Showing papers by "Texas Medical Center published in 2009"

Copy number variation in human health, disease, and evolution.

Abstract: Copy number variation (CNV) is a source of genetic diversity in humans. Numerous CNVs are being identified with various genome analysis platforms, including array comparative genomic hybridization (aCGH), single nucleotide polymorphism (SNP) genotyping platforms, and next-generation sequencing. CNV formation occurs by both recombination-based and replication-based mechanisms and de novo locus-specific mutation rates appear much higher for CNVs than for SNPs. By various molecular mechanisms, including gene dosage, gene disruption, gene fusion, position effects, etc., CNVs can cause Mendelian or sporadic traits, or be associated with complex diseases. However, CNV can also represent benign polymorphic variants. CNVs, especially gene duplication and exon shuffling, can be a predominant mechanism driving gene and genome evolution.

Ginseng Compounds: An Update on Their Molecular Mechanisms and Medical Applications

Abstract: Ginseng is one of the most widely used herbal medicines and is reported to have a wide range of therapeutic and pharmacological applications. Ginsenosides, the major pharmacologically active ingredients of ginseng, appear to be responsible for most of the activities of ginseng including vasorelaxation, antioxidation, anti-inflammation and anti-cancer. Approximately 40 ginsenoside compounds have been identified. Researchers are now focused on using purified individual ginsenoside to reveal the specific mechanism of functions of ginseng instead of using whole ginseng root extracts. Each ginsenoside may have different effects in pharmacology and mechanisms due to their different chemical structures. Among them the most commonly studied ginsenosides are Rb1, Rg1, Rg3, Re, Rd and Rh1. The molecular mechanisms and medical applications of ginsenosides have attracted much attention and hundreds of papers have been published in the last few years. The general purpose of this update is to provide current information on recently described effects of ginsenosides on antioxidation, vascular system, signal transduction pathways and interaction with receptors. Their therapeutic applications in animal models and humans as well as the pharmacokinetics and toxicity of ginsenosides are also discussed in this review. This review concludes with some thoughts for future directions in the further development of ginseng compounds as effective therapeutic agents.

Postinjury multiple organ failure

Abstract: Postinjury multiple organ failure (MOF) became prevalent as the improvements in critical care during the 1970s made it possible to keep trauma patients alive with single organ injury. Enormous efforts invested in laboratory and clinical research made it possible to better understand the epidemiology and pathophysiology of the syndrome. This has translated to improved strategies in prediction, prevention and treatment of MOF. With changes in population demographics and injury mechanisms and improvements in trauma care, changes in the epidemiology of MOF are also becoming evident. Significant improvements in trauma patient management decreased the severity and mortality of MOF, but the syndrome still remains the most significant contributor of late postinjury mortality and intensive care unit resource utilisation. This review defines the essential MOF-related terminology, summarises the changing epidemiology of MOF, describes our current understanding of the pathophysiology, discusses the available strategies for prevention/treatment based on the identified independent predictors and provides future directions for research.

Management of patients with anterior abdominal stab wounds: A western trauma association multicenter trial

Abstract: Background:The optimal management of hemodynamically stable, asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe, cost-effective manner. Common evaluation strategies include local wound exploration (LWE)/diagno

Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: A multi-center study of the american association for the surgery of trauma

Abstract: Background:Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clini

Biomarkers for early and late stage chronic allograft nephropathy by proteogenomic profiling of peripheral blood

Abstract: Background Despite significant improvements in life expectancy of kidney transplant patients due to advances in surgery and immunosuppression, Chronic Allograft Nephropathy (CAN) remains a daunting problem. A complex network of cellular mechanisms in both graft and peripheral immune compartments complicates the non-invasive diagnosis of CAN, which still requires biopsy histology. This is compounded by non-immunological factors contributing to graft injury. There is a pressing need to identify and validate minimally invasive biomarkers for CAN to serve as early predictors of graft loss and as metrics for managing long-term immunosuppression.

Blunt Vertebral Artery Injuries in the Era of Computed Tomographic Angiographic Screening: Incidence and Outcomes From 8292 Patients

Abstract: Introduction:Blunt injuries to the vertebral artery (BVI) are rare. Recent improvements in the multidetector computer tomography (MDCT) technology and increased use of screening protocols have led to a greater number of these injuries identified. Well-defined treatment recommendations are still lack

Biofilm presence in humans with chronic suppurative otitis media.

