A comparison of histamine effects on the sympathetic neurotransmission of testicular capsule and rat vas deferens

Histamine is an important modulatory agent of the sympathetic neurotransmission, but its exact action on the testicular capsule or rat vas deferens is not fully understood. The present study sought to further investigate the functional effects of histamine on the neuronal and exogenous noradrenaline-induced contraction of the testicular capsule and rat vas deferens as well as to evaluate the contractile properties of this drug. The testicular capsule or vas deferens from Wistar rats, 3–4 months old, weighing 300–400 g, was isolated and mounted in organ baths for functional experiments. The results indicated that the neuronally evoked contraction of the testicular capsule was affected by histamine (10^?10 to 10^?8 M) with participation of inhibitory (H₃ receptors) and excitatory (H₁ receptors) receptors. Histamine (10^?7 to 10^?4 M) modulated the field-stimulated vas deferens by excitatory (H₂ receptors) and inhibitory (H₁ receptors) receptors. Histamine was able to decrease the tonic response for noradrenaline-induced contractions with participation of H₁ receptors (testicular capsule) and H₃ receptors (vas deferens) followed by nitric oxide generation. At high concentration, histamine exerts contractile effects in both tissues. In the testicular capsule, the histamine-induced contractions were related to H₁ receptor activation followed by release of prostaglandins. In contrast, the contractile effects of histamine in the vas deferens were related to H₂ receptor activation followed by release of catecholamines from sympathetic nerve endings. Therefore, our results indicate that histamine induced several effects on the sympathetic neurotransmission of rat testicular capsule and vas deferens. These effects are dependent on the concentration used and with participation of multiple histamine receptors.     

Cushing's disease

Cushing's disease is a form of Cushing's syndrome, persistent inappropriate hypercortisolism, that results from pituitary ACTH hypersecretion. It currently accounts for 70 per cent of adult cases of Cushing's syndrome and affects mainly women of childbearing age. The pathology, cause, and clinical and laboratory features of the disease are discussed. The initial step in diagnosis is documentation of endogenous hypercortisolism, which is followed by identification of the cause. Selective transsphenoidal resection of ACTH-producing pituitary adenomas is the initial treatment of choice. The roles of radiotherapy and medical therapy are discussed.     

Applied pharmacology in percutaneous coronary intervention: You can't fight mother nature

• Differential outcomes based on target vessel diameter persist in the era of second generation drug eluting stents.
• These differences are mainly driven by need for target vessel revascularization without appreciable differences in hard atherosclerotic cardiovascular disease outcomes that is, mortality and myocardial infarction.
• Future non mechanistic treatment options based on patient characteristics maybe needed.

     

Epidemiological researches on diabetes mellitus in Roumanian urban and rural population

Summary This paper presents the methodology and the results of screening forDiabetes mellitus in large population groups. The investigation consisted of two phases : the detection of glycosuria and blood sugar level 2 h after on oral glucose load; and afterwards, the performance of GTT on people with blood sugar levels above the limits defined as normal for each age group. — The screening of 1314 subjects from a rural population and 7113 from an urban population, between 25 and 65 years of age indicated a prevalence ofDiabetes mellitus of 1.44% and 3.7% respectively. This estimate includes diabetics already known to a special medical centre. –74.5% of the urban population and 88.7%, of the rural population were included in the screening. -Obesity was found in 51% and 69% of the newly found urban and rural diabetics, respectively. In 2.15% of the group, glycosuria was found with normal blood sugar levels during GTT, suggesting that this group should be specially recorded and subjected to periodical survey. — Screening forDiabetes mellitus solely by glycosuria testing is both inadequate and erroneous.

---

Epidemiologische Studien über den Diabetes mellitus in der rumänischen Stadt- und Landbevölkerung

Zusammenfassung Es werden die Methoden und Resultate bei der Aufdeckung von Diabetikern in großen Bevölkerungsgruppen dargelegt. Die Untersuchungen erfolgten in zwei Teilen. Zunächst wurden der Harn- und Blutzucker zwei Stunden nach einer Glucosebelastung ermittelt. Später wurden bei den Personen mit im Vergleich zu den Normalwerten ihrer Altersgruppe erhöhten Blutzuckerwerten detailliertere Glucosetoleranzteste durchgeführt. -In einer Gruppe von 1314 Personen einer Landbevölkerung und in einer Gruppe von 7113 Personen einer Stadtbevölkerung zwischen 25 und 65 Jahren war die Häufigkeit des Diabetes 1.44% bzw. 3.7%. In der Endrechnung wurden schon bekannte Diabetiker, die in Diabeteszentren behandelt wurden, mit eingerechnet. An 74.5% der Stadtbevölkerung und 88.7% der Landbevölkerung wurden weitere Untersuchungen angeschlossen. Die Häufigkeit der Übergewichtigkeit unter den neu entdeckten Diabetikern lag bei 51% in der Stadtund bei 69% in der Landbevölkerung. Neben den Diabetikern ergaben die Massenuntersuchungen in 2.15% der Fälle eine Glykosurie bei normalen Blutzuckerwerten während des Glucosetoleranztestes. Diese Gruppe von Patienten benötigte eine ständige Überwachung. -Gleichzeitig wurde festgestellt, daß die Aufdeckung von Diabetikern allein mit dem Harnzuckernachweis unzureichend und fehlerhaft ist.

