Transesophageal Echocardiographic Diagnosis of Coronary Stenosis in a Stroke Patient

This study represents another example of the usefulness of transesophageal echocardiography in the assessment of stenosis involving the proximal, mid, and distal coronary arteries in stroke patients referred for exclusion of a cardiac source of embolism.     

Cutaneous leishmaniasis in Guatemala: comparison of diagnostic methods

A comparison was made of methods used to diagnose suspected cutaneous leishmaniasis in Guatemala. The most sensitive method was a combination of thin smears made from superficial scrapings of the ulcers and inoculation of culture medium with either aspirates or scrapings. The diagnosis was confirmed in 252 (70%) of 362 patients. Ability to cultivate Leishmania was correlated with the concentration of amastigotes seen on thin smears. Leishmania were cultured in 42 (27%) of 153 patients with no amastigotes found in 400 oil-immersion fields and in 174 (83%) of 209 patients with at least 1 amastigote. No difference in diagnostic outcome was found when we compared smears or cultures taken from the center or the border of the ulcer or from an incision made tangential from the ulcer. We found no difference when we compared smears obtained with scalpels, capillary tubes, or dental broaches. The use of scrub brushes soaked in iodine neither decreased the rate of culturing parasites nor decreased contamination rates.     

Three‐dimensional transthoracic echocardiographic identification of individual cusps of the pulmonary valve: Potential misidentification by the two‐dimensional technique

We demonstrate the incremental value of live/real time three‐dimensional transthoracic echocardiography (3DTTE) over the two‐dimensional modality in the identification of all three cusps of the pulmonary valve in patients in whom only two leaflets could be detected by the latter technique. This was because of the ability of 3DTTE to view the cusps enface permitting assessment of relationship to one another and the surrounding cardiac structures. In addition, 3DTTE showed not only the potential errors that can occur in pulmonary valve cusp identification when the two‐dimensional modality is used alone but also how some of these errors can be avoided by paying attention to the surrounding structures.     

Transpharyngeal Echocardiographic Imaging of the Right and Left Carotid Arteries

We present a technique for transpharyngeal imaging of the bilateral carotid arteries completed towards the end of a transesophageal echocardiogram. To our knowledge, this is the first report that demonstrates the bifurcation of the right common carotid artery into the right internal and external carotid arteries with a transesophageal echocardiographic probe.     

Placebo-controlled clinical trial of meglumine antimonate (glucantime) vs. localized controlled heat in the treatment of cutaneous leishmaniasis in Guatemala

Sixty-six Guatemalans with parasitologically proven cutaneous leishmaniasis were randomly and equally divided into 3 treatment groups: those receiving meglumine antimonate (Glucantime), 850 mg antimony/day im for 15 days; those receiving localized controlled heat from a radio-frequency generator, 50 degrees C for 30 sec, 3 treatments at 7 day intervals; and those receiving treatment with a placebo. Of 53 isolates identified, 40 were Leishmania braziliensis braziliensis and 13 were L. mexicana mexicana. Thirteen weeks after beginning treatment, the number of patients from each group with completely healed and parasitologically negative lesions were as follows: meglumine antimonate, 16 (73%); localized heat, 16 (73%); and placebo, 6 (27%). The cure rate for those with infections due to L. b. braziliensis in each group was as follows: meglumine antimonate, 11 out of 14 (79%); controlled heat, 9 out of 14 (64%); and placebo, 0 out of 11.     

Immunotherapy for thoracic malignancies

Purpose

Historically, thoracic malignancies, such as non-small cell lung cancer and malignant pleural mesothelioma, have been marked by poor prognosis. Current standard of care for these diseases results in limited improvements in survival benefit. This has prompted researchers to explore new and innovative treatment alternatives. Immunotherapy is an emerging therapeutic modality that harnesses the power of the human immune system against cancer cells. Herein, we summarize the concepts and current status of immunotherapy for the treatment of thoracic malignancies.

Methods

Using ClinicalTrials.gov, we conducted a literature review using the terms “immunotherapy” and “immune therapy,” and combined them with the conditions “pleural mesothelioma” and “carcinoma, non-small cell lung.” The search results yielded 452 trials, among which 122 trials met our specific criteria.

Results

Our search identified immune checkpoint blockade, immunotoxin therapy, anticancer vaccines, and adoptive cell therapy as the most common and relevant immunotherapies that are currently being assessed in clinical trials.

Conclusion

We have highlighted the successes, as well as the limitations, of immunotherapy for non-small cell lung cancer and malignant pleural mesothelioma. We have identified early phase clinical trials that assess immunotherapy as first-line, second-line, and maintenance therapy, and compared these drugs as monotherapeutics or in combination with chemotherapy or other types of immunotherapy.

     

Delayed sternal closure does not reduce complications associated with coagulopathy and right ventricular failure after left ventricular assist device implantation

Delayed sternal closure (DSC) is occasionally adopted after implantation of left ventricular assist device (LVAD). Recent studies suggest that DSC be used for high risk group of patients with coagulopathy, hemodynamic instability or right ventricular failure. However, whether DSC is efficacious for bleeding complication or right ventricular failure is not known. This study is single center analysis of 52 patients, who underwent LVAD implantation. Of those 52 patients, 40 consecutive patients underwent DSC routinely. The sternum was left open with vacuum assist device after implantation of LVAD. Perioperative outcome of the patients who underwent routine DSC were compared with 12 patients who had immediate sternal closure (IC). Mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level of IC group and DSC group were 2.7 and 2.6, respectively. Postoperative bleeding (643 vs. 1469 ml, p?<?0.001), duration of inotropic support (109 vs. 172 h, p?=?0.034), and time to extubation (26 vs. 52 h, p?=?0.005) were significantly increased in DSC group. Length of ICU stay (14 vs. 15 days, p?=?0.234) and hospital stay (28 vs. 20 days, p?=?0.145) were similar. Incidence of right ventricular failure and tamponade were similar in the two groups. Routine DSC after implantation of an LVAD did not prove to be beneficial in reducing complications associated with coagulopathy and hemodynamic instability including cardiac tamponade or right ventricular failure. We suggest that DSC be selectively applied for patients undergoing LVAD implant.