Right hepatic lobe agenesis. Where is the gallbladder?

Anomalies of the liver are infrequent. Agenesis of the right hepatic lobe is an uncommon, usually asymptomatic, entity that is diagnosed through new imaging techniques or during surgery. We present the case of a 51-year-old woman with right hepatic lobe agenesis who underwent technically difficult cholecystectomy for symptomatic gallstones. We discuss the diagnosis and technical difficulties that can be encountered during cholecystectomy when there is right hepatic lobe agenesis.     

Does gender matter in glioblastoma?

Background  

The clinical outcome of glioblastoma (GBM) patients who receive radiotherapy alone or with chemotherapy is well established. However, little is known about how many patients do not receive this treatment. We consider it is important to investigate why a proportion of operated patients do not receive further treatment after surgery.     

Left ventricular perforation following percutaneous mitral valvuloplasty. Its emergency surgical correction in situ. Apropos a case

Percutaneous mitral valvuloplasty is actually accepted as alternative to surgery for treatment of rheumatic mitral stenosis, although today it is not still free from troublesome complications like ventricular perforation. We present here a patient in which was performed a percutaneous mitral valvuloplasty and that developed a left ventricular perforation at the end of the procedure, with hyperacute cardiac tamponade, requiring an in situ surgical salvagement on an emergency basis, performing a successful repair of the ventricular rupture in the own catheterization laboratory.     

Microheterogeneity of anterior pituitary FSH in the male rat: isoelectric focusing pattern throughout sexual maturation

Anterior pituitary glands were removed from male rats at 5, 10, 15, 18, 21, 28, 30, 40, 50 and 90 days of age, and the multiple forms of FSH present within them were separated by polyacrylamide gel-isoelectric focusing (PAGE-IEF; pH range 3.0-8.0). Gel eluents were analysed for FSH content by radioimmunoassay (RIA) and a specific radioreceptor assay (RRA). All pituitaries studied exhibited one or more peaks of immunoactive FSH within a pH range of 7.0-3.0; the major peak exhibited an isoelectric point (pI) of 4.9-4.0. Between 25 and 56% of anterior pituitary FSH obtained from rats 5-30 days old focused within a pH range of 4.9-4.5, whilst in older animals (greater than or equal to 40 days) this pH range contained 17-27% of the total FSH recovered. In contrast, in animals 40-90 days old, the greatest proportion of immunoactive FSH (42-62% of the total immunoactivity recovered) focused within a pH range of 4.4-4.0; further, only these groups of animals exhibited a significant proportion of anterior pituitary FSH with a pI less than or equal to 3.9. Between 14 and 21% of total FSH from 5- to 30-day-old rats focused within a pH range of 5.4-5.0, whereas in older animals this pH range contained 6-9% of the total FSH recovered. These shifts in FSH pI occurred at the time of appearance of spermiogenesis, at 45 days of age. Although the ratio of the concentration of FSH measured by RRA to that measured by RIA declined as the pI of the anterior pituitary FSH decreased throughout a pH range of 7.0-4.0, the most acidic FSH molecules (pI less than 4.0) showed an abrupt increase in that ratio. These results demonstrate that the transition from sexual immaturity to adulthood is accompanied by qualitative changes of intracellular pituitary FSH. They contrast with previous findings in female rats in which a shift to less acidic anterior pituitary FSH forms was detected at the time of vaginal opening, thus indicating the existence of a sexual dichotomy in terms of the action of gonadal steroids on the type of FSH molecule synthesized by the anterior pituitary gland.     

Sleep spindles and human cortical nociception: a surface and intracerebral electrophysiological study

Key points

• Sleep spindle are usually considered to play a major role in inhibiting sensory inputs.
• Using nociceptive stimuli in humans, we tested the effect of spindles on behavioural, autonomic and cortical responses in two experiments using surface and intracerebral electroencephalographic recordings.
• We found that sleep spindles do not prevent arousal reactions to nociceptive stimuli and that autonomic reactivity to nociceptive inputs is not modulated by spindle activity.
• Moreover, neither the surface sensory, nor the insular evoked responses were modulated by the spindle, as detected at the surface or within the thalamus.
• The present study comprises the first investigation of the effect of spindles on nociceptive information processing and the results obtained challenge the classical inhibitory effect of spindles.

Abstract

Responsiveness to environmental stimuli declines during sleep, and sleep spindles are often considered to play a major role in inhibiting sensory inputs. In the present study, we tested the effect of spindles on behavioural, autonomic and cortical responses to pain, in two experiments assessing surface and intracerebral responses to thermo‐nociceptive laser stimuli during the all‐night N2 sleep stage. The percentage of arousals remained unchanged as a result of the presence of spindles. Neither cortical nociceptive responses, nor autonomic cardiovascular reactivity were depressed when elicited within a spindle. These results could be replicated in human intracerebral recordings, where sleep spindle activity in the posterior thalamus failed to depress the thalamocortical nociceptive transmission, as measured by sensory responses within the posterior insula. Hence, the assumed inhibitory effect of spindles on sensory inputs may not apply to the nociceptive system, possibly as a result of the specificity of spinothalamic pathways and the crucial role of nociceptive information for homeostasis. Intriguingly, a late scalp response commonly considered to reflect high‐order stimulus processing (the ‘P3’ potential) was significantly enhanced during spindling, suggesting a possible spindle‐driven facilitation, rather than attenuation, of cortical nociception.

Abbreviations

AASM

American Academy of Sleep Medicine

EKG

electrocardiogram

EMG

electromyogram

EOG

electrooculogram

LEP

laser‐evoked potentials

MNI

Montreal Neurological Institute

MRI

magnetic resonance imaging

REM

rapid eye movement

SEEG

stereo‐electroencephalography

     

A serum microRNA signature associated with complete remission and progression after autologous stem-cell transplantation in patients with multiple myeloma

We have examined serum microRNA expression in multiple myeloma (MM) patients at diagnosis and at complete response (CR) after autologous stem-cell transplantation (ASCT), in patients with stable monoclonal gammopathy of undetermined significance, and in healthy controls. MicroRNAs were first profiled using TaqMan Human MicroRNA Arrays. Differentially expressed microRNAs were then validated by individual TaqMan MicroRNA assays and correlated with CR and progression-free survival (PFS) after ASCT. Supervised analysis identified a differentially expressed 14-microRNA signature. The differential expression of miR-16 (P = 0.028), miR-17 (P = 0.016), miR-19b (P = 0.009), miR-20a (P = 0.017) and miR-660 (P = 0.048) at diagnosis and CR was then confirmed by individual assays. In addition, high levels of miR-25 were related to the presence of oligoclonal bands (P = 0.002). Longer PFS after ASCT was observed in patients with high levels of miR-19b (6 vs. 1.8 years; P < 0.001) or miR-331 (8.6 vs. 2.9 years; P = 0.001). Low expression of both miR-19b and miR-331 in combination was a marker of shorter PFS (HR 5.3; P = 0.033). We have identified a serum microRNA signature with potential as a diagnostic and prognostic tool in MM.