Application of ripple mapping to visualize slow conduction channels within the infarct-related left ventricular scar.

Background: Ripple mapping (RM) displays each electrogram at its 3-dimensional coordinate as a bar changing in length according to its voltage-time relationship with a fiduciary reference. We applied RM to left ventricular ischemic scar for evidence of slow-conducting channels that may act as ventricular tachycardia (VT) substrate.

Methods And Results: CARTO-3© (Biosense Webster Inc, Diamond Bar, CA) maps in patient undergoing VT ablation were analyzed on an offline MatLab RM system.

Direct optic nerve sheath (DONS) application of Schwann cells prolongs retinal ganglion cell survival in vivo.

Cell-based therapies are increasingly recognized as a potential strategy to treat retinal neurodegenerative disease. Their administration, however, is normally indirect and complex, often with an inability to assess in real time their effects on cell death and their migration/integration into the host retina. In the present study, using a partial optic nerve transection (pONT) rat model, we describe a new method of Schwann cell (SC) delivery (direct application to injured optic nerve sheath, SC/DONS), which was compared with intravitreal SC delivery (SC/IVT).

Automated estimation of disease recurrence in head and neck cancer using routine healthcare data.

Background: Overall survival (OS) and progression free survival (PFS) are key outcome measures for head and neck cancer as they reflect treatment efficacy, and have implications for patients and health services. The UK has recently developed a series of national cancer audits which aim to estimate survival and recurrence by relying on institutions manually submitting interval data on patient status, a labour-intensive method. However, nationally, data are routinely collected on hospital admissions, surgery, radiotherapy and chemotherapy.

Sequential strokes in a hyperacute stroke unit.

Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

Heparin for assisted reproduction: summary of a Cochrane review.

It is suggested that heparin given in the peri-implantation period may improve clinical outcomes in women undergoing assisted reproduction techniques (ART). This systematic review evaluates the use of heparin in subfertile women undergoing ART.

Surgical Stapler for Right Renal Vein Elongation Using the Inferior Vena Cava in Kidney Transplant.

Elongation of the right renal vein with the inferior vena cava (caval patch) using a vascular stapler offers a safe means of extending the deceased-donor right renal vein, while minimizing the ischemic time of the kidney during preparatory dissection. The aortic patch of the right renal artery also can be preserved, which minimize the danger of arterial stenosis, kinking, and dissection.

CT coronary angiography in the investigation of chest pain--beyond coronary artery atherosclerosis; a pictorial review.

Obstructive coronary artery disease due to atherosclerosis remains the commonest cause of chest pain, although several other conditions involving the coronary arteries, cardiac and non-cardiac structures can also result in chest pain syndromes. CT coronary angiography (CTCA) provides a non-invasive method for anatomical imaging of coronary artery disease. Whilst it does not replace diagnostic angiography, it provides a reliable 'rule out' of significant coronary artery disease in at least low to intermediate risk groups.

Paratransplant Hernia: A True Emergency After Renal Transplant.

We report a case of paratransplant hernia, a rare surgical complication of a renal transplant. It is caused by entrapment of the bowel through a defect in the peritoneum, which lines on the transplanted kidney. Careful dissection and meticulous surgical technique during transplant, closing any peritoneal defect, regardless of size, can avoid this complication.

Ciliated foregut cyst of the gallbladder. A diagnostic challenge and management quandary.

Ciliated foregut cysts are rare anomalies due to aberrant embryological development. Only a small number of gallbladder ciliated foregut cysts have been reported. We report the case of a 29-year-old woman presenting with epigastric pain associated with diarrhoea and vomiting, who was found to have raised serum bilirubin levels and abnormal liver function tests.

Radiotherapy-induced skin reactions: assessment and management.

Radiotherapy, the use of high-energy rays to either kill cancer cells or treat some benign tumours, is undoubtedly a positive intervention. However, as the primary mode of action in radiotherapy treatment is the killing of cells to prevent replication, other non-cancerous cells may be affected. For example, up to 85% of patients will experience some form of skin reaction, which will range from local erythema to moist desquamation.

Systematic review of the use of bone turnover markers for monitoring the response to osteoporosis treatment: the secondary prevention of fractures, and primary prevention of fractures in high-risk groups.

