Laparoscopic appendectomy during pregnancy

Appendectomy is the most common nonobstetric operation during pregnancy, but laparoscopy has not been considered to be the preferred procedure until recently. The objective of this study was to report the authors' experience with laparoscopic appendectomy during pregnancy and to review the available literature. Six patients underwent laparoscopic appendectomy during pregnancy, and 24 additional cases from the literature were reviewed. Two patients underwent surgery during the first trimester of pregnancy, three patients underwent surgery during the second trimester, and one patient underwent surgery during the third trimester. The Hasson open technique was used in five cases, and the Veress needle was used in one case. Port site locations were adapted to the size of the gravid uterus. Three patients had histologically confirmed appendicitis and underwent delivery of a neonate after 36 weeks (n = 1) and 37 weeks (n = 2) of gestation. Two patients had uterine infections and underwent abortions 2 days after surgery and 6 weeks after surgery, respectively. One patient had an isolated torsion of the right fallopian tube that was diagnosed using laparoscopy. These results show that laparoscopic appendectomy can be safely performed during pregnancy. One limitation may be the size of the gravid uterus, which interferes with adequate visualization and instrumentation in the third trimester of pregnancy.

Crohn's disease as a risk factor for the outcome of pregnancy

BACKGROUND/AIMS

To study the effects of Crohn's disease on the course of pregnancy and the influence of pregnancy on the activity of Crohn's disease.

METHODOLOGY

The course of 35 pregnancies in 23 women with Crohn's disease were reviewed over a 12 years period.

RESULTS

Nine pregnancies (25%) started when Crohn's disease was active. We observed 2 exacerbations among the 9 pregnancies with active disease and 7 exacerbations among the 26 pregnancies with quiescent disease: this represents a total exacerbation rate of 26% similar to non-pregnant women with Crohn's disease. The course of pregnancy was normal with a full-term delivery in 22 cases (63%). We observed 5 premature deliveries (14%), 5 spontaneous abortions (14%), 1 induced abortion (3%) and 2 liveborns with severe malformations (6%). Preterm delivery was significantly associated with reactivation of Crohn's disease during pregnancy (P = 0.009), whereas fetal loss was significantly associated with activity of Crohn's disease at the time of conception (P = 0.015).

CONCLUSIONS

Pregnancy does not appear to influence the course of Crohn's disease. The relapse rate of Crohn's disease during pregnancy is similar to that of the general Crohn's disease population. Active Crohn's disease at the time of conception or reactivation during pregnancy are risk factors for abnormal pregnancy outcome.

[Nodular lymphangitis caused by Nocardia asteroides]

BACKGROUND

Nocardia species are typically found in soil and decaying organic matter. The lymphocutaneous type or nodular lymphangitis is unusual. This is acquired in most of cases by a traumatic inoculation through the skin of a person who is immunocompetent, and is generally caused by Nocardia brasiliensis.

METHODS

We report two cases of nodular lymphangitis caused by Nocardia asteroides, that have been admitted in our hospital during one year period.

RESULTS

The two healthy persons of 26 and 56 years old suffered from a cutaneous puncture in their arms caused by a plant's pricke while they were gardening. The symptoms they showed at the area of the puncture were ulcerative lesion and inflammatory nodules through the lymphatic tract that were abscessed. There were not any systemic involvement. Cultures of the purulent drainage and skin biopsy revealed Nocardia asteroides. Treatment with oral trimethoprim-sulfamethoxazole for 8 weeks and surgical debridement resulted in a cure without relapse.

CONCLUSION

Nodular lymphangitis has specific symptoms and clinical signs. A detailed clinical and occupational history, accompanied by microbiology identification at the cutaneous biopsy and exudation, should allow specific treatment. Trimethoprim-sulfamethoxazole continues being the selected antibiotic.

