Spontaneous bacterial peritonitis caused by quinolone-resistant Escherichia coli: could steroid therapy play a role?

Prophylaxis with norfloxacin has been shown to be effective in preventing spontaneous bacterial peritonitis (SBP) in liver cirrhosis. This therapy is associated with the appearance of quinolone-resistant Escherichia coli. However, only four cases of SBP caused by quinolone-resistant E. coli have been reported so far. We present four cases of quinolone-resistant E. coli SBP in three patients receiving oral quinolones, and who were on corticosteroid therapy to treat associated disorders.     

Tratamiento adyuvante del cáncer gástrico resecable: experiencia en un servicio de Oncología

Introduction. The curative management of gastric adenocarcinoma depends on complete resection of the primary tumour. The relapse rates from the recurrent cancer are between 40% and 70%. Until recently, attempts at preventing recurrence, usually using adjuvant chemotherapy, have been ineffective. Based on INT-0116 results, gastric cancer patients from stage IB (T1N1 or T2a/b N0) to stage IV (T4 N1,2,3 M0/T1,2,3 N3M0) received combined chemotherapy and radiotherapy treatment following gastric resection. Material and methods. Patients (n=39) were included over 36 months. Results. The main toxicity was digestive grade 1 or 2 in 17/39 (44%) cases. More frequent haematological toxicity was grade 1–2 neutropenia, in 7/39 patients (26.5%). Asthenia was a relevant toxicity in 17/39 (44%) of our patients. With a median follow-up of 20.2 months, we have not reached the median overall survival nor the median disease-free survival. There was recurrence in 14/39 (35.8%) cases and the remainder are disease-free (64.2%). Conclusions. More studies are necessary to evaluate better the disease-free survival following gastric cancer resection. Also, less toxic treatments need to be developed so as to increase treatment compliance.     

Computer-guided immediate provisionalization of anterior multiple adjacent implants: surgical and prosthodontic rationale.

Immediate implant restoration has gained popularity in recent years due in part to technological advancements that use computed tomographic images to simulate the actual clinical situation. This computer-assisted simulation enables clinicians to develop a comprehensive treatment plan that can be precisely executed in a timely manner. In the aesthetic zone, however, a successful outcome requires more than merely accurate implant placement. This article discusses the significance of site development for aesthetic implant restoration and describes a computer-guided immediate pro visionalization procedure and its surgical and prosthodontic rationale     

Studies on the Mechanism of Spasmolytic Activity of (O-Methyl-)-N-(2,6-dihydroxybenzoyl)tyramine,a Constituent of Aniba riparia (Nees) Mez. (Lauraceae), in Rat Uterus,Rabbit Aorta and Guinea-pig Alveolar Leucocytes

Abstract— The mechanism of action of a nonspecific smooth muscle relaxant, (O-methyl-)-N-(2,6-dihydroxybenzoyl)tyramine (riparin), a constituent of Aniba riparia (Nees) Mez. (Lauraceae) was studied in relation to Ca²⁺ metabolism in smooth muscle tissues and in guinea-pig alveolar leucocytes. In rat depolarized uterus, riparin inhibited in a reversible and noncompetitive manner CaCl₂-induced contraction, a response mediated through voltage-dependent Ca²⁺ channels. The pD₂ value (mean±s.e.m.) for riparin was 4·98±006. When compared with sodium nitroprusside (IC50 2·5 μm ), an antagonist of receptor-operated Ca²⁺ channels, riparin was ineffective in suppressing noradrenaline-induced sustained contractions of rabbit aortic strips. However, in the aorta, the compound inhibited intracellular calcium-dependent transient contractions of noradrenaline and riparin (IC50 10·1 μm ), was approximately two and a half times more potent than procaine (IC50 25·5 μm ), a known inhibitor. In guinea-pig alveolar leucocytes, riparin (IC50 3·2 μm ), inhibited intracellular Ca²⁺ accumulation induced by the calcium ionophore A23187. The results suggest that the inhibition of Ca²⁺ influx and of Ca²⁺ release from intracellular stores contribute to the spasmolytic effects of riparin, which may not involve cyclic AMP generation as the levels of this nucleotide were not increased in alveolar macrophages treated with riparin (10–100 μm ).     

