Comparative pharmacokinetics of paracetamol (acetaminophen) and its sulphate and glucuronide metabolites in desert camels and goats

Functional and aesthetic nasal surgery has been undergoing a process of fine-tuning. The surgical approaches lean toward greater conservation-particularly aesthetic- and functional selectivity. This has been made possible by improved diagnostic methods and pre-operative programming techniques such as computerized morphometry, computerized axial tomography, rhinosinus endoscopy, rhinomanometry, acoustic rhinometry and electromyography. Another important point in functional and aesthetic nasal surgery is that a) it can be divided into different techniques for each anatomo-functional sector considered and b) these can be used together in various combinations. Experience and the literature have underscored some issues which are most pertinent to the modern methodological viewpoint. The first large-scale controversy involves a comparison of open and closed techniques for access. The advantages and disadvantages of both techniques are described, although the disadvantages can be reduced to a minimum if the right indication is chosen. In the authors' opinion, the open technique should be reserved for general revision surgery, particularly in conjunction with difficult tips, labiopalatoschisis reconstruction, septal perforation and saddle nose. The second basic point involves how to deal with the perichondrium-periostium-mucosal flaps. The two main techniques for nasal skeletizing in rhinoseptoplasty include the extra-mucosal approach which is conservative and the trans-mucosal approach which is apparently more traumatic. Curiously, however, it is the latter technique which leads to fewer medium-long term complications. The nasal tip is the crux for the neophyte to rhinoseptoplasty. Through knowledge of the indications and the risks of the various techniques makes it possible to predict the result before-hand, although with certain margin of error. Indeed, this is one of the regions of the nose where errors reap the greatest damage. In this anatomical site, the use of conservative techniques is, therefore, strongly suggested. Finally, not only has research into the field of functional nasal surgery been unable to find concrete applications in humans (for obvious ethical reasons), it has likewise been unable to provide an answer to the question most rhinosurgeons pose: why do some patients still complain of difficulty breathing, even after successful surgery? It is our conviction that the problem is due to the fact that research into the endonasal receptors has not progressed.     

Combined cis-platinum and alpha interferon therapy of advanced hepatocellular carcinoma

To evaluate the clinical efficacy of alpha-interferon(IFN-alpha) plus cis-platinum in hepatocellular carcinoma(HCC). 56 inoperable patients with HCC were divided into IFN-alpha plus cis-platinum treated group (n = 30) and no antitumor therapy group (n = 26). The survival of IFN-alpha plus cis-platinum treated patients was significantly better than that of patients who received no antitumor therapy (p = 0.001). Median survival time was 33 weeks and 14.0 weeks, respectively. The cumulative estimated survival rates of our IFN-alpha plus cis-platinum treated group (93.5% at 3mo, 75.0% at 6mo) were for longer than that of the no antitumor therapy group (84.6% at 3mo, 57.7% at 6mo). Objective tumor regression, greater than 50% was observed in 13.3% (4 of 30) of patients receiving IFN-alpha plus cis-platinum. By the univariate analysis, the absence of portal vein thrombus (p < 0.05), alkaline phosphatase lesser than 280 U/L (p = 0.001), total bilirubin less than 2.0 mg% (p < 0.05), serum triglyceride less than 155 mg/dl (p < 0.05) were shown to be the factors most significantly favoring a better survival. By the multivariate analysis, using Cox proportional hazards model, IFN-alpha plus cis-platinum treated group (p = 0.0001), alkaline phosphatase less than 280 mg/dl (p = 0.005), the absence of portal vein thrombus (p = 0.020) were independent favorable prognostic factors. We conclude that IFN-alpha plus cis-platinum is useful in patients with inoperable HCC and the above favorable prognostic factors may also be useful in the design and analysis of future clinical trials of systemic chemotherapy for HCC.     

