Ml In Cases Research Articles

Strategies to Perform Emergency Laparoscopic Partial Liver Resection for Ruptured Hepatocellular Carcinoma.

Laparoscopic hepatic resection is currently used for ruptured hepatocellular carcinoma (HCC); however, it is technically challenging. We developed and implemented surgical strategies for emergency laparoscopic partial liver resection in selected patients with peripheral lesions who were hemodynamically stable and without severe liver dysfunction. The surgical techniques used were as follows. First, the Pringle maneuver was performed to control hepatic blood inflow (step 1). Next, strong hemostatic agents were applied at the rupture point of the tumor (step 2). The hanging tape was positioned along the dorsal side of the resection line to control the partial blood inflow and outflow of the tumor, as well as to expose the surgical plane (step 3). The liver parenchyma was dissected along the hanging tape (step 4). We performed emergency laparoscopic partial liver resection in three patients who were in a pre-shock status. The tumors were located in segments 6 (cases 1 and 2) and 2 (case 3). The tumor diameters were 90, 62, and 80 mm. The Preoperative Child-Pugh scores were B7, B9, and B8. The hemostatic products performed well and controlled bleeding from the ruptured HCC. The hanging tape facilitated the dissection of the liver parenchyma. The operative time and intraoperative blood loss were 135 min and 400 ml, 266 min and 200 ml, and 191 min and 495 ml for cases 1, 2, and 3 respectively. There were no in-hospital deaths. Emergency laparoscopic partial liver resection could be an option for patients with ruptured HCC.

Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization.

The established global threshold of rCBF <30% for infarct core segmentation can lead to false-positives, as it does not account for the differences in blood flow between GM and WM and patient-individual factors, such as microangiopathy. To mitigate this problem, we suggest normalizing each voxel not only with a global reference value (ie, the median value of normally perfused tissue) but also with its local contralateral counterpart. We retrospectively enrolled 2830 CTP scans with suspected ischemic stroke, of which 335 showed obvious signs of microangiopathy. In addition to the conventional, global normalization, a local normalization was performed by dividing the rCBF maps with their mirrored and smoothed counterpart, which sets each voxel value in relation to the contralateral counterpart, intrinsically accounting for GM and WM differences and symmetric patient individual microangiopathy. Maps were visually assessed and core volumes were calculated for both methods. Cases with obvious microangiopathy showed a strong reduction in false-positives by using local normalization (mean 14.7 mL versus mean 3.7 mL in cases with and without microangiopathy). On average, core volumes were slightly smaller, indicating an improved segmentation that was more robust against naturally low blood flow values in the deep WM. The proposed method of local normalization can reduce overestimation of the infarct core, especially in the deep WM and in cases with obvious microangiopathy. False-positives in CTP infarct core segmentation might lead to less-than-optimal therapy decisions when not correctly interpreted. The proposed method might help mitigate this problem.

Streamlining robotic-assisted abdominoperineal resection

BackgroundRobot-assisted surgery has proven to be a safe and feasible approach for the management of rectal cancer, including abdominoperineal resection (APR). However, it often incurs longer operative times and higher costs. This study aimed to overcome these limitations by adopting a synchronous approach utilizing an optimized team composition.MethodsData on patients who underwent robot-assisted APR at our facility between June 2022 and June 2023 were analyzed. The key points of the optimized approach included the following: At the start of the surgery, the surgeon performed an anococcygeal ligament resection from the perineal side while the bedside assistants set up the ports. Then, through console manipulation, the presacral fascia, elevated by previously placed gauze, was easily and safely incised, providing access to the perineal region.ResultsA total of nine patients were included in this study. The median operation time was 231 min, and the intraoperative blood loss was 170 ml. The operation time was reduced to 167.5 min, and the blood loss was 80.5 ml in cases without a trainee. Surgical site infections, classified as Clavien–Dindo grade II complications, were observed in two cases, but no obvious urinary or erectile dysfunction was observed.ConclusionThe study results indicate that the challenges associated with APR can be efficiently addressed without requiring additional personnel by streamlining team composition and the synchronous approach. This optimization strategy minimizes the need for a larger surgical team, while maximizing the utilization of surgical time and resources.

