Iatrogenic dissection of the portal vein during TIPS procedure

Dissection of the portal vein is a rare entity which has been rarely described during transjugular intrahepatic portosystemic shunt (TIPS) procedure. We report three cases of dissection during this procedure and their complications. One dissection was immediately treated with coaxial stents. The two others were complicated either by a thrombus or by a false aneurysm. In the first case a second parallel stent was used to treat this complication. The patient with the portal vein false aneurysm was transplanted 4 days after this diagnosis. Portal vein dissection in TIPS procedure appeared to be less rare than has been reported and must be considered as a potential cause of TIPS dysfunction. Received: 5 May 1999; Revised: 14 July 1999; Accepted: 14 July 1999     

Objective and subjective extrapyramidal side effects in schizophrenia: their relationships with negative and depressive symptoms

The aim of this study was to show that objective extrapyramidal symptoms (O-EPS) were strongly correlated to negative and depressive symptoms while subjective extrapyramidal symptoms (S-EPS) were not. Ninety-one schizophrenic patients were evaluated by the Extrapyramidal Symptoms Rating Scale (ESRS), Montgomery and Asberg Depression Rating Scale (MADRS) and Scale for the Assessment of Negative Symptoms (SANS). While significant correlations were found between O-EPS and SANS (r = 0.51; p < 0.001) and between O-EPS and MADRS (r = 0.26; p < 0.01), no significant relationship existed between S-EPS and SANS (r = 0.19) or MADRS (r = 0.19). Similar results regarding the relationships between EPS and SANS were found in stabilized and acute subgroups and in deficit and nondeficit subgroups. A stepwise multiple regression showed that 41% of the variance of the SANS scores was due to facial mask and bradykinesia, and that 17% of the variance of the MADRS scores was due to facial mask and akathisia. This study shows the interest of evaluating subjective parkinsonism symptoms over objective ones since they are less interrelated to other symptoms, in particular to negatives ones.     

Morbid obesity: laparoscopic gastroplasty prior to plastic surgery

OBJECTIVES: Reduction of the weight in obese patients is a pre-condition for the aesthetic improvement of obesity or its after effects by plastic surgery. The aim of this study was to evaluate the effectiveness and advantages of gastric banding, using a ring positioned under laparoscopic guidance. PATIENTS AND METHODS: Thirty-nine patients with morbid obesity were operated on. For the first nine patients, gastric restriction was obtained by Mason's traditional technique. In the remaining thirty, a Kuzmak ring was positioned a few centimeters under the cardia, under laparoscopic guidance. The study concerned the evolution of weight, associated pathologies, and complications. RESULTS: Three months after surgery, all patients had lost weight (mean loss: 15 kg). At six months, a mean weight loss of 26 kg was observed. At one year, the mean weight loss was 35 kg. Two patients experienced postprandial vomiting that justified widening of the ring; one ring was poorly tolerated and was removed 10 days after surgery. CONCLUSION: This new surgical technique is effective for reducing the weight of obese patients. The laparoscopic approach to the stomach reduces parietal complications and enables subsequent abdominal plastic surgery to be performed.     

Transaortic closure of residual intramural ventricular septal defect

BACKGROUND: Residual intramural ventricular septal defect is an unusual cause of left-to-right shunt after biventricular repair of conotruncal anomalies. It results from the insertion of the patch within the trabeculated right ventricular free wall related to the ventriculoinfundibular fold creating a communication through the intertrabeculated spaces to the right ventricular cavity. This complication often leads to unsuccessful reoperations unless the exact mechanism of the shunt has been identified. METHODS AND RESULTS: Five patients presented with residual intramural ventricular septal defects. Three had double outlet right ventricle, one pulmonary atresia with ventricular septal defect, and one tetralogy of Fallot. One patient was unsuccessfully reoperated on for closure of the residual ventricular septal defect through the right ventricular approach. The surgical treatment, which consisted of patch closure of the residual intramural ventricular septal defect through aortotomy, was successful in 3 patients. In the 2 remaining patients the hemodynamically insignificant residual intramural ventricular septal defect remained untouched. No mortality or morbidity occurred. CONCLUSIONS: Residual intramural ventricular septal defect should be suspected in presence of a residual ventricular septal defect after biventricular repair of conotruncal anomalies. It is not accessible through either atriotomy or right ventriculotomy. The transaortic approach allows an easy treatment of this rare complication.     

