Pain Remapping in Migraine: A Novel Characteristic Following Trigeminal Nerve Injury

(Headache 2010;50:669‐674) The location of pain during the headache phase of migraine varies between individuals as well as between attacks in some individuals. We have observed a “remapping” or a change in the location of migraine pain following injury to the trigeminal system that is a novel characteristic to migraine and has not been described in other trigeminal pain syndromes of the head, neck, and face. Recognition of this clinical feature implies that the pathophysiology of migraine is impressionable and may be why diagnosis and treatment are often delayed.     

Use of Rigid Nephroscope for Laparoscopic Common Bile Duct Exploration—A Single-Center Experience

Background  

Increasingly, laparoscopic biliary surgeons are undertaking laparoscopic cholecystectomy and laparoscopic common bile duct exploration for patients with cholelithiasis and choledocholithiasis. In laparoscopic common bile duct exploration a flexible choledochoscope is ordinarily used, and with this instrument the surgeon usually fails to remove large impacted stones. In contrast with use of a rigid nephroscope it is possible to remove all common bile duct stones irrespective of size and degree of impaction. The present study evaluates the efficiency of rigid nephroscope for managing common bile duct stones laparoscopically.     

Patho-epidemiology of Cancer Corpus Uteri in Karachi South '1995-1997'.

Aim: To provide demographics and pathology of cancer of the uterine corpus in Karachi. Methodology: Data for 66 incident cases of cancer corpus uteri, ICD-10 category C54-5 registered at the Karachi Cancer Registry, for Karachi South, during a 3 year period, 1st January, 1995 to 31st December 1997 were reviewed. Results: Cancer uterine corpus (1995-97) was the sixth most common malignancy, following breast, oral cavity, ovary, esophagus and cervix. The age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.4 (4.73 to 8.01) and 2.9 (2.18 to 3.57). The mean age was 53.7 years (SD 15.6; range 6-90 years). Fifty eight cases were endometrial carcinoma with ASR world and CIR per 100,000 of 5.77 (4.20 to 7.33) and 2.53 (1.88 to 3.18) respectively. Sarcomas comprised 6% of the cases. Approximately a third of the females (28.8%) were below 50 years of age. The age-specific curves showed a gradual increase from the fourth till the seventh decade, followed by an actual apparent decrease in risk after 70 years. Peak incidence was observed in the 65-69 year age group. Presenting symptoms were post-menopausal bleeding (86.4%) and purulent discharge (4%). Associated pathologies included adenomyosis, adenomatous hyperplasia (12% each) or leiomyoma (8%). Associated clinical conditions were diabetes mellitus and hypertension (4% each). The majority of the cases presented as well differentiated (39.4%), localized (59.1%) lesions. Conclusion: The incidence of cancer corpus uteri in Karachi South reflects a moderate risk population, predominantly middle aged with a higher socio-economic status. On the average the malignancy is observed a decade earlier then reported elsewhere. This calls for in-depth investigation of risk factors and identification of underlying etiology.     

Effects of Sucrose and Trehalose on the Preservation of the Native Structure of Spray-Dried Lysozyme

Purpose. To investigate the effects of sucrose, trehalose, sucrose/dextran mixtures, and sucrose/trehalose mixtures on the preservation of the native structure of spray-dried lysozyme in the solid state. Methods. The intensity of the -helical band and the melting enthalpies (H_m ) of spray-dried lysozyme in the dried form and in aqueous solution were obtained using second derivative FTIR and differential scanning calorimetry (DSC) respectively. Results. The intensity of the -helical band and the H m of spray-dried lysozyme obtained were linearly correlated and both suggest that the stabilization of lysozyme in the dried form was excipient concentration-dependent with a close to maximum stabilization being conferred by sucrose or trehalose at a mass ratio 1–2 (sugar:enzyme). Sucrose appeared to be more effective than trehalose on a weight by weight basis whilst stabilizing effects of dextran/sucrose or trehalose/sucrose mixtures were found to be additive. Conclusion. Dehydration during spray drying was considered the main stress to the denaturation of lysozyme. A major effect of the sugars in protecting lysozyme against dehydration was attributable to hydrogen bonding between the sugar and protein molecules, which lead to an increase in the change in the negative value of the free energy between native and denatured states.     

Use of multiple stents to seal off an epicardial pseudoaneurysm

A 69-year-old male patient had triple-vessel coronary artery bypass graft (CABG) surgery. Three months later, an echocardiogram revealed a 6 x 6 cm cardiac mass. A computed tomography scan of the chest showed a 6 cm mass with contrast enhancement. Cardiac catheterization revealed a pseudoaneurysm of the saphenous vein graft to a circumflex marginal branch at the distal anastomosis site. The aneurysm neck was completely sealed off using 3 stents, leaving a patent saphenous vein graft and good distal run-off.     

The role of magnetic resonance cholangiopancreatography in patients with suspected biliary obstruction

Endoscopic retrograde cholangiopancreatography (ERCP) is an accepted and accurate procedure that combines the advantage of diagnosis of biliary obstruction with possible therapeutic endobiliary intervention. However, it is an operator-dependent and invasive procedure that is associated with complications and limitations. Magnetic resonance cholangiopancreatography (MRCP) is a unique noninvasive technique for the diagnosis of biliary obstruction. It is well suited to provide the information required to plan the optimal therapeutic approach for these patients. MRCP has the potential to replace or at least precede ERCP as the first-line imaging effort in the evaluation of suspected biliary obstruction. Significant advantages and some notable limitations inherent to the modality dictate its judicious use in appropriate circumstances. The present article reviews the utility of MRCP in evaluation of biliary obstruction, with brief reference to its principles and techniques.     

新生儿的恶性肝脏血管瘤

儿童的恶性肝脏血管瘤非常罕见，尤其在新生儿。本报道2例病例：1例最初被诊断为婴儿性血管内皮瘤。在接受侵入性药物治疗的同时，肿瘤迅速的增长而且向肺部转移，提示其可能正在恶变。另1例新生儿患有难以控制的腹水，肝活检表明具有血管肉瘤的组织学特征。在献中罕见报道腹水时肝血管肉瘤的组织学特征。2例患均死亡。目前为止，手术、化疗、放疗不能改善肝脏恶性血管肉瘤的转归。