Abstract: Objective To study the presence of biofilm formation in humans with chronic suppurative otitis media (CSOM). Study Design Cross-sectional study. Setting Tertiary academic hospital. Subjects and Methods Patients undergoing middle ear surgery between July 2006 and March 2008. Tissue samples were obtained from 25 patients, of which 20 specimens were successfully processed for this study. The remaining samples were not analyzed due to sample damage or loss during preparation. Of the 20 specimens studied, 10 were harvested as the experimental group from patients with CSOM and the other 10 harvested as controls from patients undergoing otologic surgery for acoustic neuroma, cochlear implant, or routine tympanoplasty. Ages ranged from 26 to 74 years (mean 45 yrs). Male-to-female ratio was 2:3. Scanning electron microscopy and confocal laser scanning microscopy were used to identify the presence of biofilms. Live-dead staining was used to assess whether bacteria present were viable. The outcome measured was the presence of adherent biofilms on middle ear mucosa. Results Biofilms were present in six of 10 samples (60%) from the CSOM group, but only in one of 10 control samples (10%). Comparative analysis revealed a statistically significant difference (P Conclusion Biofilms were statistically more common in patients with CSOM compared with control patients.

Renal transplantation in the elderly

Abstract: Elderly patients are increasingly being considered for kidney transplantation due to a global explosion of the aging population with end-stage renal disease (ESRD). However, mounting scarcity of available organs for transplant has led to a wider disparity between organ supply and demand. Consequently, the criteria for accepting kidneys for transplantation have been extended in an attempt to allow the use of organs from elderly donors or those with significant co-morbidities, so-called “expanded criteria donor” (ECD) kidneys. Excellent outcomes have been achieved from ECD kidneys with appropriate donor and recipient profiling and selection. With increasing recovery efforts directed at older donors, the concept of age-matching is becoming more accepted as a method of optimizing utilization of organs in elderly donors and recipients. Utilization of pulsatile perfusion has further improved ECD outcomes and helped the decision-making process for the UNOS (United Network for Organ Sharing) offer. However, age-related immune dysfunction and associated co-morbidities make the elderly transplant recipients ever more susceptible to complications associated with immunosuppressive agents. Consequently, the elderly population is at a higher risk to develop infections and malignancy in the post-transplant period notwithstanding improved transplant outcomes. Appropriate immunosuppressive agents and dosages should be selected to minimize adverse events while reducing the risk of acute rejections and maximizing patient and renal allograft survival.

Postinjury Abdominal Compartment Syndrome: Are We Winning the Battle?

Abstract: Postinjury (primary) abdominal compartment syndrome (ACS) was described more than 15 years ago as severe abdominal distension with high peak airway pressures, CO2 retention, and oliguria, which led to unplanned re-exploration after damage-control laparotomy. Later, a more elusive type of ACS was recognized, which develops without abdominal injuries (secondary ACS). Both syndromes were recently characterized, their independent predictors were identified, and preventive strategies were developed to reduce their incidence. Once viewed as a syndrome with almost uniform mortality, systematic preventative strategies and therapeutic efforts have reduced the prevalence, morbidity, and mortality of the syndrome. This review was designed to summarize the recent advances in the management of ACS, to classify the currently available evidence, and to identify future directions of research and clinical care.

Posterior Reversible Encephalopathy Syndrome: A Review

Abstract: Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures as well as images suggesting whitegray matter edema involving in most cases posterior regions of the central nervous system, as demonstrated by magnetic resonance image. The development of PRES is most commonly associated with hypertensive encephalopathy, preeclampsia-eclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and immunosuppressive/cytotoxic drugs. While usually reversible, the early recognition and treatment of this syndrome is important to prevent permanent neurological sequelae. The treatment is based in the management or withdrawal of the triggering factor. In this manuscript we will briefly review the pathogenesis, clinical scenario, diagnostic studies and management of PRES.

Patients with Alzheimer disease have altered transmitral flow: echocardiographic analysis of the vortex formation time.

