Primary Stenting for Acute Myocardial Infarction

Primary stenting for acute MI has been shown to be an improvement over PTCA alone. As with primary PTCA however there is an obligate delay in restoration of TIMI flow due to the time necessary for mobilization of the cath lab team. It is possible that a hybrid approach using partial thrombolysis plus early IIB/IIIA inhibitor administration followed by urgent angiography and stenting of the culprit lesion will be the ideal approach.

Ankyrin-rich membrane spanning protein as a novel modulator of transient receptor potential vanilloid 1-function in nociceptive neurons

BACKGROUND

The ion channel TRPV1 is mainly expressed in small diameter dorsal root ganglion (DRG) neurons, which are involved in the sensation of acute noxious thermal and chemical stimuli. Direct modifications of the channel by diverse signalling events have been intensively investigated, but little is known about the composition of modulating macromolecular TRPV1 signalling complexes. Here, we hypothesize that the novel adaptor protein ankyrin-rich membrane spanning protein/kinase D interacting substrate (ARMS) interacts with TRPV1 and modulates its function in rodent DRG neurons.

METHODS

We used immunohistochemistry, electrophysiology, microfluorimetry and immunoprecipitation experiments to investigate TRPV1 and ARMS interactions in DRG neurons and transfected cells.

RESULTS

We found that TRPV1 and ARMS are co-expressed in a subpopulation of DRG neurons. ARMS sensitizes TRPV1 towards capsaicin in transfected HEK 293 cells and in mouse DRG neurons in a PKA-dependent manner. Using a combination of functional imaging and immunocytochemistry, we show that the magnitude of the capsaicin response in DRG neurons depends not only on TRPV1 expression, but on the co-expression of ARMS alongside TRPV1.

CONCLUSION

These data indicate that ARMS is an important component of the signalling complex regulating the sensitivity of TRPV1.

SIGNIFICANCE

The study identifies ARMS as an important component of the signalling complex regulating the sensitivity of excitatory ion channels (TRPV1) in peripheral sensory neurons (DRG neurons) and transfected cells.

[Influence of body mass index on histopathological and intraoperative criteria in a consecutive series of patients after robotic-assisted radical prostatectomy]

BACKGROUND

In various studies it has been shown that obesity enhances the risk for a unfavorable pathological tumour stages, higher Gleason scores (GS), positive surgical margins (PSM), and certain perioperative parameters (higher blood loss, higher length of surgery, higher complication rates) after radical prostatectomy. However, for robot-assisted radical prostatectomy (RARP) there are only a few studies addressing this topic with partially conflicting results. Furthermore, none of these studies actually represents the clinical practice pattern as performed in a European centre.

MATERIAL AND METHODS

Beside further clinical and histopathological parameters, also body mass index (BMI) of patients undergoing RARP was recorded. The following categories were registered: BMI of < 25 kg/m², ≥ 25-29.9 kg/m², and ≥ 30 kg/m² defined as normal weight, overweight, and obesity, respectively. The potential correlation between BMI on the one hand and various criteria of aggressive tumour biology and specific perioperative parameters on the other hand has been examined on univariate and multivariable analyses.

RESULTS

22.8% (n=79), 59% (n=204), and 18.2% (n=63) of patients of the study group presented with normal weight, overweight, and obesity, respectively. Based on the results of various multivariable regression models there was no significant influence of obesity on pathological tumour stage, pN category, undifferentiated tumour growth (≥ GS7b), upgrading, or PSM rates. Furthermore, obese patients showed a significantly higher intraoperative blood loss and a higher length of surgery, which, however, did not result in a higher rate of grade 3a/b complications according to Clavien-Dindo classification after 90 days.

CONCLUSIONS

In the present series of consecutive patients undergoing RARP there was no evidence for a more aggressive tumour biology or a higher complication rate in obese patients.

