Paraneoplastic anti-TIF1-gamma-positive dermatomyositis as expression of cervical squamous cell carcinoma recurrence.

Idiopathic inflammatory myopathies are neuromuscular disorders characterised by muscle weakness and histologically inflammation within the muscle. Dermatomyositis and polymyositis are highly associated with a wide range of cancers, especially in antitranscriptional intermediary factor-1 (TIF1)-gamma-positive myositis. We present a case of paraneoplastic dermatomyositis in a patient with a medical history of a FIGO stage 1B1 cervical squamous cell carcinoma. Anti-TIF1-gamma autoantibodies were detected by myositis lineblot analysis and a PET-CT scan revealed an abnormality positioned at the right ovary. She underwent laparoscopic exploration and pathological analysis of the PET-positive abnormality showed a lymphogenic metastasis of a squamous cell carcinoma, competitive with cervical carcinoma recurrence. She started chemoradiation as curative oncological treatment. The dermatomyositis was successfully treated with high-dose corticosteroids. Physicians should be aware of the association between myositis and the increased risk of malignancies.

Selective homogeneous hydrogenation of biogenic carboxylic acids with [Ru(TriPhos)H]+: a mechanistic study.

Selective hydrogenation of biogenic carboxylic acids is an important transformation for biorefinery concepts based on platform chemicals. We herein report a mechanistic study on the homogeneously ruthenium/phosphine catalyzed transformations of levulinic acid (LA) and itaconic acid (IA) to the corresponding lactones, diols, and cyclic ethers. A density functional theory (DFT) study was performed and corroborated with experimental data from catalytic processes and NMR investigations. For [Ru(TriPhos)H](+) as the catalytically active unit, a common mechanistic pathway for the reduction of the C═O functionality in aldehydes, ketones, lactones, and even free carboxylic acids could be identified. Hydride transfer from the Ru-H group to the carbonyl or carboxyl carbon is followed by protonation of the resulting Ru-O unit via σ-bond metathesis from a coordinated dihydrogen molecule. The energetic spans for the reduction of the different functional groups increase in the order aldehyde < ketone < lactone ≈ carboxylic acid. This reactivity pattern as well as the absolute values are in full agreement with experimentally observed activities and selectivities, forming a rational basis for further catalyst development.

Sexual functions of men with obstructive sleep apnoea syndrome and hypogonadism may improve upon testosterone administration: a pilot study.

This study examined 72 patients with obstructive sleep apnoea syndrome (OSAS), confirmed by polysomnography. Thirty-two patients were suffering from erectile dysfunction (ED) assessed by IIEF-5 questionnaires and confirmed by nocturnal penile tumescence examination. Their testosterone levels were measured. Eight patients had normal testosterone levels and were treated with a PDE-5 inhibitor (vardenafil) only; after 6 months of treatment, 6 of these patients (75%) showed significant improvement in erectile function. The remaining 24 patients with OSAS, ED and hypogonadism (total testosterone <12 nmol l(-1)), were divided into two groups based on the indication for continuous positive airway pressure (CPAP) therapy: five patients received CPAP therapy (group 1) and 19 patients did not (group 2). The patients of group 2 received only a PDE-5 inhibitor (vardenafil 20 mg) for ED; and eight patients (42%) showed an improvement after 3 months of treatment. The five patients receiving CPAP therapy were treated with a combination of parenteral testosterone undecanoate and a PDE-5 inhibitor (vardenafil) and all had normal erectile function after 3 months of therapy. The results suggest positive effects of addition of testosterone to treatment with PDE-5 inhibitors in hypogonadal men with OSAS, which should be confirmed in larger controlled studies.

[Erectile dysfunction and obstructive sleep apnea syndrome].