Abstract: OBJECTIVE There is considerable epidemiologic evidence that Alzheimer disease (AD) is linked to cardiovascular risk factors and associated with an increased risk of symptomatic left ventricular (LV) dysfunction. Formation of a vortex alongside a diastolic jet signifies an efficient blood transport mechanism. The vortex formation time (VFT) is an index of optimal conditions for vortex formation. We hypothesized that AD and its associated cardiovascular risk factors impair diastolic transmitral flow efficiency and, therefore, shift the VFT value out of its optimal range. METHODS Echocardiographic studies were performed on 45 participants in total: 22 patients with AD diagnosed according to the American Psychiatric Association's criteria and 23 age-matched individuals as a control group with cognitive function within normal limits. RESULTS The echocardiographic ratio of the early to atrial phases of the LV filling velocities was significantly lower in the AD group (mean +/- SD, 0.67 +/- 14) when compared with the control individuals (0.79 +/- 0.14; P = .003). The interventricular septum diastolic thickness, left ventricular posterior wall diastolic thickness, and right ventricular end-diastolic diameter were significantly higher in the AD group (P

Intravenous Tissue Plasminogen Activator in Patients With Cocaine-Associated Acute Ischemic Stroke

Abstract: Background and Purpose— The safety of thrombolytic therapy in patients with cocaine-associated acute ischemic stroke (CIS) is unknown. Methods— We conducted a retrospective review of patients with CIS who presented to our stroke center. Thrombolytic treatment was compared between cocaine-positive (n=29) and cocaine-negative (n=75) patients. We also compared patients with CIS treated with tissue plasminogen activator versus those who did not receive tissue plasminogen activator (n=58). Safety outcomes were determined by the incidence of symptomatic intracerebral hemorrhage, in-hospital mortality, and modified Rankin Scale at hospital discharge. Results— There were no complications in tissue plasminogen activator-treated patients with CIS. Cocaine-positive and cocaine-negative treated patients had similar stroke severity and safety outcomes. Patients with CIS treated with tissue plasminogen activator had more severe strokes on baseline National Institutes of Health Stroke Scale but similar safety outcomes c...

Concomitant antipsychotic prescribing in US outpatient settings.

Abstract: Background Clinicians use concomitant antipsychotic therapy for management of psychotic disorders despite a paucity of evidence for this practice. Objective To examine national patterns and determinants of concomitant antipsychotic therapy. Methods Concomitant antipsychotic therapy was defined as simultaneous use of 2 or more antipsychotic agents. Prescription data from the 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey were used to characterize the prescribing of concomitant antipsychotic therapy and antipsychotic monotherapy (defined as use of a typical or atypical agent). Multiple logistic regression was applied to antipsychotic visits to examine the determinants of concomitant antipsychotic therapy based on patient and provider characteristics. Results Overall, concomitant antipsychotic therapy was documented in 9% of the visits involving antipsychotic agents, and monotherapy in 91% of the visits. The use of atypical agents, namely risperidone, olanzapine, and quetiapine, was common in both forms of therapy. Concomitant therapy was frequently used for psychoses and bipolar disorder. Logistic regression revealed that the odds of receiving concomitant antipsychotic therapy were higher for patients younger than 65 years, with greatest odds (odds ratio = 6.52) for patients 40 to 64 years old. Having a diagnosis of psychosis quadrupled (odds ratio = 4.33) the odds of receiving concomitant antipsychotic therapy. Physicians in metropolitan areas were more likely (odds ratio = 2.17) to use concomitant antipsychotic therapy than physicians in non-metropolitan areas. Conclusions Concomitant antipsychotic therapy continues to be prevalent and extensive in outpatient settings. With the use of concomitant antipsychotic therapy as a quality of care measure, there is a need to optimize prescribing of these potent combinations.

