Transgastric: A forgotten view for atrial septal defect device closure procedures?

Percutaneous closure of an atrial septal defect in the cardiac catheterization laboratory requires noninvasive imaging to assist in characterization of the atrial septal defect and deployment of the device. Transesophageal echocardiography is the modality most often used in these circumstances. Transesophageal echocardiographic guidelines exist for the assessment and guidance for atrial septal defect closures, but these guidelines do not mention transgastric views. In this case, we demonstrate that transgastric views are helpful in describing the atrial septal defect, especially as it concerns the inferior vena cava rim.

Comparing echocardiographic assessment of systolic function with catheterization data in patients with single right ventricles.

PURPOSE: Echocardiographic evaluation of systolic function in patients with single right ventricles (SRV) is important but remains challenging. Minimal data exist correlating echocardiographic indices with catheterization data in this population. The goal of this study was to evaluate which echocardiographic measurement correlated best with dP/dt (max) obtained by cardiac catheterization in SRV patients. METHODS: Patients with SRV physiology who underwent simultaneous echocardiography and cardiac catheterization were evaluated. Echocardiographic data included fractional area change % (FAC), displacement, TDI s'wave, myocardial performance index (MPI), global systolic strain, and global SR s wave. Maximum positive rate of ventricular pressure change measured as dP/dt (max) was obtained from the cardiac catheterization report. Correlations of echocardiographic and catheterization variables were examined using the Pearson correlation. RESULTS: Twenty-seven SRV patients were studied. Median age at the time of the catheterization was 11.4 months (range 0 - 132 months). dP/dt (max) values ranged from 337-1860 mmHg/s with a median of 994 mmHg/s. Mean FAC was 27.15 +/- 7.13%, displacement was 7.35 +/- 2.88 mm, TDI s' was 4.98 +/- 1.93 cm/sec, MPI was 0.41 +/- 0.17, global strain was-14.85 +/- 4.32%, and global SR s wave was -1.03 +/- 0.34 sec(-1). There were no significant correlations between dP/dt (max) and any of the echocardiographic measurements of systolic function in SRV patients. CONCLUSION: In patients with SRV physiology, catheterization-derived dP/dt (max) did not correlate with echocardiographic measurements of systolic function. Larger studies are needed to determine which non-invasive parameter best describes systolic function in patients with SRV.

Oxidation of tertiary amine-derivatized surfaces to control protein adhesion.

Selective oxidation of ω-tertiary amine self-assembled thiol monolayers to tertiary amine N-oxides is shown to transform the adhesion of model proteins lysozyme and fibrinogen upon them. Efficient preparation of both secondary and tertiary linker amides as judged by X-ray photoelectron spectroscopy (XPS) and water droplet contact angle was achieved with an improved amide bond formation on gold quartz crystal microbalance (QCM) sensors using 2-(1H-7-azabenzotriazol-1-yl)-1,1,3,3-tetramethyl hexafluorophosphate methanaminium uronium (HATU). Oxidation with hydrogen peroxide was similarly assessed, and adhesion of lysozyme and fibrinogen from phosphate buffered saline was then assayed by QCM and imaged by AFM. Tertiary amine-functionalized sensors adsorbed multilayers of aggregated lysozyme, whereas tertiary amine N-oxides and triethylene glycol-terminated monolayers are consistent with small protein aggregates. The surface containing a dimethylamine N-oxide headgroup and ethyl secondary amide linker showed the largest difference in adsorption of both proteins. Oxidation of tertiary amine decorated surfaces therefore holds the potential for selective deposition of proteins and cells through masking and other patterning techniques.

Dose-dependent behavioural fever responses in desert locusts challenged with the entomopathogenic fungus Metarhizium acridum.

Behavioural fever is a common response to immune challenge in ectotherms and confers survival benefits. However, costs accrue rapidly as body temperature rises. Thus, the magnitude of adaptive fever responses might reflect the balance of costs and benefits. We investigated behavioural fever in desert locusts, Schistocerca gregaria, infected with the entomopathogenic fungus Metarhizium acridum. We first tracked the time course of behavioural fever in infected locusts, demonstrating that body temperatures rose on the day following inoculation (day 1), and reached peak intensity on the day after that (day 2). Subsequently, the magnitude of fever responses varied during a day, and locusts tended to exhibit high-intensity fever responses in the mornings when basking was first possible. We speculate that this may have resulted from increased fungal load caused by unimpeded growth overnight when locusts could not fever. We next inoculated locusts with different M. acridum doses ranging from 0 to ca. 75,000 conidia. The magnitude of their behavioural fever responses on day 2 post-inoculation was positively related to fungal dose. Thus, we demonstrate dose-dependency in the behavioural fever responses of desert locusts and suggest that this may reflect the adaptive deployment of behavioural fever to minimize costs relative to benefits.

