Prevention of PONV by acustimulation with capsicum plaster is comparable to ondansetron after middle ear surgery

PURPOSE: To compare the efficacy of stimulation of P6 acupoint with capsicum plaster in comparison with iv ondansetron for the prevention of postoperative nausea and vomiting (PONV). METHODS: 120 patients of either sex, ASA I-II, undergoing elective middle ear surgeries under general anesthesia were included in this randomized, prospective, double-blinded and placebo-controlled study. The anesthetic technique was standardized. Patients were divided into three groups. Group I was the control group. Capsicum plaster (1 x 1 cm) was affixed at the P6 acupoint on both forearms 30 min before induction of anesthesia in patients of Group II. Patients of Groups I and III received an inactive adhesive plaster at the same site. Ondansetron 4 mg iv was given to patients of Group III at the end of surgery and the rest of the patients received a placebo. The plasters were removed six hours after transferring the patients to the postoperative unit. Criteria were fixed for the administration of rescue antiemetics (ondansetron 4 mg iv). PONV and the requirement for rescue antiemetics were recorded by a blinded observer. RESULTS: The incidence of PONV and the requirement for rescue antiemetics were significantly lower in both the acustimulation and ondansetron groups at six hours. At 24 hr there was a reduction in the requirement for rescue medication in the ondansetron group. CONCLUSION: Stimulation of the P6 acupoint with capsicum plaster is an effective method for prevention of PONV after middle ear surgery and its efficacy is comparable to ondansetron for the first six hours after surgery.     

Coronary surgery in elderly patients. In-hospital and long-term results]

BACKGROUND: Taking into account the steady increase in the number of elderly patients requiring coronary artery bypass grafting, we sought to analyze the in-hospital and long-term evolution of a group of elderly patients (>/= 75 years) who underwent coronary artery bypass grafting, and to identify clinical predictors of mortality and long-term symptoms. METHODS: Between April 1996 and February 2000, 207 patients older than 75 years of age who had undergone coronary bypass grafting were prospectively and consecutively analyze. Mean age was 78.4 +/- 2.7. RESULTS: An average of 2.6 grafts/patients was constructed. Left mammary artery was used in 93% of patients. The in-hospital incidence of heart failure, atrial fibrillation, preoperative infarction and stroke was 38%, 29%, 4.8% and 2.8% respectively. The in-hospital mortality rate was 5.8%. Mean follow-up was 18 months (25th an 75th percentiles 9-29). Late mortality rate was 4.1% in eight patients. Excluding the in-hospital deaths, the estimated probability of survival (Kaplan-Meier) at 3 years was 94% and the survival freedom from symptoms was 86%. A multivariate analysis showed that only age was predictor of in-hospital mortality (OR 1.16, p = 0.009). Only peripheral vascular disease was found as a predictor of symptoms during the long-term follow-up (p = 0.001). CONCLUSIONS: In this series of senile patients who underwent coronary surgery, those of an older age (> 80 years) showed a higher risk of in-hospital mortality. The presence of peripheral vascular disease is useful in the prognosis assessment of the group.     

Improved blood suppression in three‐dimensional (3D) fast spin‐echo (FSE) vessel wall imaging using a combination of double inversion‐recovery (DIR) and diffusion sensitizing gradient (DSG) preparations

Purpose:

To provide improved blood suppression in three‐dimensional inner‐volume fast spin‐echo (3D IV‐FSE) carotid vessel wall imaging by using a hybrid preparation consisting of double inversion‐recovery (DIR) and diffusion sensitizing gradients (DSG).

Materials and Methods:

Multicontrast black‐blood MRI is widely used for vessel wall imaging and characterization of atherosclerotic plaque composition. Blood suppression is difficult when using 3D volumetric imaging techniques. DIR approaches do not provide robust blood suppression due to incomplete replacement of blood spins, and DSG approaches compromise vessel wall signal, reducing the lumen‐wall contrast‐to‐noise ratio efficiency (CNR_eff). In this work a hybrid DIR+DSG preparation is developed and optimized for blood suppression, vessel wall signal preservation, and vessel‐wall contrast in 3D IV‐FSE imaging. Cardiac gated T₁‐weighted carotid vessel wall images were acquired in five volunteers with 0.5 × 0.5 × 2.5 mm³ spatial resolution in 80 seconds.