The Role of SRC-1 in Murine Prostate Carcinogenesis Is Nonessential due to a Possible Compensation of SRC-3/AIB1 Overexpression

Abstract: The androgen and androgen receptor (AR)-regulated gene expression plays important roles in normal prostate and prostate cancer development, and AR transcriptional control of genes is mediated by transcriptional coactivators, including the three members of the steroid receptor coactivator (SRC) family, SRC-1 (NCOA1), SRC-2 (TIF2/GRIP1/NCOA2) and SRC-3 (AIB1, ACTR/RAC3/NCOA3). SRC-1 and SRC-3 are overexpressed in multiple human endocrine cancers and knockdown of either one of them in prostate cancer cell lines impedes cellular proliferation. Knockout of SRC-3 in mice suppresses the progression of spontaneous prostate carcinogenesis. In this study, we investigated SRC-1 contribution to prostate cancer in vivo by deleting the SRC-1 gene in TRAMP mice, which contain the probasin promoter-driven SV40 T/t antigen transgene. In assessing tumor mass of mice at various ages, we found that initiation and progression of prostate cancer induced by SV40 T/t antigens were unaltered in SRC-1(-/-) mice versus WT mice. Primary tumor histology and metastasis to distant lymph nodes were also similar in these mice at all time points assessed. These results demonstrate that the role of SRC-1 in mouse prostate carcinogenesis is nonessential and different from the essential contribution of SRC-3 that is required for prostate cancer progression and metastasis in mice. Interestingly, we observed that during prostate tumorigenesis SRC-1 expression was relatively constant, while SRC-3 expression was significantly elevated. Therefore, the loss of SRC-1 function may be compensated by SRC-3 overexpression during prostate tumorigenesis in SRC-1(-/-) mice.

Performance of Dedicated Versus Integrated Bipolar Defibrillator Leads with CRT-Defibrillators: Results from a Prospective Multicenter Study

Abstract: Introduction: Right ventricular (RV) anodal stimulation may occur in cardiac resynchronization therapy defibrillators (CRT-D) when left ventricular (LV) pacing is configured between the LV lead and an electrode on the RV defibrillator lead. RV defibrillator leads can have a dedicated proximal pacing ring electrode (dedicated bipolar) or utilize the distal shocking coil as the proximal pacing electrode (integrated bipolar). This study compares the performance of integrated versus dedicated leads with respect to anodal stimulation incidence, sensing, and inappropriate ventricular tachyarrhythmia detection in patients implanted with CRT-D. Methods: Two hundred ninety-two patients were randomly assigned to receive dedicated or integrated bipolar RV leads at the time of CRT-D implantation. Patients were followed for 6 months. Results: Patients with dedicated bipolar RV leads exhibited markedly higher rates of anodal stimulation than did patients with integrated leads. The incidence of anodal stimulation was 64% at implant for dedicated bipolar RV leads compared to 1% for integrated bipolar RV leads. The likelihood of anodal stimulation in patients with dedicated leads fell progressively during the 6-month follow-up (51.5%), but always exceeded the incidence of anodal stimulation in patients with integrated leads (5%). Clinically detectable undersensing and oversensing were very unusual and did not differ significantly between lead designs. There were no inappropriate ventricular tachyarrhythmia detections for either lead type. Conclusion: Integrated bipolar RV defibrillator leads had a significantly lower incidence of RV anodal stimulation when compared to dedicated bipolar RV defibrillation leads, with no clinically detectable oversensing or undersensing, and with no inappropriate ventricular tachyarrhythmia detections for either lead type.

Technical feasibility of transnasal endoscopic anterior ethmoid artery ligation: assessment with intraoperative CT imaging.

Abstract: BACKGROUND The objective of this study was to evaluate the technical feasibility of endoscopic anterior ethmoid artery (AEA) ligation for acute control of epistaxis. METHODS A prospective study was conducted using eight cadaver heads. Pre- and intraoperative CT scans were performed using the xCAT (Xoran Technologies, Inc., Ann Arbor, MI). Skull base anatomy relative to the AEA was reviewed preoperatively. Endoscopic AEA ligation was attempted in all sides with a mesentery. Ligation was not deemed feasible in AEAs without a mesentery. It was attempted on two sides without a mesentery to assess risk of skull base and orbital disruption. Intraoperative CT scans were performed to assess the position of the clips and the integrity of the skull base and lamina papyracea. RESULTS The mean lateral lamella height was 4.75 and 4.83 mm on the right and left, respectively. Of the 16 arteries, 6 (37.5%) of the AEAs were within a bony mesentery. No AEA canals were dehiscent. Four of the six AEAs (66%) within a mesentery were successfully clipped and two (33%) were partially clipped by endoscopic evaluation. Both arteries without mesentery where clipping was attempted were partially clipped by endoscopic examination. Review of intraoperative CT scans showed that the AEA with a mesentery was clipped successfully on three sides, partially on one side, and unsuccessfully on two sides. AEA clipping was unsuccessful on both sides without a mesentery. One AEA without a mesentery showed skull base disruption after ligation by endoscopy and CT. None of the specimens showed orbital injury. CONCLUSION Intraoperative CT scanning revealed that AEA ligation was less successful than was apparent endoscopically. Effective AEA clipping was performed in 50% of cases with a mesentery. Endoscopic clipping was not technically feasible in cases with AEA without a mesentery. Overall, AEA clipping was only technically feasible in 3 of 16 sides (18.8%).

