Cutaneous angiosarcoma of the head and neck: report of 23 cases from a single institution

BACKGROUND: To report a single-institution experience in the treatment of cutaneous head and neck angiosarcoma. STUDY DESIGN: Case series. PATIENTS AND METHODS: Twenty-three patients were evaluated: 12 females and 11 males. The primary site of the lesion was the neck in 9 patients, the scalp in 9, and the face in 5. No patient had been submitted to previous treatment but 10 were submitted to incisional biopsy. The lesions' size ranged from 2.5 to 12 cm (median 4 cm). RESULTS: All but one patient were submitted to surgical resection as primary treatment. Twenty-two patients received adjuvant treatment: 8 cases of local recurrence and 12 cases of distant metastasis. Two patients presented synchronous local and distant relapses. The 5-year survival rate was 21.7 percent. In our series, the only factor affecting survival was histological grade (odds ratio = 6.7; 95% confidence interval, 1.6-28.9). CONCLUSION: Our results for 5-year survival are comparable to those in the literature with a treatment based on complete surgical resection. The only significant prognostic factor was tumor histological grade.     

Passive drainage through the vestibular oblique incision in impacted inferior third molar surgery: a preliminary study

The aim of the present study was to clinically evaluate the variables pain, swelling and trismus when two different suture techniques were applied in surgery of impacted lower third molars. The sample comprised 20 patients of both genders participating in the clinical trial at the Division of Oral and Maxillofacial Surgery, with an indication for the removal of bilaterally impacted lower third molars. They were divided into test and control groups. Complete suture was performed on the free and attached gums in the control group and only on the attached gum of the oblique vestibular incision in the test group. The results showed that the fact that the drainage of fluid through the suture was not obliterated led to diminution of pain 48 hours after surgery. No statistically significant differences were observed in relation to swelling, which diminished gradually in both groups. As regards the variable trismus, the test group presented a greater mouth opening throughout the evaluation, being statistically significant at 7 days. The probing depth, three months postoperatively, was found to be greater in the control group. This difference reached statistical significance for the vestibular distal region of the adjacent second molar. It is concluded that the strategy of not suturing the free gum of the oblique vestibular incision in the extraction of impacted lower third molars leads to the diminution of immediate painful symptomatology, but has no influence on the swelling.     

Repair of corrected transposition associated with ventricular septal defect and pulmonary stenosis

Five patients with the diagnosis of classically corrected transposition of the great arteries, ventricular septal defect (VSD), and pulmonary outflow tract obstruction underwent surgical repair. A variant of a previously described technique was used to avoid injury to conduction tissue. Through an incision into the anatomical left ventricle, the VSD patch was sutured inferiorly to the right and away from the edges of the defect and superiorly to the epicardial border of the ventriculotomy. The pulmonary artery was opened, and its proximal end was closed with a suture. A pouch containing the conduction tissue was therefore obtained. Pulmonary ventriculoarterial continuity was reestablished using a valved or nonvalved Dacron or pericardial conduit. The postoperative course of the patients was uneventful. No changes were demonstrated on comparison with preoperative cardiac rhythm. Good hemodynamic performance was noted in 2 patients in whom postoperative catheterization was performed.     

Avoidability of maternal death in Mozambique: audit and retrospective risk assessment in 106 consecutive cases

A maternal mortality audit identified 106 cases of maternal death in Maputo (340 per 100 000 live births), caused by haemorrhage (31%), hypertensive diseases of pregnancy (15%), puerperal sepsis (12%) and septic abortion (9%). Puerperal uterine inertia (12%) and malaria (9%), respectively, were the most prevalent causes of direct and indirect maternal death. The maternal mortality audit analyses, indicated that health services research is fruitful in a more detailed, systematic study on maternal deaths at the community level wit ensuing analyses of avoidability aspects. Lack of transport and poor quality of antenatal and intrapartum care in peripheral maternity units implied that women with eclampsia, obstructed labor, post partum atonic haemorrhage and uterine rupture arrived late due to deficient transport.Shortage of blood and delay in access to operating theatre contributed significantly to fatal maternal outcome in several cases. The audit provided evidence that approximately 40% of the deaths would have been avoidable with existing resources. It is particularly significant that the analysis of antenatal cards revealed that only 30% had any high risk factors, implying that more than two thirds of women dying a maternal death are low risk women.     

Phospholipase C-gamma 1 association with CD3 structure in T cells

Recently, we and others have reported tyrosine phosphorylation of phospholipase C-gamma 1 (PLC gamma 1) enzyme after CD3 activation of T cells, and have proposed that PLC gamma 1 mediates signal transduction through the T cell receptor (TCR/CD3). Here, using immunoblotting and immune complex PLC assays, we show that CD3 stimulation of Jurkat cells induces the association of PLC gamma 1 enzyme with CD3 complex. PLC activity is also found to co-precipitate with the CD3 zeta chain from activated cells. In addition, in vitro PLC assays show that CD3 activation leads to about 10-fold stimulation of PLC gamma 1 activity. These results, along with the observation that Jurkat cells preferentially express PLC gamma 1, indicate that PLC gamma 1 participates in CD3 signaling.     

Patients' recollections of experiences in the intensive care unit may affect their quality of life

Introduction

We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL).

Methods

We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire.

Results

Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30).

Conclusion

This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL.