Lactitol versus lactulose in the treatment of acute portal systemic encephalopathy (PSE): A controlled trial

Preliminary data suggest that lactitol (beta-galactoside-sorbitol), a new synthetic non-absorbable disaccharide, has beneficial effects on chronic portal systemic encephalopathy. To compare the efficacy of lactitol vs. lactulose in the treatment of acute portal systemic encephalopathy (PSE), 40 cirrhotic patients with an acute episode of PSE were randomly allocated to one of two groups: group A (20 patients) received lactulose (30 ml/6 h) and group B (20 patients) lactitol (12 g/6 h). These doses were adjusted daily to obtain two bowel movements per day. The duration of treatment was 5 days. Age, sex, hepatic and renal function, precipitating factors and level of PSE measured by clinical examination, EEG and number connection test were similar in the two groups. A complete clinical resolution of PSE occurred in 11 patients in each group. In 5 patients of the lactulose group and in 6 of the lactitol group there was a moderate improvement of PSE during the study. Finally, 4 patients in the lactulose group and 3 in the lactitol group did not respond to treatment. No side effects attributable to therapy were observed in either group. These results indicate that lactitol is as effective as lactulose in the management of patients with cirrhosis and acute PSE.     

Hyper-IgM syndrome with CHARGE association

A girl with coloboma of the iris, sensorineural deafness, growth delay, distinctive face, and cranial nerve dysfunction was diagnosed of CHARGE association in the first year of life. She presented with repeated otitis. At 3 yr of age, the patient suffered a septicemia ( Streptococcus pneumoniae , Corynebacterium sp.). The immunoglobulin G (IgG) and IgA serum levels were decreased, IgM increased and cellular immunity parameters were normal, supporting the diagnosis of hyper-IgM (HIM) syndrome. The sequence of CD40 ligand and cytidine deaminase genes were normal. From then on, she was receiving immunoglobulin intravenously with an excellent outcome . Here, we report the first case of CHARGE association and HIM syndrome in the same patient. Although the cause could not be identified, a non-random link is likely.     

Study of the localization of radiopacities similar to calcified carotid atheroma by means of panoramic radiography.

OBJECTIVE: To determine the location in soft tissues of the calcifications, similar to calcified carotid atheromas, that can be observed radiographically in the cervical region in panoramic radiographs. STUDY DESIGN: In each anatomic cadaver specimen preserved in formol, consisting of the head and neck, radiopaque spheres (made from gutta-percha) were positioned in anatomic structures of the cervical region that can be sites of calcification. For each anatomic structure marked in this way, panoramic radiography was performed, consisting of 17 radiographs. The images obtained were analyzed by 24 examiners who indicated which radiographs, in their opinion, presented the radiopaque reference projected in the region of bifurcation of the carotid artery. Analysis of 2 proportions from agreement and disagreement was used to determine radiopacities that could be confused in panoramic radiographs with calcified atheromas in the carotid artery. RESULTS: The results showed that 75% (18) of the examiners correctly indicated the reference in the bifurcation of the carotid artery and 79.2% (19) indicated a triticeous cartilage as calcified atheroma of the carotid artery. CONCLUSIONS: Calcified atheromas of the carotid artery are not the only features that can produce radiopaque images lateral to the panoramic radiograph; the presence of calcification in the triticeous cartilage also can induce an erroneous diagnosis of calcified carotid atheroma.     

PIP2 hydrolysis underlies agonist-induced inhibition and regulates voltage gating of two-pore domain K+ channels

Two-pore (2-P) domain potassium channels are implicated in the control of the resting membrane potential, hormonal secretion, and the amplitude, frequency and duration of the action potential. These channels are strongly regulated by hormones and neurotransmitters. Little is known, however, about the mechanism underlying their regulation. Here we show that phosphatidylinositol 4,5-bisphosphate (PIP₂) gating underlies several aspects of 2-P channel regulation. Our results demonstrate that all four 2-P channels tested, TASK1, TASK3, TREK1 and TRAAK are activated by PIP₂. We show that mechanical stimulation may promote PIP₂ activation of TRAAK channels. For TREK1, TASK1 and TASK3 channels, PIP₂ hydrolysis underlies inhibition by several agonists. The kinetics of inhibition by the PIP₂ scavenger polylysine, and the inhibition by the phosphatidylinositol 4-kinase inhibitor wortmannin correlated with the level of agonist-induced inhibition. This finding suggests that the strength of channel PIP₂ interactions determines the extent of PLC-induced inhibition. Finally, we show that PIP₂ hydrolysis modulates voltage dependence of TREK1 channels and the unrelated voltage-dependent KCNQ1 channels. Our results suggest that PIP₂ is a common gating molecule for K⁺ channel families despite their distinct structures and physiological properties.     

