Background: The incidence of venous thromboembolism (VTE; combined deep vein thrombosis-DVT and pulmonary embolism- PE) rises with age, especially over 65 years. Immobilization and cancer are important etiologies. There are no studies in the subset of very elderly patients (>90 years). Methods: We undertook a retrospective observational study for PE in patients above 90 years, to study the presenting symptoms, etiology and outcomes. Results: 20 patients over 90 years of age were referred for VTE over one year, of which 7 had PE. Tachypnoea (4/7; 57%) observed by the carer was the most common symptom. All patients had hypoxia on monitoring. Electrocardiogram showed sinus tachycardia with no changes of right ventricular strain; despite four of the seven patients having massive/ submassive PE. Asymptomatic proximal DVT was found in 3 of the 7 patients. The other patients likely had an insitu PE. None had a prior history of VTE. 6 of the 7 patients had immobility (> 3 months) as the risk factor. Only one patient was found to have a newly diagnosed colon cancer, investigated for iron defi - ciency anemia. Age related cancer screening was not performed in view of advanced age and poor functional status. The patient with colon cancer had a Inferior vena cava fi lter inserted, while the rest received Warfarin or Low molecular weight heparin with careful monitoring for a period of three months. None had a major bleed. Conclusions: Increased respiratory rate and hypoxemia is the commonest clinical presentation. Increased awareness by the carer is essential. Immobility remains a major non modifi able risk factor. Despite this, none were given extended duration of anticoagulation. We propose a data registry from different institutions given the small subset of patients to further study this vulnerable group.
CdSe/CdS/ZnS and CdTe quantum dots (QDs) were synthesized by successive ion layer adsorption and reaction (SILAR) technique and direct aqueous synthesis respectively using thiol stabilizers. Synthesized CdSe/CdS/ZnS and CdTe QDs stabilized with 3-mercaptopropionic acid (MPA) and mercaptosuccinic acid (MSA) were used as fluorescent labels after conjugation with folic acid (FA) and anti-HER2 antibodies. Photoluminescence quantum yield of folated CdSe/CdS/ZnS-MPA and CdTe-MSA QDs was 59% and 77% than that of non-folated hydrophilic QDs. The folate receptor-mediated delivery of folic acid-conjugated CdTe-MSA and CdSe/CdS/ZnS-MPA QDs showed higher cellular internalization as observed by confocal laser scanning microscopic studies. Folated and non-folated CdTe-MSA QDs were highly toxic and exhibited only 10% cell viability as compared to > 80% cell viability with CdSe/CdS/ZnS-MPA QDs over the concentration ranging from 3.38 to 50 pmoles. Immunohistochemistry (IHC) results of human breast cancer tissue samples showed positive results with anti-HER2 antibody conjugated CdSe/CdS/ZnS-MPA QDs with better sensitivity and specificity as compared to conventional IHC analysis using diaminobenzedene staining.
Radioactive iodine (RAI) ablation is a beneficial, adjuvant therapy for the management of differentiated thyroid cancer (DTC) after thyroidectomy. The goal of RAI is to destroy remnant thyroid and microscopic cancerous tissue. Radioactive iodine uptake is enhanced by elevating TSH levels and initiating a low iodine diet (LID) prior to ablation. An ideal LID should preferably not exceed 50 mcg/day of dietary iodine for 1-2 weeks, although the duration may be shortened to a week with a structured patient education programme. A pre-ablation spot urinary iodine concentration (UIC) of <100 mcg/l and/or a urinary iodine to creatinine ratio (UICR) of <100 mcg/gCr would support an adequate LID preparation. Hyponatraemia, most likely due to iatrogenic hypothyroidism, is a potential side effect associated with LID and occurs during and a few days after the LID. Although the overall incidence of hyponatraemia is low, patients at high risk (older age, female sex, use of thiazide diuretics) may benefit from serum sodium monitoring. The existing evidence on the impact of LID on RAI ablation has been largely inconsistent due to retrospective study designs and the lack of an objective measurement of urinary iodine levels. Future large prospective randomized control trials are needed to elucidate and confirm the crucial role of LID in achieving successful RAI ablation and greater disease-free survival in DTC.
A fissure in ano is a tear in the anoderm distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trauma to the anoderm from any cause. A tear in the anoderm causes acute pain, which results in spasm of the internal anal sphincter and decreased blood supply to the anoderm. This cycle of pain, spasm and ischemia contributes to development of a poorly healing wound that becomes a chronic fissure. In this review article our aim to discuss the surgical management and therapeutic prospectus of anal fistula.
Extramedullary plasmacytoma (EMP) is a plasma cell neoplasm without bone marrow involvement or other systemic characteristics of multiple myeloma.Few large-scale clinical studies have been conducted because of the rarity of EMP, especially when it arises from the mediastinum.Herein we report a rare case of solitary mediastinal plasmacytoma with reactive pleural effusion.A 58-year-old female presented with grade 4 dyspnea and dysphagia, with a mediastinal mass observed with on PET.CT-guided biopsy results were suggestive of IgG kappa-type EMP arising from the anterior mediastinum.The patient was treated with local radiotherapy to the mediastinum, and had clinical and radiological response s were good.Radiotherapy is an effective treatment for mediastinal EMP, but a complete workup is mandatory, including PET, as the majority of such masses coexist with multiple myeloma.(
Extensor mechanism of knee plays important role in successful long term functional outcome after total knee arthroplasty (TKA). Any injury to extensor mechanism during or after surgery can cause functional disability which can be devastating for patients. Patellar tendon injuries are not very common after TKA. The author reported a rare case of patellar tendon mid-substance tear after TKA, which was successfully managed by reconstruction using grafts without any implant.
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