Comparative study of laser versus radiofrequency myringotomy in rabbits: The effectiveness of mitomycin C application.

OBJECTIVE: To compare laser-assisted tympanostomy (LAT) with radiofrequency myringotomy (RFM), as well as the effectiveness of mitomycin C (MC) on the above techniques, in rabbits. STUDY DESIGN: Experimental animal research protocol. SETTING: University of Crete, School of Medicine, Medical Experimental Education and Research Center. METHODS: Bilateral myringotomies were performed under general anesthesia on 40 rabbits. LAT was performed on 20 animals (40 ears) and RFM on the remaining 20 animals (40 ears). MC (0.3 mg/mL) pledgets were applied to the right ears and saline pledgets to the left ears. Animals were monitored weekly using otomicroscopy until myringotomy closure. Kaplan-Meier survival techniques were used to compare myringotomy patency times. INTERVENTIONS: Under general anesthesia, bilateral LAT was performed on 20 rabbits and bilateral RFM on 20 rabbits. MAIN OUTCOME MEASURES: Myringotomy patency time. RESULTS: The mean patency times of the saline-treated ears were: 1.85 weeks (95% confidence interval [CI], 1.556-2.144 wk) for the LAT group and 1.70 weeks (95% CI, 1.494-1.906 wk) for the RFM group. This difference was not significant (p > 0.5). MC application significantly prolonged mean patency time (p < 0.0001) in both LAT and RFM groups. The mean patency times in the MC-treated ears were 5.45 weeks (95% CI, 5.226-5.674 wk) for the LAT group and 5.55 weeks (95% CI, 5.285-5.815 wk) for the RFM group. This difference was not significant (p > 0.5). CONCLUSION: There is no significant difference in myringotomy patency times between LAT and RFM techniques in rabbits, whereas MC significantly prolongs the patency rate of either technique.     

Neuroimaging in Pineal Tumors

BACKGROUND AND PURPOSE: The authors report radiological findings in 11 tumors in the pineal region, which were histologically diagnosed as germinomas, pineocytomas pineoblastomas, ependymomas, teratomas, and astrocytomas. METHODS: Computed tomography (CT) was performed in seven patients and magnetic resonance imaging (MRI) was performed in all patients. RESULTS: CT showed a solid or solid/cystic mass with variable contrast enhancement. MRI showed a heterogeneous mass, with hypointense signal on T1 and iso/hyperintense signal on T2-weighted images (WI) and gadolinium enhancement. Extension to adjacent structures occurred in five patients and spread through the cerebral spinal fluid (CSF) in two. CONCLUSIONS: Pineal region tumors have no pathognomonic imaging pattern. MRI and CT are complementary in diagnosis and are important to determine localization, extension, and meningeal spread.     

Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies.

OBJECTIVE: To identify predisposing factors associated with cardiac rhythm disturbances during the early post-pneumonectomy period (first 7 postoperative days). MATERIALS AND METHODS: During the study period (1995-1999), 259 pneumonectomies were performed for malignant (244 cases) or benign disease (15 cases). Postoperative monitoring of patients included continuous arterial pressure - rhythm monitoring and pulse oximetry. Cardiac rhythm disturbances during the intensive care unit stay were detected on the monitor screen and recorded with a 12-lead electrocardiogram. Cardiac rhythm disturbances associated with electrolytes or fluid balance abnormality, mediastinal deviation or surgical postoperative complications were excluded from the study. Age of patients, preexisting cardiac disease, side of pneumonectomy, intrapericardial procedures, stage of the malignant disease, expected postoperative FEV(1)<1200 ml, intraoperative transfusions of packed red cells, elevated right heart pressures, low postoperative serum magnesium levels and long operative times were considered as predisposing factors for the development of post-pneumonectomy cardiac rhythm disturbances. Statistical analysis has been made using logistic regression analysis, Student t-test and chi-square test. RESULTS: Cardiac rhythm disturbances were detected in 49 patients (18.91%). Atrial fibrillation/flutter (31 cases), supraventricular tachycardia (14 cases), and premature ventricular contractions (four cases) were the observed rhythm disturbances. Right pneumonectomy versus left pneumonectomy (P<0.0001) and intrapericardial pneumonectomy versus standard pneumonectomy (P<0.0001) were identified as strong predisposing factors for the establishment of post-pneumonectomy cardiac rhythm disturbances. Patients who established post-pneumonectomy cardiac rhythm disturbances had significantly higher (P=0.024) right ventricular systolic pressure (42.50+/-15.50 mmHg) when compared with patients who had postoperative sinus rhythm (29.07+/-7.71 mmHg) and had also longer operative times than patients who did not develop rhythm disturbances (P=0.015). Mortality rate in patients who developed post-pneumonectomy rhythm disturbances was 20.40%. CONCLUSIONS: Cardiac rhythm disturbances observed early after pneumonectomy are mainly of supraventricular origin, complicating right and intrapericardial pneumonectomies, patients with elevated right heart pressures and long operative times, and are associated with high mortality rates.     

