Giant mediastinal liposarcoma: a case report.

Liposarcomas are extremely rare in the mediastinum. They may achieve considerable size before causing any symptoms. Mediastinal liposarcomas may invade surrounding structures like the pericardium or the superior vena cava. Complete surgical excision is the optimal treatment in resectable cases. Excision of adjacent structures like the pericardium may be needed if the tumor infiltrates them. We report on a case of a giant liposarcoma of the mediastinum involving both hemithoraces and extending into the neck, which was successfully managed by complete surgical excision.     

Angiosarcoma of the pleura.

Angiosarcoma is a rare, highly malignant tumor arising from endothelial cells of small blood vessels. They usually occur in the skin, deep soft tissues, breast and liver. Pleural angiosarcomas are extremely rare and are restricted to case reports in medical literature. It is very difficult to distinguish them from malignant mesotheliomas on clinical, radiological and even histopathological features. Immunohistochemistry is valuable in making the diagnosis, showing negative reactivity for mesothelial markers and positivity for vascular markers. Prognosis is generally dismal except in occasional cases where the disease is localized and amenable for surgical resection. We report a 55-year-old man who presented to us with chest pain, cough and hemoptysis and was diagnosed to have a pleural angiosarcoma.     

Identification and localisation of glycosyl moieties of surface glycoproteins of teliospore wall of Karnal bunt (Tilletia indica) of wheat

This article aims to characterise and localise the glycosyl moieties of teliospore wall of Tilletia indica a quarantined fungal pathogens by biochemical and immunological approaches. Chemical enzyme modifier studies, followed by determination of structural configuration using phase contrast and SEM after periodate treatment, showed antigenic entities are glycoprotein in nature. Further characterisation using sodium dodecyl sulphate-polyacrylamide gel electrophroesis (SDS-PAGE) glycoprotein staining and western blotting using anti-teliospore antibodies showed two common proteins of molecular weight 28 and 40 kDa, which is also suggestive of glycoprotein nature of antigenic entities of teliospore wall. To study the binding patterns and localisation of glycosyl moieties on the teliospore walls, fluorescein isothiocyanate (FITC) labelled lectins [Wheat Germ Agglutinin (WGA) and Concanavilin A (Con A)] and anti-teliospore antibodies were used. The patterns of WGA and anti-teliospore antibodies binding with teliospore wall are almost similar and hence it is quite reasonable to suggest that immunodominant glycosyl entities of teliospore wall are acetylglucosamine in nature.     

Economic evaluation of a randomised trial of early return to normal activities versus cardiac rehabilitation after acute myocardial infarction

Background: Although there have been a number of economic evaluations of cardiac rehabilitation after acute myocardial infarction (AMI), none has considered only low-risk patients or control groups with no rehabilitation at all.Methods: An economic evaluation was included in a randomised controlled trial of patients following uncomplicated AMI. Eligible patients were randomised to return to normal activities after 6 weeks of standard rehabilitation (REHAB, n = 70) or to early return to normal activities 2 weeks after AMI with no formal rehabilitation (ERNA, n = 72). Outcomes were assessed weekly for 6 weeks, then 3, 6 and 12 months post-AMI. Outcomes included four quality of life (QOL) measures (physical abilities, distress, usual/social activities, self-care) and four measures of return to normal activities (paid and unpaid return to any work and to pre-AMI level of work). Statistical analysis included repeated-measures regression (QOL outcomes) and survival analysis (work outcomes).Results: There were no statistically significant differences between the two groups in any of the outcomes measured or in the use of other health services. The net cost that could be saved by the health service by targeting rehabilitation to high-risk patients was approximately $300 (Australian, 1999) per low-risk patient.Conclusions: Early return to normal activities without formal rehabilitation is cost-effective for low-risk patients.     

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

IntroductionCarotid web is increasingly recognized as the cause of ischemic embolic strokes in younger patients. The best way to treat carotid web is debatable and carotid artery stenting (CAS) has been reported as a treatment for the carotid web in only a few case series. In this study we evaluate the safety and feasibility of CAS in symptomatic carotid webs and examined the histopathology of a carotid web.Materials and methodsAt our institution between 2017 and 2019, 10 consecutive patients with symptomatic carotid webs were treated. We retrospectively analyzed the data for patient demographics, clinical presentation, imaging, treatment methodology and follow up.ResultsAll the patients had presented with ipsilateral embolic stroke. The mean age at presentation was 50 years (range 37–71) with seven female and three male patients. All patients underwent CAS except one patient who underwent carotid endarterectomy (CEA). In one stented patient, there was significant hypotension in the post-procedural period lasting a week. The patients were followed for a mean of 5.5 months (range one day-12 months). No recurrent stroke or transient ischemic attack (TIA) occurred. Surgical pathological studies confirmed fibromuscular dysplasia in one specimen.ConclusionIn our experience CAS for carotid web is feasible and safe in patients presenting with ischemic embolic strokes.     

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

Surgery Today - Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery...     

Associations between retinal microvascular structure and the severity and extent of coronary artery disease

Objective

Microvascular mechanisms are increasingly recognized as being involved in a significant proportion of coronary artery disease (CAD) cases, but their exact contribution or role is unclear. We aimed to define the association between retinal microvascular signs and both CAD extent and severity.

Methods

1120 participants of the Australian Heart Eye Study were included. Retinal vessel caliber was measured from digital retinal images. Extent and severity of CAD was assessed using several approaches. First, a simple scoring classifying participants as having one-vessel, two-vessel, and three-vessel disease was used. Gensini and Extent scores were calculated using angiography findings.

Results

After multivariable adjustment, significantly narrower retinal arteriolar caliber in women (comparing lowest versus highest quartile or reference) and wider venular caliber in men (comparing highest versus lowest quartile or reference) were associated with 2-fold and 54% higher odds of having at least one stenosis ≥50% in the epicardial coronary arteries, respectively. Women in the third versus first tertile of retinal venular caliber had 92% and ∼2-fold higher likelihood of having higher Gensini and Extent scores, respectively. Women in the lowest versus highest tertile of retinal arteriolar caliber had greater odds of having higher Extent scores, OR 2.99 (95% CI 1.45–6.16). In men, non-significant associations were observed between retinal vascular caliber and Gensini and Extent scores.

Conclusions

An unhealthy retinal microvascular profile, namely, narrower retinal arterioles and wider venules was associated with more diffuse and severe CAD among women.