Coronary artery disease in a large renal transplant population: implications for management

Coronary artery disease (CAD) accounts for approximately one-half of the sizable mortality in patients with end-stage renal disease who have undergone transplantation. The study was a retrospective review of 1460 patients who underwent renal transplantation at the Mount Sinai Medical Center from January 1, 2000 to October 31, 2009. Noninvasive stress testing was performed in 848 patients (88.1%) with 278 patients (32.8%) having abnormal results. Cardiac catheterization was performed in 357 patients (37.1%) and of these, 212 patients had obstructive disease (59.4%). At 5 years posttransplant, there was no statistically significant difference between those with nonobstructive CAD and those who required percutaneous or surgical interventions (adjusted hazard ratio [aHR], 1.243; CI 95%, 0.513-3.010; p = 0.630). Those with medically managed obstructive CAD had significantly higher rates of death at the 5-year period when compared to those who received percutaneous intervention (aHR, 3.792; CI 95%, 1.320-10.895; p = 0.013) or those who received coronary artery bypass grafting (aHR, 6.691; CI 95%, 1.200-37.323). Because noninvasive imaging is poorly predictive of coronary disease in this high-risk population, an anatomic diagnosis is recommended. Revascularization may result in improved long-term outcomes.

Iodine deficiency disorders in Bangladesh

An extensive iodine deficiency disorders survey was conducted in Bangladesh in 1993 to assess the latest iodine nutriture status of the country. The clinical variables of the survey were goitre and cretinism, and the biochemical variable was urinary iodine. The "EPI-30 cluster" sampling methodology was followed for selecting the survey sites. In each survey site, the study population consisted of boys and girls, aged 5-11 years, and men and women, aged 15-44 years, in about equal populations. The total number of survey sites was 78 and the total number of respondents was 30,072. The total number of urine samples was 4512 (15% sub-sample). The current total goitre rate (grade 1 + grade 2) in Bangladesh is 47.1% (hilly, 44.4%; flood-prone, 50.7%; and plains, 45.6%). The prevalence of cretinism in the country is 0.5% (hilly, 0.8%; flood-prone, 0.5%; and plains, 0.3%). Nearly 69% of Bangladeshi population have biochemical iodine deficiency (urinary iodine excretion [UIE] < 10 mg/dl) (hilly, 84.4; flood-prone, 67.1%; and plains 60.4%). Women and children are more affected that men, in terms of both goitre prevalence and UIE. The widespread severe iodine deficiency in all ecological zones indicates that the country as a whole is an iodine-deficient region. Important recommendations of global interest are made from the experience of the survey.

Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients

Twenty-one patients suffering from cervical spondylosis and peripheral symptoms underwent uncomplicated anterior interbody fusion of the cervical spine and were re-examined clinically and radiologically at 27 +/- 15 months (mean +/- SD) after the operation. Translatory displacement of the segment adjacent to the fusion level was noted in 14 patients. Its incidence could not be related to the age and sex of the patient, to extent of the fusion, or to postoperative time. Anterior slippage did not correlate with persistent or recurring pain.

Mandibular metastasis of an extraskeletal myxoid chondrosarcoma arising on the plantar surface of the foot: report of case

This paper presented a discussion of the initial appearance and atypical clinical course, histopathology, treatment, and prognosis of a case of extraskeletal myxoid chondrosarcoma that originated on the plantar surface of the left foot and that metastasized to the mandible. The clinical behavior of this neoplasm, as reported, is distinctively less aggressive and therefore thought to have a better prognosis than chondrosarcoma of bone. Contrary to the biologic behavior reported in the literature, however, our patient had a less than six-year remission from the neoplasm.

A new method facilitating nasotracheal intubation

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