Effect of dihydroergosine (DHESN) on the serotoninergic system and behaviour: Is DHESN a new antidepressive agent?

Acute (50.0 mg/kg) and repeated (0.1–10.0 mg/kg) administration of dihydroergosine (DHESN) to rats over 5 days lowered the concentration of 5-HIAA in the brain. DHESN given acutely increased the brain 5-HT in p-CPA-treated animals and diminished the probenecid-induced increase in brain 5-HIAA. In pargyline-treated rats DHESN enhanced the 5-HT/5-HIAA ratio. DHESN administered to rats repeatedly over 5 days decreased the level of 5-HT in blood platelets, and in vitro at concentrations of 10^-4 M and 10^-3 M inhibited the uptake of [¹⁴C]-5-HT in platelets. DHESN (10.0–100.0 mg/kg) potentiated the 5-HT syndrome produced in rats by pargyline and 5-HTP. This potentiation was blocked with cyproheptadine but not with haloperidol. DHESN (1.0 and 10.0 mg/kg) lowered the locomotor activity of rats and 10.0 mg/kg DHESN also reduced the duration of immobility in rats forced to swim in a restricted space. The results indicate that DHESN, like antidepressants, decreases the turnover of serotonin in the brain and potentiates the 5-HT-mediated behaviour. This might suggest that the drug should be further investigated for its potential antidepressive properties.     

Incarceration of the appendix into silicone drain holes without signs of appendicytis

A surgical drainage simple surgical procedure that enables elimination of pathological effluent from operative wounds or other anatomical spaces, as well as removal of possible pathological exudates (blood, pus, enteric content, pancreatic juice, etc.). Nowadays, silicone drains are used for draining of the peritoneal cavity. In this study we presented a case of 42-year old female patient who underwent surgery after traumatic injury of intraabdominal organs and fracture of pelvic ring bone structure. Postoperative drain placed into the rectovesical space could not be removed on day 17 post surgery. Additional diagnostics could not identify the actual reason of failing to remove the drain, thus relaparotomy was required. Intraoperative diagnosis revealed incarceration of the antimesenteric part of the appendix into two circumjacent side perforations in the drain, without signs of acute inflammation. This paper presents an unusual and rare case of peritoneal drainage complication. The drainage of peritoneal cavity should be performed only in appropriate clinical situations, i.e. when the procedure is surgically indicated.     

Surface‐distributed low‐frequency asynchronous stimulation delays fatigue of stimulated muscles

Introduction: One important reason why functional electrical stimulation (FES) has not gained widespread clinical use is the limitation imposed by rapid muscle fatigue due to non‐physiological activation of the stimulated muscles. We aimed to show that asynchronous low‐pulse‐rate (LPR) electrical stimulation applied by multipad surface electrodes greatly postpones the occurrence of muscle fatigue compared with conventional stimulation (high pulse rate, HPR). Methods: We compared the produced force vs. time of the forearm muscles responsible for finger flexion in 2 stimulation protocols, LPR (f_L = 10 Hz ) and HPR (f_H = 40 Hz ). Results: Surface‐distributed low‐frequency asynchronous stimulation (sDLFAS) doubles the time interval before the onset of fatigue (104 ± 80%) compared with conventional synchronous stimulation. Conclusions: Combining the performance of multipad electrodes (increased selectivity and facilitated positioning) with sDLFAS (decreased fatigue) can improve many FES applications in both the lower and upper extremities. Muscle Nerve 48 : 930–937, 2013     

Decision-Making in Clinical Practice: Oral Anticoagulant Therapy in Patients with Non-valvular Atrial Fibrillation and a Single Additional Stroke Risk Factor

Approximately 1 in 3–4 patients presenting with an ischemic stroke will also have atrial fibrillation (AF), and AF-related strokes can be effectively prevented using oral anticoagulant therapy (OAC), either with well-controlled vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). In addition, OAC use (both VKAs and NOACs) is associated with a 26% reduction in all-cause mortality (VKAs) or an additional 10% mortality reduction with NOACs relative to VKAs. The decision to use OAC in individual AF patient is based on the estimated balance of the benefit from ischemic stroke reduction against the risk of major OAC-related bleeding [essentially intracranial hemorrhage (ICH)]. Better appreciation of the importance of VKAs’ anticoagulation quality [a target time in therapeutic range (TTR) of ≥70%] and the availability of NOACs (which offer better safety compared to VKAs) have decreased the estimated threshold for OAC treatment in AF patients towards lower stroke risk levels. Still, contemporary registry-based data show that OAC is often underused in AF patients at increased risk of stroke. The uncertainty whether to use OAC may be particularly pronounced in AF patients with a single additional stroke risk factor, who are often (mis)perceived as having a “borderline” or insufficient stroke risk to trigger the use of OAC. However, observational data from real-world AF cohorts show that the annual stroke rates in such patients are higher than in patients with no additional stroke risk factors, and OAC use has been associated with reduction in stroke, systemic embolism, or death in comparison to no therapy or aspirin, with no increase in the risk of bleeding relative to aspirin. In this review article, we summarize the basic principles of stroke risk stratification in AF patients and discuss contemporary real-world evidence on OAC use and outcomes of OAC treatment in AF patients with a single additional stroke risk factor in various real-world AF cohorts.     

Is identification of malignant lesions of the liver and of hemangiomas possible by Doppler ultrasonography and radionuclide angiography?

The aim of this study was to try to diagnose malignant liver lesions and hemangiomas by means of vascularisation and perfusion studies. The study was performed in 32 patients with hepatocellular carcinoma (HCC), in 74 with metastatic liver carcinoma (MLC) and in 40 with hemangiomas (H). Color Doppler ultrasonography (DUS) was done with an ATL Ultramark 9 apparatus with convex probe 2.5 MHz using pulse and DUS. Hepatic radionuclide angiography (HRA) was performed with bolus injection of 740 MBq (99m)Tc-pertechnetate, (1 min, 1 f/s), using ROTA scintillation camera and MicroDelta computer. Hepatic perfusion index (HPI) indicated the percentage of the portal blood inflow to the liver. Our results showed that in HCC and MLC there was a decrease of portal inflow while arterial inflow was increased resulting in pulse arterial wave velocity increase and in continuous venous waves velocity in the tumors. There was significant linear correlation between the increase of the arterial inflow and the arterial pulse wave found in the center and in the margin of the tumors. In hemangiomas, hepatic perfusion index related to arterial inflow was within normal range. In conclusion, our results suggest that HCC and MLC have specific characteristics in vascular and/or perfusion studies while hemangiomas show normal liver parenchyma findings.