GFR alpha-1 is expressed in parvalbumin GABAergic neurons in the hippocampus

Glial cell line derived neurotrophic factor (GDNF) is a potent survival factor for several types of neurons. GDNF binds with high affinity to GDNF-family receptor alpha-1 (GFR alpha-1). This receptor is expressed in different areas of the brain, including the hippocampus and dentate gyrus. By using in situ hybridization and immunohistochemistry, we found that 19% to 37% of glutamic acid decarboxylase (GAD) expressing neurons co-expressed GFR alpha-1 in the hippocampus. GFR alpha-1/GAD co-expression was found mainly in the stratum (s) pyramidale (29-37%) and s. oriens (20-25%). Further characterization of GFR alpha-1 expressing interneurons, based on their calcium-binding protein immunoreactivity, demonstrated that many parvalbumin (PV) immunoreactive neurons express GFR alpha-1 in the s. pyramidale of CA1 (72%), CA2 (70%) and CA3 (70%) subfields of the hippocampus. GFR alpha-1/PV double labeled neurons were also detected in the s. oriens of CA1 (52%), CA2 (27%) and CA3 (36%) subfields. The expression of GFR alpha-1 in principal neurons and in a specific sub-population of GABAergic neurons (PV-containing neurons) suggest that GDNF might modulate, in a selective manner, functions of the entire adult hippocampus.

Safety evaluation of a recombinant myxoma-RHDV virus inducing horizontal transmissible protection against myxomatosis and rabbit haemorrhagic disease

We have recently developed a transmissible vaccine to immunize rabbits against myxomatosis and rabbit haemorrhagic disease based on a recombinant myxoma virus (MV) expressing the rabbit haemorrhagic disease virus (RHDV) capsid protein [Bárcena et al. Horizontal transmissible protection against myxomatosis and rabbit haemorragic disease using a recombinant myxoma virus. J. Virol. 2000;74:1114-23]. Administration of the recombinant virus protects rabbits against lethal RHDV and MV challenges. Furthermore, the recombinant virus is capable of horizontal spreading promoting protection of contact animals, thus providing the opportunity to immunize wild rabbit populations. However, potential risks must be extensively evaluated before considering its field use. In this study several safety issues concerning the proposed vaccine have been evaluated under laboratory conditions. Results indicated that vaccine administration is safe even at a 100-fold overdose. No undesirable effects were detected upon administration to immunosuppressed or pregnant rabbits. The recombinant virus maintained its attenuated phenotype after 10 passages in vivo.

Proteolysis of the exodomain of recombinant protease-activated receptors: prediction of receptor activation or inactivation by MALDI mass spectrometry

Protease-activated receptors (PARs) mediate cell activation after proteolytic cleavage of their extracellular amino terminus. Thrombin selectively cleaves PAR1, PAR3, and PAR4 to induce activation of platelets and vascular cells, while PAR2 is preferentially cleaved by trypsin. In pathological situations, other proteolytic enzymes may be generated in the circulation and could modify the responses of PARs by cleaving their extracellular domains. To assess the ability of such proteases to activate or inactivate PARs, we designed a strategy for locating cleavage sites on the exofacial NH(2)-terminal fragments of the receptors. The first extracellular segments of PAR1 (PAR1E) and PAR2 (PAR2E) expressed as recombinant proteins in Escherichia coli were incubated with a series of proteases likely to be encountered in the circulation during thrombosis or inflammation. Kinetic and dose-response studies were performed, and the cleavage products were analyzed by MALDI-TOF mass spectrometry. Thrombin cleaved PAR1E at the Arg41-Ser42 activation site at concentrations known to induce cellular activation, supporting a native conformation of the recombinant polypeptide. Plasmin, calpain and leukocyte elastase, cathepsin G, and proteinase 3 cleaved at multiple sites and would be expected to disable PAR1 by cleaving COOH-terminal to the activation site. Cleavage specificities were further confirmed using activation site defective PAR1E S42P mutant polypeptides. Surface plasmon resonance studies on immobilized PAR1E or PAR1E S42P were consistent with cleavage results obtained in solution and allowed us to determine affinities of PAR1E-thrombin binding. FACS analyses of intact platelets confirmed the cleavage of PAR1 downstream of the Arg41-Ser42 site. Mass spectrometry studies of PAR2E predicted activation of PAR2 by trypsin through cleavage at the Arg36-Ser37 site, no effect of thrombin, and inactivation of the receptor by plasmin, calpain and leukocyte elastase, cathepsin G, and proteinase 3. The inhibitory effect of elastase was confirmed on native PAR1 and PAR2 on the basis of Ca(2+) signaling studies in endothelial cells. It was concluded that none of the main proteases generated during fibrinolysis or inflammation appears to be able to signal through PAR1 or PAR2. This strategy provides results which can be extended to the native receptor to predict its activation or inactivation, and it could likewise be used to study other PARs or protease-dependent processes.

