Esophageal tuberculosis presenting with hematemesis

Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy (EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.     

Multivessel sequential bypass grafting without cardiopulmonary bypass

Background Multivessel sequential coronary artery bypass grafting without cardiopulmonary bypass has become a reality. Initially the revascularization of posterior coronary arteries (obtuse marginal branches of the circumflex artery) was difficult due to access and difficulty in stabilization of the heart as well as compromising the haemodynamic status of the heart. With stabilization of the heart with Octopus II (Medtronic, Inc. Minnesota, USA) we have demonstrated that sequential grafts as well as composite arterial grafts can easily and safely be used in complete arterial revascularization of the myocardium. Methods From January 1, 1996 till December 31, 1999, 832 consecutive patients underwent coronary artery bypass surgery without cardiopulmonary bypass. From July 1998, seventy-nine patients operated had atleast 1 conduit used as a sequential graft and 12 patients had composite ‘Y’ grafts. Before July 1999, 67 patients (61 sequential and 6 ‘Y’ conduits) underwent surgery without mechanical stabilization (Group A) and after July 1999 in 24 patients (18 sequential and 6 ‘Y’ conduits) mechanical stabilization (Octopus II) was used. Results Total number of sequential anastomosis including composite grafts was not significantly different in both groups. But due to Octopus II stabilization, number of anastomosis in composite ‘Y’ graft group significantly increased from 2.96 ±0.2 to 4.02 ±0.3. Also intramyocardial coronary artery revascularization which was only 10.4% in Group A increased to 20.8% in Group B. In Group A only 8.9% composite grafts were performed while in Group B it was 25% which was statistically significant. Conclusions Cardiac stabilization with Octopus II has improved ability for revascularization of remote coronary arteries arising from circumflex. Although overall anastomoses have not increased, the number of patients receiving composite grafts using all arterial conduits have increased significantly. Patency rates of all sequential conduits as well as composite grafts have remained equally good in both groups.     

治疗膝骨关节炎近十年文献中特殊内服中药分析

目的:总结和分析近10年国内医学期刊公开发表的中药内服治疗膝骨关节炎的文献中特殊中药应用现状。方法:通过统一检索式,委托专业文献查新人员检索万方、维普、CNKI三大数据库,再通过纳入标准、排除标准、资料提取与文献质量评价3个环节对检索结果进行分析。并对药物分类、特殊用药前20位药物出现频次及出现百分率进行排序。结果:最终有效文献为491篇,其中出现特殊用药的文献有209篇。中药内服治疗膝骨关节炎特殊用药前20位的药物排序依次为川乌、细辛、蜈蚣、附子、土鳖虫、草乌、全蝎、半夏、胆南星、马钱子、桃仁、红花、乌梢蛇、水蛭、血竭、三七、延胡索、路路通、穿山甲、白花蛇;药物功效分类依次为祛风寒湿药、活血止痛药、活血调经药、活血疗伤药、破血消癥药、息风止痉药、发散风寒药、温里药、温化寒痰药、化瘀止血药。结论:风、寒、湿三邪可能为膝骨关节炎的主要致病外因;膝骨关节炎风寒湿痹证出现的频率可能要比热痹证出现的频率高。     

Conceptual framework for cutting the pancreatic cancer fuel supply

Pancreatic ductal adenocarcinoma (a.k.a. pancreatic cancer) remains one of the most feared and clinically challenging diseases to treat despite continual improvements in therapies. The genetic landscape of pancreatic cancer shows near ubiquitous activating mutations of KRAS, and recurrent inactivating mutations of CDKN2A, SMAD4, and TP53. To date, attempts to develop agents to target KRAS to specifically kill cancer cells have been disappointing. In this regard, an understanding of cellular metabolic derangements in pancreatic cancer could lead to novel therapeutic approaches. Like other cancers, pancreatic cancer cells rely on fuel sources for homeostasis and proliferation; as such, interrupting the use of two major nutrients, glucose and glutamine, may provide new therapeutic avenues. In addition, KRAS-mutant pancreatic cancers have been documented to depend on autophagy, and the inhibition of autophagy in the preclinical setting has shown promise. Herein, the conceptual framework for blocking the pancreatic fuel supply is reviewed.