Effect of Hypericum perforatum on intraperitoneal adhesion formation in rats

Introduction

The aim of this study was to evaluate the efficacy of Hypericum perforatum for prevention of adhesion formation in rats.

Material and methods

Twenty-four female wistar rats underwent left uterine horn adhesion model. Rats were randomised into 4 groups. Group 1 (Control): Closure of abdominal incision without any agent administration. Group 2: Closure of incision after administration of intraperitoneal (i.p.) Ringer''s lactate solution. Group 3: Closure of incision after administration of i.p. olive oil (diluent of H. perforatum). Group 4: Hypericum perforatum extract (Ecodab^®) was administered i.p. before the closure of incision. Fourteen days later, relaparatomy was performed and surgical adhesion scores, inflammation and fibrosis scores were noted. Groups were compared according to these scores.

Results

There was statistical significant difference between ringer''s lactate group and olive oil group according to surgical adhesion score (p = 0.009). However, groups were not different according to inflammation and fibrosis scores (p > 0.05).

Conclusions

Despite antiinflammatory, antioxidants and antimicrobial properties of H. perforatum, our results revealed no positive effect of H. perforatum on the prevention of intraperitoneal adhesion formation.     

Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri,Nigeria

Background

Uterine myomas co-existing with pregnancy could cause obstetric complications.

Objectives

To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy.

Methods

A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented.

Results

Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1^st scan sequence to the 2^nd scan sequence and a reduction from 63mm to 59mm in the 3^rd scan sequence. Myoma growth rate was 0.667mm per week. Myomas in pregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas.

Conclusion

Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.     

Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome

Background

Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Its removal is commonly associated with complications. To prevent or control the occurrence of this complication requires the understanding of the factors associated with the complications.

Objective

To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in southwestern Nigeria.

Methods

Study was carried out at two large tertiary hospitals in the south west region of Nigeria.Retrospective review of case records of all surgically managed cases of uterine leiomyoma over a period of 25 years. One hundred and fifty nine women with uterine leiomyoma seen and managed surgically in South-Western Nigeria were the participants.

Results

The common presenting complaints were menstrual irregularities (47.7%), abdominal swelling (39.1%) and infertility (31.9%). The average uterine size at presentation was 15±9.7 weeks. The majority (79.9%) of the women presented with multiple leiomyomata. The commonest anatomical position of the nodules were multiple positions and intramural in 707(60.9%) and 172(14.8%) respectively. Myomectomy was performed in 54.7% of cases. Postoperative complications occurred in 20.9 % of cases with postoperative pyrexia (13.5%), blood loss warranting transfusion (12.8%) and postoperative anaemia (10.4%) been the most common complications.

Conclusion

Uterine fibroid is common in our environment and its removal is commonly associated with post-operative pyrexia, blood loss, and anaemia and wound infection. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review.     

Tuberculosis of the head and neck – epidemiological and clinical presentation

Introduction

The aim of our retrospective study was to review the clinical and epidemiological presentation of head and neck tuberculosis.

Material and methods

We analyzed the history of 73 patients with head and neck tuberculosis hospitalized in the Department of Otolaryngology, Medical University of Warsaw, between 1983 and 2009.

Results

We found that 26 (35.6%) patients presented with lymph node tuberculosis, 20 (27.4%) with laryngeal tuberculosis, 10 (13.7%) with oropharyngeal tuberculosis, 9 (12.3%) with salivary gland tuberculosis, 3 (4.1%) with tuberculosis of paranasal sinuses, 3 (4.1%) with aural tuberculosis, and 2 (2.7%) with skin tuberculosis in the head and neck region. Within the group of patients with lymph node tuberculosis in 15 cases there were infected lymph nodes of the 2^nd and 3^rd cervical region and in 11 infected lymph nodes of the 1^st cervical region. In 5 cases of laryngeal tuberculosis there was detected coexistence of cancer. Oropharyngeal tuberculosis in 7 cases was localized in tonsils, where in 1 case coexisting cancer was diagnosed. Chest X-ray was performed in all cases and pulmonary tuberculosis was identified in 26 (35.6%) cases.

Conclusions

We conclude that tuberculosis still remains a problem and must be taken into consideration in the diagnostic process. The coincidence of tuberculosis and cancer is remarkable in the head and neck region.     

Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh

Introduction

Formation of adhesions after laparoscopic hernia repair using the intra-peritoneal onlay mesh (IPOM) procedure can lead to intestinal obstruction or mesh erosion into intestinal lumen. The aims of this study included: measurement of adhesion formation with Dynamesh IPOM after laparoscopic intraperitoneal implantation, and assessment of the occurrence of isolated adhesions at the fastening sites of slowly absorbable sutures.

Material and methods

Twelve healthy pigs underwent laparoscopic implantation of 2 Dynamesh IPOM mesh fragments each, one was fastened with PDSII, and the other with Maxon sutures. An assessment of adhesion formation was carried out after 6 weeks and included an evaluation of surface area, hardness according to the Zhulke scale, and index values. The occurrence of isolated adhesions at slowly absorbable suture fixation points was also analyzed.

Results

Adhesions were noted in 83.3% of Dynamesh IPOM meshes. Adhesions covered on average 37.7% of the mesh surface with mean hardness 1.46 and index value 78.8. In groups fixed with PDS in comparison to Maxon sutures adhesions covered mean 31.6% vs. 42.5% (p = 0.62) of the mesh surface, mean hardness was 1.67 vs.1.25 (p = 0.34) and index 85.42 vs. 72.02 (p = 0.95).

Conclusions

The Dynamesh IPOM mesh, in spite of its anti-adhesive layer of PVDF, does not prevent the formation of adhesions. Adhesion hardness, surface area, and index values of the Dynamesh IPOM mesh are close to the mean values of these parameters for other commercially available 2-layer meshes. Slowly absorbable sutures used for fastening did not increase the risk of adhesion formation.     

Palliative Radiotherapy in Locally Advanced Head and Neck Cancer after Failure of Induction Chemotherapy: Comparison of Two Fractionation Schemes

Context:

Among patients with locally advanced head and neck squamous cell cancers (LAHNSCC), the prognosis after nonresponse or progression despite induction chemotherapy (IC) is dismal, and further treatment is often palliative in intent. Given that nonresponse to chemotherapy could indicate subsequent radioresistance, we intended to assess the outcomes with two different fractionation schemes.

Aims:

To compare the outcomes of two fractionation schemes- ’standard’ (consisting 3GyX5 daily fractions for 2 consecutive weeks) versus ‘hybrid’ (6GyX3 fractions on alternate days during the 1^st week, followed by 2GyX5 daily fractions in the 2^nd week).

Settings and Design:

Prospective randomized controlled two-arm unblinded trial.

Materials and Methods:

Patients with locally advanced oropharyngeal, laryngeal, and hypopharyngeal cancers treated with a minimum of two cycles of taxane, platinum, and fluorouracil-based IC were eligible if residual disease volume amounted <30 cm³. Kaplan-Meier survival curves were compared by the log-rank test. Response rates were compared using the unpaired t-test. Quality of life (QOL) was measured via patient reported questionnaires.

Results:

Of the initially enrolled 51 patients, 45 patients (24 from standard arm, and 21 from the hybrid arm) were eligible for analysis. Despite being underpowered to attain statistical significance, there still seemed to be a trend towards improvement in progression-free (Hazard ratio (HR) for progression: 0.5966; 95% CI 0.3216-1.1066) and overall survival (HR for death: 0.6062; 95% CI 0.2676-1.3734) with the hybrid arm when compared to the standard arm. Benefits were also observed with regards to response rates and QOL. Rate of complications were similar in both arms.

Conclusions:

In comparison to the routinely used palliative fractionation scheme of 30 Gray (Gy) in 10 fractions (Fr), the use of hybrid fractionation which integrates hypofractionation in the 1^st week, followed by conventional fractionation in the 2^nd week, could possibly offer better response rates, QOL increments, and potential survival benefits among LAHNSCC patients even after failing to respond to IC.     

Efficacy of vitamin E and selenium for the prevention of intra-abdominal adhesions in rats: uterine horn models

OBJECTIVE:

This study compares the efficacies of vitamin E and selenium, both individually and in combination, for the prevention of postoperative intra-abdominal adhesions in rats.

