Donor des-gamma-carboxy prothrombin positivity is a risk factor for poor early graft function in liver transplantation

Des-gamma-carboxy prothrombin (DCP) is an abnormal prothrombin that lacks coagulating activity. The aim of this study was to determine if the presence of DCP in the donor could be used as a marker of post-transplant graft function. We collected data and serum samples on 90 organ donors. DCP level was correlated with donor-specific factors and with graft function intraoperatively and in the early post-transplant period. Twenty-seven donors (30.0 %) had positive DCP levels before harvesting. Although recipients were similar in demographics, preoperative liver function, and primary disease distribution, patients transplanted with livers from DCP-positive donors needed significantly more intraoperative transfusion. Furthermore, donor DCP positivity was identified as a preoperative risk factor for poor early graft function based on multivariate analysis (odds ratio = 6.58, P = 0.0032). Our findings suggest that DCP is another valuable marker for evaluating the quality of donor livers. Received: 30 June 1997 Received after revision: 14 October 1997 Accepted: 19 November 1997     

Is permanent maxillary tooth removal without palatal injection possible?

OBJECTIVE: The aim of the present study was to demonstrate if articaine HCl could provide palatal anesthesia in maxillary tooth removal without the need for a second palatal injection. STUDY DESIGN: Of 53 patients, 23 had bilateral and 30 had unilateral extractions. In the study group 2 mL of 4% articaine/HCl with 1:100,000 epinephrine was injected into the buccal vestibule of the tooth. After 5 min the extraction was performed. 27 subjects were controls and subjected to the same protocol with palatal injection. All patients completed a Faces Pain Scale (FPS) and a 100-mm Visual Analogue Scale (VAS) after extraction. RESULTS: According to VAS and FPS scores, when permanent maxillary tooth removal with palatal injection (97.5%) and without palatal injection (96.8%) were compared the difference was not statistically significant (P > .05) [corrected]. CONCLUSION: Permanent removal of maxillary teeth without palatal injection is possible by depositing 2 mL articaine/HCl to the buccal vestibule of the tooth.     

Grading of liver lesions caused by Echinococcus granulosus

The availability of different therapeutic alternatives in hydatid liver disease necessitates a comprehensive classification system in order to evaluate indications and monitor results. We have proposed a new scheme in which lesions are graded 1–5 according to the morphology of the cyst and the presence of findings in favour of cyst rupture. Ultrasound (US), CT and cholangiographic findings in 214 hydatid liver lesions in 152 patients who underwent surgery within 15 days of their radiological examinations were evaluated retrospectively. Results of the radiological classification were correlated with surgical data. We found that purely cystic unilocular lesions never ruptured, that dilatation of biliary canaliculi around a lesion with a complex morphological appearance is a non-specific finding and that there was no reliable radiological sign for a simple biliary communication. US, CT and cholangiography were reliable in diagnosing intra-biliary and direct ruptures. We conclude that the proposed grading scheme could be useful in monitoring the results of different therapeutic modalities for hydatid disease of the liver and, with the accumulation of further data, could be helpful in allocating patients to therapeutic alternatives. Correspondence to: I. Rozanes     

Increased interleukin-4 and decreased interferon gamma production in children with asthma: function of atopy or asthma?

Both atopy and asthma are claimed to be associated with a Th-2 cytokine pattern. We sought to determine the contribution of atopy and asthma to the observed Th-2/Th-1 imbalance in these conditions. Of 60 children aged 6-16 years that were included in the study, 13 were nonatopic nonasthmatic, 15 atopic nonasthmatic, 14 nonatopic asthmatic, and 18 atopic asthmatic. Atopic children had positive skin prick tests to grass pollens only. All children were studied after an asymptomatic and drug-free period of at least three months. Total IgE was measured in serum. Peripheral blood mononuclear cells were cultured and stimulated in vitro with phytohemagglutinin and interferongamma (IFN-gamma) and interleukin-4 (IL-4) measured in the supernatants. Total IgE was significantly higher in atopic asthmatics compared to nonatopic asthmatics (p = 0.004), and nonatopic nonasthmatics (p = 0.001), but was not different from atopic nonasthmatics (p >0.05). On the other hand, IL-4 was significantly elevated in atopic asthmatics and in nonatopic asthmatics compared to nonatopic nonasthmatics (p = 0.037 and p = 0.009, respectively). Although atopic asthmatics had lower IFN-gamma values than nonatopic asthmatics, the difference did not reach statistical significance. No correlation was detected between any two parameters. Our results suggest that both atopy and asthma contribute to the increased levels of IL-4 and that, whereas nonatopic asthma is associated with increases in both IL-4 and IFN-gamma release by mononuclear cells, only atopic asthma is characterized by a Th-2 type cytokine dominance.     