Obesity and gastroesophageal refl ux disease and gastroesophageal refl ux symptoms in children

Abstract: Background: The association between body mass index (BMI) and gastroesophageal refl ux disease (GERD) has been extensively studied among adults but few studies have examined such association in children. Aims: 1) to determine the relationship between BMI in children and GERD, and 2) to use the National Center for Health Statistics (NCHS) values for BMI as a valid source for comparison. Methods: We identifi ed two cohorts of children aged between two and 17 years who were seen at Texas Children’s Hospital (TCH). The fi rst cohort consisted of children diagnosed with GERD based on upper gastrointestinal endoscopic and histologic evaluation, which was recorded in the Pediatric Endoscopic Database System-Clinical Outcomes Research Initiative (PEDS-CORI) at TCH. A diagnosis of GERD was based on the presence of erosive esophagitis or esophageal ulcers. Endoscopic reports that were incomplete or did not include demographic features, indications for endoscopy, or endoscopic fi ndings were excluded. The second cohort consisted of all children with symptoms due to gastroesophageal refl ux (GER) who received outpatient gastrointestinal (GI) consultation at TCH for any 9th revision of the International Statistical Classifi cation of Diseases (ICD-9) code suggestive of GER. There was no overlap between the two cohorts as each child was indexed only once. Children with any comorbid illnesses were excluded. Measurements: The records for each child namely, age, gender, height, and weight were obtained

Unmet prescription medication need in U.S. children.

Abstract: Objective To examine the nature and extent of unmet prescription medication need (UPMN) in children and its predictors using the 2003 National Survey of Children’s Health (NSCH). Design Retrospective cross-sectional survey. Setting United States in 2003–2004. Participants Parents or guardians who knew most about child’s ( Intervention NSCH—a population-based telephone survey—based on complex probability sampling design. Main outcome measures Nature and extent of UPMN in children and predictors of UPMN for any reason and as a result of cost, health plan problems, and lack of insurance within the conceptual framework of the Andersen behavioral model. Results According to NSCH, 0.54 million (95% CI 0.46–0.62) or 1.23% (1.05–1.41%) of children experienced UPMN. The highest prevalence of UPMN was seen among blacks (2.3%), families with income less than 200% of federal poverty level (2.4%), and those having good, fair, or poor perceived health status (3.2%). A high prevalence of UPMN was also found in children with gained (5.3%), lost (3.7%), or no insurance (6.4%). Among children with UPMN, 35.39% (28.56–42.23%) did not receive medications because of cost, 26.51% (20.28–32.74%) because of health plan problems, and 40.73% (33.21–48.24%) because of lack of insurance. Multivariate logistic regression analysis revealed that predisposing (race), enabling (poverty and insurance), and need (perceived health status and depression) factors were significantly associated with UPMN for any reason. Factors significantly associated with UPMN due to cost included enabling (insurance) and need (attention deficit hyperactivity disorder and asthma) factors. The predictors of UPMN resulting from health plan problems included predisposing (race) and enabling (insurance) factors, whereas UPMN caused by lack of insurance was only associated with an enabling factor (age). Conclusion More than 0.5 million children in the United States experienced UPMN, mainly as a result of cost, health plan problems, or lack of insurance. The study findings suggest that a need exists for addressing racial disparities and continuity of coverage issues in children to improve access to needed prescription medications.