Actin-dependent regulation of neurotransmitter release at central synapses

Depolymerization of actin by latrunculin A transiently promotes neurotransmitter release. The mean rate of mEPSCs increases by a Ca2+-independent process, without a concomitant change in the mean amplitude. The readily releasable vesicle pool size and the rate of refilling of the readily releasable pool remain unaltered by latrunculin treatment. Evoked neurotransmitter release also increases in a manner consistent with an increase in vesicle release probability. The observed enhancement of neurotransmitter release is specific to actin depolymerization mediated by latrunculin A and is not caused by cytochalasin D. Our findings indicate that actin participates in a regulatory mechanism that restrains fusion of synaptic vesicles at the active zone.

Chronic methamphetamine exposure decreases high affinity uptake function in norepinephrine afferents in the cerebellar cortex: an electrophysiological and electrochemical study

It has been reported that chronic methamphetamine (MA) treatment decreases monoamine release in different brain regions. However, the clearance of norepinephrine (NE) after chronic MA intake is not clear. In the present study, we administered MA to Sprague-Dawley rats for 1 month. The animals were later anesthetized with urethane for electrophysiological recording. Previous studies have indicated that gamma-aminobutyric acid (GABA)-induced electrophysiological responses are enhanced by norepinephrine (NE) acting via postsynaptic beta-adrenergic receptors. We found that local application of the NE high affinity uptake inhibitor desmethylimipramine (DMI) significantly potentiated GABA-induced electrophysiological depressions in cerebellar Purkinje neurons in control rats. In contrast, DMI did not augment GABA responses in rats chronically treated with MA for 1 month, or in rats withdrawn from MA for 7-14 days after a 1-month MA treatment. To further examine if DMI-induced GABA modulation is altered by post- or pre-synaptic mechanisms in chronic MA-treated rats, we examined the electrophysiological interaction of GABA and isoproterenol (ISO), a postsynaptic beta-adrenergic receptor agonist, in Purkinje neurons. We found that GABA-induced inhibition is potentiated by local application of ISO in both control and chronic MA rats, suggesting that the reduction in DMI/GABA interactions is probably not mediated through post-synaptic noradrenergic mechanisms. Presynaptic NE clearance was further examined using in vivo chronoamperometric methods. Extracellular NE levels in the cerebellar cortex were measured using Nafion-coated carbon fiber sensors. We found that local application of DMI inhibited NE clearance in control rats, but not in chronic MA animals, suggesting that presynaptic NE clearance is reduced after chronic MA treatment. In addition, NE levels in cerebellar tissue were measured using HPLC-ECD. The NE concentration was significantly decreased in chronic MA rats. Taken together, our data suggest that regulation of uptake by DMI at central noradrenergic nerve terminals is abnormal after chronic MA exposure.

Syncope associated with hypertrophic cardiomyopathy in a dromedary camel

A case of hypertrophic cardiomyopathy in a dromedary camel (Camelus dromedarius) is described for the first time. The patient, a castrated 9-year-old animal, presented with a 6-month history of several episodes of syncope after moderate exercise and later at rest. The syncope had a sudden onset and a duration of 30 to 45 seconds. After clinical, electrocardiographical and echocardiographical examination, a tentative diagnosis of hypertrophic cardiomyopathy was made. At necropsy, the heart had a globose shape and was firm on palpation. The left ventricular free wall and the interventricular septum were thickened in cross-section and the left ventricular lumen was small. The clinical diagnosis was confirmed by histologic examination of heart tissue that demonstrated hypertrophy of myocardial fibres with vesicular nuclei and the presence of diffuse interstitial fibrosis.

Severe incisional pain and long thoracic nerve injury after port-access minimally invasive mitral valve surgery

The authors describe the occurrence of severe postoperative pain and long thoracic nerve injury after Port-Access minimally invasive mitral valve surgery. The potential for these events and the impact on postoperative hospitalization and rehabilitation are emphasized.

