Congenital left atrial appendage ostial stenosis in an extremely premature infant diagnosed by transthoracic echocardiography

Congenital left atrial appendage ostial stenosis is a very rare congenital cardiac condition. We present the case of an extremely premature infant with congenital left atrial appendage ostial stenosis diagnosed by transthoracic echocardiographic imaging.     

Muscle architecture adaptations to knee extensor eccentric training: Rectus femoris vs. vastus lateralis

Introduction: Changes in muscle architecture induced by eccentric knee extensor training remain unclear, as well the adaptive responses of synergistic knee extensor muscles with different geometrical designs. Methods: Ultrasonography images were taken from rectus femoris (RF) and vastus lateralis (VL) of 20 male volunteers before and after a non‐training control period of 4 weeks, and additional evaluations were performed after 4, 8, and 12 weeks of isokinetic eccentric training. Results: RF and VL had significant changes in muscle architecture within the first 4 training weeks, and the adaptive response throughout the intervention was similar. Muscle thickness increased by around 7–10%, fascicle length increased 17–19%, and pennation angle was unchanged. Conclusions: Increased muscle thickness due to eccentric training was related to increased fascicle length and not to pennation angle changes. Although RF and VL have a different fascicular geometry, they had similar morphological adaptations to eccentric training. Muscle Nerve 48 : 498–506, 2013     

Mechanism of human accommodation as analyzed by nonlinear finite element analysis

Results of nonlinear finite element analysis support the Schachar theory of accommodation and demonstrate that the long-held Helmholtz theory of accommodation is impossible.     

Surgical resection for small cell carcinoma of the lung: a retrospective study.

BACKGROUND--A retrospective review was undertaken of the survival of 21 patients with histologically proven small cell carcinoma of the lung resected between 1977 and 1991. METHODS--Twenty one patients (20 men) of median age 60 (range 44-73) years underwent surgical resection. Patients were subjected to standard clinical staging procedures. Preoperative diagnosis was small cell carcinoma of the lung in 13, non-small cell lung cancer in one, and uncertain in seven patients. Clinical staging was stage I disease in 11 and stage II in 10 patients. RESULTS--Resection included pneumonectomy in 12 cases, lobectomy in eight, and one wedge resection. Resection was complete in 16 patients. Postoperative histopathological examination confirmed small cell carcinoma of the lung in 19 specimens and mixed small cell and non-small cell carcinoma of the lung in two. Pathological staging was stage I in 11, stage II in three, and stage III in seven patients. The final pathological diagnosis of the resected specimens (n = 18) was atypical carcinoid in one, pure small cell carcinoma of the lung in 15, and mixed small cell and non-small cell carcinoma of the lung in two patients. Fourteen patients also received chemotherapy and 10 received prophylactic cranial irradiation postoperatively. Excluding the patient with a final diagnosis of atypical carcinoid, the median survival (n = 20) was 29 months (range two to 133+). Median survival for patients with pathological stage I and II disease (n = 13) was 40 months (range nine to 133+) and for patients with pathological stage III disease (n = 7) 20 months (range two to 116+). The median disease free survival was 23 months. Eleven patients relapsed between two and 101 months. There was no advantage for those patients who received postoperative chemotherapy. CONCLUSION--Curative resection offers the best chance for long term survival in patients with small cell carcinoma of the lung with very limited stage disease.     

Fibreoptic bronchoscopic electrosurgery under local anaesthesia for rapid palliation in patients with central airway malignancies: a preliminary report.

