Treatment of long ureteric strictures with buccal mucosal grafts

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the intermediate‐term functional outcome.

PATIENTS AND METHODS

Between November 2000 and October 2006 reconstruction of seven long ureteric strictures using buccal mucosal patch grafts and omental wrapping was performed in five women (one with bilateral strictures) and one man. The surgical steps of stricture reconstruction and wrapping with omentum are described in detail. Stricture recurrence was defined as persistent impaired ureteric drainage as displayed by imaging techniques or the necessity to prolong JJ stenting. Patency rates and stricture recurrence‐free survival rates are provided.

RESULTS

With a median follow up of 18 months five of the seven strictures were recurrence‐free. Graft take was good in all patients. In one asymptomatic patient, there was impaired ureteric drainage on the reconstructed side, and in one patient with reconstruction of both ureters prolonged JJ stenting of one side was necessary. In both patients, the impaired drainage was caused by persistent stricture below the reconstructed ureteric segments.

CONCLUSIONS

At intermediate‐term follow‐up in a small group of patients with long ureteric strictures, treatment with buccal mucosal patch grafts and omental wrapping showed good functional outcome.     

Uric Acid and Antioxidant Effects of Wine

The aim of this article is to review the role of uric acid in the context of antioxidant effects of wine and its potential implication to human health. We described and discussed the mechanisms of increase in plasma antioxidant capacity after consumption of moderate amounts of wine. Because this effect is largely contributed by acute elevation in plasma uric acid, we paid special attention to wine constituents and metabolic processes that are likely to be involved in uric acid elevation.The association between light-to-moderate wine consumption and risk reduction of cardiovascular diseases and/or reduction of all-cause mortality was confirmed by numerous epidemiological studies (1-7). Among other beneficial biological effects, it has been shown that wine can increase antioxidant capacity in humans (8-12) and reduce susceptibility of human plasma to lipid peroxidation (11,13). These effects of wine attracted significant research interest, as oxidative stress is implicated in the pathogenesis of various diseases such as cancer and cardiovascular and neurodegenerative diseases (14-19).     

Magnetic resonance imaging in the evaluation of uterus didelphys with obstructed hemivagina and renal agenesis: a case report

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis usually presents after menarche with progressive abdominal pain during menses secondary to hematocolpos. Initially, the anomaly remains unrecognized, while patients most frequently referred to surgeons for assistance. The method of choice for diagnosis is magnetic resonance imaging. A greater awareness of the syndrome of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis should lead to its prompt diagnosis, allowing for early and appropriate surgical treatment as well as decreased long-term morbidity. Transvaginal excision of the septum is the appropriate mode of treatment.     

Human anterior lens capsule epithelial cells contraction

Purpose: Human anterior lens epithelial cells, attached to surgically isolated capsules, were found to contract upon stimulation. The purpose of this study was to characterize these contractions, which create gaps between cells, and to assess the underlying physiological mechanisms and their possible association with cataract formation. Methods: Lens capsules obtained during cataract surgery were stained with fluorescent dye Fura‐2. Its fluorescence, upon excitation at 360 and 380 nm, was imaged to monitor changes in cell morphology and cytosolic free Ca²⁺concentrations ([Ca²⁺]_i) in response to pharmacological stimulation by acetylcholine (ACh) and to mechanical stimulation by flow of saline or direct contact. Results: Epithelial cells contracted in approximately a third of preparations when stimulated by either ACh application, fluid movement or direct mechanical contact. Contractions started either before or at best simultaneously with the rise in [Ca²⁺]_i. Contractions also occurred when there was hardly any change in [Ca²⁺]_i upon application of physiological saline alone. The probability of contractions occurring did not differ significantly among cortical, nuclear and combined cortical + nuclear cataract. Conclusions: This study provides the evidence that contractions of the anterior lens epithelial cells take place in significant portion of human lens anterior capsule postoperative preparations after non‐specific stimulation. Contractions are at least partially independent of changes in [Ca²⁺]_i. They can be mechanically induced, are localized and reversible and have a fast response and did not differ among different types of cataract. Physiological and clinical significance of this phenomenon remains to be elucidated.     

Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers

Almost all the studies of athlete's heart have been carried out on adult and older adolescent players; hence the limited data on the cardiac response to exercise in the beginning of the active sports career in the youngest athletes. The study was designed to examine the physiological limits of left ventricle (LV) cavity size and wall thickness in elite footballers at the preadolescent age, it the beginning of the active sports career. Ninety-four highly trained male footballers (mean aged 12.85 ± 0.84) competing in the Serbian Football League and 47 age-matched healthy male controls, aged 12–14, were enrolled in the study. All the echocardiographic findings were adjusted to BSA^?0.5, while left ventricle mass (LVM) was additionally adjusted to BSA^?1.5. Reference ranges were defined as values of 5–95th centile according to the mean values in both groups. The proportions of the footballers with LV dimensions outside expected ranges were additionally noted. The data indicate significant increases in absolute values of LV dimensions, aortic root size and left atrium (p < 0.001) in preadolescent professional footballers compared with the values expected for age-matched controls, whereas there are no differences in absolute values of ventricular septal and posterior wall thickness, LV wall thickness and LVM (p > 0.05). Upon body-size adjustments, significant increases were observed in all echocardiographic parameters (p < 0.001). Our data indicate an early cardiac remodeling, already apparent in preadolescence, even after a short period of training.     

