Gallbladder carcinoma: a retrospective analysis of twenty-two years experience of a single teaching hospital

BACKGROUND: The purpose of this study was to retrospectively evaluate our experience with gallbladder cancer since the establishment of a tumour registry in our institute. METHODS: Between 1975 and 1998, 23 consecutive patients with gallbladder cancer were identified using the tumour registry database. There were 18 females (78%) and 5 (22%) males. The mean age at diagnosis was 70.6 (range 42–85) years. The diagnosis was achieved either intra-operatively or following the histological analysis of the gallbladder (n = 17), following gallbladder or liver biopsy (n = 4) or at autopsy (n = 2). Presenting symptoms included upper abdominal pain, weight loss, nausea, vomiting, fever, painless jaundice, hepatomegaly, upper abdominal mass, upper abdominal tenderness, and gastrointestinal haemorrhage. RESULTS: Histological examination revealed 20 adenocarcinomas (87%), 2 squamous cell carcinomas (9%) and one spindle cell sarcoma (4%). At presentation, 14 (61%) gallbladder cancers were stage IV, 5 (22%) were stage III and 4 (17%) were stage II. Kaplan Meier analysis revealed a mean survival of 3.2, 7.8 and 8.2 months for stage IV, III, and II disease respectively. Out of 14 patients with stage IV disease, 8 patients received adjuvant chemotherapy and survived for 4.6 months whereas six patients who did not receive adjuvant chemotherapy survived for 1.3 months. This difference was statistically significant (p = 0.04). CONCLUSION: The majority of patients with gallbladder cancer presented with advanced stage disease (stage IV) which carries a dismal prognosis. Patients who received chemotherapy with stage IV disease, however, did better than those who did not, but this is probably a reflection of patient selection

Características físico-químicas de aceites de semillas extraídos de diferentes variedades de albaricoque (Prunus armeniaca L.) de Pakistán

The fruit seed oils from four varieties of apricot (Prunus armeniaca L.), namely, Halmas, Nari, Travet and Charmagzi were analyzed for different physico-chemical characteristics. The oil yield from the apricot seeds (kernels) ranged from 32.23-42.51%, while the protein, fiber and ash contents ranged from 13.21-20.90%, 5.13-9.81% and 2.11-3.89%, respectively. The extracted oils had an average iodine value (g of I/100 g of oil) of 96.4-106.3; density at 24 °C, 0.87-0.93 mg/mL; refractive index (40 °C), 1.4655-1.4790; saponification value, 189.1-199.4 mg of KOH/g oil; unsaponifiable matter, 0.59-0.88%; free fatty acid (mg of KOH/g oil), 0.41-1.28; and color (1-inch cell), 1.31-2.96R 1 14.8-29.8Y. With regard to the oxidation state, the tested oils showed values for specific extinction at 232 and 268 nm, 2.30-3.42 and 0.82-1.04, respectively, while the peroxide value was 1.0-2.32 meq O2/kg and, p-anisidine was 1.22-1.90. The major fatty acid found in the oils was oleic acid (62.34-80.97%) followed by linoleic (13.13-30.33%), palmitic (3.35-5.93%), linolenic (0.73-1.03%) and stearic (1.10-1.68%) acids. The contents of α-, γ-, and δ-, tocopherols in the oils ranged from 14.8-40.4, 330.8-520.8 and 28.5-60.2 mg/kg, respectively. The results of our present investigation revealed that apricot seed is a potential source of oil which can be used both for edible and oleochemical applications.Se han analizado las características físico-químicas de aceites de semillas de frutos de cuatro variedades diferentes de albaricoque, Halmas, Nari, Travet y Charmagzi (Prunus armeniaca L.). La producción de aceites de las semillas de albaricoque (hueso) osciló entre 32,23-42,51%, mientras que las proteínas, fibra y cenizas dieron valores de 13,21-20,90%, 5,13-9,81% y 2,11-3,89%, respectivamente. Los aceites extraídos presentaron valores promedio de índice de yodo, de 96,4-106,3 (g de I/100 g de aceite); densidades a 24 °C de 0,87-0,93 mg/mL, índices de refracción (40 °C) de 1,4655- 1,4790; índices de saponificación de 189.1-199,4 (mg KOH/g de aceite), materia insaponificable de 0,59-0,88%, valores de acidez libre de 0.41-1.28 (mg de KOH /g de aceite), y valores de color de 1,31-2.96R 14,8-29,8Y (celda de 1 pulgada). Con respecto al estado de oxidación de los aceites estudiados, estos mostraron valores de extinción específica a 232 y 268 nm de 2,30-3,42 y 0,82-1,04, respectivamente, mientras que dieron valores de índices de peróxidos de 1,0-2,32 meq O2/kg y de p-anisidina de 1,22-1,90. El principal ácido graso que se encuentra en los aceites fue el ácido oleico (62,34 -80,97%), seguido de linoleico (13,13-30,33%), palmítico (3,35-5,93%), linolénico (0,73 - 1,03%) y esteárico (1,10 a 1,68%). El contenido de α-, γ- y δ- tocoferoles en los aceites variaron desde 14,8 hasta 40,4, 330,8 a 520,8 y 28,5 hasta 60,2 mg/kg, respectivamente. Los resultados de nuestra investigación actual revela que la semilla de albaricoque es una fuente potencial de aceite que puede ser utilizado tanto para aplicaciones comestibles como oleoquímicas

