Morbid obesity treated by gastroplasty: radionuclide gastric emptying studies

Mechanisms by which gastroplasty for morbid obesity causes weight loss are poorly understood. We studied the role of altered gastric emptying in 50 patients before surgery, 1-4 weeks after surgery, and 2-24 months after surgery using technetium-99m pentetate in water for liquid meals and a Tc-99m styrene divinylbenzene copolymer resin in oatmeal for semisolid meals. We determined the emptying half-times of the stomach before and after surgery in the proximal and distal compartments. The proximal compartment emptied promptly in the early and late postoperative periods. The distal compartment emptied liquids at rates similar to those before surgery, while the late postoperative emptying of semisolids was significantly faster. The stoma connecting the two compartments thus permits rapid transit of liquids and semisolids without delay of distal compartment emptying. No correlation was seen between the emptying half-times or changes thereof and eventual weight loss. Delayed gastric emptying is therefore not the mechanism for satiety and weight loss after gastroplasty has been performed.     

Pax3 mRNA is decreased in the hearts of rats with experimental diaphragmatic hernia

Rats with nitrofen-induced congenital diaphragmatic hernia (CDH) have heart hypoplasia and cardiovascular malformations. The mechanism of action of nitrofen involves changes in neural crest signaling. Pax3 function is required for cardiac neural crest cells to complete their migration to the developing heart. The aim of this study was to examine whether Pax3 expression is changed at two gestational endpoints in rat embryos or fetuses exposed to nitrofen. On day E9.5 of gestation, pregnant rats received either 100 mg of nitrofen (n=10) or vehicle alone (control, n=10). The fetuses were recovered on E15 or E21. Their hearts were dissected out and weighed. Pax3 mRNA expression was determined by real-time polymerase chain reaction. We used two-tailed Students t-tests to compare groups, with a threshold of significance of p<0.05. Compared with controls, nitrofen-exposed fetuses had heart hypoplasia in terms of heart/body weight ratio (0.62±0.10% vs. 0.77±0.17%, p<0.05). Pax3 mRNA expression in the heart was significantly decreased on E15 in nitrofen-treated embryos (32.94±17.11 U vs. 55.09±11.56 U, p<0.05), and it was still decreased, although not significantly, in the hearts of nitrofen-exposed fetuses recovered on E21 (15.67±5.56 U vs. 20.51±5.92 U, not significant). In conclusion, Pax3 is underexpressed in the hearts of nitrofen-exposed embryonal rats before the end of gestation. The mechanism of action of Pax3 should be further investigated because it could be one of the targets for future prenatal transplacental intervention.Paper presented at the XVIIth International Symposium of Pediatric Surgical Research, Liverpool, United Kingdom, 1–2 October, 2004.     

Does lifestyle increase the incidence of pregnancy-induced hypertension?

A case-control study was carried out in Alor Gajah to determine the socio-economic, dietary and lifestyle factors and the occurrence of pregnancy-induced hypertension. There were a total of 30 cases who were selected from antenatal mothers attending 3 selected health centers in 1998. The control group consisted of 30 antenatal mothers who were matched according to health centre, race and age. The results showed that pregnancy-induced hypertension was significantly associated with obesity (P < 0.05) and being a housewife (P < 0.05).     

Injuries among children in Karachi, Pakistan--what, where and how

OBJECTIVES: To describe the epidemiology of injuries among children in Karachi, Pakistan. STUDY DESIGN: Retrospective case series.METHODS: Data on children aged < or =15 years who were injured between October 1993 and January 1996 were extracted from the logs of the main provider of emergency medical transportation, and were classified according to the World Health Organization's basic data set for information on injuries. RESULTS: We identified 1320 cases of injuries in children < or =15 years old. The major causes were: motor vehicle crashes (MVC) (80%), falls other than from vehicles (5%), burns (5%) and drowning (3%). One in six of these children (15%) died either at the scene of the accident or during transportation to the hospital. The majority of deaths were either due to MVCs (67%) or drowning (18%) Large vehicles (buses, minibuses and trucks) were involved in 54% of all childhood road traffic injuries. Almost one-third (33%) of burns took place in the kitchen at home, and half (51%) of all drowning cases occurred in the sea. CONCLUSIONS: The majority of children transported by the ambulance service were male and were victims of MVCs. Prevention efforts aimed at stricter enforcement of driving laws and family/child education geared towards pedestrian safety could potentially reduce morbidity and mortality. This study also highlights the role of the prehospital transport system in injury surveillance.     

