Splenic infarction: 10 years of experience

Objective

The aim of this study was to study the clinical presentation of splenic infarction.

Methods

A retrospective examination of files during a 10-year period was conducted. Only computed tomography–proven diagnoses of splenic infarction were included. Signs, symptoms, medical history, and results of investigation were recorded.

Results

We found 49 episodes of acute splenic infarction. Abdominal or left flank pain was the most common symptoms (80%), and left upper quadrant tenderness was the most common sign (35%). Splenic infarction was the presenting symptom of underlying disease in 16.6% of the patients. Based on the computed tomography results, ultrasound was diagnostic only in 18% of patients. There was no in-hospital mortality or serious complications.

Discussion

We present, to the best of our knowledge, the largest series of patients with splenic infarction diagnosed on clinical and radiological grounds. Awareness of the diagnostic possibility of splenic infarction in a patient with unexplained abdominal pain is important because it can be the presenting symptom of potentially fatal diseases.     

The social,economic and political impact of the global HIV/AIDS epidemic

OBJECTIVES: This paper reviews the themes emerging from reports of the many social, economic and political effects of the HIV/AIDS epidemic on individuals, nations and the world. The impact of the global HIV/AIDS epidemic has been felt in every facet of society. APPROACH: The impact of the epidemic is described in five areas: (1) challenges and changes to traditional public health approaches to infectious diseases and sexually transmitted diseases; (2) adjustments to ‘standard’ clinical research and drug regulatory practices; (3) emphasis on the importance of personal behaviors and behavioral approaches in controlling the epidemic; (4) revealing the complexity of and recognizing the need to monitor the impacts of HIV/AIDS; and (5) highlighting the difficulties of, and need for, the international responsiveness to address HIV/AIDS. The oral health community's response to the epidemic is briefly described. CONCLUSIONS: Although in its second decade, the epidemic is still in its early stages of evolution. The challenges lie in the development and perpetual evolution of strategies to respond to the epidemic locally while thinking and acting globally. The international oral health community is one of many that has played and must continue to play an active role in a multi-disciplinary effort needed to curb this epidemic.     

Expression of NMDA receptors in multipotent stromal cells of human adipose tissue under conditions of retinoic acid-induced differentiation

The system of NMDA glutamate receptors in human adipose tissue multipotent stromal cells and SH-SY5Y human neuroblastoma cells was used as a model for studies of NMDA receptor expression during neurodifferntiation. Glutamate NMDA receptors were detected in multipotent stromal cells of human adipose tissue. The expression of NR1 subunits of NMDA receptors increased significantly after 6-day incubation of multipotent stromal cells of human adipose tissue with 10 μM retinoic acid. Only NR1 subunits of NMDA receptors were expressed in SH-SY5Y neuroblastoma cells. Incubation with retinoic acid did not promote the appearance of mRNA of other subunits (NR2A-D, NR3). The results indicate that expression of NMDA receptors can serve as an indicator of neuronal differentiation of cells and as a marker of the efficiency of neuronal differentiation protocol. __________ Translated from Kletochnye Tehnologii v Biologii i Medicine, No. 4, pp. 216–220, October, 2007     

组织多普勒检测心室收缩功能对判断扩张型心肌病患者预后的价值

目的：评价组织多普勒显像（TDI）测定的左右心室长轴方向局部收缩参数在判断扩张型心肌病（DCM）患者预后方面的价值。方法：对48例DCM患者进行常规超声和组织多普勒检查的长期随访。根据预后将患者分为两组：A组为病情加重组（发生各种心脏事件：死亡、心脏移植或因心力衰竭加重住院治疗）21例，B组为病情稳定组（心功能保持稳定或者改善）27例。用TDI方式于心尖四腔观分别检测两组患者左室侧壁（L）、室间隔（S）和右室侧壁（R）的瓣环处（1）、乳头肌水平（3）和二者中点（2）的等容收缩期速度（is）、射血期速度（ez）和左右心室侧壁处的二、三尖瓣环的位移，检测结果进行组间比较，并与患者预后进行相关性分析。结果：TDI检测的A组的R3is、S2ez、S1is、S1ez、L2ez、L1is、右室侧壁三尖瓣位移均低于B组（P均〈0．05），并且对判断DCM患者预后有较高的敏感性和特异性。结论：TDI检测左右心室收缩速度能较准确地判断DCM患者的预后。     

