Hepatoprotective effects of pecan nut shells on ethanol-induced liver damage

The hepatoprotective activity of the aqueous extract of the shells of pecan nut was investigated against ethanol-induced liver damage. This by-product of the food industry is popularly used to treat toxicological diseases. We evaluated the phytochemical properties of pecan shell aqueous extract (AE) and its in vitro and ex vivo antioxidant activity. The AE was found to have a high content of total polyphenols (192.4 ± 1.9 mg GAE/g), condensed tannins (58.4 ± 2.2 mg CE/g), and antioxidant capacity, and it inhibited Fe²⁺-induced lipid peroxidation (LP) in vitro. Rats chronically treated with ethanol (Et) had increased plasmatic transaminases (ALT, AST) and gamma glutamyl transpeptidase (GGT) levels (96%, 59.13% and 465.9%, respectively), which were effectively prevented (87; 41 and 383%) by the extract (1:40, w/v). In liver, ethanol consumption increased the LP (121%) and decreased such antioxidant defenses as glutathione (GSH) (33%) and superoxide dismutase (SOD) (47%) levels, causing genotoxicity in erythrocytes. Treatment with pecan shell AE prevented the development of LP (43%), GSH and SOD depletion (33% and 109%, respectively) and ethanol-induced erythrocyte genotoxicity. Catalase activity in the liver was unchanged by ethanol but was increased by the extract (47% and 73% in AE and AE + Et, respectively). Therefore, pecan shells may be an economic agent to treat liver diseases related to ethanol consumption.     

Increasing proportion of late diagnosis of HIV infection among patients with AIDS in Italy following introduction of combination antiretroviral therapy

We analyzed trends over time and determinants of late diagnosis of HIV infection among people diagnosed with AIDS in 1986 to 1998 in a tertiary care center in Rome, Italy. Information on the date of a first HIV test was collected prospectively, in addition to data routinely collected for AIDS reporting. Patients with AIDS were defined as "late testers" if the time interval between first positive HIV test result and AIDS diagnosis was < or = 3 months. Overall, 503 people with AIDS of 1977 included in the analysis (25.4%) were late testers. the proportion of late testers decreased from 62.5% in 1986 to 16% in 1995. Thereafter, this proportion increased to 20.5% in 1996, 33.7% in 1997, and 36.6% in 1998. In multivariate analysis, the following variables were significantly associated with late testing: AIDS diagnosis in years 1986 to 1993 or 1997 to 1998 compared with 1995, male gender, age > or = 45 years, men who have sex with men, heterosexual contacts, or having unknown transmission mode compared with intravenous drug users, and being born outside Italy. Since 1996, the overall number of AIDS cases diagnosed at our center began to decrease whereas the number of late-testing AIDS patients did not decrease, resulting in an increasing proportion of late testers during the last 3 years of the study. This findings may reflect the effect of combination antiretroviral therapy in slowing progression to AIDS of HIV-infected persons aware of their status. A relevant number of people still discover their HIV infection late and may therefore miss treatment opportunities. New testing strategies are needed to reach more people who engage in high-risk behaviors, especially those at risk for sexual transmission, and those born outside Italy.     

Cold-Knife Conization versus Loop Excision: Histopathologic and Clinical Results of a Randomized Trial

Ninety patients with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 38) or cold-knife conization (n = 52). All specimens were well evaluable at histology. The average width of the lesions at histology was 10.2 and 9.7 mm, respectively (ns). The average weight of the specimens was 2.6 and 5.6 g (P < 0.01) and the average depth was 9.2 and 15.8 mm (P < 0.01), respectively. The distance between the cervical resection margin and CIN was 14 mm after loop excision and 24 mm after cold-knife conizatiun (P < 0.06). The margins of the specimen were not clear of disease in 8 patients after loop excision and in 12 patients after conization (ns). Two patients after loop excision and in three patients after cold-knife conization had postoperative bleeding. The results suggest that, compared with cold-knife conization, loop excision removes less healthy tissue without reducing the chances for cure.     

Bone morphogenetic proteins: relevance in spine surgery

Bone morphogenetic proteins (BMPs) are low molecular weight glycoproteins that play a vital role in the development and maturation of skeletal tissue. Bone morphogenetic protein-induced mesenchymal cell recruitment and differentiation leads to the formation of chondroblasts and osteoblasts leading to the formation of de novo bone. Overwhelming pre-clinical and clinical evidence has suggested a promising role for BMPs for anterior and posterolateral spinal fusion. Strength of this approach lies in the potential ability of these growth factors to reverse inhibitory conditions common in the clinical setting and enabling predictable fusion. However, several issues related to carriers, costs, and dosages still need to be consecutively addressed. Gene therapy techniques producing in vivo osteoinductive factors and utilizing minimally invasive approaches are attractive options being developed for the future.     

Graft repair of a pulmonary artery aneurysm

Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We report the successful surgical resection and repair of a pulmonary artery aneurysm using aneurysmectomy and replacement of the pulmonary artery with Dacron, a procedure with excellent longterm outcome that eliminates the risk of recurrence. The 65-year-old male patient presented with a marked decrease in exercise tolerance and worsening dyspnea. He had a history of pulmonary stenosis diagnosed during childhood, episodic shortness of breath beginning during his teenage years, hypertension, and smoking. On physical examination, the patient appeared generally well. Computed tomographic scan of the chest revealed an 8-cm aneurysm involving the main pulmonary artery and pulmonary artery bifurcation. Coronary angiography showed a massive aneurysm of the main and left pulmonary arteries, with mild dilation of the proximal right pulmonary artery. Surgery was performed through a median sternotomy with the use of normothermic, bicaval cardiopulmonary bypass. The aneurysm of the main pulmonary artery and dilated bifurcation of the pulmonary artery was excised and reconstruction was performed using a 22-mm Dacron graft. The patient's postoperative course was uneventful. He was discharged to home on postoperative day 5 and was well at 1-month follow-up.     

Cardiopulmonary bypass in patients with pre-existing coagulopathy

Patients with pre-existing coagulopathies who undergo surgical interventions are at increased risk for bleeding complications. This risk is especially true in cardiac surgical procedures with cardiopulmonary bypass (CPB) because of the necessity for heparinization and the use of the extracorporeal circuits, which have destructive effects on most of the blood components. In this review, cases of cardiac surgeries in patients with certain pre-existing coagulopathies are summarized, which could shed a light on future managements of such patients undergoing cardiac procedures with CPB. Pre-existing coagulopathies include antithrombin III deficiency, heparin-induced thrombocytopenia, cancer, factor XII deficiency, hemophilia, idiopathic thrombocytopenic purpura, protein S deficiency, and drug-induced platelet inhibition. In summary, pre-existing coagulopathy in patients undergoing open-heart surgeries, if not recognized and appropriately managed, can cause serious complications. Management of patients undergoing cardiac procedures should include a routine coagulation work-up and a thorough past medical history examination. If any of the foregoing is abnormal, further evaluation is warranted. Proper diagnosis and management of the pre-existing coagulopathy disorders is of crucial importance to the surgical outcome and long-term morbidity.