V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES

You have accessJournal of UrologyCME1 May 2022V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Yusuke Hirano, Ryuichi Azuma, and Keiichi Ito Akio HoriguchiAkio Horiguchi More articles by this author , Masayuki ShinchiMasayuki Shinchi More articles by this author , Kenichiro OjimaKenichiro Ojima More articles by this author , Yusuke HiranoYusuke Hirano More articles by this author , Ryuichi AzumaRyuichi Azuma More articles by this author , and Keiichi ItoKeiichi Ito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral stenosis is a complication occurring secondary to transurethral prostate surgery and prostate cancer treatment, and its management remains a significant reconstructive challenge. We herein report our surgical technique of transperineal bulbovesical anastomosis and staged artificial urinary sphincter implantation for extensive posterior urethral stenoses. METHODS: Two male patients aged 77 and 76 years were referred to us for definitive management for posterior urethral stenosis (brachytherapy for prostate cancer, and repeat transurethral surgery for benign prostatic hyperplasia, respectively). A suprapubic tube was placed in both patients due to urinary retention after exhaustive urethrotomies and dilatations. Both patients had normal bladder capacity and extensive posterior urethral stenoses extending from the bulbomembranous junction to the entire prostatic urethra. After making a midline perineal incision, the bulbar urethra was fully mobilized up to the penoscrotal junction distally and transected at the obstruction site. The corpora cavernosa was separated, and a wedge of the inferior pubic bone was excised to expose the ventral side of the bladder neck in the same manner as the repair of pelvic fracture urethral injury. The scarred prostatic tissue was meticulously excised, and the bladder neck was opened. The bladder mucosa was everted and fixed to the surrounding tissue to create an anastomosis site. Eight interrupted 4-0 PDS sutures were placed to reapproximate the bulbar urethra and bladder neck. After confirming the absence of recurrent stenosis at the anastomosis site at 6 months postoperatively, an artificial urethral sphincter was implanted using a transcorporeal approach. We followed up the patients every 6 months, performed uroflowmetry, flexible cystoscopy, and examined the amount of daily pad use. RESULTS: The operative time and blood loss during bulbovesical anastomosis was 163 minutes and 201 ml in case 1 and 193 minutes and 66 ml in case 2, respectively. No Clavien grade 2 or greater perioperative complications were observed. No recurrent stenosis on cystoscopy was found after 20 and 26 months in cases 1 and 2, respectively. The maximum flow rate and the amount of daily pad use at the last recorded follow up was 32 ml/s and no pad in case 1 and 44 ml/s and one pad in case 2. CONCLUSIONS: A bulbovesical anastomosis combined with staged artificial urethral sphincter placement could effectively manage extensive posterior urethral stenoses. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e368 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akio Horiguchi More articles by this author Masayuki Shinchi More articles by this author Kenichiro Ojima More articles by this author Yusuke Hirano More articles by this author Ryuichi Azuma More articles by this author Keiichi Ito More articles by this author Expand All Advertisement PDF downloadLoading ...

Direct Cortical Stimulation in Neurosurgical Emergencies: Single-Center Experience in 2 Patients

Intraoperative neuromonitoring (IONM) is widely used for elective resection of eloquently located brain tumors to increase safety and extent of resection. Owing to the need for specially trained personnel for IONM and the sophisticated, time-consuming technical setup, standard IONM is usually not suitable for emergency situations. We report the use of a device that can be operated by the neurosurgeon autonomously for monopolar brain mapping in 2 emergency cases. Both patients were initially scheduled for elective neurosurgery under IONM. Acute neurological deterioration in both cases led to emergency surgery. For monopolar cortical/subcortical stimulation, a standard monopolar probe was connected to a new device enabling electromyography real-time tracking of 8 muscles. Preoperative application of subdermal electromyography needles and intraoperative handling of the device were performed by the neurosurgeons independently. Cortical mapping of the motor cortex was performed in both patients with a threshold of 4 mA in case 1 and 14 mA in case 2. Gross total resection with residual tumor volume of <2 mL in case 1 and subtotal resection with residual tumor volume of 4.2 mL in case 2 were achieved under use of the new device without any new neurological deficit. Grade IV glioblastoma was diagnosed in both patients. We demonstrate the feasibility of monopolar stimulation in 2 patients undergoing emergency neurosurgery using a device autonomously operated by the surgeon. Owing to fast setup and nondemanding handling, monopolar stimulation could be used during emergency neurosurgery to extend resection with preservation of neurological function in both cases.

