Effect of sildenafil on haemodynamic response to exercise and exercise capacity in Fontan patients

Giardini et al.¹ reported on the increase of peak oxygen uptakeat a cardiopulmonary exercise test in Fontan patients aftera single dose of sildenafil. This is an excellent study     

Fasting Plasma Glucose in the Screening for Type 2 Diabetes in Morbidly Obese Subjects

Background  

Higher mortality rates among morbidly obese (BMI of ≥40 or ≥35 kg/m² with weight-related comorbidities) subjects are mainly explained by comorbidities such as type 2 diabetes. As bariatric surgery ameliorates diabetes, obese diabetic subjects will receive great benefits from bariatric surgery. Screening for diabetes prior to surgical referral is therefore crucial.     

Chilaiditi's colon interposition in a patient with Rett syndrome

We report on a patient with Rett syndrome associated with Chilaiditis interposition of the colon. Episodes of severe hyperventilation with aerophagia, immobility and obstipation facilitated the occurrence of an interposition of the colon. Conservative therapeutic measures were not successful, surgical intervention was necessary to cure the symptoms.     

Bioavailability, biodistribution, and toxicity of BioZn-AAS(1): a new zinc source. comparative studies in rats

Food fortification with a proper zinc compound is an economic and effective strategy to prevent zinc deficiency. BioZn-AAS, a zinc gluconate stabilized with glycine, was compared with zinc sulfate (reference standard), zinc hydroxide, and zinc gluconate, all of them labeled with (65)Zn. This preclinical study was performed on Sprague-Dawley rats of both sexes, and the administered dose was 85 microg/kg of zinc. Bioavailability studies showed that absorption of BioZn-AAS was not statistically different than absorption from other sources in female rats (25.65% +/- 2.20% for BioZn-AAS, 28.24% +/- 4. 60% for ZnSO(4), 24.91% +/- 4.02% for Zn[OH](2), and 25.51% +/- 2. 70% for Zn-gluconate). In the case of the male rats, absorption of BioZn-AAS (27.97% +/- 4.20%) was higher (P<0.05) than that from the other compounds (23.15% +/- 2.90% for ZnSO(4), 22.62% +/- 3.90% for Zn[OH](2), and 22.30% +/- 3.90% for Zn-gluconate). Biodistribution studies demonstrated that the zinc from BioZn-AAS followed the same metabolic pathway as zinc from the other sources. Toxicity studies were performed with 50 female and 50 male rats. The value of oral lethal dose 50 (LD(50)) was 2000 mg/kg for female rats and 1900 mg/kg for male rats. Therefore, we conclude that BioZn-AAS has adequate properties to be considered a proper zinc compound for food fortification or dietary supplementation.     

Clinical stage I and II Hodgkin's disease: Long-term results of therapy without laparotomy: Experience at one institution

Background: We concluded a program in which we administeredradiotherapy only to clinical stages I and II Hodgkin's diseasepatients at standard risk, with the addition of 4 cycles ofcombination chemotherapy before radiotherapy for high-risk patients. Patients and methods: From 1980 to 1991, 313 patients with clinicalstages I or II Hodgkin's disease underwent treatment in ourhospital. Fifty percent of the patients in groups previouslyidentified as being at high risk for relapse received 4 cyclesof combination chemotherapy before radiotherapy. The remaininghalf of the patients received radiotherapy only. Results: Low- and high-risk patients aged 15–59 yearshad, respectively, complete remission (CR) rates of 97% and94%, 5-year survivals of 95% and 91%, and 5-year freedom fromrelapse (FFR) rates of 78% and 89%. Older low- and high-riskgroups had CR rates of 97% and 93%, 5-year survivals of 60%and 56% and 5-year FFR of 77% and 93%, respectively. Conclusion: Here we present our favorable results after treatingstandard-risk patients with clinical stages I and II Hodgkin'sdisease with radiotherapy only. With the addition of chemotherapy,the rate of relapse in the high-risk patients was reduced belowthat of the standard-risk patients. Overall survival was thesame for the high- and standard-risk patients. adjuvant chemotherapy, Hodgkin's disease, radiotherapy, stages I and II     

Retrospective evaluation of carcinoid tumors of the appendix in children

Carcinoids of the appendix are rare in children and are usually diagnosed incidentally on histologic investigation following appendectomy for appendicitis. To investigate the significance of the diagnosis of appendiceal carcinoid in children, we conducted a retrospective study of the treatment and follow-up of 36 children with histologically confirmed carcinoid tumors of the appendix. Between 1970 and 2000 a total of 36 patients (25 girls, 11 boys) were diagnosed with appendiceal carcinoid. The median age of the patients at diagnosis was 12.3 years (range 6-16 years). The indication for appendectomy was acute lower right quadrant pain in 27 cases and chronic right lower quadrant pain in 9 patients. In 27 specimens the tumor was localized at the apex, in 7 at the midportion, and in 2 at the base of the appendix. The median tumor diameter was 6 mm (range 3-17 mm). Concomitant severe appendicitis was diagnosed in 14 patients 2 with a perforated appendicitis. In only one tumor were mucin-producing cells detectable. After a median follow-up of 10 years (range 2 months to 30 years) all patients were tumor-free. None of the patients had a synchronous or metachronous noncarcinoid malignant tumor. Appendiceal carcinoids are usually asymptomatic, and the indication for surgical intervention is acute or chronic abdominal pains in the right lower quadrant. For most patients the prognosis is excellent after appendectomy. As in adults, appendectomy is the appropriate treatment.     

General medicine and general practitioner. The viewpoint of the teachers at the Department of Medicine of Tunis

The general medicine remains a same survey subject in countries where the debate began since several years. We have led an investigation by questionnaire close to 50 chosen hospitalo-academic physicians by pull to the fate on the list of teachers of the faculty of medicine of Tunis. The majority of our investigated (90%) consider that the physician general practitioner is the physician of the individual in its totality, the counselor and the family's confidant. The formation that receives the future general practitioner currently doesn't prepare it to assure his role. To form the future physician better general practitioner, we think that it's necessary to define the general practitioner role, to adapt the formation to the role of the general practitioner and the specificity of the general medicine.     

Costs and cost-effectiveness of a clinical intervention to increase mammography utilization in an inner city public health hospital

BACKGROUND: Studies have demonstrated the cost-effectiveness of screening women for breast cancer; however, the cost-effectiveness of strategies to motivate women to receive breast cancer screening has been less well studied. METHODS: A total of 196 women, aged 50 to 74, who were enrolled in a public health hospital clinic, were noncompliant with mammography screening, and had at least one routine clinic appointment during the study period (15 months) were entered into a randomized, controlled trial of a motivational intervention to increase mammography rates. Costs were captured via a modified Delphi technique, accounting records, sampling of staff time logs, and an estimation of miscellaneous and overhead costs. Summary costs were calculated using Excel spread sheets. RESULTS: Overall, 49% of women who received the intervention had a mammogram within 8 weeks of an index visit compared with 22% of control women. Calculation of the cost-effectiveness of the project showed an additional cost of $151 (1996 U.S.$) for each woman receiving the intervention and $559 for each additional woman motivated to receive a mammogram. CONCLUSIONS: Cost tracking and cost-effectiveness analysis can be done when intervening in a clinical setting, thereby allowing clinics to make informed decisions about implementing programs to increase motivation of their patients to receive screening.