Redefining the fluoroscopic landmarks for common femoral arterial puncture during cardiac catheterization: Femoral angiogram and computed tomography angiogram (FACT) study of common femoral artery anatomy.

BACKGROUND: The mid-femoral head (F50 ) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. METHODS: We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid-point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). RESULTS: The proximal third of femoral head (F33 ) (-1.4 mm) and IEA nadir (-2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (-12.8 mm) or cranial end of FH (-15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid-point of the CFA than F50 (0.3 mm vs. -9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non-CFA punctures (18.6%), while using F50 had a 41.2% risk for non-CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). CONCLUSIONS: The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.

Parental childhood growth and offspring birthweight: pooled analyses from four birth cohorts in low and middle income countries.

OBJECTIVE: Associations between parental and offspring size at birth are well established, but the relative importance of parental growth at different ages as predictors of offspring birthweight is less certain. Here we model parental birthweight and postnatal conditional growth in specific age periods as predictors of offspring birthweight. METHODS: We analyzed data from 3,392 adults participating in four prospective birth cohorts and 5,506 of their offspring. RESULTS: There was no significant heterogeneity by study site or offspring sex. 1SD increase in maternal birthweight was associated with offspring birthweight increases of 102 g, 1SD in maternal length growth 0-2 year with 46 g, and 1SD in maternal height growth Mid-childhood (MC)-adulthood with 27 g. Maternal relative weight measures were associated with 24 g offspring birth weight increases (2 year- MC) and 49 g for MC-adulthood period but not with earlier relative weight 0-2 year. For fathers, birthweight, and linear/length growth from 0-2 year were associated with increases of 57 and 56 g in offspring birthweight, respectively but not thereafter. CONCLUSIONS: Maternal and paternal birthweight and growth from birth to 2 year each predict offspring birthweight. Maternal growth from MC-adulthood, relative weight from 2-MC and MC-adulthood also predict offspring birthweight. These findings suggest that shared genes and/or adequate nutrition during early life for both parents may confer benefits to the next generation, and highlight the importance of maternal height and weight prior to conception. The stronger matrilineal than patrilineal relationships with offspring birth weight are consistent with the hypothesis that improving the early growth conditions of young females can improve birth outcomes in the next generation.

Development and comparison of shelf stable extended and dehydrated goat meat cubes containing four different legume based binder mixes.

A study was undertaken to develop shelf stable hot air oven dried goat meat cubes extended with different legume based binder mixes. Based on preliminary trials, four different formulations containing 80 % meat mince + 10 % Bengal gram based binder mix (HBE), 70 % meat mince + 20 % green gram based binder mix (HGR), 80 % meat mince + 10 % black gram based binder mix (HBL) and 80 % meat mince + 10 % lentil based binder mix (HLE) were selected and subjected to physico-chemical, microbiological and sensory characteristics. Among treatments, HGR showed a significantly higher pH (6.53 ± 0.01), whereas there was no significant difference in other physico-chemical parameters. Moisture content (10.37 ± 1.06 %) was highest in HLE, while protein (49.68 ± 1.78 %) and ash (8.71 ± 0.30 %) contents were higher in HBL. On texture profile analysis, hardness, gumminess and chewiness parameters were highest for HLE and lowest for HBL. In all treatments, total plate, Staphylococcus aureus and yeast and mold counts were in acceptable range and coliforms were not detected. Scores for sensory attributes of rehydrated cubes were in good to very good range in all treatments, however, higher scores for appearance, flavour, texture, juiciness and overall acceptability were observed in HBL. The dehydrated cubes could be used to prepare curry within few minutes and is a boon to busy housewives.

Feasibility of MRI in patients with non-Pacemaker/Defibrillator metallic devices and abandoned leads.

OBJECTIVE: To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. BACKGROUND: Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. METHODS: We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. RESULTS: The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up. CONCLUSIONS: With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.

Surgical resection for locally invasive renal cell carcinoma: Is it worthwhile?

BACKGROUND: Many patients with renal cell carcinoma (RCC) present with disease involving the adjacent viscera. Although survival in such patients is poor, surgery remains the only proven modality of treatment. We describe our experience with radical nephrectomy for locally invasive RCC over a five-year period. STUDY DESIGN: A retrospective analysis of the records of all patients who had undergone surgery for locally invasive RCC between January 1999 and December 2004 at our institute. MATERIALS AND METHODS: During the study period, 102 patients with RCC underwent surgery at our institute, out of which 18 (17.6%) patients had adjacent organ involvement. The survival and outcomes in terms of symptom relief are described. STATISTICAL ANALYSIS: The survival rates were calculated by the Kaplan-Meier method using EGRET statistical software package. RESULTS: Of the 18 patients, two patients had inoperable disease. Fifteen out of the 18 patients succumbed to their disease after a median period of 7.5 months. Three patients are still alive, having survived for 13, 16 and 25 months. Most patients derived considerable benefit with respect to relief of symptoms, which was long-lasting. CONCLUSION: For selected patients with locally invasive RCC, radical nephrectomy with en bloc resection of involved organs may provide the opportunity for long-term survival. In others, it may provide considerable symptomatic relief.

