Extensive Drop Metastases From Pineal Gland Tumor: A Case Report

ABSTRACT

Pineal gland tumors are an infrequent central nervous system manifestation. Their prevalence is only less than 1% of all central nervous system tumors. They generally involve children or young adults aged younger than 40 years. Extracranial or spinal drop metastases are very rare from pineal gland tumors. In this case, 18 FDG PET/CT demonstrates drops in metastases involving the entire length of the spinal as well as multiple other intracranial metastatic lesions.

Relapsed Carcinoma Cervix Presented with Multiple Rare Visceral Metastases: Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Carcinoma cervix spread to locoregional lymph nodes. Distance metastases are uncommon and occur through hematogenous routes in advanced stages. The common sites include bone and lungs. Another organ involvement is uncommon. Computed tomography (CT) and magnetic resonance imaging have a crucial role in diagnosing local and distant metastasis. 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) is a sensitive molecular imaging modality for various cancers, including gynecological ones. We present a case of recurrent cervical carcinoma presented with cervical mass and several rare visceral metastases. 18F-FDG PET/CT is a whole-body modality that accurately localized all lesions in a single study.

F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Case of Subcutaneous T-cell Lymphoma Presenting as Breast Mass and Panniculitis-Like Features: A Rare Entity

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an unusual subtype of cutaneous lymphoma and clinically appears as erythematous, subcutaneous infiltrates, and recurrent papulonodules. It is defined as a rare cytotoxic a/b T-cell lymphoma characterized by primary involvement of subcutaneous tissue-mimicking panniculitis and a predominant CD3+/CD4/CD8+ phenotype in (2005) the World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. On metabolic imaging, these lesions are invariably fluorodeoxyglucose (FDG) avid. SPTCL which presents as a breast mass is a rare entity. Here, we present a case of SPTCL presents as FDG avid breast mass and subcutaneous nodules.

Skeletal Metastases of Unknown Primary: A Rare Presentation of Carcinoma Pancreas on Fludeoxyglucose Positron Emission Tomography-Computed Tomography

Skeletal metastases of unknown primary represent skeletal metastases where primary tumors remain obscure. They usually arise from lung and prostate cancer. We present a case of a young male who presented with severe bone pains, weight loss, and generalized weakness. Fludeoxyglucose positron emission tomography-computed tomography reveals extensive skeletal metastases, a mass in the pancreas tail, and other metastatic lesions. He had no liver or lung metastases. This case presents a rare presentation of carcinoma pancreas.

Metastatic Urinary Bladder Carcinoma on Palliative Chemotherapy Showing Rapid Progression on Interim Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Bladder cancer (BC) is among the top ten most common cancer types globally. Muscle invasive BC has a high incidence of metastasis. Metastatic BC has a poor prognosis and limited treatment options. Here, we present a middle-aged man with oligometastatic BC, which was treated with palliative chemotherapy. He had significant clinical improvement. However, interim 18F-Fluorodeoxyglucose positron emission tomography/computed tomography demonstrates a rapid disease progression extensive metastasis.

Utero-Ovarian Involvement in Non-Hodgkin's Lymphoma on 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Case Series and Literature Review

Lymphomas are common solid malignancies. They are associated with substantial morbidity and mortality. Hodgkin's lymphoma (HL) and Non-HL (NHL) are subtypes of lymphoma. Lymph nodes are the most common site of involvement, though practically any organ may be involved. NHL has preponderance for extranodal involvement. Primary uterine and ovarian NHL is scarce. However, in advanced systemic disease, secondary utero-ovarian involvement may be seen. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a pivotal imaging modality in lymphomas. It abets in pretreatment staging, posttherapy restaging, and surveillance. We present three stage-IV NHL cases with secondary utero-ovarian involvement. FDG PET/CT as a baseline imaging modality established the disease burden and organ involvement.

