Radio-ablation of advanced grades of hemorrhoids with radiofrequency

BACKGROUND: For advanced degree of hemorrhoids with prolapse of the rectal mucosa, the choice is hemorrhoidectomy, which could be open, close, diathermy, Laser, or stapled one. As an effective alternative to this, in situ radio-frequency ablation of the pile mass has been found to be quite efficacious with many added advantages over the conventional hemorrhoidectomy procedures in practice. MATERIALS AND METHODS: This study included 50 patients (34 males and 16 females) treated at Gupta Nursing Home, Laxminagar, Nagpur, India, with the above technique from April 2000 to March 2001 and each case followed up over a period of 12 months. RESULTS: In first 4 weeks of the procedure, 14% of patients complained of bleeding, whereas all of the patients had some amount of pain. Eleven (22%) patients had serosanguinous discharge, but in none of them was there any incontinence or prolapse. All of the patients resumed their routine within 1 week of the procedure. A subsequent follow-up of the patients at an interval of 12 weeks and 12 months showed significant relief in all of the above early postoperative symptoms. During follow-up at the end of 1 year, 7 patients were found to have skin tag formation. However, complications like anal stenosis or stricture or incontinence was not found in any of the patients. CONCLUSION: For advanced degree of piles with prolapse as the main symptom, in situ radio-frequency ablation can be a better choice to various types of hemorrhoidectomy in the sense that the hospital stay is minimized, recurrence is rare, and return to work is faster. The results are more assuring when compared with conventional hemorrhoidectomy. The technique fits into the parameters for being called the gold standard procedure. Except the radio-frequency unit, the procedure needs no specialized instrument. It can be performed in any routine surgical setup.     

A novel multivalent human CTL peptide construct elicits robust cellular immune responses in HLA-A*0201 transgenic mice: implications for HTLV-1 vaccine design

Cytotoxic T-lymphocytes are critical in the clearance of chronic viral infections such as HTLV-1. Peptide-based vaccines may have potential application in invoking antiviral CTL responses. In the development of vaccination strategies, it is becoming increasingly important to elicit a broad immune response against several epitopes simultaneously that may provide large population coverage. In the present study, we addressed this issue, namely the processing and presentation of multiple CTL epitopes simultaneously for the generation of multispecific CTL responses. We designed a novel multivalent peptide consisting of three HLA-A(*)0201 restricted CTL epitopes, with intervening double arginine residues in tandem. These epitopes were derived from the HTLV-1 regulatory protein Tax, which is an attractive target for vaccine development against HTLV-1. Arginine residues were included to provide cleavage sites for proteasomes, to generate the intended MHC Class I ligands. Proteasomal digestion studies and mass spectrometry analysis showed cleavage of the multivalent construct to generate the individual epitopes. Immunization of HLA-A(*)0201 transgenic mice with this construct efficiently elicited cellular responses to each intended epitope in vivo, further validating the applicability of this approach. These data may have potential in the development of immunotherapeutic strategies for the treatment of HTLV-1 disease and in the future design of multivalent subunit peptide vaccines.     

Diagnosis and Management of Complicated Left Atrial Mural Endocarditis: The Role of Transesophageal Echocardiography

Mural endocarditis that involves the left atrial wall is rare. We report on the transesophageal findings in a patient with left atrial mural endocarditis and discuss its recognition, complications, and treatment.     

The structural implications of a unilateral facial skeletal cleft: a three-dimensional finite element model approach.

OBJECTIVE: For children born with a unilateral facial skeletal cleft, oral motor function is impaired and skeletal development and growth are asymmetrical with regard to the midsagittal plane. This study was designed to verify that a unilateral skeletal cleft and its dimensions (i.e., depth and width) affect the severity of the asymmetric stress and strain distribution within the maxilla. METHODS: A three-dimensional finite element model of a normal maxilla was developed from pediatric, subject-specific computerized tomography scan data. A clefting pattern then was introduced to simulate varying degrees of deformity in geometry, with the bone properties and boundary conditions held constant. The asymmetric index was introduced to quantify the asymmetrical stress and strain distribution within the maxilla with regard to the midsagittal plane. RESULTS: The unilateral skeletal cleft led to a nonuniform, asymmetric stress and strain distribution within the maxilla: intensified on the noncleft side and weakened on the cleft side. As the depth of the unilateral cleft increased, the stress and strain distribution became increasingly asymmetric as measured by the asymmetric index. In contrast, the width of the cleft had minimal effect on the asymmetrical stress and strain distribution. INTERPRETATION/CONCLUSION: These results implied that a child born with a unilateral cleft would be expected to have an asymmetric skeletal development between the noncleft and the cleft sides as a consequence of an asymmetric functional loading pattern.     

Liver abscess following superior mesenteric artery revascularization for acute mesenteric ischemia

A case of pyogenic liver abscess following successful mesenteric artery revascularization is described in a patient with acute mesenteric ischemia. Prior to revascularization, arteriography confirmed celiac and superior mesenteric artery occlusion. Occurrence of liver abscess is explained on the basis of ischemia impairing the barrier function of the intestinal mucosa, contributing to portal bacteremia that seeds ischemic or necrotic liver. In patients with acute mesenteric ischemia, sequential sonographic examination of the liver following mesenteric revascularization is advocated for early diagnosis of liver abscess if there is clinical evidence of the sepsis.