[Laparoscopic adrenalectomy. Lateral transabdominal tecnique "step by step" and analysis of 41 consecutive patients]

Since the initial report in 1992, laparoscopic adrenalectomy has proved substantial advantages over the conventional procedure in terms of decreased postoperative pain and hospital stay, allowing earlier return to normal activity. The technical details are in permanent evolution and the most widely accepted laparoscopic surgery for the adrenal gland is the transabdominal lateral approach. We hereby describe step by step the way we perform the lateral approach after 41 consecutive cases.

Bilateral episcleritis as a manifestation of cutaneous leukocytoclastic vasculitis

PURPOSE

The authors describe how bilateral episcleritis can be a sign of active systemic disease and can respond to treatment in a patient with cutaneous leukocytoclastic vasculitis.

DESIGN

Case report.

METHODS

Comprehensive ophthalmic and physical examination and color photography were used to monitor inflammation and its response to systemic immunosuppression.

RESULTS

Systemic cyclophosphamide caused regression of systemic symptoms, cutaneous lesions, and episcleritis. After an 8-month follow-up, the patient has not had a systemic or ocular recurrence.

CONCLUSION

Episcleritis may be a manifestation of cutaneous leukocytoclastic vasculitis. Careful examination of ocular inflammation is important in monitoring systemic disease and treatment.

Synthesis and biological evaluation of curcuminoid pyrazoles as new therapeutic agents in inflammatory bowel disease: effect on matrix metalloproteinases

Seven N-unsubstituted curcuminoid pyrazoles have been synthesized from the corresponding beta-diketones (including curcumin). We evaluated the possibility of curcuminoid pyrazoles regulating the activity of matrix metalloproteinases (MMPs) by human intestinal epithelial cells in vitro. Zymographic analysis revealed that three compounds significantly down-regulated MMP-9 activity on inflammation-induced intestinal epithelial cells, making them original candidates for the treatment of inflammatory bowel disease (IBD).

Energy spectrum of cosmic-ray electrons at TeV energies

The very large collection area of ground-based gamma-ray telescopes gives them a substantial advantage over balloon or satellite based instruments in the detection of very-high-energy (>600 GeV) cosmic-ray electrons. Here we present the electron spectrum derived from data taken with the High Energy Stereoscopic System (H.E.S.S.) of imaging atmospheric Cherenkov telescopes. In this measurement, the first of this type, we are able to extend the measurement of the electron spectrum beyond the range accessible to direct measurements. We find evidence for a substantial steepening in the energy spectrum above 600 GeV compared to lower energies.

Limits on an energy dependence of the speed of light from a flare of the active galaxy PKS 2155-304

In the past few decades, several models have predicted an energy dependence of the speed of light in the context of quantum gravity. For cosmological sources such as active galaxies, this minuscule effect can add up to measurable photon-energy dependent time lags. In this Letter a search for such time lags during the High Energy Stereoscopic System observations of the exceptional very high energy flare of the active galaxy PKS 2155-304 on 28 July 2006 is presented. Since no significant time lag is found, lower limits on the energy scale of speed of light modifications are derived.

Complications of three sacrospinous ligament fixation techniques

OBJECTIVES

To compare the complications of three techniques used to pass the suture through the sacrospinous ligament when performing sacrospinous ligament fixation (SSLF): (1) the standard needle driver with direct visualization; (2) the Deschamps ligature carrier by palpation; and (3) the Miya hook ligature carrier by palpation.

MATERIALS AND METHODS

A retrospective chart review of 240 patients undergoing SSLF was performed. A standard needle driver with direct visualization was used for 46 patients; the Deschamps ligature carrier was used for 173, and the Miya hook for 21 patients. Intraoperative and postoperative complications were compared between the groups.

RESULTS

Twelve women (5%) had intraoperative and forty women (17%) had postoperative complications suspected directly from the suture placement. There was no statistically significant difference in the rate of total intraoperative complications among the three groups. The proportion of patients with postoperative complications that were felt to be directly related to the suture passage technique was significantly higher in the Deschamps group compared to the direct visualization group (18% vs 2%, P=0.002).

CONCLUSION

Passing the suture through the sacrospinous ligament under direct visualization may result in less intra and postoperative complications.

