Simultaneous coronary - subclavian and vertebral - subclavian steal syndrome.

Atherosclerotic disease of the coronary artery may simultaneously involve the subclavian artery, and a significant stenosis of the left subclavian artery may result in recurrent myocardial ischemia in patients with patent left internal mammary artery (LIMA) grafts because of 'coronary steal' through the LIMA. Isometric exercise of the left arm may improve myocardial perfusion through vertebral - subclavian steal by flow reversal in the ipsilateral vertebral artery because of the change in the pressure gradient between the circle of Willis and the distal subclavian artery. The present patient had coronary steal through a LIMA after coronary artery bypass surgery and a transient vertebral - subclavian steal with improved myocardial perfusion as a result of exercise of the left arm.     

A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis

Background

Several endoscopic modified radical neck dissections (MRND) have been conducted since the introduction of the endoscopic technique to thyroid surgery with the aim of avoiding a long cervical scar. Furthermore, the recent introduction of surgical robotic systems has increased the precision of endoscopic techniques. The aim of this study was to evaluate and compare the early surgical outcomes of robotic and conventional open MRND for papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM).

Methods

From January 2009 to May 2010, 165 patients with PTC underwent bilateral total thyroidectomy with central compartment neck dissection and ipsilateral MRND. Of these patients, 56 formed the robotic procedure group (RG) and 109 the conventional open procedure group. These two groups were retrospectively compared with respect to their clinicopathological characteristics, early surgical outcomes, and surgical completeness.

Results

The operative time was longer, mean tumor size was smaller, mean age was lower, and disease stage was earlier in the RG. However, mean numbers of retrieved lymph nodes were similar in the two groups, and mean hospital stay after surgery was shorter in the RG. Furthermore, complication rates were similar in the two groups, and there was no statistical difference in postoperative Tg levels between the groups.

Conclusions

Robotic MRND was found to be similar to conventional open MRND in terms of early surgical outcomes and surgical completeness but leaves no scar on the neck area. Robotic MRND can be viewed as an acceptable alternative method in low-risk PTC with LNM.     

Pharmacological characterization of recombinant N-type calcium channel (Cav2.2) mediated calcium mobilization using FLIPR

The N-type voltage-gated calcium channel (Ca(v)2.2) functions in neurons to regulate neurotransmitter release. It comprises a clinically relevant target for chronic pain. We have validated a calcium mobilization approach to assessing Ca(v)2.2 pharmacology in two stable Ca(v)2.2 cell lines: alpha1(B), alpha2delta, beta(3)-HEK-293 and alpha1(B), beta(3)-HEK-293. Ca(v)2.2 channels were opened by addition of KCl and Ca(2+) mobilization was measured by Fluo-4 fluorescence on a fluorescence imaging plate reader (FLIPR(96)). Ca(v)2.2 expression and biophysics were confirmed by patch-clamp electrophysiology (EP). Both cell lines responded to KCl with adequate signal-to-background. Signals from both cell lines were inhibited by omega-conotoxin (ctx)-MVIIa and omega-conotoxin (ctx)-GVIa with IC(50) values of 1.8 and 1nM, respectively, for the three-subunit stable, and 0.9 and 0.6nM, respectively, for the two-subunit stable. Other known Ca(v)2.2 blockers were characterized including cadmium, flunarizine, fluspirilene, and mibefradil. IC(50) values correlated with literature EP-derived values. Novel Ca(v)2.2 pharmacology was identified in classes of compounds with other primary pharmacological activities, including Na(+) channel inhibitors and antidepressants. Novel Na(+) channel compounds with high potency at Ca(v)2.2 were identified in the phenoxyphenyl pyridine, phenoxyphenyl pyrazole, and other classes. The highest potency at Ca(v)2.2 tricyclic antidepressant identified was desipramine.     

Part-time occlusion therapy for anisometropic amblyopia detected in children eight years of age and older

PURPOSE: To determine the outcome of part-time occlusion therapy in children with anisometropic amblyopia detected after they were 8 years of age. METHODS: We analyzed 29 eyes with anisometropic amblyopia in children 8 years of age and older. The mean age was 8.79 +/- 0.98 (range 8-12) years old. The subjects whose best-corrected visual acuity (BCVA) did not improve by two lines or better within 2 weeks of wearing glasses full-time were prescribed occlusion therapy for 6 hours a day outside of school hours, along with the instruction to wear glasses full-time. Subjects who complied with occlusion for more than 3 hours a day were considered to comply well. RESULTS: The major component of the anisometropia was hyperopia in 51.7% of the subjects, and hyperopia plus astigmatism was found in 24.1%. The mean pretreatment BCVA score was 0.51 0.23 (LogMAR). Compliance was 89.66%. The mean posttreatment BCVA was 0.03 +/- 0.01 (LogMAR), and the success rate, based on a posttreatment BCVA of 0.1 (LogMAR) and better, was 96.43%. It took an average of 4.79 +/- 3.35 months to reach the desired posttreatment BCVA. The mean posttreatment stereopsis was 79.78 +/- 37.61 seconds of arc. The recurrence rate was 8%. The visual improvement was related to the degree of compliance (p = 0.000). The time taken to reach the posttreatment BCVA was shorter in subjects with a better pretreatment BCVA (p = 0.019), but it did not relate to the compliance (p = 0.366). CONCLUSIONS: The most common component of anisometropia detected after 8 years of age was hyperopia. The part-time occlusion therapy, which had been carried out after school hours, was successful in most cases.