Regional cerebral blood flow (rCBF) in migraine during the interictal period: different rCBF patterns in patients with and without aura

The aim of this study was to evaluate the rCBF (¹³³Xe clearance method) in migrainous patients free from attack. Fifty patients suffering from migraine without aura (group M) and 20 suffering from migraine with aura (group MA) (age range 20-50 years) were submitted to 32 channel rCBF mapping during the interictal period. The rCBF data of patients were compared with those obtained from 60 healthy control subjects (group C) and 21 patients suffering from tension-type headache (group TH). The mean (average of all channels) rCBF values were: group M=70.5 ± 13.7ml/100g/min; group MA=56.6 ± 11.4ml/100g/min; group C=62.3 ± 8.3ml/100g/min; group TH=62.1 ± 8.4ml/100g/min (F=11.93; p <0.001). As expected, patients belonging to group TH had a normal rCBF. The mean rCBF of group M was significantly higher than that of groups C and TH, while in group MA it was significantly lower than in groups C and TH. Group M showed a diffuse hyperemia, while group MA showed rCBF values significantly lower than normal in posterior regions, according to aura. Our results suggest that: (a) the rCBF pattern in migrainous patients is different from that in both controls and TH patients, even during the interictal period; (b) patients suffering from migraine with and without aura are two distinct subpopulations with opposite rCBF deviations.     

Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal,minimally invasive approach

Purpose

The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients.

Methods

We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology.

Results

Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76 % in relation to the number of groins resp. 7.69 % in relation to the number of patients.

Conclusions

The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can extend the range of indications for nuclear medicine in the form of SLNB using radioactive tracers in this patient group.

     

Homer-1a immediate early gene expression correlates with better cognitive performance in aging

The molecular mechanisms underlying cognitive decline during healthy aging remain largely unknown. Utilizing aged wild-type C57BL/6 mice as a model for normal aging, we tested the hypothesis that cognitive performance, memory, and learning as assessed in established behavioral testing paradigms are correlated with the differential expression of isoforms of the Homer family of synaptic scaffolding proteins. Here we describe a loss of cognitive and motor function that occurs when Homer-1a/Vesl-1S protein levels drop during aging. Our data describe a novel mechanism of age-related synaptic changes contributing to loss of biological function, spatial learning, and memory formation as well as motor coordination, with the dominant negative uncoupler of synaptic protein clustering, Homer-1a/Vesl-1S, as a potential target for the prophylaxis and treatment of age-related cognitive decline.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-012-9479-6) contains supplementary material, which is available to authorized users.     

Behavioural and emotional symptoms of preschool children with cerebral palsy: a population‐based study

Aim To describe behavioural and emotional symptoms among Icelandic preschool children with cerebral palsy (CP). Method Children with congenital CP, assessed with the Child Behavior Checklist/1½–5 (CBCL/1½–5) and Caregiver‐Teacher Report Form (C‐TRF), were enrolled in the study. A comparison group was recruited from the general population. Thirty‐six children (53% males) with CP were assessed at a mean age of 4 years 11 months (SD 5mo, range 4–6y); 26 (72%) had bilateral distribution of symptoms and 32 (89%) had spastic CP. Thirty (83%) were at Gross Motor Function Classification System levels I or II and six at levels III or IV. For comparison, 110 (43% males) and 120 (48% males) children were assessed with the CBCL/1½–5 and the C‐TRF respectively, at a mean age of 4 years 6 months (SD 6mo, range 4–6y). Results Sixteen children (48%) with CP had high scores on total problems scale of the CBCL/1½–5 and 20 (65%) on the C‐TRF compared with 18% of the comparison group, both on the CBCL/1½–5 and the C‐TRF (p<0.001). Children with CP had higher scores on all subscales of the CBCL/1½–5 and the C‐TRF, except somatic complaints. Attention difficulties, withdrawn, aggressive behaviour, and anxious/depressed symptoms were most pronounced among children with CP. Interpretation A large proportion of preschool children with CP have substantial behavioural and emotional difficulties, which need to be addressed in their treatment.     

Prevalence and risk factors of erectile dysfunction in Niger delta region, Nigeria

Background

Erectile Dysfunction (ED) is one of the major social problems causing significant distress in men. Despite the increasing difficulty in management, knowledge, and understanding of factors responsible for its development are important for prevention and care.

Objectives

To assess the prevalence and risk factors for ED among men in Niger Delta Region of Nigeria, in order to determine its contextual variables.

Methods

Subjects included 400 male patients attending the general outpatients'' clinic (GOPC) of the University of Uyo Teaching Hospital. Respondents completed the abridged version of the International Index of Erectile Function (IIEF-5).

