Pulmonary artery banding in the current era: Is it still useful?

Background: The objective of this study was to assess the results of the pulmonary artery (PA) banding in patients with congenital heart defects (CHD) and pulmonary hypertension (PH) in the current era. Methods: We analyzed data from 305 patients who underwent PA banding between April 2005 and April 2010 at our centre. All patients were approached through a left thoracotomy. Twenty percent of patients underwent PA banding based on Trusler's rule (Group 1), 55 of them underwent PA banding based on PA pressure measurement (Group 2), and the rest of them (25) based on surgeon experience (Group 3). The follow-up period was 39 ± 20 month and 75 of patients (230 cases) had definitive repair at mean interval 23 ± 10 months. Results: The rate of anatomically and functionally effectiveness of PA banding in all groups was high (97 and 92, respectively). There were no significant differences in anatomically and functionally efficacy rate between all groups (P=0.77, P=0.728, respectively). There was PA bifurcation stenosis in six cases (2), and pulmonary valve injury in one case (0.3). The mortality rate in PA banding was 2 and in definitive repair was 3. Conclusions:We believe that PA banding still plays a role in management of patients with CHD, particularly for infants with medical problems such as sepsis, low body weight, intracranial hemorrhage and associated non cardiac anomalies. PA banding can be done safely with low morbidity and mortality

The relationship between coping styles and psychological adaptation in the recovery process: Patients with coronary heart disease

Background: The relationship between coping styles and psychological adaptation during the recovery process was investigated in a sample of coronary heart disease (CHD) patients. Methods: One hundred and fifty patients from Shahid Rajaee Heart Center, Tehran, Iran, were included in this study at intake and forty five patients (27 men, 18 women) participated in the follow-up study. All participants were asked to complete the Tehran Coping Styles Scale (TCSS) and Mental Health Inventory (MHI). The Recovery Process Questionnaire (RPQ) was completed using each patient�s medical file and clinical examinations by cardiologists. Styles of coping with stress were categorized as problem-focused, positive emotional-focused and negative emotional-focused. Psychological adaptation included psychological well-being and psychological distress. Results: Objective recovery status showed no significant correlation with either coping styles or psychological adaptation. Perceived recovery revealed a significant positive association with negative emotional-focused coping (p<0.05), but no significant correlation with other coping and psychological adaptation variables. Perceived recovery revealed a significant negative association with psychological distress (p<0.05), but showed no significant correlation with psychological well-being. Conclusions: Perceived recovery in CHD patients is positively influenced by negative emotional-focused coping styles. Results and implications are discussed specifically in terms of the possible reasons for the positive relationship between perceived recovery and negative emotional-focused coping. © 2008, Tehran University of Medical Sciences. All rights reserved

Proteinuria and albuminuria at point of care

Proteinuria is a key diagnostic and pathophysiological aspect of kidney dysfunction, influencing the progression of kidney and systemic diseases. Both general practitioners and specialists should be able to discriminate the relevance of proteinuria, starting from a urine sample, and eventually referring selected patients to a nephrologist for further diagnostic workup and treatment, because most kidney diseases are not symptomatic until renal function is lost or severely compromised. As the interpretation of proteinuria is dependent on the method used to detect it, the aim of this article was to review laboratory and point-of-care diagnostic methods for proteinuria in different settings, such as the prevention and follow-up of common chronic diseases (i.e., hypertension, diabetes, chronic kidney disease). Urine dipsticks remain the most widely used method for detecting proteinuria, although different types of proteinuria, extreme pH values and urine concentration may affect their results. Albumin to creatinine ratio and protein to creatinine ratio performed on a spot urine sample are reliable tests that can effectively replace 24-hour urine collection analysis in clinical practice

Modified Blalock-Taussig shunt and giant perigraft reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented

Interrater agreement of nasal endoscopy in patients with a prior history of endoscopic sinus surgery

Nasal endoscopy is an important part of the clinical evaluation of patients with chronic rhinosinusitis. However, its objectivity and inter-rater agreement have not been well studied, especially in patients who have previously had sinus surgery

Fellowship training:a qualitative study of scope and purpose across one department of medicine

BACKGROUND: Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an &quot;invisible phase of postgraduate training&quot; lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education. METHODS: During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data. RESULTS: We interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment. CONCLUSIONS: Fellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education

Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma

Contains fulltext : 96290.pdf (Publisher’s version ) (Open Access)OBJECTIVE: Transsphenoidal pituitary surgery (TS) is the primary treatment of choice for patients with acromegaly. Macroadenomas (>1 cm) are more difficult to resect than microadenomas (remission rate +/- 50% compared to +/- 90%). Besides the conventional microscopic TS, the more recently introduced endoscopic technique is nowadays frequently used. However, no large series reporting on its results have yet been published. We evaluated the outcome of endoscopic TS in 40 patients with a growth hormone (GH)-secreting macroadenoma treated in our hospital between 1998 and 2007. METHODS: Medical records were retrospectively reviewed. Remission was defined as disappearance of clinical symptoms of acromegaly, normal serum insulin-like growth factor-1 levels (</=2 SD) and serum GH levels suppressed to <2 mU/l after an oral glucose tolerance test within the first 4 months after TS. RESULTS: In four patients TS aimed at debulking of the tumour. In the remaining 36 patients, remission was achieved in 20 patients. In the first 5 years remission was achieved in 6 out of 18 patients (33%) compared to 14 out of 22 patients (63%) in the following 5 years (p = 0.06). Thirteen patients had a mild perioperative complication. Before TS 15 patients received hormonal substitution therapy compared to 12 patients (33%) after TS. CONCLUSION: Endoscopic TS is a good primary therapeutic option for patients with a GH-secreting macroadenoma, resulting in a remission rate of up to 63% in experienced hands. This technique can potentially improve the outcome of TS in these patients

Topical use of MMC in the upper aerodigestive tract: a review on the side effects

Not much is known about the side effects of mitomycin C (MMC), an anti-fibrogenetic agent, in the upper aerodigestive tract. However, its use in ophthalmology is widely known and without quantitatively important side effects. A literature review was performed for side effects of MMC in the upper aerodigestive tract. Forty-six articles, describing the use of MMC to prevent scarring, were retracted from PubMed. Thirty-two are human studies. MMC is used in different concentrations (0.1–10 mg/ml) with different application times (2–5 min) and frequencies (up to 4 times). Five hundred and thirty-eight patients were included in those publications, of whom 19 developed side effects (3.53%). No side effects developed in studies, where post-application irrigation with saline was reported. The longest mean follow-up period is 75.5 months. Direct relations between the reported side effects and MMC seem absent in most studies. Serious complications seem to occur when MMC is used in high concentrations. Unfortunately, sometimes crucial information is lacking. One patient was described who supposedly developed laryngeal carcinoma after repeated treatment of hyperkeratosis and anterior commissure webbing. Animal studies show that excessive fibrin production can lead to acute airway obstruction. In conclusion, topical application of MMC on a wound with consecutive irrigation with saline can be performed safely to prevent scar formation in circular structures of the upper aerodigestive tract. Long-term yearly control of the application site seems advisable

ICAR: endoscopic skull‐base surgery

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