T4 sympathectomy for palmar hyperhidrosis: looking for the right operation

Most surgeons still perform T2 or T2-3 sympathectomy for palmar hyperhidrosis (PH), but both of these treatments can cause severe side effects. Some recent articles advocating T4 sympathectomy have obtained satisfactory results. The aim of this study was to compare the outcomes of 3 different levels of sympathectomy. Between July 2003 and July 2006, we treated 60 patients (20 men and 40 women, mean age 26 years) who suffer from palmar hyperhidrosis by endoscopic thoracic sympathectomy (ETS). Patients were divided into 3 groups according to the level of sympathectomy: ETS2, ETS3, and ETS4 (20 patients in each group). Data were collected by review of medical charts, outpatient clinic notes, and telephone interviews. Patients were asked whether they considered their symptoms to be "cured" or "unchanged." The degree of hand dryness was assessed subjectively. Postoperative complications (wound infection, chest pain, and Horner's syndrome) were assessed. Any occurrence of gustatory sweating, rhinitis, presence and region of reflex compensatory sweating, and recurrence was noted. Patient satisfaction was assessed. Treatment success at follow-up was 90% for the ETS2, 95% for ETS3 patients, and 100% for the ETS4 patients. In the ETS2 and ETS3 groups, a higher rate of overdryness of limbs was observed (35% and 20%, respectively). The compensatory sweating was mild in the ETS4 group, whereas moderate-to-severe reflex sweating was more common in the ETS2 and ETS3 groups. About 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their operation. All patients of the ETS4 group were satisfied with the outcome. In conclusion, ETS4 sympathectomy is an effective method for treating PH and it decreases the rate of compensatory hydrosis (CH).     

Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.     

Role of fibroscan and APRI in detection of liver fibrosis: A systematic review and meta-analysis

Background and study aimsFibroscan and APRI are promising noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. However, their overall test performance in various settings remains questionable. The aim of our study was to perform a systematic review and meta-analysis of diagnostic accuracy studies comparing fibroscan and APRI with liver biopsy for hepatic fibrosis.Patients and methodsElectronic and manual bibliographic searches to identify potential studies were performed. Selection of studies was based on reported accuracy of fibroscan and APRI compared with liver biopsy. Data extraction was performed independently by two reviewers. Meta-analysis combined the sensitivities, specificities, and likelihood ratios of individual studies. Extent and reasons for heterogeneity were assessed.Results23 studies for fibroscan and 20 studies for APRI in full publication were identified. For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity of fibroscan were 83.4% (95% confidence interval [CI], 71.7–95.0%) and specificity 92.4% (95% CI, 85.6–99.2%). For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity of APRI at cutoff point of 1.5 were 66.5% (95% CI, 25.0–100%) and specificity 71.7% (95% CI, 35.0–100%). Diagnostic threshold bias was identified as an important cause of heterogeneity for pooled results in both patient groups.ConclusionsFibroscan and APRI appear to be clinically useful tests for detecting cirrhosis however not useful tools in early stages of fibrosis.     

Accuracy of three-dimensional dental resin models created by fused deposition modeling,stereolithography, and Polyjet prototype technologies: A comparative study

Objectives: The aim of this study was to assess the dimensional accuracy of fused deposition modeling (FDM)–, Polyjet-, and stereolithography (SLA)–produced models by comparing them to traditional plaster casts.Materials andMethods: A total of 12 maxillary and mandibular posttreatment orthodontic plaster casts were selected from the archives of the Orthodontic Department at the Indiana University School of Dentistry. Plaster models were scanned, saved as stereolithography files, and printed as physical models using three different three-dimensional (3D) printers: Makerbot Replicator (FDM), 3D Systems SLA 6000 (SLA), and Objet Eden500V (Polyjet). A digital caliper was used to obtain measurements on the original plaster models as well as on the printed resin models.Results: Comparison between the 3D printed models and the plaster casts showed no statistically significant differences in most of the parameters. However, FDM was significantly higher on average than were plaster casts in maxillary left mixed plane (MxL-MP) and mandibular intermolar width (Md-IMW). Polyjet was significantly higher on average than were plaster casts in maxillary intercanine width (Mx-ICW), mandibular intercanine width (Md-ICW), and mandibular left mixed plane (MdL-MP). Polyjet was significantly lower on average than were plaster casts in maxillary right vertical plane (MxR-vertical), maxillary left vertical plane (MxL-vertical), mandibular right anteroposterior plane (MdR-AP), mandibular right vertical plane (MdR-vertical), and mandibular left vertical plane (MdL-vertical). SLA was significantly higher on average than were plaster casts in MxL-MP, Md-ICW, and overbite. SLA was significantly lower on average than were plaster casts in MdR-vertical and MdL-vertical.Conclusions: Dental models reconstructed by FDM technology had the fewest dimensional measurement differences compared to plaster models.     

Lack of MERS Coronavirus Neutralizing Antibodies in Humans,Eastern Province,Saudi Arabia

We used a lentiviral vector bearing the viral spike protein to detect neutralizing antibodies against Middle East respiratory syndrome coronavirus (MERS-CoV) in persons from the Eastern Province of Saudi Arabia. None of the 268 samples tested displayed neutralizing activity, which suggests that MERS-CoV infections in humans are infrequent in this province.     