Determination of priority organic micro-pollutants in water by gas chromatography coupled to triple quadrupole mass spectrometry

A multiclass method has been developed for screening, quantification and confirmation of organic micro-pollutants in water by gas chromatography coupled to mass spectrometry with a triple quadrupole analyzer. The work has been focused on the determination of more than 50 compounds belonging to different chemical families: 19 organochlorine and organophosphorus insecticides, 6 herbicides, 7 polychlorinated biphenyls, 16 polycyclic aromatics hydrocarbons, 2 brominated diphenyl ethers, and 3 octyl/nonyl phenols and pentachlorobenzene. Most of these analytes are included in the list of priority substances in the framework on European Water Policy. Analyte extraction was performed by solid phase extraction using C18 cartridges, and five isotopically labeled standards were added before extraction as surrogates. Analyses were performed by gas chromatography with tandem mass spectrometry (MS/MS) in electron impact mode. Accuracy and precision were evaluated by means of recovery experiments using water samples fortified at two concentration levels (25 and 250 ng L(-1)), with satisfactory results for most of analytes. The excellent selectivity and sensitivity reached in selected reaction monitoring mode allowed us satisfactory quantification and confirmation at levels as low as 25 ng L(-1). Two MS/MS transitions were acquired for each analyte, using the Q/q intensity ratio as a confirmatory parameter. The method developed was applied to the analysis of surface, ground and wastewater samples collected from the Valencia Region (Spain). Analytical methodology using negative chemical ionization mode was also validated for the organochlorine compounds selected, showing a superior sensitivity and lower detection limits.

Identification and characterization of a nodH ortholog from the alfalfa-nodulating Or191-like rhizobia

Nodulation of Medicago sativa (alfalfa) is known to be restricted to Sinorhizobium meliloti and a few other rhizobia that include the poorly characterized isolates related to Rhizobium sp. strain Or191. Distinctive features of the symbiosis between alfalfa and S. meliloti are the marked specificity from the plant to the bacteria and the strict requirement for the presence of sulfated lipochitooligosaccharides (Nod factors [NFs]) at its reducing end. Here, we present evidence of the presence of a functional nodH-encoded NF sulfotransferase in the Or191-like rhizobia. The nodH gene, present in single copy, maps to a high molecular weight megaplasmid. As in S. meliloti, a nodF homolog was identified immediately upstream of nodH that was transcribed in the opposite direction (local synteny). This novel nodH ortholog was cloned and shown to restore both NF sulfation and the Nif+Fix+ phenotypes when introduced into an S. meliloti nodH mutant. Unexpectedly, however, nodH disruption in the Or191-like bacteria did not abolish their ability to nodulate alfalfa, resulting instead in a severely delayed nodulation. In agreement with evidence from other authors, the nodH sequence analysis strongly supports the idea that the Or191-like rhizobia most likely represent a genetic mosaic resulting from the horizontal transfer of symbiotic genes from a sinorhizobial megaplasmid to a not yet clearly identified ancestor.

Nanoparticles: pharmacological and toxicological significance

Nanoparticles are tiny materials (<1000 nm in size) that have specific physicochemical properties different to bulk materials of the same composition and such properties make them very attractive for commercial and medical development. However, nanoparticles can act on living cells at the nanolevel resulting not only in biologically desirable, but also in undesirable effects. In contrast to many efforts aimed at exploiting desirable properties of nanoparticles for medicine, there are limited attempts to evaluate potentially undesirable effects of these particles when administered intentionally for medical purposes. Therefore, there is a pressing need for careful consideration of benefits and side effects of the use of nanoparticles in medicine. This review article aims at providing a balanced update of these exciting pharmacological and potentially toxicological developments. The classes of nanoparticles, the current status of nanoparticle use in pharmacology and therapeutics, the demonstrated and potential toxicity of nanoparticles will be discussed.

Senescence-associated genes induced during compatible viral interactions with grapevine and Arabidopsis

The senescence process is the last stage in leaf development and is characterized by dramatic changes in cellular metabolism and the degeneration of cellular structures. Several reports of senescence-associated genes (SAGs) have appeared, and an overlap in some of the genes induced during senescence and pathogen infections has been observed. For example, the enhanced expression of SAGs in response to diseases caused by fungi, bacteria, and viruses that trigger the hypersensitive response (HR) or during infections induced by virulent fungi and bacteria that elicit necrotic symptoms has been observed. The present work broadens the search for SAGs induced during compatible viral interactions with both the model plant Arabidopsis thaliana and a commercially important grapevine cultivar. The transcript profiles of Arabidopsis ecotype Uk-4 infected with tobacco mosaic virus strain Cg (TMV-Cg) and Vitis vinifera cv. Carménère infected with grapevine leafroll-associated virus strain 3 (GLRaV-3) were analysed using microarray slides of the reference species Arabidopsis. A large number of SAGs exhibited altered expression during these two compatible interactions. Among the SAGs were genes that encode proteins such as proteases, lipases, proteins involved in the mobilization of nutrients and minerals, transporters, transcription factors, proteins related to translation and antioxidant enzymes, among others. Thus, part of the plant's response to virus infection appears to be the activation of the senescence programme. Finally, it was demonstrated that several virus-induced genes are also expressed at elevated levels during natural senescence in healthy plants.

