Ventilatory mechanics and alveolo-capillary diffusion in diabetes

In order to appreciate the repercussion of diabetes on the respiratory function, we measured the pulmonary volumes, the ventilatory flows, the airways resistances (Raw) and the diffusing capacity for the carbon monoxide (DLCO) of 49 diabetes distributed into 27 IDDM and 22 NIDDM aged from 15 to 56 years, compared to 31 control subjects. We found a significant decrease in the total pulmonary capacity (TCL), the vital capacity (VC), the inspiratory capacity (IC), the ventilatory flows and the DLCO. The decrease of the VC and the FEV1 will be more marked in the IDDM. The decrease of the DLCO will be more pronounced within masculine sex, it seems to be correlated with the duration of diabetes and more impaired if a diabetic nephropathy is associated especially in IDDM. Our results suggest that in the diabetes evolution, the lung is among the target organs in the degenerative complications. The respiratory tests reflect the pulmonary reach in the diabetes and provides important perspectives in the following.     

Understanding the basis of CD4(+) T-cell depletion in macaques infected by a simian-human immunodeficiency virus

The efficacy of candidate AIDS vaccines to mediate protection against viral infection and pathogenesis is evaluated, at a preclinical stage, in animal models. One model that is favored because the infecting virus is closely related to HIV-1 and because of the rapidity of pathogenic outcomes is the infection of Old World monkeys by simian-human immunodeficiency virus (SHIV) chimerae. We investigated the basis for the depletion of CD4(+) T lymphocytes in a SHIV-macaque model. Molecularly cloned SHIVs, SHIV-89.6 and SHIV-KB9, differ in the ability to cause CD4(+) T-cell loss at a given level of virus replication in monkeys. The envelope glycoproteins of the pathogenic SHIV-KB9 mediate membrane-fusion in cultured T lymphocytes more efficiently than the envelope glycoproteins of the non-pathogenic SHIV-89.6. The minimal envelope glycoprotein region that specifies this increase in membrane-fusing capacity was sufficient to convert SHIV-89.6 into a virus that causes profound CD4(+) T-cell depletion in monkeys. Conversely, two single amino acid changes that decrease the membrane-fusing ability of the SHIV-KB9 envelope glycoproteins also attenuated the CD4(+) T-cell destruction that accompanied a given level of virus replication in SHIV-infected monkeys. Thus, the ability of the HIV-1 envelope glycoproteins to fuse membranes, which has been implicated in the induction of viral cytopathic effects in vitro, contributes to the capacity of the pathogenic SHIV to deplete CD4(+) T lymphocytes in vivo.     

Percutaneous removal of spilled gallstones in a subhepatic abscess

Abscess formation from spilled gallstones after laparoscopic cholecystectomy is infrequent. However, if an abscess does form and contains the spilled stones simple percutaneous drainage will not resolve the dilemma of a recurrent abscess. Open drainage has previously been recommended to remove the retained stones and decrease recurrent abscess formation. We report two cases in which the retained stones within an abscess were successfully removed using a percutaneous minimally invasive urological technique.     

Comparative assessment of MHC antigen expression in bladder and testis tumour biopsies and established urological tumour cell lines: the relevance of cytokine and gene transfection for correction of defective MHC antigens

The aim of this study using radio-binding (RB), peroxidase-anti-peroxidase (PAP) and immunoprecipitation (IP) techniques was to investigate the pattern of major histocompatibility complex (MHC) antigen expression in urological malignancies and to compare the results with those seen in established urological human tumour cell lines. The results showed that using PAP technique, the percent bladder cases showing complete loss or cases with greater than 90% of tumour cells negative with W6/32 (detects all class I antigens), HC10 (detects free heavy chain) and BMM.1 (detects beta2-mirogobulin) monoclonal antibodies (Mab) were 16%, 44% and 2% respectively. In a subgroup of 37 cases, the intensity of MHC class II antigen expression for strong, weak and negative cases were 9 (24%), 8 (22%) and 20 (54%) respectively. The expression for class I antigens on testis tumours was mainly negative and when positive, it was present in a small percent of tumour cells. This was also observed for class II antigens where only 8% of cases showed some degree of positivity. Using RB technique, 10 of 12 (85%) of tumour lines expressed class I antigens spontaneously and following interferon gamma (IFNgamma) stimulation, the 2 negative lines one testis (Tera I) and one bladder (Fen) remained negative and 2 lines (both testis lines Tera II and Ep2102) showed a significant class I up-regulation. None of the lines expressed class II antigens spontaneously and following IFNgamma stimulation, 8 of 12 (66%) were induced. The absence of class I and II antigens in the negative lines was confirmed using IP technique. In the case of one class I negative bladder cell line i.e. Fen, the biochemical analysis showed the absence of beta2-m gene product which could not be restored by IFNgamma stimulation. However, transfection of the cells with beta2-m gene resulted in the expression of fully assembled class I antigens, indicating that the loss of antigens was due to the absence of functional beta2-m gene. These results indicated the similarity between the pattern of expression of MHC antigens on tumour biopsies and established tumour cell lines. They also demonstrated that both cytokine stimulation and gene transfection could be used to correct defective class I antigens in tumour cell lines. These approaches might have important implications for pre-selection of bladder cancer patients for cytokine or gene therapies.     