Increased Male-Male Mounting Behaviour in Desert Locusts during Infection with an Entomopathogenic Fungus.

Same-sex sexual behaviour occurs across diverse animal taxa, but adaptive explanations can be difficult to determine. Here we investigate male-male mounting (MMM) behaviour in female-deprived desert locust males infected with the entomopathogenic fungus Metarhizium acridum. Over a four-week period, infected locusts performed more MMM behaviours than healthy controls. Among infected locusts, the probability of MMM, and the duration of time spent MMM, significantly increased with the mounting locust's proximity to death. In experimental trials, infected locusts were also significantly more likely than controls to attempt to mount healthy males. Therefore, we demonstrate that MMM is more frequent among infected than healthy male locusts, and propose that this may be explained by terminal reproductive effort and a lowered mate acceptance threshold in infected males. However, during experimental trials mounting attempts were more likely to be successful if the mounted locusts were experimentally manipulated to have a reduced capacity to escape. Thus, reduced escape capability resulting from infection may also contribute to the higher frequency of MMM among infected male locusts. Our data demonstrate that pathogen infection can affect same-sex sexual behaviour, and suggest that the impact of such behaviours on host and pathogen fitness will be a novel focus for future research.

Is cytologic screening an effective surveillance method for detection of vaginal recurrence of uterine cancer?

OBJECTIVE: Cytologic screening is commonly used in follow-up of women with uterine cancer to detect vaginal recurrence. The study objective was to assess the efficacy and costs associated with Pap tests in routine surveillance of women with uterine cancer. METHODS: Medical records and pathology databases identified patients with uterine cancer at one institution from 1990 to 2002. Patients with their cytologic follow-up at our institution were selected for a subset analysis of Pap tests to estimate the number of Paps and associated charges and costs during follow-up. RESULTS: Seven hundred seventeen women were diagnosed with uterine cancer; the mean age was 60.9 years and the median follow-up was 46 months. A total of 36 women had a recurrence in the vagina; 31 (86%) were apparent clinically, and only 5 (14%) were asymptomatic and identified by Pap test. Women with grade 1 tumors had decreased risk of vaginal recurrence, with an odds ratio of 0.186 (95% confidence interval 0.49-0.712) on multivariate analysis (stage and histology were not significant factors for vaginal recurrence). A subset of 435 patients received cytologic follow-up at our institution, with a median 3 Pap tests/patient (mean 4.25, range 1-24). Estimates based on our data demonstrate that 430 Pap tests are required to detect one asymptomatic vaginal recurrence, and the addition of the Pap test increases the cost of surveillance by $15,142 per asymptomatic recurrence detected (but a charge to insurance of $23,487). Pap tests identified an asymptomatic vaginal recurrence in only 0.7% of this uterine cancer population. CONCLUSION: Pap tests after diagnosis and treatment of uterine cancer infrequently detect asymptomatic vaginal recurrences and may not be cost-effective. LEVEL OF EVIDENCE: III.

Temporalis fascia transplant for vocal fold scar and sulcus vocalis.

OBJECTIVES/HYPOTHESIS: To evaluate vocal outcomes in 10 patients 1 year after autologous transplantation of temporalis fascia into Reinke's space (ATFV) for vocal fold scar and sulcus vocalis. STUDY DESIGN: Retrospective, clinical case series. METHODS: Subjective and objective evaluation was performed 12 months after surgery using laryngovideostroboscopy (LVS) in all patients, the Voice Handicap Index-10 (VHI-10) in seven patients, GRBAS (grade, roughness, breathiness, asthenia, strain) scale in nine patients, and noise-to-harmonics ratio (NHR), phonatory range (PR) and maximum phonation time (MPT) in six patients. RESULTS: LVS improved in all but one patient. A significant decrease was noted in the GRBAS subscales grade, roughness, asthenia, and strain (P<.05). Breathiness was almost significant, with a P value of .052. There was an average decrease in the VHI-10 of 8.14 (P=.032). NHR, MPT, and PR did not statistically improve. CONCLUSIONS: ATFV for vocal fold scar and sulcus vocalis results in significant subjective vocal improvement that persists at least 1 year after surgery. LEVEL OF EVIDENCE: 4.

