Vasoplegic syndrome during Whipple procedure.

Vasoplegic syndrome is an unusual cause of refractory hypotension under general anesthesia. It is commonly described in the setting of cardiac surgery, but rarely seen in noncardiac setting. We describe successful management of vasoplegic syndrome during Whipple procedure with vasopressin infusion. A high index of suspicion and prompt treatment with vasopressin can be lifesaving in patients with risk factors for vasoplegic syndrome who present with severe refractory hypotension and who respond poorly to fluid administration and routine vasopressor infusion.

The nuances of brachytherapy taught by teachers from beyond: Questionnaire-based assessment of the first cadaveric hands-on brachytherapy workshop in India.

PURPOSE: A questionnaire-based assessment of a cohort of young radiation oncologists attending the first human cadaveric hands-on brachytherapy workshop in India. METHODS AND MATERIALS: The cadaveric workshop for hands-on training in head/neck and gynecologic cancers was a novel process conducted at M.S. Ramaiah Medical College and Hospital, for which 30 attendees from all regions of India took part with an opportunity to interact with experienced resource persons, individually perform the procedure, and indulge in all aspects of brachytherapy process. The questionnaire was part of the workshop and enquired on common practices for head/neck and gynecologic brachytherapy followed by the attendees at their hospitals and their opinion on avenues for learning the skill of brachytherapy and its future as a therapeutic modality. RESULTS: Twenty-seven of thirty attendees were practicing brachytherapy at their centers out of which only 14 (46%) were doing head/neck brachytherapy. In gynecologic procedures, 89% were performing only intracavitary brachytherapy. Twenty attendees (66%) felt lack of expertise was the primary reason for dwindling brachytherapy practice in India. Ten (33%) of them felt that advancements in external radiotherapy were the second major cause for it. Some less important reasons given were lack of suitable cases, fear of toxicity, and reduced remuneration. CONCLUSIONS: Cadaveric brachytherapy workshops may be a practical and cost-effective method to inculcate this unique skill set in the next generation of radiation oncologists. This questionnaire-based assessment has tried to validate this opinion.

Expression of thyroid-stimulating hormone receptor, octamer-binding transcription factor 4, and intracisternal A particle-promoted polypeptide in human breast cancer tissues.

UNLABELLED: Abstract Background: Thyroid-stimulating hormone receptor (TSHR) is one of the members of glycoprotein hormone receptor family; activation of TSHR by thyroid-stimulating hormone (TSH) regulates thyroid function, proliferation, and differentiation. The other family members of glycoprotein hormone receptors, such as leutinizing hormone receptor (LHR), human chorionic gonadotropin (hCG), and follicle-stimulating hormone (FSH) are known to be expressed in nonendocrine tissues including human breast cancer and regulate proliferation and differentiation. The involvement of thyroid hormones in the growth and differentiation of normal breast tissue is well documented. However, the presence of TSHR in breast cancer has not been demonstrated. The aim of the present study was to establish the expression pattern of TSHR along with transcription factors, such as octamer 4 (OCT4) and intracisternal A particle-promoted polypeptide (IPP) in human breast tumor. MATERIALS AND METHODS: For this study, patients with stages I-III breast cancers and adjacent noncancerous tissues were prospectively accrued and analyzed. We employed semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis to determine the expression levels of TSHR in normal and human breast cancer tissues. RESULTS: The results indicated that a significant increase in TSHR expression was observed in tumor tissues compared to normal breast tissues. RT-PCR analysis of OCT4 and IPP also revealed a significant increase in breast tumor tissues over the controls. CONCLUSIONS: To our knowledge, this is the first report demonstrating expression of TSHR and IPP in normal breast and breast tumors. The expression of TSHR, IPP, and OCT4 increased in the human breast tumor samples over the noncancer tissues. However, further studies are needed to establish an unequivocal role for TSHR in breast tumor progression.