Predictors of long-term survival in patients with gallbladder cancer

The aim of this study was to examine the predictors of long-term survival (>24 months) in patients with gall bladder cancer. A retrospective review of 117 cases of gall bladder cancer resected between 1989 and 2000. The resections included 80 simple cholecystectomies and 37 extended procedures. Patients with survival >24 months (n=44) were compared with those having survival <24 months (n=73) for 17 prognostic factors. Overall median survival was 16 months with a 5-year survival of 27%. T status (P=.000) and adjuvant chemoradiotherapy (P=.001) were independent predictors of long-term survival. Survival advantage was seen in T3N+ve disease (P=.007) with extended procedures. Complete (R0) resection was attained in 30 patients with a 5-year survival advantage of 30% as compared with incomplete (R1) resection (P=.0002). Adjuvant chemoradiotherapy improved survival in simple cholecystectomy group (P=.0008) but no advantage was seen after extended procedures. Stage III (P=.001) and node-positive disease (P=.0005) had significant benefit with adjuvant therapy. Poor differentiation and vascular invasion were associated with poor long-term survival. R0 resection was associated with prolonged survival. Extended procedures improved survival in patients with T3N+ve disease. Addition of chemoradiotherapy made significant improvement in long-term survival in stage III and node-positive lesions and in patients undergoing simple cholecystectomy. R0 resection predicted long-term survival in gall bladder cancer. T3 N+ve disease had better survival after extended procedures. Adjuvant chemoradiotherapy improved survival in stage III and node-positive disease. Poor differentiation and vascular invasion were adverse predictors of survival.     

Implantation of parathyroid carcinoma along fine needle aspiration track

Introduction Fine needle aspiration cytology is not a commonly employed diagnostic modality in the diagnosis of parathyroid tumors.Case report A 28 year old lady being followed-up for 5 years after en bloc resection of a parathyroid carcinoma presented with a nodule in the lower neck, away from the parathyroidectomy scar. The 1 cm isolated nodule was located in the muscular and subcutaneous plane and corresponded to the needle track of FNA performed on a neck nodule before the parathyroidectomy. On evaluation, she had mild hypercalcemia and high normal serum parathyroid hormone levels. FNAC and histology including immunohistochemistry for Chromogranin A after local excision of the nodule confirmed the nodule to be a recurrent parathyroid carcinoma along the needle track.Discussion To the best of the authors’ knowledge, this is only the second case of needle track implantation after FNA in parathyroid carcinoma reported to date. This case highlights the risk of engraftment of parathyroid tissue after FNA and cautions against the use of FNA as a preoperative diagnostic modality for the evaluation of parathyroid lesions.Drs. Agarwal and Dhingra have contributed equally, as joint first authors.     

Rates of alcohol consumption and risk status among Australian university students vary by assessment questions

Introduction and Aims. Different self‐report methods tend to produce different estimates of alcohol consumption. The present study compares differences in rates and risk levels based on responses to a modified version of the Daily Drinking Questionnaire (m‐DDQ) and quantity‐frequency (QF) questions. Design and Methods. The sample comprised 2082 university students, 61% of whom were female and 39% male with a mean age of 23.5 years. An email containing an online link to a brief six‐question survey was emailed to students enrolled in participating faculties at the University of Wollongong, Australia. Current drinkers completed m‐DDQ and QF questions about alcohol consumption. Results. QF methods identified significantly lower estimates of consumption (Mean = 9.15, SD = 12.51) compared with m‐DDQ (Mean = 13.06, SD = 14.07). Allocation to risk categories based on the Australian Alcohol Guidelines were conducted for both the m‐DDQ and QF methods. Almost twice as many students were found to be drinking at levels considered risky using the m‐DDQ method compared with QF. In addition, the relative rank order of participants varied significantly between the two methods. Discussion and Conclusions. The m‐DDQ method identified higher rates of drinking and categorised almost twice as many individuals into risky categories of drinking compared with QF. Such variations have major implications for identification of risk groups in health promotion or prevention programs.[Utpala‐Kumar R, Deane FP. Rates of alcohol consumption and risk status among Australian university students vary by assessment questions. Drug Alcohol Rev 2009]     

Circulating filarial antigen in cats infected with Brugia pahangi is indicative of the presence of adult worms

Using counterimmunoelectrophoresis with rabbit antisera raised against soluble extracts of adult females of Brugia pahangi parasite antigen was detected in the serum of all cats repeatedly infected with B. pahangi. Antigen was never detected in uninfected cats. The antigen was associated with the presence of adult worms. Antigen was detected consistently in a cat that was amicrofilaraemic but at autopsy harboured only two or three adult worms. Conversely, some cats showed slowly declining numbers of microfilariae and, in these, circulating antigen declined before the number of microfilariae. Eventually no antigen was detectable in circulation whereas microfilariae, although in diminishing numbers, were still present. At autopsy no adult worms were found in these cats. Antigen also appeared in several cats before they became microfilaraemic.     

