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Praveen Srivastava Group

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Jonathan Jones
Jonathan Jones

Patient Seventeen

Methods and results: All epicardial leads and 1239 outpatient visits between January 1, 1983, and June 30, 2000, were retrospectively reviewed. Pacing and sensing thresholds were reviewed at implant, at 1 month, and at subsequent 6-month intervals. Lead failure was defined as the need for replacement or abandonment due to pacing or sensing problems, lead fracture, or phrenic/muscle stimulation. A total of 123 patients underwent 207 epicardial lead (60 atrial/147 ventricular, 40% steroid) implantations (median age at implant was 4.1 years [range 1 day to 21 years]). Congenital heart disease was present in 103 (84%) of the patients. Epicardial leads were followed for 29 months (range 1 to 207 months). The 1-, 2-, and 5-year lead survival was 96%, 90%, and 74%, respectively. Compared with conventional epicardial leads, both atrial and ventricular steroid leads had better stimulation thresholds 1 month after implantation; however, only ventricular steroid leads had improved chronic pacing thresholds (at 2 years: for steroid leads, 1.9 muJ [from 0.26 to 16 mu]; for nonsteroid leads, 4.7 muJ [from 0.6 to 25 muJ]; P

Patient Seventeen

The following case report shows photographs of a patient who is being treated for pemphigus vulgaris by the author. This section takes a closer look at some individual cases including disease stage, signs and symptoms, therapy, and treatment results.

Discover the world of abductions, scalar wave transmissions, and a program to study or manipulate the human race. Armed with a patient, a scalpel, black lights and a stud finder; we seek to verify the authenticity of this alleged Off-World Implant Technology."

Discover the world of abductions, scalar wave transmissions, and a program to study or manipulate the human race. Armed with a patient, a scalpel, black lights and a stud finder; we seek to verify the authenticity of this alleged Off-World Implant Technology.

A guy says he has an alien implant. A doctor agrees and removes it. They send it for analysis and the results are read but not really shown and then interpreted pretty loosely by a previous patient #. A surprised director doesn't realize the so-called expert is also a patient who had an implant removed. Seriously?????

Brainstem gliomas are an important oncologic problem in the pediatric age group, constituting between 10 and 15% of childhood central nervous system neoplasms. A new classification scheme based on magnetic resonance imaging (MRI) has recently been proposed leading to speculation that gadolinium-DTPA-enhanced MRI may prove useful in defining the prognosis of subsets of patients with these tumors. We retrospectively reviewed gadolinium-DTPA-enhanced MRIs in 26 consecutive newly diagnosed pediatric patients (11 males, 15 females) from our institution between June 1988 and June 1994 with the diagnosis of diffuse brainstem glioma. The site, extent of invasion, T1 and T2 signals, and the pattern and the degree of contrast enhancement of the tumors were evaluated. We correlated the image features, clinical symptoms, and survival period in each patient. Seventeen tumors demonstrated contrast enhancement and 9 did not. The survival in the whole group ranged between 3 months and > 5 years with a median of 9 months. There was no statistical difference in the median survival between patients with or without contrast enhancement (11 versus 8 months).

Leptomeningeal carcinomatosis (LMC) is frequently associated with hydrocephalus, which quickly devastates the performance of the patient. Cerebrospinal fluid (CSF) shunt is a widely accepted treatment of choice, but the clinical outcomes in patients with LMC are not well studied. This study aimed to examine the efficacy of a CSF shunt in patients with LMC.

Seventy patients with LMC confirmed by cytology or magnetic resonance imaging (MRI) underwent ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt surgery. We retrospectively analyzed the clinical characteristics of patients, symptom improvement after the shunt, rate of complications associated with the surgery, and overall survival.

Infiltration of the CSF space by cancer cells may obstruct CSF pathways and cause CSF malabsorption, resulting in increased intracranial pressure (ICP) and/or hydrocephalus [9]. The common presenting symptoms of LMC include headache, nausea, vomiting, and altered mentality, all of which are related to increased ICP and hydrocephalus. Increased ICP causes an uneven distribution of intrathecally or intraventricularly administered drugs, making them less effective [10]. Thus, hydrocephalus and increased ICP degrade the performance and prognosis of patients with LMC.

