Mallory-Weiss syndrome. Outcome of 160 cases

The Mallory-Weiss (M-W) syndrome is responsible for about 7.5% of all bleedings of oesophageal origin. Emergency endoscopic treatment allows to obtain a rapid diagnosis as well as an effective treatment. Personal experience on 160 cases of M-W tears (14.2% of all oesophageal bleeding) is reported. The tears were classified in three groups: IA and IB (30 cases); IIA and IIB (48 cases); IIC and III (82 cases). In the first two groups a complete haemostasis was obtained in 73 out of 78 cases (93.6%) with a single session and in 5/78 cases with two sessions of sclerotherapy. The third group was treated with medical therapy. There was no procedure related mortality. An analysis of etiologic factors, anatomic conditions and pathogenetic correlations has highlighted the role of portal hypertension in cirrhotic patients in favouring the bleeding in some of these patients and the role of hiatal hernia and cardial incontinence in determining the site of the lesions.     

The emergence of resistance to amikacin in Serratia marcescens isolates from patients with nosocomial infection

Administration of either amikacin (1985) or gentamicin (1984, 1986-1991) as first-choice aminoglycoside did not decrease the high incidence of amikacin-resistant Serratia marcescens (ARSm) isolates responsible for nosocomial infections at the J.A. Fernández Hospital of Buenos Aires (42% in 1984, 31% in 1985 and 41% in 1987, differences not significant). In addition, a significant peak (P = 0.003) was detected in 1986, with an ARSm incidence of 70%. The incidence of ARSm decreased by 1988-1991 for reasons not related to aminoglycoside use. In the period 1984-1987 all S. marcescens isolates carried the 6'-aminoglycoside-acetyltransferase-Ic [aac(6')-Ic] gene, while in addition 20% of the isolates contained the plasmid-encoded 3'-aminoglycoside-phosphotransferase-VIa[aph(3')-VIa] and 2% the 6'-aminoglycoside-acetyltransferase-Ib [aac(6')-Ib] genes. From 1988 to 1992 resistance to amikacin was associated with only 4 ARSm isolates and correlated with the appearance of Tn1331-related sequences in these isolates. This transposon or related sequences, however, was not widely spread in the S. marcescens population under investigation. Combined use of restriction fragment length polymorphism (RFLP), ribotyping and plasmid profile analysis revealed that S. marcescens strains of the same genotype, including isolates either expressing or not the aac(6')-Ic gene, were involved in outbreaks occurring in May 1984, May 1985 and May 1986. Furthermore, these epidemiological tools permitted discrimination of different S. marcescens clones, each bearing a particular amikacin-resistance marker.     

Endometriosis externa and interna: endoscopic diagnosis

Endometriosis is defined as the presence of the endometrium outside the endometrial cavity. If the ectopic mucosa is located within the endometrium, the disease is defined as endometriosis interna, or adenomyosis, whereas the localization of the endometrium outside the uterus is defined as endometriosis externa, or pelvic endometriosis. The diagnosis of pelvic endometriosis requires invasive techniques, such as laparoscopy or laparotomy, with histologic confirmation on the surgical specimen. The diagnosis of adenomyosis should be based on histology of hysterectomy specimen, since the endoscopic diagnosis is still too inaccurate. Laparoscopy allows the visualization of the different aspects of pelvic endometriosis, i.e. superficial implants, deep lesions, and associated adhesions. Staging is based on a score attributed to each location in order to establish a prognosis in terms of the patient's reproductive performance.     

Operative laparoscopy

Operative laparoscopy has replaced the conventional approach by laparotomy to the treatment of most benign gynecological diseases (benign adnexal cysts, ectopic pregnancy, tubal infertility, polycystic ovarian disease, endometriosis, myomas), with advantages in terms of shorter hospital stay, less discomfort and complications for the patient, minor social costs due to the early resumption of normal working activities, and comparable results in terms of reproductive outcome.     

Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects

OBJECTIVE: The role of free flaps in skull base reconstruction is discussed in detail. Twenty-six microvascular free tissue transfers performed in 22 patients are reviewed in detail. A classification scheme for skull base defects is presented. SETTING: Tertiary referral center. PATIENTS: Twenty-two patients with neoplasms that involve the skull base underwent a combined craniotomy and facial approach for resection. The resultant defects were reconstructed with a variety of microvascular free flaps. RESULTS: All 22 patients were ultimately successfully reconstructed with a free flap. One patient required a second free flap following ablative surgery for a recurrent tumor. The initial free flaps in three patients were unsuccessful and a second flap was required. The classification scheme was applied to all defects. CONCLUSIONS: The creation of a functional separation of the intracranial and extracranial cavities can be extremely difficult to accomplish, especially when multiple cavities (nasal, oral, pharyngeal) are violated. Free flaps provide a solution to this problem in select cases. Skull base defects can and should be classified for the purpose of communication, treatment planning, prognosis of reconstruction, and judging therapeutic outcome.     

Reproductive outcome after ovarian surgery: suturing versus nonsuturing of the ovarian cortex

The purpose of this study was to ascertain if microsurgical approximation of the ovarian edges after ovarian surgery alters postoperative results, as determined by both adhesion formation and reproductive outcome. Sixteen female white New Zealand rabbits were anesthetized, and the ovaries were exposed. Each ovary was longitudinally bivalved with a scalpel, but only one ovary was reconstructed microsurgically, whereas the contralateral ovary was left open. Four weeks after surgery, the rabbits were mated, and two weeks later, a laparotomy was performed to evaluate postoperative adhesions, the number of corpora lutea in each ovary, and the number of embryos in each uterine horn. The nidation index was calculated. No significant differences were found between the microsurgically sutured and the nonsutured ovaries for all the parameters evaluated. Our data suggest that not closing the ovarian incision does not alter either postoperative adhesion formation or reproductive outcome.     

Tunicamycin Dissociates Depolarization-induced Calcium Entry From Transmitter Release. Involvement of Glycosylated Protein(s) in the Process of Neurosecretion in PC-12 Cells

The process of regulated secretion in PC-12 cells is tightly coupled to calcium entry, which is absolutely dependent on extracellular Ca2+([Ca2+]ex). Tunicamycin treatment of the cells dissociated depolarization-triggered Ca2+ influx from depolarization (high K+)-induced transmitter release into two distinct and independent phases. Deplarization-evoked Ca2+ influx was not affected by tunicamycin treatment (1 microg/ml, 72 h), whereas depolarization-evoked transmitter release was strongly inhibited (> 60%), suggesting at least a two-step process, and the participation of glycosylated protein(s) in the actual fusion/secretion step. Similarly, bradykinin-mediated transmitter release was linearly related to and absolutely dependent on Ca2+ entry, and was inhibited by tunicamycin treatment (> 80%), whereas bradykinin-evoked Ca2+ entry was not impaired, indicating that glycosylated protein(s) are essential for bradykinin-evoked release at a step subsequent to Ca2+ influx. The heavily glycosylated alpha2 subunit of the dihydropyridine-sensitive channel, which was used to monitor tunicamycin inhibition of glycosylation, was not expressed in the tunicamycin-treated cells, as shown by Western blot analysis. This observation allowed us to conclude that the alpha1 subunit of the heteromeric dihydropyridine voltage-sensitive Ca2+ channel, which is responsible for Ca2+ entry, is also fully functional when not assembled with its corresponding alpha2 subunit. The molecular properties of the alpha2 subunit, whose role in the complex structure of the channel is not yet understood, are shown for the first time for the L-type Ca2+ channel of PC-12 cells. Similar to cardiac and skeletal muscle cells, the alpha2 subunit appears to be a glycosylated polypeptide of molecular weight 170 kD and to display a characteristic mobility shift to 140 kD under reducing conditions.     

Seroreactivity to human papillomavirus (HPV) types 16, 18, or 31 and risk of subsequent HPV infection: results from a population-based study in Costa Rica.

