Phase ambiguity of the threshold amplitude in pp -> pp\pi^0

Measurements of spin observables in pp -> {\vec p}{\vec p}\pi^0 are suggested to remove the phase ambiguity of the threshold amplitude. The suggested measurements complement the IUCF data on {\vec p}{\vec p} -> pp\pi^0 to completely determine all the twelve partial wave amplitudes, taken into consideration by Mayer et.al. [15] and Deepak, Haidenbauer and Hanhart [20].Comment: 4 pages, 1 table

Comparison of Radionuclide Scan and Conventional Contrast Study in Detection of Esophageal Anastomotic Leaks: A Prospective Study

INTRODUCTION: Esophageal resection and reconstruction remain a major therapeutic challenge for surgeons involved in the care of patients with benign and malignant disease of esophagus. Despite major advances in postoperative care, operative mortality rates worldwide remain high. Much of the operative mortality is related to complications of anastomotic leak. In a majority of esophageal surgeries, the anastomosis involves another segment of the esophagus, stomach, jejunum or colon. Anastomoses in operations of the stomach like total gastrectomy or proximal gastrectomy also involve the esophagus. One of the commonest complications encountered in patients after the above operations are an anastomotic leak. These leaks can lead to severe morbidity, increased hospital stay and cost and increased mortality. The crucial factors in the management of anastomotic leak are to recognize it earlier even at a sub clinical stage and act accordingly. Conservative management like delaying oral feeds and drainage techniques can be employed. However, rapidly progressing clinical scenario mandates aggressive approach. Contrast esophagography is the investigation of choice for detecting sub clinical anastomotic leaks when done from 7th to 10th postoperative days. Barium or water soluble contrasts are being used for the same. Our institution routinely performs thin barium contrast studies between the 7th to 10th postoperative day. Due to its hygroscopic property, water soluble contrast agents causes dilution of the contrast, thereby decreasing its sensitivity and specificity. Barium is more sensitive than water soluble contrast agents but is known to cause complications such as barium peritonitis and can interfere with repeat scans. Moreover, various studies show that the numbers of false negatives are high. Technetium scans are being used for diagnosis and evaluation of esophageal motility disorders and gastroesophageal reflux disease. There is no data of its use in detection of sub clinical anastomotic leaks in current literature. This study is to evaluate the diagnostic efficacy of technetium scans in detecting sub clinical leaks in comparison to barium contrast studies. It also aims at evaluating the reliability, limitations, disadvantages and complications of a Technetium sulphocolloid scan. AIMS OF THE STUDY: To evaluate the diagnostic efficacy and feasibility of Technetium sulphocolloid scans in comparison to esophageal contrast studies in diagnosis of sub clinical anastomotic leaks following esophageal anastomosis. OBJECTIVES: 1. To prospectively evaluate the feasibility of technetium sulphocolloid studies in the diagnosis of sub clinical anastomotic leaks. 2. To quantify the agreement that technetium sulphocolloid scans have with contrast studies in diagnosis of sub clinical anastomotic leaks. 3. To evaluate advantages and disadvantages of technetium sulphocolloid studies in terms of reliability, patient acceptance and cost in comparison to contrast studies. 4. To characterize Tc-99m sulphocolloid scan findings that would describe a sub clinical anastomotic leak. 5. To correlate patient dependant surgical factors with development of anastomotic leaks. This study aimed at exploring the diagnostic feasibility and efficacy of nuclear images in the detection of postoperative sub clinical anastomotic leak. METHODOLOGY: Patients; Cases for the study were selected according to a set of inclusion and exclusion criteria. They were as follows: Inclusion criteria: All patients undergoing the following operations, irrespective of age or sex, were included for the study. 1. Esophagectomy with reconstruction – Transhiatal, transthoracic (Ivor- Lewis, McKeown’s), en bloc esophagectomy. 2. Substernal colon bypass with or without esophageal resection, 3. Total gastrectomy, 4. Proximal gastrectomy. Exclusion criteria: 1. All patients who are clinically unstable and may not be able to tolerate both the studies as according to the surgeon’s judgment. 2. Patients with clinically obvious leaks. 3. Patients in whom both the studies could not done to completion. All patients who underwent the operations listed in the inclusion criteria were selected for the study after obtaining informed consent. Selected preoperative, intraoperative and postoperative data as mentioned in the proforma were collected for each patient. Patients who satisfied the exclusion criteria during the course of the study were taken off the study. PATIENT PROFILE: 51 cases were enrolled into the study of which 13 cases were excluded from the study due to the various exclusion criteria. The reasons for exclusion form the study were as follows. 1. Patients who were clinically unstable during the time of the tests – 4 patients. 2. Patients who developed clinically detectable leaks prior to the imaging – 5 patients. 3. Patients who could not complete either one of the study due to patient related factors -1 patient (Barium induced vomiting). 4. Patients who could not complete either one of the study due to technical reasons- 2 patients. CONCLUSION: 1. Technetium sulphocolloid esophageal scintigraphy have a good agreement with barium contrast studies in detecting sub clinical anastomotic leaks. 2. The sensitivity of technetium scans could not be assessed due to lack of a proper gold standard. 3. Technetium scintigraphy was found to have detected more sub clinical anastomotic leaks than barium. 4. Technetium sulphocolloid scans are more economical than barium contrast studies. 5. Technetium sulphocolloid imaging does not cause any of the complications of barium such as barium peritonitis or barium inspissation. 6. The amount of radiation exposure to the patient as well as his/her attendants is negligible. 7. Technetium is excreted from the body rapidly and so repeat scans are not confounded by the old technetium

Correlation of Carotid Intima-Medial Thickness (CIMT) and disease activity in Takayasu Arteritis : c-CAT study.

