Penetrating thoracic injury

PURPOSE To clarify the clinical aspects of penetrating thoracic injury. PATIENTS AND METHODS: Eighteen patients with penetrating thoracic injury treated from 1987 to 2005 were evaluated. There were 13 men and 5 women. The age distribution was 8 to 69 years, with an average of 36.7 years. RESULTS: There were 14 patients with stab wound and 4 with impalement injury. Five patients with stab wound were those who attempted suicide. In 4 patients with impalement injuries, the cause was fall in 2, traffic accident in 1 and sports injury in 1. The calculated injury severity score (ISS) was over 15 in 4 patients, 6 to 14 in 12, and under 5 in 2. Thoracotomy was performed in 2 patients with cardiac tamponade, 3 with massive hemothorax and 1 with an impalement injury caused by an iron bar. All of them were rescued and got well. In the other cases, after cleansing and debridement, the wound was closed and thoracic drainage was performed. Only 1 patient with cardiac arrest on arrival died within 24 hours after reviving. CONCLUSIONS: Emergent thoracotomy is indicated for patients with massive bleeding including shock, continuous air leakage and cardiac tamponade. Since cardiac arrest is difficult to cure, appropriate cooperation with the rescue team is necessary to avoid preventable trauma death.     

Effect of potassium canrenoate on serum magnesium levels after extracorporeal circulation]

Serum magnesium (Mg) levels were measured before and after operations involving extracorporeal circulation in thirty-five patients. Twenty patients were administered potassium canrenoate 200 mg/day from 2 days before operation to the 3rd postoperative day. Another 15 patients to whom there had been no administration of potassium canrenoate served as controls. We investigated the difference of serum Mg levels between the two groups. The serum Mg levels significantly decreased immediately after operations as compared to the values before surgery as from 1.9 +/- 0.2 to 1.5 +/- 0.2mEq/l (p less than 0.001) and from 1.8 +/- 0.2 to 1.4 +/- 0.2mEq/l (p less than 0.001) in the medicated and control groups, respectively. Serum Mg levels on the 2nd postoperative day recovered to within the normal range and it was significantly higher in the medicated group (1.7 +/- 0.2mEq/l versus 1.5 +/- 0.3mEq/l; p less than 0.05). Hypomagnesemia (Mg less than or equal to 1.2mEq/l) was found in seven patients (46.7%) in the control group and in two patients (10.0%) in the medicated group. Thus, there was a significant difference in the incidence of hypomagnesemia between the two groups (p less than 0.05). These results suggested that administration of potassium canrenoate is useful for keeping and improving serum Mg levels after extracorporeal circulation.     

Evaluation of apparent ectasia of the posterior surface of the cornea after keratorefractive surgery

PURPOSE: To calculate the apparent posterior corneal changes after keratorefractive surgery and reevaluate corneal ectasia displayed by Orbscan (Orbtek). SETTING: Department of Ophthalmology, Nara Medical University, Nara, Japan. METHODS: Postoperative:preoperative magnification ratio of the posterior surface of the cornea was calculated in a theoretical eye model. RESULTS: Assuming the preoperative corneal thickness is 600.00 microm, the preoperative refractive power of the anterior corneal surface is 48.0 diopters (D), the refractive power of the cornea is 1.376, the ablation diameter is 6.0 mm, the postoperative corneal thickness is 480.00 microm, the postoperative refractive power of the anterior corneal surface is 38.0 D, and the posterior surface of the cornea does not change postoperatively, the apparent image of the posterior surface of the cornea becomes 0.778% smaller postoperatively. If the posterior radius of curvature of the cornea is 6.2 mm, it becomes smaller by 48.24 microm. If this change directly affects the difference map, the posterior surface of the cornea moves forward by 48.24 microm. CONCLUSION: The results correspond to the amount of ectasia in previous reports. This artifact may explain the apparent ectasia detected by Orbscan.     

Posterior corneal surface changes after hyperopic laser in situ keratomileusis

PURPOSE: To evaluate posterior corneal surface topographic changes after hyperopic laser in situ keratomileusis (H-LASIK) using Orbscan I (Orbtek, Inc.). SETTING: Department of Ophthalmology, Nara Medical University, Nara, Japan. METHODS: In 25 eyes of 15 patients who had H-LASIK, the posterior corneal surface was measured with slit-scanning corneal topography (Orbscan I) preoperatively and 1 year postoperatively. The center as a fit zone and calculated posterior corneal surface changes were taken at 4 points: nasal, temporal, superior, and inferior sides in the 5.0 mm diameter. The posterior corneal topographic changes were analyzed using an analysis of variance. The postoperative:preoperative magnification ratio of the posterior corneal surface was calculated in a theoretical eye model. RESULTS: When a "+" reading was defined as the forward displacement and "-" was defined as the backward displacement, the mean posterior corneal topographic changes were -2.8 microm +/- 27.9 (SD) at the nasal side, -4.5 +/- 27.8 microm at the temporal side, -3.9 +/- 20.1 microm at the superior side, and -2.3 +/- 20.1 microm at the inferior side. The posterior corneal surface between any 2 examined points showed no significant difference after H-LASIK. In addition, the hypothetical change in the posterior cornea was -8.3 microm after +3.0 diopter H-LASIK, which was approximately closer to the study results. In each side, the amount of the attempted correction was significantly correlated with the posterior corneal topographic change. CONCLUSIONS: Clinical measurement of the posterior corneal displacement after H-LASIK with Orbscan revealed a backward shift. This change corresponded to the hypothetical artifactual changes with Orbscan; that is, changes in the magnification ratio.     

