Large scrotal hernia: A complicated case of mesh migration, ascites, and bowel strangulation

A 30-year-old male with 1 1/2-year history of an asymptomatic, large, reducible right indirect scrotal hernia presented to the emergency department complaining of a 2-week history of increasing abdominal distension and daily emesis. He had recently undergone an emergent exploratory laparotomy in which his asymptomatic hernia was repaired with a mesh plug from an intra-abdominal approach. The mesh plug subsequently migrated into the patients scrotum resulting in a strangulating bowel obstruction. This paper discusses a serious complication that may result from inappropriate use and placement of a mesh plug and our approach to correct the situation utilizing a bioabsorbable mesh prosthesis.     

Effect of short-term administration of sodium saccharin on rhesus monkeys

Sodium saccharin (NaS) was incorporated into biscuits or the drinking-water and fed to rhesus monkeys at progressively increasing doses in order to determine the maximum dose that the monkeys would voluntarily consume and/or tolerate. Very little rejection of NaS-treated biscuits or drinking-water was observed. However, severe diarrhoea which precluded further treatment occurred when the dose of NaS reached 8.0% (approximately 1600 mg/kg body weight/day) in the biscuits and 0.48% (approximately 900–2400 mg/kg/day) in the drinking-water. An increase in fluid intake occurred in monkeys in both treatment groups. An increase in urine volume and a decrease in urine osmolality occurred in monkeys fed NaS in the drinking-water. No effects on body weight, food consumption or urine pH were observed in monkeys in either treatment groups. All animals rapidly recovered when they were given untreated biscuits or water. Therefore, although monkeys will voluntarily consume rather high doses of NaS incorporated into biscuits or drinking-water, adverse effects on their general well-being preclude such administration for more than a few days.     

PARATHYROID HORMONE-RELATED PROTEIN IN LOWER VERTEBRATES

1. Parathyroid hormone-related protein (PTHrP) is an important mediator of humoral hypercalcaemia of malignancy in humans. Normal human subjects have very low levels of PTHrP in their circulation. 2. Parathyroid hormone-related protein has recently been demonstrated in high levels in the circulation and tissues of the sea bream and the dogfish, leading to the hypothesis that PTHrP may be a ‘classical’ hormone in fish. 3. Immunohistochemistry and in situ hybridization were performed to investigate the evolutionary history of PTHrP. Tissues were examined from a number of lower vertebrates, including lungfish, lamprey and several species of bony and cartilaginous fish. Parathyroid hormone-related protein was localized to the skin and to kidney tubules in all animals studied. In the developing lungfish, PTHrP was observed in the notochord, developing brain and skeletal muscle layers. These results suggest that PTHrP is of ancient origin and has a basic and fundamental function in vertebrates.     

Transcatheter arterial embolization of two symptomatic giant cavernous hemangiomas of the liver

Cavernous hemangiomas are usually asymptomatic; however, a small percetage may cause symptoms. This case report discusses palliation by transcatheter arterial embolization with polyvinyl alcohol particles.     

Noncompliance may render migraine prophylaxis useless, but once-daily regimens are better

Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.     

长梗绞股蓝的化学成分研究

自长梗绞股蓝( Gynostemma longipes C.Y.Wu )的地上部分分得一个新的三萜皂甙,经化学方法和光谱分析确定其化学结构为19-氧化-3β,20(S),21-三羟基达玛烷-24-烯-3-O-｛[α-L-吡喃鼠李糖基(1→2)][β-D-吡喃木糖基(1→3)]｝α-L-阿拉伯糖甙,命名为长梗绞股蓝皂甙I(gylongiposideI)。     

Intracranial circulation: preliminary clinical results with three- dimensional (volume) MR angiography

The authors assessed the clinical utility of a magnetic resonance angiography technique in the evaluation of intracranial circulation. Eighteen patients with a low likelihood of cerebrovascular disease (control group) and 40 patients with suspected cerebrovascular disease were imaged with a FISP (fast imaging with steady precession) sequence (repetition time of 50 msec, echo time of 15 msec, velocity compensation in the read and section-select directions with acceleration compensation in the read direction, 15 degrees anisotropic volume, and a 1.25-mm partition thickness). Ninety-four percent of images in the control group and 72% of images in the group with cerebrovascular disease were considered useful for diagnosis. This technique can provide accurate images of intracranial circulation and can be performed in conjunction with two-dimensional spin-echo or gradient-echo imaging. It was most useful in the evaluation of patent intracranial aneurysms, vessel displacement, and large-vessel occlusive disease. Disadvantages included limited field of view, persistent signal voids, limited spatial resolution, and inadequate depiction of lesions with slow flow.