Optimizing ischemic preconditioning for esophagogastric anastomosis: A standardized rat model to evaluate histological changes.

INTRODUCTION: A reproducible and simple model is essential for verifying gastric conduit vitality before esophagectomy. Ischemia is a major cause of esophagogastric anastomotic dehiscence and leakage. Ischemic conditioning of the stomach prior to esophageal surgery has been shown to lower the incidence of postoperative complications, including anastomotic leakage. However, the optimal timing and technique of ischemization remain uncertain. METHODS: Male Sprague-Dawley rats (n=24) were randomly divided into four groups: ischemic group - samples collected 1 hour after ischemia (I1H), ischemic group - samples collected 1 day after ischemia (I1D), ischemic group - samples collected 7 days after ischemia (I7D), and control group (C). Ischemia was induced by ligation of the left gastric (LGA) and short gastric arteries (SGA). The samples were verified using histological and macroscopic analysis, and the number and percentage of immunocompetent cells were determined. RESULTS: One hour after ischemization (I1H), ischemic denudation with mucosal erosion was observed, and the total number of eosinophils was significantly higher (p.

Cesarean scar endometriosis: our recent experiences.

INTRODUCTION: Endometriosis is defined as the presence of endometrial tissue, endometrial glands or endometrial stroma outside the uterine cavity causing chronic inflammatory response. The prevalence of abdominal wall endometriosis is less than 1%. Cesarean scar endometriosis is the most common type of abdominal wall endometriosis. Chronic lower abdominal pain amplified during menstruation and palpable mass in the area of scar are the main symptoms. Generally, surgical resection with negative resection margins offers the best chance for definitive treatment of abdominal wall endometriosis. CASE REPORT: The authors present two female patients in fertile age with chronic pain in the area of Cesarean scar. The preoperatively assumed endometriosis was histologically confirmed after complete surgical excision. CONCLUSION: Abdominal wall endometriosis is rare. However, it is a possible cause of constant lower abdominal pain, impacting quality of life of the patient.

[Intestinal endometriosis - a case report]. / Endometrióza hrubého creva - kazuistika.

Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity. The most common clinical symptoms of endometriosis are infertility and chronic pelvic pain. Endometriosis affects 8-10% of women of reproductive age and the condition is highly associated with infertility. Ectopic endometrial tissue is usually found in the small pelvis and the peritoneum, but endometrial tissue deposits have also been reported in other anatomical locations in the human body. We describe the case of a young patient with persistent abdominal pain and bleeding via the rectum during menstrual periods, hospitalised at the Second Department of Surgery, Pavol Jozef Safárik University, Faculty of Medicine and Louis Pasteur University Hospital Kosice.

Atropa belladonna L. water extract: modulator of extracellular matrix formation in vitro and in vivo.

Previously, we found that treatment of cutaneous wounds with Atropa belladonna L. (AB) revealed shortened process of acute inflammation as well as increased tensile strength and collagen deposition in healing skin wounds (Gál et al. 2009). To better understand AB effect on skin wound healing male Sprague-Dawley rats were submitted to one round full thickness skin wound on the back. In two experimental groups two different concentrations of AB extract were daily applied whereas the control group remained untreated. For histological evaluation samples were removed on day 21 after surgery and stained for wide spectrum cytokeratin, collagen III, fibronectin, galectin-1, and vimentin. In addition, in the in vitro study different concentration of AB extract were used to evaluate differences in HaCaT keratinocytes proliferation and differentiation by detection of Ki67 and keratin-19 expressions. Furthermore, to assess ECM formation of human dermal fibroblasts on the in vitro level fibronectin and galectin-1 were visualized. Our study showed that AB induces fibronectin and galectin-1 rich ECM formation in vitro and in vivo. In addition, the proliferation of keratinocytes was also increased. In conclusion, AB is an effective modulator of skin wound healing. Nevertheless, further research is needed to find optimal therapeutic concentration and exact underlying mechanism of action.

Attention deficity/hyperactivity in SLI children increases risk of speech/language disorders in first-degree relatives: a preliminary report.

