Resolution of hemolysis from pump thrombus during left ventricular assist device exchange

A 50-year-old male who underwent a Heart Mate Ⅱ left ventricular assist device placement for ischemic cardiomyopathy presented with discolored urine and hemolysis 3 mo after the operation. His hemolysis was thought to be due to thrombosis within the pump. Imaging studies were not able to visualize a left ventricular thrombus. Medical management with anticoagulation failed and he underwent surgery for a pump exchange. Intraoperatively, a firm thrombus was found within the pump of the Heart Mate Ⅱ, and the color of the urine changed dramatically from cola-colored to yellow which enabled us to confirm the diagnosis.     

Novel use of cap-assisted enteroscopy for detection of colorectal tumor in a patient with incarcerated inguinal hernia

Multiple reports have documented unsuspected ingui-nal hernias which result in difficulties during the colo-noscopic examinations of patients. In most cases, the colonoscopy can be delayed until a surgical consult has further evaluated the inguinal hernia. This case report documents a patient who required a colonoscopy but surgical intervention for the detected inguinal hernia was not appropriate due to his co-morbid medical con-ditions. With the use of the combination of an entero-scope fitted with a cap and fluoroscopy, the inguinal hernia was able to be negotiated and the diagnosis of a cecal carcinoma was able to be confirmed.     

Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia

AIM: To compare the short term outcome of endoscopic submucosal dissection(ESD) with that of laparoscopic colorectal resection(LC) for the treatment of early colorectal epithelial neoplasms that are not amenable to conventional endoscopic removal. METHODS: This was a retrospective cohort study. The clinical data of all consecutive patients who underwent ESD for endoscopically assessed benign lesions that were larger than 2 cm in diameter from 2009 to 2013 were collected. These patients were compared with a cohort of controls who underwent LC from 2005 to 2013. Lesions that were proven to be malignant by initial endoscopic biopsies were excluded. Mid and lower rectal lesions were not included because total mesorectal excision, which bears a more complicated postoperative course, is not indicated for lesions without histological proof of malignancy. Both ESD and LC were performed by the same surgical unit with a standardized technique. The patients were managed according to a standard protocol, and they were closely monitored for complications after the procedures. All hospital records were reviewed, and the following data were compared between the ESD and LC groups: patient demographics, size and location of the lesions, procedure time, shortterm clinical outcomes and pathology results. RESULTS: From 2005 to 2013, 65 patients who underwent ESD and 55 patients who underwent LC were included in this study. The two groups were similar in terms of sex(P = 0.41) and American Society of Anesthesiologist class(P = 0.58), although patients in the ESD group were slightly older(68.6 ± 9.4 vs 64.6 ± 9.9, P = 0.03). ESD could be accomplished with a shorter procedure time(113 ± 66 min vs 153 ± 43 min, P 0.01) for lesions of comparable size(3.0 ± 1.2 cm vs 3.4 ± 1.4 cm, P = 0.22) and location(colon/rectum:59/6 vs colon/rectum: 52/3, P = 0.43). ESD appeared to be associated with a lower short-term complication rate, but the difference did not reach statistical significance(10.8% vs 23.6%, P = 0.06). In the LC arm, a total of 22 complications occurred in 13 patients. A total of 7 complications occurred in the ESD arm, including 5 perforations and 2 episodes of bleeding. All perforations were observed during the procedure and were successfully managed by endoscopic clipping without emergency surgical intervention. Patients in the ESD arm had a faster recovery than patients in the LC arm, which included shorter time to resume normal diet(2 d vs 4 d, P = 0.01) and a shorter hospital stay(3 d vs 6 d, P 0.01). CONCLUSION: ESD showed better short-term clinical outcomes in this study. Further prospective randomized studies will be required to evaluate the efficacy and superiority of colorectal ESD over LC.     

Altered risky decision making in patients with early non-affective psychosis

European Archives of Psychiatry and Clinical Neuroscience - Abnormal risky decision making may represent an important factor contributing to functional impairment in psychotic disorders. Previous...     

地西泮-聚羟基丁酸酯-羟基戊酸酯共聚物缓释微球制备与性质

目的 :探索以新型生物可降解材料聚羟基丁酸酯 羟基戊酸酯共聚物 (PHBV)为载体的地西泮药物中长期缓释微球制备工艺 ;方法 :以溶剂蒸发法制备微球 ,用扫描电镜SEM观察微球表面及内部横断面形态结构 ;结果 :微球的平均粒径为 3 0 .5μm ,平均载药量 (1 8.66± 0 .2 3 ) % ,包封率 (80 .85± 1 .0 1 ) %。体外释放第一天呈突释效应 ,而后药物释放基本符合零级动力学过程 .其释放曲线方程为 Q =2 0 .55 2 .3 99t,r=0 .9569;结论 :开发与研制PHBV为载体的中长期缓释微球具有较好应用前景。     

Seroprevalences of hepatitis B virus and hepatitis C virus among participants of an Asian health fair in the Lower Mainland,British Columbia

BACKGROUND:

The seroprevalences of hepatitis B virus (HBV) and hepatitis C virus (HCV) are 0.4% and 0.8%, respectively, in Canada, but varying rates have been reported in different populations.

OBJECTIVES:

To determine the seroprevalences of HBV and HCV among attendees of an Asian health fair in the Lower Mainland, British Columbia, as well as to correlate questionnaire answers regarding vaccination status to serological profiles.

METHODS:

Attendees at an Asian health fair were invited to participate in the present study on a voluntary basis. They provided answers to a questionnaire including ethnicity and vaccination status. Blood was then drawn for HBV and HCV serology. Active HBV was defined as HBV surface antigen (HBsAg) positive while HCV seroprevalence was defined as HCV antibody reactive. Previous exposure to HBV was defined as HBV core antibody (anti-HBc) positive and HBsAg negative. Nonimmunity was defined as anti-HBc negative and HBV surface antibody negative. Only those with correct demographic information matched to serological results were included in the study.

RESULTS:

There were 192 consenting attendees of the fair, of whom 112 were included in the study. Of the participants, 91% were Chinese. Active HBV infection was found in three participants (2.7% [95% CI 0.6% to 7.6%]) and HCV infection was found in two participants (1.8% [95% CI 0.2% to 6.3%]). More than 40% of participants had been previously exposed to HBV (42% [95% CI 33% to 51%]). Almost 20% demonstrated nonimmunity to HBV (19% [95% CI 12% to 27%]). There was significant discordance when questionnaire answers regarding vaccination status were compared with serological profiles.

CONCLUSION:

The seroprevalences of HBV and HCV in this cohort were 2.7% and 1.8%, respectively – higher than nationally reported rates. Our results highlight that the lack of knowledge of HBV infection and vaccination status remains a significant clinical issue in the Asian community of British Columbia.