Outcomes of right- compared with left-side colectomy

Right colon resections are perceived as less morbid than left colon resections. The purpose of this study was to determine the differences in outcomes between right-and left-side colon resections. We reviewed 420 consecutive open colectomies over 4 years. Patient demographics, surgical indications, intraoperative variables, and outcomes were collected. Two hundred twenty-three right colectomies (RCs) were compared with 197 left colectomies (LCs). RCs were more often required for cancer (111 vs 65, P < .001) and LCs for diverticular disease (10 vs 90, P < .001). LCs were more often performed emergently (36% vs 23%, P = .004) and required longer mean operative times (149 minutes vs 130 minutes, P = .004). Complications and mortality in the two groups were equal statistically. In the emergent colectomy subset, LCs were associated with greater intraoperative blood loss (315 vs 201 mL, P = .02) but fewer complications (11% vs 17%, P = .003).     

Comparison of GnRH agonists and antagonists in normoresponder IVF/ICSI in Turkish female patients

Purpose To evaluate the results of gonadotropin-releasing hormone agonist (GnRHa) and gonadotropin-releasing hormone antagonist (GnRHant) use in two demographically matched groups of normoresponder in-vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) patients in a prospective study. Methods We randomised 93 patients undergoing IVF/ICSI between May 2005 and August 2006. Patients with IVF indications were included except for those with polycystic ovary syndrome or azoospermia, women older than 38 years and those with follicle-stimulating hormone (FSH) ≥10 IU/ml. Patients were stimulated with standard 225 IU recombinant FSH. In Group I (n=45) a daily dose of GnRHant cetrorelix acetate 0.25 mg was administered when follicles reached a diameter of ≥14 mm. Group II (n=48) patients were desensitised with the GnRHa, leuprolide acetate, in a long protocol. Human chorionic gonadotropin (hCG) was administered when at least three follicles of 18 mm in diameter were observed. Oocyte retrieval was scheduled 36 hours following hCG administration and embryos were transferred on day 3 after oocyte retrieval. Results The two groups were homogenous for age, infertility duration, basal FSH and serum oestradiol (E2) (P=0.537, P=0.911, P=0.103 and P=0.733, respectively). In Group II (the GnRHa group) more antral follicles (P<0.001), a longer induction duration (P=0.017) and higher peak E2 levels (P<0.001) were observed. No differences were observed in the number of oocytes retrieved (P=0.749), embryos achieved and transferred (P=0.677), or fertilisation rates (P=0.839) between the two groups. There was no statistically significant difference between groups in clinical pregnancy rates, cycle cancellation and ovarian hyperstimulation (P=0.437, P=0.109 and P=0.415, respectively). Conclusion GnRHant and GnRHa provide comparable results in normoresponder patients, while GnRHant allows a greater flexibility in their treatment.     

Synergistic antinociception by the cannabinoid receptor agonist anandamide and the PPAR-alpha receptor agonist GW7647

The analgesic properties of cannabinoid receptor agonists are well characterized. However, numerous side effects limit the therapeutic potential of these agents. Here we report a synergistic antinociceptive interaction between the endogenous cannabinoid receptor agonist anandamide and the synthetic peroxisome proliferator-activated receptor-alpha (PPAR-alpha) agonist 2-(4-(2-(1-Cyclohexanebutyl)-3-cyclohexylureido)ethyl)phenylthio)-2-methylpropionic acid (GW7647) in a model of acute chemical-induced pain. Moreover, we show that anandamide synergistically interacts with the large-conductance potassium channel (KCa1.1, BK) activator isopimaric acid. These findings reveal a synergistic interaction between the endocannabinoid and PPAR-alpha systems that might be exploited clinically and identify a new pharmacological effect of the BK channel activator isopimaric acid.     

