Arterial injures in the Emergency Room Practice of Traumatic Surgery

Background. Although arterial injuries occur rarely (1,15%), they often lead to serious consequences (13% limb amputation), and can be the cause of patient deaths (9%).
Material and methods. The research involved 23 cases of traumatic injury to arteries in patients admitten for traumatic surgery to the Emergency Room at the Traumatology Clinic of the Jagiellonian University's Collegium's Medicum from 1997 to 2000.
Results. The article presents the surgical methods and outcomes for the various cases reported. In two cases of damage to the abdominal artery the patient did not survive; two patients with damage to the popliteal artery and one patient with a damaged femoral artery, the limb could not be saved. In the remaining cases good results were obtained.
Conclusions. The most important factors influencing outcome in the treatment of traumatic artery damage are the localization and nature of the injury and the time that elapses from the moment of injury until the patient arrives in the operating theater. For this reason it is essential that the trauma team have a physician with experience in vascular surgery.     

Kaempferol and its glycosides in the seeds hair of Asclepias syriaca L.

The following flavonoid compounds have been isolated and identified from the seeds hair of Asclepias syriaca L.: kaempferol, kaempferol 3-O-beta-galactopyranoside, kaempferol 3-O-beta-xylopyranosyl (1 --> 2)-beta-galactopyranoside, kaempferol 3-O-beta-glucopyranosyl (1 --> 2)-beta-galactopyranoside, kaempferol 3-O-alpha-rhamnopyranosyl (1 --> 2)-beta-galactopyranoside. Their structures were established by acid hydrolysis, H2O2 oxidation and spectral analysis (UV, 1H, 3C NMR, MS).     

Oral glucose tolerance test‐based calculation identifies different glucose intolerance phenotypes within the impaired fasting glucose range

Aims/Introduction

The conventional oral glucose tolerance test (OGTT) cannot detect future diabetics among isolated impaired fasting glucose (is‐IFG) nor normal glucose tolerant (NGT) groups. By analyzing the relationship between fasting (FPG) and 2‐h plasma glucose (2hPG), the present study identifies is‐IFG subjects liable to worsening glucose homeostasis.

Materials and Methods

Oral glucose tolerance test was carried out in 619 patients suffering from obesity, hypertension or dyslipidemia, whose FPG was in the 100–125 mg/dL range. We calculated the percentage increment of 2hPG with respect to FPG (PG%) in these patients using the formula: ([2hPG − FPG] / FPG) × 100. Differences in β‐cell function within is‐IFG patients were assessed by estimated insulin sensitivity index (EISI), first‐phase insulin release (1stPH) and 1stPH/1/EISI (1stPH_corrected).

Results

Diabetes was diagnosed in 69 patients (11.2%), combined IFG/impaired glucose tolerance (IGT) in 185 patients (29.9%) and is‐IFG in 365 patients (58.9%). Is‐IFG was subdivided into PG% tertile groups: the percentage of females increased from 25% in the lowest to 45.2% in the highest tertile (χ² = 18.7, P < 0.001). Moving from the lowest to the highest PG% tertile group, insulin and 2hPG concentrations rose, whereas FPG, EISI, and 1stPH_corrected decreased progressively and significantly. Furthemore, PG% correlated inversely with EISI (r = −0.44, P < 0.0001) and 1stPH_corrected (r = −0.38, P < 0.0001).

Conclusions

Oral glucose tolerance test does differentiate the great heterogeneity in metabolic disorders of patients with FPG 100–125 mg/dL. Furthermore, PG% can expand the diagnostic power of OGTT in the is‐IFG range by distinguishing metabolic phenotypes very likely to herald different clinical risks.     

