Liver cirrhosis in a patient with alcohol dependence and autoimmune hepatitis.

BACKGROUND: Liver cirrhosis is the end-stage entity for a wide variety of chronic liver pathologies. These include viral hepatitis B and C, alcoholic liver disease, non-alcoholic fatty liver disease, hemochromatosis, Wilson disease, autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cirrhosis. In the majority of cases, liver cirrhosis remains completely asymptomatic until acute decompensation occurs. Patients may present complications of portal hypertension such as gastro-esophageal varices and upper digestive hemorrhage, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepato-renal syndrome. Establishing the right etiology of cirrhosis is of paramount importance as it helps the treating physician plan the best suitable treatment options and also improves overall outcome. CASE REPORT: We present a case of a chronic alcohol consumer, which, over time, resulted in alcoholic cirrhosis. Initial diagnosis comprised of alcoholic liver disease. However, a further look into the medical history of the patients indicated the presence of underlying autoimmune liver disease, such as autoimmune hepatitis, which might have also contributed to the chronic liver injury. CONCLUSIONS: Multiple factors can lead to liver cirrhosis. Although the most commonly found entity is alcoholism, it cannot be taken as a thumb rule for the only possible etiology. In-depth analysis and proper differential diagnosis should be carefully conducted in order not to miss out on other possible causes. As seen in our case, where an underlying autoimmune hepatitis was found to be the culprit, but due to a long history of alcohol consumption, it was masked at first instance.

Postpartum bilateral sacral stress fracture without osteoporosis-a case report and literature review.

PURPOSE: Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy. METHODS: A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included "stress fracture", "postpartum", "pregnancy", "atraumatic" and the wildcard "sacr*". Thirty-four cases were found and summarised in Table 2. RESULTS: A total of 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. A total of 70% reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bed rest, analgesia and modified weight-bearing exercises. Most patients have favourable outcome with complete symptom resolution. CONCLUSION: Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.

Combinatorial approach for improving the outcome of angiogenic therapy in ischemic tissues.

Two major populations of endothelial progenitor cells (EPC), namely endothelial colony forming cells (ECFC, or late outgrowth EPC) and circulating angiogenic cells (CAC, or early outgrowth EPC) have been reported to play important roles in vasculogenesis in numerous pathological conditions. However, the poor retention of cells into the ischemic tissue and neovessel fragility are two major flaws that need to be overcome for successful angiogenic therapy. The objective of this study was to explore and exploit the functional properties of EPC populations in order to increase the effectiveness of post-ischemic cell therapy. The results indicate different, still complementary, effects of the two EPC populations on adherence and proliferation of vascular endothelial cells. Matrigel plug assay and mouse hind limb ischemia model showed that concomitant administration of CAC-secreted factors and ECFC resulted in three-fold increase in local cell retention and improved muscle perfusion, vessel maturation and hind limb regeneration, in comparison to either treatment alone. By concluding, factors secreted by CAC co-administered at the time of ECFC transplantation improve tissue regeneration and vascular repair through stabilization of newly-derived blood vessels.

Trace element fluxes and natural potential risks from 210Pb-dated sediment cores in lacustrine environments at the Central Mexican Plateau.

The accumulation, enrichment and provenance of selected trace metals (Ag, As, Cd, Cr, Cu, Hg, Ni, Pb, V and Zn) were studied in sediment cores collected from three lakes located in the Central Mexican Plateau, selected on the basis of their contrasting degree of urbanization: Santa Elena Lake, in a rural and remote area; El Tule Lake, in a rural and slightly urbanized area; and Chapala Lake, in a highly urbanized area. Grain size, magnetic susceptibility and sedimentary constituents such as organic carbon, calcium carbonate, as well as major (Al, Fe, Mn) and minor (Ca, Li, Rb, Sr, Th) elements were analyzed to explain the concentration trends of trace metals. Factor analysis (FA) was used to assess the provenance of the trace elements. The highest metal enrichment factor (EF) above natural concentration levels was found at Chapala Lake for Ag (EF = 3.9), although other trace element EF in all lakes was <2.0, indicating slight contamination. However, the concentration levels of Cr and Ni in all lakes, Hg and Zn in Chapala Lake, Cu in El Tule Lake and As in Santa Elena Lake were above international benchmarks for which adverse effects are expected to occur frequently, even for those metals only slightly enriched (e.g. As, Cr). Through FA, the terrigenous contribution was identified as the most important source of trace metals to the three lakes, most likely related to deforestation and erosion of the surrounding areas, followed by atmospheric transport of volcanic ashes, rather than to direct sources.

Defined-size embryoid bodies formed in the presence of serum replacement increases the efficiency of the cardiac differentiation of mouse embryonic stem cells.

