Robotic transhiatal excision of epiphrenic diverticula

An epiphrenic oesophageal diverticulum is most commonly a pulsion diverticulum which develops consequent to protrusion of mucosa through the muscular wall of the distal oesophagus. Most of them are associated with underlying oesophageal motility disorders. The predominant symptoms are dysphagia with regurgitation, and sometimes retrosternal pain, if accompanied by spasm of the oesophagus. Surgical management is recommended for symptomatic patients. Traditional procedures include thoracotomy or laparotomy with excision of the diverticula, but these are associated with high morbidity. Laparoscopic approach is a safe treatment option associated with lesser morbidity. Here, we present a case of epiphrenic diverticulum which was treated by the robotic approach without any complication. There was also no associated motility abnormality in our case so fundoplication was not done. Robotic surgery is a useful tool while operating near the hiatus and gastro-oesophageal junction. We consider transhiatal robotic approach as a safe and easy approach for surgery of epiphrenic diverticulum.     

Predictors of early treatment failure following initial therapy for systemic immunoglobulin light-chain amyloidosis

We analysed factors predicting early treatment failure (ETF), after first-line therapy for light-chain amyloidosis (AL). AL amyloidosis patients seen at Mayo Clinic within 90?days of diagnosis, from 2006 to 2015, excluding those who died within 3 months of initial therapy, were analysed retrospectively. ETF was defined as progression requiring treatment change or death within 12 (ETF12) or 24 (ETF24) months of first-line treatment. Non-ETF included those with a follow-up of more than 12 or 24 months who had progression beyond 12 or 24 months. A total of 724 patients met the study criteria; 244 (33.7%) had ETF12 and 388 (53.6%) had ETF24. Patients with ETF12 were older (64.1 vs. 62.2?years) with higher prevalence of cardiac (81 vs. 64.1%) and multi-organ involvement (67.2 vs. 45.4%) and higher proportion of patients with t(11; 14) (58.5 vs. 44.3%) or in higher Mayo 2012 stage (58.5 vs. 41.1%).The median follow-up was 5.4?years from start of initial therapy. In multivariate analysis, presence of t(11; 14) and non-incorporation of autologous transplant in initial therapy are significant predictors of ETF12 (p?=?.01and p?=?.003) and ETF24 (p?=?.0001 and p?=?.005) while Mayo stage is predictive of ETF24 (p?=?.002), but not ETF12.     

Incremental benefit of three‐dimensional transthoracic echocardiography in the assessment of left atrial appendage aneurysm leading to severe extrinsic compression of a coronary artery

Left atrial appendage aneurysm (LAA AN) is a rare disease entity, which can be congenital or acquired in nature. We report an adult patient with LAA AN presenting with anginal chest pain in whom live/real time three‐dimensional transthoracic echocardiography (3DTTE) provided incremental value over the two‐dimensional (2D) technique in providing a more comprehensive assessment of the lesion. A literature review of the salient features of LAA AN is also provided in a tabular form.     

Trachyspermum ammi L. (Carom) Oil Induces Alterations in SOD-3, GST-4 Expression and Prolongs Lifespan in Caenorhabditis elegans

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - The use of herbs in the form of dietary supplements and medicine is fascinating the world, owing to their...