Contiguous Multilevel Vertebral Metastasis in Carcinoma Breast Mimicking Spondylodiscitis

A 59-year old female presented with a lump in the right breast for 6 months. She developed progressively increasing backache for 3 months. Magnetic resonance imaging spine was suggestive of hypointense heterogeneous signal intensity in multiple dorsal vertebrae (D3–D8) and suggestive of Pott's spine. Sonomammography suggested a lesion with irregular margin in the retro-areolar region. Fine-needle aspiration cytology was infiltrating duct carcinoma. Fluorodeoxyglucose (FDG) positron-emission tomography–computed tomography revealed mass in the right breast with axillary lymph node. FDG-avid lytic destructive contiguous lesion was noted in mid-dorsal vertebrae. Apart from it, FDG-avid lytic lesion was also noted in the right iliac bone. The patient underwent vertebral lesion biopsy consistent with metastatic breast carcinoma. This case report demonstrates rare contiguous involvement of multiple vertebrae masquerading Pott's spine.

18FDG-Positron Emission Tomography in patients with Tuberculous Meningitis: A Prospective Evaluation

Lower yield of available diagnostic tests for tuberculous meningitis (TBM) frequently causes delay in diagnosis. Recently, 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used in infectious disorders such as pulmonary tuberculosis; however, it is rarely used in TBM. This study was aimed to ascertain the role of FDG PET in the diagnosis and determination of the extent of disease and prognosis in patients with TBM. After excluding unsuitable patients, 25 patients were subjected to whole-body PET-computed tomography (CT) image acquisition along with separate brain protocol with an integrated PET-CT device. FDG PET was found to be abnormal in 92% patients. Extracranial FDG uptake was observed in 80% patients. Most common extracranial site of involvement was lymph nodes (60%), followed by lung (56%), vertebral body (8%), genitourinary organs (8%), and spleen (4%). FDG PET observed extracranial involvement had 80% sensitivity and 20% specificity in detecting definite TBM cases. In conclusion, FDG PET may be a useful test in TBM evaluation.

Incidental Diagnosis of Multiple Paragangliomas by Ga-68 DOTANOC Positron Emission Tomography-Computed Tomography

A 65-year-old man presented with intermittent abdominal pain for three months. Abdominal ultrasonography revealed a mass in the body of the pancreas. Moreover, abdominal contrast-enhancing computed tomography revealed a homogenously enhancing mass in the body of the pancreas. Scan findings were in favor of the neuroendocrine tumor, and the serum chromogranin level was slightly raised (111.9 ng/ml, normal <98). He had no history of vomiting, jaundice, melena, hematemesis, constipation, diarrhea, weight gain, weight loss, loss of appetite, and fever. He also had no symptoms related to the excessive production of catecholamines, such as hypertension. The patient was referred for Ga-68 DOTANOC positron emission tomography-computed tomography (Ga-68 DOTANOC PET-CT) for further evaluation. The scan was done to rule out metastatic disease or other synchronous lesions to plan surgical excision. The Ga-68 DOTANOC PET-CT revealed a pancreatic lesion with no other abdominal lesions. We noted multiple tracer avid soft tissue lesions on both sides of the neck that were not diagnosed previously. This case report demonstrates a rare case with multiple paragangliomas diagnosed by the Ga-68 DOTANOC PET-CT. This finding could lead to changes in patient management.

Lymphoscintigraphy In a Case of Recurrent Chylopericardium

Chylopericardium is an uncommon and benign condition in which triglyceride-containing chylous fluid collects in the pericardial cavity at high concentrations. Usually, chylopericardium occurs due to congenital malformation of lymphatic vessels or secondary to any trauma, surgeries, neoplasms, etc. However, if exact aetiology cannot be identified, the condition is referred to as Idiopathic chylopericardium which is a very rare presentation in day-to-day clinical practice. General physical examination, routine blood investigations and various anatomical imaging modalities may give a clue in the diagnosis, however, diagnosis can be challenging as they have a variable presentation. Also, optimal treatment poses greater difficulty as it remains controversial in most cases. We report a 47-year-old gentleman who presented with recurrent chylous pericardial effusion with no history of trauma, thoracic surgeries, cardiac disease and neoplasm in the past. Lymphoscintigraphy confirmed the communication between the lymphatic trunk and the pericardial space. The patient was managed conservatively with pericardial drainage and the patient recovered is doing well at present.