Das Reinfeldverfahren zur lokalen Keimreduzierung in Operationsräumen

A newly developed technique to reduce the local air contamination level in operating rooms is described. After physical and hygienic evaluations a mobile clean field-equipment has been used at 97 traumatic operations. At 66 operations about 300 aerobiological samples of the contaminated room air and simultaneously of clean field-air at the wound site were collected. It is shown that the bacterial level of clean field-air is comparable with those levels in a sterile operating enclosure. The advantages of the new technique and first experiences under practical operating conditions are discussed.     

Prognostic value of chromosome 1 and 8 copy number in invasive ductal breast carcinoma among iranian women: An interphase FISH analysis

Breast cancer is amongst the leading causes of death in women worldwide and the most common cancer amongst Iranian women. Unfortunately, the current clinical and histological criteria can only help 60 percent of women with breast cancer in diagnosis and long-term treatment. Therefore, genetic markers both at single gene and chromosomal level can play an important role in improving the diagnosis and prognosis of breast cancer patients. The aim of this retrospective study was to investigate the role of chromosome 1 and 8 copy number assessed by interphase fluorescence in situ hybridization (FISH), as prognostic parameters in 50 Iranian women, aged 35 to 64 years, with sporadic invasive ductal breast carcinoma. Chromosome 1 and 8 copy numbers were evaluated in relation to established clinicopathological parameters, the immunohistochemical markers ER, PR, P53 and cathepsin D, DNA index by flow cytometry, age and survival status of the patients. FISH using centromeric probes for chromosomes 1 and 8 was applied to interphase cell suspensions prepared from archived, Carnoyfixed tumor cells and selected paraffin-embedded tumor sections. Aneusomy for chromosomes 1 and 8 was present in all 50 patients to different levels. The total abnormality rate for chromosome 1 was 33.92 percent (4.24 percent monosomy and 29.68 percent polysomy), whereas for chromosome 8 this rate was 28.30 percent (6.48 percent monosomy and 21.82 percent polysomy). Statistically significant association (p<0.05) was demonstrated between monosomy 1 and patients’ age below 50 years, and between monosomy 1 and poor survival, respectively. Disomy 8 was significantly associated with P53 expression. A borderline significant correlation was demonstrated between polysomy 8 and diploid DNA content, as well as between disomy 1 and disease-free status of the patients. Chromosome 1 and 8 copy numbers may be considered as useful prognostic markers in invasive ductal carcinoma of the breast.     

Effects of malathion subchronic exposure on rat skeletal muscle glucose metabolism

Regarding the widespread use of organophosphorous pesticides (OP) especially malathion in environment and reported cases of muscle disturbances in human and animal, the present work was undertaken to explore effects of malathion subchronic exposure on rat leg skeletal muscle glucose metabolism by measuring key enzymes of glycogenolysis and glycolysis. Malathion was administered through food for 4 weeks at concentrations of 100, 200, and 400ppm to rats. Activities of enzymes including glycogen phosphorylase (GP), hexokinase (HK), and phosphofructokinase-1 (PFK) were measured in skeletal muscle homogenate of exposed rats. Levels of glucose and insulin were measured in blood. Four weeks administration of malathion at doses of 200 and 400ppm increased blood glucose concentrations to 44.4 and 60.6% of control, respectively. Malathion at doses of 200 and 400ppm increased blood insulin concentration to 36.6 and 143.2% of control, respectively. Malathion at doses of 100, 200, and 400ppm increased muscle PFK activity to 40.4, 53.5, and 83.1% of control, respectively. Malathion at doses of 400ppm increased skeletal muscle GP to 91.6% of control. Skeletal muscle HK was not influenced by malathion treatment. It is concluded that malathion influences muscle glycogenolysis and glycolysis as well as secretion of insulin from pancreas which all may explain diabetic potential of malathion.     