Of 72 patients with obstructive sleep apnea syndrome (OSAS) 32 had erectile dysfunction (ED). OSAS patients with erectile dysfunction had hypogonadism in 24 cases, in 8 men testosterone level was normal. A polysomnographic investigation with monitoring of nocturnal spontaneous erections showed that 32 patients had severe sleep fragmentation with reduced or complete absence of REM and deep sleep phases. In nocturnal penile tumescencia quantitative and qualitative characteristics were abnormal suggesting organic nature of erectile dysfunction in these patients. Eight ED and OSAS patients with normal testosterone received standard OSAS therapy with administration of FDE-5 type inhibitors. Six months later improvement of the erectile function was observed in 6 patients. OSAS patients with hypogonadism were divided into 2 groups. Group 1 (n = 5) received CPAP therapy and group 2 (n = 19) received OSAS standard therapy. Group 2 was treated with inhibitors of FDE-5 type. Three months later improvement of erectile function was seen only in 8. Group 1 received the inhibitors and testosterone replacement. Three months later all 5 patients had no ED complaints, their testosterone was normal. It is recommended to perform monitoring of nocturnal spontaneous erections in the algorithm of examination of all men with OSAS. All patients with OSAS, ED and documented hypogonadism need testosterone replacement therapy if its level persists low despite adequate therapy of OSAS.

[MR imaging in diagnosis of acute gestational pyelonephritis].

We studied efficacy of using MR imaging (MRI) in differential diagnosis of serous and pyodestructive pyelonephritis in pregnant women. We performed MRI (MR tomograph Siemens Magnetom Symphony, Germany; 1.5 T, 20 mT/m) in 28 women with acute gestational pyelonephritis (pregnancy trimester II and III) to reject pyodestructive changes in the kidneys, paranephral fat, including cases with drained kidney. Three women were operated. The decision about operation was made basing on clinical, ultrasound, MRI pictures which confirmed the diagnosis of pyodestructive process. In the other cases MRI definitely described the state of the parenchyma and calyculopelvic renal system after drainage, rejected pyodestructive lesion, and, finally gave grounds for decision on conservative therapy which later proved effective. Thus, MRI is a method of choice in suspected pyodestructive gestational pyelonephritis, in ideal conditions it is a routine method of examination of pregnant women when it is necessary to get significant information on anatomofunctional status of the kidneys and urinary tract.

[Use of levofloxacin in transcutaneous nephrolithotripsy].

The aim of the study was elucidation of levofloxacin (tavanik) efficacy in transcutaneous nephrolithotripsy (TNLT) made to prevent or treat infectious-inflammatory complications. We performed 211 transcutaneous endoscopic operations on the kidneys for urolithiasis (71 males and 117 females). Of them, 47 (25%) patients received tavanik. The concrement was located in the pelvis (n=9), calyx (n=9), pelvoureteral segment (n=5). Coral concrements were found in 24 cases (K1--in 12, K2--in 6, K3--in 3, K4--in 3 patients). Nephrolitholapaxy was performed in 39 patients, nephrolithoextraction--in 8 patients. Duplex ultrasound dopplerography conducted in all the examinees before surgery and on day 5-6 after it gave information about renal blood flow. Duration of the operation varied from 20 minutes in nephrolithoextraction to 136 minutes in nephrolitholapaxy of the coral concrements (mean time 40 +/- 6 min). Tavanik' was given according to the following scheme: 24 hours before the operation 500 mg tavanik was given orally, on the day of surgery and 3 consequent days 500 mg intravenously dropwise, the next 4 days 500 mg orally. Thus, a course of tavanik lasted 8 days. Nephroliths were removed in all the patients. Mean hospital stay was 7 days. In the group of 47 patients intraoperative complications were not observed. Pelvic microperforation (1 case) and loss of the concrement fragment in the paranephria (1 case) were not considered as complications and had no effect on postoperative period and recovery of the patient. Postoperative complications occurred in 6 (12.7%) patients: late hemorrhage (1), pyelonephritis (4), bacteriotoxic shock early after surgery (1). Thus, postoperative infectious-inflammatory complications arose in 5 (10.63%) patients. These patients received the same antibacterial treatment as the other patients except one patient with bacteriotoxic shock in whom a daily dose of tavanik was raised to 1 g in the course of 2 days. As success of transcutaneous nephrolithotripsy depends much on adequate pre- and postoperative antibacterial therapy, tavanik (levofloxacin) can be effectively used as monotherapy in transcutaneous nephrolithotripsy to prevent and treat postoperative infectious-inflammatory complications.

[State of hemostasis system at transurethral prostatic resection].

