The effects of intraabdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transesophageal echocardiography

Conflicting results have been published about the effects of carbon dioxide (CO(2)) pneumoperitoneum on splanchnic and liver perfusion. Several experimental studies described a pressure-related reduction in hepatic blood flow, whereas other investigators reported an increase as long as the intraabdominal pressure (IAP) remained less than 16 mm Hg. Our goal in the present study was to investigate the effects of insufflated CO(2) on hepatic blood flow during laparoscopic surgery in healthy adults. Blood flow in the right and middle hepatic veins was assessed in 24 patients undergoing laparoscopic surgery by use of transesophageal Doppler echocardiography. Hepatic venous blood flow was recorded before and after 5, 10, 20, 30, and 40 min of pneumoperitoneum, as well as 1 and 5 min after deflation. Twelve patients undergoing conventional hernia repair served as the control group. The induction of pneumoperitoneum produced a significant increase in blood flow of the right and middle hepatic veins. Five minutes after insufflation of CO(2) the median right hepatic blood flow index increased from 196 mL/min/m(2) (95% confidence interval (CI), 140-261 mL/min/m(2)) to 392 mL/min/m(2) (CI, 263-551 mL/min/m(2)) (P < 0.05) and persisted during maintenance of pneumoperitoneum. In the middle hepatic vein the blood flow index increased from 105 mL/min/m(2) (CI, 71-136 mL/min/m(2)) to 159 mL/min/m(2) (CI, 103-236 mL/min/m(2)) 20 min after insufflation of CO(2). After deflation blood flow returned to baseline values in both hepatic veins. Conversely, in the control group hepatic blood flow remained unchanged over the entire study period. We conclude that induction of CO(2) pneumoperitoneum with an IAP of 12 mm Hg is associated with an increase in hepatic perfusion in healthy adults.     

Prosthetic valve endocarditis caused by corynebacterium pilosum

Summary A case of prosthetic valve endocarditis caused byCorynebacterium pilosum in a 79-year-old woman developed eighty years after aortic valve replacement with bovine pericardium bioprosthesis is described. In spite of the antibiotic therapy she presented an unfavourable course that led to her death.

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Klappenprothesen-Endokarditis durch Corynebacterium pilosum

Zusammenfassung Bei einer 79 Jahre alten Frau trat acht Jahre nach Aortenklappenersatz mit einer Bioprothese aus Perikard vom Rind eine Klappenprothesen-Endokarditis auf, als deren UrsacheCorynebacterium pilosum identifiziert wurde. Trotz Antibiotikatherapie kam es zu einem letalen Verlauf der Erkrankung.

     

The clinical picture of Fuch's heterochromic cyclitis]

The authors are presenting their experience with the diagnosis and treatment of Fuchs' heterochromic cyclitis. They followed-up 13 patients with this disease for 0.5-3 years. Most often the patients were sent to the clinic with the diagnosis of recurrent anterior uveitis not responding to the treatment with corticosteroids and mydriatics. Patients underwent numerous investigations including neurological, internal and rheumatological examinations. Antibodies against EBV, HSV and CMV were detected. The examination of humoral immunity and HLA was done. The authors describe the ophthalmological findings, the course of the disease and the treatment. They did not find any correlation in the laboratory investigations and the course of the disease, the diagnosis is based on the clinical picture. They point out the advantage of the small incision in the extracapsular extraction of cataract in these patients.     

Silent renal microangiography after mitomycin C therapy

Mitomycin C (MMC) is an alkylating agent which has been associated with microangiopathic hemolytic anemia and acute renal failure, with an overall incidence between 2 and 10%. This complication can develop several months after the initiation of chemotherapy. Isolated renal impairment without overt microangiopathic hemolytic anemia, although reported, is less frequently documented. We describe a 63-year-old man who developed progressive renal failure without any evidence of hemolysis or thrombopenia 10 months after beginning chemotherapy with MMC and Ftorafur. A renal biopsy displayed features of microangiopathy. The patient required the institution of chronic hemodialysis. In conclusion, it is important to be aware of this indolent but severe renal complication in patients treated with MMC. Urinary parameters and renal function should be monitored over a long period for an early diagnosis.     

Analysis of the structural diversity of monoclonal antibodies to cyclosporine

The immunosuppressive cyclic undecapeptide cyclosporine (Cs) represents a useful model for studying the molecular basis of antibody-antigen interactions. The three-dimensional structure of the Cs molecule is known and a large panel of monoclonal antibodies (mAbs) to Cs has been well characterized by cross-reactivity studies with numerous Cs analogs. In the present study, the sequences of the variable regions of seven mAbs to Cs were determined and a striking relationship was found between the expressed variable region genes and the Cs recognition pattern. An analysis of the length and hydrophobic content of the hypervariable regions and sequence similarities suggested that the heavy chain plays a major role in Cs recognition. Different fine specificities were observed for mAbs exhibiting identical light chains, while two antibodies differed by only a single amino acid located in the heavy chain. The presence of a duplication of 12 nucleotides within the heavy chain third hypervariable region of two antibodies suggests the existence of an additional mechanism for creating antibody diversity.     

Presbycusis: neural degeneration and aging on the auditory receptor of C57/BL6J mice

Presbycusis is a progressive hearing impairment associated with aging, characterized by hearing loss and a degeneration of cochlear structures. In this paper we analyze the effects of aging on the auditory system of C57/BL6J mice, with electrophysiological and morphological studies. With this aim the auditory potentials of mice aging 1, 3, 6, 9, 12, 15, 18, 21 and 24 months were recorded, and then the morphology of the cochleal were analyzed. Auditory potentials revealed an increase in wave latencies, as well as a decrease in their amplitudes during aging. Morphological results showed a total Corti's organ degeneration, being replaced by a flat epithelial layer, and a total absence of hair cells.     

Genome evolution at the genus level: comparison of three complete genomes of hyperthermophilic archaea

We have compared three complete genomes of closely related hyperthermophilic species of Archaea belonging to the Pyrococcus genus: Pyrococcus abyssi, Pyrococcus horikoshii, and Pyrococcus furiosus. At the genomic level, the comparison reveals a differential conservation among four regions of the Pyrococcus chromosomes correlated with the location of genetic elements mediating DNA reorganization. This discloses the relative contribution of the major mechanisms that promote genomic plasticity in these Archaea, namely rearrangements linked to the replication terminus, insertion sequence-mediated recombinations, and DNA integration within tRNA genes. The combination of these mechanisms leads to a high level of genomic plasticity in these hyperthermophilic Archaea, at least comparable to the plasticity observed between closely related bacteria. At the proteomic level, the comparison of the three Pyrococcus species sheds light on specific selection pressures acting both on their coding capacities and evolutionary rates. Indeed, thanks to two independent methods, the "reciprocal best hits" approach and a new distance ratio analysis, we detect the false orthology relationships within the Pyrococcus lineage. This reveals a high amount of differential gains and losses of genes since the divergence of the three closely related species. The resulting polymorphism is probably linked to an adaptation of these free-living organisms to differential environmental constraints. As a corollary, we delineate the set of orthologous genes shared by the three species, that is, the genes that may characterize the Pyrococcus genus. In this conserved core, the amino acid substitution rate is equal between P. abyssi and P. horikoshii for most of their shared proteins, even for fast-evolving ones. In contrast, strong discrepancies exist among the substitution rates observed in P. furiosus relative to the two other species, which is in disagreement with the molecular clock hypothesis.