Use of the GuideLiner catheter for the treatment of a bifurcational total occlusion of the native left anterior descending artery through a tortuous composite venous graft

Difficulty in stent delivery is frequently encountered in cases of tortuous or calcified coronary arteries. Chronic total occlusion interventions often require extra back-up that may not be adequately provided by guiding catheters, even the most supportive guiding catheters. We report the first successful stenting of a complex native coronary artery occlusion through an angulated bypass graft with the support of a GuideLiner catheter.     

Assessment of complications following strictureplasty for small bowel Crohn’s Disease

Background

Surgical intervention is required in a significant proportion of patients with small bowel Crohn’s disease (CD). Strictureplasty is an effective bowel-sparing alternative to resection.

Aim

The aim of this study is to assess the primary complications of small bowel strictureplasty for CD (bleeding and leakage). Other postoperative complications encountered, postoperative duration of hospital stay, 30-day mortality, and the incidence of reoperative surgery are also discussed.

Methods

A retrospective review of patients undergoing small bowel strictureplasty at The Royal Hospital between 1992 and 2007 was conducted. Twenty-seven patients underwent 34 laparotomies and 100 strictureplasties.

Results

There was no procedure-specific morbidity and mortality. Other common complications encountered were ileus (3/34) and surgical site infection (3/34).

Conclusion

Most of the patients in this study have recurrent diffuse intestinal CD requiring synchronous bowel resection. Strictureplasty is a safe and effective bowel-sparing surgical option in this group of patients.     

Cord blood stem cells revert glioma stem cell EMT by down regulating transcriptional activation of Sox2 and Twist1

The dynamic nature of cancer stem cells that underlie metastasis or their ability to switch between different cellular identities, as in EMT and MET, has profound implications for cancer therapy. The functional relationship between molecules involved in cancer cell stemness and metastasis is not clear. In this regard, our studies on hGBM tissue grade IV specimens showed significant expression of Twist1 and Sox2, known mesenchymal and stemness related markers, respectively, indicating their association with glial tumor genesis and metastasis. The glioma stem cells obtained from CD133+ cells demonstrated increased expression of Twist1 and Sox2 accompanied by significant increase in the mesenchymal markers such as N-cadherin, vimentin and β-catenin. Our studies on glioma stem cells treatment with human umbilical cord blood derived- mesenchymal stem cells, showed down regulation of Twist1 and Sox2 proteins, apart from other mesenchymal stem cell markers. Based on the in vitro experiments and in vivo intracranial xenograft mouse model studies, we elucidated the potential therapeutic role of hUCBSC in suppressing glioma cancer stemness by the induction of MET.     

Brugada pattern mimicking acute coronary syndrome in a febrile state

The Brugada type pattern is characterized by a coved or saddleback shaped ST-segment elevation in the right precordial leads (V1-V3) on a surface 12 lead electrocardiogram (ECG). This pattern can be seen spontaneously, induced by sodium channel blocking drugs or rarely by hyperthermia. The mechanism is secondary to an alteration in the sodium channels induced by a febrile state. Such ECG's could easily be mistaken for acute ST segment elevation myocardial infarction and thus pose a unique clinical challenge to emergency room physicians. We report such a case of fever induced Brugada pattern and discuss the underlying mechanisms.     

HIV–tuberculosis co–infection in an Indian scenario: The role of associated evidence of immunosuppression

ObjectiveTo determine the relationship between tuberculosis and the degree of immunosuppression as determined by CD4 count. The impact of immunosuppression on the severity of tuberculosis was also studied.MethodsA retrospective analysis was performed in patients newly diagnosed with HIV infection and antiretroviral therapy (ART)-naive patients with known HIV seropositivity. All patients were diagnosed with active tuberculosis between January 2008 and December 2010, based on review of their medical records. Patients on chemoprophylaxis for opportunistic infection were excluded. Pattern and severity of tuberculosis, associated stigmata of immunosuppression, and CD4 counts were noted.ResultsOf 140 patients satisfying the inclusion criteria, 52 had mild tuberculosis with no other evidence of immunosuppression, 52 had tuberculosis of variable severity with associated evidence of immunosuppression, and 36 had severe tuberculosis with no other evidence of immunosuppression. The CD4 count was highest in the first group [(109.2±99.9) cells/μL] and least in the second group [(58.4±39.8) cells/μL], and the difference was statistically significant (P=0.004). No statistical difference was observed in the CD4 count between those with mild tuberculosis and those with severe tuberculosis.ConclusionsIn developing countries with a high prevalence of tuberculosis in the general population, the possibility of incidental tuberculosis in patients with HIV should always be considered. CD4 count does not appear to influence the severity of tuberculosis. The presence of concomitant evidence of immunosuppression in the form of category B and C conditions is indicative of underlying immunosuppression and associated with a significantly lower CD4 count.     

Cranial melioidosis with extradural extension after a fall in the bathroom

A 32-year-old diabetic male, with a past history of head injury and seizures, presented with a painful swelling over his forehead present for the past three months. Cranial MRI demonstrated the presence of a scalp collection with extradural extension through a bony defect. Biopsy from the area showed caseating necrosis suggestive of tuberculosis. Although the patient failed to return for initiation of anti-tubercular therapy for the next 11 months, the swelling did not progress, and there were no constitutional symptoms. The indolent nature of the swelling prompted re-evaluation and delayed cultures of pus from the collection grew Burkholderia pseudomallei.     

A rare case of Moraxella lacunata producing combined native mitral and aortic valve endocarditis

We describe a case of infective endocarditis due to Moraxella lacunata involving the native mitral and aortic valves, complicated by cerebral emboli and resultant hemiparesis. The patient was treated with ceftriaxone and gentamicin and improved. This appears to be the first case reported in the medical literature of native multivalvular endocarditis produced by this rare organism.