Tissue Doppler changes in three neonates with congenital diaphragmatic hernia.

Three neonatal patients with left-sided congenital diaphragmatic hernia (CDH) were evaluated with echocardiography pre- and postsurgical correction using tissue Doppler imaging (TDI). Tissue Doppler imaging parameters demonstrated improvement after surgery in both left- and right-sided myocardial performance index (MPI); furthermore, both left and right MPI correlated with clinical course in these three patients. These studies suggest that TDI measurements may be prognostic in nature in this patient population, although further studies are needed using this modality in patients with CDH to determine if it may be useful in guiding treatment and to further delineate the reasons why left ventricular function improves.

In vitro and in vivo histone deacetylase inhibitor therapy with suberoylanilide hydroxamic acid (SAHA) and paclitaxel in ovarian cancer.

OBJECTIVE: To determine effects of suberoylanilide hydroxamic acid (SAHA) with and without paclitaxel in ovarian cancer cells and a nude mouse model. METHODS: Cell viability and apoptosis of ovarian cancer cells (2774) were measured following exposure to control, SAHA, paclitaxel, or SAHA in combination with paclitaxel. Nude mice were injected intraperitoneally (IP) with cancer cells and then groups received variable SAHA doses (25-100 mg/kg/day). In a second experiment, mice were inoculated with cancer and treated IP with vehicle injection, SAHA, paclitaxel, paclitaxel followed by SAHA, or SAHA followed by paclitaxel. Survival, tumor weight, and ascites were evaluated. RESULTS: SAHA decreased viability and increased apoptosis similarly to paclitaxel, but the combination was not statistically significantly different from the single agents. The only significant difference in the SAHA alone mouse study was decreased survival in the 50 mg/kg/daily group. In the combination groups, SAHA followed by paclitaxel, paclitaxel alone, and paclitaxel followed by SAHA improved survival compared with control (p=0.0358, 0.0006, and 0.0001), but SAHA alone did not (p=0.524). The paclitaxel followed by SAHA group had improved survival compared to SAHA followed by paclitaxel (p=0.0002) but not compared to paclitaxel alone (p=0.166). CONCLUSIONS: In vitro, SAHA alone decreased viability and increased apoptosis similarly to paclitaxel. In vivo, paclitaxel followed by SAHA and paclitaxel alone increased survival compared with SAHA alone or SAHA followed by paclitaxel. This suggests adding SAHA to ovarian cancer chemotherapy could increase efficacy and that sequencing of agents is important.

The treatment of lateral T1 and T2 squamous cell carcinomas of the vulva confined to the labium majus or minus.

OBJECTIVE: To determine the pattern of lymph node metastases, recurrence rate, and survival of patients with lateral T1 and T2 squamous cell cancer (SCC) of the vulva treated by radical vulvectomy or hemivulvectomy and inguinal lymphadenectomy. METHODS: An institutional review was performed to identify lateral T1 and T2 SCC of the vulva confined to the labium majus and minus. RESULTS: Sixty-one patients with lateral T1 and 61 patients with lateral T2 SCC of the vulva were treated from 1963 to 2003. Radical vulvectomy (RV) was performed in 60 patients, and radical hemivulvectomy (RHV) in 62 patients. Seven of 61 patients (11%) with T1 lesions had ipsilateral superficial inguinal lymph node (SIL) metastases, but none had deep inguinal lymph (DIL) node metastases. Nineteen of 61 patients (31%) with T2 lesions had ipsilateral SIL metastases, and 8 had ipsilateral DIL metastases. No patient had contralateral SIL or DIL metastases. Six patients (10%) with T1 lesions and seven patients (11%) with T2 lesions developed recurrence to the ipsilateral vulva and were treated by re-excision. All patients are alive with no evidence of disease 10-195 months after treatment. One patient with T1 and three patients with T2 SCC developed distant recurrence and died of disease (DOD) 10-15 months after surgery. Disease-free survival of patients with T1 lesions was 98% at 2 years and 98% at 5 years, and with T2 lesions was 95% at 2 years and 93% at 5 years. Local or distant recurrence was not more common in patients treated by RHV than in those treated by RV. CONCLUSION: Lateral T1 and T2 squamous cell cancers of the vulva spread to the ipsilateral inguinal lymph nodes and can be treated effectively with RHV and ipsilateral SIL dissection. Deep inguinal lymphadenectomy is indicated only when the SIL are positive.

