Carotid Stent-Supported Angioplasty via Radiobrachial Route

Endovascular stent-supported angioplasty is a treatment option for atherosclerotic disease of the cervical internal carotid artery in high-risk patients. The traditional transfemoral approach is not suitable for patients who suffer from common femoral artery or abdominal aorta atheropathy. We report a case of carotid stent deployment using the radial route in a 68-year-old man with type B aortic dissection, having severe right internal carotid artery origin stenosis, presenting with ipsilateral retinal ischemic events. Technical aspects of carotid stenting via the radial approach are described and the related literature is discussed.     

Osmotic nephrosis with mannitol: review article

Mannitol is commonly used to lower intracranial and intraocular pressures. Large doses/massive infusions of mannitol have been found to be associated with acute renal failure (MI-ARF), that is, osmotic nephrosis. While many researchers have reported individual experiences with this pathology, we felt that there is need of an updated comprehensive review of all reported cases with elaboration of etiology, pathogenesis, diagnosis and management plan for MI-ARF. The purpose of the present communication is to share our own experience with MI-ARF, to review the effect of mannitol on kidney function and to highlight the dynamics of MI-ARF with considerations for the cautious use of mannitol in patients with risk factors for kidney diseases.     

Aggressive differentiated thyroid cancer

Differentiated thyroid cancer is characteristically associated with an innocuous clinical course, but a minority of cases may manifest surprisingly aggressive behaviour. Such aggressive DTC are directly responsible for the majority of thyroid cancer related deaths. Moreover, they contribute indirectly to increased DTC-related morbidity, because our inability to differentiate these tumours from innocuous DTC at an early stage fuels a significant degree of DTC overtreatment around the globe. In the present paper we describe how improved understanding of the clinicopathological thyroid tumour progression model and optimization of clinical staging systems continues to improve our ability to diagnose and treat aggressive DTC. Early recognition of aggressive DTC allows instillation of an aggressive management strategy which is based upon surgical-oncologic completeness, and minimization of treatment-related sequelae through continued development of reconstructive options and focussed delivery of adjuvant treatments.     

Bivalirudin as a Bridge for Anticoagulation in High Risk Neurosurgical Patients with Active DVT or High Risk of Thrombosis

Background

Bivalirudin is an ultrashort acting direct thrombin inhibitor, which has been used in place of heparin in selected settings. We describe our preliminary experience with the use of bivalirudin in patients who required anticoagulation for a deep vein thrombosis, prosthetic heart valve, or hypercoagulable state but were felt to be at high risk for the use of heparin.

Methods

Eight patients in our neurocritical care unit required anticoagulation but were felt to be poor candidates for heparin either due to heparin-induced thrombocytopenia or due to high risk for intracranial hemorrhage. A standard protocol was utilized for bivalirudin with a loading dose of 0.75 mg/kg followed by a continuous infusion of 0.15 mg/kg hr. Serial aPTT levels were checked on a routine basis to monitor therapeutic effect. The bivalirudin infusion was continued for a period of 2 days to 2 weeks prior to starting coumadin therapy.

Results

These patients were in the early postoperative period (within 48 h) following craniotomy, had suffered a recent large hemispheric infarct with hemorrhagic conversion, or had presented with an acute intracerebral hemorrhage. In this small series of patients, no intracranial hemorrhagic complications were encountered. No patients demonstrated progressive systemic thrombotic issues while on bivalirudin.

Conclusion

Based on these findings, bivalirudin may represent a reasonable alternative in patients for whom heparin anticoagulation is contraindicated. A larger multicenter trial of bivalirudin in this setting may be appropriate     

Operability and early outcome in 48 Irish patients with peritoneal malignancy treated by surgery and intraperitoneal chemotherapy in a specialized centre

BackgroundIn selected cases of peritoneal malignancy a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. The experience with 48 consecutive Irish cases undergoing laparotomy in a specialized centre is reported.Patients and methodsA subset of 48 Irish patients out of a total of 120 cases with peritoneal malignancy underwent surgery between September 1999 and March 2011 in an English National referral centre. Overall 37/48 (77%) had appendiceal mucinous tumours with pseudomyxoma peritonei type syndrome. The treatment strategy involved macroscopic complete tumour removal (complete cytoreduction) combined with intra-operative, intraperitoneal chemotherapy.ResultsOverall 30/48 (62.5%) had complete cytoreduction, 15/48 (31.3%) had major debulking and 3 (4.2%) had laparotomy and biopsy only. The median (range) operating time in hours was 9.8 (4.8–16) in the 30 who had complete cytoreduction compared with 6.3 (4.5–11) in the 15 who had debulking (p = 0.019). There was no post-operative mortality.Overall five year survival for the complete tumour removal group was 66% compared with 12% for those only amenable to major debulking.ConclusionThis novel strategy of cytoreduction combined with intraperitoneal chemotherapy is effective in selected patients with peritoneal malignancy. The complex surgery is particularly effective for appendiceal tumours and provides the only possibility of cure in this challenging disease.     

The first morphologically controlled synthesis of a nanocomposite of graphene oxide with cobalt tin oxide nanoparticles

In the present research, the degradation and decolorization of Reactive Black 5 synthetic dye at 30 ppm concentration under sun irradiation in the presence of a newly synthesized graphene based cobalt tin oxide nanocomposite were investigated. These nanoparticles were synthesized by a simple hydrothermal approach using precursor chloride salt i.e., stannous chloride and cobalt chloride and then adsorbed on the surface of RGO by a solvothermal process by changing the condition. The newly synthesized product was subjected to various instrumentation to study the morphology and other properties. X-ray powder diffraction analysis (XRD) explained the structural composition and various parameters of the product, which were further verified by Vesta software. The surface morphology of the product was analyzed by scanning electron microscopy (SEM) and it was observed that the size of each cube was approximately 5–10 μm from every face of the cube. Transmission electron microscopy (TEM) explained that the nanoparticles were within the range of 100–250 nm. These synthesized nanocubes were used in one more application, which was the investigation of the fuel efficiency in the presence of different concentrations of newly synthesized nanocomposites as a catalyst. The efficiency of kerosene oil was investigated by studying different parameters: the flash point, fire point, specific gravity, cloud point, pour point, and calorific value at increasing dosages of catalyst (0, 30, 60 and 90 ppm). It was observed that the values of these parameters changed significantly by changing the concentration of the catalyst dosage. The effect of the nanoparticles on the degradation of the RB 5 azo dye showed the highest removal percentage at the largest value of catalyst dosage, which was 0.70 mg ml⁻¹ with the highest value of 3 ml of hydrogen peroxide.

Tin cobalt hydroxide nanoparticles were synthesized by a simple hydrothermal technique. A graphene based cobalt tin oxide nanocomposite was synthesized by a solvothermal method.