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Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia.

Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.

Adult↗

Banana leaf dressing for skin graft donor areas.

Skin grafting is an integral part of burn wound management. The pain experienced at skin graft donor sites is significant. Banana leaf dressing (BLD) developed by our unit in 1996 is an excellent, non-adhesive, pain-free, cheap and easily available dressing material. We conducted a trial to compare efficacy of BLD with vaseline gauze (VG) dressing used by majority of burns centers for dressing skin graft donor areas. Thirty patients undergoing skin grafting were included in the study. BLD was applied on one half and VG on the other half of the donor area. Dressing change was done on the eighth day. Using the visual analogue scale we assessed the pain score, the dressing removal pain score and ease of dressing removal score. The advantage of early epithelisation of donor areas cannot be over stressed in burnt patients. The epithelisation status of the donor area on eight post-operative day was noted. The day of complete epithelisation was also noted. The average pain score with BLD was 1.1+0.71 while that with VG was 6.9+0.84. The average dressing removal pain score was 0.97 with BLD while that with VG it was 9.47. Ease of dressing removal score average was 1.1 with BLD while it was 9.53 with VG. In all the above scores the difference observed was statistically significant with P<0.001. The mean complete epithelisation day was 8.67 in the BLD covered areas as compared to 11.73 in the VG covered areas. This observation was highly significant with P<0.001. Our study clearly indicates that BLD is a completely non-adherent and painless dressing. We strongly recommend the use of BLD for all skin graft donor areas.

Adult↗

Evaluation of banana leaf dressing for partial thickness burn wounds.

An important factor in the healing of superficial and moderate partial thickness burn is early and effective coverage with a dressing that protects the wound from trauma and dessication and is non-adherent. In our country cost is also a very important factor. Disturbed by the pain and anxiety experienced by the patients during and after dressing changes, search for a new dressing material was begun for partial thickness burn wounds and the banana leaf dressing (BLD) was subsequently developed and optimised by June 1996. An open controlled study was carried out to compare banana leaf dressing and boiled potato peel bandage (BPPB), the dressing being used in our Burn Unit since 1994. Thirty patients all less than 40 years of age, with burn size less than 50% TBSA, involving comparable body areas with partial thickness burn, were included in the study. BLD along with a topical agent was applied over the right sided extremity while BPPB was applied with the same topical agent on the left sided extremity. Dressing was changed every day. The pain during dressing change, feeling of comfort and ease of handling dressing was assessed by awarding scores by the patients and care givers for each type of dressing. Analysis of the scores revealed that both BLD and BPPB caused easily tolerable, minimal pain during dressing change in majority of the patients. The days taken for epithelialisation, eschar formation and the need for skin grafting over deep partial thickness burns, did not reveal any significant difference between the areas treated by BLD and those by BPPB. So both the dressings were observed to have equal efficacy in protecting the wounds and aiding healing. Thus, the efficacy of BLD and BPPB was parallel in all respects. But BLD is 11 times cheaper than BPPB. Banana plants can be easily grown, the leaves are easily available throughout the year. The leaves of banana are large thus offering larger surface area and the surface is non-adherent, waxy and cool. The dressing can be prepared very easily with little training. It is also the cheapest dressing available today. We strongly recommend the use of banana leaf dressing for all partial thickness burn wounds in our environment.

Adult↗

Spontaneous bursting activity of dopaminergic neurons in midbrain slices from immature rats: role of N-methyl-D-aspartate receptors.

Dopamine neurons in midbrain coronal slices from adult rats (40-70 days old) discharged only in pacemaker-like mode. Irregular or bursting mode was never observed. In contrast, dopamine neurons in slices from immature rats (15-21 days old) exhibited not only pacemaker-like firing (53.4% of neurons), but also irregular and bursting patterns (28.3 and 18.3%, respectively). Glutamate and kainate increased the firing rate but failed to induce bursts in dopamine neurons from either adult or immature rats. N-Methyl-D-aspartate augmented the firing rate in all neurons from adult rats and produced a modest increase of bursts in only three out of 18 cells. In slices from immature rats, N-methyl-D-aspartate activated the discharge rate in all neurons and also induced bursts in 37 and 53% of pacemaker and irregular neurons, respectively, and increased the occurrence of spikes in bursts in 76% of spontaneously bursting neurons. The selective N-methyl-D-aspartate receptor antagonist (+/-)2-amino,5-phosphonopentanoic acid prevented N-methyl-D-aspartate-induced changes and also reduced spontaneous bursts, suggesting that bursting discharge is mediated by N-methyl-D-aspartate receptor activation. While pacemaker neurons from immature and from adult rats exhibited the same sensitivity to N-methyl-D-aspartate-induced stimulation of firing rate, spontaneously bursting neurons were more sensitive than pacemaker neurons from either immature or adult rats. The present study indicates that spontaneous bursting, dependent on N-methyl-D-aspartate receptor activation, is present, and may be induced, in dopamine neurons in slices from immature rats. Its absence from cells in slices from adult rats may reflect a reduced sensitivity of N-methyl-D-aspartate receptors on dopamine or the loss of the N-methyl-D-aspartate-activated burst generator.