The pluripotent nature of embryonic stem (ES) cells makes them powerful tools in cell replacement therapy for severe degenerative diseases, such as heart failure. However, the development of strategies to increase the efficiency of cardiomyocyte (CMC) differentiation is still needed to produce a sufficient amount of cells for clinical applications. This paper evaluates the impact of the size and the aggregation of embryoid bodies (EBs) on the efficiency of ES cell differentiation into CMCs. ES cells were generated from RAP inbred mice. These cells expressed pluripotency markers and induced teratomas when injected into syngeneic mice, which made them suitable for differentiation into CMCs. We found that the EBs that were formed as a result of in vitro ES cell aggregation generated contractile tissue in direct correlation with the initial number of ES cells. Furthermore, the presence of knock-out serum replacement (KO-SR) during ES cell aggregation resulted in less compacted EBs and increased cell differentiation into CMCs compared to the presence of foetal bovine serum. In conclusion, cardiac differentiation of ES cells is dependent on the size and the degree of compaction of EBs, and the presence of KO-SR during initiation of EBs may lead to improved cardiogenic differentiation of ES cells.

[Reparation of the parcel defect of duodenum with pediculated jejunal patch by laparoscopy. Experimental study]. / Repararea leziunii parcelare duodenale cu patch jejunal pediculat pe cale laparoscopica. Studiu experimental.

The objectives were to evaluate the intraoperative aspects of the repairing by laparoscopy of a parcel duodenal defect, using a pediculated jejunal patch and to emphasize the intraoperative complications. The research has been made on 6 pigs. The pediculated jejunal patch was been achieved by excluding from the intestinal tract of a 2-4 cm segment with nutritional pedicle and the cut of intestinal tube on the anti-mesenteric border. The suture of the duodenal defect has been accomplished in one layer manner. The animals were followed 2 hours, under anesthesia. There was not intraoperative mortality, wether conversion to laparotomy. There was been a good cover of the defect, without any leakage. We did not notice intraperitoneal blood or bile. The duodenoplasty with pediculated jejunal patch is effective. The laparoscopic accomplishing of this procedure has no complications and it can be applied in clinical activity for selected cases.

Historical trace metal fluxes in the Mexico City Metropolitan Zone as evidenced by a sedimentary record from the Espejo de los Lirios lake.

The accumulation of selected trace metals (Ag, Cd, Co, Cr, Cu, Hg, Ni, Pb, V and Zn) was studied in a sediment core collected at Espejo de los Lirios lake, a precipitation-dominated seepage lake in Northern Mexico City Metropolitan Zone (MCMZ). A (210)Pb-derived chronology, obtained from the same core, was used to reconstruct the historical metal fluxes at the site, allowing evaluation of the impact of environmental changes promoted by the development of the City during the last approximately 125 years. The highest levels of metal enrichment above natural concentration levels (NCL) in the sediments from Espejo de los Lirios lake were found for Ag and Pb (approximately 250%) as well as a slight enrichment for Cd (55%), Cr (84%), Co (20%), Cu (60%), Hg (47%), Ni (45%), V (59%) and Zn (66%). Fluxes of trace metals appeared to have noticeably increased from the last 45 years showing the maximum increments for Cd, Co, Cr, Ni, V and Zn during the 1980's (9 to 13 fold natural fluxes), for Ag and Cu (17 and 12 fold, respectively) during the 1990's and for Hg and Pb (2 and 13 fold) during the middle 1970's. Low levels of metal enrichment observed have evidenced that the most conspicuous consequences of the expansive growth of this area of the MCMZ, are mostly related to deforestation and erosion of the surrounding areas, rather than to trace metal pollution. Based on PCA, it can be assumed that atmospheric deposition, weathering of bedrock and soil within the watershed and authigenic production, are the most important processes that explain the trace metal distribution in the site.

Oxprenolol-loaded bioadhesive microspheres: preparation and in vitro/in vivo characterization.

Biologically adhesive delivery systems offer important advantages over conventional drug-delivery systems. In this paper, microspheres intended as a sustained release carrier for oral or nasal administration have been prepared by associating a known bioadhesive polymer, poly(acrylic acid), in gelatin microspheres. A model drug oxprenolol hydrochloride was chosen. It was found that some of the formulation variables can influence the characteristics of the beads in a controlled manner. The internal structure of the microspheres studied by X-ray diffraction, thermal analysis and optical microscopy showed the absence of drug crystals in microspheres and a lowering in the glass transition temperature. The dynamic swelling of the beads obeyed the square root of time and a shift from the diffusional to the relaxational process dependent on the content of poly(acrylic acid) in gelatin microspheres was observed. As expected, drug release from gelatin/poly(acrylic acid) microspheres was influenced by the poly(acrylic acid) content in beads, by the particle size of microspheres and by the pH of the medium. The mechanism of release was analysed by applying the empirical exponential equation and by calculation of the approximate contribution of the diffusional and relaxational mechanisms to the anomalous release process by fitting the data to the coupled Fickian/Case II equation. In vitro and in vivo experiments in rats showed good adhesive characteristics of the gelatin/poly(acrylic acid) microspheres, which were greater if the poly(acrylic acid) content was greater. A significant retardation in gastric and intestinal emptying time of the beads was observed. This was also suggested by the bioavailability of the model drug after intragastric and intranasal administration of the microspheres. The pharmacokinetic parameters after microsphere administration were more appropriate to a slow release drug-delivery system. The work suggests the potential of this pharmaceutical delivery system as an alternative controlled-release dosage form, either for oral or nasal administration.

