Gastrojejunostomy in proximal resection of the stomach

Correlations between specific binding of labeled adrenoligands in the frontal cortex and hypothalamus and peripheral blood plasma testosterone were studied in BALB/cLac, CBA/Lac, and S57BL/6J male mice. A negative correlation was detected between blood testosterone and the extent of specific binding of 3H-clonidine, a 1.6 nM alpha 2-adrenoceptor agonist, in the hypothalamus. No correlations were revealed between specific binding of 3H-clonidine in the frontal cortex and binding of the rest radioligands (0.4 nM alpha 1-adrenoceptor antagonist 3H-prazosin and 1.6 nM beta-adrenoceptor antagonist 3H-dihydroalprenolol) in both brain segments and blood testosterone level. Further experiments in six mouse strains (A/He, BALB/cLac, CBA/Lac, C57BL/6J, DD, and YT) revealed a reliable negative genotypic correlation between hypothalamic maximal specific binding of 3H-clonidine and testosterone level. The detected feedback may be an important regulatory mechanism of the hypothalamo-hypophyseo-gonadal system in male mice.     

Long-term atrovent treatment of chronic obstructive bronchitis

AIM: The study of effects of long-term ipratropium bromide on the course of chronic obstructive bronchitis. MATERIALS AND METHODS: A 3-month atrovent monotherapy (3-6 doses daily) was performed in 19 patients with verified chronic obstructive bronchitis of moderate severity. Monitoring consisted of symptoms registration, pickflowmetry (two times a day), external respiration measurements. RESULTS: Atropen produced a positive trend in all the clinical symptoms, course of viral infections, exercise tolerance, bronchial permeability, respiratory capacity. The highest atrovent efficacy was recorded in patients with chronic bronchitis of smokers and chronic bronchitis in tracheobronchial diskinesia. No side effects were observed. CONCLUSION: Basic atrovent monotherapy modifies the course of chronic obstructive bronchitis and can be recommended for secondary prophylaxis of this disease.     

Microbiological examination of bandage soft contact lenses used in laser refractive surgery

BACKGROUND: Disposable soft contact lenses are known to be colonized by bacteria and play a key role in bacterial keratitis pathogenesis. Such lenses, commonly used after laser refractive surgery procedures in which postoperative corneal infiltrations are sometimes observed, are potentially a substrate for bacterial inoculation. This study evaluates the extent of such a contamination. METHODS: Sixty disposable lenses collected from 60 eyes of patients who underwent photorefractive keratectomy (PRK), photoastigmatic refractive keratectomy (PARK), or laser in situ keratomileusis (LASIK) for the treatment of myopia or hyperopia were collected under sterile conditions over 4 months and cultured in various media. Results were statistically analyzed and the correlation with clinical and epidemiological data was examined. RESULTS: Eleven (18.3%) of the examined lenses were contaminated with Staphylococcus epidermidis. No other bacteria or fungi were found. Contamination was significantly more common among female patients (P = .036). Correlation with the other clinical or operative parameters examined was statistically insignificant. CONCLUSIONS: Contamination was independent of the surgical procedure and females who were frequent users of eyelid cosmetics displayed higher contamination frequencies, suggesting that bacteria possibly originate from eyelid flora. The isolation of Staphylococcus epidermidis requires close postoperative surveillance, since it is a known cause of keratitis. Prophylactic postoperative treatment with tobramycin, gentamycin, or sulphonamides could be indicated.     

Radiofrequency catheter ablation of an incessant supraventricular tachycardia initiated by a Hisian parasystole

The coexistence of a parasystolic focus, tachycardia dependent right bundle branch aberrancy, and an AV accessory pathway is reported here. This condition was present in a 40-year-old man, which led to an incessant AV reciprocating tachycardia. Further electrophysiological study revealed that the parasystolic focus was located somewhere in the His bundle; endocardial mapping disclosed a right posterior accessory pathway. Radiofrequency current was delivered at the atrial level of the right posterolateral AV groove and successfully ablated the accessory pathway, leading to a dramatic improvement in cardiac function. In conclusion, the recognition of the electrophysiological mechanism of incessant supraventricular tachycardia was of crucial importance for the therapy decision. A definitive intervention using radiofrequency catheter ablation should be considered early and not postponed in patients with tachycardia-induced cardiomyopathy.     

Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis)

Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores; 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with the severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there was an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural 'new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a 'steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.     

Do experienced diagnosticians agree about the diagnosis of dementia from survey data? The effects of informants' reports and interviewers' vignettes

Dementia in community settings is often diagnosed by computerized algorithms. This study examines the extent to which independent diagnosticians agreed among themselves in diagnosing dementia, severity and type when presented with data obtained during a population-based incidence study of cognitive decline and dementia. Secondly, it examines how judgements, based initially on respondents' self-reports and cognitive performance, were affected first by informants' reports and then by short case-vignettes written by trained lay interviewers. Thirdly, it compares diagnosticians' diagnosis of dementia with the algorithmic diagnosis (AGECAT). The items presented were selected from two screening interviews at wave 1 and wave 2 separated by an interval of 2 years and from wave 2 assessment and informant interviews, and included medical, psychiatric and ADL items and interviewers' own observations. The sample (N = 42) was derived from the first year of the wave 2 assessments, potential dementia cases entering consecutively while presumed normals were selected randomly. Informants were available in 30. Agreement on diagnosis and type of dementia improved with increasing information, particularly from informants, but remained poor regarding severity. The number of cases of dementia, defined operationally, increased from 10 to 12 and uncertain cases fell from eight to six, but no respondent initially diagnosed as a dementia case was rediagnosed as a non-case, or vice versa. Dementia type changed from agreement about Alzheimer's disease to agreement about vascular dementia in one case. Operational and algorithmic diagnoses showed good agreement. Causes of disagreement, the role of vignettes and the relevance of the results for population surveys are discussed.     

Aspirative lipectomy in patients with alimentary-constitutional obesity

The results of aspirative lipectomy in patients with 2nd and 3rd stage of alimentary-constitutional obesity are analysed. The effectiveness of lipectomy with surgical creation of a small ventricle and without previous surgery, has been demonstrated. The criteria of patients selection, based on their somatic and psychic features, are formulated. Aspirative lipectomy has certain advantages over other types of plastic surgery as it has the minimal rate of postoperative complications.