The use of silymarin in patients with toxic and viral liver diseases

Effective use of Silybum marianum medicines is still urgent in hepatology practice. Data about effectiveness and safety of silymarin in patients with acute and chronic toxic injuries including drug-induced ones and patients with acute and chronic viral hepatitis is reviewed in the article. An attempt of trials limitations and disadvantages systematization is made and methods of their solvation are discussed. A possibility of silymarin use as antiviral agent in patients with chronic hepatitis C is also reviewed and perspectives of this drug clinical use in future is discussed.     

Adhesive process in the abdominal cavity in patients with end colostomies and its influence on the reestablishment of the large intestine continuity

Under analyses there were reparative operations on 79 patients with end colostomies performed using medial access in 42 patients and parastomal access in 37 patients. The investigation of prevalence of the adhesive process in 61 patients has shown that marked adhesions were formed in the area of the medial scar in 41 (67.2%) patients, the stump of the suppressed gut--in 31 (50.9%) patients and colostomy--in 27 (44.3%) Reestablishment of intestine continuity from the parastomal access allowed avoidance of adhesions in the zone of the medial postoperative scar which shortened the time of operation and decreased the level of intra- and postoperative complications.     

Postmortem Pittsburgh Compound B (PiB) Binding Increases with Alzheimer's Disease Progression

The development of imaging reagents is of considerable interest in the Alzheimer's disease (AD) field. Some of these, such as Pittsburgh Compound B (PiB), were designed to bind to the amyloid-β peptide (Aβ), the major component of amyloid deposits in the AD brain. Although these agents were designed for imaging amyloid deposits in vivo, a major avenue of evaluation relies on postmortem cross validation with established indices of AD pathology. In this study, we evaluated changes in the postmortem binding of PiB and its relationship to other aspects of Aβ-related pathology in a series of AD cases and age-matched controls. We also examined cases of preclinical AD (PCAD) and amnestic mild cognitive impairment (MCI), both considered early points in the AD continuum. PiB binding was found to increase with the progression of the disease and paralleled increases in the less soluble forms of Aβ, including SDS-stable Aβ oligomers. Increased PiB binding and its relationship to Aβ was only significant in a brain region vulnerable to the development of AD pathology (the superior and middle temporal gyri) but not in an unaffected region (cerebellum). This implies that the amyloid deposited in disease-affected regions may possess fundamental, brain region specific characteristics that may not as yet be fully appreciated. These data support the idea that PiB is a useful diagnostic tool for AD, particularly in the early stage of the disease, and also show that PiB could be a useful agent for the discovery of novel disease-related properties of amyloid.     

EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer

Objectives

Our aim is to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC).

Methods

The working panel performed a literature review of the new data emerging from 2007 to 2010. The guidelines were updated, and the levels of evidence (LEs) and/or grades of recommendation (GR) were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews.

Results

Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). Although LHRH antagonists decrease testosterone without any testosterone surge, their clinical benefit remains to be determined. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation (IAD) results in equivalent oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir after radiation therapy (RT). Therapy for PSA relapse after RP includes salvage RT at PSA levels <0.5 ng/ml and salvage RP or cryosurgical ablation of the prostate in radiation failures. Endorectal magnetic resonance imaging and ¹¹C-choline positron emission tomography/computed tomography (CT) are of limited importance if the PSA is <2.5 ng/ml; bone scans and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include screening for the metabolic syndrome and an analysis of PSA and testosterone levels. Treatment of castration-resistant prostate cancer (CRPC) includes second-line hormonal therapy, novel agents, and chemotherapy with docetaxel at 75 mg/m² every 3 wk. Cabazitaxel as a second-line therapy for relapse after docetaxel might become a future option. Zoledronic acid and denusomab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications.

Conclusion

The knowledge in the field of advanced, metastatic, and CRPC is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice. A full version is available at the EAU office or online at www.uroweb.org.     

Method of treatment of combined injuries of the liver and spleen in children

Since 1980 operations for combined injuries of the liver and spleen have been made on 57 children aged from 5 through 16 years. Autografting of splenic tissue into the liver wound was performed in 17 (29.8%) patients using an original technique developed in experiments. The novelty of the suggested technique is that autografting of splenic tissue into the liver wound was followed by fixing the fragments with Pi-like stitches through the spleen transplant capsule. It ensures the impermeability of the liver wound, adequate hemostasis without applying artificial hemostatic materials and helps to avoid alloplastic materials for additional drainage of the subhepatic space, provides a direct physiological contact between the splenoid and liver tissue that is effective for prevention of hyposplenism following spleenectomy.     