Effect of chronic administration of sildenafil on sodium retention and on the hemodynamic complications associated with liver cirrhosis in the rat

Previous studies demonstrated increased phosphodiesterase-5 (PDE5) activity and expression in the kidneys of rats with liver cirrhosis. Acute intravenous administration of PDE5 inhibitors enhanced sodium excretion in these rats. The aim of the present study was to examine the effects of chronic administration of sildenafil on renal sodium handling and hemodynamics in rats with liver cirrhosis. Male Sprague-Dawley rats underwent bile-duct ligation and excision or sham operation and were housed in metabolic cages throughout the study. Body weight, food intake, water intake and urine volume were measured daily, and plasma samples were obtained twice weekly. Fourteen days following surgery sildenafil or its vehicle (dimethylsulfoxide) were administered (20 mg/kg subcutaneously 3 times/day). Two weeks later, systemic hemodynamics were measured under general anesthesia. Sildenafil enhanced the systemic vasodilatation associated with liver cirrhosis and reduced the arterial pressure. There was no reduction in the glomerular filtration rate, however. Despite these hemodynamic changes, sildenafil prevented the decrease in sodium excretion observed in the bile-duct-ligated group receiving vehicle and markedly increased fractional sodium excretion relative to the other groups. These results suggest that chronic sildenafil administration may help prevent or ameliorate sodium retention in cirrhosis, but that hemodynamic adverse effects may ensue.     

Enhancement of Insulin Transport Across Primary Rat Alveolar Epithelial Cell Monolayers by Endogenous Cellular Factor(s)

Purpose To characterize factor(s) contained in apical medium of primary cultured rat alveolar epithelial type II cell-like monolayers (RAECM-II) that enhance insulin absorption across alveolar epithelial cells. Materials and Methods Primary rat alveolar epithelial cell monolayers cultured on Transwells in the presence and absence of 10 ng/ml keratinocyte growth factor for 6 days were dosed from the apical compartment with radiolabeled insulin in: newborn bovine serum-containing medium (SM), conditioned medium from apical compartment of rat alveolar epithelial type I cell-like monolayers (RAECM-I) (CMI), or conditioned medium from apical compartment of RAECM-II (CMII). At the end of 2 h incubation, basolateral medium was collected and amounts of transported radiolabeled insulin were determined using a gamma counter. In order to determine the molecular size range of the enhancing factor(s), CMII was centrifuged in 50 kDa molecular weight cut-off Centricon tubes, and both retentate and filtrate were used as separate dosing solutions. Heat denaturation and ammonium sulphate precipitation were used to determine if the involved factor(s) represent proteins or other smaller soluble factors. Transalveolar transport rates of a paracellular marker, ¹⁴C-mannitol, and fluid-phase marker, horseradish peroxidase, were determined in the presence and absence of the factors. Effects of temperature (4, 16 and 37°C) on radiolabeled insulin fluxes were also measured. Results Conditioned medium obtained from the apical compartment of RAECM-II, CMII, increased transport of insulin across the monolayers when compared to SM or CMI. The enhancing effect of CMII was retained in the precipitate following ammonium sulfate treatment and in the retentate after Centricon filtration. The enhancing effect of CMII was significantly decreased when heated at 80°C for 15 min. CMII did not affect the transport of ¹⁴C-mannitol or HRP, while its effect on insulin transport was decreased by 87% when temperature was lowered to 4°C from 37°C. Conclusions Conditioned medium from type II cell-like monolayer cultures appears to contain protein factor(s) which seem to be involved in facilitating active transcellular transport of insulin across primary cultured RAECM-II.     

The effects of two systemic α<Subscript>1</Subscript>-adrenergic blockers on pupil diameter: a prospective randomized single-blind study

Our aim was to investigate the effects of two α₁-adrenergic blockers—tamsulosin and alfuzosin—on pupil diameter (PD). In this prospective randomized single-blind clinical trial, 64 patients with benign prostatic hyperplasia received treatment with either tamsulosin or alfuzosin. The same ophthalmologist, masked to the given medication, evaluated patients prior to, 4 weeks after and 6 months after the start of the medication (day 0, day 28 and month 6). Best corrected visual acuity and PD under mesopic, scotopic, and dilated conditions were measured. t-test, ANOVA, and Dunnett’s multiple comparison post-test were used for statistical analysis. With tamsulosin treatment, both mesopic and scotopic PD decreased, respectively, from 3.9 ± 0.7 and 5.7 ± 0.6 mm at day 0 to 3.6 ± 0.9 and 5.5 ± 0.8 mm at day 28, and 3.6 ± 0.7 and 5.4 ± 0.7 mm at month 6 (ANOVA; P = 0.021 and  = 0.040, respectively). However, the difference in dilated PD was not significant (day 0 7.8 ± 0.6 mm, day 28 7.7 ± 0.7 mm, and month 6 7.6 ± 0.6 mm, P = 0.379). In the alfuzosin group, PD did not differ significantly from the baseline except for the scotopic measurements, which decreased from 5.6 ± 0.6 mm at day 0 to 5.5 ± 0.6 mm at day 28 and 5.2 ± 0.8 mm at month 6 (P = 0.004). Compared to baseline values, small but statistically significant decreases were detected in mesopic and scotopic illumination in patients treated with tamsulosin and in scotopic PD in patients treated with alfuzosin. The clinical significance of these differences needs further evaluation.     

