Operability and early outcome in 48 Irish patients with peritoneal malignancy treated by surgery and intraperitoneal chemotherapy in a specialized centre

BackgroundIn selected cases of peritoneal malignancy a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. The experience with 48 consecutive Irish cases undergoing laparotomy in a specialized centre is reported.Patients and methodsA subset of 48 Irish patients out of a total of 120 cases with peritoneal malignancy underwent surgery between September 1999 and March 2011 in an English National referral centre. Overall 37/48 (77%) had appendiceal mucinous tumours with pseudomyxoma peritonei type syndrome. The treatment strategy involved macroscopic complete tumour removal (complete cytoreduction) combined with intra-operative, intraperitoneal chemotherapy.ResultsOverall 30/48 (62.5%) had complete cytoreduction, 15/48 (31.3%) had major debulking and 3 (4.2%) had laparotomy and biopsy only. The median (range) operating time in hours was 9.8 (4.8–16) in the 30 who had complete cytoreduction compared with 6.3 (4.5–11) in the 15 who had debulking (p = 0.019). There was no post-operative mortality.Overall five year survival for the complete tumour removal group was 66% compared with 12% for those only amenable to major debulking.ConclusionThis novel strategy of cytoreduction combined with intraperitoneal chemotherapy is effective in selected patients with peritoneal malignancy. The complex surgery is particularly effective for appendiceal tumours and provides the only possibility of cure in this challenging disease.     

Successful treatment of oral linear IgA disease using mycophenolate

Linear IgA disease (LAD) is a rare acquired autoimmune bullous disorder, characterized by linear deposition of IgA along the dermoepidermal basement membrane zone. The clinical presentation of LAD consists of vesiculobullous lesions affecting the skin and mucosal surfaces. The present case report presents a rare presentation of this vesiculobullous disorder. Although more than 50% of LAD patients present with oral lesions, there are few reported cases of involvement of the mouth as the sole manifestation. A 79-year-old female presented with a sore mouth and erosions affecting the palate. The symptoms resolved following the provision of mycophenolate, an antiproliferative immunosuppressant which has not previously appeared to have been reported in the long-term successful management of linear IgA disease limited to the mouth. We found that mycophenolate is a useful adjunct to the successful treatment of oral linear IgA when the uses of other immunosuppressants are contraindicated.     

Global Childhood Unintentional Injury Study: Multisite Surveillance Data

Objectives. We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan).Methods. We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes.Results. Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents.Conclusions. Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children’s safety and underscoring the need for intensified context-appropriate injury prevention.Injuries cause upwards of 5 million deaths each year, of which unintentional injuries account for approximately 80% (3.9 million).1 Unintentional injuries kill approximately 830 000 children every year, and more than 95% of child injury deaths (both intentional and unintentional) occur in low- and middle-income countries (LMICs).2 The 5 most common unintentional injuries reported by the World Health Organization (WHO) are road traffic injuries (RTIs), falls, burns, drowning, and poisoning.2 Global aggregate data reveal that the burden of childhood unintentional injuries is highest in South-East Asia and Africa, with a cause-specific mortality of 64 and 55 children per 100 000 population, respectively.1,2 The disproportionate share of the burden of unintentional childhood injury in LMICs results from a number of factors. First, children are more susceptible to injuries because of their curious nature, which, combined with their low capacity to assess and comprehend risks, and a general lack of safe play spaces in many LMICs, puts them at high risk.3 Second, global economic trends have uprooted communities and traditional forms of subsistence, necessitating persons from rural areas moving to urban slums and at times forcing children into labor, some in hazardous conditions, to contribute to a household’s income. For instance, it has become increasingly dangerous for children to share the road with the ever-growing number of motor vehicles.2,3 In this light, unintentional injuries not only affect children themselves, leaving them temporarily hospitalized or with short- or long-term disabilities, but also adversely affect their families and society as a whole.2,4–6The WHO has called for better data collection on child injury and its determinants for the purposes of national research and investment priority settings, as well as the targeting of high-risk groups.2 Reductions in child injury mortality have been observed in several high-income countries (HICs) as a result of the implementation of evidence-based programs.2,7,8 Likewise, a number of studies have provided reliable information to characterize the pattern of injuries in HICs.9,10 Despite the high burden of unintentional injuries in LMICs, there are few studies that provide standardized data from multiple sites. In the absence of reliable national population data, hospital-based data are an important source of injury information, particularly for children.11,12 In response, the Global Childhood Unintentional Injury Surveillance (GCUIS) study was initiated to collect standardized child injury data from emergency departments (EDs) at 5 sites: Bangladesh, Colombia, Egypt, Malaysia, and Pakistan.4,13 The objectives of the GCUIS study were (1) to determine the epidemiology of 5 major childhood unintentional injuries in 5 EDs in urban LMIC sites; (2) to explore potential risk factors and determinants of injury severity and outcomes, based on the injury records in the GCUIS study; and (3) to briefly summarize the characteristics of injuries sustained in homes, based on GCUIS data.6 In 2009, partial data from GCUIS were analyzed to report the initial pattern of injuries in 4 sites.13 This article adds data from an additional site and further analyses; therefore, it provides more insights into key unintentional injuries.     