UNLABELLED: Specific language impairment (SLI) or developmental dysphasia denotes the inability to acquire normal expression and/or comprehension of language in the absence of peripheral hearing impairment, neurological disorder, and mental retardation. The presence of attention deficit/hyperactivity in some SLI children has previously been documented. This family history study used 27 SLI families, identified through the parents from the Dysphasia Association, to examine the relationship between attention deficit/hyperactivity in SLI children and the risk to first-degree relatives. All SLI children were clinically diagnosed with speech/language disorder; medical records were searched for the presence of any of the exclusion criteria noted above. The 13 SLI children with medical record of attention deficit/hyperactivity had a significantly higher chance of having first-degree relatives with speech/language disorders than 14 SLI children without such record (15/27 and 4/46, respectively). This preliminary report suggests that additional study is warranted to investigate the relationship between speech/language disorders and attention deficit/hyperactivity in families of SLI children. LEARNING OUTCOMES: As a result of this activity, the participant will be able to describe the SLI phenotype, its prevalence, and complexity and to recognize the relationship between comorbid attention deficit/hyperactivity in SLI children and the risk of speech/language disorder in their relatives.

Pretest clinical diagnosis of coronary artery disease and stress myocardial perfusion scintigram.

BACKGROUND: To assess the probability of perfusion defects at exercise stress myocardial perfusion SPECT scintigraphy from pretest clinical diagnosis (medical personal history, previous ergometric investigation). To determine the value of clinical factors for probability of scintigraphic defects with respect to avoiding unnecessary investigation in subjects with low probability of abnormal scintigrams. MATERIAL AND METHODS: 2143 subjects (1235 men, 908 women) were investigated by SPECT perfusion scintigraphy at stepwise increasing exercise stress. They were divided into three groups with regard to their medical history and exercise test at scintigraphy: subjects without any signs of coronary artery disease (CAD), patients with high likelihood of CAD (i.e., typical anginal pain, in particular at stress, positive stress ECG changes, angiographically documented important CAD) and patients after myocardial infarction (MI). Important risk factors (hypertension, diabetes, age and sex), as well as the role of revascularisation procedures, were taken into account for multiple logistic regression in order to express their importance for the odds of scintigraphic defect visualisation. RESULTS: Perfusion scintigraphic defects (PSD) were found in 5.2% of subjects without signs of CAD, in contrast to patients with manifest CAD (68.8% with PSD) and in those after MI (90.2% with PSD). There were other important factors corroborating the likelihood of PSD (in decreasing order of importance): diabetes, male, ECG changes at stress, increasing age. Successful revascularisation improved scintigraphic images. CONCLUSION: The examination of CAD symptom-free subjects, in particular with atypical chest discomfort, is useless. SMPS in patients after documented MI is to be carried out for other intended purposes, not for CAD diagnosis only. SMPS is highly recommended in patients with CAD symptoms and high CAD probability in order to decide further treatment and prognosis.

[Multisegmental posterior wedge osteotomies of the lumbar vertebrae for correction of kyphosis in ankylosing spondylitis. A report on 5 cases]. / Visesegmentne straznje klinaste osteotomije lumbalne kraljeznice u korekciji kifoze kod ankilozantnog spondilitisa. Prikaz 5 bolesnika.

Operative treatment of Ankylosing spondilitis is usually performed in treatment of extraspinal pathology, i.e. in treatment of hip contractures. Operative treatment of fixed spinal kyphosis in AS is rarely indicated, and patients make their decision for the operation when deformation becomes extreme. Instead of several hundred of operated patients in foreign literature, authors describe only 5 operations from 1989 to 2000. Results suggest that multiple spinal osteotomy in AS is a time consuming operation with a significant intraoperative and postoperative blood loss. Mild, transient radicular irritations are noticed. However, reconstruction of lumbar lordosis significantly improve quality of life in operated patients. It is concluded that indication for the operation in AS should be indicated earlier. Better results with less risk would be achieved.

Exploring the impact of extended phenotype in stratified samples.

We have performed initial nonparametric sib-pair genome scans in the early (N = 52) and late (N = 53) onset subgroups of the COGA pedigrees, stratified near the median value of pedigree mean age of onset for ALDX1 diagnosis of alcoholism. Because the early group contained a higher proportion of smokers, traits of alcoholism, smoking, and addiction (defined as either alcoholism or smoking) were examined. Subgroups and phenotypic definitions influenced initial linkage results, corrected for the number of analyzed traits. Evidence for linkage to the ALDX1 alcoholism phenotype at the ADH3 functional candidate gene was increased in the late onset subgroup (Bonferroni corrected significance level < 0.002), as compared with the unstratified sample that replicated COGA linkage obtained in the same analysis; there was no evidence for linkage at this locus in the early onset subgroup. The theoretical implication of this result is that the loss of power due to contracting sample size through stratification may in some cases be more than offset by extraction of a more homogeneous subgroup from the etiologically complex trait.