Detection of Helicobacter species in chronic liver disease and chronic inflammatory bowel disease

AIM: To study the association between helicobacters and chronic liver diseases and chronic inflammatory bowel diseases. PATIENTS AND METHODS: Thirty-two patients with various chronic liver diseases and 137 patients with inflammatory bowel disease were enrolled. Antibodies to H. pylori, H. hepaticus, H. bilis, and H. pullorum were measured by enzyme immunoassay (EIA), and sera positive in a non-pylori helicobacter EIA were further examined by immunoblot assay. Detection of Helicobacter DNA in liver biopsies was done by denaturating gradient gel electrophoresis of PCR products (PCR-DGGE) and DNA sequence analysis. RESULTS: Six inflammatory bowel disease patients, four with ulcerative colitis and two with Crohn's disease, and one liver disease patient with autoimmune cholangitis had antibodies to non-pylori helicobacters by an immunoblot assay. Four immunoblot assay-negative patients, three with autoimmune and one with non-autoimmune liver disease, had Helicobacter DNA in liver biopsies; three of the polymerase chain reaction (PCR) products were closely related to non-pylori helicobacters. CONCLUSION: Evidence for non-pylori helicobacters was scant in Finnish patients with inflammatory bowel disease or chronic but not end stage liver disease. We cannot, however, rule out their role in these diseases.     

Novel effect of estrogen on RANK and c-fms expression in RAW 264.7 cells

Temporomandibular disorder (TMD), a progressive disease entity, and osteoarthrosis preferentially affect females, denoting a possible role of estrogen. Using RAW 264.7 cells, the expression of estrogen receptors (ERs) alpha and beta and the consequent effect of estrogen was investigated. We present the novel detection of ER beta expression in RAW 264.7 cells. Furthermore, we innovatively demonstrated the increase in expression of both ER alpha and beta, as well as RANK and c-fms, with estrogen treatment. However, a decrease in expression of c-fms, RANK and ER beta, and nearly no change in the expression of ER alpha were experienced upon further increase in estrogen concentrations. These findings lead us to hypothesize a new mechanism of inflammation in TMD.     

Genotoxicity of air borne particulates assessed by comet and the Salmonella mutagenicity test in Jeddah, Saudi Arabia

Fine airborne respirable particulates less than 10 micrometer (PM10) are considered one of the top environmental public health concerns, since they contain polycyclic aromatic hydrocarbons (PAHs) which are among the major carcinogenic compounds found in urban air. The objective of this study is to assess the genotoxicity of the ambient PM10 collected at 11 urban sites in Jeddah, Saudi Arabia. The PM10 extractable organic matter (EOM) was examined for its genotoxicity by the single cell gel electrophoresis (SCGE) comet assay and the Salmonella mutagenicity (Ames) test .Gas chromatography-mass spectrometry was used to quantify 16 PAH compounds in four sites. Samples from oil refinery and heavy diesel vehicles traffic sites showed significant DNA damage causing comet in 20-44% of the cells with tail moments ranging from 0.5-2.0 compared to samples from petrol driven cars and residential area, with comet in less than 2% of the cells and tail moments of < 0.02.In the Ames test, polluted sites showed indirect mutagenic response and caused 20-56 rev/ m3, mean while residential and reference sites caused 2-15 rev /m3. The genotoxicity of the EOM in both tests directly correlated with the amount of organic particulate and the PAHs concentrations in the air samples. The PAHs concentrations ranged between 0.83 ng/m3 in industrial and heavy diesel vehicles traffic sites to 0.18 ng /m3 in the residential area. Benzo(ghi)pyrene was the major PAH components and at one site it represented 65.4 % of the total PAHs. Samples of the oil refinery site were more genotoxic in the SCGE assay than samples from the heavy diesel vehicles traffic site, despite the fact that both sites contain almost similar amount of PAHs. The opposite was true for the mutagenicity in the Ames test. This could be due to the nature of the EOM in both sites. These findings confirm the genotoxic potency of the PM10 organic extracts to which urban populations are exposed.     

Reflections on multiple strategies to reduce transfusion in cancer patients: A joint narrative

Transfusion of red blood cells, platelets and plasma is widely used in the management of anemia and coagulopathy in cancer patients undergoing surgery, chemotherapy, and radiation. The decision to transfuse should not be made lightly as exposure to transfused blood, whether from an allogeneic or even autologous source, is not without risk and the long-term effect of blood transfusion on cancer outcomes remains questionable. Recognition of anemia associated with nutritional deficiency should be promptly corrected while avoiding the use of erythropoiesis stimulating agents. Minimizing blood loss and the prompt control of bleeding, coupled with a restrictive transfusion strategy, seem to be a reasonable approach that does not appear to be associated with long-term sequelae. Limiting platelet transfusion to patients with severe hypo-proliferative thrombocytopenia, and implementation of local hemostatic measures, together with the use of fractionated coagulation factor concentrates, as an alternative to frozen plasma transfusion, may reduce the exposure of cancer patients to potentially harmful thrombogenic and pro-inflammatory cellular microparticles. This joint narrative highlights current opinions for minimizing blood usage in patients with cancer.