Increased incidence of papillary thyroid cancer among total thyroidectomies in Crete.

OBJECTIVE: To investigate the increased incidence of papillary thyroid cancer as found in specimens of total thyroidectomies and potential correlation with etiological factors. STUDY DESIGN AND SETTING: A retrospective study on patients who underwent total thyroidectomy, from 1990 to 2004, in an academic tertiary referral medical center. Patients' records were placed in a database, which included medical condition, history, and demographics. Histopathological slides were reviewed with special focus on papillary cancer. RESULTS: Our series consisted of 2379 patients. Thyroid cancer was confirmed in 354 patients (14.88%). Papillary carcinoma represented the most frequent type (316 patients, 89.26%). Increased incidence of papillary carcinomas was noticed after 1995, reaching the maximum value in the year 2000. After 2000, there was a descending trend and then a plateau. CONCLUSION: The increased incidence of papillary thyroid cannot be attributed to dietary patterns or increased diagnostic and therapeutic activity. It is likely to be associated with increased radiation and may be associated with the Chernobyl fallout.     

Is the outcome of in-vitro fertilization and embryo transfer treatment improved by spontaneous or surgical drainage of a hydrosalpinx?

A pilot study was designed to examine whether the outcome of embryo transfer in women with a hydrosalpinx might be improved by surgical drainage of the hydrosalpinx at the time of oocyte collection for in- vitro fertilization treatment. A comparative, controlled but retrospective analysis of the results was performed of all women with infective tubal damage aged <40 years old, who had ovulatory cycles, a normal uterus and a partner with normal spermatozoa. A standardized treatment regimen was used. A maximum of three embryos were transferred. Hydrosalpinx was defined by prior hysterosalpingography and/or laparoscopy with transcervical dye injection. A total of 237 embryo transfer cycles in women with hydrosalpinges (tubal distension not visible in 151, visible but not drained in 30 and drained in 56) were compared with 705 embryo transfer cycles in women with tubal disease but no hydrosalpinx. Results were analysed in the first three cycles but also separately in the first cycle to check for bias. Success rates were higher in the first cycle, but did not significantly influence overall differences. Implantation rates were significantly reduced overall in the hydrosalpinx group (8.0 versus 13.2% for controls; P < 0.001), being 8.3% (P < 0.01) in the subgroup without evident tubal distension and 7.5% (not significant) in the drained hydrosalpinx group. This study shows that tubal damage with distal occlusion is associated with a marked reduction in embryo implantation, even in the absence of obvious fluid distension. Surgical drainage of distended hydrosalpinges appears to offer no benefit.      

住院精神分裂症患者十年前后用药情况对比分析

目的对十年前后精神分裂症患者用药情况的变化进行调查分析.方法对十年前后两个五年段的各500份符合精神分裂症诊断标准的病历进行回顾性调查,并对各项指标进行对比分析.结果两组折算用药剂量经t检验差异无显著性(P>0.05);两组合并用药、合并抗胆碱药及疗效经χ2检验差异有显著性(P<0.01);十年后非典型抗精神病药物氯氮平在临床上的应用比例明显增大并上升为首位.结论十年前后两组抗精神病药的应用发生了明显变化,疗效好、副作用轻的非典型抗精神病药的应用比例明显增加.     

Left ventricular pseudoaneurysm after mitral valve replacement

Development of left ventricular pseudoaneurysm is a rare complication of mitral valve surgery and requires urgent surgical intervention. We describe a case of pseudoaneurysm of membranous septum following repeat mitral valve replacement with the use of multimodality imaging.