Pseudotumorous choroid granuloma in miliary tuberculosis]

Recently, tuberculosis re-emerged as a serious public health problem, in industrialized countries, while remaining it remains a major cause of mortality and morbidity in third world countries. Intraocular localization is rare. The most common manifestation of ocular tuberculosis in patients with miliary is Bouchut tubercules. An atypical feature of ocular tuberculosis is discussed: a pseudotumoral choroid granuloma. The behavior of the lesion and its response to antituberculous therapy was documented clinically by fundus photography on fluorescein angiography.     

Brainstem ischemia and preeclampsia.

Diffuse neurological manifestations of preeclampsia are due to endothelial involvement that lead to ischemia, hemorrhage, or edema. We analyzed clinical and radiological features and the course of brainstem ischemic strokes in a preeclampsia patient. We report a case of severe preeclampsia in a 30-year-old woman who was admitted 10 hr after a vaginal delivery at home. The pregnancy was at 39 wk, with no prenatal care. At her admission, she was conscious, and she had tetraparesia, swinging deep tendon reflex testing, drowsiness, and dysarthria; the BP was at 160/100 mmHg and 4 + proteinuria; magnetic resonance imaging revealed brainstem ischemic stroke. The evolution was favorable with symptomatic treatment. The patient was discharged on the 16th day; 2 months later she had a normal recovery. Brainstem strokes are rare. They are frequently due to hemorrhage; sometimes, they can also be ischemic. Their course is favorable.     

Exploring the anticancer activities of novel bioactive compounds derived from endophytic fungi: mechanisms of action,current challenges and future perspectives

Cancer is the second leading cause of death all around the world. The natural compounds derived from the endophytic flora of fungi are possible solutions to cancer treatment because they are safe for health, cost-effective, biocompatible and have fewer toxicity issues. The active ingredients in endophytic fungi that are responsible for anti-cancer activities are alkaloids, terpenoids, glycosides, saponin, peptides, steroids, phenols, quinones, and flavonoids. This review highlights the anti-cancer activities of entophytic fungus against human papillary thyroid carcinoma (IHH4), human pancreatic (PANC-1), ovarian (OVCAR-3), hepatic (HepG2), lung (A-549), human lymphoma (U937), human skin carcinoma (A431), breast (MCF-7), and Kaposi’s sarcoma. The emerging evidence suggested that bioactive compounds isolated from endophytic fungi showed their anti-cancer activities by revealing the disturbance of the microtubule network caused by increased levels of Bax and Bcl-2 proteins that triggers cell cycle arrest at the G2-M phase, by inhibiting the DNA replication via binding with topoisomerase II, by regulating the activity of extracellular signal-regulated kinase and NF-kB, by evaluating the levels of p21, p27, and cyclins B/D1/E that led to cell death by apoptosis and cell cycle arrest. This review will assist readers in better comprehending bioactive chemicals and the beneficial interaction between the fungal endophytes and medicinal plants.     

Novel Chronic Anaplasmosis in Splenectomized Patient,Amazon Rainforest

We report a case of unusual human anaplasmosis in the Amazon rainforest of French Guiana. Molecular typing demonstrated that the pathogen is a novel Anaplasma species, distinct to all known species, and more genetically related to recently described Anaplasma spp. causing infections in rainforest wild fauna of Brazil.     

Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results

BACKGROUND: The introduction of composite graft repair of aortic root aneurysm by Hugh Bentall in 1968 promised Marfan patients the choice for a normal life expectancy. We performed our first Bentall composite graft procedure in 1976 and herein report our 24-year experience with 271 Marfan patients. METHODS: Between September 1976 and August 2000, 232 Marfan patients had a composite graft replacement of the aortic root, 15 patients received a homograft, and 24 had a valve-sparing procedure. RESULTS: Two hundred thirty-five Marfan patients underwent elective aortic root replacement with no 30-day mortality. Two early deaths occurred among 36 patients who underwent urgent or emergent operation. Eighty-three percent of patients in this series are currently alive. The actuarial freedom from thromboembolism, endocarditis, and reoperation on the residual aorta 20 years postoperatively was 93%, 90%, and 74%. Twenty-four patients have undergone valve-sparing procedures with encouraging results. CONCLUSIONS: Elective aortic root replacement for Marfan patients can be performed with low operative risk. Elective repair before the aortic root reaches 6 cm in diameter is recommended to minimize risk of dissection and rupture.     