Selective photoionization of lithium isotopes in a hollow cathode lamp: a feasibility study for a laser ion source and detector

Two-step selective photoionization of lithium isotopes is carried out in a hollow cathode (HC) discharge lamp using a nitrogen-laser-pumped homemade tunable dye laser (∼0.2  cm^-1, 7 ns, 640-680 nm). The HC lamp is developed in-house and used as a lithium ion source as well as a detector. The dark space region of HC discharge is illuminated by a dye laser exciting pulse followed by an ionizing radiation from the nitrogen laser. The high electric field (∼kV/cm) present in HC dark space is exploited for fast charge collection, produced by the simultaneous interaction of exciting and ionizing laser beams with sputtered lithium atoms, enabling the detection of photoionization signal. Photoionization signals with a high signal-to-noise ratio are obtained without using any amplifier. Effects of the ionizing laser pulse energy and the precise tuning of the dye laser on lithium photoionization signal, across 670.780 nm (S_1/22→P_1/2,3/22) transition, are studied. The fine structure of lithium is clearly identified, and its two isotopes (Li7,6) are fairly resolved in the measured photoionization spectrum. Using a saturation technique, the photoionization cross section and the number density of lithium atoms for the Li7 (P_3/22) excited level are also measured as 18.5±2.4  Mb, N₀∼1.7×10⁹  (atoms/cm³). The results obtained infer that HC-lamp-based photoionization is an easier and cost-effective way of selective photoionization of lithium atoms, and it can be applied for other elements also.

Development of a see-through hollow cathode discharge lamp for (Li/Ne) optogalvanic studies

Development of a demountable and see-through hollow cathode (HC) discharge lamp suitable for optogalvanic (OG) spectroscopy is described. The design of the HC lamp is simple, compact, and inexpensive. Lithium, investigated rarely by the OG method, is selected for cathode material as its isotopes are important for nuclear industry. The HC lamp is characterized electrically and optically for discharge oscillations free OG effect. Strong OG signals of lithium as well as neon (as buffer gas) are produced precisely upon copper vapor laser pumped tunable dye laser irradiation. The HC lamp is capable of generating a clean OG resonance spectrum in the available dye laser wavelength scanning range (627.5-676 nm) obtained with 4-(Dicyanomethylene)-2-methyl-6-(4-dimethylaminostyryl)-4H-pyran dye. About 28 resonant OG lines are explicitly observed. Majority of them have been identified using j-l coupling scheme and assigned to the well-known neon transitions. One line that corresponds to wavelength near about 670.80 nm is assigned to lithium and resolved for its fine (²S_1/2 → ²P_{1/2, 3/2}) transitions. These OG transitions allow 0.33 cm^-1 accuracy and can be used to supplement the OG transition data available from other sources to calibrate the wavelength of a scanning dye laser with precision at atomic levels.

Hyperfine structure studies of neutral europium transitions at 601.815 and 580.027 nm by saturation absorption spectroscopy

We report Doppler-free spectroscopy of neutral europium carried out using the saturation absorption technique. In the present experiment, Eu/Ne hollow cathode discharge is used as an atomic vapor source of europium. The Eu transition 4f⁷6s²(S8_7/2°)→4f⁷6s6p(P8_9/2) at 601.815 nm and 4f⁷5d6s(aD10_13/2°)→4f⁷5d6p(zD8_11/2) at 580.027 nm are investigated. The frequency separation between the adjacent hyperfine transitions as well as hyperfine structure (HFS) constants are calculated from the obtained experimental spectra. The HFS constant obtained for the state 4f⁷6s6p(P8_9/2) are A¹⁵¹=664.8  MHz; B¹⁵¹=293.5  MHz, and for state 4f⁷5d6p(zD8_11/2), the values are A¹⁵¹=7.6  MHz; B¹⁵¹=-60  MHz. These obtained values are in good agreement with the results reported in the literature using laser induced atomic beam fluorescence technique.