METHODS:

Forty-seven female rats were divided into five groups. The sham animals (S group, n = 7) were given only laparotomies and intraperitoneally received 0.9% NaCl (2 ml). In the 40 other rats, abrasions of the left uterine horn were performed, followed by intraperitoneal administration of either 2 ml 0.9% NaCl (C group), 10 mg vitamin E (vitamin E group), 0.2 mg/kg selenium (Se group) or 10 mg vitamin E with 0.2 mg/kg selenium (vitamin E + Se group), with 10 animals in each treatment group.

RESULTS:

Adhesion formation was significantly reduced in animals in the Se and vitamin E + Se groups (p<0.05). Tissue catalase and glutathione peroxidase activities did not significantly differ between the groups. However, catalase and glutathione peroxidase activities and reduced glutathione levels were slightly increased in the vitamin E, Se and vitamin E + Se groups. In the vitamin E group, malondialdehyde concentrations were significantly lower than in the C group (p<0.05), but no significant differences were present among the S, C, Se and vitamin E + Se groups. Levels of nitric oxide were significantly higher in the C group than in the other groups (p<0.01).

CONCLUSION:

Intraperitoneal administration of selenium or combined vitamin E and selenium appears to be effective in preventing intra-abdominal adhesion formation in rat models through the reduction of lipid peroxidation products.     

Plasma vitamin C concentration in pregnant women with pre-eclampsia in Mulago hospital, Kampala, Uganda

Background

Oxidative stress plays a role in the aetiology of pre-eclampsia and vitamin C may prevent pre-eclampsia.

Objective

To determine the association between plasma vitamin C and pre-eclampsia in Mulago Hospital, Kampala, Uganda.

Methods

This case-control study was conducted at Mulago Hospital from 1^st May 2008 to 1^st May 2009; 207 women were the cases and 352 women were the controls. Plasma vitamin C was assayed in the women using a colorimetric method. An independent t test was used to find the difference in the means of plasma vitamin C and logistic regression was used to find the association between plasma vitamin C and pre-eclampsia.

Results

The mean plasma vitamin C was 1.7(SD=0.7) × 10³ µg/L in women with pre-eclampsia and 1.9(SD=0.7) × 10³ µg/L in women with normal pregnancy (P=0.005).Women with low plasma vitamin C were at an increased risk of pre-eclampsia (OR 2.91, 95% CI: 1.56–5.44).

Conclusion

There was a strong association between low plasma vitamin C, and pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala.Health workers need to advise women at risk in the antenatal period about diet, especially foods which are rich in vitamin C to probably reduce pre-eclampsia.     

The pattern and challenges of infertility management in Lagos,Nigeria

Background

Infertility remains a threat to successful reproduction by couples desirous of pregnancy.

Objective

To determine the pattern of infertility cases amongst infertile couples seeking care in Lagos University Teaching Hospital as well as challenges in their management.

Methods

A review of the management of couples referred for infertility to the gynaecological outpatient clinic of the Lagos University Teaching Hospital (LUTH), Nigeria from 1^st January 2005 to 31^st December 2006.

Results

The incidence of infertility was found to be 26.8% of the gynaecological consultations with a mean duration of infertility of 4.3 ± 3.4 years. The mean age of the women was 33.8 ± 5.2 years and 66.1% were nulliparous. Secondary infertility accounted for 80% of cases. Male factors only was the cause in 11.1%, female factor only in 37.8%, both male and female factors in 40% while no cause was identifiable in 11.1%. There was no association between tubal occlusion and a history of induced abortion in this study (p >0.05). There was a high rate of discontinuation of care by their large numbers lost to follow up.

Conclusion

Infertility is still a public health problem in Lagos, Nigeria.     

Audiometric Patterns in Ototoxicity After Radiotherapy and Chemotherapy in Patients of Head and Neck Cancers

Introduction:

Inspite of various strategies adopted to protect the sensitive structures during organ preservation strategies, radiation damage can occur from the pharyngotympanic tube to the brain stem auditory pathway causing hearing loss. The purpose of this study is to evaluate the audiometric abnormalities and characterize them among the patients of head and neck cancers who have undergone radiotherapy (RT) and chemoradiation therapy (CT+RT).