Cerebellum and brain stem volume loss in relapsing remission multiple sclerosis by MRI volumetry: relation to neurological disability score and number of relapses

BackgroundMRI is the method of choice in the diagnosis of MS as well as in monitoring the disease activity. MRI volumetry is used to assess whole or regional brain volume loss which reflects neurodegenerative aspect of the disease and plays an important role in all stages of disease. The aim of this work is to study MRI volumetry in the evaluation of cerebellum and brain stem volume loss in RRMS patients and its correlation with neurological disability score and number of relapses.ResultsVolumes of whole brainstem, medulla, and pons showed a significant decrease in RRMS cases compared to controls (p < 0.05). Brainstem volume had a mean volume of 22.17 and 25.09 cm3 in cases and controls, respectively. However, midbrain volume showed no significant difference between cases and controls (p = 0.134). Volume of left cerebellar cortex showed a significant decrease in RRMS cases compared to controls (p < 0.001). It had mean volumes of 81.64 and 92.14 ml in cases and controls, respectively, at left cerebellar hemisphere, while right cerebellar hemisphere cortex volumes were 80.37 and 91.97 ml in cases and controls, respectively. Cerebellar white matter showed no significant volume decrease in cases and controls.ConclusionVolumetric MR imaging is an important tool for quantifying the MS disease, assesses MS activity, progression, and tissue loss. The degree and the pattern of atrophy on MRI images correlate significantly with the neurological disability score and number of relapses.

MALONDIALDEHYDE IN TYPE 2 DIABETICS AND ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS

Background: Type 2 diabetes mellitus (T2DM) is a progressive chronicdisease with high prevalence all over the world. It is expected to have 693million people affected by diabetes by 2045. Many body systems areaffected due to complications of DM with major effect on thecardiovascular system. Dyslipidemia is one of the major risk factors forcardiovascular disease in diabetes mellitus. Malondialdehyde (MDA) is ahighly toxic end product formed by lipid oxidation that mediates its toxiceffects due to its high reactivity particularly towards proteins and DNA.Malondialdehyde interacts both irreversibly and reversibly with proteinsand phospholipids causing profound effects, especially in the collagen ofthe cardiovascular system. Normally, MDA level remains within normalvalues due to antioxidant effects, but in DM these protective effects aredisrupted.Objective: Measure serum Malondialdehyde level as a marker of lipidperoxidation in type 2 diabetic patients and its association with othercardiovascular risk factors.Patients and methods: The study included 40 diabetic patients recruitedfrom Outpatient Diabetes Clinic at Alexandria Main University Hospitalin addition to healthy 40 healthy subjects as a control group. Basic data,clinical examination and laboratory analysis were obtained from all thesubjects within the two groups. Serum Malondialdehyde (MDA) wasmeasured in the participants within the two groups by using ELISA kit.Results: The mean serum MDA level was statistically significant higherin the diabetic cases as compared to the controls (Median MDA was30.72nmol /ml in cases and 25.16 nmol /ml in the control). There is asignificant increase in serum MDA level with increasing the risk of CVdisease in the whole study subjects and in the diabetic cases. In the casesgroup MDA shows positive correlation with all the study parametersexcept high density lipoproteins (HDL) where it revealed negativecorrelation. BY ROC curve analysis, a cutoff point more than > 26.57 had62.5% sensitivity, 70% specificity, 66.4 % positive predictive value (PPV)and 72.5% negative predictive value (NPV).Conclusion: Malondialdehyde is a non-invasive biomarker that could beutilized in differentiation of T2DM cases form healthy controls in additionfor identifying the high-risk diabetic patients for cardiovascular disease(CVD). However, further large-scale studies are recommended toaccurately determine its sensitivity and specificity.

Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆

ObjectiveTo investigate whether women who developed acute colonic pseudo-obstruction (ACPO) after cesarean section have a higher degree of gastro-intestinal symptoms than women who did not develop ACPO after cesarean section. ACPO is a colonic dilatation without mechanical obstruction, and with an unknown pathophysiology. In younger people it is mostly seen in women after cesarean section. The hypothesis of the present study is that long-term consequences of gastrointestinal symptoms evolve after ACPO, due to the impact on the colon. Study design40 women who developed ACPO after cesarean section (cases) and 80 women, who did not develop ACPO after cesarean section (controls), were asked to participate in the study. The controls were matched based on time of cesarean section (± 14 days), age (±5 years), singleton or twin, parity, cesarean section grade, and ASA-group. Baseline characteristics and information regarding the cesarean section were collected from medical records. An electronic collection of surveys was distributed to the participants, including the following: Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS), Rome IV, Gastrointestinal Symptoms Rating Scale (GSRS), Visceral Sensitivity Index (VSI), Patient Health Questionnaire 15 (PHQ15), The MOS 36-item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The score from IBS-SSS after cesarean section was used as the primary outcome. Results25 cases and 37 controls participated in the study. A difference in blood loss was found with a median of 600 mL in cases, compared to 400 mL in controls during cesarean section (p = 0.002). No difference was found between cases and controls in the IBS-SSS score after cesarean section. However, cases yielded a higher difference between IBS-SSS before and after cesarean section, indicating a higher degree of deterioration in gastrointestinal symptoms (p = 0.026). In addition, cases reported a higher degree of pain in everyday life (p = 0.039). No difference was found in the remaining surveys. ConclusionWomen undergoing cesarean section developed mild grade of irritable bowel syndrome. However, gastrointestinal symptoms did not seem to be more prevalent in women who developed ACPO, although women with ACPO had a higher degree of deterioration in gastrointestinal symptoms than controls.

