Post-operative course in a surgical model of acute myocardial infarction in the rabbit

This study was undertaken to evaluate the post-operative (post-OP) course of rabbits in a surgical model of myocardial infarction (MI). Ten New Zealand White rabbits were subjected to coronary artery ligation after lateral thoracotomy. Anesthesia was delivered using a xylazine-ketamine-isoflurane protocol after endotracheal intubation. Among other cardiorespiratory parameters, arterial pressure was monitored via central ear artery catheterization. Post-OP care included oxygen, antibiotic and analgesic treatment as well as nutritional and fluid support. A series of cardiorespiratory, hematological, blood biochemical and clinical parameters were assessed during the first 21 days. The mortality rate was 10%. Hypotension and hypothermia, noted during the operation, reverted within the first few post-MI hours. Electrocardiographic alterations, which included ST segment elevation and Q wave, appeared after MI and remained throughout the study period. Tachycardia was observed during the first 5 days. Hematological examination revealed mild and transient anemia during the post-OP period and leucocytosis up to the 5th day. Urea was increased up to the 12th post-MI hour while increased AST, ALT, LDH and CK levels normalized by the first 4-5 days. Although the post-OP anorexia period lasted around 5 days, the animals did not manage to regain their body weight by the end of the study period. In conclusion, the present model offers a low mortality rate and could be useful in mid- or long-term MI studies. The animals go through a critical post-OP period of around 5 days during which special care should be given. After that time, their clinical and blood laboratory parameters tend to normalize.     

A clinico-demographic analysis of maxillofacial trauma in the elderly

doi: 10.1111/j.1741‐2358.2010.00431.x A clinico‐demographic analysis of maxillofacial trauma in the elderly Introduction: The elderly represent an increasing proportion of society. Management of maxillofacial trauma in this population may be complicated by coexisting medical conditions, requiring multi‐disciplinary care. Methods: This retrospective audit assesses the incidence and pattern of maxillofacial trauma in elderly patients (≥60 years) presented to the Merseyside Regional Maxillofacial Unit. Over the time period of 2003, 2004 and 2005, 7905 trauma patients presented to the accident and emergency department, of whom 757 were elderly (10%). Results: Results indicated that the male to female ratio was 1:1.4. The commonest cause of injury was a fall (83%) followed by an assault (6%); the majority of falls occurring in the home. Conclusion: Management of maxillofacial injuries in this population should focus on targeted prevention programmes, which address known risk factors for falling. We believe that this is a public health issue. Members of the maxillofacial team should be aware of common risk factors of falls in elderly. Better collaboration with the Medicine for Elderly team should be considered at an early stage on managing these patients.     

Prevention of trauma to edentulous ridge from opposing natural teeth

doi: 10.1111/j.1741‐2358.2010.00397.x Prevention of trauma to edentulous ridge from opposing natural teeth Objective: To suggest a technique to prevent trauma of the edentulous ridge from opposing natural or restored teeth. Background: The prevalence of the condition where one edentulous arch opposes a natural or restored dentition is quite common. In most of cases, the maxillary arch is completely edentulous and either all teeth or only anterior teeth are present in the mandibular arch. These remaining teeth may continuously cause trauma to the opposing edentulous ridge during the night when a removable prosthesis is kept out of the mouth. Materials and methods: A thermoplastic acrylic resin mouthguard was fabricated on a cast of the remaining teeth dentition. Conclusion: This article presents a simple and inexpensive procedure to prevent self‐induced trauma of the edentulous ridge from opposing natural teeth by using a thermoplastic acrylic resin mouthguard.     

巨大痛风石手术切除一例及文献复习

目的:探讨晚期巨大痛风石结节的临床表现及手术治疗效果.方法:回顾性分析一例典型病例患者的临床资料、手术方法的选择以及病理学表现.结果:该患者为晚期通风症患者,发展为痛风石.表现为痛风石结节增生,破坏肌腱以及骨组织.各项辅助检查以及手术后病理结果均支持痛风病的诊断.通过手术切除第一跖趾关节旁巨大痛风石,疗效满意.结论:痛风是一种因嘌呤代谢紊乱所致的疾病,本例患者经过各种保守对症治疗均无效.接收此患者后,通过文献复习分析以及临床检查确诊,本病例痛风病变已发展至晚期巨大痛风石结节.只有通过手术治疗才能彻底治愈.手术后证明对晚期巨大痛风石结节同时伴有骨关节破损的痛风石患者行手术治疗是完全可行,且疗效显著.     

激光治疗急性踝关损伤40例临床疗效观察

采用SUNDOM-300I型半导体激光（波长810nm,终端输出功率0mW-500mW,连续可调,光速直径5mm）,治疗急性踝关节损伤40例,平均治疗次数为4次,治愈率72.5％,有效率27.5％,示发现明显毒副作用。结果显示激光在治疗软组织疼痛的早期有较好的疗效。     

Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion.Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible.We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training.Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast.     

Esophageal squamous cell carcinoma and adenocarcinoma in Malaysia – Pooled data from upper gastrointestinal centers in a multiethnic Asian population

BackgroundEsophageal cancer is the sixth leading cause of cancer death worldwide with considerable geographical histological variation There is a paucity of data in esophageal cancer in demographics, histology, and survival among the multi-ethnic Malaysian population. This paper is a review of esophageal cancer epidemiology and survival among esophageal cancer patients from data collected by the Malaysian Upper Gastrointestinal Surgical Society.MethodsThis is a multicenter retrospective observational study of esophageal cancer patients from six upper gastrointestinal surgical centers in Malaysia between 2005 and 2019. Patient characteristics, histological type and stage were compared and survival analyzed.ResultsThere were 820 patients with esophageal cancer included, where 442 (53.9 %) cases had squamous cell carcinoma (SCC) and 378 (46.1 %) had adenocarcinomas (AC). Malays were the predominant ethnicity with AC (66.7 %) while Indians were the ethnic majority (74.6 %) with SCC. Majority of patients (56.8 %) presented as stage IV disease. Overall, the 1-, 3-, and 5-years’ survival were 35.8 %, 13.8 % and 11.0 %, respectively. Surgical resection with curative intent yielded the best 5-year survival (29.4 %). Intervention in stage IV AC yielded superior survival when compared to SCC (median survival, 7.9 months vs 4.8 months; p, 0.018) Our series demonstrated an increase in AC to SCC over the last 15 years.ConclusionsThere was an ethnic preponderance seen between different histology in this region, not previously discussed. An increase in AC was observed over the last 15 years. Late diagnosis seen in most patients imparts poor prognosis as curative surgery affords the best outcome.     

Animal-assisted Psychotherapy and Trauma: A Meta-analysis

The present meta-analysis examined the efficacy of animal-assisted psychotherapy for individuals who have experienced trauma. Eight studies quantitatively assessed the treatment effects of involvement in animal-assisted psychotherapy. A random effects model was used to aggregate each study into an overall effect size. Eight effect sizes were included in the pre-versus post-comparison analysis. The results indicate a large effect size (Hedge’s g = 0.86, p < 0.001, 95% CI [.53, 1.18]). Two effect sizes were included in the treatment versus control comparison analysis. The results indicated a small to moderate effect size (g = 0.46, p = 0.03, 95% CI [0.04, 0.06]). Limited moderator analyses were able to be conducted due to lack of consistent reporting across studies. Place of study and percentage of female participants in the treatment group were found to statistically moderate the effect of animal-assisted psychotherapy. The results indicate that animal-assisted therapy is an efficacious treatment for trauma.