Placenta percreta with invasion of the bladder wall: management with a multi-disciplinary approach.

Placenta percreta with pelvic organ invasion carries a high mortality for mother and fetus. Appropriate multidisciplinary consultation, strategy, and preoperative planning for Cesarean hysterectomy permitted caregivers to provide a maternal-infant bonding experience, surgical hemostasis, preservation of bladder function, and a healthy, vigorous neonate.

Physician stated atrial fibrillation management in light of treatment guidelines: data from an international, observational prospective survey.

Background: The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RecordAF) study is the first worldwide, prospective, survey of real-life management of atrial fibrillation (AF) in recently diagnosed patients (n = 5604) with a 1-year follow-up.

Hypothesis: Surveys of AF management have identified a divergence between guidelines and clinical practice, and an overinterpretation of guidelines in low-risk patients.

Methods: : Physicians' theoretical approaches to rhythm and rate control were investigated using a pre-study questionnaire.

Radiation therapy of recurrent anal squamous cell carcinoma in-situ: a case report.

Introduction: High-grade anal intraepithelial neoplasia, also referred to as anal squamous carcinoma in-situ, or Bowen's disease of the anus, make up less than 1% of all digestive system cancers in the United States. The treatment of choice is surgical resection with anal mapping. However, this disease often recurs or persists, requiring additional surgery for these patients.

What is the optimal gestational age for history-indicated cerclage placement?

We estimated the optimal gestational age for placement of a history-indicated cerclage in a retrospective cohort study of pregnancies during the period between 1994 to 2007. Pregnancies were divided into two groups: group 1, cerclage <14 weeks (N = 83), and group 2, cerclage >or=14 weeks (N = 59). The primary outcome was spontaneous preterm birth (SPTB) <35 weeks.

Incredibly late thromboses in first generation drug eluting stents: a case series.

Background: The drug-eluting stents have decreased the incidence of instent restenosis compared to bare metal stents. But, the incidence of late and very late stent thrombosis has increased with the drug-eluting stents.

Case Presentation: We are here, reporting three cases of incredibly late instent thrombosis, each one occurring after more than 50 months of drug-eluting stent placement.

Adjuvant therapy for atrial fibrillation.

Atrial fibrillation (AF) is the most common heart rhythm disorder, with increasing prevalence in the aging US population and affecting more than 2.3 million people. Current approaches for managing AF are rate- or rhythm-control strategies, both using anti-thrombotic therapy to prevent thromboembolism.

Vernakalant hydrochloride for the rapid conversion of atrial fibrillation after cardiac surgery: a randomized, double-blind, placebo-controlled trial.

Background: Postoperative atrial arrhythmias are common and are associated with considerable morbidity. This study was designed to evaluate the efficacy and safety of vernakalant for the conversion of atrial fibrillation (AF) or atrial flutter (AFL) after cardiac surgery.

Methods And Results: This was a prospective, randomized, double-blind, placebo-controlled trial of vernakalant for the conversion of AF or AFL after coronary artery bypass graft, valvular surgery, or both.

Use of antibacterial agents in renal failure.

This article provides background information on the pharmacokinetics of antibacterial agents in patients who have normal and impaired renal function. Tables are provided to allow quick determination of appropriate dosages for varying degrees of renal failure. The use of serum levels; newer strategies for cefazolin, vancomycin and aminoglycoside dosing; methods of dialysis and associated antibiotics dosage adjustments, and antibiotic toxicity in renal failure are reviewed.

Mallory-Weiss tear diagnosed in the immediate postpartum period: a case report.

Background: Mallory-Weiss tears occur rarely during pregnancy, labour and delivery, and the puerperium, despite the increased frequency of retching and vomiting.

Case: We describe a Mallory-Weiss syndrome diagnosed during the immediate postpartum period in a 34-year-old primigravida. The syndrome initially manifested as lower gastrointestinal bleeding and melena.

Tissue inhibitor of metalloproteinase-4 is elevated in early-stage breast cancers with accelerated progression and poor clinical course.

An increasing number of breast cancer patients are diagnosed with small, localized, early-stage tumors. These patients are typically thought to have a good prognosis for long-term disease-free survival, but epidemiological studies indicate that up to 30% may have a recurrence within 3 to 5 years of diagnosis. Identifying patients with a high risk of recurrence and/or progression is important because they could be more aggressively treated at diagnosis to improve their chances for disease-free survival.

Dronedarone.

Amiodarone is the most effective antiarrhythmic drug for maintaining sinus rhythm for patients with atrial fibrillation. Extra-cardiac side effects have been a limiting factor, especially during chronic use, and may offset its benefits. Dronedarone is a noniodinated benzofuran derivative of amiodarone that has been developed for the treatment of atrial fibrillation and atrial flutter.

Overuse of stress ulcer prophylaxis in the critical care setting and beyond.

Background: Patients admitted to the intensive care unit (ICU) are susceptible to stress ulcers. We hypothesize that despite recommendations, stress ulcer prophylaxis (SUP) is still overused in the ICU and often continued after resolution of risk factors for bleeding.

Methods: We retrospectively studied all ICU admissions for 4 months.

Large obstructive cardiac myxofibrosarcoma is nearly invisible on transthoracic echocardiogram.

Malignant primary cardiac tumors are exceptionally rare, and the most common of these are sarcomas. We present a case of a patient who was found to have a large mass in the left atrium causing obstruction of mitral inflow. Only selected views on a transthoracic echocardiogram reveal the mass and its hemodynamic effect.

Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report.

Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein.

When lightning strikes: bolting down the facts & fiction.

MYTH: There's no danger from lightning until the rain starts. FACT: Lightning often precedes the storm by up to 10 miles. A reasonable guideline is the "30-30 rule," by which you count the seconds between the flash and the thunder.

Purtscher-like retinopathy associated with primary hypereosinophilic syndrome.

Purpose: To describe a patient with undiagnosed primary hypereosinophilic syndrome (HES) who presented with Purtscher-like retinopathy and to review the literature.

Methods: Observational case report.

Patient: A 25-year-old man presented with a 1-week history of bilateral visual blur.

Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy.

Background: Neoadjuvant therapy for rectal cancer has led to improved tumor downstaging and higher complete pathologic response rates. At the same time, the introduction of transanal endoscopic microsurgery (TEM) technique has renewed interest in local excision of rectal cancer. There has been concern that radiation may make the more radical local excision with TEM unsuitable.

Stentless versus stented bioprosthetic aortic valves: a systematic review and meta-analysis of controlled trials.

Objective: : This meta-analysis sought to determine whether stentless bioprosthetic valves improve clinical and resource outcomes compared with stented valves in patients undergoing aortic valve replacement.

Methods: : A comprehensive search was undertaken to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in patients undergoing aortic valve replacement available up to March 2008. The primary outcomes were clinical and resource outcomes in randomized controlled trial (RCT).