Iloprost in embolic renal failure

Cholesterol embolism is a serious disease with a high morbidity and mortality rate. There is no clear evidence that any specific treatment helps this syndrome. We report a patient who developed acute renal failure due to cholesterol crystal embolism following percutaneous transluminal angioplasty of a renal artery. Treatment with iloprost for peripheral symptoms of cholesterol emboli resulted in rapid resolution of toe cyanosis, decrease in leg pain and a significant decrease in serum creatinine shortly after initiation of treatment. One month after initiation of iloprost therapy, skin signs of cholesterol emboli disappeared and leg pain diminished. Gradually reduction in serum creatinine level was also observed (from 390 to 160 micromol/L). Eighteen months after the arteriography, the patient had stable renal function with creatinine levels of 150-160 micromol/L, and he was asymptomatic.     

Dermatology for the urologist

Dermatoses of the male genital area are widely diverse clinically and etiologically. Both dermatologists and urologists are involved in diagnosing and treating those dermatoses. This article will focus mainly on the important or commonly encountered entities classified according to their etiology as infectious, inflammatory, autoimmune, vascular, nervoid or other.     

Different oral contraceptives and voice quality--an observational study

The classical literature on endocrine effect on voice considers oral contraceptives (OCs) as a risk factor for voice. However, recent studies revealed no adverse effect of new-generation OCs on voice. It was also suggested that OCs could improve specific voice characteristics via different mechanisms. The aim of the present study was to evaluate the effect of OCs on voices of women who use different formulations containing drospirenone (n=10), desogestrel (n=9) and gestodene (n=10). Acoustic voice measures of the 29 women were evaluated twice during the menstrual cycle. Fundamental frequency, frequency as well as amplitude stability and noise characteristics were measured using a computerized voice analysis program. Results indicated that vocal stability and quality were similar in the three groups tested. Marginal differences were observed between the drospirenone group and the other two groups. This preliminary observational study indicates that although drospirenone was previously shown to reduce water retention, this effect was not found to directly influence voice characteristics of women who use OCs.     

Sustained neural activity associated with cognitive control during temporally extended decision making

Decision making has both cognitive and affective components, but previous neuroimaging studies in this domain predominantly have focused on affect and reward. The current study examined a decision-making paradigm that placed strong demands on cognitive control processes by making reward payoffs contingent upon decision-making history. Payoffs were maximized by choosing the option that, paradoxically, was associated with a lower payoff on the immediate trial. Temporal integration requirements were manipulated by varying, across conditions, the window of previous trials over which the reward function was calculated. The cognitive demands of the task were hypothesized to engage neural systems responsible for integrating and actively maintaining actions and outcomes over time and the top-down biasing of response selection. Brain activation was monitored with functional magnetic resonance imaging (fMRI) using a mixed-blocked and event-related design to extract both transient and sustained neural responses. A network of brain regions commonly associated with cognitive control functions, including bilateral prefrontal cortex (PFC), bilateral parietal cortex, and medial frontal cortex, showed selectively sustained activation during the task. Increasing temporal integration demands led to a shift from transient to sustained activity in additional regions, including right hemisphere dorsolateral and frontopolar PFC. These results demonstrate the contribution of cognitive control mechanisms to temporally extended decision-making paradigms and highlight the benefits of decomposing activation responses into sustained and transient components.     

Randomized trial of sertraline versus venlafaxine XR in major depression: efficacy and discontinuation symptoms

BACKGROUND: The comparative efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) was recently debated. Meta-analyses, based mainly on fluoxetine comparator data, suggest that the SNRI venlafaxine has superior efficacy to SSRIs in treatment of major depression. OBJECTIVE: To compare quality of life (QOL), efficacy, safety, and tolerability associated with sertraline and venlafaxine extended release (XR) for treatment of DSM-IV major depression. METHOD: This was an 8-week, double-blind, randomized study of sertraline (50-150 mg/day) versus venlafaxine XR (75-225 mg/day), followed by a 2-week taper period. Subjects were recruited from 7 sites in Turkey and 6 sites in Australia between October 2002 and July 2003. The primary outcome measure was the Quality of Life Enjoyment and Satisfaction Questionnaire. Secondary outcome measures included measures of depression (including response and remission), anxiety, pain, safety (e.g., blood pressure), and tolerability (e.g., discontinuation symptoms). RESULTS: A total of 163 subjects received study treatment (women, 69%; mean age, 37.0 [SD = 12.9] years). No significant differences in QOL or efficacy were noted between treatments on the primary or secondary endpoints for the total study population or the anxious depression and severe depression subgroups. A priori analyses of symptoms associated with treatment discontinuation demonstrated no difference between treatment groups. However, in post hoc analyses, sertraline was associated with less burden of moderate to severe discontinuation symptoms. Venlafaxine XR was associated with a relative increase in mean blood pressure (supine diastolic blood pressure, -4.4 mm Hg difference at week 8/last observation carried forward). CONCLUSION: Sertraline and venlafaxine XR demonstrated comparable effects on QOL and efficacy in treatment of major depression, although sertraline may be associated with a lower symptom burden during treatment discontinuation and a reduced risk of blood pressure increase.     

Understanding the esthetic evaluation for success

With any restorative procedure, a thorough evaluation, diagnosis, and treatment plan is essential for a positive outcome. When dealing with esthetic dilemmas, the some holds true. Without a sequential esthetic evaluation, diagnosis, treatment plan, and execution, an acceptable outcome is difficult to predict. The treating clinician should be able to visualize the esthetic problem, visualize the proposed changes, and devise a way to achieve the result while still maintaining mechanically, functionally, and biologically sound principles.     

Fast multicolor primed in situ protocol for chromosome identification in isolated cells may be used for human oocytes and polar bodies

OBJECTIVE: To present and evaluate the use of a new ultra-fast multicolor primed in situ (PRINS) procedure for karyotyping human oocytes and first polar bodies. DESIGN: In situ chromosomal identification on isolated cells, using combinations of specific primers for chromosomes 1, 7, 9, 16, and 18 and fluorescent nucleotides. SETTING: Sixteen unfertilized oocytes were obtained from women participating in an IVF program. PATIENT(S): Five patients undergoing an IVF-ET. INTERVENTION(S): In vitro unfertilized oocytes were fixed on slides, and sequential PRINS reactions were performed on each preparation. MAIN OUTCOME MEASURE(S): Ultrarapid in situ identification of three or four chromosomes on oocyte and polar body chromosome spreads. RESULT(S): On the basis of the direct in situ mixing of the colors of fluorochromes (FITC, TRITC, Cascade Blue) that were incorporated in sequential PRINS reactions, this method allows rapid and efficient labeling of three or four individual chromosomes. Each PRINS reaction consists of a unique 4- to 6-minute step for both in situ annealing and elongation. The procedure can be combined with fluorescence in situ hybridization (FISH) reactions. CONCLUSION(S): By simplifying the multicolor PRINS procedure, this new protocol should facilitate the use and adaptation of PRINS to chromosome screening. This approach could be used in parallel or in combination with FISH for efficient aneuploidy assessment on isolated cells.     

Survival of frozen-thawed human ovarian fetal follicles in long-term organ culture

Ovarian follicles obtained from second and third-trimester human fetuses survived 4 weeks in organ culture and secreted 17-beta estradiol (E(2)).