Gene expression associated with compatible viral diseases in grapevine cultivars

Viral diseases affect grapevine cultures without inducing any resistance response. Thus, these plants develop systemic diseases and are chronically infected. Molecular events associated with viral compatible infections responsible for disease establishment and symptoms development are poorly understood. In this study, we surveyed viral infection in grapevines at a transcriptional level. Gene expression in the Vitis vinifera red wine cultivars Carménère and Cabernet-Sauvignon naturally infected with GLRaV-3 were evaluated using a genome-wide expression profiling with the Vitis vinifera GeneChip from Affymetrix. We describe numerous genes that are induced or repressed in viral infected grapevines leaves. Changes in gene expression involved a wide spectrum of biological functions, including processes of translation and protein targeting, metabolism, transport, and cell defense. Considering cellular localization, the membrane and endomembrane systems appeared with the highest number of induced genes, while chloroplastic genes were mostly repressed. As most induced genes associated with the membranous system are involved in transport, the possible effect of virus in this process is discussed. Responses of both cultivars are analyzed and the results are compared with published data from other species. This is the first study of global gene profiling in grapevine in response to viral infections using DNA microarray.

Selective inhibition of phosphodiesterase-4 ameliorates chronic colitis and prevents intestinal fibrosis

The phosphodiesterase-4 (PDE4) inhibitors may be an important target in the treatment of several inflammatory conditions. The anti-inflammatory effect of PDE4 inhibitors bears similarities with that of steroids, without interfering with the hypophysary-adrenal-axis. We compared the effect of rolipram, a selective PDE4 inhibitor, with steroids on the clinical course of experimental colitis induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS). Three groups of rats (n = 20) received TNBS. One group received methylprednisolone from day 7, another group received rolipram from the same day, and control group received no further treatment. On days 14 and 21 after TNBS instillation, sets of 10 rats underwent colonic dialysis to measure eicosanoid release. Colonic lesions were blindly scored, and colons were homogenized for quantification of myeloperoxidase (MPO) activity and collagen content. Concentration of tumor necrosis factor alpha (TNF-alpha) and transforming growth factor beta1 (TGF-beta1) in colonic tissue was also measured. Both treatments reduced significantly the eicosanoid release and MPO activity. On day 14, both rolipram and methylprednisolone significantly reduced TNF-alpha content, but TGF-beta1 was only inhibited by rolipram. On day 21, lesion scores and collagen content were significantly reduced only in rolipram-treated group. In conclusion, PDE4 inhibition by rolipram markedly ameliorates the course of chronic colitis and it is superior to methylprednisolone in preventing late collagen deposition.

[Hypovolemic shock during surgery caused by a rectus sheath hematoma]

Prophylactic treatment with low molecular weight heparins (LMWH) is currently widely used to prevent thromboembolic events. However, such treatment is not free of risk. Among the possible complications described is rectus sheath hematoma. We report the case of a patient undergoing surgery for a hypophysial adenoma approached by the transsphenoidal route. He received LMWH prophylaxis for thromboembolism and showed a tendency to hypotension during surgery. The patient's condition deteriorated to hypovolemic shock accompanied by episodes of atrial fibrillation with rapid ventricular response. With the transfusion of medications, blood products and plasma volume expanders, the patient was stabilized and surgery was completed. A computed tomography scan then revealed a hematoma occupying the greater part of the left anterior rectus muscle. With conservative wait-and-see treatment the abdominal symptoms disappeared and the hematoma gradually receded until fully resolved. Spontaneous rectus sheath hematoma is a rare condition. Presentation is quite nonspecific and computed tomography is needed for reaching a firm diagnosis. When a hematoma is large, the initial clinical picture may include hypovolemic shock, which may develop during surgery if the hematoma is not diagnosed early. Intraoperative management will be much more difficult than it would have been if diagnosis and treatment had taken place before the operation.

Avoiding Free Nipple Grafts During Reduction Mammaplasty in Patients With Gigantomastia

Excessive breast hypertrophy or gigantomastia (>2000 g excision of tissue per breast) has traditionally been approached with breast amputation and free nipple grafting during reduction mammaplasty procedures. Disadvantages of free nipple grafts include loss of sensation, poor projection, uneven nipple-areolar complex pigmentation, and loss of lactation. We report our experiences utilizing the inferior pedicle technique of reduction mammaplasty with successful preservation of the nipple-areola complex for patients with gigantomastia. Between 2001 and 2003, 15 patients (ages 19--45) were identified with gigantomastia through review of pathology and operative reports. The inferior pedicle technique was performed in all cases by the attending staff assisted by plastic surgery residents. Patients were followed regularly from 1 week up to 1 year postoperatively. All patients reported relief from the physical sequelae of breast hypertrophy. One patient experienced bilateral partial nipple desquamation; she maintained sensation throughout and healed well with moist dressings. Otherwise, there were no complications and all patients achieved satisfactory esthetic outcomes. Our results suggest that inferior pedicle technique can be successfully performed in patients with gigantomastia. Breast amputation with free nipple grafting need not be considered standard practice for this patient population. Maintaining a wider pedicle base and meticulous intraoperative handling of the pedicle may contribute to the increased viability of the nipple-areolar complex during these cases.