Prospective Observational Study of Adverse Drug Reactions of Anticancer Drugs Used in Cancer Treatment in a Tertiary Care Hospital

Adverse drug reactions associated with the use of anticancer drugs are a worldwide problem and cannot be ignored. Adverse drug reactions can range from nausea, vomiting or any other mild reaction to severe myelosuppression. The study was planned to observe the suspected adverse drug reactions of cancer chemotherapy in patients aged >18 years having cancer attending Postgraduate Institute of Medical Education and Research, Chandigarh. During the study period, 101 patients of breast cancer and 73 patients of lung cancer were screened for occurrence of adverse drug reactions during their treatment with chemotherapy. About 87.36% patients experienced adverse drug reactions, 90.09% and 83.56% of breast and lung cancer patients experienced at least one adverse drug reaction respectively. In breast cancer patients, 41.58% patients were prescribed fluorouracil+doxorubicin+cyclophosphamide while paclitaxel was prescribed to 22.77% patients. Alopecia (54.94%), nail discolouration (43.96%), dysgeusia (38.46%), anorexia (30.77%), nausea (29.67%), and neuropathy (29.67%) were found to be very common in breast cancer patients treated with single/combined regimen. In lung cancer group of patients, cisplatin with docetaxel, cisplatin with pemetrexed and cisplatin with irinotecan were prescribed to 30.14, 24.65 and 17.81% patients, respectively. Dysgeusia (40.98%), diarrhoea (39.34%), anorexia (32.77%) and constipation (31.15%) and alopecia (31.15%) were commonly observed adverse drug reactions having lung cancer patients. Causality assessments using World Health Organization causality assessment scale showed that observed adverse drug reactions were of probable (64.67%) and possible (35.33%) categories. Alopecia, dysgeusia, anorexia, constipation diarrhoea, nausea, nail discoloration were more prevalent amongst the cancer patients undergoing chemotherapy.

Studies on laser-assisted Penning ionization by the optogalvanic effect in Ne/Eu hollow cathode discharge

Laser-assisted Penning ionization (LAPI) is detected in a Ne/Eu hollow cathode (HC) discharge lamp using the pulsed optogalvanic (OG) method. In the Ne/Eu discharge, doubly ionized europium excited energy levels Eu[4f(7)(P(7/2,5/2)6)] lie within the thermal limit (∼kT) from the laser-excited neon's energy level [2p(5)(P3/202)3p or 2p(8) (in Paschen notation)] lying at 149,848  cm(-1). Therefore, Penning ionization (PI) of europium atoms likely to occur into its highly excited ionic states is investigated. To probe the PI of europium, the temporal profiles of its counterpart neon OG signal are studied as a function of discharge current for the transitions (1s(4)→2p(8)) and (1s(2)→2p(2)), corresponding to 650.65 and 659.89 nm wavelengths, respectively. It is observed that PI of europium alters the overall discharge characteristics significantly and, hence, modifies the temporal profile of the OG signals accordingly. The quasi-resonant ionizing energy transfer collisions between laser-excited Ne 2p(8) atoms and electronically excited europium P(9/2)10 atoms are used to explain the LAPI mechanism. Such LAPI studies carried out in HC discharge could be useful for the discharge of a metal-vapor laser with appropriate Penning mixtures.

Studies on pulsed optogalvanic effect in Eu/Ne hollow cathode discharge

The optogalvanic (OG) effect has been observed in a Eu/Ne hollow cathode discharge lamp using pulsed laser irradiation. An OG spectrum is recorded in dye laser wavelength region 574–602 nm using a boxcar-averager. In total 41 atomic lines are observed. Of these, 38 lines are assigned to neon transitions. Two lines observed corresponding to wavelengths 576.519 and 601.815 nm are assigned to europium transitions; (4f 7 6s 2 , S 8 7/2 →4f 7 6s6p , zP 6 7/2 ) and (4f 7 6s 2 , S 8 7/2 →4f 7 6s6p , zP 8 9/2 ), respectively, and the remaining line at 582.475 nm could not be assigned. The effect of the discharge current on europium as well as neon OG signals is also studied. At moderate discharge current values, an extra positive peak is observed in neon OG signal for the transition (1s 5 →2p 2 ) at 588.189 nm, which is explained by Penning-ionization process using the quasi-resonant energy transfer interactions between excited neon and europium atoms lying in 2p 2 and D 10 9/2 states, respectively.

