Effect of oral contraceptives (Lyndiol) on rat brain gamma aminobutyric acid system.

(1) Virgin female albino rats were treated with the estrogenic substance mestranol, the progestogenic substance lynestrenol or with a combination of these two compounds. These two drugs are the components of the oral contraceptive pill Lyndiol®. (2) Mestranol pretreatment caused a significant increase in brain GABA level, lynestrenol pretreatment caused a significant decrease in brain glutamic acid level and pretreatment with a combination of the two drugs caused a significant rise in brain GABA content. Other changes were statistically insignificant. All three types of treatment, however, caused an identical and significant decrease in the glutamic acid: GABA ratio in rat brains. (3) The changes produced by oral contraceptive steroids on two brain enzymes, namely glutamate decarboxylase and aminobutyrate aminotransferase could not satisfactorily justify the assumption that the brain GABA concentration is controlled solely by the activities of such enzymes.     

Liposarcome multiple du mésentère et du mésocôlon

Liposarcoma represent the single most common type of soft tissue sarcoma. Its abdominal localization is rare, occurring in only 5% of cases. A 60-year-old male was found to have a case of primary multiple liposarcoma of the mesentery and mesocolon. Computed tomography revealed the presence of a peritoneal mass presenting a homogeneous density with an adipose component. Preoperative biopsies were falsely reassuring. A laparotomy confirmed the presence of multiple tumors in the mesentery and the mesocolon. The masses were removed and the histopathological report noted a well-differentiated liposarcoma. Chemotherapy was prescribed. The patient was well at 18 months follow-up. Surgery currently represents the best curative therapy for this type of tumor. Chemotherapy seems promising in liposarcoma. Diagnostic and therapeutic problems related to this type of neoplasm as well as a literature reviews are reported.     

After more than 300 defibrillation shocks,patient still alive 12 years later refractory torsade de pointes due to polypharmacy and persistent vomiting

Acquired torsade de pointes ventricular tachycardia (TdP) is a rare but serious life-threatening arrhythmia caused by an array of cardiac and non-cardiac drugs. It is often refractory to pharmacological therapy and may result in death or require frequent defibrillations. In our case study a young female patient with no underlying heart disease developed very frequent sustained TdP requiring frequent defibrillations without which she would have certainly died. The ventricular arrhythmia in this patient was of multifactorial origin – cisapride, drug–drug interaction and persistent vomiting resulting in electrolyte disturbance and malnutrition. The patient survived after more than 300 defibrillation shocks over a period of 5 days and she is still alive 12 years later.     

Chemokines and chemokine receptors in the brain: implication in neuroendocrine regulation

Chemokines are small secreted proteins that chemoattract and activate immune and non-immune cells both in vivo and in vitro. In addition to their well-established role in the immune system, several recent reports have suggested that chemokines and their receptors may also play a role in the central nervous system (CNS). The best known central action is their ability to act as immunoinflammatory mediators. Indeed, these proteins regulate leukocyte infiltration in the brain during inflammatory and infectious diseases. However, we and others recently demonstrated that they are expressed not only in neuroinflammatory conditions, but also constitutively by different cell types including neurons in the normal brain, suggesting that they may act as modulators of neuronal functions. The goal of this review is to highlight the role of chemokines in the control of neuroendocrine functions. First, we will focus on the expression of chemokines and their receptors in the CNS, with the main spotlight on the neuronal expression in the hypothalamo-pituitary system. Secondly, we will discuss the role--we can now suspect--of chemokines and their receptors in the regulation of neuroendocrine functions. In conclusion, we propose that chemokines can be added to the well-described neuroendocrine regulatory mechanisms, providing an additional fine modulatory tuning system in physiological conditions.     

