Primary hepatic carcinoid tumours

BACKGROUND: Carcinoid tumours of the liver are predominantly metastases from the gastrointestinal tract. Primary hepatic carcinoids are extremely rare. DISCUSSION: In contrast to metastases, primary hepatic carcinoids are usually solitary and resectable. It is important that these tumours are differentiated from metastases. Complete surgical resection should be contemplated and is generally curative.     

Laparoscopic removal of an artery forceps.

Numerous foreign bodies, such as surgical gauze, pads and instruments, and other items, have been left behind in the abdominal cavity during open surgeries. These have been traditionally removed at redo open surgeries. Here we describe a case of an artery forceps left behind at a previous surgery (open cholecystectomy and appendicectomy) performed 5 years earlier that was removed by laparoscopy.     

Outcomes after identical and compatible orthotopic liver transplantation for fulminant hepatic failure: a single center experience in UK

To analyze the outcomes between identical and compatible liver transplantation (OLT) for fulminant hepatic failure (FHF) from September 1984 to November 2005. The patients were divided in three groups; group 1 (identical), group 2 (compatible) and group 3 (incompatible), according to the donor-recipient blood type matching. We analyzed several outcomes regarding mortality, patient and graft survival, incidence of acute graft rejection during the first postoperative month (30 days), incidence of biliary complications and indications of re-transplantation. We also analyzed the relationship of Coomb's positive test with postoperative hemolysis to all the above mentioned factors. During the study period, 168 males and 112 females underwent their first OLT for FHF, with 37.1% overall mortality and 42.1% overall graft failure rate. The results between group 1 (203 patients) and group 2 (73 patients) were comparable. A statistically significant difference was recorded in 1 year and overall graft survival between group 1 and group 2 (P = 0.049 and log-rank = 0.035 respectively). Coomb's positive test did not influence the outcomes. OLT in FHF can be safely carried out whether the donor organs are identical or compatible. Hemolysis (Coomb's positive test) after identical or compatible OLT does not influence the outcomes.     

Permanent transfemoral pacemaker insertion after repair of congenital heart disease

In certain patients with anomalies of systemic venous connection, traditional transvenous pacemaker lead insertion may not be technically feasible. We report the use of the femoral venous approach to insert a permanent pacemaker in a patient with congenital heart disease who had undergone two previous cardiac operations and had persistent anomalies of the superior systemic venous circulation. We recommend that the femoral venous approach be considered in select patients requiring permanent pacing.     

Aldrin poisoning of Sarus cranes (Grus antigone) and a few granivorous birds in Keoladeo National Park,Bharatpur, India

Between 1987–88 and 1989–90, 18 Sarus cranes (Grus antigone), more than 50 collared doves (Streptopelia decaocto) and a few blue rock pigeons (Columba livia) were found dead during winter in Keoladeo National Park, Bharatpur, which coincided with the application of aldrin in the crop fields around the Park. Brain tissue of Sarus cranes, collared doves and blue rock pigeons contained an average of 19.33 (3.56–43.46), 15.19 (7.40–20.70), and 20.42 (14.61–26.23) ppm, wet weight, of dieldrin, respectively. Dieldrin in other tissues ranged from 0.78 ppm to 92.26 ppm in Sarus cranes, 3.44 ppm to 66.17 ppm in collared doves and 16.92 ppm to 20.99 ppm in blue rock pigeons. Residues of aldrin were as high as 89.75 ppm in the gastrointestinal tract of a Sarus crane and 104.00 ppm in a collared dove. Very high residues of aldrin in the gastrointestinal tract, and dieldrin at much higher quantities in the brain than the lethal level (4–5 ppm) clearly indicate that dieldrin, after being metabolized from aldrin, was responsible for the deaths. A decline in the breeding population of Sarus cranes in Keoladeo National Park has been noticed, and is suspected to be an indication of its general population trend. The Registration Committee under the Indian Insecticide Act of 1968 has decided to include aldrin in the banned list with the ban taking effect from January 1994.     

A "cleanup procedure" involving periodate oxidation in the enzymatic synthesis of chemically pure alpha-32P and alpha-33P labelled deoxyribonucleotides.

Enzymatic synthesis of alpha-(32)P and alpha-(33)P labelled deoxyribonucleotides involves the transfer of radiolabelled phosphorus from either gamma-(32)P adenosine triphosphate (gamma-ATP) or gamma-(32)P guanosine triphosphate (gamma-GTP). Subsequent removal of these ribonucleotides is essential for the preparation of chemically pure deoxyribonucleotides. Agarose-phenyl boronate columns, which bind specifically to cis-diol moieties, have been used for the removal of ribonucleotide contaminants. However, this involves column losses and additional radiation exposure. In the present work we describe a chemical method for the improvement of the chemical purity, based on the preferential oxidation of ribose sugars by periodate. The cis-diol moiety of ribose is specifically oxidised to the dialdehyde. The excess periodate ions were destroyed using ethylene glycol. The phosphate group was then cleaved by beta-elimination using alkali. The product was purified using anion exchange chromatography. The efficiency of the process was validated using tracer gamma-(32)P ATP and alpha-(32)P dATP. Samples at various steps were analysed by TLC, autoradiography and HPLC. During the process ATP is oxidised whereas 2'-deoxyadenosine triphosphate (dATP) remains intact. The alpha-(32)P dATP synthesized by this process was assayed for its incorporation in lambda-DNA by the random priming method and was found to be effectively incorporated. The process developed is an efficient and convenient method for the preparation of chemically pure deoxyribonucleotides.     

Surgical treatment of congenital coronary artery fistula.

Six patients with congenital coronary artery fistula underwent successful corrective surgery. Precise diagnosis was established either by retrograde aortography or more recently by selective arteriography. The left coronary artery was involved in four and the right in two cases. The fistula communicated with the right ventricle in three and the right atrium in three subjects. The operative approach is dictated by the site of entry of the vessel into the cardiac chamber. The use of cardiopulmonary bypass for intracardiac repair allows accurate closure of the fistula thereby reducing the chances of recurrence. A follow-up of one to seven years showed that all patients are asymptomatic and leading normal lives.     

Experience with the surgical treatment of coarctation of the aorta in India.

Between 1961 and 1977, 51 patients underwent operations for coarctation of the aorta. The average age of presentation of these cases was higher than in other series. Only three were asymptomatic, a finding which is not seen in reports from the West. Operative procedures included resection and graft interposition, resection and end-to-end anastomosis, and bypass grafting. However, the technique of patch angioplasty, routinely performed in the last three years of this review, seemed by far the most satisfactory procedure. The overall operative mortality was 9.8%. Hypertension did not regress in some cases in spite of a successful operation. Recoarctation was not seen in this series. Associated defects influenced results adversely. The overall results of operation for coarctation of the aorta have been very satisfactory and comparable with those in other recorded series.