Evaluation of Central Macular Thickness and Retinal Nerve Fiber Layer Thickness using Spectral Domain Optical Coherence Tomography in a Tertiary Care Hospital

Purpose: To evaluate the normative data of macular thickness and retinal nerve fiber layer thickness (RNFL) among normal subjects using spectral domain optical coherence tomography (OCT).

Materials and methods: Normal subjects presenting to a tertiary medical hospital were included in the study. All patient underwent clinical examination followed by study of macular thickness and RN FL thick ness by spectral domain Topc on OCT. The data was collected and analyzed for variations in gender and age. The data was also compared with available literature.

Results: Total numbers of patients enrolled in the study were 154 (308 eyes). Numbers of males were 79 (158 eyes) and numbers of females were 75 (150 eyes). The mean age among males was 42.67 ± 12.15 years and mean age among females was 42.88 ± 11.73 years.

Overall the mean mac ular thickness (central 1 mm zone) with SD - OCT was 241.75 ± 17.3 microns. The mean macular volume was 7.6 cu. mm ± 0.33. On analysis of the RNFL thickness, we observed that the RNFL was thickest in the inferior quadrant (138.58) followed by superior (122.30) nasal (116.32) and temporal quadrant (73.04).

Gender-wise comparison of the data revealed no statistically significant difference for age, macular thickness parameters, volume and RFNL values except outer temporal thickness among males and females. No age-related difference was noted in the above parameters. On comparison with available norma tive data from India and elsewhere, we found significant variations with different machines.

Conclusion: The study is the first to provide normative data using SD-OCT from central India. The data from spectral domain OCT correlated well with the values obtained from similar studies with SD - OCT. Values obtained from time domain OCT machines are different and are not comparable.

How to cite this article: Agarwal P, Saini VK, Gupta S, Sharma A. Evaluation of Central Macular Thickness and Retinal Nerve Fiber Layer Thickness using Spectral Domain Optical

Coherence Tomography in a Tertiary Care Hospital. J Curr Glaucoma Pract 2014;8(2):75-81.

Macular Thickness Variability in Primary Open Angle Glaucoma Patients using Optical Coherence Tomography

Aim: To compare the difference of retinal macular thickness and macular volume using optical coherence tomography (OCT) in primary open angle glaucoma (POAG) patients with the normal subjects.

Materials and methods: This observational case control study included primary open angle glaucoma (POAG) patients (n = 124 eyes) and healthy subjects in the control group (n = 124 eyes). All subjects underwent detailed history, general and systemic exami -nation. Complete ocular examination included best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), central corneal thickness, gonioscopy, dilated fundus biomicroscopy. Field analysis was done by white on white Humphrey Field Analyzer (Carl Zeiss).

Optical coherence tomography imaging of macular area was performed using Stratus OCT (OCT 3, Version 4, Carl Zeiss Inc, Dublin, California, USA). In both these groups, parameters analyzed were macular thickness, inner macular thicknesses (IMT), outer macular thicknesses (OMT), central macular thick ness (CMT) and total macular volume (TMV).

Results: The POAG group had significantly decreased values of TMV, OMT and IMT, compared to control group, while there was no difference in CMT, presumably due to absence of ganglion cells in the central part. Thus, macular thickness and volume parameters may be used for making the diagnosis of glaucoma especially in patients with abnormalities of disc.

Conclusion: Macular thickness parameters correlated well with the diagnosis of glaucoma.

How to cite this article: Sharma A, Agarwal P, Sathyan P, Saini VK. Macular Thickness Variability in Primary Open Angle Glaucoma Patients using Optical Coherence Tomography. J Current Glau Prac 2014;8(1):10-14.

