The diagnosis and management of gall bladder in private patients in Harare

Gall bladder disease is getting more and more common in Africans. Some present with typical right upper quadrant pain but some are found on routine examination of the abdomen. The diagnosis is now very easy with ultrasound scan of the abdomen. The treatment used to be laparotomy and cholecystectomy but now is with laparoscopic surgery which leaves very little scarring. The results of the Harare study show chronic cholecystitis with cholesterol stones and very few bilirubinate stones.     

Nonopioid analgesics shorten the duration of postoperative ileus

Morphine inhibits propagating and stimulates nonpropagating colon contractions in monkeys and humans. The use of morphine or other opioids that inhibit propulsive contractions prolongs postoperative ileus. In contrast, ketorolac tromethamine, a nonsteroidal analgesic, has no effect on colon contractions in monkeys. In 14 patients having elective abdominal operations, bipolar electrodes were implanted on the right (n = 13) and left (n = 10) colon. Group A (n = 8) received ketorolac, 30 mg IM q6h, for pain relief. Group B (n = 6) needed supplemental morphine, 2-10 mg IV or IM, plus ketorolac to control their pain. Myoelectric activity was recorded from each subject on postop Days 1-5 and analyzed by computer for electrical control activity (ECA), short and long electrical response activity (ERA), and propagation of long ERA. There was a difference between the two groups in return of propagated long ERA bursts that correlated with clinical recovery from postoperative ileus. Postoperative analgesia with ketorolac resulted in faster resolution of ileus compared to morphine plus ketorolac because opioid-induced motor abnormalities in the colon were avoided.     

Model reduction of digital systems using discrete Walsh series

This study discusses the application of discrete Walsh series expansion to reduce the order of a linear time-invariant digital system described byz-transfer function. The approach is based on matching the discrete Walsh spectra to determine both the coefficients of the denominator and numerator of the reduced model. The proposed method is simple for computation, can preserve the dynamic characteristic of the original model satisfactorily, and guarantees to have the same zero initial response as the original system.     

Can an immunologically, nonreactive potential allograft recipient undergo transplantation without a donor-specific crossmatch?

Performance of the pretransplant crossmatch requires 4 or more hours . Delays in the crossmatch might alter operating room availability and thereby increase donor organ cold ischemia time that might then result in increased risk of delayed graft function. To avoid these problems, recipients could be identified who would be expected to display negative donor crossmatches and who could be transplanted with a concurrent or retrospective rather than a pretransplant crossmatch. We, therefore, evaluated the percent reactive antibodies and donor IgG-antihuman globulin (AHG) crossmatch results of 1165 sera from 220 potential allograft recipients. Twenty-five (11%) of 220 recipients consistently displayed a 0% PRA and, with only one exception, their sera (n= 156) tested IgG-AHG crossmatch-negative against potential cadaveric donors (a 0.6% IgG-AHG positive crossmatch risk). These data suggest that the timing of the pretransplant serum crossmatch could be altered for a highly selected group of immunologically nonreactive recipients.     

Synthesis characterization of magnetic properties in La0.7−x Lnx Pb0.3 MnO3 (, Nd, Gd, Dy, Sm and Y) perovskite compounds

The influence of La substitution by rare-earth elements on the magnetization behaviors of perovskite oxides, La_0.7−x Ln_x Pb_0.3 MnO₃ (Ln=Pr, Nd, Gd, Dy, Sm and Y), is investigated. The replacement of La ion by Pr, Nd, Gd, Dy, Sm or Y results in a considerable decrease in the ferromagnetic ordering temperature T_C and clearly irreversible behavior in the FC–ZFC curves showing a short-range spin order phase. The fact is in agreement with the smaller ionic radii of Pr, Nd, Gd, Dy, Sm and Y ions in contrast to La ion and the corresponding larger distortion of perovskite structures. The saturation magnetization M_S increases as Pr or Nd content increases while M_S decreases as Sm or Y content increases. Moreover, the saturation magnetization M_S increases and then decreases as Gd or Dy content increases. These results can be explained in terms of the competition between the increase of ferromagnetically interacting spins due to the introduction of magnetic ions with f-shell electrons and suppression of ferromagnetism due to structure tuning induced by the small ionic radius of the interpolated cation into the La-site.     

A phase I study of adenovirus-mediated wild-type p53 gene transfer in patients with advanced non-small cell lung cancer

Mutations of the tumor suppressor gene p53 are the most common genetic alterations observed in human cancer. Loss of wild-type p53 function impairs cell cycle arrest as well as repair mechanisms involved in response to DNA damage. Further, apoptotic pathways as induced by radio- or chemotherapy are also abrogated. Gene transfer of wild-type p53 was shown to reverse these deficiencies and to induce apoptosis in vitro and in preclinical in vivo tumor models. A phase I dose escalation study of a single intratumoral injection of a replication-defective adenoviral expression vector encoding wild-type p53 was carried out in patients with incurable non-small cell lung cancer. All patients enrolled had p53 protein overexpression as a marker of mutant p53 status in pretreatment tumor biopsies. Treatment was performed either by bronchoscopic intratumoral injection or by CT-guided percutaneous intratumoral injection of the vector solution. Fifteen patients were enrolled in two centers, and were treated at four different dose levels ranging from 10(7) to 10(10) PFU (7.5 x 10(9) to 7.5 x 10(12) particles). No clinically significant toxicity was observed. Successful transfer of wild-type p53 was achieved only with higher vector doses. Vector-specific wild-type p53 RNA sequences could be demonstrated in posttreatment biopsies of six patients. Transient local disease control by a single intratumoral injection of the vector solution was observed in four of those six successfully transduced patients. There was no evidence of clinical responses at untreated tumor sites. Wild-type p53 gene therapy by intratumoral injection of a replication-defective adenoviral expression vector is safe, feasible, and biologically effective in patients with advanced non-small cell lung cancer.