Abstract WMP9: Procedural Parameters Predicting Reduced MRI Infarct Growth in Mechanical Thrombectomy

Background: Successful recanalization after a single pass and shorter procedural duration during mechanical thrombectomy (MT) in emergent large vessel occlusion (ELVO) have been associated with both rapid neurologic improvement and long-term clinical outcome, although conflicting data exists regarding their direct effect on infarct growth. We aimed to determine whether less device passes or shorter procedural times are associated with decreased infarct growth. Methods: We reviewed consecutive patients presenting to a comprehensive stroke center from January 2016 to December 2018 with (ELVO). Standard protocol included pre-procedural MRI imaging and only those with post-procedural MRI were included in this study. Number of passes attempted and procedural times were recorded. Infarct volume on MRI was measured using region of interest analysis blinded to procedural outcomes. MRI infarct growth was analyzed using linear regression as a function of procedural times and number of passes. Results: Of 173 patients undergoing MT after MRI, 118 patients had MRI imaging post-procedure. Successful recanalization (TICI &gt;2b) was achieved in 106/118 patients. For each additional minute of procedural duration, MRI infarct growth increased by 0.23 mL (p=.04). Average MRI infarct growth was different amongst the passes (p=0.001): 14.65 mL in cases with only one pass (n=67), 25.67 mL with two passes (n=26), 28.68 mL with three passes (n=17), and 98.42 mL with four or greater passes (n=8). Conclusion: Longer procedural duration and increased number of passes are associated with increased MRI infarct growth.

Combined Transarterial and Transvenous Onyx Embolization of Jugular Foramen Paragangliomas

Jugular foramen paragangliomas are highly vascular tumors known to have significant venous hemorrhage during resection even after conventional transarterial embolization. The authors report a novel technique to the endovascular embolization of jugular foramen paragangliomas using a combined transarterial and transvenous access for better intraoperative control of blood loss and visualization. This is a retrospective data collection of 2 patients diagnosed with jugular foramen paragangliomas with novel embolization technique and surgical resection. Two patients underwent embolization of jugular foramen paragangliomas through combined transarterial and transvenous routes using 2 double-lumen balloon microcatheters. In both cases, single arterial vessel embolization was performed through the occipital artery in Case 1 and the tympanic branch of the ascending pharyngeal artery in Case 2. Simultaneously, balloon microcatheter occlusion in the sigmoid sinus and single venous outflow vessel embolization was performed. Near-complete occlusion was established, with angiographic disappearance of tumor blush. Surgical resection was performed in both cases. Estimated blood loss BL was 600 mL in Case 1 and 200 mL in Case 2. No blood transfusions were required, intraoperatively or postoperatively. There were no cranial nerve deficits post embolization. One patient had a persistent House Brackman 2 facial nerve palsy after resection. The initial experience with simultaneous transvenous and transarterial paraganglioma embolization demonstrated the safety of the technique and superior embolic agent penetration. This was supported by our observations during embolization and intraoperatively during tumor resection. Additional patients need to be treated with this technique for better assessment of long-term efficacy and incidence of embolization-related cranial neuropathies.

