of the annulo-papillary continuity. This results in significant downgrading of ventricular function. Analyzes various reports to accurately assess the advantages of chordal preservation. This review briefly briefly reviews the surgical techniques. The advantages of chordal preservation are analyzed, with particular emphasis on the technical difficulties and potential complications involved.     

Hypertension in the developing world: A consequence of progress

Hypertension is one of the leading causes of death and disability in developing countries. The increasing burden of hypertension in these countries has been attributed to several indicators of economic progress such as increased life expectancy, urbanization and its attendant lifestyle changes, and the overall epidemiologic transition these countries are experiencing currently. The public health response to this challenge must be to promote health among all sections of the populations of these countries, and a concerted effort to promote awareness about hypertension, its risk factors, and risk behaviors. The health policies of these countries need to be reoriented to include chronic diseases in their ambit. These efforts have the potential to reduce the emergence or lessen the toll of hypertension and its complication in many parts of the developing world.     

Foreign bodies in upper digestive tract

Foreign body ingestion is a common problem frequently encountered in both children and adults. A total number of 152 patients (104 children and 48 adults) with ingested foreign body admitted in our hospital are reviewed. Location of foreign body was made out by radiological examination. History of having swallowed foreign body was the most common symptom in both blunt and sharp foreign bodies. Endoscopic removal of foreign body was done under general anaesthesia for all cases, except one in which foreign body was removed by open surgical method. Blunt, foreign bodies were common among children, where as meat with bone was common in adults (19/48). Most of blunt foreign bodies in children (83.5%) were impacted in post cricoid region. Where as in adutls, the foreign bodies (37.5%) were seen in upper oesophagus. Retropharyngeal abscess was seen in 2 cases, which was associated with sharp foreign bodies. In all but one, endoscopic removal was successful. In one case denture impacted in post cricoid region was removed by open surgical method. There was no mortality in our series.     

In vivo assessment of enhanced topical delivery of terbinafine to human stratum corneum.

PURPOSE: The objective of this study was to evaluate, using attenuated total reflectance Fourier transform infrared spectroscopy, the stratum corneum (SC) bioavailability of terbinafine (TBF) following topical treatment with four different formulations. METHODS: Four skin sites on the ventral forearms of five healthy volunteers were treated for 2 h using one of four formulations based on a vehicle consisting of 50% ethanol and 50% isopropyl myristate. Three of these formulations included a percutaneous penetration enhancer: either 5% oleic acid, 10% 2-pyrrolidone or 1% urea. The SC concentration profile of TBF was measured by repeated infrared spectroscopic measurements while sequentially stripping off the layers of this barrier membrane with adhesive tape. This method was validated by HPLC analysis of TBF extracted from the stripped tapes. Transepidermal water loss (TEWL) measurements were also performed, to permit facile estimation of SC thickness. RESULTS: The SC concentration profiles of TBF were fitted to the appropriate solution of Fick's second law of diffusion, thereby allowing determination of the characteristic diffusion and partitioning parameters of the permeating drug. This analysis enabled the efficacies of the different formulations tested to be compared to the no-enhancer control. While it was found that the formulation containing 5% oleic acid significantly enhanced the SC availability of TBF, the other formulations did not improve the apparent drug delivery. CONCLUSIONS: A facile and minimally invasive methodology to evaluate an important aspect of topical drug bioavailability has been described. The analytical methods used (infrared spectroscopy and HPLC) allow estimates of both relative and absolute drug bioavailability in the SC and may be useful, therefore, in the critical determination of bioequivalence between topical formulations.     

Efalizumab for severe refractory atopic eczema: retrospective study on 11 cases

Background Efalizumab is a recombinant humanized murine monoclonal antibody against CD11a, approved for the treatment of plaque psoriasis. However, recent reports suggest that it also may be effective in the treatment of severe atopic dermatitis (AD). Objective To evaluate the clinical effect of efalizumab in AD. Methods A systematic retrospective study of the medical files of patients treated with efalizumab for AD in Danish dermatology departments. Positive outcome was defined as improvement of the disease registered in the patient's file over a period exceeding 6 months. Results Two of eleven patients had a positive outcome. Nine patients stopped treatment due to progression of AD or lack of effect. Limitations Retrospective study. Conclusions Only a minority of patients with severe AD responded to efalizumab treatment in a standard dose.