Place of laparoscopic surgery in Crohn''s disease

PURPOSE: We describe our therapeutic strategy and correlate the anatomic results and clinical outcomes in patients who received immediate fibrinolytic therapy for thromboembolic complications occurring during endovascular treatment of an intracerebral aneurysm. METHODS: The medical records and angiographic examinations of 19 patients were reviewed. All endovascular procedures were performed with the patients under general anesthesia and fully heparinized. Thirteen patients received an intravenous bolus injection of aspirin. Thromboemboli occurred during catheterization or insertion of embolic material (Guglielmi detachable coils or mechanical detachable spirals) or in the first hours after the intervention. Clot distribution was within the MCA territory in 14 patients, the ACA in three patients, and the basilar trunk in two patients. A continuous intraarterial injection of urokinase was administered immediately, either superselectively distal to the thrombus or selectively within or closely proximal to the thrombus. In nine cases, chemical lysis was combined with mechanical clot fragmentation. Initial anatomic recanalization as well as clinical outcome at 3 months were evaluated. RESULTS: Ten patients showed complete recanalization and nine patients showed partial recanalization. Fourteen patients had a good clinical recovery. One patient was moderately disabled and two were severely disabled according to their scores on the Glasgow outcome scale. Two patients died, one as a consequence of the preexisting subarachnoid hemorrhage and the other because of a large intracerebral hematoma that developed after fibrinolysis. Of the 14 patients with a good clinical outcome, nine exhibited complete recanalization and five partial recanalization. CONCLUSION: Pharmacological thrombolysis seems to be a safe and efficient therapy that facilitates the natural fibrinolytic process, increasing the rate of recanalization in thromboembolic events. Clot fragmentation and superselective drug infusion appear to improve the rate of recanalization. Complete recanalization increases the chance of a better clinical outcome; however, clinical outcome does not always correspond to recanalization and vice versa.     

Conjunctival nevi in Denmark 1960-1980. A 21-year follow-up

The clinicopathological characteristics of 343 naevi of the conjunctiva were studied. A significant increase in the number of naevi excised per year was observed. This may have been caused by an increased exposure to actinic rays. An approximately even distribution was found between the three main locations: caruncle, limbal area and eye ball. Intrastromal naevi were excised at a higher median age than compound naevi, and the lowest median age at excision was for junction naevi, which is in accordance with the known histopathological nature of naevi. Recurrence occurred in nine patients (2.7%), and one had transformed into a malignant melanoma. Eight of the recurring naevi were located in the limbal area. Eight of the nine patients were women, suggesting hormonal factors as a possible cause. Recommendations for the handling of conjunctival naevi are given, based on the present findings and on previous reports.     

Prevalence and risk factors for diabetic retinopathy among Omani diabetics

To determine the minimal contrast dosage required for diagnostic contrast-enhanced three-dimensional (3D) magnetic resonance angiography (MRA) image quality of the pulmonary (PAs) or renal arteries (RAs). In 12 volunteers (10 females, 2 males; mean age 24 years) imaging was performed with 4 different dosages: 0.05, 0.1, 0.2 and 0.3 mmol/kg of body weight (BW) 0.5 M gadolinium (Gd) contrast agent. The PAs and RAs were evaluated separately each in groups of six volunteers. Qualitative and quantitative signal-to-noise ratio (SNR) image analysis was performed. For the PAs, the increases in signal-to-noise ratio were paralleled by increases in image quality ratings. For the PAs, with the use of 0.05 mmol/kg, only 50.3% of all segments were rated diagnostic, whereas with higher dosages the percentage rose to 89.2% for 0.1 mmol/kg, 98.2% for 0.2 mmol/kg. and 99.1% for 0.3 mmol/kg. For the RAs, 0.3 mmol/kg provided no significant increase in singal-to-noise ratio compared to 0.2 mmol/kg (p = 0.4). Only by a dosage of 0.2 and 0.3 mmol/kg, all evaluated segments were diagnostic evaluable. A dose of 0.2 mmol/kg is required for proper assessment of the RAs or PAs.     

Dynamics of the marital structure with respect to the nationality and birthplace of spouses in a modern urbanized Siberian population (as exemplified by Tomsk)

To analyze a population's marital structure with respect to the ethnicity and birthplace of the spouses and to estimate the indices of endogamy, migration, and marriage assortativeness, the records of marriages in Tomsk during two periods of time (1970-1972 and 1985-1990) were studied. The parameters of the population-genetic and demographic structure proved to change during the studied period: the endogamy index and the indices of marriage assortativeness increased, and the migration index decreased. These data suggest that the genetic structure of the Tomsk urbanized population stabilized with time and that the intrapopulation subdivision decreased (a tendency for panmixia).     