Whether antibodies to human papillomavirus (HPV) capsids, elicited by natural infection, are protective is unknown. This question was addressed in a population-based cohort of 7046 women in Costa Rica by examining the association between baseline seroreactivity to HPV-16, HPV-18, or HPV-31 virus-like particles and the risk of subsequent HPV infection at a follow-up visit 5-7 years after enrollment. Seropositivity to HPV-16, HPV-18, or HPV-31 was not associated with a statistically significant decreased risk of infection with the homologous HPV type [relative risk (RR) and [95% confidence interval (CI)], 0.74 (0.45-1.2), 1.5 (0.83-2.7), and 0.94 (0.48-1.8), respectively]. Seropositivity to HPV-16 or HPV-31 was not associated with a decreased risk of infection with HPV-16 or its genetically related types [RR (95% CI), 0.82 (0.61-1.1) and 0.93 (0.68-1.2), respectively]. Seropositivity to HPV-18 was not associated with a decreased risk of infection with HPV-18 or its genetically related types (RR 1.3; 95% CI 1.0-1.8). Thus, we did not observe immunity, although a protective effect from natural infection cannot be excluded because of the limits of available assays and study designs.     

Approval summary: Docetaxel in combination with prednisone for the treatment of androgen-independent hormone-refractory prostate cancer.

PURPOSE: Docetaxel, a taxane previously approved for the treatment of breast cancer and non-small cell lung cancer, was approved by the United States Food and Drug Administration on May 19, 2004 for use in combination with prednisone for the treatment of metastatic androgen-independent (hormone-refractory) prostate cancer. The purpose of this summary is to review the database supporting this approval. EXPERIMENTAL DESIGN: In a randomized, global study enrolling 1,006 patients, two schedules of docetaxel were compared with mitoxantrone + prednisone as follows: MTZ q 3w, mitoxantrone 12 mg/m2 every 21 days + prednisone 5 mg twice a day for a total of 10 cycles; TXT q 3w, docetaxel 75 mg/m2 every 21 days + prednisone 5 mg twice a day for a total of 10 cycles; and TXT qw, docetaxel 30 mg/m2 days 1, 8, 15, 22, and 29 every 6 weeks + prednisone 5 mg twice a day for a total of 5 cycles. RESULTS: There was a statistically significant overall survival advantage shown for the TXT q 3w arm over MTZ q 3w (median survival 18.9 months versus 16.5 months, P = 0.0094). No overall survival advantage was shown for TXT qw compared with MTZ q 3w. The most commonly occurring adverse events included anemia, neutropenia, infection, nausea, sensory neuropathy, fluid retention, alopecia, nail changes, diarrhea, and fatigue. CONCLUSIONS: This report describes the Food and Drug Administration review supporting this first approval of a combination therapy for hormone-refractory prostate cancer based on demonstration of a survival benefit.     

Vascular endothelial growth factor and p53 expressions in liver and abdominal metastases from colon cancer.

OBJECTIVE: To determine the relationship between p53 overexpression and vascular endothelial growth factor (VEGF) upregulation in liver and abdominal metastases from colon cancer. The analysis in the two metastatic sites was carried out to evaluate the potential role of microenvironment in the molecular regulation of VEGF. METHODS: Bioptic specimens of liver and abdominal metastases from colon carcinomas were examined by immunohistochemistry for p53 and VEGF expressions. Consecutive cases with assessable tumor tissue were selected. RESULTS: The study population consisted of 24 cases having liver metastases and 34 cases having abdominal metastases. Abdominal metastases showed a higher number of VEGF-positive cases and a higher intensity of VEGF immunoreactivity than liver metastases did (p = 0.01). The combined analysis of p53 and VEGF showed a strong association between the two markers in the 24 liver metastases; 9 cases were VEGF positive/p53 positive and 15 cases were VEGF negative/p53 negative. This relationship was not found in the 34 abdominal metastases, which showed concordance between the two markers in 9 VEGF-positive/p53-positive cases only. CONCLUSIONS: Microenvironment factors like hypoxia may have a predominant role in inducing VEGF expression and they can override the molecular control of p53 on VEGF.