ROLE OF BRONCHODILATOR TESTING IN IDENTIFYING COPD, ASTHMA, AND ASTHMA-COPD OVERLAP SYNDROME: NHANES III ANALYSIS

SESSION TITLE: Asthma: From Blood Biomarkers to Biologics and Disease Burden SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Spirometry with Bronchodilator (BD) testing is not routinely utilized in clinical practice to diagnose chronic obstructive pulmonary disease (COPD) despite the recommendation to use the post BD ratio of forced expiratory volume in the first second (FEV1) over forced vital capacity (FVC).1,2 We aimed to determine the role of BD testing in avoiding COPD overdiagnosis and identifying subjects with possible alternate diagnosis like asthma and asthma-COPD overlap syndrome (ACOS). METHODS: The National Health and Nutrition Examination Survey (NHANES) data was analyzed from 2007-2012.3 Subjects age ≥ 40 years with spirometry studies meeting the American Thoracic Society (ATS) quality standards were included. Blood eosinophil count ≥ 300cells/μL and FEV1 change > 12% and > 200ml with BD testing were used to define blood eosinophilia and BD reversibility (BDR) respectively. Asthma history was identified using NHANES question “Has a doctor or health care professional ever told that you have Asthma?”. Subjects with probable ACOS were identified using two major criteria (Post-BD FEV1/FVC < 0.7, and asthma history or FEV1 change ≥ 400ml in cases without asthma history) along with any one minor criteria (BDR or blood eosinophilia).4 Post-BD FEV1/FVC ≥ 0.7 with BDR and/or blood eosinophilia were used to identify probable asthma cases. We analyzed non-weighted samples using SPSS version 21. RESULTS: We identified 8002 subjects age ≥40 years who completed pre-BD spirometry testing, 625 of them met ATS spirometry quality standards and had a pre-BD FEV1/FVC < 0.7. Of these 625 subjects, 381(61%) had post-BD FEV1/FVC < 0.70 confirming irreversible airway obstruction. Among these 381 subjects with post-BD FEV1/FVC < 0.7, twelve (3.1%) subjects had asthma history and BDR; 16 (4.2%) had asthma history and blood eosinophilia; 2 (0.7%) had FEV1 change ≥ 400ml and blood eosinophilia making ACOS more likely than COPD alone in these subjects. Among the remaining 244 cases (39%) with pre-BD FEV1/FVC < 0.7 but post- BD ratio ≥ 0.7, twenty-four (9.8%) had BDR alone and 10 of these had BDR and eosinophilia making asthma more likely. Moreover, 18 of the 24 subjects with BDR and 6 of the 10 subjects with BDR and eosinophilia had no prior asthma history and would likely be misdiagnosed as COPD if pre-BD FEV1/FVC ratio alone was used. CONCLUSIONS: Routine underutilization of spirometry with BD testing may lead to over diagnose 39% of subjects as having COPD. Further evaluation for potential asthma would be needed in 9.8% of these subjects. Moreover, post-BD spirometry values along with the recommended criteria for ACOS help identify 8% of COPD subjects who likely have ACOS. CLINICAL IMPLICATIONS: Routine use of Post-BD spirometry values will not only prevent over diagnosis of COPD but also help identifying subjects with potential ACOS and asthma. DISCLOSURES: No relevant relationships by Srinadh Annangi, source=Web Response No relevant relationships by Angel Coz Yataco, source=Web Response

Partial Vertebrae Resection Laterally to Harvest Supplemental Autograft Bone for Anterior Cervical Discectomy and Fusion: A Technical Note and Outcomes

To evaluate the safety and effectiveness of partial vertebrae resection laterally through intervertebral space to harvest supplemental autograft bone for anterior cervical discectomy and fusion (ACDF). Patients who accepted 1-segment (n= 19, 38.2 months follow-up) or 2-segment (n= 17, 40.4 months follow-up) ACDF with supplemental autograft bone were included. Cervical lordosis (CL), segmental lordosis (SL), anterior segment height (ASH), and posterior segment height (PSH) on neutrally lateral radiography, and intervertebral fusion rate on computed tomography were measured. The operation time, intraoperative blood loss, Japanese Orthopedic Association score, visual analog scale around the neck or arm, Neck Disability Index, and complications were also recorded. Mean operation time was 86.2 and 115.6 minutes, and the intraoperative blood loss was 41.7 and 79.4 mL in cases with 1-segment and 2-segment ACDF, respectively. At the final visit, the visual analog scale score and Neck Disability Index significantly decreased, and the Japanese Orthopedic Association score significantly increased. Significant increases were observed in the ASH, PSH, CL, and SL after 2-segment ACDF. Significant increases were observed in the CL and SL after 1-segment ACDF, but not in the ASH and PSH. All the ASH, PSH, CL, and SL kept unchanged at the final visit. All cases acquired definite intervertebral fusion, and the incidence of cage subsidence was 5.3% after 1-segment and 17.6% after 2-segment ACDF at the final visit. Partial vertebrae resection laterally through the intervertebral space was a safe and effective method to harvest supplemental autograft bone for the ACDF.

Death due to non-traumatic hemoperitoneum in Milan 2002-2016, with focus on two cases of abdominal apoplexy (idiopathic spontaneous hemoperitoneum) and review of the literature.

