Endoscopic treatment of biliary duct strictures in sclerosing cholangitis: follow-up assessment of a new therapeutic approach

Endoscopic sphincterotomy was performed on 10 patients with sclerosing cholangitis to improve biliary tract drainage and to remove bile duct sludge and stones. In addition, Gruentzig-type balloons were placed endoscopically to dilate severe biliary duct strictures in eight of these patients, and endoprostheses were inserted to bridge high grade strictures in three patients. In order to assess the effectiveness of endoscopic treatment, we compared the number of hospitalizations for clinical episodes of cholangitis in this patient group for similar periods of time before and after therapy. Episodes of cholangitis requiring hospitalization decreased from 2.5 +/- 0.4 per patient in the 12 months prior to endoscopic therapy to 0.2 +/- 0.2 episodes per patient in the year following treatment and to 0.33 +/- 0.2 episodes per patient in the additional follow-up period during the second year. Liver function tests have improved significantly over the follow-up period of 19.1 +/- 2.6 months from the time of endoscopic treatment. The serum bilirubin decreased from 6.9 +/- 2.0 mg/dl to 2.7 +/- 1.4 mg/dl; serum alkaline phosphatase decreased from 959 +/- 214 IU to 385 +/- 89 IU; and serum transaminase decreased from 117 +/- 17 IU to 77 +/- 12 IU. Endoscopic treatment appears to be effective in patients with severe sclerosing cholangitis.     

Fracture of the styloid process associated with mandibular fracture. A case report

A case of styloid process fracture associated with bilateral mandibular fracture is reported. The possible fracture mechanism, clinical features, radiographic diagnosis and treatment are discussed.     

Primary aliphatic amine metabolism: the formation of a stable imine metabolite

The possible role of hydroxylamine and imine intermediates in the metabolism of amphetamine and related primary amines is discussed. The inherent instability of imines, has hitherto precluded the recognition of these compounds as metabolites of primary amines. During studies on the metabolism of o-methylbenzhydrylamine using washed hepatic microsomes from a number of mammalian species, the formation of o-methylbenzophenoneimine as a metabolite was observed. This metabolite was identified by preparative thin layer chromatography followed by gas-chromatography combined with mass spectrometry.     

Ovarian hyperstimulation syndrome--two case reports

Two cases of ovarian hyperstimulation syndrome (OHSS) following the GIFT procedure are reported. This article highlights the potential dangers of this condition and discusses the classification and management.     

Is blood pressure related to kidney size and shape?

Objective: To examine the relationship between blood pressure and the size and shape of the kidneys in healthy volunteers from the community. Design: A cross-sectional community-based study of normal volunteers in Portsmouth City, Hampshire, UK. Subjects: Subjects numbered 185 (99 female), aged 19-66 years. Results: Blood pressure was higher in men, and in those with higher body mass index. Both systolic and diastolic blood pressure were correlated with the derived kidney volume. However, when corrected for age, sex and BMI the relationship was not statistically significant. Blood pressure correlated inversely with the width : length ratio of the left kidney. Conclusions: Blood pressure was not correlated with kidney size in this group of adults. Key words: blood pressure; hypertension; kidney size; kidney volume; kidney dimensions      

Comparative analysis of microbial genomes to study unique and expanded gene families in Mycobacterium tuberculosis

Mycobacterium tuberculosis, the causative agent of tuberculosis, is the leading infectious disease agent, causing millions of deaths annually. The incidence of disease is increasing with the AIDS pandemic, and current vaccines and therapies are not 100% efficient, resulting in the emergence of drug resistance. The ability of the organism to evolve with enhanced pathogenicity appears, at least in part, to be provided by the mechanism of gene duplication. This evolutionary mechanism results in expansion of gene families, thereby providing the organism with extra copies of the gene and thus the opportunity to evolve new functions. This project aims to identify the expanded gene families in M. tuberculosis and investigate the potential contribution of gene duplication events to pathogenicity. Comparative genomics tools were used to compare the proteomes of over 80 pathogenic and non-pathogenic microorganisms, including several mycobacteria, to identify unique proteins and determine the extent of family expansion in M. tuberculosis. We selected proteins from this organism that were either unique to M. tuberculosis and other pathogens or restricted to pathogenic mycobacteria, as well as expanded families in the mycobacteria, for further analysis. Up to half of all M. tuberculosis proteins belong to expanded families, some of which are unique to this organism or the mycobacteria, suggesting that they have a role to play in evolution of these genomes. Although the evolution of M. tuberculosis is thought to be relatively recent, the maintenance of these duplicated families in the genome suggests they have a role to play in the pathogenic lifestyle of the organism.     

Treatment Strategies for Myoclonic Seizures and Epilepsy Syndromes with Myoclonic Seizures

Summary:   Despite the availability of numerous treatment options, the diagnosis and treatment of myoclonic seizures continue to be challenging. Based on clinical experience, valproate and benzodiazepines have historically been used to treat myoclonic seizures. However, many more treatment options exist today, and the clinician must match the appropriate treatment with the patient's epilepsy syndrome and its underlying etiology. Comorbidities and other medications must also be considered when making decisions regarding treatment. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Most epileptic myoclonus can be treated pharmacologically, but some cases respond better to surgery, the ketogenic diet, or vagus nerve stimulation. Because myoclonic seizures can be difficult to treat, clinicians should be flexible in their approach and tailor therapy to each patient.