Staged coil embolisation for the management of persistent aneurysmal right subclavian artery

A 70-year-old patient, who had previously undergone open surgical repair of an aneurysmal aberrant right subclavian artery (ARSA), presented with recurrent symptoms and reperfusion of the aneurysm at the site of proximal ligation. This was successfully treated by a staged endovascular procedure.

PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

OBJECTIVES

The aim of this article was to assess the success, safety, complication profile and factors associated with long-term patency of tunnelled peritoneal drains (PleurX) in the treatment of refractory malignant ascites.

METHODS

Over a 4-year period, 28 consecutive patients (32 drain insertions) with refractory malignant ascites were treated with a PleurX drain. The study group comprised 7 males and 21 females (mean age, 61 years). A combination of fluoroscopic and ultrasound guidance was used to insert 4 drains; the remaining 28 drains were inserted under ultrasound guidance alone. Patient history, biochemical profiles, pathological and procedural records and clinical follow-up until death were reviewed. Statistical analysis included multivariate logistic regression analysis and Kaplan-Meier curves (p<0.05 was considered significant).

RESULTS

There was a 100% technical success rate for the insertion of the drain; there were no procedure-related deaths and no major complications. Only minor complications were reported: three (10%) immediate; three (10%) early; and two (7%) late. Factors significantly associated with these complications included current chemotherapy, low haemoglobin levels, low albumin levels, high white cell count and high c-reactive protein levels. The length of time the drains remained in situ, and therefore patent, ranged from 5 to 365 days (mean, 113 days). Out of the original 28 tunnelled drains, 24 (86%) remained in situ and functioning until the patients' death. Four (14%) drains dislodged and a subsequent PleurX drain was inserted on the opposite side of the abdominal wall. These new drains remained patent until the patient's death. The annual event rate was 0.45 events per year. A comorbid diagnosis of renal disease or chemotherapy was significantly related to a decreased length of patency.

CONCLUSION

The use of tunnelled peritoneal drains is safe and effective and we would advocate their use as a first-line approach in patients with refractory malignant ascites. Care and regular follow-up is indicated following insertion of the drain in all patients, especially those on chemotherapy and those with a pre-procedure diagnosis of renal disease.

Outcome of elderly patients with oesophageal squamous cell carcinoma after surgery

Background

Oesophagectomy may have morbidity and mortality rates that severely compromise long-term survival in elderly patients. The aim of this study was to compare clinical outcomes in elderly patients with oesophageal squamous cell carcinoma (SCC) with those of younger controls.

Methods

Elderly patients at least 70 years old with oesophageal SCC were matched 1 : 1 with controls aged less than 70 years according to sex, tumour stage, tumour location, histological grade, surgical approach, completeness of resection and surgical period. Co-morbidities, surgical complications, surgical mortality and long-term survival were compared.

Results

One hundred and thirty-six patients were included in each group. Surgical mortality was greater in the elderly group (5·9 versus 0·7 per cent; P = 0·036). Overall and disease-specific 5-year survival rates were worse among patients aged at least 70 years (30·0 versus 41·8 per cent, and 31·5 versus 44·7 per cent respectively), as were 10-year rates (13·7 versus 26·4 per cent, and 20·2 versus 29·0 per cent). Disease-free survival rates after 5 years (24·0 versus 35·5 per cent) and 10 years (12·3 versus 24·3 per cent) were not statistically significant (P = 0·076).

Conclusion

Poor functional status may account for higher morbidity and mortality rates in elderly patients with oesophageal SCC. Acceptable perioperative mortality rates and substantial long-term survival can still be achieved. Elderly patients should not be denied oesophagectomy.

Plasticity at glycinergic synapses in dorsal cochlear nucleus of rats with behavioral evidence of tinnitus

Fifteen percent to 35% of the United States population experiences tinnitus, a subjective "ringing in the ears". Up to 10% of those afflicted report severe and disabling symptoms. Tinnitus was induced in rats using unilateral, 1 h, 17 kHz-centered octave-band noise (116 dB SPL) and assessed using a gap-startle method. The dorsal cochlear nucleus (DCN) is thought to undergo plastic changes suggestive of altered inhibitory function during tinnitus development. Exposed rats showed near pre-exposure auditory brainstem response (ABR) thresholds for clicks and all tested frequencies 16 weeks post-exposure. Sound-exposed rats showed significantly worse gap detection at 24 and 32 kHz 16 weeks following sound exposure, suggesting the development of chronic, high frequency tinnitus. Message and protein levels of alpha(1-3,) and beta glycine receptor subunits (GlyRs), and the anchoring protein, gephyrin, were measured in DCN fusiform cells 4 months following sound exposure. Rats with evidence of tinnitus showed significant GlyR alpha(1) protein decreases in the middle and high frequency regions of the DCN while alpha(1) message levels were paradoxically increased. Gephyrin levels showed significant tinnitus-related increases in sound-exposed rats suggesting intracellular receptor trafficking changes following sound exposure. Consistent with decreased alpha(1) subunit protein levels, strychnine binding studies showed significant tinnitus-related decreases in the number of GlyR binding sites, supporting tinnitus-related changes in the number and/or composition of GlyRs. Collectively, these findings suggest the development of tinnitus is likely associated with functional GlyR changes in DCN fusiform cells consistent with previously described behavioral and neurophysiologic changes. Tinnitus related GlyR changes could provide a unique receptor target for tinnitus pharmacotherapy or blockade of tinnitus initiation.

High prevalence of risk behaviour concurrent with links to other high-risk populations: a potentially explosive HIV epidemic among men who have sex with men in Guangzhou, China

OBJECTIVES

HIV disproportionately affects men who have sex with men (MSM), but HIV prevalence among MSM in Guangzhou has not shown the rapid increasing trend as it has elsewhere in China. The aim of this study is to detect the epidemic and to determine the characteristics of MSM in Guangzhou susceptible to HIV.

METHODS

A cross-sectional survey with serological testing for HIV, syphilis, HBV and HCV through long-chain referral sampling strategy to help control the bias generated from non-statistic sampling.

RESULTS

The most important features of MSM in Guangzhou are being young and mobile, and of comparable education and income level to that of the general population. The HIV prevalence was 1.3% (95% CI 0.3 to 2.7%) in 2006. Many HIV risk factors were identified: low awareness of HIV risk perception and prevention, high prevalence of diverse, multiple partners and versatile sexual role, more than half of them actively having sex with women, low persistent condom use with both male and female partners, commercial sex and one out of 27 practising needle or syringe sharing during illicit drug use.

CONCLUSION

HIV has been introduced into MSM in Guangzhou. Demographic and behavioural risk factors and overlapping risk populations contribute to a potentially rapidly rising epidemic among MSM and the potential for a bridge to female partners in Guangzhou if timely and effective interventions are not implemented.