Sequential drain amylase to guide drain removal following pancreatectomy

Background

Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal.

Clinical efficacy of amiodarone as an antiarrhythmic agent

Amiodarone, administered orally in doses of 200 to 600 mg/day, was remarkably effective in the treatment and prevention of a wide variety of atrial and ventricular arrhythmias. Total suppression and control was provided in 98 (92.4 percent) of 106 patients with supraventricular arrhythmias and in 119 (82 percent) of 145 patients with ventricular arrhythmias. The rates of total control of the arrhythmia were: 96.6 percent in 30 patients with recurrent atrial flutter or fibrillation, 96.6 percent in 59 patients with repetitive supraventricular tachycardia, 100 percent in 27 patients with Wolff-Parkinson-White syndrome and 77.2 percent in 44 patients with recurrent ventricular tachycardia unsuccessfully treated with other drugs. Excellent results were obtained in 6 of 8 patients with repetitive ventricular tachycardia and ventricular fibrillation related to postinfarction ventricular aneurysm and in 12 of 14 patients with ventricular extrasystoles and ventricular tachycardia related to Chagasic myocarditis. Amiodarone proved safe in patients with severe congestive heart failure and severe myocardial damage. Its clinical efficacy was related to its electrophysiologic properties and to two unique properties: its wide safety margin and its cumulative effect. The latter liberates patients from a rigid hourly schedule and provides for continuous antiarrhythmic control, days and even weeks after treatment is discontinued.     

Autologous fat as a rectal–prostate spacer for prostate brachytherapy: Results at 6 months

PurposeImplanted rectal spacers (IRS) have been developed to increase the distance between the prostate and the rectum, thus optimizing dose escalation. Cost is a disadvantage and there are still uncertainties as to their durability. We have developed an autologous fat transfer (AFT) technique to use as an IRS. We aim to present the feasibility and durability at 6 months of AFT placed immediately after the implant of the seeds in low-dose-rate brachytherapy (BT).Methods and MaterialsThirty-five patients underwent AFT (12 were treated with primary BT, 7 with a combined primary treatment of external beam radiotherapy + BT, 16 with salvage BT). The isodose used for primary BT was 14400 cGy, 11,000 cGy after 4600 cGy of external beam radiotherapy in the combined group, and 14400 cGy for the salvage group. Patients underwent a CT scan at 1, 3, and 6 months to measure the distance between the rectum and the prostate.ResultsAn average of 32.7 cc (20–40) of fat was transferred successfully in 100% of cases. The mean distance to the rectum at the level of the base, middle, and apex at 1 and 6 months were 11.2, 9.7, and 7.6 mm; 8.3, 8.1, and 5.9 mm, respectively. No rectal toxicity or major complications were reported.ConclusionsThe use of fat as an IRS seems to be a valid alternative to reduce rectal toxicity after BT, achieving equivalent distances to synthetic IRS. It is feasible, safe, and the loss of distance at 6 months is small. Cost is lower than other alternatives.     

Heterochromatic variants and their association with neoplasias. I. Chronic and acute leukemia

C-banding studies of the heteromorphism of chromosomes #1, #9, and #16 were performed in 120 leukemic patients: 56 with chronic myelocytic leukemia (CML), 45 with acute lymphoblastic leukemia (ALL), and 19 with acute nonlymphoblastic leukemia (ANLL). No differences were found among patients and controls with regard to sex. Our data showed a significant increase of polymorphism in chromosome #1 in the three neoplastic groups; the heterochromatic variant preferentially involved 1qh-, whereas there were no significant differences in heteromorphism in chromosomes #9 and #16.     

Effects of dietary protein on urinary calcium in normal subjects and in patients with nephrolithiasis.

The effect of high-protein diets on the excretion of calcium in urine was evaluated in four normal persons and in four patients with nephrolithiasis. All subjects were housed in a metabolic unit and given constant metabolic diets each day containing 0.5 g protein/kg and 300–600 mg calcium, 1000 mg phosphorus, and 69 mEq sodium. During the experimental phase, each person received an additional 1.5 g protein/kg/day consisting of purified casein, gluten, lactalbumin, and gelatin. There was a consistent increase in urinary calcium with the high-protein diet, averaging 88% above control in the normals and 82% in the patients. In addition, the normal subjects showed significant (p < 0.05) increases in urinary phosphorus (mean increases, 219 ± 53 mg/d, mean ± SE), nitrogen (8.8 ± 0.9 g/d), titratable acid (19 ± 5 mEq/d), and ammonium (22 ± 3 mEq/d), whereas the patients showed increases in urinary magnesium (18 ± 2 mg/d), nitrogen (12 ± 1.0 g/d), and ammonium (34 ± 2 mEq/d), and in creatinine clearance (14 ± 3 ml/min). In both groups, there was a small increase in the filtered, excreted, and reabsorbed calcium and a small decrease in the percentage reabsorption of calcium. Serum chemical values did not change from values with the low-protein diet. In two of the patients who were known to be hyperabsorbing calcium, sodium cellulose phosphate (chelator of intestinal calcium) reversed the increase in urinary calcium produced by the high-protein diet. In the remaining patients, neither sodium cellulose phosphate nor a low-calcium diet could counteract the increase in excretion of calcium with the diet. It is concluded that a high-protein diet can increase urinary calcium by altering renal function and/or increasing intestinal absorption of calcium and that dietary protein must be considered in the evaluation and treatment of patients with hypercalciuria and nephrolithiasis.     

Efficacy of amiodarone during long-term treatment of potentially dangerous ventricular arrhythmias in patients with chronic stable ischemic heart disease

Amiodarone was administered orally to 30 patients with chronic stable coronary artery disease and severe ventricular arrhythmias. Control studies revealed frequent (more than 30/hr) ventricular premature beats (VPBs) (27 patients), bigeminy (21 patients), couplets (29 patients), R-on-T phenomenon (14 patients), ventricular tachycardia (16 patients), and ventricular fibrillation (1 patient). Two 24-hour Holter recordings and stress tests were performed before treatment, and an average of 3.6 per patient were done during treatment. Amiodarone caused suppression of all ventricular arrhythmias in 13 (43%) of the 30 patients and suppression of all complex forms and greater than 90% reduction of VPB number in 14 patients (47%) during a follow-up of 12.4 months. The mean dose was 590 mg/day in the 27 responders and 300 mg/day in the three nonresponders. A similar antiarrhythmic response was observed during stress testing. One of the 30 patients died due to massive pulmonary embolism and no arrhythmias were detected. In addition, amiodarone suppressed the occurrence of anginal pain and effort-induced ST changes in 9 of 10 patients and in 11 of 13 patients, respectively. The rate—pressure product and peak heart rate were significantly reduced in all patients. Our results suggest that amiodarone may be ideally suited for treatment of ventricular arrhythmias and for possible prevention of sudden death in patients with ischemic heart disease.