Residual bound Ca2+ can account for the effects of Ca2+ buffers on synaptic facilitation

Facilitation is a transient stimulation-induced increase in synaptic response, a ubiquitous form of short-term synaptic plasticity that can regulate synaptic transmission on fast time scales. In their pioneering work, Katz and Miledi and Rahamimoff demonstrated the dependence of facilitation on presynaptic Ca(2+) influx and proposed that facilitation results from the accumulation of residual Ca(2+) bound to vesicle release triggers. However, this bound Ca(2+) hypothesis appears to contradict the evidence that facilitation is reduced by exogenous Ca(2+) buffers. This conclusion led to a widely held view that facilitation must depend solely on the accumulation of Ca(2+) in free form. Here we consider a more realistic implementation of the bound Ca(2+) mechanism, taking into account spatial diffusion of Ca(2+), and show that a model with slow Ca(2+) unbinding steps can retain sensitivity to free residual Ca(2+). We demonstrate that this model agrees with the facilitation accumulation time course and its biphasic decay exhibited by the crayfish inhibitor neuromuscular junction (NMJ) and relies on fewer assumptions than the most recent variants of the free residual Ca(2+) hypothesis. Further, we show that the bound Ca(2+) accumulation is consistent with Kamiya and Zucker's experimental results, which revealed that photolytic liberation of a fast Ca(2+) buffer decreases the synaptic response within milliseconds. We conclude that Ca(2+) binding processes with slow unbinding times (tens to hundreds of milliseconds) constitute a viable mechanism of synaptic facilitation at some synapses and discuss the experimental evidence for such a mechanism.     

Interdisciplinry approach to the treatment of diffuse germinogenic ovarian tumours

The first stage in the treatment of disseminated germinogenic ovarian tumours (HOT) is induction chemotherapy in accordance with the IGCCCG prognosis group. Dynamic observation is indicated in case of incomplete induction in patients with seminoma excepting those with PET-positive residual tumours bigger than 3 cm to whom second-line chemotherapy or retroperitoneal lymphadenectomy is indicated. Ablation of residual tumour of any localization is indicated to patients with disseminated non-seminoma HOT (NHOT), incomplete induction, and negative level of tumour markers. The necessity of adjuvant chemotherapy in case of a viable malignant HOT in the removed tissues remains debatable. Refractory and recurring HOT are usually treated with a combination of fosfamide and vinblastine. Residual tumours need to be removed after salvation chemotherapy. Surgical treatment is the preferred option for the management of late NHOT relapses.     

Evaluation of the SCHILLER BR-102 plus noninvasive ambulatory blood pressure monitor according to the International Protocol introduced by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension

OBJECTIVE: To evaluate the SCHILLER BR-102 plus (Schiller AG, Baar, Switzerland) noninvasive ambulatory blood pressure recorder according to the International Protocol for validation of blood pressure measuring devices in adults introduced by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. METHOD: One SCHILLER BR-102 plus blood pressure recorder was tested by a validation team, consisting of three persons: two observers (nurses) and a doctor, acting as supervisor and 'expert'. The European Society of Hypertension International Protocol comprises two phases. Fifteen participants were recruited for the first phase and, following a successful test, a further 18 persons (giving a total of 33) were recruited additionally. For phase 1, five of the 15 participants had systolic blood pressure and diastolic blood pressure in each of the ranges: low, medium and high. For phase 2, 11 of the 33 participants (including the first 15 participants) had systolic blood pressure and diastolic blood pressure in each of the ranges. The mercury standard for validation was preferred over the optional Sphygmocorder. Because the SCHILLER BR-102 plus has the oscillometric method as backup to the basic auscultatory measurement, both systems of measurement were subjected to individual validations. RESULTS: Results obtained show that the SCHILLER BR-102 plus noninvasive ambulatory blood pressure recorder meets all the requirements specified in the International Protocol for both oscillometric and auscultatory methods. CONCLUSION: On the basis of these results, the SCHILLER BR-102 plus can be recommended for ambulatory blood pressure measurement in clinical practice using both auscultatory and oscillometric modes.