Evaluation of regional lymph node dissection in patients with upper urinary tract urothelial cancer

OBJECTIVE: The role of the lymph node dissection (LND) in conjunction with nephroureterectomy (NU) in upper tract urothelial cell carcinoma (UT-UCC) remains undefined. We evaluated the manner in which the LND was applied at NU, the patterns of lymph node (LN) involvement and the preoperative variables that could identify patients at high risk for lymph node metastasis (LNM). METHODS: We examined clinical, radiological and pathological records of patients who underwent NU for UT-UCC between 1985 and 2004. The central pathology laboratory reviewed all specimens and graded tumors using the 2002 World Health Organization/International Society of Urologic Pathologists grading system. RESULTS: Of the NU performed in 252 patients for UT-UCC, 105 (42%) were N0, 28 (11%) N+ and 119 (47%) Nx. Some form of LN resection was performed with NU in 53% of patients, with a median of four LN sampled (interquartile range, 2-10). After adjustment for tumor and patient characteristics, surgeon remained a significant predictor of LN resection (P < 0.0005). Of the evaluated variables, suspicious LN on preoperative computed tomography, present in 60% of N+ patients, was the only preoperative variable associated with the pathological finding of LNM (P < 0.0005). CONCLUSIONS: LND in patients with UT-UCC is surgeon-dependent. Given the prognostic importance of LN status and the limited accuracy of preoperative staging of the regional LN, surgeons should perform a regional LND at the time of NU.     

Right atrial appendage tachycardia: A rare cause of tachycardia induced cardiomyopathy with successful radiofrequency ablation using the 3D mapping system

We report the case of a 40-year-old patient with incessant supraventricular tachycardia (SVT). As this SVT was resistant to medical therapy and was complicated by severe LV dysfunction and cardiogenic shock, the patient was referred for EPS (electrophysiologic study) and ablation. EPS and successful ablation of the right atrial appendage (RAA) tachycardia were performed by means of a 3D mapping system NavX (St. Jude Medical, St. Paul, MN, USA) with complete resolution of symptoms and normalization of LV function, as evaluated at three-month follow-up examination.     

Novel indole based hybrid oxadiazole scaffolds with N-(substituted-phenyl)butanamides: synthesis,lineweaver–burk plot evaluation and binding analysis of potent urease inhibitors

In the study presented herein, 4-(1H-indol-3-yl)butanoic acid (1) was sequentially transformed in the first phase into ethyl 4-(1H-indol-3-yl)butanoate (2), 4-(1H-indol-3-yl)butanohydrazide (3) and 5-[3-(1H-indol-3-yl)propyl]-1,3,4-oxadiazole-2-thiol (4) as a nucleophile. In the second phase, various electrophiles were synthesized by reacting substituted-anilines, 5a–j, with 4-chlorobutanoyl chloride (6) to afford 4-chloro-N-(substituted-phenyl)butanamides (7a–j). In the final phase, nucleophilic substitution reaction of 4 was carried out with different electrophiles, 7a–j, to achieve novel indole based oxadiazole scaffolds with N-(substituted-phenyl)butamides (8a–j). The structural confirmation of all the as-synthesized compounds was performed by spectral and elemental analysis. These molecules were screened for their in vitro inhibitory potential against urease enzyme and were found to be potent inhibitors. The results of enzyme inhibitory kinetics showed that compound 8c inhibited the enzyme competitively with a K_i value 0.003 μM. The results of the in silico study of these scaffolds were in full agreement with the experimental data and the ligands showed good binding energy values. The hemolytic study revealed their mild cytotoxicity towards cell membranes and hence, these molecules can be regarded as valuable therapeutic agents in drug designing programs.

In the study presented herein, 4-(1H-indol-3-yl)butanoic acid (1) was sequentially transformed in the first phase into ethyl 4-(1H-indol-3-yl)butanoate (2), 4-(1H-indol-3-yl)butanohydrazide (3) and 5-[3-(1H-indol-3-yl)propyl]-1,3,4-oxadiazole-2-thiol (4) as a nucleophile.     

Retrograde Percutaneous Closure of a Ventricular Septal Defect after Myectomy for Hypertrophic Obstructive Cardiomyopathy

In patients with hypertrophic obstructive cardiomyopathy, hemodynamically significant ventricular septal defect after septal myectomy is a rare sequela that warrants closure. Percutaneous closure provides a safer alternative to repeated sternotomy, which is associated with significant morbidity and mortality rates. We report a possibly unique case of successful retrograde percutaneous closure, with an AMPLATZER Muscular VSD Occluder, of an iatrogenic ventricular septal defect consequent to surgical therapy for hypertrophic obstructive cardiomyopathy.Key words: Cardiac catheterization/methods, cardiomyopathy, hypertrophic/therapy, heart septal defects, ventricular/therapy, iatrogenic disease, myectomy, postoperative complications, prosthesis implantation/methods, septal occluder device, ventricular septal defectPatients with hypertrophic obstructive cardiomyopathy (HOCM) are candidates for surgical myectomy or ethanol ablation if, despite medical therapy, they remain symptomatic with New York Heart Association functional class III disease and severe left ventricular outflow tract (LVOT) gradients.¹ A rare sequela of myectomy via the Morrow procedure is iatrogenic ventricular septal defect (VSD). Although surgical closure remains the mainstay of treatment for most VSDs, treatment of clinically significant postoperative residual VSDs remains a challenge. Percutaneous closure provides a safer alternative to reoperation.^2,3 We report a possibly unique case of successful retrograde percutaneous closure of an iatrogenic VSD, consequent to surgical therapy for HOCM, by means of an AMPLATZER® Muscular VSD Occluder (St. Jude Medical, Inc.; St. Paul, Minn).