BACKGROUND : Clinical analysis of Takayasu Arteritis (TA) disease activity, response to treatment and detection of relapse remains suboptimal. The currently used NIH criteria demand an invasive procedure and have other limitations. B-mode carotid ultrasound is a safe, reliable and non-invasive method of measuring CIMT which may have a role as a marker of disease activity. OBJECTIVE : To assess correlation of Carotid Intima-Medial Thickness (CIMT) with disease activity in patients with Takayasu’s arteritis (TA). METHODS : An observational study on 41 consecutive patients with TA seen in the Cardiology department from August 2008 to January 2010. Disease activity was assessed in these patients using (i) acute phase reactants- ESR, CRP (ii) NIH (National Institute of Health) criteria, & (iii) ITAS score (Indian Takayasu arteritis Activity Score. Angiographic extent of the disease was also assessed at enrollment. CIMT images were acquired with a high-end ultrasound system, at end diastole. CIMT were then measured in the proximal, mid & distal common carotid artery on both the left & right side. CIMT was also measured in 30 healthy controls, of a similar age group as the study population. RESULTS : A total of 41 patients were studied. The male, female ratio was approximately 1:4. CIMT was increased in patients with Takayasu arteritis as compared to the controls. The mean CIMT among the study population was 0.85 ± 0.30, which was significantly higher than that of the controls which was 0.50 ± 0.06 (p = 0.00). Patients with active disease (CIMT = 1.05 ± 0.33) had higher values than those with inactive disease (CIMT = 0.73 ± 0.20). CIMT ≥ 0.80mm was found to have a statistically significant association with ESR ≥ 40mm in 1 hour, NIH score ≥ 2, and ITAS score ≥ 3. CIMT ≥ 0.80mm has a sensitivity of 86% & a specificity of 61% in the detection of active TA. CONCLUSION : Abnormal CIMT (CIMT ≥ 0.80mm) is an easily available & economical tool that can be used to reliably assess disease activity in patients with TA

Pre-operative assessment to predict post-operative complications in patients undergoing lung resection surgeries in a tertiary hospital in India

BACKGROUND: Post-operative complications that are commonly encountered following lung resection surgeries are atelectasis, pneumonia and bronchopleural fistula and increased ICU stay. Previous studies have shown that FEV-1, ppo (predicted post-operative) FEV-1 and DLCO have value in predicting cardiopulmonary complications. We evaluated the potential of pre-operative Spirometry parameters, primarily FEV-1 and other pulmonary function tests, six minute walk test and cardiopulmonary exercise testing and also quality of life questionnaire (SGRQ – St George Respiratory Questionnaire) to predict these post operative complications. AIM OF THE STUDY: 1. To show that pre-operative tests, mainly FEV-1 can predict post-operative complications like atelectasis, pneumonia, bronchopleural fistula, increased duration of post-operative hospital stay, duration of admission in HDU and mortality rates. 2. To show that other pulmonary function tests like FVC, 6min walk test and also Cardiopulmonary testing like V02 max and VE/VCO2 can predict these outcomes. 3. To obtain a clinical profile of patients undergoing lung resection surgery. 4. To evaluate actual post-operative lung function and exercise capacity and its correlation with the predicted post operative lung function. METHODS: It is a prospective observational study done in a single tertiary centre with co-ordination between the departments of Thoracic Surgery and Pulmonary Medicine. Patients who were planned for lung resection surgery were included. Sample size was 99 and data collection began from March 29th 2016. Patients were monitored for perioperative and post-operative complications and after discharge monitoring was done via phone calls or email. RESULTS: A total of 49 post operative patients have reviewed till date with repeat pulmonary function testing and quality of life questionnaire assessments done. The most common indication for lung resection surgery was malignancy (37%) with Carcinoid tumors being the most common type. Lobectomy was the most common type of lung resection surgery performed. The spirometrical parameters which showed statistical significance in predicting post operative fever were - FVC(Forced vital capacity), TLC(Total lung capacity), RV(residual volume), PEFR(Peak expiratory flow rate) and DLCO% (diffusion capacity of the lung for carbon monoxide %). For atelectasis, RV, RV% and TLC had statistically significance. PPO FEV-1 had a strong Spearman’s correlation co-efficient with both FEV-1 pre op and FEV-1 post op with values of 0.910 and 0.838 respectively. CONCLUSION: In our series of 100 patients of lung resection surgery the morbidity and mortality is low and comparable to published international literature. Only in 37% of patients, surgery was done for resection of neoplasm. Remaining surgeries were done for infections and post infective sequelae. Although FEV-1 could not predict post lung resection surgery complications, they are valuable to select appropriate patients and to achieve good outcomes and low mortality. Quality of life as measured by SGRQ, exercise capacity as measured by six minute walk test and DLCO/VA ratio had improved, which could imply that resecting the diseased lung improved overall functional capacity of the patient. FEV1/FVC ratio can affect duration of ICU stay. Predicted post-operative FEV-1 (ppo FEV-1) correlated very strongly with the actual post-operative FEV-1. It is accurate to predict FEV1 within - 76 ml to + 76 ml of actual post-operative FEV-1 but using the anatomical formula for the prediction of post-operative VO2 max and DLCO were not so accurate