Evidence of linkage in subtypes of alcoholism.

We believed that subtyping alcoholism might be an efficient strategy for mapping susceptibility genes. Cluster analysis is one of the possible statistical techniques for such a purpose. We required that, ideally, the variables to be used in cluster analysis should be: 1) related to alcoholism, 2) related to the severity of alcoholism, and 3) familial, i.e., correlated within families. Only three variables met all three conditions. Those included age of onset of ALDX1, smoking, and TPQ-HA. A global score of symptoms of alcoholism was systematically introduced as one of the variables composing a subset for cluster analysis, although this score did not show any familial aggregation. Our strategy led to a strong evidence of linkage at D15S230 in only 20 families whose members are mainly characterized by heavy smoking.

[Helicobacter heilmanni (Gastrospirillum hominis) as a new cause of gastritis--case report]. / Helicobacter heilmanni (Gastrospirillum hominis) novi uzrocnik gastritisa--prikaz slucaja.

INTRODUCTION: During the course of research into Helicobacter pylori, further microorganisms colonizing the gastric mucosa have been detected. The large spiral-shaped bacteria deviating from Helicobacter pylori was originally described by Dent. The bacteria was initially named Gastrospirillum hominis, but after sequencing of 16S rRNA it was classified as Helicobacter and named Helicobacter Heilmannii in honour of the pathologist Prof. Dr. Konrad Heilmann. We report two additional cases. CASE REPORTS: In 1997 at the Department of Pathology of General Hospital in Senta 268 gastric biopsies (151 male, 117 female), average age of 50.4 were analyzed. Helicobacter pylori was identified in 176 biopsies (65.7%). Helicobacter Heilmannii was found in two cases (0.74%). The clinical details were as follows: Case 1. A 32-year-old male complained of dyspepsia. Esophagogastroduodenoscopy disclosed hyperemia and scattered erosions in the lower third of stomach. Case 2. a 55-year-old female was admitted at the hospital with lumbar pain, loss of appetite and body weight. Esophagogastroduodenoscopy findings were normal. The patient lived in rural household in contact with various domestic animals. In the biopsy specimens of both cases in the antral gastric mucosa large bacteria resembling a corkscrew were found, 6-10 microns length, consisting of 5-9 regular tight spiral. The bacteria were midly eosinophilic and Gram negative. The bacteria stained strongly with the Warthin-Starry silver stain, and with Giemsa stain. The distribution of Helicobacter Heilmannii was patchy in the central zones of the gastric pits, deep or more superficial including the foveolar opening on the mucosal surface. A mild degree of chronic gastritis characterized both cases, with, focally active inflammation and lymphoid aggregates. None of biopsies had atrophy, intestinal metaplasia or epithelial damage. There was a symptomatic improvement after a 4-week course with triple therapy (H2 antagonist & metronidazole & amoxycillin). After treatment rebiopsy specimens displayed mild chronic gastritis and no spiral organisms. CONCLUSION: Our reported cases are the first described cases of gastritis caused by Helicobacter Heilmannii in our region with successful eradication after therapy. Morphologically similar bacteria have been found in the stomachs of domestic animals. It is a general opinion that Helicobacter Heilmannii is characteristic for animals but it is occasionally transmitted to humans.

Analysis of background-dependent genetic interactions without inbred strains.

Experimental analysis of background dependent effects of genetic interactions can be designed using strains generated by introgression of small genetic regions containing identical genotypes at loci in question into different inbred strains. We use a novel multilocus paradigm, denoted conditional intergenic functional association (CIFA), to simulate this procedure, with the trade-off of power for convenience that is affordable when sufficiently strong effects are present. We analyze nine enzyme loci at three chromosomes in groups of D. melanogaster with different developmental rates that showed similar allelic frequencies at individual loci. Results obtained suggest the presence of adaptive interaction between particular alleles at two loci when genetic variation at seven background loci is eliminated. Biochemical considerations show that, in the resulting developmental context, strong interaction between these genes may emerge from shifted control of the pentose phosphate pathway, with cascading effects on the glycolysis, TCA cycle, and biosynthetic pathways: one gene may assume control of the irreversible rate-limiting step in the pentose phosphate pathway, whereas the other gene may assume control of the NADP+ level that regulates the same rate-limiting step as an electron acceptor. The newly developing functional genomics research and the absence of inbreeding make CIFA directly applicable to complex human traits in large samples.

Clinical study of recovery and half-life of vapor-heated factor VII concentrate.