2-Amino-5-phosphonovalerate↗

Effect of ethanolic extract of Khaya senegalensis on some biochemical parameters of rat kidney.

The effect of administration of ethanolic extract of Khaya senegalensis (2mg/kg body weight) on some biochemical parameters of rat kidney were investigated. Experimental animals were randomly divided into the control, those administered with the extract for 6 days and those administered with extract for 18 days, respectively. The prolonged administration of the extract resulted in significant reduction in the alkaline phosphatase activities of the kidney and its body weight ratio (P<0.05). In contrast, the same prolonged administration of the extract resulted in significant increase in the serum sodium ion concentration (P<0.05) while there was no significant difference in serum potassium ion concentration when compared to control (P>0.05). Administration of the extract for 6 days produced no significant difference from the control values in all the parameters investigated except in serum urea concentration which produced a significant increase (P<0.05). The available evidence in this study suggest that the ethanolic extract of Khaya senegalensis exerted more deleterious effect on the kidney when administered continuously over a prolonged period than a short one and this will adversely affect the functioning of the kidney.

Administration, Oral↗

Research advances on transgenic plant vaccines.

In recent years, with the development of genetics molecular biology and plant biotechnology, the vaccination (e.g. genetic engineering subunit vaccine, living vector vaccine, nucleic acid vaccine) programs are taking on a prosperous evolvement. In particular, the technology of the use of transgenic plants to produce human or animal therapeutic vaccines receives increasing attention. Expressing vaccine candidates in vegetables and fruits open up a new avenue for producing oral/edible vaccines. Transgenic plant vaccine disquisitions exhibit a tempting latent exploiting foreground. There are a lot of advantages for transgenic plant vaccines, such as low cost, easiness of storage, and convenient immune-inoculation. Some productions converged in edible tissues, so they can be consumed directly without isolation and purification. Up to now, many transgenic plant vaccine productions have been investigated and developed. In this review, recent advances on plant-derived recombinant protein expression systems, infectious targets, and delivery systems are presented. Some issues of high concern such as biosafety and public health are also discussed. Special attention is given to the prospects and limitations on transgenic plant vaccines.

Administration, Oral↗

Fatal hyperkalemia related to combined therapy with a COX-2 inhibitor, ACE inhibitor and potassium rich diet.

We describe the case of a 77-year old mildly hypertensive woman with no underlying renal disease who was admitted to the Emergency Department (ED) in a comatose state with fever. The patient had been on low dose enalapril and a potassium rich diet. Five days before admission, rofecoxib, a new selective COX-2 inhibitor nonsteroidal anti-inflammatory drug (NSAID), was added for leg pain. She was found to have severe hyperkalemia and died 90 min after her arrival. We cannot absolutely determine whether the COX-2 inhibitor was the dominant contributor to the development of hyperkalemia or the combination itself, with an intercurrent infection and some degree of dehydration. Physicians should be aware of this possible complication and only prescribe NSAIDs, including the new COX-2 drugs, to the elderly under close monitoring of kidney function and electrolyte tests.

Aged↗

Single-ventricle physiology.

The patient with single-ventricle physiology presents a significant challenge to the intensive care team at all stages of management. An integrated approach that applies a working knowledge of cardiac anatomy, cardiopulmonary physiology, and the basic principles of intensive care is essential to guide management for each individual patient. This management requires cooperative and constructive involvement of surgeons, cardiologists, and intensivists, as well as a nursing and respiratory care team experienced in the management of single-ventricle patients. The outcome of each stage of palliation for single-ventricle lesions should continue to improve as new ideas are developed and as older ideas are subjected to rigorous scientific analyses.

Anastomosis, Surgical↗

Long-term evaluation of sandblasted and acid-etched implants used as orthodontic anchors in dogs.

