Analysis of prognostic factors for 5 year survival in surgically treated patients with carcinoma cervix stages IB1, IB2 and IIA

Aim: To identify pathological and clinical prognostic factors that best predict 5 year survival among patients with early stage cervical carcinoma treated with radical hysterectomy. Methods: Data from 77 patients diagnosed at Safdarjung Hospital, New Delhi, India with carcinoma cervix were taken from 1997 to 2002. Patients were followed up for 5 years. Survival probability was calculated through Kaplan–Meier method for overall survival at 5 years. Univariate and multivariate analysis with Cox's regression model was used to statistically identify the best combination of these risk factors to predict prognosis. Results: Univariate analysis revealed tumour size, lymph node involvement and parametrial spread as significant prognostic factors for survival. Multivariate analysis showed that lymph node involvement and parametrial spread remained significant prognostic factors. Overall carcinoma with tumour size of less than 4 cms had a higher chance for survival. Conclusion: The presence of lymph node involvement and parametrial spread decreased the chance of survival by two and a half and threefold, respectively. Lack of awareness about the screening, symptoms of disease and non‐availability of early diagnostic facilities such as the Pap smear at a primary health care level are areas of priority. The most pressing need is to spread awareness among sexually active women to undergo Pap tests at regular intervals.     

OEDEMA FLUID COMPOSITION IN CHILDHOOD DISORDERS

ABSTRACT. Oedema fluid was collected from the leg through a sterile 21 gauge needle inserted into the subcutaneous space in 12 patients with protein energy malnutrition, 12 with nephrosis, 5 with Indian childhood cirrhosis, 4 with acute nephritis, 4 with epidemic dropsy and 3 with congestive heart failure. The concentrations of protein, free amino acids and electrolytes were measured in plasma and oedema fluid. The plasma/oedema fluid ratios were 36: 1, 49: 1, 32: 1 and 52: 1 in protein energy malnutrition, nephrosis, Indian childhood cirrhosis and congestive heart failure. These ratios were significantly smaller in epidemic dropsy (4: 1) and acute nephritis (21: 1). The free alpha amino nitrogen concentrations in these two compartments were almost in equilibrium. This was also found for essential and non-essential amino acid distributions in protein energy malnutrition and nephrosis, whereas differences in amino acid patterns were found in nephritis and epidemic dropsy. Sodium and potassium concentrations varied substantially between diseases where the underlying cause was gross hypoproteinemia compared to non-hypoproteinemic conditions.     

Magnetic Resonance Imaging in Occult Spinal Dysraphism

A prospective study was carried out in 100 cases of suspected occult spinal dysraphic anomalies with Magnetic Resonance Imaging in order to determine its diagnostic efficacy as the initial imaging modality. MR imaging provided accurate preoperative information in 91 out of 92 cases (98.9%). Some of the unusual and interesting findings in the series were: presence of intrinsic cord abnormality in 19 out of 21 cases (90.4%) with a normal plain radiograph, 4 cases of diastematomyelia with a dermoid in the dorsal and lumbar region associated with syringohydromyelia, intradural fibrous/glial bands, sgringo-hydromyelia/myelomalacia of the conus with tethered cord syndrome having a normally placed conus, and myelocystocele. It is concluded that MRI is an excellent primary diagnostic tool, together with a plain radiograph, for complete preoperative evaluation of mid-tine spinal anomalies.     

减影冠状动脉CT血管成像对轻中度钙化积分患者的诊断价值

目的:探讨减影冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)在轻中度钙化积分(Agatston score400分)患者中的临床应用价值。方法:对接受减影CCTA扫描的69例冠状动脉轻中度钙化患者的临床资料进行回顾性分析。采用4分法评估冠状动脉节段图像质量。定量评估每个钙化节段的狭窄程度,将狭窄分为Ⅰ、Ⅱ、Ⅲ、Ⅳ共4个等级。定量测量每个病变节段所需时间。结果:69例患者共113个钙化节段。常规CCTA与减影CCTA评估钙化节段的平均成像质量分别为(3.4±0.6)分、(3.8±0.4)分,差异有统计学意义(P0.01);常规CCTA与减影CCTA定量测量钙化节段狭窄程度所需平均时间分别为(105±44)s、(72±44)s,差异有统计学意义(P0.01)。描述这两种成像方法评估狭窄分级一致性的Kappa值为0.77。结论:上述两种成像方法对评估轻中度钙化冠状动脉狭窄程度具有良好的一致性;与常规CCTA相比,减影CCTA可提高成像质量,减少定量评估冠状动脉病变节段狭窄所需时间。     

Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts

Background  Bleeding from ectopic varices is uncommon but can be difficult to manage.
Aim  To report our experience of the use of transjugular intrahepatic portosystemic stent shunts (TIPSS) in the management of uncontrolled bleeding from ectopic varices.
Methods  A retrospective study of patients who had TIPSS for bleeding ectopic varices. Patients were selected from a dedicated data base.
Results  Over 14 years, of 750 TIPSS insertions, 28 patients had TIPSS for bleeding ectopic varices (Child–Pugh score: 8.8 ± 1.8). Varices were rectal (12), stomal (8), duodenal (4) and at other sites (4). Concomitant variceal embolization was performed in five. Portal pressure gradient fell from 18.2 ± 6.4 to 7.2 ± 3.5 mmHg. TIPSS achieved haemostasis in six of nine patients who presented with active bleeding. Five patients rebled from ectopic varices. This was related to shunt dysfunction in two and responded to shunt interventions. Three patients rebled despite a functional shunt. Of these, thrombin controlled bleeding in one. Eight patients developed hepatic encephalopathy post-TIPSS.
Conclusions  Transjugular intrahepatic portosystemic stent shunt is a safe and effective treatment for bleeding ectopic varices. Rebleeding from ectopic varices related to shunt dysfunction responds to shunt intervention. A significant proportion of patients have rebleeding despite a patent shunt, when other adjunctive measures like thrombin injection may be tried.