Sulfonylureas and their use in clinical practice

Many anti-diabetic drugs with different mechanisms of action are now available for treatment of type 2 diabetes mellitus. Sulfonylureas have been extensively used for treatment of type 2 diabetes for nearly 50 years and, even in our times, are widely used for treatment of this devastating chronic illness. Here, we review some of the available data on sulfonylureas, evaluating their mechanism of action and their effects on glycemic control. We can conclude that sulfonylureas are still the most used anti-diabetic agents: maybe this is due to their lower cost, to the possibility of mono-dosing and to the presence of an association with metformin in the same tablet. However, sulfonylureas, especially the older ones, are linked to a greater prevalence of hypoglycemia, and cardiovascular risk; newer prolonged-release preparations of sulfonylureas are undoubtedly safer, mainly due to reducing hypoglycemia, and for this reason should be preferred.     

miRNAs can be generally associated with human pathologies as exemplified for miR-144*

Background

miRNA profiles are promising biomarker candidates for a manifold of human pathologies, opening new avenues for diagnosis and prognosis. Beyond studies that describe miRNAs frequently as markers for specific traits, we asked whether a general pattern for miRNAs across many diseases exists.

Methods

We evaluated genome-wide circulating profiles of 1,049 patients suffering from 19 different cancer and non-cancer diseases as well as unaffected controls. The results were validated on 319 individuals using qRT-PCR.

Results

We discovered 34 miRNAs with strong disease association. Among those, we found substantially decreased levels of hsa-miR-144* and hsa-miR-20b with AUC of 0.751 (95% CI: 0.703–0.799), respectively. We also discovered a set of miRNAs, including hsa-miR-155*, as rather stable markers, offering reasonable control miRNAs for future studies. The strong downregulation of hsa-miR-144* and the less variable pattern of hsa-miR-155* has been validated in a cohort of 319 samples in three different centers. Here, breast cancer as an additional disease phenotype not included in the screening phase has been included as the 20^th trait.

Conclusions

Our study on 1,368 patients including 1,049 genome-wide miRNA profiles and 319 qRT-PCR validations further underscores the high potential of specific blood-borne miRNA patterns as molecular biomarkers. Importantly, we highlight 34 miRNAs that are generally dysregulated in human pathologies. Although these markers are not specific to certain diseases they may add to the diagnosis in combination with other markers, building a specific signature. Besides these dysregulated miRNAs, we propose a set of constant miRNAs that may be used as control markers.

     

The effect of recombinant factor VIIa (NovoSeven(R)) on peri-operative bleeding during total knee replacement in a non-hemophiliac patient

Background. Recombinant factor VIIa has been in use for some time to control bleeding in persons with hemophilia. In the present study we describe our experience with the use of a commercial form of recombinant factor VIIa, NovoSeven(R) (Novo Nordisk, Denmark), to control perioperative bleeding in the course of total knee replacement on a patient who, though not hemophiliac, had a very low tolerance for blood loss. Case report. A 44-year-old patient with anemia and rheumatoid arthritis, with a history of significant perioperative blood loss was referred for total knee replacement. The employment of two relatively small doses of NovoSeven(R) caused a considerable decrease in peri-operative surgical site bleeding, and post-operative blood loss from the surgical wound within the first 20 hours after the procedure was easily controlled. No complications were encountered. Conclusions. NovoSeven(R) can be used safely and successively to control perioperative bleeding even in non-hemophiliac patients.     

Prof. Ludwik Bierkowski: in search of the roots of orthopedics, traumatology, and rehabilitation in Cracow

This article describes the life and accomplishments of Prof. Ludwik Bierkowski (1801-1860), who held the Chair of Surgery in the Faculty of Medicine at the Jagiellonian University from 1831 until his premature death in 1860. The list of "firsts" in Polish medicine accumulated by Prof. Bierkowski is a long one, but two are of particular importance: he was the first surgeon to perform an operation in Poland using ether-induced general anesthesia (only a matter of several months after the first such operation in the world was performed in Boston), and the first to establish a "School of Medical Gymnastic", which we could call today a medical rehabilitation center.
Prof. Bierkowski's life coincided with a very turbulent period in the history of Poland, Cracow, and the Jagiellonian University. He left an indelible mark on Polish medicine and on the University he severed faithfully throughout his adult life. He is also remembered for his devotion to his patients, especially to the most unfortunate; he never turned away a patient who was unable to pay for his services, even in his private practice, and his newspaper advertisements openly proclaimed that fact. When he died of liver cancer; by his students, who regarded him as their Master and paradigm; and by his patients, who gratefully remembered his selflessness and devotion.