Successful weaning from cardiopulmonary bypass after cardiac surgery using inhaled nitric oxide

Two cases of very difficult weaning from cardiopulmonary bypass after cardiac surgery in children with pulmonary hypertension and ventricular dysfunction are reported. Children fail to respond to conventional therapy combining nitrovasodilators and inotropic support and react successfully to combined inhaled nitric oxide (NO) and epinephrine or left atrial infused norepinephrine. Postoperative NO inhalation must be prolonged and no toxicity appears. Pulmonary endothelial function recovers only after several days.     

The value of lymph node dissection in hereditary medullary thyroid carcinoma: a retrospective,European, multicentre study

Abstract. Clinical data of 139 patients with hereditary medullary thyroid carcinoma (HMTC) from nine european centres surgically treated from 1980 to 1991 were reviewed retrospectively to analyse the value of systematic versus selective lymphadenectomy (LA). Biochemical cure rate was significantly higher in patients who underwent LA compared to patients who did not. In nodal-positive HMTC, systematic LA compared to selective LA improved biochemical cure in small but not large tumours. In nodal-negative HMTC, systematic LA compared to selective LA could not improve biochemical cure in either small or large primary tumours. To prevent local recurrences with the risk of increased surgical and tumour-related morbidity, systematic LA should be performed in all HMTC patients regardless of the primary tumour stage. However, an improvement of biochemical cure by systematic LA seems to be possible only in nodal-positive small primary tumours without distant metastases.     

Five-Year Safety and Efficacy of a Novel Polymethylmethacrylate Aesthetic Soft Tissue Filler for the Correction of Nasolabial Folds

BACKGROUND A novel soft tissue filler composed of polymethylmethacrylate (PMMA) microspheres suspended in a collagen gel matrix containing 0.3% lidocaine (ArteFill, Artes Medical, Inc.) was recently approved by the Food and Drug Administration for the correction of nasolabial folds. A randomized, multicenter, controlled pivotal trial performed in the United States established the safety and efficacy of this medical device throughout a 12-month study period.
OBJECTIVE The objective was to substantiate the long-term 5-year safety and efficacy of this novel soft tissue PMMA filler.
METHODS AND MATERIALS Attempts were made to contact all subjects treated with the PMMA filler that were enrolled in the original pivotal study. Safety was assessed by standard adverse event reporting methods. Efficacy was determined using a validated six-point facial fold assessment photometric grading scale using blinded observers' assessment of standardized photographs.
RESULTS Subjects ( n =119) demonstrated significant improvement in nasolabial folds comparing baseline (before any treatment) to 5 years after their last treatment ( p <.001). Notably, subjects also demonstrated continued improvement between 6 months after their last treatment and Year 5 ( p =.002). No serious unanticipated device-related adverse events were reported.
CONCLUSION This PMMA filler is the first soft tissue filler to demonstrate continued improvement and persistence of correction over a 5-year period posttreatment.     

An indication for a process dimension in medical problem-solving

Several recent studies have concluded that medical problem-solving, as evidenced in a written simulation, is heavily influenced by the medical content of the particular case. The method employed in these studies did not allow process and content aspects to be separated, so the contribution of each could not be independently assessed. The present study employed a method that allowed such a separation.
Medical students were required to write problem lists, to order laboratory tests and to choose a final diagnosis for each of five casts. They were given corrective feedback after each part (e.g. after writing problem lists they were given the correct problem list) so that all students were working with the same information as they began each section of the case. The results on factor analysis showed more similarity in performance on the same aspect of problemsolving across different clinical cases than on the different processes within a given case. The present study clarifies some issues, but more work is needed to define further the specific processes in problemsolving.     

Expression of c-erbB-2 protein, neuron-specific enolase and DNA flow cytometry in locally advanced transitional cell carcinoma of the urinary bladder

Expression of c-erbB-2 protein, neuron-specific enolase (NSE) and DNA ploidy was studied by immunohistochemistry and flow cytometry in formalin-fixed and paraffin-embedded specimens from 104 patients with locally advanced transitional cell carcinoma of the bladder. Positive membrane bound c-erbB-2 staining was found in 15% of the tumours, and 38% of the tumours were positive for NSE. Only one tumour stained positively for both NSE and c-erbB-2. Expression of c-erbB-2 protein and NSE was neither correlated to tumour stage nor to histopathological grade. The frequency of non-diploid tumours was 78% in 49 c-erbB-2/NSE negative tumours, 98% in 40 NSE positive tumours, and 100% in 16 c-erbB-2 positive tumours ( P =0.004). Whether the c-erbB-2 expression is a useful prognostic marker in addition to other conventional parameters, remains to be shown.