Conservative management of recurrent bilateral ovarian cysts in pregnancy: a case report

This is a case report of recurrent bilateral ovarian cysts in pregnancy. From the clinical picture these are likely to be theca lutein cysts. A lookout for complications involving these cysts is important. Patients can be managed conservatively in the absence of complications. Likely mechanisms for the causation of this phenomenon are discussed.     

Restoration of p16INK4A protein induces myogenic differentiation in RD rhabdomyosarcoma cells

p16INK4A (p16) tumour suppressor induces growth arrest by inhibiting function of cyclin-dependent kinase (CDK)4 and CDK6. Homozygous p16 gene deletion is frequent in primary rhabdomyosarcoma (RMS) cells as well as derived cell lines. To confirm the significance of p16 gene deletion in tumour biology of RMS, a temperature-sensitive p16 mutant (E119G) gene was retrovirally transfected into the human RMS cell line RD, which has homozygous gene deletion of p16 gene. Decrease from 40 degrees C (restrictive) to 34 degrees C (permissive) culture temperature reduced CDK6-associated kinase activity and induced G1 growth arrest. Moreover, RD-p16 cells cultured under permissive condition demonstrated differentiated morphology coupled with expressions of myogenin and myosin light chain. These suggest that deletion of p16 gene may not only facilitate growth but also inhibit the myogenic differentiation of RD RMS cells.     

The Variability of Fetal Lie, Presentation and Position During "Normal" Pregnancy

Summary: The fetal lie, presentation, and position was recorded serially from the 16th week of gestation until delivery in 100 pregnant women.
The incidence of these characteristics varied with gestation and parity, with stabilization of fetal lie occurring at the 22nd week in nulliparous patients, and at the 30th week in parous patients; the frequency of longitudinal lie rose from 63% at 16 weeks of gestation to 99% at 32 weeks of gestation.
Only 1 persistent breech presentation and 1 persistent transverse lie occurred in the 100 patients. The predominant position in the cephalic presentations was left occipital with a significantly higher incidence in the nullipara.
Considerable variability of lie, presentation, and position occurred in serial examinations, and late spontaneous version from breech to vertex occurred in 4 multiparous patients.     

Response to control of hyperthyroidism in patients with myasthenia gravis and thyrotoxicosis

Three patients presenting with both myasthenia gravis and thyrotoxicosis were treated initially with pyridostigmine and carbimazole respectively. Control of the hyperthyroidism was achieved in all cases but was accompanied by deterioration of the myasthenic symptoms in two and persistence in one. Thymectomy was performed with subsequent improvement in all three patients. Histology showed thymic hyperplasia in each case. The relationship of myasthenia gravis, thyrotoxicosis and the thymus is discussed.     

Naloxone suppresses buprenorphine stimulation of plasma prolactin

The effects of parenterally-administered buprenorphine and simultaneous injection of naloxone was evaluated in six healthy adult males. Each subject was studied on six occasions, an average of 10 days apart, and received either two simultaneous intramuscular injections of saline, buprenorphine 0.3 mg and saline, or buprenorphine 0.3 mg and 0.6 mg, 0.45 mg, 0.3 mg, or 0.15 mg of naloxone. Simultaneous injection of buprenorphine 0.3 mg and saline resulted in an average increase in plasma prolactin above baseline levels of approximately 10 and 25 ng/ml, 30 and 55 minutes after injection. Buprenorphine-induced stimulation of plasma prolactin levels was statistically significantly greater than basal prolactin values (p less than 0.01). When 0.6 mg of naloxone was simultaneously injected with 0.3 mg buprenorphine, peak plasma prolactin levels were significantly lower (p less than 0.05) than prolactin values after administration of 0.3 mg buprenorphine and saline. Simultaneous injection of 0.45 mg naloxone and 0.3 mg buprenorphine also resulted in a significant attenuation (p less than 0.05) of buprenorphine-stimulated prolactin levels. Injection of 0.3 mg or 0.15 mg of naloxone did not inhibit prolactin stimulation produced by buprenorphine 0.3 mg. These findings demonstrate a dose-effect relationship between naloxone concentration and suppression of the increase in plasma prolactin levels produced by administration of buprenorphine 0.3 mg. As prolactin stimulation occurs shortly after opioid agonist administration and is temporally concordant with the rapid induction of pharmacologic reinforcement associated with opiate abuse, naloxone added to buprenorphine parenteral preparations may reduce the abuse potential of buprenorphine.     

The determinants of mortality and morbidity after multiple-valve operations

The factors predictive of hospital mortality and morbidity after contemporary multiple-valve surgical procedures were identified to develop strategies to improve the results of such procedures. Preoperative, intraoperative, and postoperative information was collected prospectively on 90 consecutive patients undergoing surgical procedures between 1982 and 1984. The operative mortality was 5.6%, and the incidence of postoperative low-output syndrome was 16.7%. Multivariate logistic regression analysis identified tricuspid regurgitation (p less than .03, improvement-of-fit chi square) and the aortic valve lesion (p less than .03) as the independent predictors of postoperative complications (mortality or low-output syndrome). Patients with tricuspid regurgitation and right ventricular decompensation and those with aortic stenosis and left ventricular hypertrophy had limited ventricular functional reserve and faced an increased risk. Improved methods of myocardial protection may reduce the risk in these patients.     