The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India.

BACKGROUND/OBJECTIVES: To determine the extent and sociodemographic determinants of anemia, overweight, metabolic syndrome (MetS) and the co-occurrence of anemia with cardiometabolic disease risk factors among a cohort of Indian adults. SUBJECT/METHODS: Cross-sectional survey of adult men (n=3322) and nonpregnant women (n=2895) aged 18 years and older from the third wave of the Andhra Pradesh Children and Parents Study that assessed anemia, overweight based on body mass index, and prevalence of MetS based on abdominal obesity, hypertension and blood lipid and fasting glucose measures. We examined associations of education, wealth and urbanicity with these outcomes and their co-occurrence. RESULTS: The prevalence of anemia and overweight was 40% and 29% among women, respectively, and 10% and 25% among men (P<0.001), respectively, whereas the prevalence of MetS was the same across sexes (15%; P=0.55). The prevalence of concurrent anemia and overweight (9%), and anemia and MetS (4.5%) was highest among women. Household wealth was positively associated with overweight and MetS across sexes (P<0.05). Independent of household wealth, higher education was positively correlated with MetS among men (odds ratio (95% confidence interval): MetS: 1.4 (0.99, 2.0)) and negatively correlated with MetS among women (MetS: 0.54 (0.29, 0.99)). Similar sex-specific associations were observed for the co-occurrence of anemia with overweight and MetS. CONCLUSIONS: Women in this region of India may be particularly vulnerable to co-occurring anemia and cardiometabolic risk, and associated adverse health outcomes as the nutrition transition advances in India.

Mixed exocrine-endocrine pancreatic carcinoma in childhood.

A 7-year-old boy with mixed exocrine-endocrine pancreatic cancer is presented. This may be the second reported case of such a tumor in childhood.

A phase II study of gemcitabine and cisplatin in patients with advanced hepatocellular carcinoma.

The primary objective of this study was to determine the response rates of a combination of gemcitabine and cisplatin in unresectable hepatocellular carcinoma (HCC) in Indian patients. The secondary objectives were to evaluate the toxicity, time to progressive disease and overall survival for this combination. Chemonaive patients with histopathologically proven, bidimensionally measurable, stage Ill or IV unresectable HCC were enrolled into this study. All the patients were required to have a Zubrod's performance status not greater than 2, should not have undergone prior radiotherapy and were required to have adequate major organ function. Patients received gemcitabine (1250 mg/m2 intravenously over 30 to 60 min) on days 1 and 8, and cisplatin (70 mg/m2 intravenously over 2 hours) on day land every 21 days. Response assessment was done by a Computed Tomography scan after every two cycles of chemotherapy. From May to December 1999, 30 patients were enrolled in the study; they were all eligible for efficacy and toxicity analysis. Six (20%) patients achieved a partial response and 13 (43%) patients demonstrated stable disease with 11 (37%) patients showing disease progression. The median time to progression was 18 weeks (range 1 to 74 weeks) and the median duration of response was 13 weeks (range 4 to 68 weeks). The 1-year survival rate was 27% and the median overall survival was 21 weeks (95% CI: 17 to 43 weeks). WHO grade 3 and 4 anemia was seen in 11 (37%) and 2 (7%) patients, respectively. Four (13%) patients each experienced grade 3 and 4 neutropenia and grade 3 and 4 thrombocytopenia was seen in 2 (7%) patients each. Major, non-hematologic toxicities were grade 4 elevated bilirubin levels and grade 3 oral toxicity, in 1 patient (3%) each. This regimen was well tolerated and did show activity in Indian patients with advanced unresectable HCC. There is a need to further evaluate this combination in order to define its role in the treatment of HCC.

Childhood hepatic angiosarcoma--a case report.

Hepatic angiosarcoma (HAS) is an extremely rare liver tumor in children. We report a case of childhood HAS in a six year old girl who presented with acute abdominal pain and fever with a mass in epigastrium. Left hepatic lobectomy was performed with a clinical diagnosis of hepatoblastoma. Histopathological examination revealed features typical of hepatic angiosarcoma. The case is presented for its rarity and to discuss the interrelation between infantile hemangioendothelioma (IHE) and HAS.

Effect of some plant starches and carrageenan as fat substitutes in chicken patties.

This study evaluated the effect of different flours on the physicochemical, textural, and sensory properties of chicken patties. pH; cooking yield %; water holding capacity (WHC); proximate analysis (cooked); cholesterol content; and storage stability studies of control (Con) and sorghum flour (SF; 10%w/w), finger millet flour (FMF; 10%w/w), and carrageenan (Cgn; 0.5% w/w) treated chicken patties were observed in this study. Texture profile analysis (TPA) parameters like hardness, springiness, cohesiveness, gumminess, chewiness, and sensory parameters were estimated on cooked patties. Highly significant (P < 0.01) difference in fat %, total ash %, and cholesterol content; significant (P < 0.05) difference in moisture % (cooked); and no significant (P > 0.05) difference in pH, WHC, and protein % among control and treatments were noticed. Storage stability was dependent on treatments and storage periods. Significant difference (P < 0.05) was observed in different TPA parameters among the treatments, except for hardness value. Sensory scores showed no significant difference (P > 0.05) between Con and treatments.