Alterations in aortic elasticity in noncompaction cardiomyopathy

Background: Noncompaction cardiomyopathy (NCCM) is a recently recognized disorder frequently associated with systolic and diastolic heart failures. This study was designed to examine aortic stiffness in NCCM patients and to compare these results to age- and gender-matched controls. Methods: A total of 20 patients with typical echocardiographic features of NCCM (age 38 ± 16 years, eight males) were investigated. Their results were compared to 20 age- and gender-matched controls. All subjects underwent a complete two-dimensional transthoracic echocardiographic examination. Systolic (SD) and diastolic (DD) ascending aortic diameters were recorded in M-mode at a level of 3 cm above the aortic valve from a parasternal long-axis view. Aortic stiffness index (β) was calculated as a characteristic of aortic elasticity, as ln(SBP/DBP)/[(SD - DD)/DD], where SBP and DBP are the systolic and diastolic blood pressures, respectively, and ln is the natural logarithm. Results: The number of noncompacted segments in the NCCM patients was 4.6 ± 2.0. NCCM patients had significantly increased left ventricular dimensions and reduced left ventricular ejection fraction. Compared to controls, aortic stiffness index (β) was significantly increased in NCCM patients (8.3 ± 5.2 vs. 3.5 ± 1.1, p < 0.001). Conclusion: Increased aortic stiffness can be observed in patients with NCCM with moderate to severe heart failure. These alterations may be due to neurohormonal changes in heart failure

Alterations in aortic elasticity in noncompaction cardiomyopathy

BACKGROUND: Noncompaction cardiomyopathy (NCCM) is a recently recognized disorder frequently associated with systolic and diastolic heart failures. This study was designed to examine aortic stiffness in NCCM patients and to compare these results to age- and gender-matched controls. METHODS: A total of 20 patients with typical echocardiographic features of NCCM (age 38 +/- 16 years, eight males) were investigated. Their results were compared to 20 age- and gender-matched controls. All subjects underwent a complete two-dimensional transthoracic echocardiographic examination. Systolic (SD) and diastolic (DD) ascending aortic diameters were recorded in M-mode at a level of 3 cm above the aortic valve from a parasternal long-axis view. Aortic stiffness index (beta) was calculated as a characteristic of aortic elasticity, as ln(SBP/DBP)/[(SD - DD)/DD], where SBP and DBP are the systolic and diastolic blood pressures, respectively, and ln is the natural logarithm. RESULTS: The number of noncompacted segments in the NCCM patients was 4.6 +/- 2.0. NCCM patients had significantly increased left ventricular dimensions and reduced left ventricular ejection fraction. Compared to controls, aortic stiffness index (beta) was significantly increased in NCCM patients (8.3 +/- 5.2 vs. 3.5 +/- 1.1, p < 0.001). CONCLUSION: Increased aortic stiffness can be observed in patients with NCCM with moderate to severe heart failure. These alterations may be due to neurohormonal changes in heart failure

Microvascular Decompression for Trigeminal Neuralgia

Background: The majority of patients with trigeminal neuralgia can be managed by medical treatment. Those patients who are not relieved with medicines can be offered some surgical treatment. Microvascular decompress-ion (MVD) of the trigeminal nerve in the root entry zone is the most suitable surgical procedure.Methods: This study included 80 patients who underwent MVD for trigeminal neuralgia from January 2002 to December 2005.Results: Out of the total 80 patients, 48 (60%) were males and 32 (40%) were females with male: female ratio of 3:2. The maximum number of patients was in the 6th decade of life (30%) followed by 7th and 5th decades (over 18%). Peroperatively, an arterial loop was found compressing the 5th nerve in the root entry zone in 60 (75%) patients, only veins in 10 (12.5%) and an artery and a vein (combined) in 6 (7.5%) patients.Conclusion: An arterial loop compressing the trigeminal nerve at root entry zone is the commonest finding at microvascular decompression (75%), followed by veins (12.5%).Keywords: Trigeminal neuralgia, Microvascular decompression, Root entry zon

Value of assessment of tricuspid annulus: real-time three-dimensional echocardiography and magnetic resonance imaging