Conservation Strategies of Euphorbia wallichii Hook. f—A Species with Cryptocotylar Seeds

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Euphorbia wallichii locally known as Kaali Heerbi is used as a folk medicine for the treatment of various...     

Cod Liver Oil,but Not Retinoic Acid,Treatment Restores Bone Thickness in a Vitamin A-Deficient Rat

Vitamin A plays a prominent role for maintaining optimal bone status, but its impact upon the bone in response to vitamin A deficiency is not well defined. The purpose of this study was to evaluate how replenishing vitamin A by either whole food cod liver oil (COD) or the active metabolite of vitamin A, retinoic acid (RA), altered bone thickness of vitamin A-deficient (VAD) rats. Weanling rats were administered a control diet (CTRL) or VAD diet for 9 weeks. This was followed by four weeks of treatment in which the VAD group was divided into the following 4 subgroups: (1) VAD (9 weeks)-VAD (4 weeks); (2) VAD-CTRL; (3) VAD-COD; and (4) VAD-RA. Compared to controls, VAD rats had thicker bones which showed marked dysplasia. VAD-rats treated with COD produced a thinner bone that was not significantly different from that of untreated rats. In contrast, RA did not significantly change the thicker bone, and also had significantly greater periosteal and endosteal osteoblast numbers compared to VAD-COD. Active osteoclasts were not detected in VAD rats, nor during the treatment period. These findings suggest that the abnormal bone thickness in VAD rats appears to be more effectively restored to bone thickness of untreated control rats when treated with COD.     

宫血净口服液治疗崩漏的止血机理研究

目的:探讨宫血净口服液治疗崩漏的止血机理.方法:通过宫血净口服液与血康口服液对气虚血淤动物模型作用的相关指标的测定,采用单因素方差分析的统计学方法来分析宫血净口服液治疗崩漏的止血机理.结果:宫血净口服液能降低大鼠全血粘度比、血浆粘度、全血低切还原粘度、全血低切相对粘度,宫血净大剂量组与模型组对照,全血低切相对粘度、全血低切还原粘度数数值有极显著差异(P＜0.01),全血粘度比(高低切)、血浆粘度有显著性差异(P＜0.05);其中全血粘度比(低切)与血康组比较有显著性差异(P＜0.05);宫血净小剂量组与模型组对照全血低切相对粘度、全血低切还原粘度值有极显著性差异(P＜0.01),全血粘度比(高、低切)、血浆粘度有显著性差异(P＜0.05),与血康组比较,全血粘度比(高、低切)有显著性差异(P＜0.05);明显延长BT、CT,以小剂量组明显(P＜0.01);宫血净口服液大剂量组使E2上升,与模型组E2对照,有显著性差异(P＜0.05);宫血净口服液小剂量组有增强大鼠子宫收缩力的作用,使子宫平滑肌收缩幅度提高,活动力增强;阳性对照组有抑制子宫收缩幅度及收缩活动力的作用.结论;宫血净口服液治疗崩漏的止血机理上是一综合作用.     

Bedside lung mechanics predict survival in hypoplastic lung disease

Newer bedside pulmonary mechanics using conventional ventilators allow for CONTINUOUS serial determinations of tidal volume (V(T)). We sought to determine whether the degree of pulmonary hypoplasia could be measured using bedside pulmonary graphics and whether survival could be predicted in potential extracorporeal membrane oxygenation (ECMO) candidates. Data on all neonates considered for or treated with ECMO at our center between April 2000 and March 2005 were collected. The "maximal bedside V(T)" was measured daily at the peak pressure where "beaking" began with a peak end expiratory pressure of 4 cm H(2)O. Twenty-two patients were reviewed: eight ECMO plus fourteen similar patients in whom the threshold for ECMO intervention was not achieved. Independent of need for ECMO, any patient with V(T) of < 3 mL/kg or < 0.2 mL/cm length died ( N = 4). All other measures of lung capacity or blood gas assessments were less valuable than V(T) in predicting survival. We conclude that bedside V(T) can be easily measured and that values < 3 mL/kg or < 0.2 mL/cm length demarcate severe lung hypoplasia, which in our patient population was incompatible with survival. We speculate that bedside V(T) may assist in evaluating the utility of ECMO.