Ovarian cancer screening with annual transvaginal sonography: findings of 25,000 women screened.

BACKGROUND: Ovarian cancer has the highest mortality rate of all gynecologic malignancies, and most women present with advanced-stage disease. The current investigation was performed to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer. METHODS: Annual TVS screening was performed on 25,327 women from 1987 to 2005. Asymptomatic women aged>or=50 years and women aged>or=25 years who had a family history of ovarian cancer were eligible for participation in this trial. RESULTS: Among 364 patients (1.4%) with a persisting ovarian tumor on TVS who underwent exploratory laparoscopy or laparotomy with tumor removal, 35 primary invasive ovarian cancers, 9 serous ovarian tumors of low malignant potential, and 7 cancers metastatic to the ovary were detected. Stage distribution was as follows: 28 patients had stage I disease, 8 patients had stage II disease, and 8 patients had stage III disease. Four patients died of disease, 2 patients died of other causes, and 38 patients were alive and well from 0.5 years to 15.8 years after diagnosis (mean, 5.3 years). Nine women developed ovarian cancer within 12 months of a negative screen (false-negative results), and 3 of these patients died of disease. TVS screening had a sensitivity of 85.0%, specificity of 98.7%, positive predictive value of 14.01%, and negative predictive value of 99.9%. After 107,276 screening years, there have been 7 ovarian cancer deaths in the annually screened population and 3 ovarian cancer deaths among women who were noncompliant. Excluding patients with nonepithelial or borderline ovarian malignancies, the survival of patients with ovarian cancer in the annually screened population was 89.9%+/-10.1% at 2 years and 77.2%+/-22.8% at 5 years. CONCLUSIONS: TVS screening, when it was performed annually, was associated with a decrease in disease stage at detection and with case-specific ovarian cancer mortality, but it was not effective in detecting ovarian cancers in women who had normal ovarian volume.

Qualitative human chorionicgonadotropin testing of cervicovaginal washings for the detection of preterm premature rupture of membranes.

OBJECTIVE: This study was performed to determine whether a qualitative human chorionicgonadotropin (hCG) test using cervicovaginal washings obtained from pregnant women is a useful predictor of recent preterm premature rupture of the membranes (PPROM). STUDY DESIGN: A prospective observational analysis of qualitative hCG testing on cervicovaginal washings in patients with either known PPROM or with intact membranes was performed. Patients with singleton gestations between 24 and 34 completed weeks were included. PPROM patients had documented confirmatory tests, including visualized pooling of amniotic fluid in the vaginal vault that was nitrazine-positive and demonstrated ferning. Those with vaginal bleeding or an anomalous fetus were excluded. Before collection, all patients were screened for bacterial vaginosis and trichomoniasis. Washings were then collected from the posterior vaginal fornix with the use of a 5-mL sterile saline irrigation and aspiration technique. Samples were then agitated manually and applied to the Quickvue Onestep qualitative pregnancy test (Quidell, San Diego, Calif) with a threshold of 25 mIU/mL. Data were analyzed with the t test, chi 2, and Fischer exact tests. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were calculated. When applicable, all 2-tailed P <.05 were considered significant. RESULTS: Fifty-two patients were enrolled in the study with 24 in the PPROM group and 28 in the control group. The 2 groups were similar with respect to demographic characteristics and wet preparation results. The mean gestation age was 31.4 +/- 2.4 (X +/- SD) and 30.8 +/- 2.7 weeks in the PPROM and control groups, respectively. The hCG test was positive in 19 (79%) of the PPROM patients and in 1 (3.6%) of the controls (sensitivity 79%, specificity 96%, PPV 95%, NPV 84%). CONCLUSION: Qualitative hCG testing of cervicovaginal washings appears to be an useful predictor of PPROM.