Asystole associated with cluster headache

A 43-year-old man with asystole and syncope occurring during cluster headache attacks is reported. The asystole and syncope attacks disappeared completely following prophylactic therapy with methysergide maleate. To the authors' knowledge, the present case is unique in associating asystole with cluster headache attacks and may be due to hyperactivity of the parasympathetic system.     

Malignant non-teratoid medulloepithelioma with submandibular metastases

Medulloepithelioma is a tumor of the primitive medullary epithelium overlying the ciliary body. Most become evident early in life, and they may be malignant, although distant metastases are rare. The purpose of this report is to describe a malignant nonteratoid neoplasm and its metastasis to the submandibular lymph nodes and to introduce this uncommon neoplasm with otolaryngologists.     

Cardiac Troponin T in Children With Acute Rheumatic Carditis

The existence of cardiac damage in active rheumatic carditis patients is unknown, especially in those without pericarditis. The aim of this study was to determine cardiac myocyte damage using cardiac troponin T (cTnT) measurements in active rheumatic carditis. The levels of creatine kinase MB isoenzyme (CK-MB), cTnT, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), cardiothoracic ratio (CTR), and fractional shortening (FS) were compared using Mann–Whitney U test between 28 patients with active rheumatic carditis and 32 controls (healthy children). Association of cTnT levels with ESR, CRP, and CTR was evaluated with Spearman correlation analysis. ESR, CRP, cTnT levels, and CTR were statistically higher in the patients than in the controls. There were no differences between the groups for CK-MB levels and FS. No relationships were found between cTnT levels and ESR, CRP, and CTR in the patient group. The results of the study suggest that when cTnT levels are within non-pathological range, there is no serious cardiac damage; however, statistically significant increases in cTnT levels may indicate minor damages in patients with active carditis due to acute rheumatic fever.     

Subcutaneous placement of a free jejunum and pedicled colon segment to create a diversionary conduit for total esophageal reconstruction

In this report, we describe a case of difficult esophageal reconstruction with a pedicled colon segment interposition and a free jejunal flap. Laryngectomy and bilateral neck dissection for larynx carcinoma had been attempted in a 59-year-old patient 6 years previously. The patient then received radiotherapy. One year later, large resection was performed due to recurrence of the tumor. Since then the patient had been fed through a gastrostomy tube. Previous attempts at esophageal reconstruction in other institutions were unsuccessful. We reconstructed the total esophagus with subcutaneously tunneled pedicled colon segment interposition and a free jejunal flap using the diversionary loop technique to divert the passage of the foot from the pharynx to the new inlet at the buccogingival sulcus, thus keeping the native esophagus untouched. Following a postoperative training period, the patient learned to swallow successfully and smoothly via the new inlet. The patency of the newly reconstructed esophagus was corroborated by radiological imaging. In summary, although the technique requires complex surgical procedures, it is effective and may be considered as an alternative and reliable option in selected cases.     

Algorithms for scheduling of chemotherapy plans

Chemotherapy is used to control and cure cancer by using drugs to destroy cancer cells. Treatment schedules for chemotherapy may vary depending on the type of cancer, the goals of treatment, the type of chemotherapy and the patient's state of health. Chemotherapy is usually given in cycles of a treatment-period followed by a rest-period. An oncologist decides the choice of a particular regimen; however, modifications to drug dose and schedule are often necessary because of variabilities in the health of an individual patient. Therefore an orderly execution of chemotherapy regimens requires management, scheduling and allocation of the resources available. Chemotherapy scheduling is an optimization problem. In this paper, a two-phase approach has been adopted to deal with the problem. An adaptive negative-feedback scheduling algorithm is proposed for the first phase to control the load on the system. Two heuristics based on the ‘Multiple Knapsack Problem’ have been evaluated for the second phase to assign patients to specific infusion seats. The overall design has been put to test at a local chemotherapy center and has yielded good results for patient waiting times, orderly execution of chemotherapy regimen and utilization of infusion chairs.