Hemostasis system was examined at 58 patients who underwent transurethral prostate resection due to benign prostatic hyperplasia. All the patients were divided into 2 groups: the study group where the surgery was performed under spinal anesthesia, and control - under intravenous anesthesia. The hemostasis system was examined before surgery and on 1st, 3rd and 5th day after it. It is revealed that the surgery under intravenous anesthesia is associated with increase of coagulation potential and decrease of fibrinolytic activity that is the most marked on 3rd and 5th day.

[Acute gestation pyelonephritis in terms of systemic inflammatory reaction syndrome].

Laboratory indices reflecting phases and level of systemic inflammatory reaction were analysed in 30 patients with acute gestation pyelonephritis (AGP). The patients were divided into two groups depending on clinical manifestations and drainage of the kidney. AGP course runs according to major regularities of systemic inflammatory reaction the analysis of which enables formulation of principles of optimal AGP treatment.

Immediate-loading dental endosteal implants and the elderly patient.

The concept of immediately loading dental implants has the potential of being a viable addition to treatment modalities. The major decision-making challenge in managing depleted dentitions and complete edentulism in an aging society lies in differentiating the treatment outcomes, especially patient-mediated assessments (including economic analyses) of the various prosthodontic options available for older adults. The ability to chew properly is of great importance to maintain a healthy nutrition and improve oral comfort and quality of life, particularly in the elderly years.

Neurobehavioral profiles of neonates exposed to cocaine prenatally.

This study examined the effects of maternal cocaine use on performance on the Neonatal Behavioral Assessment Scale (NBAS). Cocaine-exposed newborns (n = 56) were compared with a non-cocaine-exposed group (n = 30) born to mothers with similar sociodemographic characteristics. Cocaine-exposed newborns showed significant reduction in birth weight but did not experience greater obstetric or postnatal complications. On neurobehavioral assessments using the NBAS, cocaine-exposed newborns showed significantly depressed performance on the habituation cluster but not on other NBAS clusters when differences in birth weight were controlled. In a sample of 30 cocaine-exposed newborns matched on birth weight, gestational age, and race to the 30 non-cocaine-exposed newborns, cocaine-exposed newborns continued to show depressed habituation performance. The significance of a selective effect of cocaine exposure on early habituation performance is discussed in terms of the implications for attentional regulation in the first year of life.

Children's anticipation of impending surgery. Shifts in object-representational paradigms.

The authors used Rorschach assessments of the quality of object-representations to measure psychological shifts in children facing surgery. Fifteen children, ages 7 to 11, were given the Rorschach test three times: one week prior to elective hernia surgery, the day before the surgery, and 3 weeks after hospitalization. These children were compared with a nonsurgical group of 13 children matched for age and IQ and tested at the same time intervals. The authors hypothesized that the two groups would have similar Rorschach Mutuality of Autonomy (MOA) scale scores at Times 1 and 3, but would differ substantially at Time 2. This hypothesis was confirmed using the Mann-Whitney U test. Within the surgical group, there was an overall significant difference in MOA scores over time, and, as hypothesized, these children's scores at Time 2 were significantly more malevolent than at Time 1 (p less than .003). The effects of surgery were somewhat attenuated by Time 3, but the Time 3 MOA scores were still more malevolent than at Time 1 (p = .05) and were not significantly different from those at Time 2 (p = .18). The authors highlight the need to amply prepare children for even minor surgical procedures.

Identification of stress buffers.

A large amount of research has been published about the role of intervening variables as buffers for the effects of stress precursors on adverse stress impacts. A review revealed that most of these reports focused on single candidates or a subjectively selected constellation of variables using narrow definitions of both precursors and impacts with a variety of statistical procedures. A set of 22 variables was investigated to determine the relative importance of each as a stress buffer, using broadened measures for precursors and impacts. Discriminant analysis with t-test follow-up of data from 668 normally functioning men and women indicated the existence of 7 strong and 7 moderate buffers and a differential effect by sex. Reanalysis, comparing the results from other statistical procedures, concluded that there were 4 "true" buffers: sense of competence, exercise pattern, sense of purpose, and leisure activity. Eleven of the 22 demonstrated main effects independent of stress. This study discusses the importance of using standard statistical procedures with comprehensive measures in order to further knowledge about the human stress process.