Relation Between Anal Electrosensitivity and Rectal Filling Sensation and the Influence of Age

PURPOSE The aim of this study was to assess the effect of age and sex on the rectal filling sensation and anal electrosensitivity and to explore the relation between anal electrosensitivity and the parameters of the rectal filling sensation.METHODS Anal mucosal electrosensitivity and anorectal manometry, including the rectal filling sensation test were performed in 19 control subjects; 10 were younger than 60 years and 9 were older than that. Altogether, there were 11 men and 8 women. RESULTS Anal electrosensitivity did not differ between the two age groups. Women had a significantly lower electrosensitivity 4 and 5 cm from the anal verge than men, as well as a significantly shorter anal high-pressure zone. The rectal filling sensation did not differ between sexes. In the older age group, the rectal volumes required to induce filling sensations were smaller than those observed in the younger age group, but rectal pressures were comparable; as a consequence, rectal compliance was lower in older subjects. Anal electrosensitivity at different anal levels did not correlate with the rectal volume or pressure parameters of successive rectal filling sensations. The pressure recorded in the proximal anal canal at the consecutive rectal filling sensations strongly correlated with the rectal balloon pressure needed to elicit them.CONCLUSIONS The zones of high anal electrosensitivity and high pressure seem to coincide. The fact that both are shorter in females did not influence the parameters of the rectal filling sensation. Lower rectal volumes but comparable rectal pressures were needed to induce the rectal filling sensation in the older age group. Rectal sensation did not correlate with anal electrosensitivity, probably because the receptors are not stimulated by the type of anal stimulation used or because different receptors are involved. Hence, the rectal filling sensation test cannot be replaced by the simpler anal electrosensitivity test.     

Renal function damage in 131 cases of urogenital tuberculosis

The functional sequelae of 131 patients with urogenital tuberculosis were examined. At the time of diagnosis, more than half of the patients already suffered from global renal failure which was moderate in 42.7 per cent and severe in 15.5 per cent. We believe that the' primary functional damage occurs at the medullary level with tubular and interstitial involvement. Indeed, the red phenol test for postglomerular blood flow was altered in a higher proportion than was the creatinine clearance (67.9 per cent). The maximum concentrating ability was altered even more frequently (84 per cent). When we compared various glomerular filtration levels with the grade of alteration of the maximum ability concentration test, we also saw clearly that the alteration of the tubular interstitial medullar function dominated the alteration of the glomerular global function. This proves at a functional level the predominantly medullary localization of the lesion in renal tuberculosis.     

Renal functional contrast-enhanced magnetic resonance imaging: evaluation of a new rapid-clearance blood pool agent (p792) in sprague-dawley rats

OBJECTIVES: The objective of the present study was to compare P792, a new rapid clearance blood pool agent characterized by negligible interstitial diffusion but unrestricted glomerular filtration, with Gd-DOTA in both qualitative and quantitative aspects of renal functional magnetic resonance imaging. MATERIALS AND METHODS: Dynamic imaging was performed with a fast T1-weighted gradient-echo sequence on a 1.5-T magnet in 25 Sprague-Dawley rats, after injection of 13 micromol Gd/kg-1 of P792 (n = 10), 100 (n = 10), or 50 micromol Gd/kg-1 of Gd-DOTA (n = 5). Signal-time curves from 6 regions of interest (ROIs), including renal parenchyma and contents, were analyzed. RESULTS: Qualitative analysis depicted a typical pattern of temporal enhancement as previously described with extracellular gadolinium chelates, including early and brief enhancement of the aorta, renal vessels and cortex, quickly followed by enhancement of the medulla and then renal pelvis. However, a decrease in signal intensity was noted in the inner medulla and the renal pelvis approximately 90 seconds after bolus injection, being more marked when using the full dose of Gd-DOTA. Curve analysis showed a similar vascular phase within each parenchymal ROI, confirmed by similar upslopes, which ranged from 0.015 +/- 0.007 to 0.019 +/- 0.005. Following this initial phase, T1-enhancement appeared greater and longer within the medulla and renal pelvis, and subsequently in the whole kidney ROI with P792 (time to maximal enhancement (sec)/ enhancement rate: 85.5 +/- 15.9/3.1 +/- 0.4) as compared with Gd-DOTA full (53.0 +/- 18.9/ 2.7 +/- 0.3) or half dosage (65.2 +/- 20.1/ 2.2 +/- 0.2). The subsequent decrease in signal intensity, characterized by a downslope during the minute following maximal enhancement, was faster with Gd-DOTA (0.006 +/- 0.002) as compared either to P792 or half dosage Gd-DOTA (0.003 +/- 0.001). CONCLUSIONS: Due to its physicochemical and pharmacokinetic properties, P792 allows the use of a reduced dosage of gadolinium, resulting in less T2* effect without compromising T1 enhancement. Thus, P792 appears suitable for renal functional MR imaging.     