Iatrogenic posterior tibial nerve division during ankle arthroscopy

AIM: To evaluate the validity of cumulative rim/disc area (RA/DA) curve analysis as a clinical tool for the identification of glaucoma induced optic disc pathology. METHODS: 71 normal and 83 glaucomatous eyes were evaluated from a series of 154 subjects recruited for this study. For each eye, the cumulative distribution of RA/DA was calculated from 36 equally spaced rim sectors of each optic disc obtained by the automatic evaluation of simultaneous videographics (Image-net X Rev.3/51b). To increase the sensitivity of this analysis in early glaucoma and in normal eyes, these cumulative curves were subsequently divided into two equal segments and the slopes of their respective regression lines compared. RESULTS: The median RA/DA value obtained from the 36 sectors was significantly different in glaucomatous eyes compared with normals (p < 0.001). Nevertheless, the curves (5th-95th percentile of the cumulative curves distribution) of early glaucomatous eyes fell within the normal range. When the cumulative curve of these marginal cases was then divided into two equal segments, the comparison of the slopes of the regression lines showed a significant difference (p < 0.05) in 100% of early glaucomatous eyes. Furthermore, normal eyes were shown to be true negatives in 93% of the cases in which no significant difference between the two slopes was observed. CONCLUSION: Analysis of the RA/DA cumulative curve from 36 sectors of the optic disc was a valid method for the identification of glaucomatous disc pathology; however, a further calculation of the slopes of the two RA/DA regression lines was needed to identify early glaucomatous damage.     

Correlation of the risk factors and stomach cancer morbidity in men and women

A comparative analysis is given of the gastric cancer incidence in the Tjumen Province for a period of 1959--1973. There was noted a direct dependence between the rate and number of risk factors (the complexes of unfavourable factors) in males and females. A conclusion is made that a higher incidence rate (1.7 times more) of gastric cancer among males may be attributed to the complexes of infavourable factors to which they are subject to a greater extent, 1.7 times as often as females, (mainly to bad habits) but not to biological features of the organism. Elimination of these harmful effects on the body would lessen the risk of this affection.     

Prognostic factors of the probability of the occurrence of complications in the radiation therapy of malignant neoplasms

The authors present an analysis of the causes of radiation induced complications in 383 patients referred to the Chair of Clinical Radiology from different medical institutions of the country. It was found that under distant gamma therapy, to prevent the development of complications the value of TDF-factor should not exceed 105--110, for the associated radiotherapy--130--140, and that for close focal roentgenotherapy--130--150. In vast majority of patients (95.3%) the complications resulted from surpassing the normal tissue tolerance. To prevent radiation injuries it is suggested to take into consideration the TDF-factor values, while in planning radiotherapy to choose such schedules of irradiation, which preclude any surpassing of the tolerance of normal tissues and organs adjacent to the tumor.     

Aurothioglucose inhibits murine thioredoxin reductase activity in vivo

Gold (I)-containing compounds, including aurothioglucose (ATG), are potent in vitro inhibitors of several selenocysteine-containing enzymes. Gold compounds have also been shown to potentiate the virulence of several viruses in mice, including coxsackievirus, implicated as a possible infectious agent in Keshan disease. One possible mechanism by which gold compounds may be increasing the virulence of viral infections in mice is by acting as a selenium antagonist in vivo and inducing oxidative stress. To investigate the possible role of gold compounds in inducing oxidative stress in mice, we assessed the ability of ATG administered in vivo to inhibit the activity of the selenocysteine-containing enzymes thioredoxin reductase (TR) and glutathione peroxidase (GPX1). Doses as low as 0. 025 mg ATG/g body weight caused significant and prolonged inhibition of TR activity in all tissues examined. No such inhibition of GPX1 activity was seen, indicating differential in vivo sensitivity of the enzymes to inhibition by ATG. In liver and heart, some recovery of TR activity was observed after a 7-d period, but no recovery was observed in pancreas or kidney. Because TR is involved in several important cellular redox functions, its inhibition most likely will affect multiple cellular processes. These results indicate that in vivo administration of ATG results in significant and long-lasting inhibition of TR activity. Such inhibition of TR could lead to increased levels of oxidative stress in vivo, thereby increasing the virulence of several viruses including the coxsackievirus.     

Stereochemical influence on the stability of radio-metal complexes in vivo. Synthesis and evaluation of the four stereoisomers of 2-(p-nitrobenzyl)-trans-CyDTPA

Distinct differences in in vivo stability of the two diastereomeric C-Functionalized CyDTPA chelating agents, (CHX-A DTPA and CHX-B DTPA, both racemates), as recently reported prompted further investigation as to why differences in configuration produced striking effects on the in vivo stability of their yttrium complexes. To this end, the four individual component stereoisomers of CHX-A and CHX-B were synthesized and ability to bind yttrium was investigated both in vitro and in vivo.