Materials and Methods:

Sixty-six histopathologically proven head and neck cancer patients receiving RT and 34 patients receiving concomitant CT + RT underwent evaluation for audiometric abnormalities from 1^st September 2010 to 31^st August 2012.

Results:

Hearing losses were predominately of sensorineural type and mild. Patients who received concomitant CT+RT experienced greater sensorineural hearing loss compared with patients treated with RT alone. A paired sample t-test was conducted to compare the hearing losses before therapy and 6 and 12 months after therapy and was found to be significant (P < 0.05). It was found that hearing loss was persistent. Significant difference was found in the proportion of hearing loss after RT and RT+CT (P < 0.05) after 1 month. In addition, mixed hearing loss occurred due to damage to the middle ear contents and can be improved if intervened appropriately.     

Hypoalbuminemia in critically sick children

Context:

There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children admitted to intensive care unit (ICU).

Aims:

The aim was to study frequency of hypoalbuminemia and examine association between hypoalbuminemia and outcome in critically ill-children.

Settings and Design:

Retrospective review of medical records of 435 patients admitted to 12 bedded pediatric ICU (PICU).

Materials and Methods:

Patients with hypoalbuminemia on admission or any time during PICU stay were compared with normoalbuminemic patients for demographic and clinical profile. Effect of albumin infusion was also examined. Odds ratio and 95% confidence interval were calculated using SPSS 16.

Results:

Hypoalbuminemia was present on admission in 21% (92 of 435) patients that increased to 34% at the end of 1^st week and to 37% (164 of 435) during rest of the stay in PICU. Hypoalbuminemic patients had higher Pediatric Risk of Mortality scores (12.9 vs. 7.5, P < 0.001) and prolonged PICU stay (13.8 vs. 6.7 days, P < 0.001); higher likelihood of respiratory failure requiring mechanical ventilaton (84.8% vs. 28.8%, P < 0.001), prolonged ventilatory support, progression to multiorgan dysfunction syndrome (87.8% vs. 16.2%) and risk of mortality (25.6% vs. 17.7%). Though, the survivors among recipients of albumin infusion had significantly higher increase in serum albumin level (0.76 g/dL, standard deviation [SD] 0.54) compared with nonsurvivors (0.46 g/dL, SD 0.44; P = 0.016), albumin infusion did not reduce the risk of mortality.

Conclusions:

Hypoalbuminemia is a significant indicator of mortality and morbidity in critically sick children. More studies are needed to define role of albumin infusion in treatment of such patients.     

Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty

OBJECTIVES:

Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter.

METHOD:

A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7^th, 14^th, 21^st, 30^th and 42^nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection.

RESULTS:

There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation.

CONCLUSION:

Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.     

Bile acids cycle disruption in patients with nasopharyngeal carcinoma promotes the elevation of interleukin-10 secretion

Background

Unclear pathogenesis existed for nasopharyngeal carcinoma.

Aims

to analyze the role of bile acids in the pathogenesis of nasopharyngeal carcinoma.

Methods

20 healthy volunteers and 20 patients with nasopharyngeal carcinoma were enrolled between January 1^st, 2013 and December 31^st, 2014. ESI-QTOF-MS analysis of serum was performed to find altered bile acids components. The biological function of changed bile acids was investigated using in vitro experiment.

Results

Compared with healthy volunteers, the level of DCA and GDCA exhibited higher abundance in patients with nasopharyngeal carcinoma (p<0.01). Furthermore, the biological function was investigated for the inhibition of DCA and GDCA towards the secretion of IL-10 by CD4+CD25− T cells. Both DCA and GDCA significantly inhibited the secretion of IL-10 by CD4+CD25− T cells. Furthermore, DCA+GDCA can show stronger inhibition towards the secretion of IL-10 than DCA and GDCA.

Conclusion

The inhibition of IL-10 secretion by elevated DCA and GDCA components in nasopharyngeal carcinoma patients is the inducer for nasopharyngeal carcinoma.     

Demographic profile and epidemiology of injury in Mthatha,South Africa

Objective

To determine the magnitude, socio-demographic and epidemiological characteristics of injury at a Provincial referral hospital.

