Acute pulmonary thromboembolism complicating pneumonectomy: successful operative management.

Pulmonary thromboembolism after pneumonectomy carries high fatality. Here we present a case of acute embolism to the left pulmonary artery with thrombus in the right atrium and inferior vena cava following right pneumonectomy. Diagnosis was made clinically and radiologically before proceeding to emergency surgery. Thromboembolectomy was successfully performed on cardiopulmonary bypass and the patient was subsequently discharged home after uneventful recovery.     

LYMPHOCYTE SUBPOPULATION AND NATURAL KILLER CELL CYTOTOXICITY AFTER LAPAROSCOPIC ASSISTED RESECTION OF RECTOSIGMOID CARCINOMA—A PROSPECTIVE RANDOMIZED TRIAL

We compared the lymphocyte subpopullation and natural killer cell cytotoxicity in patients after laparoscopic assisted resection with those after open resection of rectosigmoid carcinoma. Background: Laparoscopic assisted resection of colorectal carcinoma is technically feasible and less traumatic, the postoperative immunosuppression thus may be reduced and potentially beneficial to tumour surgery. Methods: Forty patients with rectosigmoid carcinoma, without evidence of metastatic disease and suitable for laparoscopic assisted resection were randomized to receive either laparoscopic assisted (20 patients) or conventional open (20 patients) resection of the tumour. Clinical parameters were recorded. Blood were collected before operation, 24 hours, 72 hours and 8 days after operation for lymphocyte subsets and natural killer (NK) cell cytotoxicity studies. Data were analyzed by intention to treat. Results: The demographic data of the two groups were comparable. Clinically the laparoscopic group had significantly earlier return of bowel function, earlier mobilization and required less analgesia. The lymphocyte subpopulations and NK cell cytotoxicity of both groups showed a typical suppression after surgery. The suppression of T cell activation and NK‐like T cells was significantly less after laparoscopic assisted resection than in the open group, while the difference in other lymphocyte subpopulation and NK cell cytotoxicity were not significant. Conclusion: This study showed that some cellular components of immune system were less suppressed after laparoscopic assisted than conventional open resection of rectosigmoid carcinoma. This may have implication on the patient survival.     

Lymphoepithelioma-like carcinoma of the lung in a patient with silicosis.

Silicosis is an important form of pneumoconiosis, which is caused by significant exposure to crystalline silica. The carcinogenicity of silica, despite traditional beliefs, in relation to lung cancer has been controversial. Lymphoepithelioma-like carcinoma of the lung, an Epstein-Barr virus-associated undifferentiated carcinoma, is a rare entity of pulmonary malignancy, which tends to affect young nonsmoking Asians. The first case of silicosis, initially complicated by pulmonary tuberculosis, which later developed into advanced lymphoepithelioma-like carcinoma of the lung is reported. A combination of 5-fluorouracil, cisplatin and calcium folinate resulted in partial tumour response.     

Species variation in biology and physiology of the ciliary epithelium: Similarities and differences

Glaucoma is a leading cause of irreversible blindness worldwide. Lowering intraocular pressure (IOP) is the only strategy documented to delay the appearance and retard the progression of vision loss. One major approach for lowering IOP is to slow the rate of aqueous humor formation by the ciliary epithelium. As discussed in the present review, the transport basis for this secretion is largely understood. However, several substantive issues are yet to be resolved, including the integrated regulation of secretion, the functional topography of the ciliary epithelium, and the degree and significance of species variation in aqueous humor inflow. This review discusses species differences in net secretion, particularly of Cl⁻ and HCO₃⁻ secretion. Identifying animal models most accurately mimicking aqueous humor formation in the human will facilitate development of future novel initiatives to lower IOP.     

Hyperleptinaemia and chronic inflammation after peritonitis predicts poor nutritional status and mortality in patients on peritoneal dialysis.

BACKGROUND: The serum leptin level is elevated in patients undergoing peritoneal dialysis (PD) and associated with a loss of lean body mass. The nutritional status of PD patients may further be worsened following peritonitis. We investigated the association between hyperleptinaemia, inflammation and malnourishment in PD-related peritonitis. METHODS: We conducted a prospective study on PD patients who developed peritonitis. Blood samples were obtained as baseline (D0) before the onset of peritonitis, and once peritonitis developed, leptin, adiponectin (ADPN) and other inflammatory markers were collected, on day 1 (D1), day 7 (D7) and day 42 (D42) of peritonitis. Patients were followed-up for any censor event or 1 year after peritonitis. RESULTS: Forty-two patients with a mean age of 62.9+/-13.2 years were recruited. Fourteen (33.3%) were diabetic. The serum leptin levels increased significantly from baseline to day 1 and 7, but fell back to the premorbid state at day 42. In contrast, the ADPN level decreased from a baseline value of 15.60+/-10.4 microg/ml to 13.01+/-8.1 microg/ml on day 1 (P=0.01) but rose to 14.39+/-8.9 microg/ml on day 7 (P=0.28) and 13.87+/-7.9 microg/ml on day 42 (P=0.21). High-sensitivity C-reactive protein (hs-CRP) increased significantly from baseline to day 1, 7 and even at day 42. The lean body mass (LBM) and nutritional markers decreased significantly after peritonitis. For patients with high hs-CRP (>3.0 mg/l) at day 42, there was a higher mortality rate than for those with lower hs-CRP (<3.0 mg/l, P=0.02), even if they were in clinical remission of peritonitis. CONCLUSIONS: Our study confirmed an increase in serum leptin during acute peritonitis and a prolonged course of systemic inflammation after apparent clinical remission of peritonitis. These factors related to the persistent chronic inflammation may contribute to the development of malnourishment and poor survival rate.     

Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation

The effectiveness of oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration was compared in women in the 6th to 12th week of pregnancy. Sixty-four nulliparous women requesting termination of pregnancy between 6th to 12th weeks of gestation were randomized to receive either 400 μg misoprostol orally or 1 mg vaginal gemeprost at 12 hr or 3 hr prior to vacuum aspiration, respectively. The cervical dilatation at vacuum aspiration, the ease of the subsequent surgical procedure, and the incidence of complications and side effects were compared between these two methods of cervical priming. The median cervical dilatation at vacuum aspiration in the misoprostol group was significantly greater than that in the gemeprost group (8.0 mm versus 7.0 mm, p<0.02). Preoperative side effects were significantly less frequent in the misoprostol group (p<0.01). The ease of dilatation assessed subjectively by the operating surgeons was also improved significantly in the misoprostol group (p<0.01). However, the duration of operation and blood loss were similar in both groups. Since misoprostol is also much cheaper and more convenient to use, we conclude that oral misoprostol is better than vaginal gemeprost for cervical dilatation prior to vacuum aspiration in first trimester pregnancy.