Chromatographic behavior of zwitterionic enalapril-exploring the conditions for lipophilicity assessment

The chromatographic behavior of enalapril was investigated under different stationary and mobile phase conditions in an effort to unravel interferences in the underlying retention mechanism, which would affect its relation to octanol-water partitioning. Extrapolated retention factors, logk(w), were used as relevant chromatographic indices. The retention/pH profile was established and the peak split phenomenon, associated with cis/trans interconversion, was also monitored as a function of pH. The pH at maximum retention and minimum peak split occurrence was chosen for further investigation, so that the presence of zwitterionic structure was guaranteed and any effect of cis/trans interconversion could be ignored. Retention of zwitterionic enalapril was found to be very sensitive to mobile phase conditions in regard to organic modifier as well to the aqueous component. The use of morpholine-propanesulfonic acid (MOPS) as buffer and the presence of n-octanol as mobile phase additive proved critical factors for maximum suppression of secondary interactions. Nevertheless, the corresponding extrapolated retention factor was considerably larger than octanol-water logD value at the isoelectric point. However, logk(w) could be successfully converted to logD by means of a calibration equation established for ionized acidic compounds.     

The superiorly based platysma flap for oral reconstruction in conjunction with neck dissection: a case series.

PURPOSE: The purpose of this study was to access the reliability and use of the superiorly based platysma flap for reconstruction of small and medium oral defects. PATIENTS AND METHODS: This case series consists of 5 patients who were reconstructed with a superiorly based platysma flap for defects of the following oral region: buccal mucosa, floor of the mouth, and lateral gingiva. The flaps were monitored for complications, including skin loss and ischemia in the postoperative period. RESULTS: Three patients (60%) had some skin sloughing in the recipient site. None of the patients had complications in the donor site. CONCLUSION: The superiorly based platysma flap can survive after the facial artery has been ligated, which is the normal procedure during neck dissection. If skin sloughing occurs, it is usually inconsequential for intraoral reconstruction because the underlying muscle remains viable and undergoes epithelialization.     

Primary malignant peripheral nerve sheath tumour in the temporalis muscle.

INTRODUCTION: Primary malignant neoplasms of nerve sheath origin are rare, highly aggressive tumours that account for no more than 5% of all soft tissue sarcomas. In the head and neck where the great majority of peripheral nerve neoplasms are benign, as in the rest of the body, malignant peripheral nerve sheath tumours (MPNSTs) are unusual lesions. PATIENT: A case of a large MPNST is reported, which originated in the left temporalis muscle of a 74-year-old man who did not suffer from von Recklinghausen's disease. It had been treated as an abscess for a long time. DISCUSSION: The clinicopathologic properties of this neoplasm have been widely discussed and the emphasis is on the need for its early identification since the tumour's non-specific symptoms may result in delayed diagnosis and treatment. CONCLUSION: To date, to our knowledge, no case of MPNST located in the temporalis muscle has been described. The rarity of the tumour along with its clinical appearance and the vague symptoms may result in delayed referral and thus the tumour being quite large when diagnosed.     

IL-15 is elevated in serum and cerebrospinal fluid of patients with multiple sclerosis

Interleukin-15 (IL-15) is a novel proinflammatory cytokine having similar biological activities to IL-2 which is implicated in the pathogenesis of multiple sclerosis. It is produced by activated blood monocytes, macrophages and glial cells. There is little information about the involvement of IL-15 in the development of multiple sclerosis (MS). The objective of our study was to measure IL-15 serum and cerebrospinal fluid (CSF) levels in MS patients and to correlate serum and CSF IL-15 concentrations with clinical parameters of the disease. CSF IL-15/Serum IL-15 ratio (c/s IL-15 ratio) was introduced to assess the origin of elevated IL-15 levels. MATERIALS AND METHODS: We measured serum and CSF IL-15 levels in 52 patients with MS and 36 age and gender matched patients with inflammatory (IND) and non-inflammatory neurological diseases (NIND) studied as control groups. IL-15 levels were correlated with clinical parameters as duration, disability, MRI activity and clinical subtypes of the disease. RESULTS: MS patients were found to have significantly higher serum IL-15 levels compared with IND (p=0.00016) and NIND patients (p=0.00045). Elevated levels of IL-15 were also found in CSF samples from MS patients compared with patients with IND (p=0.00034) and NIND (p=0.0003). Among MS subgroups there were no statistically different IL-15 serum and CSF concentrations. No significant correlation of serum and CSF IL-15 concentrations with MRI activity, disability assessed by EDSS score and duration of the disease were also found. C/S IL-15 ratio was found lower in MS patients compared with IND (p=0.01) and not significantly different compared with NIND patients (p=0.14) suggesting that systemic activation might be the source of high CSF IL-15 levels in MS patients. CONCLUSIONS: Our findings suggest a possible role of IL-15 in the immunopathogenetic mechanisms of MS.     