Immunolocalization and expression of bone morphogenetic proteins 2 and 4 in fracture healing

Recently, it has become increasingly evident that fracture healing involves a complex interaction of many local and systemic regulatory factors. The roles of some of these growth factors have been described; however, little is understood about the presence of the bone morphogenetic proteins in fracture repair, despite the fact that they are the most potent osteoinductive proteins known. This study defines and characterizes the physiologic presence, localization, and chronology of the bone morphogenetic proteins in fracture healing with an established rat fracture healing model. With use of a recently developed monoclonal antibody against bone morphogenetic proteins 2 and 4 developed with standard avidin-biotin complex/immunoperoxidase protocols, frozen undecalcified fracture calluses were analyzed semiquantitatively for the percentage of various types of fracture cells staining positively. During the early stages of fracture healing, only a minimum number of primitive cells stained positively in the fracture callus. As the process of endochondral ossification proceeded, the presence of bone morphogenetic proteins 2 and 4 increased dramatically, especially in the primitive mesenchymal and chondrocytic cells. While the cartilaginous component of the callus matured with a concomitant decrease in the number of primitive cells, there was a concomitant decrease in both the intensity and the number of positively staining cells. As osteoblasts started to lay down woven bone on the chondroid matrix, these osteoblastic cells exhibited strong positive staining. The intensity of this staining decreased, however, as lamellar bone replaced the primitive woven bone. A similar observation was noted for the areas of the callus undergoing intramembranous ossification. Initially, within several days after the fracture, periosteal cells and osteoblasts exhibited intense staining for bone morphogenetic proteins 2 and 4. As the woven bone was replaced with mature lamellar bone, this staining decreased. These data, and the awareness of the strong osteoinductive capacities of bone morphogenetic protein, suggest that bone morphogenetic proteins 2 and 4 are important regulators of cell differentiation during fracture repair.     

Effects of the novel NMDA-receptor antagonist SDZ EAA 494 on memory and attention in humans

Effects of the novel competitiveN-methyl-d-aspartate (NMDA)-receptor antagonist SDZ EAA 494 were investigated on memory and attention in humans. SDZ EAA 494 was administered either as single doses at a dose range of 1–50 mg, or as multiple doses over the course of 1 week at doses of 25 mg once or twice daily. Selected cognitive functions were assessed at baseline, 2 and 4 h after single dose administration, and at baseline, 2, 4 and 8 h on days 1 and 7 of multiple dose administration. The assessments included simple and complex reaction time tests to assess attention, and verbal, non-verbal and spatial memory tests with immediate and late recall. Verbal and non-verbal memory test performance was significantly impaired at a dose level of 50 mg after single administration, and of 25 mg twice daily after multiple administration, without concomitant significant impairment of reaction time. Spatial memory test performance was not significantly affected. The maximum effect occurred 2 h postmedication and was more pronounced after repeated administration. These results suggest that the inhibition of NMDA-receptors in humans may impair memory processes.     

Contemporary management of penile fracture

Penile fracture (PF) is an uncommon injury defined as the rupture of the tunica albuginea and corpus cavernosum of the penis, usually resulting from direct blunt trauma to the erect penis during sexual intercourse or masturbation. PF is one of the few urologic emergencies. This article reviews the status, contemporary management, and the controversies of the diagnostic approaches and therapeutic modalities of penile fractures. It is usually diagnosed only clinically with the history of the patient, inspection, and physical examination. However, additional imaging procedures such as cavernosography, ultrasonography, magnetic resonance imaging, and retrograde ureterography may also be indicated whenever the diagnosis or the extent of the severity and location of the rupture is not clear, and/or when an accompanying urethral injury is suspected. Although the diagnosis of PF is usually easily recognized, optimal therapy remains controversial. The most widely accepted approach for the treatment of PF is early surgical treatment, but some investigators still advocate nonoperative conservative management.     

Palatal myoclonus occurring during complex partial status epilepticus

Summary Palatal myoclonus is thought to occur after damage to certain brain-stem structures, and with a delay following the causative lesion. A case of palatal myoclonus, probably of epileptic nature, is described.