Clinical and Laboratory Findings during Gonadotropin Therapy of Post Pubertal Hypogonadotropic Hypogonadism

Abstract: Zusammenfassung Klinische und Laboratoriums-Befunde wahrend einer Gonadotrophin-Therapie bei postpuberalem hypogonadotropen Hypogonadismus Kasuistische Mitteilung einer Beobachtung von hypogonadotropem Hypogonadismus (postpuberal aufgetreten), bei der es gelang, durch eine Behandlung mit HCG (2000 I.E. dreimal wochentlich) und vom 35. Tage zusatzlich dreimal wochentlich 1 Ampulle Pergonal (HMG) eine Oligozoospermie im Ejakulat mit 14.8 Mill. Sp./ml bei 70% Motilitat zu erreichen. Vom 126. bis 334. Behandlungstage wurde die HMG-Dosis auf 3 mal 2 Ampullen pro Woche gesteigert, die HCG-Behandlung blieb unverandert. Gleichzeitig mit einem Anstieg der Testosteron-Werte im Blutplasma kam es erstmalig auch zu einer Entleerung von Ejakulat, ein Phaenomen, das bis dahin nicht zu beobach-ten gewesen war. Die Ejakulatmenge stieg kontinuierlich unter der Behandlung bis auf 3,5 ml. Das gleiche gilt fur die Spermatozoendichte und die Motilitat. In der 7. Woche nach Behandlungsbeginn (2. Woche nach Beginn der HMG-Zufuhr) kam es zu einer deutlichen Steigerung von Libido und Potentia coeundi; gleichzeitig trat eine Akne vulgaris auf, und es kam zu einer Zunahme des Haarwachstums im Bartbereich, sowie in den Axillen und am Korper. Mit Absetzen der Hofmonzufuhr waren alle Parameter, deren Zunahme unter der Behandlung festzustellen war, wieder rucklaufig. Resumen Hallazgos clmicos y de laboratorio, durante el tratamiento con gonadotrof inas del hipogonadismo hipogonadotrofico, post-puberal Parece claro que la estimulcacion eficaz de la espermatogenesis, requiere no solo HMG, sino tambien HCG. En este trabajo, los autores exponen los resultados de production de testosterona, recuento espermatico y respuesta clinica antes y durante la terapia con HCG y HMG, en un varon de 32 afios, casado, que consulto por impotencia y esterilidad. Presentaba una piel fina y seca, barba escasa, vello corporal de distribution femenina. Pene normal. Testes blandos, de 3×1,5 cm. Prostata pequefia. Silla turca y cariotipo noimales (se descarto la eyaculacion retrogada). La testosterona plasmatica era baja. La biopsia testicular mostro tubulos seminiferos pequenos con celulas de Sertoli y alguna espermatogonia. En el intersticio no habia celulas de Leydig. Hizo tratamiento con HCG (2000 UI, tres veces por semana), 35 dias. El dia 30 eyaculo, si bien no habia espermatozoides. La testosterona plasmatica aumento. A partir del dia 35, se anadio HMG. A la segunda semana de tratamiento con HMG, aumento la libido y la potencia, aperecio acne, crecio el vello axilar y corporal. Entre el dia 98 y 126 de tratamiento, aparecieron espermatozoides meviles en el eyaculado, Uegandose a 14′8 milliones/ml. y 70% de formas moviles. La testosterona no cambio. Al suspender el tratamiento, disminuyb la testosterona plasmatica, la libido y la potencia. Se trate con 200 mg. de enantato de testosterona cada 3 semanas con lo que se reinstauro la potencia y la libido; la barba y el vello corporal se mantuvieron. Habio eyaculacion pero no espermatozoides. La evaluacion de la funcion gonadal revelo una incapacidad para producir niveles normales de testosterona in vivo y una disminucion en la capacidad de matabolizar un precursor esteroideo a testosterona “in vitro”. Como se esperaba la actividad espermatogenica y estereidogenica respondieron a la terapia con HMG y HCG, si bien ningun parametro alcanzo cifras de un adulto normal. Es posible que las dosis empleadas fuesen insuficientes. La respuesta clinica fue, no obstante optima. Esto sugiere que en el adulto normal, ias manifestaciones clinicas de androgenicidad (potencia, libido, crecimiento de la barba) pueden ser mantenidas con niveles circulantes de testosterona por debajo de lo normal.