Steady‐state amprenavir and tenofovir pharmacokinetics after coadministration of unboosted or ritonavir‐boosted fosamprenavir with tenofovir disoproxil fumarate in healthy volunteers

Objective

An open‐label, three‐period pharmacokinetic study was conducted to investigate the drug interaction potential between fosamprenavir (FPV) and tenofovir disoproxil fumarate (TDF).

Methods

Thirty‐six healthy subjects received TDF 300 mg once daily (qd) for 7 days (period 1), and then were randomized to 14 days of either FPV 1400 mg twice daily (bid) or FPV/ritonavir (RTV) 700/100 mg bid alone or with TDF (period 2). Subjects continued their randomized dose of FPV for 14 more days, adding or removing TDF based upon its receipt in period 2 (period 3). Twenty‐four‐hour pharmacokinetic sampling was carried out on day 7 of period 1 and on day 14 of periods 2 and 3. Steady‐state plasma amprenavir (APV) and tenofovir (TFV) pharmacokinetics were assessed by noncompartmental analysis and parameter values observed with each regimen were compared using geometric mean ratios with 90% confidence intervals.

Results

After TDF coadministration, APV geometric mean minimum concentration (C_min), maximum concentration (C_max), and area under the plasma concentration–time curve (AUC) increased by 31, 3 and 7% above values observed with unboosted FPV alone; they also increased by 31, 4 and 16% above values observed with FPV/RTV alone. TFV C_min, C_max and AUC decreased by 12, 25 and 15% after FPV coadministration and by 9, 18 and 7% after FPV/RTV coadministration. No significant changes in RTV pharmacokinetics were observed. No differences were noted in adverse events among dosing periods.

Conclusions

In this evaluation of the interaction between FPV and TDF, increases in APV exposures and modest decreases in TFV exposures were observed. These were unlikely to be clinically significant.

     

Pathways of Bone Marrow Mononuclear Cell Differentiation after Transplantation into Postinfarction Heart

We studied homing and differentiation fate of transplanted bone marrow mononuclears after non-selective intracoronary injection on day 30 after acute myocardial infarction in rats. Mononuclear cells migrated to the cicatrix zone where they differentiated into fibroblasts and myofibroblasts. Mononuclear cells did not differentiate into cardiomyocytes, endothelial cells, or smooth muscle cells of vascular media. Stimulation of angiogenesis and reparation of the myocardium was observed under these conditions.     

Early onset of diabetic nephropathy

A 12 year old Asian girl with a four year history of poorly controlled insulin dependent diabetes mellitus developed overt diabetic nephropathy. There were no clinical features of Rabson-Mendenhall syndrome. Screening for microalbuminuria would have identified incipient diabetic nephropathy and highlighted the importance of good glycaemic control. Although screening for microalbuminuria is recommended after five years from diagnosis, it may be appropriate to undertake this annually in those with poor glycaemic control.     

Analysis of Changes in Cell Volume of a Mouse Early Embryo Exposed to Osmotic Shock

The impact of the osmotic component of the incubation medium for the volume of mouse early embryonic cell was studied by laser scanning microscopy. Common Dulbecco’s medium caused a prolonged hyperosmotic effect. Adaptive phase of regulatory compensation for the osmotic shock was observed under hypotonic conditions. From these data, water permeability of the blastomer membrane is evaluated as 0.4 μ/(min×atm).     

Effects of female genital mutilation on birth outcomes in Switzerland

Objective  The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland.
Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes.
Design  A retrospective case–control study.
Setting  A teaching hospital.
Population  One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls.
Methods  Data for patients' wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age.
Main outcome measures  Patients' satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures.
Results  Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears.
Conclusion  An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.