Abdominal apoplexy, also known as idiopathic spontaneous hemoperitoneum, is a rare event related to sudden death, whose diagnosis and treatment is extremely challenging and whose pathologic mechanisms are still mainly unknown. It is frequently associated with vascular disorders (alterations in the vascular structures) and mainly linked to liver cirrhosis. However, the presence of hemoperitoneum may in such cases pose many challenges to forensic post-mortem examinations since the source of bleeding remains often unknown even after a careful and thorough dissection. The Authors present two cases of sudden death related to massive hemoperitoneum (4,650ml in case 1 and 5,100ml in case 2) occurred in two cirrhotic males aged 49 and 51: no traumatic injuries were detected and the source of bleeding was not identified although a careful dissection of organs and vascular structures was performed. Rare cases have been already described in the literature, only as case reports, and no systematic studies have been performed on this issue. Nevertheless, this event ought to be taken into account asa cause of sudden death in people with advanced liver disease. A general glimpse is provided among the different causal mechanisms and the challenges within forensic pathology.

Cardiac Structural and Functional Abnormalities in Females with Untreated Hypopituitarism due to Sheehan Syndrome: Response to Hormone Replacement Therapy

Data on cardiac abnormalities in females with untreated hypopituitarism are limited. We investigated echocardiographic abnormalities in females with untreated hypopituitarism and their response to treatment. Twenty-three females with treatment-naïve hypopituitarism and 30 matched healthy controls were evaluated for cardiac structure and function. Echocardiographic evaluation was done at presentation and after achieving a euthyroid and eucortisol state. Fourteen (61%) patients had mitral regurgitation, and 11 (48%) had pericardial effusion as against none among controls. Indices of left ventricular (LV) size like LV end diastolic dimension (LVEDD; 44.5 ± 3.5 mm in cases vs. 47.6 ± 3.8 mm in controls, P = .004), and LV diastolic volume (LVEDV; 91.8 ± 18.0 mL versus 106.5 ± 20.4 mL, P = .009) were significantly lower in the SS group compared with controls. LV mass (LVM) was 70.8 ± 19.2 g in cases and 108.0 ± 33.2 g in controls (P = .02). Similarly, indices of LV systolic function like stroke volume (SV; 59.1 ± 12.0 mL in cases and 74.4 ± 15.8 mL in controls; P = .000), ejection fraction (EF; 64.3 ± 6.2 % in cases against 69.9 ± 9.2 % in controls; P = .03), and fractional shortening (FS; 34.9 ± 4.7% versus 40.1 ± 4.4%, P = .000) were significantly decreased in patients compared with controls. Cardiac abnormalities normalized with restoration of a euthyroid and eucortisol state. Pericardial effusion, mitral regurgitation, and diminished LVM are common in females with untreated hypopituitarism. ACTH = adrenocorticotrophic hormone BMI = body mass index DT = deceleration time EDV = end-diastolic volume EF = ejection fraction FS = fractional shortening GH = growth hormone IGF-1 = insulin growth factor-1 ITT = insulin tolerance test IVSd = interventricular septal diameter LH = luteinizing hormone LV = left ventricular LVEDD = LV end diastolic dimension LVEDV = LV end diastolic volume LVM = LV mass MRI = magnetic resonance imaging MVP = mitral value prolapse PPH = postpartum hemorrhage PWd = posterior wall diameter SS = Sheehan syndrome SV = stroke volume T3 = triiodothyronine T4 = thyroxine TSH = thyroid-stimulating hormone.

The Toxicological Effects of Nerium oleander and Yucca glauca as Crude Leaf Extracts by Different Methods against Cowpea Aphid, Aphis craccivora (Koch) and Their Chemical Components