In vitro evaluation of the dissolution behaviour of itraconazole in bio-relevant media

Drugs in the gastrointestinal tract are exposed to a medium of partially digested food, comprising mixtures of fat, protein and carbohydrate. The dissolution behaviour of itraconazole was evaluated in bio-relevant media which were developed to take this into account. Media containing milk with different fat contents, protein (albumin, casein, gluten and gelatin), carbohydrates (glucose, lactose and starch) and amino acids (lysine, glycine, alanine and aspartic acid) to mimic a digested meal and bile components (sodium taurocholate and lecithin) to represent a key endogenous digestive material were investigated. The effect of medium composition on the intrinsic dissolution rate of itraconazole was evaluated as this drug has extremely poor solubility and its bioavailability is affected by food. Dissolution tests were carried out in simple compendial media based on dilute solutions of hydrochloric acid or neutral solutions of phosphate buffer and in more complex media containing the dietary components. The data obtained showed that most of the dietary components enhanced the solubility compared to simulated gastric fluid (SGF) but to differing extents. The greatest increase in dissolution was observed with the addition of milk and albumin although an increase was also seen with other proteins, amino acids and simulated gastrointestinal fluids.     

Marginal adaptation of zirconia complete-coverage fixed dental restorations made from digital scans or conventional impressions: A systematic review and meta-analysis

Statement of problemIntraoral scanners have been increasingly used in recent years. However, the accuracy of digital scans as it affects marginal adaptation is unclear.PurposeThe purpose of this systematic review and meta-analysis was to compare the marginal adaptation of single-unit zirconia crowns fabricated with digital scans or with conventional impressions.Material and methodsThe electronic databases PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (ISI), Scopus, and EMBASE were searched and complemented by a manual search. Risks of bias were assessed by using a modified methodological index for nonrandomized studies (MINORS). Mean ±standard deviation (SD) values of marginal accuracy of studies were extracted for both methods. Mean marginal difference and 95% confidence interval (CI) were calculated to evaluate the marginal accuracy of each method. Pooled data were statistically analyzed by using a random-effect model.ResultsSeventeen studies were used to perform the meta-analysis. Subgroup analysis was performed based on intraoral scanners. Standardized mean marginal difference and 95% CI of each subgroup were as follows: Lava: -0.85 μm (95% CI: -1.67, -0.03) (P=.043); CEREC: -1.32 μm (95% CI: -2.06, -0.59) (P<.001); iTero: -0.44 μm (95% CI: -1.35, 0.47) (P=.338); TRIOS: -1.26 μm (95% CI: -2.02, -0.51) (P=.001); unknown scanner: -0.21 μm (95% CI: -1.14, 0.72); all studies: -0.89 μm (95% CI: -1.24, -0.54) (P<.001).ConclusionsDigital scanning of prepared teeth for single-unit zirconia restorations resulted in better marginal accuracy than conventional techniques using elastomeric impression materials.     

Hand-assisted Laparoscopic Colorectal Surgery: Initial Experience of a Single Surgeon

Background/Aim:

As totally laparoscopic colorectal surgery is considered challenging and technically demanding with a long steep learning curve, we adopted hand-assisted laparoscopic colorectal surgery as a bridge to totally laparoscopic assisted colorectal surgery. This prospective study aims to highlight the initial experience of a single surgeon with this technique.

Materials and Methods:

A prospective analysis of the first 25 cases of hand-assisted laparoscopic colorectal resections which were performed by a single surgeon over a 15-month period. There were 15 males and 10 females with a mean age of 55.5 (range 20-82) years.

Results:

The indication in majority of cases was cancer (76%). The procedures consisted of 18 (72%) various colectomies and 7 (28%) anterior resections. The operative time ranged between 110-400 (mean 180) min. There was one conversion (4%) and the mean operative blood loss was 80 (range 60-165) ml. The number of lymph nodes retrieved in the cancer cases was 5-31 (mean 15) nodes. The mean length of hospital stay was five (range 3-10) days. The total number of short-term complications was six (24%) and there was one death due to anastomatic leak and multiorgan failure. Long-term complications after a maximum follow up of 30 months were two incisional hernias at the hand port site, but none of the patients developed adhesive small bowel obstruction or late anastomotic stricture. Currently all our colorectal procedures are conducted laparoscopically.

Conclusion:

Hand-assisted laparoscopic colorectal procedures are easy to learn as a good bridge to master totally laparoscopic colorectal surgery.