Trichophyton tonsurans associated tinea corporis infection with the development of Majocchi's granuloma in a renal transplant patient

Trichophyton tonsurans is an uncommon cause of tinea corporis, and an even more uncommon cause of Majocchi's granuloma. We report a patient who developed tinea corporis with Majocchi's granuloma from T. tonsurans infection. Immunocompromised hosts are predisposed to develop cutaneous fungal infections, as was the case with this patient. Majocchi's granuloma is a rare complication with immunosuppression, but is significant to consider when a fungal infection is suspected because it may require more aggressive therapy.     

Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine

BACKGROUND: QuikClot powder (QC), chitosan dressing (CD), and fibrin sealant dressing (FSD) are new hemostatic products touted to be more effective in controlling severe extremity bleeding than the current standard gauze dressing. All have been utilized in the global war on terrorism. Our objective was to evaluate the hemostatic efficacy of these three products in a model of severe extremity arterial hemorrhage that could not be stopped by standard gauze treatment. METHODS: A model of severe extremity arterial hemorrhage was developed in swine that was 100% fatal with standard gauze application and manual compression. The Army Field Bandage (AFB) was the standard gauze control. Anesthetized animals (n = 60, 15/group, 37.7 +/- 2.5 kg) were splenectomized and instrumented. A reproducible femoral artery injury was created using a 6 mm aortic punch, and free bleeding was allowed for 45 seconds. Each hemostatic agent was applied twice with three-minute compressions. All products were applied on actively bleeding wounds through a pool of blood. Fluid resuscitation was started with the first compression and titrated to a mean pressure of 65 mm Hg. Animals were observed for 180 minutes or until death. Endpoints were percent survival, survival time, blood loss, resuscitation volume, wound temperatures and tissue histology. Data are expressed as mean +/- SD and analyzed by Fisher's exact, logrank, and nonparametric ANOVA tests. RESULTS: Baseline physiologic parameters were similar among groups. AFB did not produce hemostasis. QC also showed no hemostatic benefit, and QC treatment markedly increased maximum wound temperatures to an average of 70.8 +/- 4.2 degrees C (p < 0.001). CD stopped bleeding temporarily in only one animal. There were no survivors in the AFB, QC, or CD groups. CD numerically prolonged survival time (58.9 +/- 21.1 minute) compared with the control (38.4 +/- 24.7 minutes, p = 0.045) but the difference was not significant. FSD reduced bleeding (p < 0.05) and prevented exsanguination in 10/15 (2/3) animals, and resulted in a significantly longer average survival time (p < 0.0001). CONCLUSION: FSD was superior to other currently utilized hemostatic products in controlling lethal arterial hemorrhage in this model of a fatal extremity wound. CD showed some hemostatic benefit. The exothermic reaction of QC was significant and resulted in gross and histologic tissue changes of unknown clinical significance. Controlled human studies with the promising products are required.     

Impact of prostate size and body mass index on perioperative morbidity after laparoscopic radical prostatectomy

PURPOSE: We prospectively evaluated the impact of body mass index (BMI) and prostate gland size on operative time, estimated blood loss (EBL) and hospital stay (LOS) in patients undergoing laparoscopic radical prostatectomy at our institution. MATERIALS AND METHODS: A total of 70 consecutive laparoscopic radical prostatectomies were performed at our institution from May 2002 to April 2003. Patients who had pelvic lymphadenectomy were excluded. A total of 62 cases were available for analysis. Two cases were converted to open surgery. Perioperative data on each group were recorded, including patient age, height, weight, American Society of Anesthesiologists score, prostate specific antigen, operative time, EBL, time to regular diet and LOS. Pathology data, including specimen weight, Gleason score and the margin status, were reviewed. Patients were grouped into 3 categories based on obesity, as measured by BMI (25 or less, 26 to 29 and greater than 29 kg/m) and prostatic gland size (less than 30, 30 to 50 g, and greater than 50 gm). Furthermore, an analysis of our initial 20, middle 20 and last 22 cases was also performed. RESULTS: Mean patient age was 63 years and mean American Society of Anesthesiologists score was 2.4. Mean operative time was 247 minutes and average EBL was 413 cc. The average LOS in all groups was 2.2 days. There were no statistically significant differences in operative parameters (operative time, EBL or LOS) among the ideal body weight (BMI 25 kg/m or less), overweight (BMI 26 to 29) and obese (BMI greater than 29) groups. The initial 20 cases, the second 20 and the last 22 had similar operative time, EBL and LOS. The surgical margin positive rate in our series was 17.7% for all stages. Of the patients 82% were completely dry at 6 months. CONCLUSIONS: In our cohort of patient body mass index (25 or less, 26 to 29 and greater than 29 kg/m) did not have a significant impact on operative or postoperative morbidity. However, a positive correlation between prostate gland size (greater than 50 gm) and EBL approached but did not achieve statistical significance. Laparoscopic prostatectomy can be performed safely in obese patients and patients with a large prostate gland.