Alterations in heart rate variability before and after percutaneous coronary intervention in patients with ischaemic heart disease

Objectives: Heart rate variability (HRV) is the beat-to-beat variation of heart rate and an important non-invasive tool to study the cardiac autonomic nervous system activity. Ischaemic heart disease (IHD) patients are often considered to have a state of sympathetic predominance. Elimination of myocardial ischaemia with percutaneous coronary intervention (PCI) could restore autonomic balance. Hence, this study aimed to evaluate HRV measures, after successful revascularisation among IHD patients. Materials and Methods: A total of 145 male IHD patients planned for coronary angiography were recruited. Fifteen minutes of electrocardiogram recording was done. Short-term HRV analyses of all the patients were acquired and time-domain indices (standard deviation of normal-to-normal intervals [SDNN], root-meansquared differences of successive R-R intervals [rMSSD]) and frequency-domain indices (low-frequency [LF] power, high-frequency [HF] power and total power [TP]) were analysed. Before and after PCI, all measurements were made. Results: This study included 145 male IHD patients with the mean age of 54.57 ± 10.81 years. There was a significant decrease in SDNN, rMSSD, LF, HF and TP whereas increase in LF/HF ratio following revascularisation. These changes in measures of neurocardiac regulation correlated with risk factors and medication on regression analysis. Conclusion: Increase in LF/HF ratio with the decrease in SDNN, rMSSD, LF, HF and TP in patients with IHD who underwent coronary intervention infers changed cardiac autonomic balance with this surgical procedure. These measures could be potentially used as prognostic measures in the future studies.

Dual surrogate markers for rapid prediction of epidermal growth factor receptor mutation status in advanced adenocarcinoma of the lung: A novel approach in resource‑limited setting.

INTRODUCTION: Tyrosine kinase inhibitors have revolutionized the treatment of metastatic lung cancer in patients with epidermal growth factor receptor (EGFR) mutations. Amplified refractory mutation system (ARMS)‑reverse transcription‑polymerase chain reaction (RT‑PCR), the current standard for detecting EGFR mutation status is time‑consuming and highly expensive. Consequently any surrogate test which are cheaper, faster and as accurate as the PCR method will help in early diagnosis and management of patients with lung cancer, especially in resource‑limited settings. MATERIALS AND METHODS: Eighty‑five patients, all of South Indian origin, with adenocarcinoma of lung, registered between October 2009 and January 2013, were evaluated for EGFR mutation status by using scorpion probe based ARMS RT‑PCR method. Immunohistochemical (IHC) was performed using the phosphorylated AKT (P‑AKT) and thyroid transcription factor‑1 (TTF‑1) on above patient’s sample, and the results were compared with EGFR mutation tests. RESULTS: EGFR mutation was positive in 34 of 85 patients (40%). P‑AKT and TTF‑1 were positive in 50 (58.8%) and 68 (80%) patients respectively. Both P‑AKT and TTF‑1 had statistically significant correlation with EGFR mutation status. Positive and negative predictive value of P‑AKT in diagnosing EGFR mutation was 58% and 85.5% and that for TTF‑1 was 48.5% and 94.1%, respectively. The problem of low positive predictive value can partly be overcome by testing P‑AKT and TTF‑1 simultaneously. CONCLUSION: P‑AKT and TTF‑1 using IHC had statistically significant correlation with EGFR mutation with high negative predictive value. In the case of urgency of starting treatment, EGFR mutation testing may be avoided in those patients who are negative for these IHC markers and can be started on chemotherapy.

Minimally invasive radioguided surgery for parathyroid adenomas (MIRP).

BACKGROUND: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Conventional surgical management includes bilateral neck exploration with removal of the adenoma(s) and biopsy of one of the other glands with visualization of all glands. It is associated with a risk of permanent hypoparathyroidism. Radioguided excision of parathyroid adenoma is a widely accepted technique which provides accurate localization and complete excision of the lesion with low morbidity. We report our experience with this technique. METHODS: We performed radioguided excision of parathyroid adenomas in 15 patients. All of them had preoperative localization of the adenoma using a dual tracer, dual phase 99mTc-Sestamibi scan. A dose of 8-10 mCi of 99mTc-Sestamibi was injected intravenously 2 hours before surgery. Under local anaesthesia, surgical excision of the lesion was done after localizing it using a hand-held gamma probe. Complete excision was confirmed by frozen. section of the excised lesion and an intraoperative quick parathormone assay. RESULTS: The 99mTc-Sestamibi scan revealed an increased uptake by the adenoma in all patients and complete excision was possible in all the patients. Frozen section confirmed the diagnosis and the quick parathormone assay (within 15 minutes) revealed a drop in parathormone levels to < 50% after excision in all of them. Three patients developed hypocalcaemia postoperatively and were treated with intravenous calcium supplementation. At a follow up of 2-29 months, all the patients were normocalcaemic. The renal functions improved in 2 of 6 patients who had renal failure. CONCLUSION: Minimally invasive radioguided excision of parathyroid adenomas is a simple, safe and effective technique associated with a low morbidity and can be done as a day-care procedure.

Neoadjuvant chemotherapy before surgery of hepatoblastoma.

Though surgical resection is the main stay of treatment for childhood hepatoblastoma (HB), many are unsuitable for radical surgery at diagnosis due to extensive intrahepatic and/or extra hepatic disease. We report experience in five patients of HB from a single institution (2001-2005) with preoperative Neoadjuvant chemotherapy (NACT) followed by surgery. Three patients received cisplatin, doxorubicin; and two cisplatin / vincristine /5-fluorouracil. All showed more than 50% reduction in tumor size confirmed by CT scan. Hepatic resection R0 was performed in all. There was no chemotherapy related toxicity nor post surgical morbidity or mortality. All are disease free at median follow up of 4 years. NACT produces adequate down staging of the HB with acceptable toxicity. Though cisplatin with doxorubicin produced good results, new protocol with cisplatin, vincristine and 5FU is promising without cardiotoxicity.

Blood bioamines, cortisol and aminoacid levels in leukemic patients.

In patients of chronic myeloid leukemia blood adrenaline, noradrenaline, dopamine and glutamate level were significantly elevated. The GABA levels were decreased along with no significant alterations in aspartate levels in these patients. In cases of acute myeloid leukemia only adrenaline and glutamate levels were enhanced with decreased GABA levels. However, plasma cortisol levels were significantly enhanced in both chronic and acute myeloid leukemia patients. These observations suggest that the circulating bioamines, cortisol and certain aminoacids level are considerably altered in chronic and acute myeloid leukemia. All these changes may possibly be attributed to the stress induced by the disease.