BACKGROUND: The in vivo recovery and half-life of intermediate-purity, vapor-heated factor VII (FVII) concentrate were determined in patients having a congenital deficiency for FVII according to the 1991 guidelines of the International Society for Thrombosis and Haemostasis. STUDY DESIGN AND METHODS: A total of 11 patients received a single infusion of the FVII concentrate. Blood was drawn before infusion and 15 and 30 minutes and 1, 2, 4, 8, 12, and 24 hours after. Recoveries were calculated from the highest FVII activity of the first four blood samples drawn after infusion. The two-phase linear regression method was used to estimate the half-life according to the two-compartment model. In addition, a noncompartmental approach was applied. RESULTS: The mean recovery value obtained for FVII concentrate, 110.53 percent (SD, +/- 26.37), indicates rapid and efficient incorporation into the blood stream. Equivalent results were obtained with both pharmacokinetics methods and indicate a very short half-life for FVII. A half-life of 6.49 hours (SD, +/- 2.42) was obtained with the compartmental method and a half-life of 5.25 hours (SD, +/- 2.42) with the noncompartmental method. CONCLUSION: The half-life and recovery reported here, along with the specificity of the replacement therapy, the earlier anecdotal cases of clinical efficacy, and the clinical safety of the concentrate with regard to viral infections, recommend vapor-heated FVII concentrate for the treatment of patients with hereditary FVII deficiency.

Myocardial scintigraphy using 99m-Tc-methoxyisobutylisonitrile (Tc-MIBI): Is it equivalent to 201-Tl?. / Scintigrafie myokardu pomocí 99m-Tc-metoxyisobutylisonitrilu (Tc-MIBI): Rovnocenná náhrada 201-Tl?

The results of selective coronary angiography, myocardial 201-Tl scintigraphy (stress and redistribution) and after 99m-Tc-methoxyisobutylisonitrile stress and rest injections (Tc-MIBI, Cardiolite, DuPont de Nemours, USA) were compared in 19 patients with manifest ischemic heart disease in identical three projections and after same ergometric load. All three investigations were carried out within three consecutive days. 16 patients had significant stenoses of 1-3 main coronary arteries inclusive of left coronary artery main stem, insignificant stenoses (less than 50%) were present in remaining 3 patients. Scintigraphic localizations of accumulation defects in both Tc-MIBI and 201-Tl stress scintigraphy were in accordance in 70.6% of evaluated left ventricular wall segments. A positive 201-Tl redistribution and rest-stress Tc-MIBI scintigraphic difference agreed in 52.6% images of all three projections with verified accumulation defects. The sensitivity of the detection of ischemic area in reference to the coronary angiography was nearly identical in 201-Tl (75%) and Tc-MIBI scintigraphy (81.2%). False positive accumulation defects in the apical area were revealed in three patients with insignificant coronaro-angographic findings equally after both radiopharmaceuticals. Better physical properties of 99m-Tc from the point of view of a gamma camera detection, a possibility to get markedly higher counting rate and sufficient accumulation of the radiopharmaceutical in the perfused myocardium enable to reach scintigraphic pictures with a high contrast after labelled Tc-MIBI injection, even in case of sequential impulse summation during heart cycle (gating). Thus MIBI labelled by 99m-Tc is equivalent to 201-Tl as used for myocardial scintigraphy in patients with ischemic heart disease.

[Psychological changes in diabetic patients with polyneuropathy]. / Psihi cke promene u dijabetesnih bolesnika sa polineuropatijom.

The study has multi-sidedly examined and considered the possible relations between psychic, especially unsuitable emotional charges and the most frequent peripheral nerve complications in diabetes mellitus patients. By the comparative method of researching the psychic status and electro-physiological characteristics in patients with diabetic polyneuropathy, it has not been determined that distinct psychic disorders exist in patients with roughly expressed nervous complications in relation to the control group on condition, which consists of patients with complications of a lighter form. The results of this research lead the assumptions, of a possible psychic induction of nervous complications in the course of diabetes mellitus, to a doubt.

[Alzheimer's disease from the aspect of hormonal and metabolic disorders]. / Alzheimerova bolest sa stanovista hormonskih i metabolickih poremecaja.

Some facts of metabolical disturbances and functional changes of brain tissue hormones in Alzheimer's disease are reviewed. Characteristics of aetiopathogenesis, clinical picture and diagnostics are referred with observations on sociomedical importance of the disease. From the known data it can not yet be concluded if these changes are a cause or outcome of the illness.