Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications

BACKGROUND: Wound complications associated with long incisions used to harvest the greater saphenous vein are well documented. Recent reports suggest that techniques of endoscopic vein harvest may result in decreased wound complications. A prospective, nonrandomized study was developed to compare outcomes of open versus endoscopic vein harvest procedures. METHODS: There were 106 patients in the open vein harvest group, and 154 patients in the endoscopic vein harvest group. Patient characteristics and demographics were similar in both groups. Wound complications identified were dehiscence, drainage for greater than 2 weeks postoperatively, cellulitis, hematoma, and seroma/lymphocele. RESULTS: Wound complications were significantly less in the endoscopic vein harvest group (9 of 133, 6.8%) versus the open vein harvest group (26 of 92, 28.3%), p less than 0.001. By multivariable analysis with logistic regression, the open vein harvest technique was the only risk factor for postoperative leg wound complication (relative risk 4.0). CONCLUSIONS: Endoscopic vein harvest offered improved patient outcomes in terms of wound healing compared with the open vein harvest technique.     

Emetine ditartrate: a possible lead for emergency contraception

Interception of pregnancy in its initial stage is an attractive and viable approach to contraception. A chemical agent, taken within the first few days of missed menses, intercepts the conception, which is expelled with menstrual flow. The main targets of such agents are the uterus, blastocyst and the growing trophoblasts, whose nutritional requirement is inhibited. Our previous work has identified several nonsteroidal chemical entities as pregnancy interceptives in rodents and infrahuman primates. However, none reached clinical stage due to their ineffectiveness by oral route. Nevertheless, parallel to these rationally designed synthetic compounds, a program was ongoing to identify natural product(s) that can be used as interceptives. We are reporting for the first time the detailed profile of emetine ditartrate, a compound whose pregnancy interceptive efficacy has been studied in mouse, rat, hamster, guinea pig and rabbit by oral and intravaginal routes of administration. By the oral route, the compound caused 100% resorption of the fetuses in rat, hamster and guinea pig at 6.0, 5.0 and 3.0 mg/kg, respectively, on administration during peri- and early postimplantation periods of pregnancy (depending upon the day of implantation in each species). By intravaginal route, the compound was administered once in the form of a vaginal pessary on the day of implantation in respective species; interception of pregnancy was not achieved completely in rat and hamster at doses four to five times the oral dose in multi-day schedule. However, in guinea pig and rabbit it was fully effective at 7.0 and 70.0 mg/animal, respectively. The compound was devoid of estrogenic, antiestrogenic and progestational activity but possessed mild antiprogestational activity at the high dose in vivo. In in vitro assay, however, it did not show any significant binding to estrogen and progesterone receptors. The mode of action of the compound was found to be mainly on the uterus and early embryos around implantation, possibly on the trophoblasts and endometrial cells at the attachment site. The absence of 100% efficacy in rat and hamster by intravaginal route, but not by oral route, is possibly due to poor absorption of the compound through the vagina in these species. The guinea pig and rabbit, therefore, seem the better species for evaluating the efficacy of the compound administered by the vaginal route.     

Syntheses and bioevaluation of substituted dihydropyridines for pregnancy-interceptive activity in hamsters

A number of 2,6-dimethyl-3,5-bis(methoxycarbonyl)-4-substituted-1,4- dihydropyridines were synthesized and evaluated for pregnancy-interceptive activity in mated hamsters. Out of 24 compounds, 12, 15, 21, 22, 28, and 34 caused a marked reduction in the number of implantations when administered on days 3-8 postcoitum. In an in vitro competition assay, none of the compounds exhibited noticeable binding affinity for uterine progesterone receptors. The results reported here have helped to identify new leads for developing pregnancy-interceptive agents and the active compounds do not seem to elicit their interceptive effect through receptor-mediated inhibition of progesterone action in hamster uterus.     

Acute renal failure due to rifampicin

A 23-year-old male patient with bacteriologically proven pulmonary tuberculosis was treated with the various regimens of antituberculosis drugs for nearly 15 months. Rifampicin was administered thrice as one of the 3-4 drug regimen and each time he developed untoward side effects like nausea, vomiting and fever with chills and rigors. The last such episode was of acute renal failure at which stage the patient was seen by the authors of this report. The patient, however, made a full recovery.     

Angioimmunoblastic Lymphoma With Proliferative Glomerulonephritis: A Rare Association

IntroductionAngioimmunoblastic T-cell lymphoma (AILT) is a subtype of peripheral T-cell lymphomas characterized by a polymorphous infiltrate involving lymph nodes, with a prominent proliferation of high endothelial venules and follicular dendritic cells along with systemic disease. It accounts for only 1%-2% of non-Hodgkin lymphomas. It usually involves peripheral lymph nodes, liver, spleen, bone marrow, and skin. Proliferative glomerulonephritis with AILT is extremely rare and is reported in only 5 cases in the literature. We describe a unique case of proliferative glomerulonephritis without immune deposits in a patient with AILT.Patients and MethodsA 68-year-old male presented with complaints of shortness of breath, fever, and weakness since 3 months. Physical examination revealed generalized lymphadenopathy with multiple, nontender, mobile lymph nodes with average size between 2-5 cm and hepatosplenomegaly. 1+ pitting edema was noted on the lower extremities, and skin examination revealed evidence of generally distributed pigmented skin macules associated with itching. Patient clinical course was worsened by a progressive renal failure and nephrotic range proteinuria. Axillary lymph node biopsy revealed architectural effacement, vascular growth with monoclonal T-cell population with T-cell receptor gamma gene restriction consistent with angioimmunoblastic T-cell lymphoma. Kidney biopsy revealed proliferative glomerulonephritis with increased mesangial cellularity and endocapillary proliferation and mild interstitial fibrosis. Immunofluorescence showed focal 1+ C3 staining in the glomerular capillary walls and mesangium. There were no immune deposits on electron microscopy. Patient required 1 episode of dialysis with improvement in renal function. A single cycle of chemotherapy with the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) was given. However, the patient developed neutropenic sepsis and died.ResultsThe occurrence of proliferative glomerulonephritis with AILT is extremely rare. Most of the cases described so far had immune deposits. Our case is unique since the kidney biopsy did not show any evidence of immune deposits at any site. Mechanisms proposed to explain the renal lesions in lymphoid malignancies include expression of tumor antigens, autologous nontumor antigens, viral or fetal antigens, immune complex deposition and disordered T-cell function.ConclusionIn our opinion, cell-mediated immune reaction and/or alternate complement pathway activation (as evidenced by focal C3 staining) might have contributed to the glomerulonephritis in this case. The number of cases with this presentation is very few and the optimum management is not known. This case adds to the literature and helps us in better understanding the disease.