Results

A total of 166 (41.5%) subjects had ED; 66 (16.5%) had mild; 32 (8.0%) mild to moderate; 24 (6.0%) moderate; while 45 (11.3%) had severe 37 (9.2%) resulted from hypertension and its medications; 29 (7.3%) from diabetes; 49 (12.2%) from a combination of both and their therapies (P=0.044); 24 (6.0%) had history of previous surgery; while for 27 (6.8%) it was from undiagnosed medical conditions (p=0.001). The ED increases with age and is more among married and educated men.

Conclusion

ED is a common problem among men in Niger Delta region. Therefore, efforts must be made to reduce the incidence by dealing with the factors responsible for its development.     

The antiemetic efficacy of tropisetron plus dexamethasone as compared with conventional metoclopramide-dexamethasone combination in Orientals receiving cisplatin chemotherapy: a randomized crossover trial

1We report a single-blind randomized crossover trial comparing the efficacy of tropisetron plus dexamethasone (TROPDEX) vs conventional combination of metoclopramide, dexamethasone and diphenhydramine (METDEX) in prevention of acute and delayed vomiting in Chinese patients receiving high dose cisplatin. 2Thirty-six consecutive patients with nasopharyngeal carcinoma were entered into the study, all received cisplatin at a dose range of 60–100 mg/m². Patients were randomized in the sequence of antiemetic regimens used in two consecutive cycles. 3The TROPDEX regimen consisting of tropisetron 5 mg i.v. and dexamethasone 20 mg i.v. given on day 1 of chemotherapy, followed by oral maintenance with tropisetron 5 mg daily and dexamethasone 4 mg twice daily from day 2 to 6. The METDEX regimen consisting of metoclopramide 1 mg kg⁻¹ i.v., dexamethasone 20 mg i.v. and diphenhydramine 25 mg i.v. given before chemotherapy and then 2 hourly for two more doses on day 1, followed by oral metoclopramide 20 mg 6 hourly from day 2 to 6. 4Complete control of acute vomiting was observed in 64% of patients with TROPDEX as compared with 14% with METDEX (P<0.01). While complete plus major control of acute vomiting was observed in 84% with TROPDEX as compared with 58% with METDEX. The mean vomiting episodes on day 1 were 1.4 with TROPDEX as compared with 3.5 with METDEX (P<0.01). There was, however, no significant difference between the two regimens in the control of delayed vomiting. 5When patients randomized to TROPDEX in the second cycle were compared with those with TROPDEX in the first cycle, the antiemetic efficacy was reduced, with mean acute vomiting episodes of 2 in the former compared with 0.8 in the latter (P<0.01). 6The most common adverse effect observed was headache in TROPDEX (27%) and dizziness in METDEX (40%). 7In conclusion, the antiemetic regimen TROPDEX is effective in Chinese patients receiving high dose cisplatin chemotherapy and is well tolerated. It is better than conventional METDEX regimen in the control of acute vomiting, but not in the control of delayed vomiting.     

新决明内脂诱导HepG2细胞内脂质代谢相关基因的差异表达

目的研究新决明内脂与细胞内脂质代谢有关的生物学效应及分子机理。方法首先用动物实验检查该化合物的生物学效应。再用细胞学方法研究该化合物对3T3-L1前脂肪细胞分化的作用。最后用含有10 000个人类基因和ESTs的高密度cDNA微阵列去研究新决明内脂如何改变HepG2细胞的基因表达图谱。结果新决明内脂可减少大鼠的体重增加率，但对3T3-L1前脂肪细胞分化的作用有限。HepG2肝细胞基因表达图谱结果显示新决明内脂调节了46个与脂质代谢、蛋白代谢、细胞增生与凋亡等功能有关的基因。结论新决明内脂的生理效果可能与一系列与脂质代谢有关的重要基因有关。     

Laparoscopic radical prostatectomy: an audit after 2 years

Introduction: Laparoscopic radical prostatectomy (LRP) was first attempted in 1992. It was not until 1998 that this technique was recognized as an feasible alternative to traditional open surgery. Laparoscopy offers good visualization, magnification and allows precise dissection and intracorporeal suturing. An audit on the clinical outcomes was done on this novel technique. Patients and Methods: 28 patients underwent LRP from March 2002 to February 2004. Inclusion criteria for surgery were similar to conventional open surgery's criteria: patients with high chance for organ‐confined disease and life expectancy of more than 10 years were included. Earlier series of open retropubic radical prostatectomy in the same hospital was used as the audit's standard for comparison. Results: Favourable results over the open series were found with regard to catheter time, transfusion, hospital stay and later functional outcomes including continence and erectile function. Complications and oncological control was found to be similar for the two groups. Operative time was observed to have reduced from 480 min to less 200 min in the 28‐case series for the laparoscopic cases. Conclusion Early results suggested favourable outcomes, but longer follow up and a controlled comparative study is needed to justify any definite conclusion for this relatively novel technique.