Polymorphic properties of micronized carbamazepine produced by RESS.

Carbamazepine microparticles were produced by the rapid expansion of supercritical carbon dioxide solutions (RESS) method. The characteristics of the resulting particles were studied by X-ray powder diffraction (XRPD), differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and image analysis. X-ray diffractograms and SEM photomicrographs revealed that the crystalline nature of the produced carbamazepine microparticles depended on operating pressure and temperature conditions. Different polymorphs were obtained under various operating conditions. Under certain temperature (below 40 degrees C) and pressure (below 240 bar) conditions, it was possible to form primarily the carbamazepine polymorph stipulated by US Pharmacopeia. A significant reduction was observed in the particle size and size distribution range of carbamazepine produced by RESS. The processed particles had a mean diameter smaller than 3 microm and a size distribution range between 0.5 and 2.5 microm compared to unprocessed starting material with a mean diameter of approximately 85 microm and a size distribution range between 15 and 336 microm. Thus, this study demonstrates that the polymorphic characteristics of carbamazepine microparticles produced by the RESS method can be controlled by varying operating pressure and temperature parameters.

[Iris-corneal dysgenesis]. / Disgenezie irido--corneana. Consideratii în legatura cu o familie.

This work presents a family, a mother and her 3 daughters, aged: 10 months, 4 years, 5 years with Rieger's anomaly. For children, this anomaly is associated with glaucoma and buphtalmy, this last element is the one that made the family ask for medical assistance and come to the hospital. The study of the disease was done on five generations in the same family, on the mother's line. This revealed that in the mother's family the grand grandmother and her two sisters were blind at an early age (30-40 years old). The presence of the anomaly in many generations proves the genetic transmission of the disease. We have to mention that in the last generation, the most serious appearance was registered at the patient with the earliest age (10 months).

[Less frequent etiology in uveitis]. / Uveitele cu etiologie mai putin frecventa.

This material intends to present three clinical observations regarding the uveitis etiology, that is represented by the association of some etiological factors less known: Toxoplasma gondii, Listeria monocytogenes, Leptospira icterohaemorrhagiae. The uveitis described here have been severe in the fast evolution and with trends of reappearence. This work demonstrates that the strict etiological antibacteria and antiparasite therapy is not enough and only corticotherapy is able to fight against the accentuated inflammatory phenomena that go along with type of uveitis.

Structure-properties relationship in cross-linked high-amylose starch for use in controlled drug release.

Cross-linked high-amylose starch (CLHAS), obtained by high-amylose starch cross-linking, was recently introduced as an excipient (Contramid) for monolithic dosage forms that are able to control drug release over 18-24 h. These control properties are related to tablet swelling and are strongly dependent on the degree of the cross-linking of CLHAS. The permeability of solutes through CLHAS hydrogels depends on the chemical structure of the polymer. The aim of this study was to obtain a better understanding of how modifications in CLHAS molecular structures at the level of long-range and short-range order during the cross-linking and processing conditions relate to the release properties of the CLHAS matrices. Structural parameters such as crystallinity contribute significantly to the physical and mechanical aspects of starch products. X-ray diffractometry, FTIR spectroscopy, dissolution tests in vitro, and mechanical hardness (of dry tablets) were found to be sensitive to the cross-linking degree (cld) variation. Best release properties and highest mechanical hardness were obtained from CLHAS matrices with low-to-moderate crystallinity, where the V- and the B-type structures coexist with amorphous regions. X-ray and FTIR profiles of dry CLHAS powders were found to be predictive for release properties of CLHAS tablets.

[The characteristics of crystalline lens metabolism]. / Particularitati ale metabolismului cristalinian.

The crystalline lens has a slow metabolism comparatively with others ocular structures: its energy is necessary to keep the transparency, ensure the nourishment for development and growth of the fibres. At the origin of the cataract are the old mitochondria that establish decreasing of available energy. This decreases the transport and necessary metabolism for the synthesis of proteins.

[Plagiocephaly with telorbitism]. / Plagiocefalie cu telorbitism.

The case of a 5-year-old child, who is hospitalized for right eye deviation in divergence and facial asymmetry, is presented. The clinical exam together with the radiologic exploration, form the diagnosis of plagiocephaly with telorbitism. The plagiocephaly is a craniostenosis determined by early unilateral synostosis of the coronal link, and it is the cause of the malformation of interorbital space.