Analysis of a clinical sign in traditional Chinese medicine using Doppler ultrasound

Using Doppler ultrasound, a study was done on the characteristics of the radial pulse at the wrist in pregnant and non‐pregnant women in order to test the hypothesis that the traditional Chinese medicine ‘smooth pulse’ of pregnancy has a physiological basis. Comparison of pulse characteristics in a small series of subjects strongly supports this hypothesis.     

Recurrent malignant pilomatrixoma invading the cranial cavity: Improved local control with adjuvant radiation

We report the case of a 41‐year‐old mentally retarded male with recurrent pilomatrix carcinoma of the occipital region which invaded the occipital bone, left cerebellum and left temporal lobe. At his initial presentation the patient had a craniotomy and subtotal excision of the lesion with positive margins. He received no adjuvant therapy. After an early intracranial recurrence he had subtotal debulking and was referred for external beam radiotherapy. At 27 months follow‐up after adjuvant external beam radiotherapy the intracranial component has not progressed and the patient remains clinically well.     

The waiting game: natural history of a cataract waiting list in New Zealand

Aims : To identify the demographic and visual function of patients on the reserve waiting list for cataract surgery at a large public hospital within New Zealand and to determine the ultimate outcome of those on a priority‐based, rationed, health‐care waiting list. Methods : Patients from a defined geographical population, placed on a reserve waiting list for possible cataract surgery, during the period January 1997 to March 2000, were invited to attend for further clinical assessment and asked to complete a visual assessment questionnaire. Results : Of 193 patients in the pilot study group who had been on the reserve waiting list for a mean of 18.2 ± 11.6 months (range 0.1–62.7 months), only 94 (49%) were deemed suitable for, and subsequently underwent, surgery in the public sector. Forty‐nine (25%) had undergone surgery earlier, the majority of these (84%) in the private sector. A further 23 (12%) patients were deceased, four (2%) declined surgery and in six (3%) cataract surgery was no longer indicated. The remaining 11 (6%) patients could not be traced. Patients still awaiting surgery had a mean age of 77.2 years (range 48–95 years). Fifty‐four were women. Vision had deteriorated by a mean of 0.05 LogMAR units, from Snellen equivalent 6/30 at listing to 6/36, over this time. Conclusions : Current methods of prioritization for cataract surgery are imperfect, as are the resources for performing adequate levels of cataract surgery. Analysis of a residual waiting list for cataract surgery highlights that the majority (51%) do not ultimately progress to cataract surgery in the public sector for a variety of reasons. During a mean waiting time of 1.5 years vision further deteriorates in this predominantly older population.     

Radiofrequency ablation for incidentally identified primary intrahepatic cholangiocarcinoma

Cholangiocarcinoma is the second most common primary hepato-biliary malignancy. The majority of patients with primary hepatic tumors are not suitable candidates for resection, due to advanced stage of the disease at presentation, anatomic limitations and medical co-morbidities. At present, radiofrequency ablation (RFA) may offer an alternative, feasible and safe therapy for selected patients with hepatic tumors, who are not otherwise candidates for hepatic resection. Herein, we present the case of successful RFA in a patient with a solitary, primary intrahepatic Cholangiocarcinoma. The patient remained free of disease 24 mo after the procedure, and is still followed up. This is the first report of RFA application in the treatment of primary intrahepatic Cholangiocarcinoma.     

Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases

BACKGROUND: Hepatic arterial infusion pump chemotherapy is an important component in the treatment of patients with hepatic metastases. Successful use of a hepatic arterial infusion pump requires a low technical complication rate. We evaluated the complications and longterm durability of these devices at our institution. STUDY DESIGN: Between April 1986 and March 2001, 544 patients underwent hepatic arterial infusion pump placement for treatment of unresectable colorectal liver metastases. Patient- and pump-related data were collected by chart review. Pump-related complications, duration of pump function, and overall patient survival were recorded. RESULTS: Median patient survival was 24 months after pump placement. The incidences of pump failure were 9% at 1 year and 16% at 2 years. Pump complications occurred in 120 (22%) of the patients. Complications that occurred early after operation (< 30 days) were more likely to be salvaged than those occurring late (70% versus 30%, p < 0.001). Increased pump complication rates occurred in the setting of variant arterial anatomy (28% versus 19%, p = 0.02), when the catheter was inserted into a vessel other than the gastroduodenal artery (42% versus 21%, p = 0.004), if the pump was placed during the first half of the study period (1986 to 1993, 25% versus 1994 to 2001, 18%; p = 0.05), and if the surgeon had performed fewer than 25 earlier procedures (< 25, 31% versus > or = 25, 19%; p < 0.002). CONCLUSIONS: In this large single institution experience, pump-related complications were low, the majority of early pump complications were salvaged, and pump complication rates improved as institutional experience accumulated. Longterm durability of pump function was excellent.     

Malignant versus nonmalignant retroperitoneal fibrosis: differentiation with MR imaging

To evaluate the features on magnetic resonance (MR) images of malignant and nonmalignant retroperitoneal fibrosis (RPF) and to assess the usefulness of MR imaging in differentiating the two conditions, MR studies of nine patients with malignant RPF were retrospectively examined and compared with those of eight patients with nonmalignant RPF. Morphologic findings at MR imaging were similar for both conditions. The lesions were, however, heterogeneous in six of the nine patients with malignant RPF and homogeneous in all eight patients with nonmalignant RPF. On T2-predominant images, malignant RPF showed high signal intensity, while nonmalignant RPF showed low signal intensity. On T2-predominant images, signal intensity and T2 were significantly higher in malignant RPF than in nonmalignant RPF. Differentiation between malignant and nonmalignant RPF appears feasible and depends on tissue contrast rather than on morphologic characteristics.