An isolate of human immunodeficiency virus type 1 originally classified as subtype I represents a complex mosaic comprising three different group M subtypes (A, G, and I)

Full-length reference clones and sequences are currently available for eight human immunodeficiency virus type 1 (HIV-1) group M subtypes (A through H), but none have been reported for subtypes I and J, which have only been identified in a few individuals. Phylogenetic information for subtype I, in particular, is limited since only about 400 bp of env gene sequences have been determined for just two epidemiologically linked viruses infecting a couple who were heterosexual intravenous drug users from Cyprus. To characterize subtype I in greater detail, we employed long-range PCR to clone a full-length provirus (94CY032.3) from an isolate obtained from one of the individuals originally reported to be infected with this subtype. Phylogenetic analysis of C2-V3 env gene sequences confirmed that 94CY032.3 was closely related to sequences previously classified as subtype I. However, analysis of the remainder of its genome revealed various regions in which 94CY032.3 was significantly clustered with either subtype A or subtype G. Only sequences located in vpr and nef, as well as the middle portions of pol and env, formed independent lineages roughly equidistant from all other known subtypes. Since these latter regions most likely have a common origin, we classify them all as subtype I. These results thus indicate that the originally reported prototypic subtype I isolate 94CY032 represents a triple recombinant (A/G/I) with at least 11 points of recombination crossover. We also screened HIV-1 recombinants with regions of uncertain subtype assignment for the presence of subtype I sequences. This analysis revealed that two of the earliest mosaics from Africa, Z321B (A/G/?) and MAL (A/D/?), contain short segments of sequence which clustered closely with the subtype I domains of 94CY032.3. Since Z321 was isolated in 1976, subtype I as well as subtypes A and G must have existed in Central Africa prior to that date. The discovery of subtype I in HIV-1 hybrids from widely distant geographic locations also suggests a more widespread distribution of this virus subtype, or at least segments of it, than previously recognized.     

Anatomical, electrophysiological and pharmacological studies of ascending brainstem hippocampal synchronizing pathways

The present review has provided evidence that very potent ascending brainstem hippocampal synchronizing pathways originate in the rostral pons region (RPO and PPT), and ascend to and synapse with several midline caudal diencephalic nuclei (posterior hypothalamic and supramammillary) which send projections to the medial septal region (MS/vDBB). The medial septal region in turn is a critical nodal point, sending projections to limbic structures such as the hippocampal formation, cingulate cortex, and entorhinal cortex. The pontine and diencephalic nuclei appear to play a critical role in determining the translation of increasing levels of activation into moment to moment changes in the frequency of hippocampal theta field and theta-related cellular discharges, relayed to the MS/vDBB nuclei. The MS/vDBB nuclei appear to play a critical role in translating increasing levels of ascending synchronizing activation into moment to moment changes in the amplitude of hippocampal theta field activity and the accompanying rate and pattern of phasic theta-ON cells. The MS/vDBB carries out this role through a balance of activity in the septohippocampal cholinergic and GABA-ergic projections. Cholinergic projections provide the afferent excitatory drive for hippocampal theta-ON cells and the GABA-ergic projections act to reduce the overall level of inhibition by inhibiting hippocampal GABA-ergic interneurons (theta-OFF cells). Both activities must be present for the generation of hippocampal theta and theta-related cellular activities. The balance between the cholinergic and GABA-ergic projections may determine whether hippocampal synchrony (theta) or asynchrony (LIA, large amplitude irregular activity) occurs. These same ascending pathways influence the electrophysiological and pharmacological properties of the neocortex as well. The functional significance of the ascending brainstem synchronizing pathways is the generalized regulation of activities in these cortical structures as they relate to sensorimotor behavior.     

The blood coagulation aspects of acute infectious myocarditis]

With the increase in infectious disease epidemics and the need to protect health-care workers, the use of rubber gloves has increased twofold. Recent reports have noted an increase also in the prevalence of natural rubber latex allergy among some of these workers. A newly emerging problem, the allergy has potentially life-threatening consequences for those affected, a fact which has far-reaching ramifications for all those working in contact with latex, critical care nurses in particular. Indeed, the allergy has had a major impact on one such nurse, to the extent that she has had to relinquish her career and make significant changes to her lifestyle. Latex allergy was first recognised in 1927 but has become more prevalent in the last few years. There are two types of reactions, type I and type IV, with symptoms varying from a mild itch to anaphylaxis. Diagnosis is made via a blood or skin test, as well as a patient history. Treatment is to medicate for symptoms, while avoidance is the only way to prevent occurrences. The case study which follows reveals the impact that this allergy can have on a critical care nurse.