BACKGROUND--Obstruction of a major airway by tumour causes serious morbidity. There is still scope for a widely applicable, simple and effective treatment to provide rapid palliation. METHODS--A fibreoptic bronchoscope prototype with an insulated inner sheath was used under local anaesthesia in 17 patients with locally advanced tracheobronchial malignancies. An insulated flexible electro-surgery probe was used to coagulate intraluminal tumour mass using standard electrosurgery equipment. RESULTS--Immediate reopening of the airway was obtained in 15 of the 17 patients. Two appeared to have extraluminal disease. Eleven patients had an obvious bronchoscopic response in whom a > 75% reopening of the normal airway diameter was achieved. Eight patients had subjective improvement of their dyspnoea, but only in four cases was there an objective improvement in physiological parameters. Haemoptysis resolved in four. There were no deaths resulting from treatment. Minor bleeding occurred in one patient and an aspiration pneumonia occurred in one. Three patients received additional treatment. CONCLUSIONS--Fibreoptic bronchoscopic electrosurgery is a simple technique for rapid palliation and immediate tumour debulking in patients with central tracheobronchial tumours. Further work is needed to compare its efficacy with other techniques.     

Comparison of IgG subclasses in foetal serum, maternal serum at delivery and milk in IgA-deficient and control women

Immunoglobulin G subclass concentrations were measured in paired foetal (cord) and maternal serum specimens at delivery from 27 IgA-deficient (serum IgA < 0.01 g/l) and 15 control women. IgA-deficient women had significantly higher serum IgGl and IgG3 concentrations than control women but 2 of the group had concomitant IgG2/IgG4 deficiency and a further 12 had low IgG4 concentrations (serum IgG4 < 0.025 g/l). Foetal serum also had significantly higher IgGl concentrations than control foetal serum but lower IgG2 and IgG4 levels. Concentrations of IgG subclasses and IgM were measured in breast milk collected on the fifth day postpartum from 19 of these IgA-deficient and 18 control women. Between-group differences in IgG subclass levels resembled those in serum. Compared with serum, proportionally less IgG3 was present in milk in both groups although the contribution of IgG3 to total IgG was not less than that of IgG4. Slightly higher IgM was found in milk from the IgA-deficient mothers.     

多层螺旋CT对食管鱼刺异物的诊断价值

目的 探讨MSCT对食管鱼刺异物的检出率及临床诊断价值.方法 实验组:取3种鱼的鱼刺各30根,分为大、中、小鱼刺3组,3组鱼刺长度分别为(23.36±0.15)、(28.51±0.07)和(30.89±0.10)mm,直径分别为(4.4.9±0.31)、(1.78±0.09)和(0.49±0.07)mm.将鱼刺按照与食管长轴平行、垂直、斜行方式插入食管模型中,MSCT检查采用轴面扫描结合三维重组技术,观察MSCT和X线平片(CR和DR)对鱼刺的显示情况.临床组:回顾性分析20例经内镜或临床手术证实的食管鱼刺异物患者的资料,所有患者均行MSCT平扫,其中11例行X线平片(CR和DR)检查,15例行食管吞钡棉絮检查,17例行内镜检查,观察几种检查方法对鱼刺的显示情况.对不同方法对鱼刺显示情况的比较采用配对卡方检验.结果 实验组:MSCT检出鱼刺90根(100%),X线平片(CR和DR)检出鱼刺60根(66.7%),MSCT对鱼刺的检出率高于X线平片(CR和DR)(X2=28.03,P<0.01).临床组:20例中,MSCT检出鱼刺20例,且清楚显示鱼刺的位置、大小及其与食管壁和邻近组织的关系;X线平片检出鱼刺2例,食管吞钡棉絮检出鱼刺9例,内镜检出鱼刺14例.MSCT对食管鱼刺异物检出率高于X线平片(cR和DR)检查(X2=7.11,P<0.05)及食管吞钡棉絮检查(X2=4.17,P<01 05),与内镜检查差异无统计学意义(X2=1.33,P>0.05).结论 MSCT轴面扫描结合三维重组技术对食管鱼刺异物及其周围并发症的检出率高,可作为食管鱼刺异物的首选检查方法.     

Amyloid tumour resected by laser therapy

We report a patient presenting with dyspnoea, cough and fever with a middle lobe atelectasis. Amyloid deposits in the bronchial wall caused almost complete obstruction of the middle lobe bronchus. The patient was treated with neodymium yttrium aluminium garnet (NdYAG) laser photoresection resulting in complete clearance of the middle lobe bronchus. Laser therapy has to be considered as first-line therapy for patients with endobronchial amyloidosis.