Fatal outcome from extreme acute gastric dilation after an eating binge

OBJECTIVE: A 22-year-old woman is presented with acute gastric dilation after an eating binge, who died of complications of acute reperfusion syndrome. METHOD: A young patient was admitted in our clinic with critical condition without any significant previous medical history. Her initial complaints--diarrhea, vomiting and abdominal pain--began after an enormous food intake. There was no history of medications or toxic substances. Physical examination showed a normally-developed, well-nourished female in severe distress with an extremely distended abdomen. Femoral pulses were absent. The US and CT scan showed a dilated stomach, extended into the pelvis, dislocating the intestinal organs and compressed the aorta and mesenteric veins. RESULTS: Urgent laparotomy was performed. An enormously distended stomach was encountered without volvulus, obstruction or adhesions. About 11 liters of gastric content was removed gastrotomy and nasogastric tube. Following the gastric decompression, the mesenteric and femoral pulses reappeared. During the operation, the cardio-respiratory status was stabilized, but in the following 24 hours irreversible shock developed, possibly due to the reperfusion of the retroperitoneal organs and the lower extremities. In the postoperative period disseminated intravascular coagulopathy developed. In an uncontrollable state of diffuse bleeding, 36 hours post-operation, the patient died. In retrospective investigation, the family confessed that previous psychological treatments which aimed at her bulimic attacks. CONCLUSION: Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare.     

Magnetic resonance imaging of the pelvis: Prostate and urinary bladder

Magnetic resonance imaging has opened up a new horizon in the evaluation of the male pelvis. Its direct multiplanar imaging and display of the unique tissue contrast allows for the demonstration of prostate anatomy. Prostatic disease, even when confined to the gland, is easily depicted. However, one cannot distinguish benign from malignant processes. In a patient with a known prostatic neoplasm, magnetic resonance is useful as a staging modality. Accuracy in the staging of prostatic malignancies by MRI surpasses that of ultrasound or CT. In the evaluation of the urinary bladder, the greatest advantage of magnetic resonance is its ability to differentiate between a normal bladder, and other pathologic conditions affecting the bladder, including inflammatory, congestive and neoplastic processes. In the evaluation of bladder carcinoma, magnetic resonance is useful as a staging modality. Clinical application of magnetic resonance is just beginning and therefore, the full potential of the modality has yet to be explored.     

Effects of personality on use of medications,alcohol, and cigarettes during pregnancy

Purpose  

The aim of the study was to examine the role of personality in a pregnant woman’s consumption of medications, cigarettes, and alcohol.     

Blockers of voltage-gated sodium channels for the treatment of central nervous system diseases

Voltage gated sodium channels play important roles both in vital physiological functions and several pathological processes of the central nervous system. Epilepsy, chronic pain, neurodegenerative diseases, and spasticity are all characterized by an over-excited state of specific groups of central neurons that is accompanied by an abnormally increased activity of sodium channels. An efficient strategy of controlling such diseases is to use blockers that preferentially act on these over-excited cells. State dependently acting agents, such as phenytoin, or lamotrigine, leave normal physiological functions relatively intact, resulting in a favorable therapeutic window. Nine isoforms of the channel forming alpha subunit are known, which show distinct expression patterns in different tissues. Another possible way to decrease the chance of adverse effects is to develop agents selectively inhibiting the channel subtype involved in the pathomechanism of the disease to be treated. Many recent patents claim sodium channel blockers with improved characteristics regarding state dependency or subtype selectivity. Such agents may offer a breakthrough in the treatment of a variety of central nervous system diseases. This review focuses on the current trends in sodium channel research, surveying the traditional and newly emerging therapeutic fields, and the diverse medicinal chemistry of sodium channel blockers.     

Oncostatin M-induced genes in human astrocytomas

Oncostatin M (OSM) is a member of the interleukin-6 (IL-6) cytokine family and known to be induced in the nervous system as a result of cell stress. OSM is expressed in most human brain tumors, but the effects on tumor cells are unclear. The cytokine is known to activate the JAK/STAT signaling pathway by binding to its receptors gp130/OSMbeta or gp130/LIFRbeta and thereby initiating activation or suppression of a number of STAT target genes. The objective of the study was to identify OSM-regulated genes that could help in understanding the function of OSM in glioma cells. The glioma cell line, U1242MG was stimulated by OSM and the gene expression patterns were analyzed by microarray. In total, nineteen differentially expressed genes were selected due to high intensity, level of up/down-regulation and biological functions. The differentially expressed genes were verified using quantitative PCR. Additional validation of the confirmed OSM-induced proteins was performed in human astrocytoma tissues by immunohistochemistry. Among the up-regulated genes were CHI3L1, PLAU, MT2A and EPAS1. These genes are known to be involved in cell matrix remodeling, migration, proliferation control and angiogenesis. The results suggest that OSM induces genes that might contribute to the development and progression of astrocytomas.     

Reduced antioxidant level and increased oxidative damage in intact liver lobes during ischaemia-reperfusion

AIM:To determine whether increased blood flow of theliver can cause oxidative stress and hepatocyte damage,and to elaborate methods suitable for measuring theantioxidant defence during hepatic surgery on rat model.METHODS:In nembutal narcosis,the left lateral andthe medial lobes of the liver were clipped for 45 minto make the total blood supply flow through the otherlobes.Total antioxidant status,glutathione peroxidaseand superoxide dysmutase activity,as well as theconcentrations of diene conjugates and free sulphydrilgroups,H-donating ability and reducing power of theliver samples were determined.Chemiluminescentintensity of the liver was also measured.Metal ions(Al,Ca,Cu,Fe,Mg,Mn,Zn)and P and S concentrations ofthe liver were determined with an inductively coupledplasma optical emission spectrometer and Se contentwas measured by cathodic stripping voltammetry.RESULTS:Glutathione peroxidase and superoxidedysmutase activities of the liver decreased significantlyin the hyperemia group compared to those observedin the sham operated group.The level of totalantioxidant status was also significantly lower in thehyperemia group.H-donating ability,reducing powerand free sulphydril group concentration showed thesame tendency.A significant correlation(P<0.05)wasfound between the changes in non-specific antioxidantactivities.This pointed to simultaneous activity of the antioxidant defence system.AI,Cu,Mn,Zn,and S werelower in the hyperemia group than in the sham operatedgroup when the levels of Ca,Fe,Mg,Se and P ions werehigher during hyperemia.CONCLUSION:Oxidative stress is one of the mainfactors for the injury of intact liver lobes duringischaemia-reperfusion.     

Molecular imaging for personalized cancer care

Molecular imaging is rapidly gaining recognition as a tool with the capacity to improve every facet of cancer care. Molecular imaging in oncology can be defined as in vivo characterization and measurement of the key biomolecules and molecularly based events that are fundamental to the malignant state. This article outlines the basic principles of molecular imaging as applied in oncology with both established and emerging techniques. It provides examples of the advantages that current molecular imaging techniques offer for improving clinical cancer care as well as drug development. It also discusses the importance of molecular imaging for the emerging field of theranostics and offers a vision of how molecular imaging may one day be integrated with other diagnostic techniques to dramatically increase the efficiency and effectiveness of cancer care.