Subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano

The results of subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano were analyzed in a series of 60 patients operated upon over a period of two years. Immediate relief from pain with painless first bowel movement was accomplished in 97 per cent of the patients with very low morbidity rates. All patients were treated on an outpatient basis and had a minimum follow-up of two years without any recurrences. The incidence of sphincter dysfunction is very low and is usually only temporary.     

The association of Fanconi's anemia and squamous cell carcinoma

Fanconi's anemia is a rare autosomal recessive disorder which manifests itself in early childhood, presenting as pancytopenia, pigmentation changes, skeletal deformities, small statures and chromosomal aberrations. Most patients ultimately die from sepsis as a result of their hematologic abnormalities, however, some patients live long enough to develop malignancies such as leukemia, hepatocellular carcinomas and squamous cell carcinoma. The association of Fanconi's anemia and squamous cell carcinoma is examined with a report of a patient with Fanconi's anemia and squamous cell carcinoma of the pyriform sinus and hypopharynx.     

Anti-beta2 glycoprotein 1 and the anti-phospholipid syndrome

PURPOSE: To describe a patient who presented with bilateral retinal vascular occlusion and the use of anti-beta2 glycoprotein 1 (GPI) antibody testing in the diagnosis of antiphospholipid syndrome. DESIGN: Observational case report. METHODS: Hematological investigations were performed on a 49-year-old man who presented with rapid onset of bilateral severe central retinal vein occlusion. RESULTS: Lupus anticoagulant and anticardiolipin antibody testing was negative. Markedly raised titers of anti-beta2 GPI antibodies were detected on two separate occasions. CONCLUSIONS: The raised titers of anti-beta2 GPI antibodies were considered to strongly suggest an underlying diagnosis of the antiphospholipid syndrome.     

Patterns of failure after surgical cure of large liver tumors: A change in the proximate cause of death and a need for effective systemic adjuvant therapy

During a period of 7 years, we have aggressively treated liver tumors whether primary or metastatic. Our experience after 43 curative major liver resections has shown an excellent overall survival: 34 of 43 patients still alive a median of 12 months after liver resection (patient ages ranged from 21 to 85 years, median 57 years). Nineteen patients underwent right hepatic lobectomy, 9 trisegmentectomy, 5 left hepatic lobectomy, 5 extended left hepatic lobectomy, 4 right lobectomy plus left lobe wedge resection, and 1 patient underwent a major hilar wedge resection. Two patients died from sepsis and hepatic failure on or before the 60th postoperative day. One patient with no evidence of recurrent colorectal cancer was lost to follow-up after 2.5 years. One patient died without cancer 12 months after left hepatic lobectomy for colon cancer metastases. Cumulative survival for the entire series and for patients after resection of colorectal cancer metastases was the same: 1 year survival 90 percent; 2 year survival 75 percent, and 3 year survival 65 percent. Seventeen of 30 patients remain disease-free after resection of liver metastases. Of the 13 who had recurrence, 8 are still alive. Ten recurrences were outside of the residual liver (predominantly multiple pulmonary metastases). One recurrence was in the right hemidiaphragm, and only three were in the residual or regenerated liver. Serial carcinoembryonic antigen analysis was the best indicator of recurrence in these 13 patients, 12 of whom were asymptomatic. These data confirm that major liver resection can be performed with minimum postoperative mortality (4.7 percent in this series). More importantly, the majority of patients were cured of their liver metastases. The next goal should be the initiation of adjuvant systemic therapy trials after liver resection in such patients.     

The surgical management of aortic root vessel anomalies presenting in adults

Anomalies of the aortic root vessels may present in adults and are common incidental findings during standard vascular imaging. Knowledge of their presentation and management is important for surgeons dealing with vascular pathology within these anomalous vessels. A comprehensive literature search was conducted and a review of the current opinion performed on the embryology, clinical features, and surgical treatment of aortic root vessel anomalies, with particular emphasis on their management in adults. A classification system for aortic arch anomalies based on arch configuration is presented: (1) double aortic arch, (2) right aortic arch, (3) left aortic arch with abnormal branching, and (4) interrupted aortic arch. Anomalies of the aortic root vessels may be classified based on their presence or absence, their anomalous size or course, or their atypical origin, bifurcation, or subsequent branching pattern. A symptomatic aberrant right subclavian artery may be encountered by vascular surgeons, and a right supraclavicular approach would appear the most appropriate method of repair. Knowledge of aortic arch and root vessel anomalies is important for any clinician dealing with cardiothoracic, head and neck, or intracranial pathology. Vascular surgeons may encounter these anomalies during routine practice and may need to deal with their clinical sequelae.     