---

Recherches êpidêmiologiques concernant le diabète sucré dans la population urbaine et rurale de la Roumanie

Résumé Les auteurs exposent la méthodologie et les résultats obtenus dans le dépistage du diabète sucré parmi de larges groupes de population. — L'exploration a été effectuée en deux phases : la glycosurie et la glycémie prise deux heures après la charge en glucose et après l'exploration parle test du GTT chez des sujets ayant des taux de glycémie dépassant les limites définies comme normales pour chaque groupe d'âge. — Chez un groupe de 1314 personnes parmi la population rurale et 7113 parmi la population urbaine, âgées de 25 à 65 ans, l'incidence du diabète sucré a été respectivement de 1.44% etde3.7%.Dansle calcul final on a considéré aussi les diabétiques déjà en traitement dans un centre médical spécial. Des investigations plus approfondies ont été faites sur 74.5% des malades du milieu urbain dépistés et sur 88.7% des malades provenant du milieu rural. -L'incidence de l'obésité parmi les diabétiques dépistés a été de 51% dans la population urbaine et de 69% dans la population rurale. — A part les cas de diabète sucré, les recherches en masse ont montré une proportion de 2.15% de glycosurie pour une glycémie normale lors du GTT, ce qui suggère que cette catégorie de malades devrait être recensée dans un centre médical et soumise à un controle périodique. -En même temps on a démontré que la méthode de dépistage du diabète sucré seulement d'après la glycosurie est insuffisante et erronée.

     

Radiological findings correlate with neurological deficits but not with pain after operatively treated sacral fractures: An 11-year follow-up study of 28 patients

Background and purpose

Neurological deficits and pain are common after displaced sacral fractures. However, little is known about the association between the long-term clinical outcomes and radiological findings. We examined the long-term radiological findings and their correlations with lumbosacral pain and neurological deficits in the lower extremities after surgery for sacral fractures.

Methods

28 consecutive patients with operatively treated displaced sacral fractures were followed for mean 11 (8–13) years. Sensorimotor impairments of the lower extremities were classified according to the American Spinal Injury Association (ASIA). Pain was assessed using a visual analog scale (VAS). All patients underwent conventional radiographic examination and CT, and the images were scrutinized for nonunion, residual displacement, narrowing of the sacral foramina, and post-foraminal encroachment of the L5 and S1 nerves.

Results

There was residual displacement of ≥ 10 mm in 16 of the 28 patients. 26 patients had narrowing of 1 or more neural root foramina in L5-S4. 8 patients reported having no pain, 11 had pain only in the lumbosacral area, and 9 had pain in combination with radiating leg pain. Statistically significant correlations were found between narrowing of the sacral foramina and neurological deficits in the corresponding dermatomes. Significant correlations were also found between post-foraminal encroachment of L5 nerves and both sensory and motor deficits. No correlations were found between pain and radiological findings.

Interpretation

Pathological radiological findings are common 11 years after operatively treated displaced sacral fractures. Sacral foraminal and L5 post-foraminal bony encroachments were common findings and correlated with neurological deficits. However, lumbosacral pain did not correlate with radiological sequelae after fracture healing.High-energy trauma with displaced sacral fracture is frequently associated with concomitant injuries to the intrapelvic soft tissue structures, including the lumbosacral plexus (Huittinen 1972, Denis et al. 1988, Majeed 1992). These injuries may cause considerable morbidity (Pohlemann et al. 1994, Tornetta and Matta 1996, Tötterman et al. 2006). However, little is known about which factors determine long-term clinical outcome in these patients, or what may explain the progression of neurological symptoms observed in a small proportion of patients (Adelved et al. 2012). Pelvic malunions and nonunions have been put forward as prognostic factors for impaired long-term outcome (Matta et al. 1996, Mears and Velyvis 2003, Oransky and Tortora 2007), but long-term structural changes of the sacrum after fracture healing have not been explored.Our primary aim was to assess long-term radiological findings after surgically treated displaced sacral fractures. In addition, we wanted to assess whether pathological radiological findings, including bony structural changes of the sacrum, may contribute to neurological dysfunctions of the lower extremities or to the occurrence of pelvis-related pain.     

Sample size calculation in cost‐effectiveness cluster randomized trials: optimal and maximin approaches

In this paper, the optimal sample sizes at the cluster and person levels for each of two treatment arms are obtained for cluster randomized trials where the cost‐effectiveness of treatments on a continuous scale is studied. The optimal sample sizes maximize the efficiency or power for a given budget or minimize the budget for a given efficiency or power. Optimal sample sizes require information on the intra‐cluster correlations (ICCs) for effects and costs, the correlations between costs and effects at individual and cluster levels, the ratio of the variance of effects translated into costs to the variance of the costs (the variance ratio), sampling and measuring costs, and the budget. When planning, a study information on the model parameters usually is not available. To overcome this local optimality problem, the current paper also presents maximin sample sizes. The maximin sample sizes turn out to be rather robust against misspecifying the correlation between costs and effects at the cluster and individual levels but may lose much efficiency when misspecifying the variance ratio. The robustness of the maximin sample sizes against misspecifying the ICCs depends on the variance ratio. The maximin sample sizes are robust under misspecification of the ICC for costs for realistic values of the variance ratio greater than one but not robust under misspecification of the ICC for effects. Finally, we show how to calculate optimal or maximin sample sizes that yield sufficient power for a test on the cost‐effectiveness of an intervention. Copyright © 2014 John Wiley & Sons, Ltd.     

Malignant melanoma in a child with giant congenital melanocytic nevus and satellite flekers: A rare entity

Malignant melanomas in the pediatric age are remarkably rare representing 0.9% of various pediatric malignancies. Congenital nevi occur in 1 in 100 newborns, whereas giant congenital melanocytic nevus (GCMN) measuring more than 20 cm is seen in 1 in 20 000 cases. Very few cases of malignant melanoma arising from GCMN have been described in English literature. The risk of developing malignant melanoma from GCMN is believed to be directly proportional to the size of the nevus and varies from 2.6% to 20% depending on the size of nevus. We present a case of malignant melanoma in a 12‐year‐old female child who had a congenital giant nevus and multiple satellite flekers all over the body.