Methods

This review was conducted on all trauma patients admitted at the Mthatha Hospital Complex and Nelson Mandela Academic Hospital from the 1^st January 1997 to the 31^st December 2000.

Results

The incident rate of injuries was 3.2% (n=2460/75,833 total admissions). Injured patients were mostly black (80%) and males (ratio: 5 men: 1 woman). Only 8.1% of injured patients were transported to hospital by ambulances. The leading causes of injuries were inter-personal violence accounting for 60% of cases, and motor vehicle accidents accounting for 19%; of them 38% were due to poor visibility, over speeding, and fatigue. The overall mortality was 33% (n=821) independently predicted by poverty (OR=8.2 95%CI 6–11.1; P<0.0001) and age>40 years(OR=7.8 95%CI 7.7–12.1;P<0.0001).

Conclusion

The burden of injury is a mass issue that warrants regional attention with quality of care and training.     

Comparing the effects of inorganic nitrate and allopurinol in renovascular complications of metabolic syndrome in rats: role of nitric oxide and uric acid

Introduction

The epidemic of metabolic syndrome is increasing worldwide and correlates with elevation in serum uric acid and marked increase in total fructose intake. Fructose raises uric acid and the latter inhibits nitric oxide bioavailability. We hypothesized that fructose-induced hyperuricemia may have a pathogenic role in metabolic syndrome and treatment of hyperuricemia or increased nitric oxide may improve it.

Material and methods

Two experiments were performed. Male Sprague-Dawley rats were fed a control diet or a high-fructose diet to induce metabolic syndrome. The latter received either sodium nitrate or allopurinol for 10 weeks starting with the 1^st day of fructose to evaluate the preventive role of the drugs or after 4 weeks to evaluate their therapeutic role.

Results

A high-fructose diet was associated with significant (p < 0.05) hyperuricemia (5.9 ±0.5 mg/dl), hypertension (125.2 ±7.8 mm Hg), dyslipidemia and significant decrease in tissue nitrite (27.4 ±2.01 mmol/l). Insulin resistance, as manifested by HOMAIR (20.6 ±2.2) and QUICKI (0.23 ±0.01) indices, as well as adiposity index (12.9 ±1.1) was also significantly increased (p < 0.1). Sodium nitrate or allopurinol was able to reverse these features significantly (p < 0.05) in the preventive study better than the therapeutic study.

Conclusions

Fructose may have a major role in the epidemic of metabolic syndrome and obesity due to its ability to raise uric acid. Either sodium nitrate or allopurinol can prevent this pathological condition by different mechanisms of action.     

Predictive factors of proximal advanced neoplasia in the large bowel

Introduction

The aim of the study was to evaluate the impact of sex, age, family history and distal findings on the risk of proximal advanced neoplasia (cancer or advanced adenoma) in the large bowel.

Material and methods

Records for 10 111 asymptomatic participants of the Colonoscopy Screening Program (CSP), recruited from the Warsaw region between 2000 and 2004, were analyzed. A multivariate logistic regression model was used to estimate the impact of sex, age, family history and most advanced distal lesions on the occurrence of proximal advanced neoplasia. To enhance comparability of the study two definitions of the proximal colon were applied – either the splenic flexure (1^st) or the bend between the descending and sigmoid colon (2^nd definition) represented the boundary.

Results

One hundred and thirty-three (1^st) and 167 patients (2^nd definition) were found to have at least one advanced neoplastic lesion in the proximal part, respectively. Eleven and 14 patients were found to have carcinoma, while in 130 and 163 patients at least one proximal advanced adenoma appeared. Men were at twice as high risk of having advanced neoplasia in the proximal colon than women (OR = 1.94, 95% CI: 1.31–2.87, p = 0.001 or OR = 1.69, 95% CI: 1.20–2.40, p = 0.003, respectively). The presence of distal advanced neoplastic lesions was associated with 3.5 times higher risk of proximal advanced neoplasia (OR = 3.58, 95% CI: 2.00–6.43, p < 0.0001 or OR = 3.41, 95% CI: 1.95–5.96, p < 0.0001), respectively.

Conclusions

The results may confirm some limitation of flexible sigmoidoscopy in the screening settings in comparison with colonoscopy, at least in men and people with distal advanced neoplasia.