Results:

Data from healthy volunteers indicate that the proposed method yields a statistically significant (P < 0.01) improvement in blood suppression and lumen‐wall CNR_eff compared to standard DIR and standard DSG methods alone.

Conclusion:

A combination of DIR and DSG preparations can provide improved blood suppression and lumen‐wall CNR_eff for 3D IV‐FSE vessel wall imaging. J. Magn. Reson. Imaging 2010; 31: 398–405. © 2010 Wiley‐Liss, Inc.     

Promoter hypermethylation in Indian primary oral squamous cell carcinoma

We evaluated promoter hypermethylation of a panel of tumor suppressor genes as a means to detect epigenetic alterations in oral squamous cell carcinomas (OSCC) of Indian‐origin and compare with North‐American head and neck squamous cell carcinomas (HNSCC). Quantitative‐methylation‐specific PCR was used to investigate the promoter methylation status of DCC, EDNRB, p16^INK4a and KIF1A in 92 OSCC, and compared to 48 paired normal tissues and 30 saliva and sera samples from healthy control subjects. Aberrant methylation of at‐least one of these genes was detected in 74/92 (80.4%) OSCC; 72.8% at EDNRB, 71.7% at KIF1A, 47.8% at p16^INK4a and 58.7% at DCC; and in 5 of 48 (10.4%) normal oral tissues. None of the saliva and sera samples from controls exhibited DNA methylation in these four target genes. Thirty‐two of 72 node positive cases harbored p16^INK4a and DCC hypermethylation (p = 0.005). Thus, promoter hypermethylation in genes analyzed herein is a common event in Indian OSCC and may represent promising markers for the molecular staging of OSCC patients. We found higher frequency of p16^INK4a methylation (47.8%) in this Indian cohort in comparison with a North‐American cohort (37.5%). In conclusion, aberrant methylation of EDNRB, KIF1A, DCC and p16^INK4a genes is a common event in Indian OSCC, suggesting that epigenetic alterations of these genes warrant validation in larger studies for their potential use as biomarkers.     

Fine structure of the epidermal cuticle of some Brazilian earthworms (Oligochaeta: Annelida)

Electron microscopic techniques were adopted to study the epidermal cuticle of 4 species of brazilian earthworms. Basically this structure consists of collagenous fibers arranged in alternate layers and embedded in an amorphous and fibrillar matrix. Of characteristics, the ellipsoidal projections of the cuticle of P. hawayana were found to be enclosed between 2 parallel layers, where each layer consists of 2 electron dense lines, separated by a space filled with an electron dense material.     

Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma

BACKGROUND: Bulky endobronchial tumours in patients with lung cancer are difficult to treat. Brachytherapy and photodynamic therapy (PDT) are variably effective, and the combination of these treatments is not often recommended. However, cell culture studies and animal studies indicate a possible synergistic effect of combining PDT with ionising radiation. We assessed the safety and effectiveness of combined brachytherapy and PDT in patients with bulky endobronchial lung cancer. METHODS: Patients with histologically proven non-small cell bronchogenic carcinoma and bulky endobronchial tumours were treated using a combination of PDT (Photofrin, 2 mg/kg) and brachytherapy. Six weeks after PDT, brachytherapy was applied with five fractions of 4 Gy at weekly intervals. Follow up was performed with standard and autofluorescence bronchoscopy and tissue biopsies every 3 months. RESULTS: Thirty two patients were treated. Tumours were extensive with lengths ranging from 10 to 60 mm along the bronchus and estimated volumes ranging from 40 to 3500 mm3. At a mean follow up of 24 months, 26 patients were free of residual tumour and local recurrence. The remaining patients received a second treatment with PDT, brachytherapy, Nd:YAG laser coagulation, or external beam radiation. Distant metastases (lung, lymph node) developed in two of the six patients. Currently, all 32 patients are well. There is no evidence of residual or local recurrent endobronchial cancer in 28 patients and none had severe complications. CONCLUSION: The combination of PDT and brachytherapy for treating patients with lung cancer and extensive endobronchial tumour is safe and, in this study, had excellent therapeutic efficacy.