Benefits of intra-abdominal pack placement for the management of nonmechanical hemorrhage

Massive nonmechanical bleeding following severe liver injury is a difficult problem. Placement of intra-abdominal packs tamponades this nonmechanical bleeding and allows time for correction of various metabolic disturbances (ie, hypothermia, hypotension, acidosis, and coagulopathy). The purpose of this retrospective study was to evaluate the severity of these metabolic disturbances at the time of pack placement and the sequential improvement. It was found that most life-threatening disturbances that developed during the initial operative procedure could be corrected within 18 hours after pack placement and aggressive resuscitation. We concluded that the onset of nonmechanical bleeding and a coagulopathy marks a grave prognosis for the patient, and consideration should be given at this time for pack placement. Patients can then be aggressively resuscitated and returned to the operating room within 24 hours for pack removal if stability is achieved.     

Remote distal arteriovenous fistula to improve infrapopliteal bypass patency

The results of the use of prosthetic materials for femorocrural bypass surgery have been less than optimal. The creation of a distal anastomotic arteriovenous fistula to augment blood flow and velocity through the graft is well known. However, it may create turbulence at the anastomosis and steal blood flow away from the distal artery. A canine model was developed to evaluate the effect of fistula size on graft/arterial hemodynamics. In 16 patients we have constructed a distal arteriovenous fistula, which is remote from the distal anastomosis, and we studied the effect of such fistulas on bypass patency and distal arterial hemodynamics. Patients selected for this procedure had multiple previously failed reconstructions and limb-threatening ischemia and did not have usable autogenous vein. Femorotibial bypass graft reconstructions were performed with polytetrafluoroethylene followed by the creation of a side-to-side arteriovenous fistula 5 to 15 cm below the distal anastomosis in the same artery and accompanying veins. We have achieved a 1-year patency of 67% with a 75% limb salvage rate. We also serially measured blood flow and velocity within the bypass, the arteriovenous fistula, and the distal outflow vessel using duplex scanning after surgery. Mean estimated blood flow through the bypass during the immediate postoperative period was 264 ml/min, the arteriovenous fistula was 157 ml/min, and the distal artery was 19 ml/min. Unlike an arteriovenous fistula created at the distal anastomosis, a remote distal arteriovenous fistula not only increases graft blood flow but also augments native arterial blood flow between the distal anastomosis and fistula and thus may improve distal limb perfusion.     

T regulatory markers expression in unexplained recurrent spontaneous abortion

Objective: To evaluate expression of glucocorticoid-induced tumor necrosis factor receptor (GITR), cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and IL-10 in peripheral blood mononuclear cells (PBMCs) of 20 women with unexplained recurrent spontaneous abortion (URSA) compared to 20 normal non-pregnant women (NNP) during luteal phase in the window of implantation.

Methods: Quantitative real-time PCR (qRT-PCR) was performed using the Taqman method for expression of GITR and SYBR Green method for expression of CTLA-4 and IL-10.

Results: Expression of CTLA-4 in the NNPs (median; interquartile range; 3; 1.8–10) was significantly higher than the URSAs (0.72; 0.26–3.81, p?=?0.015). Expression of GITR in the NNPs (53; 10–139) was significantly higher than the URSAs (6; 3–27, p?=?0.005). However, IL-10 expression in the URSAs was significantly higher than the NNPs, did not meet a significant value. A significant correlation was found between CTLA-4 and GITR expression in the study population (p?=?0.0001).

Conclusions: Expression of CTLA-4 and GITR were significantly down-regulated in the URSAs compared to NNPs at the window of implantation, which shows the essential role of Treg cells in creating an immunological privileged site for fetus as an allograft at the maternal–fetal interface by high expression levels of CTLA-4 and GITR during a normal pregnancy.     

Influence of testosterone on morphine analgesia in albino rats

Pain threshold for thermal stimulus after morphine, naloxone alone and naloxone in combination with morphine was studied in male rats before and after three days treatment with testosterone. It was also determined 15 days after gonadectomy and administration of testosterone in such rats. There was significant reduction in morphine analgesia after administration of testosterone and also after gonadectomy. Naloxone increased the pain threshold in gonadectomised rats and it enhanced morphine induced analgesia instead of antagonising it. Naloxone, however, had no effect on morphine analgesia in testosterone treated control rats and gonadectomised rats.     

Finding the right fit: studying the biomechanics of under-tapping with varying thread depths and pitches

Background Context

Compromise of pedicle screw purchase is a concern in maintaining rigid spinal fixation, especially with osteoporosis. Little consistency exists among various tapping techniques. Pedicle screws are often prepared with taps of a smaller diameter, which can further exacerbate inconsistency.

Molecular mechanisms, diagnosis, and rational approaches to management of and therapy for Charcot-Marie-Tooth disease and related peripheral neuropathies.

During the last decade, 18 genes and 11 additional loci harboring candidate genes have been associated with Charcot-Marie-Tooth disease (CMT) and related peripheral neuropathies. Ten of these 18 genes have been identified in the last 2 years. This phenomenal pace of CMT gene discovery has fomented an unprecedented explosion of information regarding peripheral nerve biology and its pathologic manifestations in CMT. This review integrates molecular genetics with the clinical phenotypes and provides a flowchart for molecular-based diagnostics. In addition, we discuss rational approaches to molecular therapeutics, including novel biologic molecules (eg, small interfering ribonucleic acid [siRNA], antisense RNA, and ribozymes) that potentially could be used as drugs in the future. These may be applicable in attempts to normalize gene expression in cases of CMT type 1A, wherein a 1.5 Mb genomic duplication causes an increase in gene dosage that is associated with the majority of CMT cases. Aggresome formation by the PMP22 gene product, the disease-associated gene in the duplication cases, could thus be avoided. We also discuss alternative therapeutics, in light of other neurodegenerative disorders, to disrupt such aggresomes. Finally, we review rational therapeutic approaches, including the use of antioxidants such as vitamin E, coenzyme Q10, or lipoic acid to relax potential oxidative stress in peripheral nerves, for CMT management.     

Quadruple mutations in dihydrofolate reductase of Plasmodium falciparum isolates from Car Nicobar Island, India

Quadruple mutations in the Plasmodium falciparum dihydrofolate reductase (PFDHFR) enzyme give rise to the highest level of pyrimethamine resistance leading to treatment failures. We describe here the presence of these quadruple mutations in a majority of P. falciparum isolates from Car Nicobar (Andaman and Nicobar) Island, India. Isolates from the mainland, however, continue to show a prevalence of double PFDHFR mutations and some with triple but none with quadruple mutations. In conclusion, the antifolate drug pressure is very high in the island, which should be a cause of concern for the malaria control program in the country.