Laser-induced optogalvanic signal oscillations in miniature neon glow discharge plasma

Laser-induced optogalvanic (OG) signal oscillations detected in miniature neon glow discharge plasma are investigated using a discharge equivalent-circuit model. The damped oscillations in OG signal are generated when a pulsed dye laser is tuned to a specific neon transition (1s5→2p2) at 588.2 nm under the discharge conditions where dynamic resistance changes its sign. Penning ionization via quasi-resonant energy transfer collisions between neon gas atoms in metastable state and sputtered electrode atoms in ground state is discussed to explain the negative differential resistance properties of discharge plasma that are attributed to oscillations in the OG signal. The experimentally observed results are simulated by analyzing the behavior of an equivalent discharge-OG circuit. Good agreement between theoretically calculated and experimental results is observed. It is found that discharge plasma is more sensitive and less stable in close vicinity to dynamic resistance sign inversion, which can be useful for weak-optical-transition OG detection.

Adsorption of As(III) from aqueous solutions by iron oxide-coated sand

Arsenic is a toxic element and may be found in natural waters as well as in industrial waters. Leaching of arsenic from industrial wastewater into groundwater may cause significant contamination, which requires proper treatment before its use as drinking water. The present study describes removal of arsenic(III) on iron oxide-coated sand in batch studies conducted as a function of pH, time, initial arsenic concentration, and adsorbent dosage. The results were compared with those for uncoated sand. The adsorption data fitted well in the Langmuir model at different initial concentration of As(III) at 20 g/l fixed adsorbent dose. Maximum adsorption of As(III) for coated sand is found to be much higher (28.57 microg/g) than that for uncoated sand (5.63 microg/g) at pH 7.5 in 2 h. The maximum As(III) removal efficiency achieved is 99% for coated sand at an adsorbent dose of 20 g/l with initial As(III) concentration of 100 microg/l in batch studies. Column studies have also been carried out with 400 microg/l arsenic (pH 7.5) by varying the contact time, filtration rate, and bed depth. Results of column studies demonstrated that at a filtration rate of 4 ml/min the maximum removal of As(III) observed was 94% for coated sand in a contact time of 2 h. The results observed in batch and column studies indicate that iron oxide-coated sand is a suitable adsorbent for reducing As(III) concentration to the limit (50 microg/l) recommended by Indian Standards for Drinking Water.

Biosorption of copper(II) from aqueous solutions by Spirogyra species

Batch studies were conducted to investigate the kinetics and isotherms of Cu(II) biosorption on the biomass of green alga Spirogyra species. It is observed that the biosorption capacity of the biomass strongly depends on pH and algal dose. The maximum biosorption capacity of 133.3 mg Cu(II)/g of dry weight of biomass was observed at an optimum pH of 5 in 120 min with an algal dose of 20 g/L. Desorption studies were conducted with 133.3 mg/g of Cu(II) loaded biomass using different desorption agents including HCl, EDTA, H2SO4, NaCl, and H2O. The maximum desorption of 95.3% was obtained with HCl in 15 min. The results indicate that with the advantages of high metal biosorption capacity and satisfactory recovery of Cu(II), Spirogyra can be used as an efficient and economic biosorbent material for the removal and recovery of toxic heavy metals from polluted water.

Removal of chlorophenols from wastewater using red mud: an aluminum industry waste

Removal of toxic substances from wastewaters using low-cost alternatives to activated carbon is an important area in environmental sciences. Efforts have been made to convert red mud, an aluminum industry waste, into a low-cost potential adsorbent, and the final material has been used for the removal of phenol, 2-chlorophenol, 4-chlorophenol, and 2,4-dichlorophenol from wastewater. It is pertinent to mention that phenol and chlorophenols are highly carcinogenic and an priority class of pollutants which needs to be removed from effluents before discharge into water bodies. 2,4-Dichlorophenol and 4-chlorophenol are sorbed by the developed adsorbent up to 94-97%, while the removal of 2-chlorophenol and phenol was up to 50-81%. The removal of phenols and its derivatives was achieved up to 98% by column experiments at a flow rate of 0.5 mL/min. The order of removal was 2,4-dichlorophenol > 4-chlorophenol > 2-chlorophenol > phenol, and the removal takes place through a particle diffusion mechanism. The adsorption was found to be endothermic in nature and follows both Langmuir and Freundlich models. Estimation of the phenols was carried out by capillary electrophoresis, and the adsorbent has been successfully tried for the removal of chlorophenols from a wastewater. The developed process is very useful, economic, rapid, and reproducible for the removal of phenols.