The decree of June 15th, 1888, the first text that legislates the pharmacy practice in Tunisia and the progress of the pharmaceutical legislation before and after the independence

In 1881, the French protectorate is established in Tunisia whose independence will not be officially declared before March 20th, 1956. This article presents the content of the decree of June 15th, 1888, the first text that legislates pharmacy practice in Tunisia. The publication of this decree, a real fundamental text, did not put an end to the illegal practice of pharmacy in the Regency, which could be explained by the few shortcomings of the text, the legislator's inability to implement the law, the ignorance and the inadvertency of the diplomats, and also the "regime of the surrenders" (le régime des capitulations) which, by preventing the pharmaceutical inspection, gave free rein to all the offenders. This situation led in the course of time to the promulgation of a number of laws which progressively allowed a better organization of the pharmaceutical profession in the Regency. The progress made by the pharmaceutical legislation throughout the French protectorate continued after the independence of Tunisia as is attested by the law number 73-55 of August 3rd, 1973 which is still in use at present.     

Venous thromboembolism in acute spinal cord injury patients

Background:

The western literature on deep vein thrombosis (DVT) and pulmonary embolism (PE) following spinal cord injury (SCI) report an alarmingly high incidence, necessitating thromboprophylaxis. The literature on incidence from the Asian subcontinent is scanty and from India is almost nonexistent.

Materials and Methods:

Seventy hospitalized acute SCI patients presenting within five days of the injury were included in the present analysis. Forty-two cases were subjected to color Doppler studies and 28 cases had to be subjected to venography due to lack of facility at some point of time. The clinical course of the patients was closely observed during the period of hospitalization. All except 14 were managed nonoperatively. Thromboprophylaxis was not given to any patient at any stage; however, treatment was instituted in those showing the features of DVT on investigations.

Results:

Twelve patients died during the period of hospitalization. Deep vein thrombosis could be detected in seven patients only, three in the proximal and four in the distal segment of the lower limb and of these three died. Based on the clinical course and positive investigation report in favor of DVT, we presumed that the cause of death in these three patients was pulmonary embolism. In the other nine, in the absence of an autopsy report, the cause of deaths was considered as pulmonary infection, asphyxia, diaphragmatic paralysis, hematemesis, cervicomedullary paralysis etc. Clinical features to diagnose DVT were of little help.

Conclusions:

There is a much lower incidence (10%) of DVT and PE following spinal cord injury (SCI) in India than what is reported from the western countries. Higher age group and quadriplegia were the only factors which could be correlated. Deep vein thrombosis extending proximal to the knee was significant. In the absence of autopsy and other screening tests like D-dimer test or 125I fibrogen uptake study, the true incidence of venous thromboembolism remains uncertain. Noninvasive screening of all patients for the detection of deep vein thrombosis in SCI patients is strongly recommended.     

Intrapericardial teratoma presenting as recurrent pericardial tamponade: Report of a case

Intrapericardial teratomas are rare after infancy. An accurate diagnosis can only be made with a high index of suspicion. Most of the time, a mediastinal teratoma ruptures/perforates the pericardial cavity, thus causing either pericardial effusion or life-threatening tamponade. These factors emphasize the importance of an early surgical excision even for extrapericardial locations. This report presents the case of a 16-year-old girl with intrapericardial teratoma who presented with cardiac tamponade which is a rare complication of this rare tumor with only eight cases reported so far beyond infancy. This patient presented with recurrent tamponade, and underwent multiple procedures of pericardiocentesis and developed pyopericardium and polyserositis. This intrapericardial teratoma was not detected by imaging modalities.