Cardiac amyloidosis in a patient with multiple myeloma: A case report and review of literature

We report a case of a 52‐year‐old man with multiple myeloma and rapidly progressive heart failure who died unexpectedly from a probable arrhythmia. Postmortem examination revealed infiltrative amyloid cardiomyopathy, a rare cause of predominantly diastolic myocardial disease. Cardiac amyloidosis should be considered in any patient presenting with congestive heart failure, preserved systolic function, and a discrepancy between a low QRS voltage on electrocardiography and an apparent left ventricular hypertrophy on sonogram. The pattern of left ventricular diastolic dysfunction changes during the course of amyloidosis and the classically described restrictive physiology occurs only in advanced stages of the disease. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

Outcome of Tumor-Specific Mesorectal Excision for Rectal Cancer: The Impact of Laparoscopic Resection

Objective

The study aimed to compare the outcomes of laparoscopic and open resection for rectal cancer in 1,063 consecutive cases in a single center.

Methods

We performed an analysis of 11 years of experience in rectal cancer surgery and compared the outcome of laparoscopic and open surgery. Multivariate and subgroup analysis was performed to look at the effect of the level of tumor and stage of disease on short-term outcomes like conversion rate, anastomotic leak rate, length of stay, complication rate, 30-day mortality, and long-term outcomes like local recurrence and survival.

Results

A total of 1,063 patients underwent rectal resection with 470 (44.2 %) patients undergoing the laparoscopic approach. Groups were comparable in terms of age, sex, or co-morbidities, and the operating time was longer in the laparoscopic group (210 vs. 150 min; p value < 0.001). A conversion rate of 6.8 % was noted, with an anastomotic leak rate of 3.87 % in the open group and 2.97 % in the laparoscopic group. The laparoscopic group had a lower blood loss (100 vs. 350 ml; p < 0.001), lower complication rates, and shorter length of stay (6 vs. 9 days). The local recurrence rate was comparable, and the laparoscopic approach had better overall and cancer-specific survival, even after adjusting for stages. The laparoscopic approach was an independent factor associated with better overall and cancer-specific survival on multivariate analysis.

Conclusion

We confirmed the oncological safety of laparoscopic rectal cancer surgery. Laparoscopic surgery also showed superiority in the short-term and long-term outcomes of rectal cancer.     

中、低收入国家卫生智囊团的实践经验影响政策改变

近年来,中、低收入国家独立卫生政策研究机构的数量与日俱增,原因在于政府研究能力有限和民主化进程中的压力。本研究的目标是：（1）调查中﹑低收入国家中卫生政策研究机构对卫生政策的议程设置﹑制定﹑执行、监管和评估所作的贡献;（2）评估包括组织形式和结构在内的哪些因素支持中﹑低收入国家的卫生政策研究机构对卫生政策发挥积极作用。本研究在孟加拉﹑加纳﹑印度﹑南非﹑乌干达和越南选取了6家卫生政策研究机构开展案例研究,研究对象包括两个非政府组织、两所大学和两个政府办政策研究机构。案例研究通过文献查阅、财务信息分析、对工作人员和其他利益相关人员进行半结构式访谈,以及对结论草案进行多次反馈等方式开展。其中有些机构对他们各自国家的政策发展作出了巨大贡献。这些机构都积极建言献策,多数从事与政策相关的研究,而开展政治对话﹑系统评价或委托性研究的机构则相对较少。这些机构所开展的工作大多以政府或出资人的需求为导向,多数机构的主要成果一般为研究报告,经常与面向政府官员的口头汇报相结合。在支持对政策的有效参与方面,有几个关键因素,其中包括支持性的政策环境﹑管理和财务的相对独立性,以及与决策者建立可增进信任和影响的密切关系。当研究机构与政府之间的正式关系未处在重要位置时,政府内部单位则面临相当大的困难。     

Sanitation in rural communities in Bangladesh

Household sanitation in developing countries, especially in the rural areas, is poor. An evaluation of what was achieved in this regard during the 1980-90 decade of safe water supply for all was carried out in the present study. It was observed that even where a safe water supply and sanitary latrines were provided, people did not always use them. While 23% of the studied households had sanitary latrines, children in about 11.5% of these households did not use them and women in about 6% of households did not use them for micturition at night. Not a single house in the study area could fulfil all the criteria of sanitary housing in a strict sense; for example, although 34.5% of the households had tubewells, only 11.5% of them had a satisfactory level of water usage. Since socioeconomic conditions and education influence the level of sanitation, improvements in both are required.