Aim: To detect the accuracy of real-time three-dimensional echocardiography (RT3DE) and two-dimensional echocardiography (2DE) for tricuspid annulus (TA) assessment compared with magnetic resonance imaging (MRI). Methods: Thirty patients (mean age 34 ± 13 years, 60% males) in sinus rhythm were examined by MRI, RT3DE, and 2DE for TA assessment. End-diastolic and end-systolic TA diameter (TAD) and TA fractional shortening (TAFS) were measured by RT3DE, 2DE, and MRI. End-diastolic and end-systolic TA area (TAA) and TA fractional area changes (TAFAC) were measured by RT3DE and MRI. End-diastolic and end-systolic right ventricular (RV) volumes and ejection fraction (RV-EF) were measured by MRI. Results: The TA was clearly delineated in all patients and visualized as an oval-shaped by RT3DE and MRI. There was a good correlation between TADMRIand TAD3D(r = 0.75, P = 0.001), while TAD2Dwas fairly correlated with TAD3Dand TADMRI(r = 0.5, P = 0.01 for both). There were no significant differences between RT3DE and MRI in TAD, TAA, TAFS, and TAFAC measurements, while TAD2Dand TAFS2Dwere significantly underestimated (P < 0.001). TAFS2Dwas not correlated with RV-EF, while TAFS3Dand TAFAC3Dwere fairly correlated with RV-EF (r = 0.49, P = 0.01, and r = 0.47, P = 0.02 respectively). Conclusion: RT3DE helps in accurate assessment of TA comparable to MRI and may have an important implication in the TV surgical decision-making processes. RT3DE analysis of TA function could be used as a marker of RV function

Bicaval obstruction complicating right atrial tuberculoma:the diagnostic value of Cardiovascular MR

Cardiac tuberculosis is rare and usually involves the pericardium. Myocardial tuberculoma is a very rare occurrence and only a few cases were reported

New Scores for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Nonsurgical management of patients with symptomatic mitral valve stenosis has been established as the therapeutic modality of choice for two decades. Catheter-based balloon dilation of the stenotic valvular area has been shown, at least, as effective as surgical interventions. Unfavorable results of catheter-based interventions are largely due to unfavorable morphology of the valve apparatus, particularly leaflets calcification and subvalvular apparatus involvement. A mitral valve score has been proposed in Boston, MA, about two decades ago, based on morphologic assessment of mitral valve apparatus by two-dimensional (2D) echocardiography to predict successful balloon dilation of the mitral valve. Several other scores have been developed in the following years in order to more successfully predict balloon dilatation outcome. However, all those scores were based on 2D echocardiography, which is limited by ability to distinguish calcification and subvalvular involvement. The introduction of new matrix-based ultrasound probe has allowed 3D echocardiography (3DE) to provide more detailed morphologic analysis of mitral valve apparatus including calcification and subvalvular involvement. Recently, a new 3DE scoring system has been proposed by our group, which represents an important leap into refinement of the use of echocardiography guiding mitral valve interventions

Evaluation of left atrial systolic function in noncompaction cardiomyopathy by real-time three-dimensional echocardiography

Background Noncompaction cardiomyopathy (NCCM) is a rare disorder with persistance of the embryonic pattern of myoarchitecture. NCCM is characterized by loosened, spongy myocardium associated with a high incidence of systolic and diastolic left ventricular (LV) dysfunction and heart failure (HF). It is known that LV dysfunction contributes to elevated left atrial (LA) and pulmonary vascular pressures, however atrial function has not been examined in NCCM. The objective of the present study was to assess LA systolic function characterized by LA ejection force (LAEF) in NCCM patients using real-time three-dimensional echocardiography (RT3DE) and to compare to control subjects. Methods The study comprised 17 patients with an established diagnosis of NCCM and their results were compared to 17 healthy age-matched controls with no evidence of cardiovascular disease. Forty-one percent of NCCM patients were in NYHA functional class II / III HF. Previously proposed echocardiographic diagnostic criteria for NCCM were used. All patients underwent conventional two-dimensional echocardiography and RT3DE. LAEF was measured based on MA annulus diameter (LAEF3D-MAD) and area (LAEF3D-MAA) using RT3DE. Results The presence and severity of mitral regurgitation were more frequent in NCCM patients than in control subjects. LV diameters and mitral annulus were significantly increased in NCCM patients. Compared with control subjects, both LAEF3D-MAD (3.8 ± 2.2 vs 2.3 ± 1.0 kdyne, P < 0.05) and LAEF3D-MAA (12.7 ± 7.6 vs 4.9 ± 2.1 kdyne, P < 0.01) were significantly increased in NCCM patients. Conclusions LAEF as a characteristic of LA systolic function is increased in NCCM patients compared to normal individuals. These results can suggest compensating left atrial work against the dysfunctional LV in NCCM patients