The current study carried out during Spring season of 2015 year under laboratory conditions, in at Plant Protection Research Institute , Doki, Giza, Egypt. The experiment aimed to study the toxic effects of Oleander, Nerium oleander and Soapweed, Yucca glauca as a botanical leaf extracts against Aphis craccivora nymphs , fecundity, physic-chemical properties and the identification of their chemical components. Botanical leavesextracted using chloroform , ethanol and water as a solvents. The results showed that crude extracts produced from N. oleander were the superb toxic than Yucca glauca, also N. oleander with Chloroform was the most effective followed by ethanol and water against A. craccivora , whereas water produced the least toxic extracts. On the other hand, the results indicated that Y. glauca recorded lowest LC50s and LC90s with Chloroform compared with Y glauca with other solvents. In case of , N. oleander extracts ( with chloroform, ethanol and water ) reduced fecundity (offspring number) of A. craccivora compared with Y glauca extracts, wherever N. oleander with chloroform recorded the lowest fecundity at a 800 ppm concentration followed by other concentrations. In addition to there are differences in physico-chemical properties between two botanical extracts with different solvent , the obtained result showed that foam disappearance in case of extracts with chloroform and ethanol but were 33 and 3 ml in case Y. glauca and N. oleander with water alone, surface tension were decreased when adding chloroform and ethanol recorded 18.74, 31.81 and 19.54, 31.81 with Y. glauca with chloroform , ethanol and N. oleander with chloroform and ethanol, respectively, but adding water to Y. glauca and N. oleander cause increasing surface tension recorded 59.48 and 65.14, respectively . Also, PH values ranged between high acidic and slightly acidic. On the other hand data showed that number of component of Yucca glauca and Nerium oleander extracts were contain 27 and 38 compounds, respectively. Recommendation : The paper recommended using Nerium oleander and Yucca glauca extracts with chloroform in A. craccivora ( Koch ) control.

Preoperative transarterial embolization using gelatin sponge for hypervascular bone and soft tissue tumors in the pelvis or extremities.

Preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors plays an important role in reducing intraoperative blood loss (IBL). To evaluate the use of a gelatin sponge in preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors in the pelvis or extremities. Thirty-seven patients (21 men, 16 women; median age, 61 years; age range, 23-79 years) underwent preoperative transcatheter arterial embolization between April 2004 and January 2015. Medical records and images were reviewed, and the technical success rate, clinical success rate, and complications were evaluated. Technical success was defined as a devascularization rate of 75% or higher, and clinical success was defined as intraoperative blood loss (IBL) <1500 mL in cases undergoing surgery within 3 days of transarterial embolization and <3000 mL in cases operated 4 or more days later. Tumor sizes were in the range of 2.0-13.0 cm (median, 5.0 cm). The devascularization rate was decreased by >75% at follow-up angiography in all cases, and the technical success rate was 100 % (37/37). The median IBL was 491 mL (range, 30-3800 mL), and the clinical success rate was 89% (33/37). The minor complication of local pain was observed in 13 out of 37 cases (35%) during or after embolization, but was controllable by an analgesic. Preoperative transarterial embolization using a gelatin sponge appears to be feasible and safe, and may contribute to decreasing IBL.

Aktualne spojrzenie na masywny krwotok actual view-point for massive hemorrhage

A massive hemorrhage is the main cause of death in injures caused by war activities, terrorism, and transpotration accidens.The total loss of blood during 24 hours is considered to be massive hemorrhage.The first hours of hemorrhage are connected with a decline of coagulation potential and with development of coagulopathy,witch when combined with a drop of body temperature and a developing metabolic acidosis constitutes a very serious life,s threat.Therefore,the current approach to the treatment of massive hemorrhage is based on the avoidance of an excessive transfusion od blood substitute fluids ,because this leads to a dilution of components of coagulation ,and instead focused on-as aerly as possibile an application of full blood or products from blood particulary those that increase a coagulation potential.Most often it is a FFP ( fresh frozen plasma),or PCC (prothrombin complex concentrate)A special attention is paid to fibrinogen supplementation (usually 2,5–5,0 g/adult and 1–2 g/child is needed),so that it,s level in serum exceeds 150mg/dl.The source of fibrinogen other that FFP are crioprecipitat (0,4g/100ml) and fibrinogen concentrat ( Haemocomplletan®).Thromboelastography is recommended for a lab diagnosis of massive hemorrhage.The basic rule of the initial treatment that determines victim,s future outcome is the demage control resuscitation ,that is,performing only those procedures that are absolutely necessary to save life.With regard to hemorrhage here they are:1. Stop loos of blood with nonsugical or surgical methods depending on their availability.2. Blood transfusion( particulary fresh or fresh / warm ) or blood products with special attention given to fibrynogen supplementation.3. While transfusing blood products are performing has to keep a ratio erythrocytes/thrombocytes/FFP 1:1:1.The level of hemoglobin must be a minimum 7g/dl,fibrinogen 150mg/dl and thrombocytes 100 000/ml4. Prevent dropping body,s temperature.5. Restrict transfusion of fluids such as cristaloids an particulary artificial coloids to a bare minimum.No more that 700 ml in case that hemostasis was not performed.6. Supplemented calcium so that its ionized level does not drop below 0.9 mmol/l.7. Stabilize broken bons ,because its decreases secondary blood loss.8. Prophylacticly prescribe a wide spectrum antibiotic9. Transport a victim patient to higher level hospital.

