Asymmetric conjoined twins

Despite recent advances in diagnosis, particularly organ-imaging, and therapeutic options, the management of conjoined twins is still very challenging. We report conjoined twins attached end-on at the lumbo-sacral level and describe the anatomical findings, methods of investigation, and management.     

Septic arthritis due to actinobacillus actinomycetemcomitans

Actinobacillus actinomycetemcomitans, a gram-negative aerobic bacillus of the family Parvobacteriaceae which is a nomral inhabitant of the oral flora, is a rare cause of human infection. We report a case of septic arthritis caused by this organism in an uncompromised child.     

Congenital small bowel diverticulosis and intestinal atresia: a rare association

An unusual case of multiple intestinal atresias with multiple small bowel diverticulae is presented. To the best of our knowledge this is the first reported case of its kind in the literature.     

Pulmonary inflammatory pseudotumour in children

Inflammatory pulmonary pseudotumour is an uncommon, non-neoplastic, occasionally aggressive spindle cell proliferative process of uncertain nosology. It has distinctive histopathological features and benign clinico-biological behaviour with multifocal lesions or recurrences in a minority of cases. Recognition of this entity is of paramount importance because it has considerable therapeutic and prognostic implications. The radiological features of two patients with pulmonary pseudotumour that was confirmed on histopathological examination are described.     

Development of heparin antagonists with focused biological activity

Heparin, a complex glycosaminoglycan, has long been used to temporarily render the blood incoagulable during extracorporeal circulation, cardiovascular surgery, and other arterial interventions. But bleeding complications are especially common when the arterial tree is violated, occurring in as many as 10-15% of cases. For cardiovascular surgery and many related interventions, protamine has long been the standard antagonist when acute and complete neutralization of heparin s anticoagulant effect is necessary. Protamine s efficacy is related in part to its total net cationic charge, but unfortunately so is its toxicity. For these reasons, there is renewed interest in developing heparin antagonists which will replace the use of protamine. At Commonwealth Biotechnologies, Inc., we have used a rationale design approach for the preparation of a family of low molecular weight helix peptides which bind heparin with high affinity. For each of the new compounds, we have assessed their ability to bind heparin using isothermal titration calorimetry and circular dichroism spectrometry and have examined potential complexes formed with the anticoagulant pentasaccharide unit of heparin using molecular modeling techniques. The biological potencies of these compounds were assessed in ex vivo experiments where their ability to compete with antithrombin for binding heparin was determined. The best of the compounds, designated HepArrestTM, is highly effective in reversing heparin-mediated and HepArrest is a safer drug than protamine because of reduced adverse hemodynamic side effects compared with those associated with protamine. HepArrest binds low molecular weight heparins and causes reversal of anticoagulation by low molecular weight heparins, as determined by activated partial thromboplastin time, thrombin time, or factor Xa neutralization assays. These highly promising preclinical results indicate that HepArrest is a novel heparin neutralizing agent that may well fill a substantial unmet need for vascular surgeons and cardiac anesthesiologists who perform coronary artery bypass grafts and several other major vascular surgeries, as well as for cardiologists and interventional radiologists.     

Near-total laryngectomy in advanced cancers of the larynx and pyriform sinus: a comparative study of morbidity and functional and oncological outcomes.

This prospective study, performed from 1991 to 1996, analyzes the differences in oncological safety, functional utility, and surgical morbidity in 14 advanced lesions of the larynx (10 T3 and 4 T4; 7 N+) and 40 pyriform sinus lesions (1 T2, 20T3, and 19 T4; 29 N+) subjected to Pearson near-total laryngectomy. The laryngeal cancer patients healed much faster, with a minimal wound complication rate of 28%, in comparison to the 68% rate encountered in the pyriform sinus cases (p < .05). The 3-year disease-free survival rate for the laryngeal cancers was 74%, while the 5-year survival rates for pyriform sinus cases were 66% for medial wall lesions and 54% for lateral wall lesions. Lung-powered shunt speech deemed qualitatively superior by acoustic analysis was obtained in 81% of the individuals (93% in laryngeal cases and 76% in pyriform sinus cases). Aspiration-free deglutition was achieved by 90% over periods ranging from 15 to 30 days. This study conclusively attests to the therapeutic efficacy of near-total laryngectomy for advanced lesions of the larynx and pyriform sinus that are unsuitable for radiotherapy, that are deemed too large or risky (because of aspiration) for partial laryngectomy, and that in the past would have merited total laryngectomy.     

Cervical metastasis of occult origin—Treatment options and outcome

Ninety one patients with metastases of unknown origin in cervical nodes seen between 1986 and 1990 were respectively analysed. Majority of the patients (58%) presented with a nodal mass of more than 6 cm size. Jugulodigastric node was the commonest site of involvement seen in 74%, 76% and 69% of patients who presented with single node, multiple ipsilateral nodes and bilateral nodes respectively. Two year disease free survival (DFS) was 17% with radical radiotherapy alone and 48% with combined radiotherapy and radical neck dissection. Overall 2 year DFS with N₁, N₂and N₃ disease were 100%, 35% and 14% respectively, with combined therapy offering better results in patients with a nodal size of more than 3 cm. 14% of the patients who received curative therapy developed a primary, with a majority (10%) within the field of irradiation. Use of combined surgery and radiation, successful salvage of locoregional failures and possibly use of adjuvant systemic therapy would result in improved DFS in patients with advanced nodal disease.