High Grade Gynecomastia: Surgical Correction and Potential Impact on Erectile Function

IntroductionGynecomastia denotes benign enlargement of the male breast. It is a common belief that gynecomastia is stigmatizing and may frequently cause social embarrassment and psychological stress. It is possible that this may reflect on erectile function of the afflicted. High grade gynecomastia requires radical breast tissue excision and skin reduction ending up in aesthetically unappealing scars.AimThe purpose of this study is to evaluate the reduction mammaplasty using no vertical scar technique in males with high grade gynecomastia; as regards technical refinements and outcome in the hope of providing a cosmetically appealing solution to this condition. This study also reports on the effect of high grade gynecomastia on erectile function, as well as the effect of surgery.MethodsFifteen male patients with gynecomastia underwent breast reduction using the “no vertical scar reduction mammaplasty.” Erectile function was evaluated before and after surgery.Main Outcome MeasuresSurgical outcome and erectile function.ResultsAll patients but one were satisfied with the outcome. Complications were minimal and manageable. Eleven out of 15 patients had a preoperative International Index of Erectile Function (IIEF) score less than 20 denoting erectile dysfunction. All but one (n = 10) showed improvement in their IIEF score following surgery. The difference between pre-operative IIEF (average 17.8) and postoperative (average 23.5) was statistically significant.ConclusionsThe “no vertical scar reduction mammaplasty” is a reliable technique in cases with gynecomastia and significant ptosis. It has the added benefits of avoiding the vertical scar, hiding the transverse scar in the shadow of the inferior aspect of the breast, with minimal complications. Gynecomastia as a condition causing a feminized outlook may have a negative impact on self confidence and body image. We suggest that this may have a potential negative effect on erectile function, that can be improved by adequate surgical correction. El Noamani S, Thabet AM, Enab AA, Shaeer O, and El-Sadat A. High grade gynecomastia: Surgical correction and potential impact on erectile function.     

Ischemic Gastropathy: An Unusual Cause of Abdominal Pain and Gastric Ulcers

Chronic mesenteric ischemia classically presents as “intestinal angina” with generalized postprandial abdominal pain lasting up to 3 hours. Over time, these episodes can become much more intense and ultimately lead to sitophobia with significant weight loss. Symptoms are not specific and often mistakenly attributed to other gastrointestinal etiologies such as peptic ulcer disease. Gastric ulcerations as a direct result of mesenteric ischemia have been reported but are relatively rare because of the rich collateral blood supply to the stomach. Therefore, a diagnosis of ischemic gastropathy is seldom entertained in patients presenting with abdominal pain and gastriculcers.     

Uric Acid Directly Promotes Human T-Cell Activation

BackgroundAbnormally high serum uric acid levels have been associated with several disease conditions including gout and kidney stone disease. More recently, it was shown that uric acid crystals stimulate dendritic cell maturation, activate the NALP3 inflammasome, and enhance antigen-specific immune responses. We hypothesize that uric acid can also stimulate T cells directly and in the absence of antigen presentation.MethodsPurified primary human T cells were incubated with and without uric acid at concentrations of 50, 100, 150, and 200 μg/mL. The expression of T-cell activation markers CD25 and CD70 was assessed by flow cytometry. In other experiments, Jurkat T cells were used and the expression of the costimulatory molecule CD70 was determined at the mRNA level.ResultsUric acid directly activates primary human T cells in the absence of antigen presentation. Furthermore, primary human T cells and Jurkat T cells treated with uric acid overexpress the costimulatory molecule CD70, which plays an important role in T cell-B cell interaction and antibody production.ConclusionsThe finding that uric acid directly promotes T-cell activation in an antigen-independent system is novel and might play a mechanistic role in the inflammatory response observed in gouty arthritis and other immune-mediated diseases.     