Evaluation of the effects of manuka honey on salivary levels of mutans streptococci in children: a pilot study

BACKGROUND

There has been much debate in the past about whether honey is harmful to the teeth, mostly as part of the debate about raw sugar versus refined sugar and the results have been equivocal. However, what has not been taken into account is that honey varies markedly in the potency of its antibacterial activity. Manuka (Leptospermum scoparium) honey from New Zealand has been found to have substantial levels of non-peroxide antibacterial activity associated with an unidentified phytochemical component, denoted as Unique Manuka Factor (UMF).

AIMS

Considering the potential antimicrobial effects of manuka honey, the present study attempted to investigate effects of twice daily use of manuka honey with UMF 19.5 on salivary levels of Mutans streptococci in children.

STUDY DESIGN

The investigation was a stratified comparison of two parallel groups of children who either used manuka honey with regular tooth brushing regimen or continued only with regular tooth brushing regimen twice daily under professional supervision for a 21-day period. A total of three salivary samples were taken from each individual at baseline, day 10, and day 21; colony counts of Streptococcus mutans (S. mutans) were determined. All data was subjected to paired T-test and Wilcoxon's signed ranks sum for intra- and intergroup comparisons respectively.

RESULTS

Children using manuka honey showed statistically significant reductions in salivary S. mutans after 10 and 21 days.

CONCLUSION

Manuka honey with UMF 19.5 may be considered as an effective adjunctive oral hygiene measure for reducing colony counts in children.

A Simple Goniometer for Use Intraoperatively in Total Knee Arthroplasty

Intraoperative range of motion (ROM) assessment can be challenging during total knee arthroplasty (TKA) surgery. As computer assisted surgery is costly and not readily available to many surgeons, we have developed a simple, cost-effective intraoperative device to precisely measure knee flexion and extension. A simple knee goniometer system was constructed consisting of a digital level mounted to a base that rigidly attaches two standard needles. The needles are pushed through the overlying soft tissue of the distal femur. The device is then applied to the proximal tibia, where an angle measurement of the knee is registered. A validation study for this device was conducted on two pairs of intact cadaveric lower limbs at 0 deg, 10 deg, 15 deg, 20 deg, 25 deg, and 30 deg. Two orthopedic surgeons experienced with the system performed three measurements at each angle. Systematic error, defined as the goniometer reading at 0 deg flexion anatomically as determined by the navigation system, ranged from −9.1 deg to 3.0 deg, consistent for each operator on every case. Measurement error, defined as the variability in repeated, fixed angle measurements made with the goniometer, was 1.5 ± 1.0 deg across all surgeons, cases, and prescribed flexion angles. For both surgeons and all imposed flexion angles, measurement errors were below the 4 deg clinical threshold. The simple knee goniometer system generated accurate, repeatable measures of changes in flexion angle intraoperatively with measurement error comparable to errors obtained using the commercial navigation system (1 deg–2 deg). However, the knee goniometer is less complex, less time intensive, and less costly than currently available computer assistive devices. Taken together, our results are very promising for the continued development of this device.

[A very uncommon reason for chest pain]

A 25-year old female immigrant from Kosovo living in Switzerland for three years complained of intermittent atypical chest pain and shortness of breath for three months. The patient was febrile (38.4 °C) and had a regular tachycardia of 120/min and a blood pressure of 105/65 mmHg. The ECG showed deep symmetric negative T-waves on the leads V1 - V6. The conventional chest X-ray revealed a small bulge of the left cardiac outline. Leucocytes and differential count were normal but the C-reactive protein was markedly elevated (118mg/L). Computed tomography of the chest revealed several pleural and paramediastinal cystic masses on the left side. One of these cystic lesions covered a small defect of the aortic wall appearing as a pseudoaneurysm at the beginning of the descending aorta. Echocardiography showed pericardial cysts on the left ventricle and a small pericardial effusion. Serological tests for Echinococcus granulosus were strongly positive. Thus, the patient was diagnosed with cystic echinococcosis with pericardial, pleural and mediastinal involvement with a pseudoaneurysm of the descending aorta.

