Evaluation of the clinical, hemodynamic and neurohormonal response to levosimendan administration in decompensated heart failure patients. One-month follow-up.

INTRODUCTION: Levosimendan is an inodilatory drug with hemodynamic effects in patients with decompensated chronic heart failure. AIM: Short-term (one month) evaluation of clinical, hemodynamic and neurohormonal changes in patients with decompensated chronic heart failure undergoing levosimendan therapy. METHODS: Twenty-six (21 male) consecutive patients were studied, corresponding to 32 levosimendan administrations (bolus + 24h infusion), aged 56.7+/-13.0 years, with decompensated chronic heart failure, in NYHA functional class III-IV (78.1% in class IV), and cardiac index (CI) <2.5 l/min/m2. Clinical (NYHA class), non-invasive hemodynamic (echocardiography) and neurohormonal (Elecsys ECLIA NT-ProBNP) evaluations were performed before levosimendan administration and on days 1, 4, 10 and 30. RESULTS: 1) Until day 10, there was a progressive decrease in NT-ProBNP values and weight (p<0.001), with an increase in CI (p<0.001); 2) NYHA functional class improved progressively, with 76% of the patients in NYHA class II at day 30; 3) NT-ProBNP values at day 1 correlated inversely (r=-0.414; p=0.024) with CI at day 4; and 4) the absolute decrease in NT-ProBNP values at day 4 (relative to baseline values) correlated with weight loss at day 4 (r=0.495, p=0.005), day 10 (r=0.424, p=0.031) and day 30 (r=0.486, p=0.030). CONCLUSION: Levosimendan therapy in patients with decompensated chronic heart failure contributes to progressive NYHA class improvement. The variations seen in NYHA class and hemodynamics was reflected in changes in NT-ProBNP.     

Human papillomavirus and HIV coinfection and the risk of neoplasias of the lower genital tract: a review of recent developments

ONE OF THE RISK FACTORS FOR HUMAN PAPILLOMAVIRUS (HPV) INFECTION and subsequent lower genital tract neoplasias and cancers is impaired cell-mediated immunity. HIV-positive women with severe immunosuppression are 5 times more likely than HIV-negative women to have lower genital tract neoplasias. A corresponding increase in the risk of invasive vulvar and anal cancers, but not of cervical cancer, has also been observed among HIV-positive women. Treatment failure and recurrence of neoplasia occur much more frequently among HIV-positive than among HIV-negative women. In this review, we discuss recent advances in the understanding of the relation between HIV and HPV coinfection and the development of lower genital tract neoplasias and cancers in women. In addition, we present strategies for monitoring and treating noninvasive and invasive neoplasias of the lower genital tract in HIV-positive women.     

Misdiagnosed fibrosarcoma of the mandible mimicking temporomandibular disorder: a rare condition.

The jawbones can be sites of various neoplastic conditions. Given the variety of processes affecting this particular anatomical area, formulation of a precise diagnosis can be challenging to clinicians. Limited jaw movement, pain, and facial asymmetry are common signs among patients, especially those with temporomandibular disorder (TMD). This paper reports a case of primary fibrosarcoma affecting the mandible and surrounding structures in a 14-year-old girl presenting signs and symptoms similar to TMD. Her condition was misdiagnosed, and she was treated for TMD over an extended period before the correct diagnosis was made for fibrosarcoma. The patient underwent surgical resection with postsurgical radiotherapy and chemotherapy and now is being followed up. Although malignant lesions are rare in the temporomandibular joint (TMJ) region, dentists are advised to be aware of the condition and to keep in mind that patients who are admitting for TMD can also possibly be affected from neoplasms. Hence, those patients have to be examined meticulously to avoid misdiagnosis and mistreatment.     

Three-Dimensional Reconstruction of Basal Cell Carcinomas

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin cancer. One of the main problems with BCC is the risk of local recurrence of the tumor after treatment. This is mainly due to its irregular outgrowths, which cannot be detected clinically. OBJECTIVE: To better understand the tumor morphology and growth pattern of BCC, we tried to develop a method that provides a precise three-dimensional model of the tumor. METHODS: Because Mohs surgery provides the best overview of the tumor and the tumor margins (both lateral and in depth), the reconstruction was based on slides from Mohs surgery. After digitization and processing of the slides, the tumor was then surrounded by a Mohs surgeon on a computer screen. These selections (lines) were used for a three-dimensional reconstruction of the tumor using MedSurf3D software. RESULTS: This method allows three-dimensional reconstruction of any given BCC. The MedSurf3D software enables visualization of a three-dimensional model of the tissue, which is removed during the surgical procedure. CONCLUSIONS: Three-dimensional reconstruction is a fascinating tool that might improve our understanding of the behavior, growth pattern, and tumor morphology of BCCs. This technique might also be useful in other fields of cutaneous oncology, such as the calculation of the tumor volume of melanomas.     

Bulk polymerization of lactides initiated by aluminium isopropoxide, 3. Thermal stability and viscoelastic properties

The thermal stability of poly(L -lactide) and L /D -lactide stereocopolymers polymerized in bulk with aluminium isopropoxide as initiator was investigated by thermogravimetric analysis, and time and temperature dependence of molecular weight and polydispersity. Compared to poly(L -lactide) prepared with stannous octoate as catalyst the thermal stability of polylactides is remarkably enhanced when the ring-opening polymerization is initiated by aluminium alkoxide. Ultimate mechanical properties and viscoelasticity of these melt-stable thermoplastics have also been studied in relation to the polyester enantiomeric composition.