Evaluation of the behaviour of a thermal diffusion sensor in a high field strength magnetic resonance system: an experimental study.

Patients with acute brain pathology requiring ferromagnetic bio-medical implants for on-going invasive monitoring are largely excluded from the benefits of MRI scanning. We evaluated the behaviour of a thermal diffusion cortical blood flow (TD-CBF) sensor both in vitro (phantom gelatin model) and in vivo environments in a high field strength MRI system.Two baboons underwent cranial subdural implantation of 2 TD-CBF sensors/hemisphere and a single left parietal sensor was implanted subcortically to determine any deleterious effects. Using standard MRI sequences, artefact size, thermal effects, current generation, movement and reliability of recordings were assessed during scanning.The deflection forces were negligible, no observable thermal effects were demonstrated, while wide fluctuations in cerebral blood flow recordings were recorded. Mean image artefact size for implanted sensors was 6 times larger than in vitro. Patients with an implanted TD-CBF sensor may be safely imaged provided the device is disconnected. The MRI images obtained are of an acceptable quality.     

Fenestration and occlusion of the posterior semicircular canal for benign positional vertigo

Benign positional vertigo is a potentially disabling condition characterized by episodic vertigo following certain provocative head movements. In most patients it is self limiting; however, in a few it may prove intractable, causing considerable social morbidity. In these patients surgery may be considered. Surgery previously involved section of the vestibular or singular nerves, involving a significant risk to hearing and to the facial nerve. Ablation of the labyrinth may even be considered. The new surgical technique of occlusion of the posterior semicircular canal has proved to be curative in most patients with benign positional vertigo with little risk to hearing. This paper describes our experience of fenestration and occlusion of the posterior semicircular canal in four patients.     

Duodenogastric reflux after choledochoduodenostomy

Duodenogastric reflux (DGR) has been implicated in several disease processes. The present study was carried out to document the incidence and evaluate the clinical significance of DGR after choledochoduodenostomy (CDD). A total of 13 patients who had undergone cholecystectomy with a standard side-to-side CDD for choledocholithiasis or chronic pancreatitis were studied by symptom evaluation, scintigraphy, endoscopy, and gastric mucosal histology at least 6 months after surgery. The scintigraphic findings were then compared with those of 10 patients who had undergone cholecystectomy alone. Only two patients (15%) had mild dyspeptic symptoms. The incidence of DGR after CDD was 69% compared to 20% in the cholecystectomy alone group (P < 0.05). In the majority of patients the DGR was only mild to moderate and the severity correlated well with the degree of endoscopic gastritis, but not with the clinical symptoms or histological findings. These results indicate that while CDD is associated with a high incidence of DGR, its occurrence does not produce significant clinical symptoms.     

Dermatomyositis in a patient with high grade papillary urothelial carcinoma of urinary bladder

Inflammatory myopathies like dermatomyositis are associated with increased incidence of malignancies. This association has been commonly reported with malignancies of ovaries, gastro‐intestinal tract, breast and non‐Hodgkin's lymphomas but occurrence of dermatomyositis with bladder cancer has been rarely reported. We report a patient with carcinoma bladder who developed dermatomyositis while being treated for the bladder cancer.     

Lung dose rate and interstitial pneumonitis in total body irradiation for bone marrow transplantation

The effect of dose rate to the lungs and development of interstitial pneumonitis (IP) was evaluated in 114 bone marrow transplant patients receiving fractionated total body irradiation (TBI) (1200 rads TD in 6 fractions twice daily over 3 days) as part of their pre-conditioning regimen. The tumour dose (TD) was calculated as the mean lung dose as previously described (1). A 6MV linear accelerator at a mid-line dose rate of 7.5 rads/minute was used between March 1981 and June 1985 and a Co-60 source at 5 rads/minute thereafter. This resulted in a range of dose rates to the lung of between 6.9 and 8.9 rads/minute and 2.9 and 6.5 rads/minute respectively. In the majority of patients the aetiology of IP was investigated by lung biopsy with histology and culture. There was no statistically significant difference in the incidence of IP over the two sets of dose rates. Our study suggests tat the incidence of IP using fractionated TBI is not influenced by dose rates below 8.9 rads per minute.