Mutations in LPL, APOC2, APOA5, GPIHBP1 and LMF1 in patients with severe hypertriglyceridaemia

OBJECTIVES

The severe forms of hypertriglyceridaemia (HTG) are caused by mutations in genes that lead to the loss of function of lipoprotein lipase (LPL). In most patients with severe HTG (TG > 10 mmol L(-1) ), it is a challenge to define the underlying cause. We investigated the molecular basis of severe HTG in patients referred to the Lipid Clinic at the Academic Medical Center Amsterdam.

METHODS

The coding regions of LPL, APOC2, APOA5 and two novel genes, lipase maturation factor 1 (LMF1) and GPI-anchored high-density lipoprotein (HDL)-binding protein 1 (GPIHBP1), were sequenced in 86 patients with type 1 and type 5 HTG and 327 controls.

RESULTS

In 46 patients (54%), rare DNA sequence variants were identified, comprising variants in LPL (n = 19), APOC2 (n = 1), APOA5 (n = 2), GPIHBP1 (n = 3) and LMF1 (n = 8). In 22 patients (26%), only common variants in LPL (p.Asp36Asn, p.Asn318Ser and p.Ser474Ter) and APOA5 (p.Ser19Trp) could be identified, whereas no mutations were found in 18 patients (21%). In vitro validation revealed that the mutations in LMF1 were not associated with compromised LPL function. Consistent with this, five of the eight LMF1 variants were also found in controls and therefore cannot account for the observed phenotype.

CONCLUSIONS

The prevalence of mutations in LPL was 34% and mostly restricted to patients with type 1 HTG. Mutations in GPIHBP1 (n = 3), APOC2 (n = 1) and APOA5 (n = 2) were rare but the associated clinical phenotype was severe. Routine sequencing of candidate genes in severe HTG has improved our understanding of the molecular basis of this phenotype associated with acute pancreatitis and may help to guide future individualized therapeutic strategies.

[Simultaneous robot-assisted laparoscopic cystectomy and laparoscopic nephrectomy: first experience on 3 patients with short-term follow-up]

BACKGROUND

The standard treatment for the muscle-invasive bladder cancer (MIBC) adheres to the open radical cystectomy (RC), although in the last few years the RC was established in some centres. The MIBC with simultaneous renal pathology (carcinoma, loss of function) can be a reason for an RC in combination with a nephrectomy. In the present paper we give a report about our first 3 patients in whom we combined the robotic RC with a laparoscopic nephrectomy as a minimally invasive treatment.

PATIENTS AND METHODS

Between January and September 2010 3 male patients (average age 66 years) with MIBC and an associated renal pathology (2×loss of function, 1×upper tract carcinoma) were treated by the simultaneous robot-assisted RC and laparoscopic nephrectomy at our hospital. Clinical and pathological criteria, surgical techniques and preoperative complications were recorded prospectively. Follow-up of the 3 patients continued for at least of 18 months.

RESULTS

In all 3 cases primarily the kidney was prepared in a transperitoneal-laparoscopic way and clipped by the vessel pedicle, then the robot-assisted RC followed and specimens were removed through a 10-cm median laparotomy. In all cases an ileum conduit was built extracorporally in using this way. The median OP time (including nephrectomy, connection of Da-Vinci, RC with extended lymph node dissection) amounted to 7 h (6.5-7.5 h) in total. The intraoperative blood loss was 330 mL on average. One of our patients showed a grade 2 complication following the Clavien-Dindo classification (1×grade 1, 1×without perioperative complications). On average 32 (22-46) lymph nodes were taken out, whereby all patients showed a pN0 status. The pathological stagings of MIBC were pT3a, pT4a and pT4b. With one patient the cancer of the renal pelvis was limited to the lamina propria, with another patient an incidental prostate cancer was detected. All histopathological findings of the different cancers showed negative surgical margins. The median hospitalisation time was 17 (16-19) days. In an 18- to 26-month follow-up period all patients ­remained without any further postoperative complications and ­without a tumour relapse.