A New Maneuver for Prevention of Postpartum Haemorrhage.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Many methods have been developed to decrease its rate. The aim of this study was to evaluate the applicability of a new non-pharmacologic maneuver in decreasing its rate. This case series study was conducted in one center in Cairo, Egypt, from January-2010 to June-2013. 400 pregnant women, aged 18years or more and candidate for normal labor, were enrolled to this study. High risk subjects for PPH were excluded. After placental delivery, the new maneuver was done by sustained traction of the anterior and posterior lips of the cervix by two ovum forceps for duration of 90s. The amount of blood loss was estimated by standardized visual estimation after removal of the forceps. All subjects were followed up for 6h. The rate of PPH, defined as more than 500ml, was eight cases (2%) with 95% CI (0.63-3.37%). The rate of PPH was not affected by parity, gestational age, episiotomy, or the presence of tears. PPH is more in cases with anemia (p 0.032). It occurred in all cases with uterine atony (p<0.001). The range of estimated blood loss was 550-600ml in cases with PPH and 150-450ml in cases without PPH. Severe PPH more than 1,000ml did not occur. This pilot study introduced a novel maneuver that can be helpful in decreasing the rate of PPH and reducing the amount of postpartum blood loss. Further RCT is recommended to investigate it.

Concurrent Transperitoneal Repair for Incidentally Detected Inguinal Hernias During Robotically Assisted Radical Prostatectomy

To report our experience with concurrent intraperitoneal inguinal herniorrhaphy using prosthetic mesh during robotically assisted radical prostatectomy (RARP) for incidentally discovered inguinal hernias. We performed a retrospective review of 1118 consecutive RARPs performed by one surgeon between July 2005 and July 2011. Cases that included concurrent hernia repair were compared with a group of patients matched 1:1 for age, body mass index, and year of surgery, who underwent RARP alone (controls). A total of 91 patients underwent 113 concurrent inguinal hernia repairs during RARP. Twenty-two patients (24%) underwent bilateral repair. Of the 69 patients undergoing unilateral repair, 41 (45%) underwent left-sided repair, and 29 (31%) underwent right-sided repair. Thirty-five (38%) patients had previous inguinal hernia repair. Body mass index of cases and controls were 27.5 ± 3.4 and 27.8 ± 3.1 kg/m(2), respectively. Mean operative time in cases was 185 ± 28 minutes vs 168 ± 31 minutes in controls (P <.001). Estimated blood loss was 170 ± 61 mL for cases vs 194 ± 82 mL for controls (P = .03). No differences were observed in length of stay or prevalence of postoperative complications. There was 1 hernia recurrence, which necessitated repeat repair 1 year after surgery. No mesh infections or other complications related to hernia repairs were observed. Inguinal hernias are a common intraoperative finding during RARP. Concurrent repair appears safe and effective with only a slight increase in operative time, and no increase in morbidity.

A comparative analysis of in vitro expansion of natural killer cells of a patient with autoimmune haemolytic anaemia and ovarian cancer with patients with other solid tumours

The functional profile of natural killer (NK) cells has been reported to be lower in auto-immune haemolytic anaemia (AIHA). In this study, we report a comparative analysis of peripheral blood mononuclear cells (PBMNCs) and the in vitro expansion of NK cells in a patient with AIHA and cancer, with that of other cancer patients without AIHA. PBMNCs and in vitro NK-cell expansion of a 64-year old female patient with ovarian cancer and AIHA was compared with that of four other patients with cancer without AIHA who underwent autologous immune enhancement therapy (AIET). The NK cells were cultured using autologous plasma without feeder layers. The quantities of PBMNCs, NK cells and CD3-CD56+ cells were compared. The average quantity of PBMNCs per ml in Cases I to V were 10.71, 39.2, 49.26, 65.16 and 49.33×10(4), respectively, and the average maximum count of NK cells was 3.9, 1730.03, 1824.16, 1058.61 and 761×10(6), respectively. The average percentage of CD3-CD56+ cells in Cases I to V following in vitro expansion was 1.2, 65.7, 28.63, 65.9 and 40%, respectively. In the present study, probably the first in the literature, the in vitro expansion of NK cells was found to be significantly lower in the AIHA patient. Previously, only a lower NK-cell functional profile was reported. Further studies are required to establish the association between AIHA and NK-cell profile and in vitro expansion, and to find common antibodies between red blood cells (RBCs) and NK cells.