The aim of this study was the clinical, radiographic, and histologic evaluation of the tissue surrounding SLA (sandblasted and acid-etched) implants loaded with a continuous and constant force for 52 weeks, after a healing period of 6 weeks, after implant insertion. SLA implants were placed in the maxilla of 3 dogs and the mandible of 5 dogs after a 12-week healing period after extraction. Abutments were attached to the 6 test implants (2 in the maxilla, 4 in the mandible). Superelastic nickel-titanium coil springs were activated between the SLA implants and the canines, producing a force of 200 g (2 N). Two unloaded implants (1 in the maxilla, 1 in the mandible) served as controls. Histologic analysis showed a corticalization of bone trabeculae, thicker at the loaded than at the unloaded implants. New bone formation at the level of the crest was slightly superior in the test implants. A difference between the tension and compression areas could not be observed in the test implants. The mean bone-implant contact values of the test implants for the maxilla and mandible were 40.23% and 49.33%, respectively. In the control implants, the bone-implant contact value was 67.91% for the maxilla and 49.23% for the mandible. SLA implants can be used as an anchorage unit with confidence, in spite of a short healing period and a prolonged force application. Further studies with different force magnitudes and healing periods are required to clarify the effects of healing period and force magnitude on bone quality and quantity.

Acid Etching, Dental↗

Methods of assessing spinal radiographs in scoliosis are functions of its geometry.

The most important feature of scoliosis is the lateral curvature of the spine. It can be treated either conservatively or by surgery; however, treatment choice depends mainly on curve progression which is determined by frequent curve assessment. This is a review of methods of curve measurement and proof of the relationship between them.

Disease Progression↗

Cognitive aspects of social phobia: a review of theories and experimental research.

Cognitive theories of social phobia have largely been inspired by the information-processing models of anxiety. They propose that cognitive biases can, at least partially, explain the etiology and maintenance of this disorder. A specific bias, conceived as a tendency to preferentially process socially-threatening information, has been proposed. This bias is thought to intervene in cognitive processes such as attention, memory and interpretation. Research paradigms adopted from experimental cognitive psychology and social psychology have been used to investigate these hypotheses. The existence of a bias in the allocation of attentional resources and the interpretation of information seems to be confirmed. A memory bias in terms of better retrieval for threat-relevant information appears to depend on specific encoding activities.

Cognition↗

Intracavitary cardiac hydatid cyst and the wall sign criteria.

Cardiac hydatid is rare at any age, accounting for less than 2% of all hydatid disease. The case is discussed of a 48-year-old female with a cardiac hydatid cyst attached intracavitary in the posterior wall of the right atrium. The Echinococcus cyst grows very slowly and, unless located in a critical anatomic site, it takes many years to evolve. Since the introduction of two-dimensional echocardiography, more cases are being diagnosed. The cyst was discovered incidentally by X-ray computed tomography and confirmed by trans-oesophageal echocardiography utilizing the wall-sign criteria developed by the authors. The cyst was removed surgically and the patient recovered by medical therapy.

Antinematodal Agents↗

Segmental portal hypertension due to a splenic Echinococcus cyst.

A 60-year-old Libyan woman developed perihilar splenic varices without other signs of portal hypertension. Plain abdominal X-ray examination showed two calcified structures in the left and right hypochondria. Ultrasound examination disclosed a 3-cm diameter, globally calcified hydatid cyst lodged in a critical location at the hilar region of the spleen. The cyst was compressing the hilar vessels which resulted in dilatation and varix formation. Another hydatid cyst measuring 5 cm in diameter, with extensive wall calcification was visualized in the right lobe of the liver. The splenic size was within normal limits. The liver revealed normal texture and size and the portal vein was of normal caliber. The patient underwent an uneventful splenectomy and was well at discharge.

Echinococcosis↗

Influence of layer position on in vitro and in vivo release of levodopa methyl ester and carbidopa from three-layer matrix tablets.

A versatile oral controlled release system for the simultaneous delivery of levodopa methyl ester and carbidopa, consisting of a three-layer matrix tablet, has been studied and developed. Each individual layer of the matrix exhibited a different release mechanism, i.e. the first layer was swellable (S), the second one was erodible (E) and the third one was disintegrating (D). The three layers have been assembled in the monolithic matrix in different relative positions. It was found that in the monolith the three layers could interact, producing in vitro release profiles depending on their relative position. The monoliths having the configurations DSE and SDE were administered to human volunteers in order to determine the plasma profiles. The pharmacokinetic data showed a significant difference between the early time plasma curves: the monolith DSE, having the fast release profile, gave rise to a rapid appearance of a high levodopa plasma level, whereas the slower releasing monolith SDE produced a smoothed plasma concentration profile.

