Usefulness of live/real time three-dimensional transthoracic echocardiography in the assessment of atrioventricular septal defects

We studied nine patients (five newborns and infants, two children, and two adults) with atrioventricular septal defects (four complete, one intermediate, and four partial) utilizing live/real time three-dimensional transthoracic echocardiography (3DTTE) and a 4-MHz matrix array transducer. In all patients, 3DTTE provided additional morphological and/or functional information as compared to standard two-dimensional transthoracic echocardiography (2DTTE). 3DTTE may be a useful supplement to 2DTTE in the assessment of atrioventricular septal defects.     

Heart rate variability in patients with allergic rhinitis

Considering the role of autonomic imbalance in the pathogenesis of hypersensitivity reactions, we evaluated the autonomic system through time-domain analysis of heart rate variability (HRV) in patients with allergic rhinitis. Twenty-four patients with allergic rhinitis and 22 healthy subjects (mean age, 41 +/- 8 years and 37 +/- 9 years, respectively) were enrolled in the study. The diagnosis of allergic rhinitis was based on the history, symptoms, and skin prick tests results. Twenty-four-hour ambulatory electrocardiographic recordings were obtained, and the time-domain indices were analyzed. Analysis of HRV revealed that the SD of normal RR intervals, SD of successive differences in normal cycles, and HRV triangular index were not significantly different between the groups, but the root mean square successive difference, number of RR intervals exceeding 50 milliseconds, and percentage difference between adjacent normal RR intervals exceeding >50 milliseconds were significantly greater in the study group, compared with the control group. Our findings showed that HRV indices, which predict parasympathetic predominance, were increased in patients with allergic rhinitis. This finding shows that vagal activation is present not only in the nose but also in other systems, including the cardiovascular system.     

Surgical outcome of radical retropubic prostatectomy is not adversely affected by preexisting three-piece inflatable penile implant

OBJECTIVES: We report on our surgical findings and outcome of radical retropubic prostatectomy (RRP) in patients who have had three-piece inflatable penile implants. METHODS: We looked at the retrospective data of 6 patients who have undergone RRP for cancer of the prostate after a prior insertion of a three-piece inflatable penile implant. We looked at the data involving operating time, blood loss, infection of the penile implant, damage to the penile implant, surgical margins of the prostate, damage to other pelvic structures, length of hospital stay, time interval between penile implant and RRP, technique of placing of the reservoir during the penile implant surgery. RESULTS: The RRP procedures all went well, with no injury to the preexisting penile implants. There was also no compromise in the surgery for the cancer treatment, or injury to other pelvic organs. CONCLUSIONS: With increasing treatment of men with erectile dysfunction and also with increasing early diagnosis of cancer of the prostate, we are going to be seeing increasing numbers of patients who have had inflatable penile implants who subsequently need RRP for treatment of cancer of the prostate. We feel the surgery can be accomplished without any complication to the implant or compromise to the cancer surgery or injury to other pelvic organs.     

Use of bi-level biotinylation for concurrent measurement of in vivo recovery and survival in two rabbit platelet populations

BACKGROUND: The objectives of this research were 1) to determine whether two populations of platelets may be labeled with different levels of biotin and followed concurrently in vivo by flow cytometry and 2) to determine whether the level of biotinylation affects the in vivo platelet recovery and survival. STUDY DESIGN AND METHODS: Two platelet aliquots were biotinylated under conditions that resulted in either a lower or a higher number of biotin molecules per platelet. After transfusion, the two populations were distinguished and quantitated by flow cytometry. RESULTS: In five animals, recoveries were 69.8 +/− 27.0 percent for low-biotin platelets and 72.6 +/− 26.7 percent for high-biotin platelets. For each animal, the recoveries agreed closely. Life span, determined by the multiple-hit method, was 2.68 +/− 0.63 days for low-biotin platelets and 2.58 +/− 0.69 days for high-biotin platelets. These values for recovery and life span are consistent with those measured in rabbits by using radioisotope labels. CONCLUSION: Platelet biotinylation offers a nonisotopic method for direct comparison of alternative harvest and storage conditions. It also offers the potential for simultaneous evaluation of the in vivo characteristics of platelets from at least two donors.     

Recent advances in diagnosis of the childhood muscular dystrophies

Abstract: Recent advances in molecular genetics research have revolutionised our understanding of the childhood muscular dystrophies. The first breakthrough came in 1987 with the identification of the gene for dystrophin, the protein that is abnormal in X-linked Duchenne muscular dystrophy. Dystrophin is bound to a complex of proteins in the muscle membrane, and primary abnormalities of these protein have now been identified as the cause of some autosomally inherited forms of muscular dystrophy. A group of transmembrane proteins known as α- (adhalin) β-, γ- and δ-sarcoglycan are deficient in autosomal recessive limb-girdle muscular dystrophy, and the extracellular matrix protein merosin (α2-laminin), is deficient in a subset of patients with congenital muscular dystrophy. Identification of primary deficiencies in these 'dystrophin associated proteins' will result in improved diagnostic accuracy, more accurate genetic counselling and, in some cases, the availability of prenatal diagnosis.     

Management strategies for hepatocellular carcinoma: old certainties and new realities

Hepatocellular carcinoma (HCC) is a highly prevalent disease ranking among the ten most common cancers worldwide with increasing trend of incidence in most developed countries. The great healthcare costs and economic burden of HCC dictate proper preventive interventions as well as surveillance and screening programs to decrease disease incidence and allow early diagnosis. HCC treatment outcomes are affected by several variables, including liver function, patient’s performance status, and tumor stage. In line with the Barcelona Clinic Liver Cancer (BCLC) staging curative treatments, such as surgery or radio-frequency ablation, are indicated in early-stage HCC (BCLC-A), and the noncurative treatments are indicated in intermediate and advanced stages of HCC (BCLC-B, C). Transarterial chemoembolization (TACE) represents the treatment of choice for intermediate-stage HCC with Child–Pugh A cirrhosis, and the long-term survival after liver transplantation is inferior to that of early-stage HCCs. In advanced-stage HCC or when complete necrosis is not achieved or early recurrence after TACE develops, individualized treatments such as systemic treatment or combined radiation therapy are indicated. The increasing knowledge of the genomic landscape of HCC and the development of molecular-targeted therapies is heading toward expanding the armamentarium for HCC management.     

What is the outcome of rheumatic carditis in children with Sydenham's chorea?

We evaluated the echocardiographic features of 69 children diagnosed with Sydenham's chorea at the first attack of acute rheumatic fever. By echocardiography, carditis was detected in 71% of cases and silent carditis was shown in 28.9% of cases at initial presentation. Most patients had mild or moderate valvular regurgitation. Sixty-three cases were followed from 1-10 years. The improvement rate in valvulitis in cases with silent carditis (29.4%) was not different than in cases with clinical carditis (18.5%) (p > 0.05). Persistence of valvular pathologies occurred in 72.2% of cases with carditis in the long-term follow-up (> 2 years). Most patients (88.8%) complied with secondary prophylaxis, so relapse of carditis was exclusively prevented in our patients. Recurrence of chorea was identified in 20.6% of cases and was not associated with clinical or laboratory evidence for streptococcal reinfection. Patients with chorea usually had mild carditis, and carditis showed resolution. Relapse of carditis in our population was exclusively prevented with secondary prophylaxis. Recurrence of chorea was not rare, despite regular treatment with benzathine penicillin.