Removal of cadmium and nickel from wastewater using bagasse fly ash--a sugar industry waste

The bagasse fly ash, an industrial solid waste of sugar industry, was used for the removal of cadmium and nickel from wastewater. As much as 90% removal of cadmium and nickel is possible in about 60 and 80 min, respectively, under the batch test conditions. Effect of various operating variables, viz., solution pH, adsorbent dose, adsorbate concentration, temperature, particle size, etc., on the removal of cadmium and nickel has been studied. Maximum adsorption of cadmium and nickel occurred at a concentration of 14 and 12 mg x l(-1) and at a pH value of 6.0 and 6.5, respectively. A dose of 10 g x l(-1) of adsorbent was sufficient for the optimum removal of both the metal ions. The material exhibits good adsorption capacity and the adsorption data follow the Langmuir model better then the Freundlich model. The adsorption of both the metal ions increased with increasing temperature indicating endothermic nature of the adsorption process. Isotherms have been used to determine thermodynamic parameters of the process, viz., free energy change, enthalpy change and entropy change.

Management of penetrating heart wounds

The records of ninety-two patients treated between 1965 and 1976 at the Boston City Hospital for penetrating wounds of the heart were reviewed and the results were compared with a previous series of twenty-five patients admitted to the same institution between 1956 and 1964. The annual incidence rose from 2.8 cases during the first period to 8.0 during the more recent years. Gunshot wounds increased in frequency in the second period. The overall mortality was similar in the two series. However, there were more complex wounds and agonal patients subjected to immediate emergency room thoracotomy during the second phase of this experience. The salvage rate in the latter group of patients gradually improved and averaged 24% between 1965 and 1976. These data indicate that an aggressive approach, including the use of immediate thoracotomy, to the agonal patient with a heart wound will be rewarded with salvage of some patients.

Nutrient myocardial blood flow in experimental myocardial ischemia. Effects of intraaortic balloon counterpulsation and coronary reperfusion

This experimental study was designed to evaluate the effect of intraaortic balloon pumping (IABP) upon nutrient myocardial blood flow (NMBF) following acute myocardial ischemia in dogs, but also to determine whether IABP improves NMBF following revascularization. Localized myocardial ischemia was produced by ligation of one or two small branches of the circumflex coronary artery combined with a three hour snare occlusion of the left anterior descending coronary artery distal to the first septal branch. NMBF was measured by NaI131 washout at three points corresponding to the peripheral, intermediate, and central zones of the infarct. Occlusion of the coronary arteries reduced NMBF. Release of occlusion after three hours, or the equivalent of coronary artery revascularization, increased NMBF but did not restore it to control levels. The increase in flow was more marked in the peripheral zones of ischemia. IABP increased NMBF significantly both during and after release of occlusion. The effect was sustained after cessation of IABP only when the latter was maintained during the period of reperfusion. The results indicate that NMBF, defined by washout of a locally injected tracer, was improved by both IABP and reperfusion. The beneficial effect was maximal when the two techniques were combined.

Portal hypertension in chronic leukaemia

Portal haemodynamic studies were carried out in 11 subjects, seven with chronic myeloid leukaemia and four with chronic lymphatic leukaemia, and results compared with those obtained in five patients with 'idiopathic' splenomegaly and with control subjects. All 11 patients with chronic leukaemia had intrasplenic pressures above 11 mmHg and of these four had pressures above 20 mmHg. Portosystemic collaterals were seen on splenovenography in four of these patients. Hepatic vein wedge pressure was above 7 mmHg in nine patients and these high levels were a result of increased free hepatic vein pressure. The corrected sinusoidal pressure and post sinusoidal resistance were essentially normal in all patients. Evidence of increased pre-sinusoidal resistance was seen in six patients. Estimated hepatic blood flow above 1500 ml/min was seen in six patients and all had evidence of histological portal or sinusoidal infilatration. Patients with 'idiopathic' splenomegaly regardless of increased liver blood flow did not have a significant increase in intrasplenic pressure and no alteration in other haemodynamic parameters. It appears that increased liver blood flow alone in a normal liver can only minimally elevate intrasplenic pressure but can play a significant part in the pathogenesis of portal hypertension when liver structure is altered.