Evaluation of a Supervised Adapted Physical Activity Program Associated or Not with Oral Supplementation with Arginine and Leucine in Subjects with Obesity and Metabolic Syndrome: A Randomized Controlled Trial

Background: In patients with obesity and metabolic syndrome (MetS), lifestyle interventions combining diet, in particular, and physical exercise are recommended as the first line treatment. Previous studies have suggested that leucine or arginine supplementation may have beneficial effects on the body composition or insulin sensitivity and endothelial function, respectively. We thus conducted a randomized controlled study to evaluate the effects of a supervised adapted physical activity program associated or not with oral supplementation with leucine and arginine in MetS-complicated patients with obesity. Methods: Seventy-nine patients with obesity and MetS were randomized in four groups: patients receiving arginine and leucine supplementation (ALs group, n = 20), patients on a supervised adapted physical activity program (APA group, n = 20), patients combining ALs and APA (ALs+APA group, n = 20), and a control group (n = 19). After the baseline evaluation (m0), patients received ALs and/or followed the APA program for 6 months (m6). Body composition, MetS parameters, lipid and glucose metabolism markers, inflammatory markers, and a cardiopulmonary exercise test (CPET) were assessed at m0, m6, and after a 3-month wash-out period (m9). Results: After 6 months of intervention, we did not observe variable changes in body weight, body composition, lipid and glucose metabolism markers, inflammatory parameters, or quality of life scores between the four groups. However, during the CPET, the maximal power (Pmax and Ppeak), power, and O₂ consumption at the ventilatory threshold (P(VT) and O₂(VT)) were improved in the APA and ALs+APA groups (p < 0.05), as well as the forced vital capacity (FVC). Between m6 and m9, a gain in fat mass was only observed in patients in the APA and ALs+APA groups. Conclusion: In our randomized controlled trial, arginine and leucine supplementation failed to improve MetS in patients with obesity, as did the supervised adapted physical activity program and the combination of both. Only the cardiorespiratory parameters were improved by exercise training.     

Stimulation of brain lipase activity by polyamines. Comparison with the effect of ACTH

Polyamines, as well as ACTH, strongly stimulate at pH 5.75 triacylglycerol lipase (TAGL) activity from rat brain. Whether the activating potency is expressed in terms of molar concentration or amount of positive charges, polyarginine, polylysine, spermine and spermidine exhibit, in this order, decreasing potencies. By contrast to other lipases, heparin (25 micrograms/ml) inhibits brain TAGL. Polyarginine, polylysine and spermine reverse the heparin-dependent inhibition and further stimulate TAGL activity above basal values; spermidine is much less potent. In the presence of heparin, ACTH has the greatest stimulating effect, being 1.6-fold and 3.3-fold more potent than polyarginine and polylysine, respectively. Taken together, the data suggest that polybasic effectors modify the interaction of TAGL with its substrate, resulting in increased levels of TAGL activity. In the presence of heparin, the enzyme charge density is mandatory for determining the stimulation process. Such cationic interactions appear to be specific of brain TAGL and should be considered in assessing any direct neuro-hormonal role to ACTH or physiological polyamines in brain.     

In vivo MRI tracking of exogenous monocytes/macrophages targeting brain tumors in a rat model of glioma

This study has shown that murine monocytes/macrophages (Mo/Ma) can be labeled simply and efficiently with large, green-fluorescent, micrometer-sized particles of iron-oxide (MPIO). Neither size nor proliferation rate of the Mo/Ma is significantly affected by this labeling. The labeled Mo/Ma have been administered intravenously to rats that had developed a glioma following stereotactic injection of C6 cells. The labeled Mo/Ma were shown to target the brain tumors, a process that could be monitored non-invasively using T2*-weighted MRI. MRI observations were confirmed by Prussian blue staining, lectin staining and fluorescence histology. Overall, the results of this study suggest that the use of Mo/Ma may be envisaged in the clinic for vectorizing therapeutic agents toward gliomas.