How to prevent echocardiographic misinterpretation of Gerbode type defect as pulmonary arterial hypertension.

We present a rare case of left ventricular to right atrial communication, a Gerbode type defect discovered in an adult female, originally misinterpreted as pulmonary arterial hypertension. The case report will be followed by the review of the literature and a discussion about how to prevent echocardiographic misinterpretation of this defect as pulmonary arterial hypertension using careful echocardiographic examination.     

Role of menthol in treatment of candidial napkin dermatitis

Background  

The antibacterial, antifungal and probable anti-inflammatory effects of menthol were evaluated in the treatment of napkin dermatitis (ND).     

Early clinical experience with the POEM procedure for achalasia

Background

Per oral endoscopic myotomy (POEM) is a viable alternative to standard Heller myotomy for surgical treatment of achalasia. Outcomes from the United States, Europe and Asia have been reported. We sought to report data after the initiation of POEM in a Canadian centre.

Methods

We enrolled patients with achalasia in a research ethics board–approved pilot study. Surgeons learned the POEM procedure in a systematic manner that included visiting experts in POEM, practice in an animal laboratory and mentoring from POEM experts. Preoperative evaluation included manometry, 24-hour pH, barium swallow, endoscopy and Eckhardt Symptom Score. All patients underwent gastrograffin swallow on postoperative day 1. Patients were re-evaluated using the Eckhardt score on postoperative day 14.

Results

Ten patients underwent POEM. Seven patients had previous endoscopic treatments: 6 had balloon dilatation and 1 had botulinum toxin injection. Mean preoperative Eckhardt score was 8.1 ± 2.4. Mean preoperative lower esophageal sphincter resting and residual pressure was 32.3 ± 9.2 and 20.8 ± 5.3, respectively. Mean duration of surgery was 141.3 ± 43.7 minutes. Mean length of hospital stay was 1 day. No major perioperative complications occurred. On postoperative day 14, the mean Eckhardt score was 1 ± 1.2.

Conclusion

Our approach to POEM introduction was systematic and deliberate. The procedure is safe, feasible and has good perioperative outcomes. Our early results are consistent with current literature.     

The administration of oxytocin during early reperfusion, dose-dependently protects the isolated male rat heart against ischemia/reperfusion injury

In our previous study, the administration of oxytocin (OT) could precondition the heart against ischemia/reperfusion injury. In this study, to investigate the cardiac postconditioning effect of oxytocin, isolated rat hearts were mounted on a Langendorff perfusion apparatus. In all groups, the hearts underwent 30 min of regional ischemia followed by 120 min of reperfusion. In the ischemia/reperfusion (IR) group, ischemia and reperfusion was induced. In the ischemic postconditioning (Ipost) group, hearts underwent 6 cycles of 10s reperfusion and 10s ischemia at the beginning of reperfusion. In the other groups (III-IX), OT was perfused 5 min before the onset of reperfusion and continued for 25 min with following doses (Molar): 10(-12), 5 × 10(-12), 8 × 10(-12), 10(-11), 2 × 10(-11), 5 × 10(-11), and 10(-10). The infarct size and coronary effluent levels of creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) and malondialdehyde (MDA) were calculated at the end of reperfusion. The infarct size decreased considerably in Ipost group compared to IR group (P<0.05). Also, the infusion of oxytocin by doses of 8 × 10(-12)M, 10(-11)M and 2 × 10(-11)M dose-dependently reduced infarct size (P<0.05) significantly compared to the IR group. LDH level in coronary effluent was markedly decreased in Ipost group and treatment with oxytocin by doses of 8 × 10(-12)M, 10(-11)M, 2 × 10(-11)M and 5 × 10(-11)M (P<0.05) compared to IR group. Ipost, OT 2 × 10(-11)and 10(-11)M significantly decreased CK-MB level (P<0.05). Ipost, OT 8 × 10(-12), 10(-11) and 2 × 10(-11)M significantly decreased MDA level as compared to IR group. Our study shows that oxytocin dose-dependently exerts cardiac postconditioning.     

Replacing Effective Spectral Radiance by Temperature in Occupational Exposure Limits to Protect Against Retinal Thermal Injury from Light and Near IR Radiation

Exposure to visible light and near infrared (NIR) radiation in the wavelength region of 380 to 1400 nm may cause thermal retinal injury. In this analysis, the effective spectral radiance of a hot source is replaced by its temperature in the exposure limit values in the region of 380–1400 nm. This article describes the development and implementation of a computer code to predict those temperatures, corresponding to the exposure limits proposed by the American Conference of Governmental Industrial Hygienists (ACGIH®). Viewing duration and apparent diameter of the source were inputs for the computer code. At the first stage, an infinite series was created for calculation of spectral radiance by integration with Planck^’s law. At the second stage for calculation of effective spectral radiance, the initial terms of this infinite series were selected and integration was performed by multiplying these terms by a weighting factor R(λ) in the wavelength region 380–1400 nm. At the third stage, using a computer code, the source temperature that can emit the same effective spectral radiance was found. As a result, based only on measuring the source temperature and accounting for the exposure time and the apparent diameter of the source, it is possible to decide whether the exposure to visible and NIR in any 8-hr workday is permissible. The substitution of source temperature for effective spectral radiance provides a convenient way to evaluate exposure to visible light and NIR.     

Case series on patients with primary central nervous system lymphoma: From clinical presentations to outcomes

Primary central nervous system lymphoma (PCNSL) is a rare form of non‐Hodgkin lymphoma. In this report, we present 11 cases of PCNSL which were treated with high‐dose MTX and WBI with a localized radiation boost to the tumor bed.     

Cardiac involvement in systemic sclerosis

Objective. To assess the incidence and extent of cardiac involvement in systemic sclerosis (SSc) patients with no apparent cardiac symptoms. Methods. Surface electrocardiography, ambulatory electrocardiography, radionuclide ventriculography, myocardial scintigraphy, and echocardiography were performed in 18 patients. Results. These studies demonstrated ventricular tachycardia in 1 patient, nonsustained ventricular tachycardia in 5, supraventricular tachycardia in 6, decreased left ventricular ejection fraction in 2, decreased right ventricular ejection fraction in 8, and stress-induced reversible myocardial perfusion abnormalities in 6. Conclusion. These observations demonstrate a high rate of cardiac abnormalities in SSc patients without cardiac symptoms.