Isotropic medium chain mono-diglyceride/oil/water formulations for solubilization of lipophilic and hydrophilic drugs

The aim of the study was to investigate isotropic mono- and diglyceride (MCMDG)/oil/water systems as vehicles for combinations of hydrophilic and lipophilic drugs. For two-component systems, MCMDG was mixed with various masses of water. For MCMDG/oily vehicles/water systems, mixtures were prepared by mixing oil and MCMDG prior to the addition of the appropriate masses of water. The isotropic region was examined by visual inspection and confirmed using polarized light microscopy. Viscosities of the systems were determined. Solubilities of hydrophilic (levamisole HCl) and lipopohilic (abamectin) drugs were determined in the isotropic formulations by HPLC analysis. The isotropic regions in the two-component and three-component systems had water contents of up to 18% at 25 °C. The isotropic formulations exhibited Newtonion flow. The viscosity of formulations having the same percentage of water increased with increasing ratio of MCMDG to oil in three-component systems. The solubilities of the levamisole HCl and abamectin were higher in the isotropic MCMDG/sesame oil/water formulations than in equivalent MCMDG/water formulations. In some formulations, the solubility of levamisole HCl was higher in the absence of abamectin than in combination with abamectin. Isotropic MCMDG/oil/water systems were obtained without the use of co-surfactants. Increasing water content in the system did not proportionally increase the solubility of hydrophilic drug. Solubilization of hydrophilic drug was affected by lipophilic drug in the presence or absence of SO and lipophilic drug solubility was affected by hydrophilic drug in the absence of SO. These systems are suitable vehicles to deliver both hydrophilic and lipophilic drugs and could be of interest for pharmaceutical formulations.     

Isotropic systems of medium-chain mono- and diglycerides for solubilization of lipophilic and hydrophilic drugs

The aim of this study was to investigate isotropic mono- and diglyceride-based (MCMDG) systems, which are potential vehicles for injectable products containing both hydrophilic and lipophilic drugs. For two-component systems, MCMDG was mixed with various masses of water. For three-component systems, the samples were prepared by mixing propylene glycol or glycerol formal or short-chain alcohols with MCMDG prior to the addition of water. The isotropic region was examined by visual inspection and confirmed using polarized light microscopy. Viscosities of formulations were measured. Solubilities of levamisole phosphate (hydrophilic) and abamectin (lipophilic) were determined in the isotropic formulations using high-performance liquid chromatography assay. The isotropic region in the two-component systems had a water content of up to 18% at 25 degrees C. Solvents such as propylene glycol (PG), glycerol formal (FG), and ethyl alcohol increased the isotropic region. The area of isotropic region in these three-component systems increased with increasing temperature. The area of the isotropic region became larger with decreasing dielectric constant and solubility parameter of the series of short-chain alcohols, except n-butyl alcohol, at 25 degrees C. The systems exhibited Newtonian behavior. The solubility of both hydrophilic and lipophilic drugs was high in formulations at 25 degrees C. It was concluded that more water was solubilized in MCMDG/short-chain alcohols/water systems, and the isotropic region in the short-chain alcohol systems enlarged compared with MCMDG/PG/water or MCMDG/GF/water systems, except the n-butyl alcohol system. Hydrophilic and lipophilic drugs solubilize in the systems. The isotropic formulations containing MCMDG may represent an alternative to more traditional formulations for injectable formulations containing both lipophilic and hydrophilic drugs.     

D2 lymphadenectomy in the management of gastric cancer

Background Gastric carcinoma is a significant cause of death in Ireland. Surgery offers the best option of cure, but the five-year survival following resection remains dismal at 10–15%. Experience from Japan and from some Western units suggest that an extended (D2) lymphadenectomy in association with gastrectomy increases the prospect of cure, but concern about the morbidity and mortality of this operation and lack of evidence from randomised studies has limited its acceptance. Aims This study reports the experience of a specialist upper gastrointestinal unit with D2 gastrectomy in a four-year audit. Methods Sixty-two resections were performed for gastric cancer. Results Nineteen patients were deemed unsuitable for the D2 procedure and underwent a more limited lymphadenectomy (DO or D1). Forty-three patients underwent D2 resection, 12 with an oesophagogastrectomy, 22 with total gastrectomy and nine with a sub-total distal resection. Eight patients undergoing D2 resection had extended resections, five with splenectomy and three with a distal pancreatectomy. Post-operative complications occurred in 31% of patients. Thirty-day and 90-day mortality were zero. Median survival was 822 days in the D2 group (range 120–1,320). Conclusions These results show that a D2 gastrectomy can be performed with a low morbidity and mortality and a median survival of greater than two years.