Primary tuberculosis of the oral cavity.

Two cases of primary tuberculosis of the mouth are reported. Painless ulceration of long duration and enlargement of the regional lymph nodes that did not respond to conservative and antibiotic therapy were the main manifestations of the disease in both cases. In the first case the tubercle ulcer was located in the lower buccogingival sulcus of a 17-year-old girl. In the second case the lesion occurred as a chronic periodontal inflammation around the gingiva of the left lower second molar tooth. When the tooth was extracted, a painless ulceration appeared around the socket, which was filled by granulation tissue. Histopathologic examination; bacteriologic, serologic, and blood tests; and chest x-ray film confirmed the diagnosis. Predisposing factors that might favor primary inoculation of tubercle bacilli into oral mucosa are also discussed. Finally we emphasize that in such cases it is essential to attempt to locate a possible primary site elsewhere in the body before oral tuberculosis is considered the primary disease.     

Prophylaxis of Venous Thromboembolism Using Two Different Doses of Low-Molecular-Weight Heparin (Nadroparin) in Bariatric Surgery: A Prospective Randomized Trial

Background: Obese patients undergoing bariatric surgery are at a high risk of developing fatal pulmonary embolism or post-thrombotic syndrome.The prophylactic use of low molecular weight heparins (LMWHs) is correlated with a significant reduction in post-operative venous thrombosis in patients undergoing orthopedic or general surgery. In morbidity obese patients, the limited number of comparative trials are too sparse to allow a consensus on the effective dose and dosing schedule. Methods: In a prospective study to evaluate the effect of two doses of nadroparin as prophylaxis for venous thromboembolism following bariatric surgery, 60 consecutive patients undergoing Rouxen-Y gastric bypass were randomized to receive either 0.6 ml (5700 IU) or 1.0 ml (9500 IU) of nadroparin started pre-operatively and then given once daily post-operatively until discharge. Results: No statistically significant differences between the two groups were detected in any of the measured coagulation parameters either preoperatively or at days 1, 3 and 5 postoperatively.No thrombotic events were observed pre- or post- operatively, and no patient developed meta-thrombotic syndrome at the 3 and 6 months follow-up. No bleeding events occurred in the patients given the lower dose compared with two major hemorrhages in those given the higher dose. Conclusion: Our results indicate that 0.6 ml (5700 IU) of nadroparin once daily is safe and well-tolerated, and it is as effective in prophylaxis of venous thromboembolism as the higher dose of 1 ml (9500 IU), in such high risk patients.     

Combined treatment with low-dose interferon plus vinblastine is associated with less toxicity than conventional interferon monotherapy in patients with metastatic renal cell carcinoma.

The outcome of treatment of advanced renal cell carcinoma is disappointing. In interferon (IFN)-treated patients, the high incidence of adverse effects causes many patients to withdraw from treatment. This 12-week randomized study compared the incidence of toxicity associated with high-dose IFN monotherapy (15 x 10(6) U thrice weekly) and treatment with the combination of low-dose IFN (5 x 10(6) U thrice weekly) and 6 mg/m2 vinblastine (VBL) every 14 days in 100 consecutive patients. There was no significant difference in response rate between treatment arms (42% IFN vs. 34% IFN + VBL) or between subgroups (by tumor location). Combined treatment was associated with a significantly lower incidence of fever, fatigue, and weight loss but with a higher incidence of leukopenia. There was no significant difference in the incidence of other events. More patients treated with IFN monotherapy required bed rest, and overall treatment costs were 60% higher than for combined treatment. It is concluded that combined treatment with low-dose IFN and VBL, without loss of short-term efficacy, is better tolerated and less expensive than high-dose IFN monotherapy.