ST Segment Analysis by Holter Monitoring:

Background: There has been a renewed interest in ST segment analysis by Holter Monitoring, especially in multicenter clinical trials, but consensus on how to define an ischemic event is missing. We conducted a survey of European and U.S. publications involving ST segment analysis by Holter monitoring from 1975 to 2002 and found no notation of any correction for baseline ST segment depression in 52% of them. In 45% J‐point depression was required in addition to ST segment depression measured either 60 ms (24%) or 80 ms (76%) after the J point. In 28% ST segment elevations were included. Method: Four different criteria for an ischemic event found in our survey were applied to Holter recordings from 66 patients with acute ischemic syndrome enrolled in the Esmolol Myocardial Ischemia Trial (EMIT). Only lead CM5 was used and the analyzer was a Reynolds Medical Pathfinder 600. Results: By the most sensitive method (J + 80) , there were 16 (24%) patients who had ischemic events in their Holter recording compared to only 10 (15%) patients if J‐point depression was also required. If corrections were made for baseline ST segment depression, only 3 (4.5%) recordings were positive for ischemia. Conclusion: The outcome of Holter analysis for ischemic events is greatly dependent upon how an ischemic event is defined. Consensus on how to define an ischemic event is urgently needed.     

Adenosine bronchial provocation with computerized wheeze detection in young infants with prolonged cough: correlation with long-term follow-up

BACKGROUND: Chronic cough in babies is often associated with bronchial hyperreactivity (BHR). The objective documentation of BHR in babies is difficult, and acoustic methods have been described (provocative concentration of a substance causing wheeze) for conducting bronchial provocation tests (BPTs). We conducted a study to evaluate automatic computerized wheeze detection (CWD) in determining BHR in young infants with prolonged cough, and its correlation with the subsequent development of wheezing. METHODS: Infants aged < 24 months with prolonged cough (ie, > 2 months) underwent acoustic BPTs with the response determined by CWD and auscultation by a physician. Telephone interviews with parents were conducted after 1 month and yearly for the next 3 years. RESULTS: A total of 28 infants who were 4 to 24 months old with prolonged cough were included in the study. Twenty of these infants (71.4%) had BHR as determined by a positive acoustic BPT result. In 11 of these 20 tests, the CWD occurred earlier, and in 9 tests it occurred at the same step as auscultation by a physician. Rhonchi or whistles often preceded wheezes. Seventeen of the 20 patients with BHR completed 3 years of follow-up. Of these, 14 had recurrent episodes of wheezing and shortness of breath, and 3 were well. Six of the eight adenosine-negative patients completed 3 years of follow-up and had no symptoms of BHR. CONCLUSIONS: Acoustic BPT is a technically feasible test for the detection of BHR in young infants. CWD provides an earlier detection of wheeze than stethoscope auscultation. In our group of infants, a positive acoustic BPT result had high correlation with symptoms compatible with BHR over the next 3 years.     

How good is endoscopic ultrasound for TNM staging of gastric cancers？ A meta-analysis and systematic review

AIM： To evaluate the accuracy of endoscopic ultrasound （EUS） for staging of gastric cancers.
METHODS： Only EUS studies confirmed by surgery were selected. Only studies from which a 2×2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing ＆ allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2×2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method （fixed effects model） and DerSimonian Laird method （random effects model）. The heterogeneity of studies was tested using Cochran＇s Q test based upon inverse variance weights.
RESULTS： Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies （n = 1896） which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% （95% CI： 84.5-91.1） and T2 was 82.3% （95% CI： 78.2-86.0）. For T3, pooled sensitivity was 89.7% （95% CI： 87.1-92.0）. T4 had a pooled sensitivity of 99.2% （95% CI： 97.1-99.9）. For nodal staging, the pooled sensitivity for N1 was 58.2% （95% CI： 53.5-62.8） and N2 was 64.9% （95% CI： 60.8-68.8）. Pooled sensitivity to diagnose distant metastasis was 73.2% （95% CI： 63.2-81.7）. The P for chi-squared heterogeneity for all the pooled accuracy estimates was 〉0. 10.
CONCLUSION： EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is     

Identification of T lymphocytes in human mixed hemopoietic colonies

The addition of a T-cell growth-promoting medium (PHA-TCM) to culture conditions that support growth of multi-lineage hemopoietic colonies enhances the proliferation of cells with lymphoid morphology within these colonies. These cells were identified as T lymphocytes by their ability to form rosettes with SRBC and their reaction with monoclonal antibodies (OKT3, OKT4) directed against T-cell-specific surface components. They continue to proliferate extensively under the influence of PHA-TCM after transfer of mixed colonies into liquid suspension culture. Supportive evidence for a common progenitor of myeloid and lymphoid cells within single mixed colonies is provided by Y-chromatin body analysis of E-rosette positive and negative cells in colonies grown in cocultures of male and female bone marrow cells.