Primary percutaneous balloon pericardiotomy for malignant pericardial effusion

Objectives : Pericardial effusion associated with malignancy is a life‐threatening complication of late‐stage disease. While simple drainage is effective in relieving the symptoms, reaccumulation of effusion may cause further symptomatic episodes, often during a period when overall patient management is focused on improving the quality of remaining life. Over a 16‐year period, we have adopted a strategy of managing such patients with balloon pericardiotomy as the initial preferred treatment. The results are described and compared to alternative management strategies. Methods : A retrospective analysis of patients who presented with symptomatic, malignant pericardial effusion, their management, procedural complication rates, and the need for further therapy for the same condition was made. Survival, reaccumulation rates, and readmissions after the index procedure were recorded and compared. Results : Forty‐three patients were treated for malignant pericardial effusion. Balloon pericardiotomy was the primary treatment in 27/43 patients, simple drainage in 14/43, and surgery in 2/43. Reaccumulation rates between balloon pericardiotomy and simple aspiration (7.4% vs. 14.3%, respectively, P = 0.48) and complication rates (7.4% vs. 7.1%, respectively, P = 0.98) were not statistically different. Survival following intervention was driven by the underlying pathology and was poor, with overall median survival of 56 days. Conclusions : Balloon pericardiotomy, as initial management of symptomatic malignant pericardial effusions, allows a definitive procedure to be performed at presentation. This can be achieved with low complication rates, similar to treatment by simple drainage. © 2008 Wiley‐Liss, Inc.     

Regional audit: perioperative management of MRSA orthopaedic patients in the Oxford region

AIM: Methicillin resistant staphylococcus aureus (MRSA) colonisation or infection is of particular importance in patients undergoing operations involving implantable materials, such as in orthopaedic surgery. An audit of the perioperative management of orthopaedic patients in the Oxford region was carried out to assess the level of clinician awareness and the uniformity of current guidelines between hospitals. METHODS: A postal questionnaire was designed for asking information on various aspects of perioperative management of MRSA patients and was sent to each hospital. RESULTS: Responses were obtained from nine of 10 hospitals in the region. The average response rate for each hospital was 75%, and the overall individual response rate was 67.5% (27/40). Seventy-eight per cent of respondents knew that there was a pre-admission screening policy. Fifteen per cent were unaware of any MRSA policy. Forty-four per cent indicated that teicoplanin was used for prophylaxis in implant surgery whilst 44% used vancomycin. Eighteen per cent believed that cefuroxime was used for prophylaxis. Forty-eight per cent of hospitals had an MRSA-free zone for orthopaedic patients. CONCLUSION: This study indicates a lack of uniformity in the perioperative management of MRSA-positive patients in the region and a lack of awareness of both MRSA guidelines and their implementation. Uniformity of MRSA guidelines is necessary to allow better clinician awareness and compliance, especially in surgical trainees who are travelling between different training hospitals in the region. Implementation of such a policy with re-audit of subsequent awareness and compliance is proposed.     

Solitary epithelioid histiocytoma (reticulohistiocytoma) of the glans penis

Solitary epithelioid histiocytoma (previously called reticulohistiocytoma) is a rare benign dermal histiocytic proliferation characterized by the presence of large, eosinophilic histiocytes with 'glassy' cytoplasm. This entity assumes importance because of its close histologic resemblance to several benign as well as malignant cutaneous lesions. Involvement of the penis is extremely rare, and to our knowledge, only one case has been previously described in the literature. We report a case of solitary epithelioid histiocytoma in a 34-year-old man who presented with a nodule in the glans penis. Microscopy showed proliferation of large epithelioid histiocytes with abundant eosinophilic cytoplasm, which expressed CD68, CD163 and vimentin. This case highlights the significance of recognizing this unusual lesion and differentiating it from its histologic mimics.     

Bilateral loss of light reflex and accommodation following 360° peripheral retinal laser therapy

We report a case of bilateral loss of pupillary light reflex and accommodation following 360° peripheral retinal laser therapy. A 24 years old male underwent prophylactic laser barrage for peripheral retinal lattice degenerations. Soon after the procedure, he developed bilateral loss of pupillary light reflex and accommodation. The patient faced difficulty while doing near work. On instillation of 0.125% pilocarpine, both pupils demonstrated the phenomenon of denervation supersensitivity. Damage to the short ciliary nerves was the most likely mechanism responsible for this adverse outcome.     

3β-Hydroxysterol-Delta24 reductase plays an important role in long bone growth by protecting chondrocytes from reactive oxygen species

Desmosterolosis is an autosomal recessive disease caused by mutations in the 3β-hydroxysterol-Delta24 reductase (DHCR24) gene, with severe developmental anomalies including short limbs. We utilized DHCR24 knockout (KO) mice to study the underlying bone pathology. Because the KO mice died within a few hours after birth, we cultured metatarsal bones from newborn mice. The growth of bones from KO mice was significantly retarded after 1 week of culture. Absence of proliferating chondrocytes in the growth plate and abnormal hypertrophy of prehypertrophic chondrocytes were observed in the bones from KO mice. Hypertrophic differentiation was evidenced by higher expression of Indian hedgehog, alkaline phosphatase, and matrix metalloproteinase 13. Since elevated levels of reactive oxygen species (ROS) during chondrogenesis are known to inhibit proliferation and to initiate chondrocyte hypertrophy in the growth plate, and since DHCR24 acts as a potent ROS scavenger, we hypothesized that the abnormal chondrocyte proliferation and differentiation in KO mice were due to decreased ROS scavenging activity. Treatment with an antioxidant, N-acetyl cysteine, could correct the abnormalities observed in the bones from KO mice. Treatment of bones from wild-type mice with U18666A, a chemical inhibitor of DHCR24, resulted in short broad bones with a disrupted proliferating zone. Treatment of ATDC cells with hydrogen peroxide (H₂O₂) induced hypertrophic changes as evidenced by the expression of the marker genes specific for hypertrophic chondrocyte differentiation. H₂O₂-induced hypertrophic change was prevented by adenoviral delivery of DHCR24. Induction of chondrocyte differentiation in ATDC cells by insulin was associated with increased ROS production that was markedly enhanced by treatment of ATDC5 cells with DHCR24 siRNA. This is the first demonstration that DHCR24 plays an important role in long bone growth by protecting chondrocytes from ROS     

静脉输液组间冲管液量数学模型及体外实验研究

目的:探讨静脉输液组间冲管液量的数学模型及主要影响因素。方法:推演冲管液量的数学模型并以体外实验进行验证,分别将1mL、3mL、5mL的B液注入输液管墨菲氏小壶内,然后以A液滴注冲洗,用分光光度计测定滴出液体的吸光度,当吸光度值趋于0时收集滴出的液体量,即为实际冲管液量,并与数学模型计算所得值进行比较。结果:墨菲氏小壶内B液量分别为3mL、5mL时,实际冲管液量与计算结果比较其差异均无统计学意义(P0.05)。结论:静脉输液组间冲管液量数学模型经体外实验验证,能够指导临床工作;冲管液量主要与墨菲氏小壶内的原药液体积有关,其体积越小,所需冲管液量越少。