Retroperitoneoscopic pre-transplant native kidney nephrectomy

AIMS: Laparoscopic nephrectomy has become a standardized procedure for removal of benign non-functioning kidneys. We present our experience of retroperitoneoscopic pre-transplant native kidneys nephrectomy. METHODS: Comparison of 40 patients who underwent retroperitoneoscopy with 40 open simple pre-transplant nephrectomy patients was done. RESULTS: Forty retroperitoneoscopic nephrectomies were done between June 2003 and April 2005. The mean operative time was similar in the two groups; however, the mean blood loss, postoperative analgesic requirement, complication rate, hospital stay and convalescence period were significantly less in the retroperitoneoscopic group. CONCLUSION: Retroperitoneoscopic nephrectomy should be offered as the primary treatment modality to patients requiring pre-transplant native kidney nephrectomy, except in patients where it is contraindicated.     

Effectiveness of Oximes 2-PAM and HI-6 in Recovery of Muscle Function Depressed by Organophosphate Agents in the Rat Hemidiaphragm: An in Vitro Study

Effectiveness of Oximes 2-PAM and HI-6 in Recovery of MuscleFunction Depressed by Organophosphate Agents in the Rat Hemidiaphragm:An in vitro Study. REDDY, V. K., DESHPANDE, S. S., CINTRA, W.M., SCOBLE, G. T., AND ALBUQUERQUE, E. X. (1991). Fundam. Appl.Toxicol. 17, 746–760. Phrenic nerve diaphragm musclesof young adult rats were used to study the ability of the oximes2-PAM and HI-6 to recover muscle function depressed by organophosphate(OP) agents. The single twitch of diaphragm muscles which wereexposed to soman (0.2 mm) recovered after washing with salinefor 3 hr, but the muscles pretreated with sarin (0.4 µM),VX (0.2 µM), or tabun (0.4 µM) showed only partialrecovery. In addition, after 3 hr washing, the muscles pretreatedwith soman as well as with tabun did not recover the tetanussustaining ability (TSA), yet complete recovery was observedwith muscles pretreated with sarin and VX. These results indicatethat the OPs have different effects on muscle contractile propertiesand that VX- and sarin-pretreated muscles recover equally wellafter wash with physiological solution. The recovery of twitchtension of diaphragm muscles by 2-PAM and HI-6 was similar tothat achieved by washing with saline for 3 hr for sarin- andsoman-exposed muscles. The most remarkable differences wereseen in the recovery of TSA. Both 2-PAM and HI-6 recovered theTSA of muscles that were pretreated with sarin and VX. Although2-PAM recovered the TSA after tabun pretreatment, HI-6 had nodiscernible effect. On the other hand, HI-6 recovered the TSAof soman-pretreated muscles but 2-PAM did not. The effectivenessof muscle function recovery was not related to the oximes' abilityto reactivate AChE, thus indicating that the recovery of musclecontractility may be attributed to a direct effect of thesecompounds on the muscle.     

Inhibition of Tumor Growth and Metastases in Mice Bearing a Malignant Fibrosarcoma by T Cell-Mediated Immune Response to Oncofetal Antigens

ABSTRACT: The presence of fetal antigens on a wide variety of tumors has been well-documented it has been attributed, for the most part, to de-repression of genes normally operative in the early stages of embryonic development. Controversy still exists, however, about the role of fetal antigens in antitumor immunity. It is not clear whether the tumor inhibition shown in some systems is due to an immune response. In the present study, conducted in a weakly immunogenic Lewis T241 fibrosarcoma, syngeneic for C57B1/ 6J mice, immunization of normal mice with syneneic fetal cells resulted in striking inhibition of growth and metastases of tumors. On the other hand, immunization with syngeneic normal, adult spleen cells or with allogeneic A/J fetal cells did not inhibit tumor growth or metastases. Mice that had gone through single pregnancy also showed inhibition in tumor growth and metastases. Immunization of female mice with syngeneic tumor cells or fetal cells, prior to pregnancy, resulted in a high incidence of fetal death in these mice. Further studies showed that tumor inhibitory response evoked by fetal cell immunization was due to fetal antigens the male-specific HY antigen was not responsible for antitumor response. When tumor cells were mixed with spleen cells from fetal antigen-immunized mice and then injected into normal mice (Winn neutralization assay), significant inhibition of tumor growth and metastases was observed. In this assay, mixing tumor cells with syngeneic fetal cells, normal adult spleen cells, or spleen cells from C57 mice immunized with allogeneic fetal cells did not inhibit the tumor growth or metastases. These results show that inhibition in tumor growth and metastases, following fetal cell immunization, was due to a specific immune response to the oncofetal antigens involved. Analysis of effector cells showed them to be T cells of Lyt-1⁺ and Lyt-2^? phenotype.     

Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation

Summary. Background: Few studies have evaluated the long‐term economic consequences of deep vein thrombosis (DVT). None of them have incorporated prospectively collected clinical data to ensure accurate identification of incident cases of DVT and DVT‐related health outcomes of interest, such as post‐thrombotic syndrome (PTS). Objectives: To prospectively quantify medical and non‐medical resource use and costs related to DVT during 2 years following diagnosis, and to identify clinical determinants of costs. Methods: Three hundred and fifty‐five consecutive patients with acute DVT were recruited at seven Canadian hospital centers. Resource use and cost information were retrieved from three sources: weekly patient‐completed cost diaries, nurse‐completed case report forms, and the Quebec provincial administrative healthcare database (RAMQ). Results: The rate of DVT‐related hospitalization was 3.5 per 100 patient‐years (95% confidence interval [CI] 2.2–4.9). Patients reported a mean (standard deviation) of 15.0 (14.5) physician visits and 0.7 (1.2) other healthcare professional visits. The average cost of DVT was $5180 (95% CI $4344–6017) in Canadian dollars, with 51.6% of costs being attributable to non‐medical resource use. Multivariate analysis identified four independent predictors of costs: concomitant pulmonary embolism (relative increase in cost [RIC] 3.16; 95% CI 2.18–4.58), unprovoked DVT (RIC 1.65; 95% CI 1.28–2.13), development of PTS during follow‐up (RIC 1.35; 95% CI 1.05–1.74), and management of DVT in the inpatient setting (RIC 1.79; 95% CI 1.33–2.40). Conclusions: The economic burden of DVT is substantial. The use of measures to prevent the occurrence of PTS and favoring outpatient care of DVT has the potential to diminish costs.     

EGF IMPROVES RECOVERY FOLLOWING RELIEF OF UNILATERAL URETERAL OBSTRUCTION IN THE NEONATAL RAT

PURPOSE: Renal epidermal growth factor (EGF) is suppressed by unilateral ureteral obstruction (UUO), and we reported previously that exogenous EGF attenuates renal injury due to UUO in the neonatal rat. In this study, we wished to determine whether administration of epidermal growth factor (EGF) improves long-term renal cellular recovery after relief of obstruction. MATERIALS AND METHODS: One ureter of 1 day-old rats was occluded or sham-operated, and rats received daily injections of EGF, 0.1 mg./kg., or saline for the following 7 days. Five days following UUO, the obstruction was removed. Kidneys were removed 28 days following release of UUO or sham operation, and processed for histomorphometry and immunohistochemistry. RESULTS: Kidney weight and the number of glomeruli were reduced in the postobstructed kidney regardless of administration of EGF. However, EGF reduced tubular vimentin by 36% and clusterin expression by 70% (markers of tubular injury), and decreased tubular atrophy by 50% in the postobstructed kidney compared with saline-treated rats. EGF also reduced interstitial alpha-smooth muscle actin and interstitial collagen deposition by 50% in the postobstructed kidney. CONCLUSIONS: Short-term administration of EGF markedly attenuates both tubular and interstitial injury one month following the release of UUO in the neonatal rat. This suggests therapeutic potential for targeted delivery of growth factors to optimize recovery after release of urinary tract obstruction.     

Effectiveness of Physostigmine as a Pretreatment Drug for Protection of Rats from Organophosphate Poisoning

Effectiveness of Physostigmine as a Pretreatment Drug for Protectionof Rats from Organophosphate Poisoning. DESHPANDE, S. S., VIANA,G. B., KAUFFMAN, F. C., RICKETT, D. L., AND ALBUQUERQUE, E.X. (1986). Fundam. Appl. Toxicol. 6, 566-577. The effectivenessof physo stigmine and atropine pretreatment against the lethaleffects of sarin was studied in rats given lethal subcutaneousinjections (130 µg/kg) of the organophospate. Pretreatmentof these animals with physostigmine 30 min prior to injectionof sarin reduced mortality to 28% and when the drug coadministeredwith atropine only 4% of the animals died. The latter treatmentalso reduced significantly the extent and duration of symptomsdue to sarin; however, atropine, pyridostigmine, and neostigmineinjected alone did not protect animals against the lethal effectsof sarin. Physostigmine caused only slight inhibition of cholinesterasein blood and skeletal muscle. Cholinesterase activity in bloodand muscle of rats pretreated with physostigmine before sarinadministration was significantly higher than in tissues fromrats injected with sarin alone. In rats receiving sarin followingpretreatment with physostigmine, twitch potentiation of extensormuscles and maintenance of tension during tetanic stimulationof the nerve recovered to near control levels. Muscle functionrecovered despite significant inhibition of cholinesterase.Effective protection against lethality by physostigmine couldbe related to protection of cerebral cholinesterase since inhibitionof this enzyme by satin was lowered significantly after pretreatmentwith physostigmine. Alternatively, physostigmine may also interactwith the nicotinic acetylcholine receptor ion-channel complexdirectly.     

A Wide Complex Tachycardia with Changing Atrial Activation Sequence

Change of the retrograde atrial activation sequence during radiofrequency (RF) ablation of left‐side accessory pathway can be due to another accessory pathway, another mechanism for the tachycardia, or due to intraatrial conduction block, partial or complete, caused by RF delivery to a site proximal to the site of insertion of the accessory pathway. In this case report, a temporary complete intraatrial conduction block was created by RF delivery proximal to the site of accessory pathway insertion, causing a change in the retrograde atrial activation sequence during ongoing tachycardia that was terminated by ablation at the insertion site of accessory pathway. (PACE 2013; 36:e23–e26)