CONCLUSION

In this paper we have described the surgical steps of a small series of simultaneous robot-assisted RC and laparoscopic nephrectomy as a minimally invasive treatment in case of a specific indication. As a result of our report, we show that this surgical technique is possible without essential perioperative morbidity and with satisfying oncological results. Long-term data of our patients and results of any further studies are crucial to evaluate the efficiency of this complex surgical method.

Extreme xanthomatosis in patients with both familial hypercholesterolemia and cerebrotendinous xanthomatosis

Two unrelated individuals were referred to Lipid Clinics in The Netherlands and Chile with extreme xanthomatosis and hypercholesterolemia. Both were diagnosed with heterozygous familial hypercholesterolemia (heFH) after molecular genetic analysis of the low-density lipoprotein (LDL) receptor gene. Since heFH by itself could not account for the massive xanthomas, the presence of an additional hereditary lipid or lipoprotein disorder was suspected. Further genetic analysis revealed homozygozity for mutations in the sterol 27-hydroxylase gene, confirming the diagnosis of cerebrotendinous xanthomatosis (CTX). Markedly, the typical neurological manifestations of CTX were absent, suggestive of a protective role of LDL-receptor deficiency against the severe neurological consequences of CTX.

The comparative evaluation of the effects of tongue cleaning on salivary levels of mutans streptococci in children

OBJECTIVES

The study compared and evaluated the effects of tongue scraping and tongue brushing on salivary mutans streptococci levels in children.

METHODS

The investigation was a single-blind, stratified comparison of three parallel groups of children who performed either tongue scraping or tongue brushing along with tooth brushing or only tooth brushing twice daily under professional supervision for a 21-day period. A total of three saliva samples were taken from each individual, at baseline, on day 10 and on day 21, and colony counts of mutans streptococci were determined. All data were subjected to statistical analysis using Wilcoxon's signed-ranks sum test and Mann-Whitney U-test.

RESULTS AND CONCLUSIONS

The results of the present study show that tongue scraping and tongue brushing demonstrated statistically significant reductions in salivary mutans streptococci counts after 10 days and also after 21 days. It was also noted that tongue scraping and tongue brushing were equally effective in reducing colony counts.

Comparative cost and performance of light-emitting diode microscopy in HIV-tuberculosis-co-infected patients

Light-emitting diode (LED) microscopy has recently been endorsed by the World Health Organization (WHO). However, it is unclear whether LED is as accurate and cost-effective as Ziehl-Neelsen (ZN) microscopy or mercury vapour fluorescence microscopy (MVFM) in tuberculosis (TB)-HIV-co-infected subjects. Direct and concentrated sputum smears from TB suspects were evaluated using combinations of LED microscopy, ZN microscopy and MVFM. Median reading time per slide was recorded and a cost analysis performed. Mycobacterial culture served as the reference standard. 647 sputum samples were obtained from 354 patients (88 (29.8%) were HIV-infected and 161 (26%) were culture-positive for Mycobacterium tuberculosis). Although overall sensitivity of LED compared with ZN microscopy or MVFM was similar, sensitivity of all three modalities was lower in HIV-infected patients. In the HIV-infected group, the sensitivity of LED microscopy was higher than ZN microscopy using samples that were not concentrated (46 versus 39%; p = 0.25), and better than MVFM using concentrated samples (56 versus 44; p = 0.5). A similar trend was seen in the CD4 count <200 cells · mL(-1) subgroup. Median (interquartile range) reading time was quicker with LED compared with ZN microscopy (1.8 (1.7-1.9) versus 2.5 (2.2-2.7) min; p ≤ 0.001). Average cost per slide read was less for LED microscopy (US$1.63) compared with ZN microscopy (US$2.10). Among HIV-TB-co-infected patients, LED microscopy was cheaper and performed as well as ZN microscopy or MVFM independent of the staining (ZN or auramine O) or processing methods used.