The effect of physeal traction applied to the triradiate cartilage on acetabular growth

Summary Physeal distraction was applied with an external fixator to the triradiate cartilage of dogs with the aim of increasing the capacity of the acetabulum. The force was continued for from 2 to 6 weeks and the consequent changes were evaluated with regard to function and structure by radiography and microscopy. The distraction, without producing epiphysiolysis and destruction of the cartilage, resulted in expansion of the pelvic bones. The depth and volume of the acetabulum were increased, but the acetabular angle was decreased. Distraction also caused proliferation of the lacunar cells and the number of mammillary processes in the cartilage columns increased. Distraction can therefore be applied to the triradiate cartilage to enlarge the capacity of the acetabulum without producing epiphysiolysis.

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Résumé Dans cette étude une distraction a été appliquée sur le cartilage en Y. Douze chiens bâtards, âgés de 2.5 à 4 mois, ont été utilisés pour cette expérimentation. Une force de distraction de 80 Newton a été appliquée d'emblée sur le cartilage en Y. L'application de cette force a été poursuivie sur les animaux pendant 2, 4 ou 6 semaines. A la fin de cette période, les changements de la cavité cotyloïde et du cartilage en Y ont été évalués sur le plan fonctionnel, morphologique, radiologique et histopathologique Aucune altération fonctionnelle n'a été mise en évidence dans les groupes opérés par rapport au groupe de contrôle. On a observé que la distraction a déterminé une expansion massive de l'ilion, du pubis et de l'ischion. Sur les hanches de contrôle la profondeur de la cavité cotyloïde a été évaluée à 13.5 mm, le volume à 1.96 cc et l'angle de la cavité cotyloïde à 29.9°. Après distraction ces valeurs ont été respectivement de 14.4 mm, de 2.10 cc et de 25.7°. La distraction entraîne donc un accroissement de profondeur et de volume de la cavité cotyloïde, mais inversement une diminution de l'angle de cette cavité. Ces résultats montrent que la distraction détermine une prolifération des cellules lacunaires et un accroissement des processus mammaires dans les colonnes du cartilage en Y. Ils montrent également qu'elle peut augmenter la taille de l'acetabulum.

     

Lymphoblastoid α-Interferon for Chronic Hepatitis C: A Randomized Controlled Study

Forty patients with chronic hepatitis C (CHC) were included in an open randomized controlled trial of lymphoblastoid α-interferon (L-IFN) versus no treatment. Twenty patients entered each group, and features of therapy and control cases were similar. L-IFN was given in low doses (1.5-4.5 megaunits) for 1 yr. In 16 of 20 patients treated with L-IFN (80%), but in only one of 20 nontreated cases (0.5%; p < 0.001), aminotransferase activities became normal. In four patients there was a reactivation of the disease during treatment after 4, 5, 6, and 8 months with normal aminotransferase levels. A posttherapy reactivation of hepatitis was observed in four additional cases after 1, 1, 1, and 3 months of follow-up. The other eight patients (40%) continued with normal aminotransferase levels for 1.52 ± 0.74 (range, 1-2.1) yr after IFN doses were discontinued. In all treated patients except two nonresponders, but in only one of 20 nontreated cases ( p < 0.001), Knodell's histological activity index decreased. Procollagen type III aminoterminal peptide levels did not change significantly in nontreated and nonresponder patients, diminished slightly in patients with a transient response, and normalized in cases with a long-standing response, suggesting that this serum test may be a reliable marker for monitoring response to IFIN therapy in patients with CHC. Finally, L-IFN treatment induced significant increments in CD4/CD8 index, phytohemagglutinin-induced blastogenesis, and natural killer activity. This study shows that L-IFN diminish inflammatory and fibrogenic activity in most patients with CHC. In 40% of patients treated in this trial, a long-standing remission of the disease was observed.     

Anesthesia of a woman with extreme morbid obesity (260 kg)

Patients with morbid obesity present a series of functional and morphologic alterations and require a careful planning for anesthetic management. We report a case of a woman weighing 260 kg who was operated on twice for the treatment of her base condition. In the first operation, general anesthesia was carried out and in the second one, epidural anesthesia was conducted. Main complications included hypoxemia and hypercapnia which persisted during the first week after operation carried out under general anesthesia.     

Clusterlike Headache as a First Sign of Brain Metastases of Lung Cancer

We report on a patient with clusterlike headache and multiple brain metastases of lung cancer. Initially, cluster headache was suggested clinically by characteristic symptoms without any focal central nervous system signs. However, magnetic resonance imaging demonstrated multiple brain metastases. It is possible that tumor necrosis factor may have played a role in initiating the clusterlike headache.