Isolation of an attenuated myxoma virus field strain that can confer protection against myxomatosis on contacts of vaccinates

Twenty MV strains obtained from a survey of field strains currently circulating throughout Spain were analyzed for their virulence and horizontal spreading among rabbits by contact transmission. A virus strain with suitable characteristics to be used as a potential vaccine against myxomatosis in wild rabbit populations was selected. Following inoculation, the selected MV strain elicited high levels of MV specific antibodies and induced protection of rabbits against a virulent MV challenge. Furthermore, the attenuated MV was transmitted to 9 out of 16 uninoculated rabbits by contact, inducing protection against myxomatosis.

Treatment of catheter-induced thrombotic superior vena cava syndrome: a single institution's experience

Thrombosis is the most frequent benign etiology of superior vena cava syndrome among cancer patients who have a long-term central venous catheter. In this paper, six cases of thrombotic superior vena cava syndrome are discussed. There were four women and two men. One patient was treated with streptokinase and five with urokinase. The mean age was 46 years (range 22-69), and the mean time for thrombosis development after catheter insertion was 125 days (range: 53-211 days). The mean time for resolution of thrombosis was 7 days (range 2-11) in five patients. One patient had no response to fibrinolysis.

Influence of mixing and water addition on the removal rate of toluene vapors in a biofilter

The effects of successive mixing (homogenization) of packing material (peat), with or without water addition, on the removal of toluene vapors in a biofilter were studied. Over a period of 50 days, an increase in the Elimination Capacity (EC) of approximately 240% was obtained by successive mixing and water additions. After each mixing, a high EC of toluene was maintained only for a short period of 3-4 days. After this time, decreased biofilter performance was observed, probably associated with the development of dried and/or clogged zones. In the long-term experiments, an attenuation of the EC recovery was observed after successive mixing. In this case, an increase of 110% over 4 months of experiment was obtained. The global reduction of EC over time could be explained by the colonization of the biofilter by filamentous fungi which was facilitated by the mixing of the packing material. The most frequently observed fungi were identified as Scedosporium sp. and Cladosporium sp.

Glial cell line-derived neurotrophic factor in the rat pituitary gland

The presence of glial cell line-derived neurotrophic factor (GDNF) is described within specific regions of the adult rat pituitary gland. Immune staining methods revealed a small number of GDNF-immunopositive cells in the anterior lobe, and in areas of the neural lobe, while no immunoreactive endocrine cells were observed in the intermediate lobe. In the neural lobe, immunofluorescence methods were also used to demonstrate that GDNF and glial fibrillary acidic protein (GFAP) are co-localized in the glial cells (pituicytes) of the neural lobe. GDNF was not co-localized with neurofilament (NF) in nerve fibers of the neural lobe, suggesting that it is not present in axonal fibers. Measurements of GDNF content in separated anterior and neurointermediate lobes were also performed, using an enzyme-linked immunoassay (ELISA). Values for GDNF were slightly higher in the neurointermediate lobe than those obtained for the anterior lobe. The presence of GDNF in areas of the pituitary is discussed in the context of its possible function to support and maintain hypothalamic innervation, as well as a potential autocrine factor within endocrine cells.

Acute ethanol induction of c-Fos immunoreactivity in pre-pro-enkephalin expressing neurons of the central nucleus of the amygdala

Previous studies have shown that acute ethanol administration induces expression of c-Fos immunoreactivity in the central nucleus of the amygdala (CNA) [S.L. Chang, N.A. Patel, A.A. Romero, Activation and desensitization of Fos immunoreactivity in the rat brain following ethanol administration, Brain Res., 679 (1995) 89-98; M. Morales, J.R. Criado, P.P. Sanna, S.J. Henriksen, F.E. Bloom, Acute ethanol induces c-fos immunoreactivity in GABAergic neurons of the central nucleus of the amygdala, Brain Res., 798 (1998) 333-336; A.E. Ryabinin, J.R. Criado, S.J. Henriksen, F.E. Bloom, M.C. Wilson, Differential sensitivity of c-Fos expression in hippocampus and other brain regions to moderate and low doses of alcohol, Mol. Psychiatry, 2 (1997) 32-43]. We recently showed that over 70% of these c-Fos immunoreactive neurons are GABAergic [M. Morales, J.R. Criado, P.P. Sanna, S.J. Henriksen, F.E. Bloom, Acute ethanol induces c-fos immunoreactivity in GABAergic neurons of the central nucleus of the amygdala, Brain Res, 798 (1998) 333-336]. In the present study, we report that ethanol-induced c-Fos immunoreactivity was mainly confined to neurons that express pro-enkephalin (ENK). In contrast, a small number of c-Fos immunoreactive neurons express corticotrophin releasing factor (CRF). Our results thus provide anatomical evidence indicating that within the amygdala, GABAergic neurons that contain ENK are responsive to acute ethanol exposure.

