The New Normal? Patient Satisfaction and Usability of Telemedicine in Breast Cancer Care

Annals of Surgical Oncology - Telemedicine was adopted to minimize exposure risks for patients and staff during the coronavirus disease 2019 pandemic. This study measured patient satisfaction and...     

Spinal accessory nerve palsy due to neurovascular compression. Report of a case diagnosed by magnetic resonance imaging and magnetic resonance angiography

The case of a young patient with left accessory nerve paralysis is reported. He had slight tilting of the head to the right side, developed over a period of about 6 months. On neurological examination hypotrophy of the left sternocleidomastoid and trapezius muscles was observed. MRI and MR-angiography imaged the presence of a neurovascular compression between the medulla oblungata, at the level of the nerve entry zone, and a vessel loop of an elongated left vertebral artery. In spite of the absence of a surgical demonstration it is our opinion that the neurovascular conflict is the cause of the accessory nerve palsy.     

Unconscious perception of "extinguished" visual stimuli: reassessing the evidence.

When parietal-damaged patients fail to report a contralesional stimulus because of extinction, is this because the stimulus is not perceived, or because it is perceived but cannot reach conscious awareness? VOLPE et al. [10] reported an intriguing study that seemed to locate the problem at least partly in the transfer of information to conscious awareness. They showed patients with extinction pairs of stimuli, one in each hemifield. Although patients were predictably poor at reporting the identity of the contralesional stimulus, they were able to make accurate same/different judgements comparing the two stimuli. This was interpreted as evidence that both stimuli were perceived. In the present paper, we point out that the dissociation between identification and same/different matching could also be due to the possibility that less visual information about the contralesional stimulus is necessary to make a same/different judgement than to identify the stimulus, and that chance performance is considerably higher in the first than in the second type of task. In Experiment 1, we verified this by degrading one side of a stimulus display and "replicating" the dissociation with normal subjects. We also equated the amount of visual information needed for the two tasks by yoking the stimulus pairs on "different" trials of the same/different matching task with the choice pairs on a forced choice identification task. Under these conditions, the dissociation vanished. In Experiment 2, we administered these tasks to three parietal-damaged patients with extinction. When the original method was used, same/different matching was better than identification of the contralesional stimulus. With the forced choice identification method, the dissociation again vanished.     

Pseudo-Takayasu in Behcet's disease

Behcet's disease is a chronic multisystem vasculitis that is frequent in Lebanon. The great arteries involvement is rare. We report here an unusual case of subclavian artery occlusion (pseudo-Takayasu) with a literature review.     

Inframalleolar bypass in limb salvage. Late results

STUDY OBJECTIVE: The objective of this retrospective study was to report the long-term results of distal revascularization at the ankle in patients with critical ischemia. PATIENTS AND METHODS: From January 1989 to November 1999, 50 inframalleolar bypasses were performed in 49 patients (35 males and 14 females with a mean age of 75 years [range: 51 to 95 years]). Twenty-five patients (50%) were diabetics. All patients presented with critical ischemia of the lower limb. Distal anastomosis was performed at the retromalleolar posterior tibial artery in 28 cases (56%), pedal artery in 20 cases (40%) and distal fibular artery in two cases (4%). Bypasses were performed using a greater saphenous vein (n = 38), a cryopreserved arterial allograft (n = 9), or a PTFE graft (n = 2). A composite graft with greater saphenous vein and arterial allograft was performed in two cases. RESULTS: There were two early postoperative deaths. One patient presented a blow-out of the distal anastomosis that required bypass ligation and subsequent leg amputation. Early thrombosis of the graft occurred in four cases, leading to major amputation in three cases. No patients were lost to follow-up and mean follow-up was 26.7 months (range: 1 to 86 months). Graft thrombosis occurred in 15 patients and led to amputation in 6 cases. Bypass graft patency rate was 72% and 61% at 1 year and 3 years, respectively, yielding a 80% limb salvage rate at 3 years. The 3-year actuarial survival rate was 53%. CONCLUSION: Inframalleolar bypasses are a valuable tool in patients with critical ischemia. The lower limb salvage rate is satisfactory in this elderly population. Based on this experience, angiography with good run-off and, when necessary, a surgical approach to verify patency of the arteries at the ankle should always be performed before undertaking a major amputation.     

An intravitreal biodegradable sustained release naproxen and 5-fluorouracil system for the treatment of experimental post-traumatic proliferative vitreoretinopathy

BACKGROUND/AIMS: To determine the potential of an intravitreal sustained release naproxen and 5-fluorouracil (NA/5-FU) codrug for the treatment of experimental proliferative vitreoretinopathy (PVR) in a model for trauma associated tractional retinal detachment (TRD). METHODS: Sustained release pellets were prepared by covalently linking naproxen to 5-fluorouracil. Drug release was tested in vitro and toxic effects were evaluated by electroretinography and light microscopy. Traumatic PVR was induced in pigmented rabbits by performing a scleral laceration, followed by repair and intravitreal injection of 0.4 ml of autologous blood. Thirty six eyes were treated with a sustained release implant containing 1.5 mg NA/5-FU as a codrug and 36 control eyes were submitted to surgery alone. Eyes were evaluated for TRD by serial indirect ophthalmoscope examination at different time points followed by postmortem fundus evaluation of the enucleated eye RESULTS: The NA/5-FU pellets were found to provide linear release of 5-FU and naproxen over the 30 day duration of the in vitro release test. Both the severity of PVR grade and the percentage of eyes with moderate or worse tractional detachment were significantly lower in eyes treated with the codrug pellet. There were no drug related toxic effects evident on histopathological or electroretinograph examination of eyes containing the NA/5-FU pellet. CONCLUSIONS: The results suggest that this NA/5-FU codrug device effectively inhibits the progression of PVR in a rabbit trauma model that closely resembles PVR in humans. Additional studies to add knowledge to these initial findings and to clarify the potential of the codrug device for the treatment of human PVR are warranted.     

Heavy Metal Uptake by Euplotes mutabilis and its Possible Use in Bioremediation of Industrial Wastewater

A ciliate protozoan, Euplotes mutabilis, isolated from heavy metal laden industrial wastewater, has been shown to tolerate multiple heavy metals thus suggesting its significance in bioremediation of industrial effluents. This ciliate tolerated Zn²⁺ up to 33 μg/mL, Cd²⁺ up to 22 μg/mL and Ni²⁺ up to 18 μg/mL. The ciliate could uptake 85% Zn²⁺, 84% of Cd²⁺ and 87% of Ni²⁺ after 96 h of inoculation of growth medium containing 10 μg/mL of Zn²⁺ and 5 μg/mL of Cd²⁺ and Ni²⁺, with actively growing ciliates. After 6 days of incubation the ciliate removed 87% Cd²⁺, 92% Ni²⁺, and 93% Zn²⁺ from the wastewater. The heavy metal uptake capability of Euplotes mutabilis may be employed for metal detoxification operations.