Background: There is currently no standard practice for the monitoring of patients receiving treatment for osteoporosis. Repeated dual-energy X-ray absorptiometry (DXA) is commonly used for monitoring treatment response, but it has its limitations. Bone turnover markers have advantages over DXA as they are non-invasive, relatively cheap and can detect changes in bone turnover rates earlier.

Two cases of culture proven Mycobacterium tuberculosis presenting with a broad-complex tachycardia and non-caseating granulomas.

Tuberculosis is a leading cause of death worldwide. It affects pulmonary and extra-pulmonary sites with a multitude of differing presentations. In this report, we describe two cases in which TB causes myopericarditis and presents with a broad-complex tachycardia that did not respond typically to standard anti-arrhythmic therapy; a very rare presentation with limited description in the literature.

Ethnicity differences in genetic susceptibility to ulcerative colitis: a comparison of Indian asians and white northern Europeans.

Background: Studies in Caucasian populations have identified a number of genetic associations with ulcerative colitis (UC), but reports from other ethnic groups have been limited. Recent studies from India have reported an association with UC and a single polymorphism (SNP) in CARD15/NOD2 (SNP5, rs2066842), which has not been reported in Caucasian UC cohorts. In addition, strong genetic associations with SNPs in the HLA region have been reported in Indian UC populations.

Spinal extradural solitary fibrous tumor with retiform and papillary features.

We report a 66-year-old man with a spinal, extradural solitary fibrous tumor showing unique retiform and papillary architecture. The patient presented in May 2008 with worsening right-sided lower back pain and urinary frequency. Magnetic resonance imaging of the spine documented a heterogeneously enhancing dumbbell-shaped extradural lesion causing cord compression at T11/12 level.

Missing red flags in back pain--tuberculosis of the spine: an important differential for back pain in non-endemic countries.

Chronic back pain is an extremely common complaint. All primary care physicians will be on the lookout for the 'red flags' that suggest serious pathology. The diagnosis of spinal infection with tuberculosis (TB) is uncommon and often not considered, especially in areas where the rate is very low such as the south west of England.

Surgical Trainee Opinions in the United Kingdom Regarding a Three-Dimensional Virtual Mentoring Environment (MentorSL) in Second Life: Pilot Study.

Background: Medical mentoring is becoming increasingly complex with the evolving needs of trainees and the complexities of their personal and social lives. The Internet is an enabling technology, which increasingly facilitates interaction with multiple people at a distance. Web 2.

Transplant of kidneys with small renal cell carcinoma in incompatible, heavily immunosuppressed recipients.

Renal cell carcinoma (RCC) is considered a contraindication for transplant. However, an increasing number of cases of transplant kidneys with RCC have been reported with encouraging results. We present our experience of two cases of transplanting kidneys with small RCCs.

Massive levemir (long-acting) insulin overdose: case report.

A 52-year-old insulin-dependant diabetic man presented to the Emergency Department 2 hours after a deliberate massive overdose of 2100 units of long-acting Levemir insulin and a large quantity of whisky. On initial assessment, his GCS was 3/15 and his capillary blood sugar was 2.6 mmol/L.

Salivary duct carcinomas can be classified into luminal androgen receptor-positive, HER2 and basal-like phenotypes.

Aims: The aim of this study was to devise a molecular classification for salivary duct carcinomas (SDCs) based on the similarities between SDCs and breast carcinomas and on characteristics of the microarray-based gene expression profiling-defined molecular subtypes of breast cancer.

Methods And Results: Forty-two pure salivary duct carcinomas, 35 of which contained an in-situ component as defined by histological review and/or immunohistochemical analysis, were stained with antibodies for oestrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin (CK) 5/6. Based on these markers, tumours were classified into HER2, luminal androgen receptor-positive, basal-like, luminal and indeterminate phenotype.

The 'Silver Book' on elderly care in hospitals and community settings.

The number of people aged 85 and over is set to increase by two-thirds in the next 20 years, making it imperative that appropriate structures are in place and guidance is available for clinicians in every setting on best practice in caring for older people over the first 24 hours of an urgent care episode. This article discusses the launch of the Silver Book, which recommends ways in which emergency admissions can be reduced and the experience of those admitted improved.