Compliance calibration for fatigue crack propagation testing of ultra high molecular weight polyethylene

Ultra High Molecular Weight Polyethylene (UHMWPE) total joint replacement components under certain conditions are at risk of fatigue fracture. Thus, the fatigue crack inception/propagation resistance of UHMWPE is of interest. During fatigue crack propagation tests of UHMWPE, crack growth is often followed visually; however, this approach can be time consuming and requires that the specimen be accessible during testing. The objective of this study was to demonstrate the applicability of the compliance method for fatigue crack propagation tests of UHMWPE. We hypothesized that the standard calibration coefficients developed for metals may not be appropriate for UHMWPE and that different UHMWPE materials would require different compliance calibration coefficients. Three UHMWPE materials: sterilized (30 kGy); highly crosslinked and annealed (100 kGy, 130 degrees C); and highly crosslinked and remelted (100 kGy, 150 degrees C) were examined under ambient conditions. The results support the applicability of the compliance method for determination of crack length during fatigue crack propagation testing of UHMWPE. As hypothesized, the standard calibration coefficients were found to be inaccurate for UHMWPE. New UHMWPE-specific calibration coefficients were determined which predicted the crack growth behavior accurately. Also, as hypothesized, the compliance calibration coefficients for the three materials were significantly different. This is the first reported study to demonstrate the applicability of a compliance method to measure crack length in UHMWPE.     

Comprehensive temporal information detection from clinical text: medical events,time, and TLINK identification

Background

Temporal information detection systems have been developed by the Mayo Clinic for the 2012 i2b2 Natural Language Processing Challenge.

Objective

To construct automated systems for EVENT/TIMEX3 extraction and temporal link (TLINK) identification from clinical text.

Materials and methods

The i2b2 organizers provided 190 annotated discharge summaries as the training set and 120 discharge summaries as the test set. Our Event system used a conditional random field classifier with a variety of features including lexical information, natural language elements, and medical ontology. The TIMEX3 system employed a rule-based method using regular expression pattern match and systematic reasoning to determine normalized values. The TLINK system employed both rule-based reasoning and machine learning. All three systems were built in an Apache Unstructured Information Management Architecture framework.

Results

Our TIMEX3 system performed the best (F-measure of 0.900, value accuracy 0.731) among the challenge teams. The Event system produced an F-measure of 0.870, and the TLINK system an F-measure of 0.537.

Conclusions

Our TIMEX3 system demonstrated good capability of regular expression rules to extract and normalize time information. Event and TLINK machine learning systems required well-defined feature sets to perform well. We could also leverage expert knowledge as part of the machine learning features to further improve TLINK identification performance.     

Gut hyperpermiability after ischemia and reperfusion: attenuation with adrenomedullin and its binding protein treatment

Ischemia bowel remains a critical problem resulting in up to 80% mortality. The loss of gut barrier function plays an important role. Our previous studies have shown that administration of adrenomedullin (AM), a novel vasoactive peptide, and its binding protein (AMBP-1), reduces the systemic inflammatory response and organ injury after systemic ischemia induced by hemorrhagic shock. However, it remains unknown whether administration of AM/AMBP-1 preserves gut barrier function after gut ischemia reperfusion (I/R). We therefore hypothesized that AM/AMBP-1 prevents structural and functional damages to the intestinal mucosa after gut I/R. To test this, gut ischemia was induced by placing a microvascular clip across the superior mesenteric artery (SMA) for 90 min in male adult rats. After release of the SMA clamp, AM (12 mug/kg BW) and AMBP-1 (40 mug/kg BW) in combination or vehicle (1-ml normal saline) were administered intravenously over a period of 30 min. The mucosal barrier function in the small intestine was assessed in an isolated everted ileum sac using fluorescein-isothiocyanate dextran (FD4) at 4 h after AM/AMBP-1 treatment. FD4 clearance was used as a measure of gut permeability. In additional groups of animals, blood and small intestine samples were collected at 4 h after the treatment. Morphological changes in the small intestine were assessed by H-E staining. Serum concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, lactate and lactate dehydrogenase were also assessed. The gene expression and protein levels of TNF-alpha in the small intestine were determined by RT-PCR and ELISA, respectively. Our results showed that administration of AM/AMBP-1 significantly attenuated the development of intestinal mucosal hyperpermeability during the reperfusion. Treatment with AM/AMBP-1 dramatically improved I/R-induced intestinal mucosal damages, attenuated remote organ injury, and downregulated gene expression and protein levels of TNF-alpha in the small intestine. In conclusion, AM/AMBP-1 attenuates structural and functional damages to the intestinal mucosa, and it appears to be a novel treatment for reperfusion injury after gut ischemia. The beneficial effect of AM/AMBP-1 on gut barrier function after I/R is associated with downregulation of TNF-alpha.