Direct visualization of coronary sinus ostium and branches with a flexible steerable fiberoptic infrared endoscope.

BACKGROUND: Placement of electrophysiology catheters and pacing leads in the coronary sinus is challenging in some patients, particularly those with dilated cardiomyopathy. We hypothesized that cannulation of the coronary sinus and its branches can be facilitated by direct visualization. This study reports our experience with navigation into and within the coronary sinus in a closed-chest animal preparation, using a flexible steerable fiberoptic infrared endoscope that allows visualization through flowing blood. OBJECTIVES: The purpose of this study was to assess the feasibility of direct visualization of endocardial structures through infrared endoscopy. METHODS: Internal jugular venous access was obtained in 10 healthy mongrel dogs (weight 35-45 kg). The infrared endoscope (2900 fiber imaging bundle, wavelength 1,620 nm, frame rate 10-30/s, 320 x 256 pixels) was advanced to the coronary sinus ostium and branches by direct visualization of anatomic landmarks, such as the tricuspid valve and inferior vena cava. Localization was confirmed by fluoroscopy, contrast injection, and pathologic examination. RESULTS: Structures such as the tricuspid valve and inferior vena cava were visualized at distances of 1 to 2 cm, allowing successful coronary sinus identification and engagement in all 10 dogs. Coronary sinus branch images closely resembled pathologic findings. CONCLUSION: Direct visualization of the coronary sinus ostium and branches is possible through infrared endoscopy. This technique likely will facilitate coronary sinus engagement and navigation for pacing lead and catheter placement.     

Age-associated deficits in pattern separation functions of the perirhinal cortex: a cross-species consensus

Normal aging causes a decline in object recognition. Importantly, lesions of the perirhinal cortex produce similar deficits and also lead to object discrimination impairments when the test objects share common features, suggesting that the perirhinal cortex participates in perceptual discrimination. The current experiments investigated the ability of young and aged animals to distinguish between objects that shared features with tasks with limited mnemonic demands. In the first experiment, young and old rats performed a variant of the spontaneous object recognition task in which there was a minimal delay between the sample and the test phase. When the test objects did not share any features ("Easy" perceptual discrimination) both young and aged rats correctly identified the novel object. When the test objects contained overlapping features, however, only the young rats showed an exploratory preference for the novel object. In Experiment 2, young and aged monkeys were tested on an object discrimination task. When the object pairs were dissimilar, both the young and aged monkeys learned to select the rewarded object quickly. In contrast, when LEGOs? were used to create object pairs with overlapping features, the aged monkeys took significantly longer than did the young animals to learn to discriminate between the rewarded and the unrewarded object. Together, these data indicate that behaviors requiring the perirhinal cortex are disrupted in advanced age, and suggest that at least some of these impairments may be explained by changes in high-level perceptual processing in advanced age.     

Acute renal failure as the presenting feature of leukaemic infiltration in chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia (CLL) is a neoplastic condition of B cells which commonly affects the lymph nodes, liver, spleen and bone marrow. Leukaemic involvement of the kidney is also relatively common in CLL, but characteristically is not associated with renal impairment. Our report describes a patient who developed acute renal failure as the initial presenting feature of CLL. The renal failure was subsequently found to be due to direct leukaemic infiltration. Treatment with chlorambucil and prednisolone resulted in stabilisation of the renal function for approximately 1 year prior to the need for long-term haemodialysis. Leukaemic infiltration of kidney should always be considered when a patient with CLL presents with renal impairment, regardless of the clinical stage, as the renal failure often responds well to chemotherapy.     

Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography

OBJECTIVE: To assess the ability of contrast enhanced computed tomography (CECT) to detect active hemorrhage and other vascular injuries in chest, abdominal, and pelvic trauma patients, using angiographic findings and need for intervention as paired gold standards. METHODS: We obtained approval from the Institutional review board for a retrospective search of the radiology information system: seeking trauma patients undergoing angiography within 24 hours of CECT for chest, abdominal, or pelvic injuries. CECT protocol was standard trauma CT, not specialized for CT angiography. Angiographic techniques varied with indication. Clinical and imaging reports and selected radiologic studies were reviewed, but the original dictated report was the interpretive standard. We used Fisher's exact test for statistical analysis. RESULTS: During the 30-month study period, 466 patients underwent emergent interventional radiologic procedures. Of those, 418 were excluded for nontrauma indications or neuroangiographic procedures. Fourty-eight patients (33 male, 15 female, average age 43.4) thus constituted the study population in whom we evaluated 63 traumatic injuries. CT findings had statistically significant associations (p < 0.0001) with both angiographic evidence of active hemorrhage and the need for intervention, which were tabulated separately. CT had 94.1% sensitivity and 97.6% negative predictive value (NPV) for detection of active hemorrhage, and 92.6% sensitivity and 91.2% NPV for predicting need for surgical or endovascular intervention. CONCLUSIONS: CECT findings correlate strongly with angiographic findings, though sensitivity remains imperfect. However, when CT is used in the context of other clinical features, particularly hemodynamic instability, it may enable clinicians to reserve emergent angiography for those patients in whom emergent intervention is planned.     

Oral cancer survival in young people in South East England

The incidence rate of oral cancer among young people in the UK has been increasing since 1970s. The objective of this study was to compare relative survival of young people (under 45 years of age) diagnosed with oral cancer with that of older people (45 years and older) resident in South East England. Between 1986 and 2002, 5 year relative survival was higher among young people compared with the older group, suggesting age was a strong independent predictor of survival. Apart from age other independent predictors of survival included stage, treatment and affluence but residence was not a significant predictor of survival in either age group. For the young age group (0–44 years) mean relative survival for the period under study was relatively constant but consistently higher in younger women than in younger men.     

Topical p38 MAPK inhibition reduces bacterial growth in an in vivo burn wound model

BACKGROUND: Although the inflammatory response is a prerequisite for wound healing, excessive activation of the innate immune system can induce epithelial cell damage and apoptosis, which may further compromise dermal integrity. In a noninfectious burn wound model, we previously demonstrated that topical inhibition of p38 MAPK, an important inflammatory signaling pathway, attenuated epithelial cell damage and apoptosis. We now question whether attenuating local inflammation would weaken bacterial wound resistance and compromise host defense. METHODS: Rats received 30% total body surface area burn, and the wound was treated with topical application of a p38 MAPK inhibitor or vehicle. At 24 hours after injury, burn wounds were inoculated with Pseudomonas aeruginosa. At 48 hours postinjury, animals were sacrificed, and the burn wound was analyzed. RESULTS: Inoculating burn wounds induced significant bacterial growth. Dermal inflammatory changes were markedly accentuated in the inoculated animals. Topical p38 MAPK inhibition reduced the proinflammatory cytokine expression in the burn wounds and neutrophil sequestration with or without bacterial inoculation. Interestingly, the bacterial wound growth was significantly attenuated in animals treated with topical p38 MAPK inhibitor. CONCLUSIONS: Topical p38 MAPK inhibition attenuated wound inflammation without interfering with bacterial host defense. Attenuation of excessive burn wound inflammatory signaling may prevent secondary damage of the dermal barrier and reduce the growth of opportunistic pathogens.     

Oral squamous cell carcinoma arising from chronic traumatic ulcers

Clinical Oral Investigations - A proportion of oral squamous cell carcinoma (OSCC) is preceded by oral potentially malignant disorders (OPMD), and the rest might not be associated with any...