Development of two spanish versions of the verbal selective reminding test

The Selective Reminding procedure has become a widely used test for evaluating verbal learning and memory. However, since this test was mainly devised for use in English speaking individuals, disadvantages could appear when translations of the test are applied to Spanish speaking patients. To overcome these difficulties, two Spanish versions of the Verbal Selective Reminding Test were devised and administered to 48 healthy individuals, 19-31 years in age, in two separate sessions. We found that performances on the two forms were comparable, except for one measure. All the variables on both forms yielded significant positive correlations. We also examined test-retest reliability separately for both possible orders, with Order 2 (Form 2 administered first) being more reliable than Order 1 (Form 1 administered first).

Vitamin D(3) attenuates cortical infarction induced by middle cerebral arterial ligation in rats

We have previously reported that intracerebral administration of glial cell line derived neurotrophic factor (GDNF) reduces the extent of middle cerebral arterial (MCA) ligation-induced cortical infarction in rats. Recent studies have shown that application of 1, 25 dihydroxyvitamin D(3) (D3) enhances GDNF mRNA expression in vitro. The purpose of the present study was to investigate if administration of D3 in vivo will protect against ischemic brain injury. Adult male Sprague-Dawley rats were injected daily with D3 or with saline for four or eight days. Animals received a 90-min right MCA ligation on the 4(th) or 8(th) day after anesthesia with chloral hydrate. Animals were sacrificed for tri-phenyl-tetrazolium chloride (TTC) staining 24 h after the onset of reperfusion. A subset of animals receiving eight days of D3 or saline treatment were used for blood gas and cerebral GDNF protein level analysis. We found that pretreatment with D3 for four days did not attenuate the ischemic injury. However, animals receiving eight days of D3 injections showed a significant reduction in the amount of infarction in the cortex. Eight day D3 treatment did not alter blood gases or blood pressure; however, it did increase calcium levels. Pretreatment with D3 significantly increased GDNF levels in the cortex. In conclusion, our data indicate that D3 reduces ischemia-induced brain damage and supports the hypothesis that this effect may be through the up-regulation of GDNF mechanisms in cortex.

Horizontal transmissible protection against myxomatosis and rabbit hemorrhagic disease by using a recombinant myxoma virus

We have developed a new strategy for immunization of wild rabbit populations against myxomatosis and rabbit hemorrhagic disease (RHD) that uses recombinant viruses based on a naturally attenuated field strain of myxoma virus (MV). The recombinant viruses expressed the RHDV major capsid protein (VP60) including a linear epitope tag from the transmissible gastroenteritis virus (TGEV) nucleoprotein. Following inoculation, the recombinant viruses induced specific antibody responses against MV, RHDV, and the TGEV tag. Immunization of wild rabbits by the subcutaneous and oral routes conferred protection against virulent RHDV and MV challenges. The recombinant viruses showed a limited horizontal transmission capacity, either by direct contact or in a flea-mediated process, promoting immunization of contact uninoculated animals.

Clinical implications of increased plasma angiotensin II despite ACE inhibitor therapy in patients with congestive heart failure

AIMS

The aim of the study was to assess the incidence and clinical implications of increased plasma angiotensin II despite chronic ACE inhibitor therapy in patients with heart failure.