Relationship between patent foramen ovale and ischemic cerebrovascular events in children

Objectives: The objective is to report the feasibility and technique of treating popliteal artery aneurysms (PAA) with a stent made of nitinol rings externally supported by thin polyester (Anaconda limbs). Background: PAA are the most common peripheral aneurysms. The main limitations of stents used in these settings are: short lengths, longitudinal and horizontal compliance mismatch; graft failure from angulation and movement at the joint level; and dislodgment. Methods: This is a prospective multicenter cohort study of consecutive symptomatic and asymptomatic PAA treated in tertiary vascular centers. Outcomes included patency of the stent and postoperative time‐to‐independent‐ambulation and to‐climb‐a‐flight‐of‐stairs. Results: Fourteen PAA were treated in 12 men, age 72 ± 3 years. The median ASA classification was 2.5. The length of artery covered was 147 ± 41 mm. The PAA diameter was 31 ± 5 mm, 6 were symptomatic. One stent was used in 6 aneurysms, two in 7, and three in 1. The average stent diameter was 10 ± 1 mm. The length of the proximal neck was 24 ± 6 mm with a diameter of 9.8 ± 1.9, and length of the distal neck 23 ± 3 mm with a diameter of 8.7 ± 1.2 mm. In 6 aneurysms, the stent crossed the knee joint. There was no mortality, and one stent occluded (primary patency 93% at 6 ± 3 months). The median hospital stay was 1.7 days, time to independent ambulation was 3 hr and the time to climbing a flight of stairs was 1 day. Conclusions: The use of Anaconda limbs for endovascular repair of PAA is feasible and safe. © 2008 Wiley‐Liss, Inc.     

Atrial activity during cardioplegia and postoperative arrhythmias

Cardioplegia provides excellent protection for the left ventricle, but the right atrium may be poorly protected. Myocardial temperatures, right atrial electrical activity, and postoperative arrhythmias were assessed in 103 patients participating in two consecutive randomized trials comparing blood cardioplegia (n = 36), crystalloid cardioplegia (n = 38), and diltiazem crystalloid cardioplegia (n = 29). Both right atrial and right ventricular temperatures were significantly warmer (p less than 0.05) during delivery of the blood cardioplegic solution than during delivery of either the crystalloid or the diltiazem crystalloid cardioplegic solutions; the aortic root temperatures were 9 degrees +/- 2 degrees C with blood cardioplegia and 5 degrees + 1 degrees C with both crystalloid and diltiazem crystalloid cardioplegia. Atrial activity during cardioplegic arrest was greatest with blood cardioplegia (12 +/- 3 beats/min), lower with crystalloid cardioplegia (10 +/- 2 beats/min), and minimal with diltiazem crystalloid cardioplegia (5 +/- 1 beats/min, p less than 0.05). Perioperative ischemic injury (by creatine kinase MB isoenzyme analysis) was greatest with crystalloid cardioplegia (p less than 0.05). Postoperative supraventricular arrhythmias (both treated and untreated) were more frequent after crystalloid cardioplegia (crystalloid, 63%; blood, 40%; diltiazem, 47%; p less than 0.05). Patients in whom supraventricular arrhythmias developed had significantly more postoperative ischemic injury (by creatinine kinase MB isoenzyme analysis, p less than 0.05). Blood cardioplegia reduced supraventricular arrhythmias by reducing ischemic injury despite warmer intraoperative temperatures and more right atrial activity. Diltiazem crystalloid cardioplegia reduced postoperative arrhythmias by improving intraoperative myocardial protection and suppressing intraoperative and postoperative atrial activity. Crystalloid cardioplegia cooled but did not arrest the right atrium intraoperatively, resulted in the most perioperative ischemic injury, and yielded the highest incidence of postoperative supraventricular arrhythmias.     

Epirubicin,Cisplatin and Protracted Venous Infusion 5-Fluorouracil Chemotherapy for Advanced Salivary Adenoid Cystic Carcinoma

AimsAdenoid cystic carcinoma (ACC) is a rare tumour that usually arises in the salivary glands. Initial management is surgery often combined with adjuvant radiotherapy. Chemotherapy is reserved for treatment of symptomatic recurrence. We evaluated the combination of epirubicin, cisplatin and protracted venous infusion 5-fluorouracil (ECF) in the management of ACC.Materials and methodsPatients referred for treatment of advanced, symptomatic ACC were considered. The drugs given were epirubicin 50 mg/m² 3-weekly, cisplatin 60 mg/m² 3-weekly and protracted venous infusion 5-fluorouracil 200 mg/m²/day.ResultsEight patients (median age 46 years) received a median of five cycles of chemotherapy. All patients had had previous surgery, seven had had previous radiotherapy and one had had previous chemotherapy. One patient showed a partial response (duration 34 months) and five showed stable disease (median duration 13.6 months [6.8–15.9+ months]). Median survival was 27 months (3.5–62.3 months).ConclusionsThe activity of ECF in ACC of the head and neck seems to be similar to the combination of cisplatin and 5-fluorouracil and single-agent epirubicin.