Administration, Oral↗

Intestinal obstruction due to phytobezoars of banana seeds: a case report.

Phytobezoars are a well-known, though rare, cause of mechanical alimentary tract obstruction. They occur mainly in patients who have undergone abdominal surgery, where most literature reports describe the causes as persimmons and oranges. We report four cases, seen within a period of 19 months in Laos, with intestinal obstruction caused by phytobezoars from jungle banana seeds. They had no history of previous gastrointestinal surgery. The recommended therapy in total obstruction is laparotomy, "milking" through the ileocaecal junction, or enterotomy and direct extraction. As recurrence and presentation at multiple sites are possible, all of the gastrointestinal tract should be thoroughly examined intraoperatively.

Adolescent↗

The effect of PARS inhibition on ileal histopathology, apoptosis and lipid peroxidation in LPS-induced obstructive jaundice.

In our experimental study, we investigated the protective effect of 3-aminobenzamide (3-AB), the poly (ADP-ribose) synthetase (PARS inhibitor), on the ileal histopathology and the apoptosis in lipopolysaccharide (LPS)-induced inflammation in rats with obstructive jaundice (OJ). We randomized 40 rats into five groups. Group 1: sham group; Group 2: OJ group; Group 3: OJ+LPS; Group 4: OJ+3-AB+LPS; Group 5: OJ+LPS+3-AB. At the fifth day; the rats were jaundiced. In Group 3; 10 mg kg(-1) LPS was injected intraperitoneally at the fifth day and then after 6h the rats were sacrificed. In Group 4; 10 mg kg(-1) 3-AB was administrated intraperitoneally at the fifth day and repeated daily for 3 days and at the eighth day, 10 mg kg(-1) LPS was injected intraperitoneally. In Group 5, 10 mg kg(-1) LPS was injected intraperitoneally at the fifth day and after 6h 10 mg kg(-1) 3-AB was administrated intraperitoneally and repeated daily for 3 days. At the eighth day, rats were sacrificed. Blood samples were taken for detection of serum MDA levels. Ileum samples were taken after relaparotomy for histopathological examination to evaluate the endotoxin-related intestinal injury and Caspase-3 apoptosis and for detection of tissue MDA and ATPase activities. There was marked destruction of villous and crypt epithelial cells and extensive apoptosis in Groups 3 and 5 in histopathological examination. In Group 4, the scores of intestinal mucosal damage and apoptotic cells were reduced significantly (P<0.05). On the other hand, the scores of intestinal mucosal damage and apoptotic cells were not improved in Group 5. After the administration of 3-AB (Group 4), serum and ileal MDA levels decreased, ileal ATPase increased as compared to Groups 1 and 2. Our study showed that 3-AB prevented the mucosal damage and apoptotic loss of intestinal epithelial cells significantly if it was administrated before LPS. However, 3-AB failed to prevent the mucosal damage and apoptotic loss of intestinal epithelial cells significantly if there was established endotoxemia in OJ.

Adenosine Triphosphatases↗

The effects of antithrombin-III on inducible nitric oxide synthesis in experimental obstructive jaundice. An immunohistochemical study.

The absence of bile in the gastrointestinal tract stimulates bacterial overgrowth and bacterial translocation. In the response to endotoxin and LPS-induced endotoxemia which may be prevented by antithrombin-III (AT-III); endothelial cells; and various cells release cytokines, nitric oxide (NO) and other mediators. The purpose of this study was to examine blood NO levels and renal inducible NO synthase (iNOS) expression and determine whether AT-III has an inhibiting effect on renal injury and iNOS expression in obstructive jaundice (OJ). Forty rats were randomized into four groups: group A (Sham), group B (Sham+AT-III, 250 IU kg(-1)), group C (OJ), group D (OJ+AT-III, 250 IU kg(-1)). All animals were sacrificed on the 10th day and blood samples were taken for bilirubin and NO level determination. In addition, iNOS expression of the renal tissues was evaluated immunohistochemically. Blood NO levels were found to be 32.99 micromol l(-1) in group A, 32.26 micromol l(-1) in group B, 46.33 micromol l(-1) in group C, and 34.71 micromol l(-1) in group D. The intensity of iNOS staining in the OJ+AT-III group was less than the intensity of iNOS staining in the OJ group in the renal tissue. This study shows that OJ causes increased production of NO in blood and increased iNOS expression in the kidney. AT-III inhibits iNOS expression and reduces the level of blood NO. Thus, our findings indicate that under conditions of OJ, AT-III limits renal cellular injury by inhibiting LPS-induced iNOS expression.

Animals↗