METHODS AND RESULTS

The studied population consisted of 70 patients (mean age 59+/-9 years). Plasma renin activity and plasma concentration of aldosterone, norepinephrine, atrial natriuretic peptide, angiotensin II, tumour necrosis factor, interleukin-6 and interleukin-1B were assessed at 6 months of ACE inhibitor therapy. Mean left ventricular ejection fraction was 24+/-5% and the end-systolic and end-diastolic diameters were 59+/-9 and 71+/-8 mm, respectively. Despite chronic enalapril or captopril therapy, 35 patients (50%) had increased plasma angiotensin II (median 33 pg. ml(-1), range 17-84), while it was in the normal range in the remaining 35 patients (median 10 pg. ml(-1), range 5-15). Plasma renin activity (P=0.005), interleukin-6 (P=0.004), New York Heart Association functional class III-IV (P=0. 006), furosemide dose (P=0.01), lack of beta-blocker therapy (P=0. 04) and norepinephrine (P=0.04) were univariately associated with increased angiotensin II. Multivariate regression analysis identified the plasma renin activity (0.0004), norepinephrine (0.02) and interleukin-6 (0.03) as independent predictors of plasma angiotensin II. During follow-up (35+/-29 months), nine (12.8%) patients died and 13 had new heart failure episodes. Increased plasma angiotensin II, despite ACE inhibitor therapy, was a significant predictor of death or heart failure according to the Kaplan-Meier survival method by log rank test (P=0.002).

CONCLUSION

Fifty per cent of patients with heart failure, ha increased plasma angiotension II despite chronic ACE inhibitor therapy. These patients had higher neurohormonal activation and poor prognosis.

A selective group of dopaminergic neurons express Nurr1 in the adult mouse brain

Nurr1, an orphan receptor of the nuclear receptor superfamily, is widely expressed in the central nervous system (CNS) including brain regions where dopaminergic neurons are abundant. Recent analyses of Nurr1 null mutant mice have shown that Nurr1 is essential for the development and survival of midbrain dopaminergic neurons. However, other dopaminergic neuronal populations do not seem to be affected by ablation of the Nurr1 gene. The purpose of the present study was to investigate the degree of co-existence of Nurr1 mRNA and tyrosine hydroxylase (TH) immunoreactivity in the brain of adult mice to better characterize the selective effects of Nurr1 on catecholaminergic neurons. Our results indicate that the majority of TH-immunoreactive neurons in the substantia nigra (SN; 96%), ventral tegmental area (VTA; 95%), retrorubral field (91%), olfactory bulb (85%), linear nucleus raphe (91%) and central grey (61%) express Nurr1. In contrast, dopaminergic cells of the paraventricular and periventricular hypothalamic nucleus showed only a few Nurr1/TH double labeled neurons, while TH-immunoreactive neurons in the arcuate nucleus and zona incerta did not express Nurr1 mRNA. Nurr1 expression was also excluded from (nor)adrenergic neurons of the brainstem. In conclusion, Nurr1 transcripts were not found in all CNS catecholaminergic neurons. Nurr1 expression was confined to periglomerular and midbrain dopaminergic neurons. These results suggest that within the adult mouse brain, Nurr1 may participate in dopaminergic functions of the olfactory bulb and midbrain.

Possible participation of an islet B-cell calcium-sensing receptor in insulin release

The calcium-sensing receptor gene was recently shown to be expressed in rat pancreatic islets and purified islet B-cells. In this study, we investigated the possible role of this receptor in the regulation of insulin release from isolated rat pancreatic islets. Poly-L-arginine (0.2-0.3 microM) and poly-L-lysine (0.03-0.1 microM) increased insulin output evoked by D-glucose (8.3 mM). This positive effect faded out at higher concentrations of the basic peptides. Likewise, the release of insulin evoked by 8.3 mM D-glucose was significantly lower at high (1.0 mM) than low (0.05-0.1 mM) concentrations of neomycin. The insulinotropic action of Ba2+ in Ca2+-deprived islets was potentiated in rats pretreated with pertussis toxin. However, Gd3+ inhibited insulin release evoked by D-glucose in islets prepared from normal rats or animals pretreated with pertussis toxin and incubated in the absence or presence of either theophylline or forskolin. Gd3+ (0.3 mM) failed to affect effluent radioactivity from islets prelabeled with myo-[2-3H]inositol and cyclic AMP net production in islets incubated in the absence or presence of forskolin. Gd3+ decreased, however, 45Ca efflux from prelabeled islets perifused in the absence or presence of extracellular Ca2+. It is speculated that a negative insulinotropic action mediated by the calcium-sensing receptor, and possibly attributable to a fall in cytosolic Ca2+ concentration, may prevent excessive insulin secretion in pathological situations of hypercalcemia.