Septic lung and shock lung in man

Two series of patients were studied by serial measurements of blood gas exchange and pulmonarmonary dysfunction and to evaluate the dangers of respiratory failure in post traumatic patients. There were 27 patients who had sustained profound hemorrhagic shock and massive blood replacement averaging 9.7 liters and 38 patients who suffered general peritonitis or other forms of fulminating nonthoracic sepsis. All were supported by endotrachael intubation and volume controlled ventilators. The overall mortality for the post shock patients without sepsis was 12% while in the septic patients it was 35%. The maximal pulmonary arteriovenous shunt encountered in the post hemorrhagic shock patients at 36 hours averaged 20 plus or minus 8% and was accompanied by high cardiac indices (average 5.1 plus or minus 1.3 L/M-2/min) but no significant rise of pulmonary arterial pressure or peak inspiratory pressure (PIP). Severe pulmonary dysfunction subsequently occurred only in those patients who later became septic. The studies on the septic patients were divided according to the magnitude of the cardiac indices (the high indices averaged 4.8 plus or minus 1.6L/M-2/min) and thelow indices averaged 1.9 plus or minus 1.0 L/M-2/min. In the former, the average maximal shunt of 30 plus or minus 6% was sustained for 4 or more days, accompanied by an elevation of PIP to 36 plus or minus 6 cm H2O and by Pa pressure of 28 plus or minus 5 mm Hg. The patients in low output septic shock usually had an associated bronchopneumonia and had an average venous admixture of 34 plus or minus 8% and PIP values of 41 plus or minus 8 cm H2O. The mean Pa pressure in this group was 29 plus or minus 6 mm Hg.

Applications of intra-aortic balloon counterpulsation

Intra-aortic balloon counterpulsation (IABC) is the form of mechanical circulatory assistance in widest clinical use today. The clinical results with IABC employed in 63 patients over a four-year period are presented. The clinical conditions necessitating mechanical circulatory assistance were: cardiogenic shock following acute myocardial infarction; myocardial infarction complicated by mitral valyular regurgitation or ventricular septal defect; preinfarction angina syndrome; postcardiotomy cardiogenic shock with pump oxygenator dependence; postcardiotomy cardiogenic shock during the postoperative recovery period; and septic shock. Survival and discharge from hospital occurred with 32 of 63 patients (51%). Evaluations of left ventricular function were studied in 20 patients on IABC by construction of Frank Starling curves, with cardiac output determined by thermodilution techniques. In general, IABC shifted the curves to the left and increased their slope.

Thoracic duct and hepatic lymph in idiopathic portal hypertension

Lymph dynamics in idiopathic portal hypertension has been studied in two phases. In the first phase thoracic duct lymph transport was studied in 11 patients with idiopathic portal hypertension by cannulating the duct. This revealed altered lymph transport in the form of a distended thoracic duct, raised pressure in the duct, and haemorrhagic lymph with an increased flow rate. The lymph flow rate was analysed in relation to various hepatic haemodynamic and biochemical parameters. In the second phase of the study hepatic lymphatics were studied by percutaneous hepatography in 16 patients with idiopathic portal hypertension. By this technique hepatic lymphatics were opacified in patients with idiopathic portal hypertension and cirrhosis with equal frequency. The significance of this finding in relation to the altered hepatic haemodynamics and thoracic duct lymph transport is discussed.

Management of bleeding oesophageal varices by draining lymph from the thoracic duct

The thoracic duct was cannulated in six patients who were actively bleeding from varices and had not responded to conservative treatment but draining lymph from the thoracic duct did not control bleeding in five patients. There was no drop in intrasplenic pulp pressure following this procedure when recorded in three of these patients. Bleeding stopped in one patient after lymph had been drained for nine and a half hours, and there was only a modest change in intrasplenic pressure. The therapeutic use of this technique to control oesophageal varices could not be substantiated.