Human ehrlichiosis

BACKGROUND: Human ehrlichiosis is a newly recognized disease. It is a tick-borne disease caused by several bacterial species of the genhus Erlichia. These are small gram-negative pleomorphic cocci, that are obligatory intracellular bacteria. Tick Ixodes is the principle vector in Europe, and Amblyomma amenicanum in the United States. Bacterial organisms replicate in a tick, and are transmited from infected cells in a vector to the blood cells of animals or humans. Human ehrlichiosis is a name for a group of diseases caused by different species of Ehrlichia. One of them is the disease named human monocytic ehrlichiosis, caused by Ehrlichia chaffeensis, and the other is a human granulocytic ehrlichiosis caused by Anaplasma phagocytophilia. CASE REPORT: We reported a 23-year-old patient admitted for the clinical treatment with the symptoms of high febrility (above 40 degrees C), headache, vomiting, general weakness and exhaustion, but without data on a tick bite. The patient was treated with trimetoprim-sulfamethoxazole for a week when Ehrlichia chaffeensis was confirmed by the immunofluoroscence test, and the therapy contimed with doxacyclin. CONCLUSION: Human ehrlichiosis is also present in our country, so this disease should be considered everyday, especially in infectology practice.     

Pregnancy outcome during the bombing of Yugoslavia from March 24 to June 9, 1999

BACKGROUND/AIM: The aim of this study was to evaluate pregnancy outcome during the bombing of Yugoslavia in the period from March 24 to June 9, 1999. METHODS: A retrospective study included a total of 81 spontaneous abortion following XII gestation week, and 1448 deliveries, hospitalized in the regional hospital. The analyzed were: the incidence of spontaneous abortion, Cesarean section, post-term delivery, vaginal delivery following the previous Cesarean section within the period from March 24 to June 9, 1999, and compared to the same periods in 1998 and 2000 by the use of chi2 and Kolgomorov-Smirnov tests. RESULTS: Under the conditions of a three-month stress imposed by the bombing, significantly increased were the incidence of spontaneous abortion and vaginal delivery following the previous Cesarean section, while the incidence of Cesarean section and post-term delivery were decreased, but the incidence of perinatal outcome was paradoxically improved. The analysis of findings on admittance revealed that iterative Cesarean section was performed electively, close to the expected term of delivery, and vaginal delivery following the previous Cesarean section mainly two weeks before that term with the admittance finding confirming a high active stage pregnancy. CONCLUSIONS: Within the bombing, statistically significantly was increased the percentage of abortions after XII gestation week, and the biological duration of pregnancy was reduced. The reduced duration of pregnancy complete with the accelerated fetal mutation (also caused by the stress) resulted in better perinatal outcome, and statistically significantly lower percentage of Cesarean section.     

Exogenous nitric oxide and bubble formation in divers

PURPOSE: Prevention of bubble formation is a central goal in standard decompression procedures. Previously we have shown that exercise 20-24 h prior to a dive reduces bubble formation and increases survival in rats exposed to a simulated dive. Furthermore, we have demonstrated that nitric oxide (NO) may be involved in this protection; blocking the production of NO increases bubble formation while giving rats a long-lasting NO donor 20 h and immediately prior to a dive reduces bubble formation. This study determined whether a short-lasting NO donor, nitroglycerine, reduced bubble formation after standard dives and decompression in man. METHODS: A total of 16 experienced divers were randomly assigned into two groups. One group performed two dives to 30 m of seawater (msw) for 30 min breathing air, and performed exercise at an intensity corresponding to 30% of maximal oxygen uptake during the bottom time. The second group performed two simulated dives to 18 msw for 80 min breathing air in a hyperbaric chamber, and remained sedentary during the bottom period. The first dive for each diver served as the control dive, whereas the divers received 0.4 mg of nitroglycerine by oral spray 30 min before the second dive. Following the dive, gas bubbles in the pulmonary artery were recorded using ultrasound. RESULTS: The open-water dive resulted in significantly more gas bubbles than the dry dive (0.87 +/- 1.3 vs 0.12 +/- 0.23 bubbles per square centimeter). Nitroglycerine reduced bubble formation significantly in both dives from 0.87 +/- 1.3 to 0.32 +/- 0.7 in the in-water dive and from 0.12 +/- 0.23 to 0.03 +/- 0.03 bubbles per square centimeter in the chamber dive. CONCLUSION: The present study demonstrates that intake of a short-lasting NO donor reduces bubble formation following decompression after different dives.