Sonography of a rupture of the tendon of the extensor pollicis longus muscle: initial clinical experience and correlation with findings at cadaveric dissection

OBJECTIVE: The objectives of our study were to report our initial clinical experience with sonography of the wrist for diagnosing a proximal rupture of the tendon of the extensor pollicis longus (EPL) muscle and to perform sonographic-anatomic correlation of the EPL tendon. MATERIALS AND METHODS: Clinical and imaging files of five patients who underwent sonography and subsequent open wrist surgery were reviewed retrospectively. Imaging was performed by four radiologists experienced in musculoskeletal sonography. Tendon retraction was evaluated on sonography and at surgery. In cadavers, sonography was performed in concert by two musculoskeletal radiologists during progressive stages of dissection of four embalmed specimens. One specimen was sliced in the transverse plane. RESULTS: In cadavers, the EPL tendon was located on or adjacent to Lister's tubercle and extended to the base of the thumb. The EPL tendon crossed over the extensor carpi radialis tendons where it exhibited a flattened aspect. In the five patients in the study, a tubular-shaped hypoechoic area was evident at the position of the ruptured EPL tendon on sonograms. At surgery, this area corresponded to fluid, hemorrhage, and scar tissue in the EPL tendon sheath. The assessment of tendon retraction on sonography correlated with findings at surgery. CONCLUSION: Sonography may aid in diagnosing a rupture of the EPL tendon and in the preoperative assessment of gap size and position of the retracted tendon ends. A characteristic tubular hypoechoic area may be seen crossing over the extensor carpi radialis tendons.     

Postoperative opiate analgesia requirements of smokers and nonsmokers

BACKGROUND: Smoking cigarettes and other forms of nicotine administration appear to blunt the perception of pain. Abrupt discontinuation of nicotine in nicotine-dependent patients appears to increase the perception of pain. The clinical importance of nicotine's effect on pain perception is not fully understood. OBJECTIVE: To determine whether smokers who abruptly discontinue smoking as a result of being hospitalized for coronary artery bypass graft (CABG) require more postoperative opiate analgesics than nonsmokers. METHODS: A retrospective review of patients who underwent a CABG was performed. Smokers (n = 20) were compared with nonsmokers (n = 69) with regard to opiate analgesic use during the first 48 hours postoperatively. The use of nonopiate sedatives was also compared between the groups. RESULTS: When normalized for weight and body mass index, smokers required 23% and 33%, respectively, more opiate analgesics than did nonsmokers (p = 0.027 and 0.023, respectively). The percentage of patients who received benzodiazepines postoperatively was similar in the 2 groups. CONCLUSIONS: In this study, smokers deprived of nicotine required a greater amount of opiates in the first 48 hours after CABG than did nonsmokers. Healthcare providers need to be aware of the potential for increased narcotic requirements among nicotine-deprived smokers. Further study is needed to determine whether nicotine replacement lessens the requirement for postoperative analgesics in smokers.     

Immune properties of recombinant vaccinia virus encoding CD154 (CD40L) are determined by expression of virally encoded CD40L and the presence of CD40L protein in viral particles

Expression of costimulatory molecules by recombinant poxviruses is a promising strategy for enhancing therapeutic vaccines. CD40-CD40L interactions are critical for conditioning dendritic cells (DC) and priming T- and B-cell immunity. We constructed a vaccinia virus expressing murine CD40L (rV-CD40L) and studied its immunomodulatory properties in vitro. Direct DC infection with control vaccinia or psoralen/UV-inactivated rV-CD40L stimulated high levels of interleukin 12 (IL-12) release. However, replication-competent rV-CD40L did not stimulate IL-12 under similar conditions. We observed a high level of CD40L protein on purified viral particles and demonstrated that induction of IL-12 by nonreplicating rV-CD40L was blocked by anti-CD40 antibodies suggesting that functional CD40L on viral particles contributed to alterations in IL-12 synthesis.Since cross-presentation of tumor-associated antigens by DC is augmented by viral infection of tumor cells, we infected MC38 murine colon carcinoma cells with rV-CD40L. Infected cells stimulated IL-12 secretion by DC and proliferation of B cells and DX5(+) (NK/NKT) cells through direct CD40-CD40L interaction. A subpopulation of NKT cells expressing CD40 (NK1.1(+), CD3(lo)) appeared to be a major effector population responding to MC38/rV-CD40L. These results highlight the complex immune regulatory effects of rV-CD40L defined by the cumulative effects of CD40L expression, presence of CD40L protein in viral particles, and the replication potential of the virus.