High frequency oscillatory ventilation in children. What do we know so far?

Respiratory failure in children continues to be a common and important indication for admission to intensive care units around the world. Acute respiratory distress syndrome represents the most severe form of respiratory failure in children and results from a variety of pulmonary and extra-pulmonary conditions. Despite important strides in our understanding and improved ventilator strategies of this very heterogeneous disease process, the mortality continues to be fairly high at 33%. High frequency oscillatory ventilation is an alternative form of mechanical ventilation with some attractive features in respect to attempting to improve gas exchange limiting ventilator induced lung injury. The objective of this review is to discuss the principles and the physiology of high frequency oscillatory ventilation, and its role in the management of children with respiratory failure. The adult literature will briefly be reviewed. The main emphasis on this review will be on the use of the "open lung" strategy in conditions that cause a reduction in functional residual capacity. In addition the "low volume" strategy that is useful in the setting of airleaks, such as pneumothorax and pneumomediastinum, will be briefly discussed.

Submandibular synovial sarcoma with t(X;18) and synovial sarcoma of the toe with additional cytogenetic abnormalities: presentation of two cases and review of the literature.

We report cytogenetic findings from fine-needle aspiration samples of two synovial sarcoma patients. The cases are of interest because (1) one case is of a rare site (submandibular region) of the head and neck, and (2) the other is a patient with synovial sarcoma of the toe showing additional cytogenetic abnormalities along with t(X;18). The literature of this tumor is reviewed.

Cytogenetic characterization of Ewing tumors using fine needle aspiration samples. a 10-year experience and review of the literature.

Chromosomal analysis was performed in fine needle aspiration samples of 98 primary Ewing tumors (ETs) prior to treatment. Among the 58 (59.18%) successful cultures, t(11;22)(q24;q12) was observed in 87.9% and 6.8% had abnormalities other than t(11;22), viz., del(22)(q12), der(16)t(1;16)(q12;q11), and variant t(8;22)(q24;q12). Involvement of breakpoints 1q21, 1q22, 3p14, 16q22, and 17p13 was also observed. Numerical abnormalities such as trisomies 8 and 12 were found in 29.3% and 20.6% and trisomy 18 in 17.2%. An attempt was made to evaluate the role of these additional changes in the process of tumor development, metastasis, and progression of the disease. This is the largest cytogenetic study on ET from a single center using a simple and reliable technique of fine-needle aspiration culture. The literature on cytogenetics of ET is reviewed.

Changes in extensibility of raw beef muscle during storage.

The mechanical properties of raw meat under tension were studied to characterise the factors responsible for tenderisation during storage. Extensibility and irreversible lengthening in the direction of muscle fibres was determined continuously from 2 h to 10 days after stunning by cycling the muscle between two applied forces. In post-rigor meat, extensibility increased slightly and the muscle lengthened by 40%. Lengthening occurred earlier at higher post-rigor temperatures and was more sensitive to changes in temperature than the changes in texture of cooked meat. Increasing the maximum applied stress also caused lengthening to occur earlier in post-rigor meat. No lengthening was detected pre-rigor. The relationship between the maximum applied stress and the rate of lengthening showed that lengthening would not have occurred with a stress of 0·07 Ncm(-2) or less. These findings suggest that weakening which occurs during conditioning commenced at rigor and that the component responsible for tenderising was about 30 times weaker than indicated using previous techniques. Histological sections showed regular cracks spaced at about 17 µm apart. This was believed to be indicative of the involvement of extracellular components in the texture of conditioned meat.

Neonatal pulmonary flow pattern--a pulsed Doppler echo study.

The pulmonary flow pattern was analysed by pulsed Doppler in 77 normal neonates, at < 48 hours (36 subjects), 49 to 96 hours (25 subjects) and 97 to 148 hours (16 subjects). From the flow velocity spectrum, using an built in computer system, the acceleration time and the ejection time were measured, and the ratio was calculated. This ratio was 0.24 +/- 0.08 in the subjects within 48 hours whereas this ratio was 0.53 +/- 0.11 in the subjects above 97 hours; thus the ratio increased with age. We noticed that the ratio obtained from the pulsed Doppler is useful in assessing the pulmonary vascular status, even in neonates.

Hemangiopericytoma of bone--a case report.

A case of low grade hemangiopericytoma of three years duration occurring in the upper end of the femur of a 70 year old man is described. Radiologically, the upper third of the right femur showed a destructive expansile osteolytic lesion with soft tissue extension. The tumour was partially encapsulated. Mitoses were 0-1 per 10 high power fields, suggesting the low grade malignant nature of the lesion. It is felt that all hemangiopericytomas occurring in bone should be considered biologically malignant.

Unusual splenic metastasis from oesophageal cancer.

The most common visceral metastasis from oesophageal carcinomas are lungs and liver. A case of splenic metastasis from a squamous carcinoma of oesophagus is reported. To our knowledge, splenic metastasis without any nodal disease has not been described previously. The pattern of reported metastasis is summarised.