Human sparganosis in Thailand: an overview

Human sparganosis is caused by cestode larvae (spargana) of the genus Spirometra, which exploit copepods as the first intermediate host. A wide range of amphibians, reptiles, birds, and mammals serve as second intermediate/paratenic hosts. Human infections occur mainly by ingesting raw intermediate/paratenic hosts. Cases are found mainly in China, Japan and Korea, and sporadically also in Thailand and other Asian countries. In the period 1943–2010, there were 52 reported cases of sparganosis in Thailand. The average patient age was 32 years (range 11–82 years). From the available patient information, the prevalence of sparganosis infection was higher among females than males, at a ratio of F:M = 2:1 (27:15). Patients have mainly been found in the northeast, north, and central regions of Thailand, with only a few in the south. Although a single subcutaneous nodular lesion was the most common feature, about one third of patients had ocular lesions. In particular, patients having ocular lesions were about half of total cases reported pre-1990, with several confirmed cases’ applying fresh frog muscle as a poultice to relieve sore eyes, according to traditional medicine. In Thailand, sparganosis is not merely a food-borne disease but is also caused by the traditional belief of applying frog muscles (contaminated with sparganum) to sore eyes.     

A Markov decision analysis of allogeneic hematopoietic cell transplantation versus chemotherapy in patients with acute myeloid leukemia in first remission

Various prospective trials have been performed to assess the roles of allogeneic hematopoietic cell transplantation (allo-HCT) and chemotherapy in patients with acute myeloid leukemia (AML) in first complete remission (CR1). However, the results have not always been consistent, and there has been a limited evaluation of quality of life (QOL) in these postremission strategies. We performed a Markov decision analysis that enabled us to compare survival outcomes with a QOL evaluation using a database of 2029 adult AML patients who achieved CR1. The Markov decision model compared 2 strategies: allo-HCT or chemotherapy in CR1. Patients who had intermediate- or unfavorable-risk AML had a longer life expectancy when they received allo-HCT in CR1 than patients treated with chemotherapy alone. Likewise, patients who had a suitable related donor who received allo-HCT in CR1 had a longer life expectancy. The life expectancy was shortened to a greater degree by adjustment for QOL in the allo-HCT group. Nevertheless, QOL-adjusted life expectancies in most of the subgroups remained longer in the allo-HCT group than in the chemotherapy group. Our results showed that older patients with a related donor and younger patients with unfavorable cytogenetics benefited the most from allo-HCT in CR1.     

Paclitaxel-2′-Ethylcarbonate Prodrug Can Circumvent P-glycoprotein-mediated Cellular Efflux to Increase Drug Cytotoxicity

Purpose The aim of the study was to investigate whether 2′-ethylcarbonate-linked paclitaxel (TAX-2′-Et) circumvents P-glycoprotein (P-gp)-mediated cellular efflux and cytotoxicity enhanced by TAX-2′-Et activation within human culture cells transfected with a rabbit liver carboxylesterase (Ra-CES) cDNA. Materials and Methods TAX-2′-Et transport was characterized in a human colon carcinoma cell line (Caco-2) and paclitaxel (TAX)-resistant ovarian carcinoma cells (SKOV3/TAX60). Expression of P-gp, multidrug resistance protein (MRP) 2 and Ra-CES was detected by Western blotting. Cytotoxicity against Ra-CES-expressing cells and cellular amount of TAX produced were determined by MTT assay and using HPLC, respectively. Results Unlike rhodamine123 and TAX, TAX-2′-Et did not exhibit polarized transport in the Caco-2 cells in the absence or presence of verapamil. P-gp levels were expressed much higher in the SKOV3/TAX60 cells than in the Caco-2 cells. MRP2 protein was not detectable in the SKOV3/TAX60 cells. Uptake by the SKOV3/TAX60 cells was similar in quantity to the amount internalized by P-gp-negative SKOV3 cells. In the SKOV3/TAX60 cells, cellular uptake of TAX-2′-Et was not altered regardless of the absence or presence of verapamil. The cytotoxicity to the untransfected SKOV3 cells induced by TAX-2′-Et was significantly lower than that induced by TAX. In the Ra-CES-expressing SKOV3 line, the EC₅₀ value of TAX (10.6 nM) was approximately four-fold higher than that of TAX-2′-Et (2.5 nM). Transfection of Ra-CES into another TAX-resistant ovarian carcinoma cells (KOC-7c) conferred a high level of TAX-2′-Et cytotoxicity via prodrug activation. The intracellular levels of TAX produced from TAX-2′-Et in the Ra-CES-positive KOC-7c cells significantly increased compared with the levels seen in exposure of the untransfected KOC-7c cells to TAX. Conclusions TAX-2′-Et can circumvent P-gp-associated cellular efflux of TAX. TAX-2′-Et is converted into TAX by the Ra-CES, supporting its potential use as a theoretical GDEPT strategy for cancer cells expressing high levels of P-gp. The TAX-2′-Et prodrug efficiently increased the amount of intracellular TAX, which mediates tumor cell death.