A prospective study of delusional misidentification syndromes in Parkinson's disease with dementia

Delusional misidentification syndromes (DMS) are a group of neuropsychiatric disorders due to disturbances in familiarity. DMS in organic diseases have been related to deficits in executive, memory, and visuospatial function. DMS are frequently reported in dementia with Lewy bodies (DLB). The presence of DMS in Parkinson's disease with dementia (PDD), which shares similar clinical and neuropsychological features with DLB, has not been studied. We describe the frequency and clinical features of DMS in a cohort of PDD patients, and we compare the neuropsychological profile between PDD patients with and without DMS. Prospective study of 30 PDD patients recruited from an outpatient setting, who received a structured behavioral interview assessing DMS and hallucinations, and a neuropsychological battery assessing executive function, memory, language, and visuospatial abilities. DMS were found in 16.7% of PDD patients. All DMS subjects also exhibited hallucinations that were significantly more severe than in PDD without DMS. DMS were responsive to neuroleptic drugs. PDD subjects with DMS presented a different neuropsychological profile than PDD subjects without DMS, with more severe memory and language deficits, but similar levels of executive and visuospatial impairment. DMS is a neuropsychiatric feature associated with PDD. Greater impairment in language and memory in PDD with DMS suggests a prominent role of the temporal cortex in the genesis of DMS in PDD. © 2007 Movement Disorder Society     

Effects of caudate nuclei or frontal cortical ablations in cats. I. Neurology and gross behavior

Methods are described for performing one-stage ablation of the caudate nuclei through a midline approach in cats, for maintaining the animals indefinitely, and for their neurological and gross behavioral evaluation. Sixteen cats with extensive bilateral caudate lesions, 13 with extensive unilateral caudatectomy, 14 with bilateral removal of the frontal cortical areas, and eight sham-operated animals, were studied for months. The results of anatomical, neurological, and gross behavioral observations are described in this first paper. A behavioral change labeled “compulsory approaching syndrome” was observed following surgery in all cats with bilateral caudate ablation. This was a long-lasting effect persisting even under unusual conditions. The “syndrome” was characterized by stereotyped and prolonged approaching and/or following of persons, cats, or objects. Visual cues were most effective in eliciting the syndrome but acoustic and tactile stimuli were also adequate. Other components of the syndrome were marked passivity, exaggerated forelimb treading, marked purring, rooting, hyperactivity, hyperreactivity, and sexual changes. The magnitude and duration of the syndrome appeared to be related to the extent of the ablation with its essential features persisting for over 1 yr in cats with the largest ablations (70 to 100% of the nuclei). The syndrome was not observed in sham-operated cats. Bilaterally acaudate cats were remarkably free of permanent gross neurological deficits. Deficits such as motor weakness, faulty awareness, and defective eating and drinking were seen in the early postoperative period. Only moderate hyperactivity along with the compulsory approaching syndrome and some impoverishment and slowness of movements persisted in the chronic state. In all unilaterally acaudate cats, there was an absence of any permanent gross neurological or behavioral changes including the compulsory approaching. Our findings suggest that the caudate nuclei do not have any gross lateralized behavioral or neurological function and indicate a large functional reserve. The cats with bilateral frontal cortical areas removed exhibited early, short-lasting visual tracking, but none of the characteristics of the compulsory approaching syndrome was present (except in three animals, where the characteristics appeared transiently and combined with aggressiveness). Other neurological defects of frontally-operated cats were consequences of ablation of the sensory-motor areas. The syndrome is discussed in terms of the specificity of the caudate ablation in its production and it is tentatively explained as resulting from absence of an inhibitory caudate modulatory influence on polysensory inputs. It is concluded that total ablation of the caudate nuclei in cats is possible and produces a characteristic behavioral change of which the exact nature remains to be elucidated. The caudate does not appear to have an essential role in the control of basic metabolic functions, elementary sensory-motor functions, or elementary cognitive processes as previously postulated.