Real time three-dimensional echocardiography in assessment of left ventricular dyssynchrony and cardiac resynchronization therapy

Left ventricular (LV) mechanical dyssynchrony is an important prognostic marker for higher morbidity and mortality in patients with symptomatic heart failure. However, the response rate to resynchronization varies among patients meeting current guidelines for Cardiac resynchronization therapy (CRT). Two-dimensional echocardiography and Doppler-based techniques have shown variable results in the assessment of LV dyssynchrony. There is an obvious need for a noninvasive tool that can reliably measure LV dyssynchrony. Accurate prediction of response to CRT will improve patient selection for such therapy. Real time three-dimensional echocardiography (RT3DE) is a novel noninvasive imaging modality that has been recently used in quantitative evaluation of global and regional LV function. A number of published studies have described the use of RT3DE in the measurement of LV dyssynchrony in patients with normal or reduced LV function. The systolic dyssynchrony index derived from RT3DE has been used to quantify LV dysynchrony and to evaluate and predict the response to CRT. This review will discuss the recently published data regarding the role of RT3DE in CRT.     

Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis

Tuberculosis （TB） occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and inter- nally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by anti- biotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to anti- tubercular drug therapy （ATT）, the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.     

Locking Compression Plate in Musculoskeletal Oncology 'a Friend in Need'

Background

We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture.

Methods

A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends.

Results

There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures.

Conclusions

Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.     

An open-label phase 1 clinical trial of the allogeneic side population adipose-derived mesenchymal stem cells in SMA type 1 patients

Neurological Sciences - Spinal muscular atrophy (SMA), an autosomal recessive neurodegenerative disorder of alpha motor neurons of spinal cord associated with progressive muscle weakness and...     

Does transcranial stimulation for motor evoked potentials (TcMEP) worsen seizures in epileptic patients following spinal deformity surgery?

Purpose

To investigate the effect of Transcranial Motor Evoked Potentials (TcMEP) in increasing the severity or frequency of post-operative seizures in patients undergoing deformity corrective spine surgery with a known history of seizures pre-operatively.

Methods

The information on all patients with history of epilepsy/seizures who underwent spinal TcMEP cord monitoring for deformity correction surgery was retrospectively collected through a review of the hospital notes. The benefits of TcMEP in the early detection of potential cord ischemia were deemed by the operating surgeon to outweigh the increased risks of seizures, tongue biting, etc. Data on age, gender, pre-operative diagnosis, curve type, intra-operative monitoring alerts, duration of hospital stay, and post-operative in-hospital seizures were collected. Additionally, the patients were contacted following discharge and data on any change in the frequency of the seizures or an alteration in seizure-related medication post-operatively was also collected.

Results

The records of 449 consecutively monitored patients were reviewed and 12 (2.7 %) patients with a history of seizures pre-operatively were identified. The mean age was 23 (9–59) years, 7 females, 11 scoliosis corrections (4 neuromuscular, 1 degenerative, 6 idiopathic adolescent), and one sagittal balance correction surgery. Intra-operatively, all patients had TcMEP monitoring, were catheterised, and had no neuromonitoring alerts or record of tongue biting or laceration. Post-operatively, the mean hospital stay was 12 (4–25) days with no recorded seizures. At a mean of 23 (12–49) months post-discharge, none of the patients reported a worsening of seizures (pattern or frequency) or required an alteration in the seizure-related medications.

Conclusion

TcMEP does not appear to trigger intra-operative or post-operative seizures and is not associated with deterioration in the seizure control of patients suffering seizures pre-operatively.

     

The role of pathologists in recognition of morphologic and biologic features of genetically mutated breast cancer

The recent introduction of genomic medicine and emphasis on optimizing breast cancer risk reduction mortalities has provided opportunities for pathologists to partner with clinicians in advancing the diagnosis and management of breast cancer patients. The discovery of breast cancer genes BRCA1, BRCA2, and other breast cancer genes is considered a major breakthrough in the understanding of hereditary breast cancer. These discoveries have contributed to investigate the nature of tumorigenesis and the genetic and molecular pathology in multistep tumor development, as well as their relationship to endocrine and environmental factors. The recognition of unique morphologic and biological features associated with genetically mutated breast cancer by pathologists may have an impact on appropriate follow‐up management of breast cancer patients.