Although CSF shunt surgery is a relatively simple neurosurgical procedure, the percentage of patients who receive it is less than the incidence of increased ICP, and its outcomes are little and rarely reported [11,12,13]. As the prognoses of patients with LMC are poor, there is a tendency for physicians to decline aggressive treatment such as surgical intervention. Furthermore, complications such as hemorrhage, infection, and device malfunction, along with the risk of peritoneal transfer of cancer cells, are reasons to not perform CSF shunt in patients with LMC [14, 15].

This retrospective study aimed to evaluate the efficacy of CSF shunt in patients with LMC in terms of (1) symptom improvement, (2) malfunction rate, including cancer cell-caused obstruction or spillage, and (3) overall survival (OS) benefit.

This retrospective review was based on the electronic medical records of 70 consecutive patients that underwent placement of either ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt for treatment of increased ICP or hydrocephalus secondary to LMC between 2002 and 2017 at a single institution, National Cancer Center, Korea. All patients were diagnosed by CSF cytology and had a suggestive or definite finding of LMC [16] on gadolinium-enhanced MRI. This retrospective study was reviewed and approved by the Institutional Review Board of the National Cancer Center of Korea (NCC2018-0043).

Fifty-one and 19 patients underwent VP shunt and LP shunt, respectively. There was no predilection for shunt type according to preceding disease. Forty-six patients (92%) with VP shunts and 13 patients (68%) with LP shunts had a programmable valve [that difference was because of late availability of programmable valves for LP shunt (since 2012)].

Shunt malfunction occurred in eight patients. In four patients, shunt function study documented the malfunction site. Two patients with VP shunts and glioblastoma (case 9) and medulloblastoma (case 10) showed distal and ventricular catheter obstruction, respectively. No cancer cell obstruction but only myxoid material was found in the ventricular catheter from the patient with medulloblastoma. Two patients with LP shunts with fixed pressure-valve reservoirs had proximal catheter obstruction (case 14) and distal catheter leakage at the junction with the reservoir (case 16), respectively. In another two patients, X-ray examination revealed mechanical failures due to proximal catheter migration (case 11) and distal catheter malposition into the pre-peritoneal space (case 13), respectively. The remaining two patients had LP shunts with fixed pressure-valve reservoirs. Under-drainage was suspected in those patients because of deterioration before revision, although neither obstruction nor malfunction was found during revision surgery. One patient received a VP replacement shunt (case 12), and the other received an intraventricular Ommaya (case 15).

This is the conceit of Patient Seventeen, a new documentary released last month by Jeremy Kenyon Lockyer Corbell. Patient Seventeen chronicles the final surgery of Roger Leir, a foot surgeon and prominent ufologist who claimed to remove extraterrestrial nanotechnology that had been embedded in his patients.

It was these hostile encounters with extraterrestrials in his childhood that led Patient Seventeen to seek out Leir to surgically remove what could be invasive alien technology. Leir claimed to have surgically removed embedded extraterrestrial nanotechnologies from seventeen different patients, although he never seemed interested in sharing his data or these objects with other researchers.

Moderate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.

In-hospital mortality was 2.8% (3 patients). The causes of the in-hospital death were cerebral infarction (1 patient), respiratory failure (1 patient) and low cardiac output syndrome (1 patient). The early postoperative period was complicated in two patients by atrioventricular block requiring pacemaker implantation. Univariate analysis identified left ventricular ejection fraction (LVEF)

The present study demonstrated satisfactory outcomes of AVR with 17-mm SJMR valve in terms of midterm survival, physical capacity and hemodynamic performances. The data of our study corroborate with previous studies indicating the presence of moderate P-PtM early after surgery was not a risk factor of intermediate mortality. However, in our subgroup analysis, moderate P-PtM was associated with a significant decrease in overall survival in patients with impaired LV systolic function. These findings emphasize the importance of a prospective strategy for selection of appropriate AVR candidate and operative methods to achieve satisfactory results in patients with small aortic annulus.

Previous studies have demonstrated that the influence of P-PtM on postoperative outcomes is an age-dependent phenomenon. As reported by Mohty et al. [12] and Moon et al. [20], moderate -to- severe P-PTM was detrimental to survival in young patients (

Moderate P-PtM after implantation of a small mechanical prosthesis at aortic position is associated with increased midterm mortality and valve-related complications in patients with pre-existing LV dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical results and midterm survival after isolated AVR with a 17-mm SJMR valve. 041b061a72


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