Changes in Home Versus Clinic Blood Pressure With Antihypertensive Treatments: A Meta-Analysis

Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare with the changes in clinic blood pressure (CBP). We searched PubMed using the terms “home or self-measured blood pressure,” and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects. As there was significant heterogeneity in most of the outcomes, a random effects model was used for the meta-analyses. The mean changes (±SE) in CBP and HBP (systolic/diastolic) were −15.2±0.03/−10.3±0.03 mm Hg and −12.2±0.04/−8.0±0.04 mm Hg respectively, although there were wide varieties of differences in the reduction between HBP and CBP. The reductions in CBP were correlated with those of HBP (systolic BP; r=0.66, B=0.48, diastolic BP; r=0.71, B=0.52, P<0.001). In 7 studies that also included 24-hour BP monitoring, the reduction of HBP was greater than that of 24-hour BP in systolic (HBP; −12.6±0.06 mm Hg, 24-hour BP; −11.9±0.04 mm Hg, P<0.001). In 5 studies that included daytime and nighttime systolic BP separately, HBP decreased 15% more than daytime ambulatory BP and 30% more than nighttime ambulatory BP. In conclusion, HBP falls ≈20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP

Preventing misdiagnosis of ambulatory hypertension: algorithm using office and home blood pressures

Objectives—An algorithm for making a differential diagnosis between sustained and white coat hypertension (SH and WCH) has been proposed–patients with office hypertension undergo home blood pressure monitoring (HBPM) and those with normal HBP levels undergo ambulatory blood pressure monitoring (ABPM). We tested whether incorporating an upper office blood pressure (OBP) cutoff in the algorithm, higher than the traditional 140/90 mmHg, reduces the need for HBPM and ABPM. Methods—229 normotensive and untreated mildly hypertensive participants (mean age 52.5 ± 14.6, 54% female) underwent OBP measurements, HBPM, and 24-hour ABPM. Using the algorithm, sensitivity (SN), specificity (SP), and positive and negative predictive values (PPV, NPV) for SH and WCH were assessed. We then modified the algorithm utilizing a systolic and diastolic OBP cutoff at a SP of 95% for ambulatory hypertension –those with office hypertension but OBP levels below the upper cutoff undergo HBPM and subsequent ABPM if appropriate. Results—Using the original algorithm, SN and PPV for SH were 100% and 93.8%. Despite a SP of 44.4%, NPV was 100%. These values correspond to SP, NPV, SN, and PPV for WCH respectively. Using the modified algorithm, the diagnostic accuracy for SH and WCH did not change. However, far fewer participants needed HBPM (29 vs. 84) and ABPM (8 vs. 15). Conclusions—In this sample, the original and modified algorithms are excellent at diagnosing SH and WCH. However, the latter requires far fewer subjects to undergo HBPM and ABPM. These findings have important implications for the cost-effective diagnosis of SH and WCH

What is the optimal interval between successive home blood pressure readings using an automated oscillometric device?

Objectives: To clarify whether a shorter interval between three successive home blood pressure (HBP) readings (10 s vs. 1 min) taken twice a day gives a better prediction of the average 24-h BP and better patient compliance. Design: We enrolled 56 patients from a hypertension clinic (mean age: 60 ± 14 years; 54% female patients). The study consisted of three clinic visits, with two 4-week periods of self-monitoring of HBP between them, and a 24-h ambulatory BP monitoring at the second visit. Using a crossover design, with order randomized, the oscillometric HBP device (HEM-5001) could be programmed to take three consecutive readings at either 10-s or 1-min intervals, each of which was done for 4 weeks. Patients were asked to measure three HBP readings in the morning and evening. All the readings were stored in the memory of the monitors. Results: The analyses were performed using the second–third HBP readings. The average systolic BP/diastolic BP for the 10-s and 1-min intervals at home were 136.1 ± 15.8/77.5 ± 9.5 and 133.2 ± 15.5/76.9 ± 9.3 mmHg (P = 0.001/0.19 for the differences in systolic BP and diastolic BP), respectively. The 1-min BP readings were significantly closer to the average of awake ambulatory BP (131 ± 14/79 ± 10 mmHg) than the 10-s interval readings. There was no significant difference in patients' compliance in taking adequate numbers of readings at the different time intervals. Conclusion: The 1-min interval between HBP readings gave a closer agreement with the daytime average BP than the 10-s interval