Two-Year Results on Morbidity, Weight Loss and Quality of Life of Sleeve Gastrectomy as First Procedure, Sleeve Gastrectomy After Failure of Gastric Banding and Gastric Banding

Background

Sleeve gastrectomy (SG) is an alternative to gastric bypass and laparoscopic adjustable gastric banding (GB).

Methods

From January 2004 to January 2006, 111 patients with a follow-up longer than 24 months were prospectively followed. Three treatment groups were defined. Sleeve gastrectomy as first procedure (SGFP; n?=?50), sleeve gastrectomy after failure of GB (SG after GB; n?=?9) and GB (n?=?52). We compared morbidity, mortality, length of stay, number of procedures under general anaesthesia, excess weight loss (EWL) and quality of life.

Results

Mean initial body mass index (BMI) was 50.4 (SG), 50.8 (SG after GB) and 43.8 (GB; p?=?0.000001). Mean operating time was 97.1 min (SGFP), 122.2 min (SG after GB) and 69.8 min (GB; p?<?0.0001). The reoperation rate under general anaesthesia was 2% (SGFP), 11% (SG after GB) and 30.76% (GB; p?=?0.00001).The fistula rate was 2% (SGFP), 0% (SG after GB) and 0% (GB). BMI at 24 months was 33.8 (SGFP), 35.3 (SG after GB) and 33.2 (GB; NS). EWL at 24 months was 67.4 (SGFP), 60.3 (SG after GB) and 58.6 (GB; NS). In the SGFP group and in the SG after GB group, the mean quality-of-life score was 1.1. In the GB group, the mean score was 0.95 (NS).

Conclusions

Initial BMI was significantly higher in the SG group but was no longer significantly different from the BMI of the GB group at 12 and 24 months. Excess BMI loss was higher after SG than after GB. This reduction of BMI was considered to be a success for GB. Thus, results of SG should be considered as a success. Quality of life was not significantly different between the three groups. These results validated SG as first procedure or after failure of GB.     

Muscle Strength and Damage Following Two Modes of Variable Resistance Training

Nautilus Machine (NM) and Elastic Resistance (ER) have gained considerable popularity among athletes and recreational lifters seeking to increase muscle strength. However, there is controversy concerning the use of ER for increasing muscle hypertrophy and strength among healthy-trained individuals. The aim of the study was to compare the effect of repeated near maximal contractions by ER/NM on indicators of muscle damage including: maximal strength decrement (MVIC), rate of muscle soreness (DOMS), concentration of plasma creatine kinase (CK) and increased high muscle signal on T2 weighted images using magnetic resonance imaging (MRI). Nine healthy male subjects completed two modalities of exercise (5 sets × 10RM ER/NM) in a counterbalance cross-over study design with three weeks “wash-out” period between experiments. The MVIC was measured and DOMS rated and recorded for 4 consecutive days while blood samples were collected on day 1, 3, 5 and 7. Prior to and forty eight hours after completion of each mode of exercise, subjects underwent MRI scanning. The average of applied forces demonstrated significantly higher value for NM compared with ER (362 ± 34.2 N vs 266.73 ± 44.6 N respectively) throughout the 5 sets of dynamic exercise (all p < 0.05). However, the indicators of muscle damage (T2 relaxation time, DOMS, MVIC and serum CK) exhibited a very similar response across both modes of training. Plasma CK increased significantly following both modes of training with the peak value on Day 3 (p < 0.05). The time course of muscle soreness reached a significant level after both modes of exercise and showed a peak value on the 2^nd day (p < 0.05). The T2 relaxation time demonstrated a statistically significant increase following ER and NM compared with the pre-test value (p < 0.05). The similarity of these responses following both the ER and NM exercise training session suggests that both modes of training provide a similar training stress; despite a considerably lower external force generation during ER. The importance of these findings is underlined by the fact that exercise-induced muscle damage has been shown to be the underlying mechanism of further muscle hypertrophy.

Key points

• Exercise induced muscle soreness increased levels of plasma CK, increased MRI T2 signal and prolonged strength loss indicate the moderate to intense nature of the training protocol.
• The similarity of these responses following both the Elastic Resistance and Nautilus Machine exercise training session suggests that both modes of training provide a similar training stress; despite a considerably lower external force generation during ER.
• The data in the present study suggest elastic training is a viable mode of resistance exercise that can provide a training stimulus greater than that employed in rehabilitation settings.

Key words: Elastic resistance training, magnetic resonance imaging, muscle strain, muscle hypertrophy