Cortical resection tailored to awake, intraoperative ictal recordings and motor mapping in the treatment of intractable epilepsia partialis continua: Technical case report

Abstract: OBJECTIVE: Epilepsia partialis continua (EPC) is a form of status epilepticus that is characterized by continuous simple partial seizures and can occur as a manifestation of a variety of underlying pathological processes. Because these seizures typically take onset within or close to motor cortex, the treatment of refractory EPC with resective surgery risks significant postoperative deficits. CLINICAL PRESENTATION: We describe our experience using ictal recordings obtained intraoperatively during awake craniotomy, in conjunction with direct cortical stimulation mapping, to tailor surgical resections in 2 patients with refractory EPC. Both patients had pan-hemispheric pathologies that made extraoperative recording difficult. INTERVENTION: Awake craniotomy takes advantage of a unique feature of refractory EPC, namely the near-continuous presence of focal seizure activity. It allows the surgeon to record seizures in the operating room and precisely define the anatomic location of epileptic activity, to resect the seizure focus, and to both visually and electrographically confirm successful cessation of EPC after resection, all within a single operation. We used standard methods of awake craniotomy to finely tailor a cortical resection to the epileptogenic cortex while sparing nearby eloquent motor areas. The precision of awake mapping made this approach safe and effective. CONCLUSION: The cases we describe demonstrate the role of focal resection in the treatment of EPC. Standard techniques of awake craniotomy have application in the treatment of this challenging problem.

A fatal case of posttraumatic gastric mucormycosis.

Abstract: A Fatal Case of Posttraumatic Gastric Mucormycosis John Berne;David Villarreal;Thomas McGovern;Stephen Rowe;Forrest Moore;Scott Norwood; The Journal of Trauma: Injury, Infection, and Critical Care

An enzymatic defect in androgen biosynthesis in human testis: a case report and response to therapy.

Abstract: Zusammenfassung Enzymatischer Defekt der Androgen-Biosynthese im menschlichen Hoden: Bericht uber eine eigene Beobachtung und Reaktion auf die Therapie:: Bei einem 35jahrigen Mann mit Oligozoospermie und sekundarer Infertilitat wird uber eingehende experimentelle Untersuchungen berichtet, die eine exzessive Aktivitat der 5α-Reduktase im Hodengewebe aufdeckte. Man kann davon ausgehen, das eine hohe Gewebskonzentration von Testosteron im Hoden erforderlich ist fur eine normale Spermiogenese. Das bedeutet, das die Reifung des Androgenbiosynthese-Weges letztlich eine Verminderung der 5α-Reduktase-Aktivitat nach sich zieht. Eine Behandlung mit Gonadotropinen wurde vorgenommen aufgrund folgender uberlegungen: Ein Anstieg der zirkulierenden Gonadotropinwerte konnte zu einem Anstieg der Gesamtsteroid-bildung in den Hoden und konsequenterweise zu einer hoheren Testosteronproduktion fuhren. Andererseits konnte die Gonadotropintherapie zu einer weiteren Reifung der Androgen-Biosynthese und einer dadurch verursachten herabgesetzten 5α-Reduktase-Aktivitat mit Anstieg der Testosteronproduktion fuhren. Unter der Gonadotropinzufuhr, die uber viele Monate durchgefuhrt wurde, kam es zu einem Anstieg der Testosteronproduktion und auserdem zu einem vollig normalen Spermiogramm. Es besteht die Moglichkeit, das der hier vorgestellte Fall eine inkomplette oder gestoppte Reifung des Androgen-Biosyntheseweges in den Hoden darstellt. Resumen Defecto enzimatico en la biosintesis de androgenos en el testiculo humano: Presentacion de un caso y respuesta al tratamiento: La mayoria de las veces en pacientes con oligozoospermia o azoospermia se llega a un diagnostico de fallo del tubulo seminlfero no especifico. Los autores han estudiado un hombre oligozoospermico con aparente alteracion en la biosintesis esteroidea testicular, al parcer debida a defecto enzimatico especifico. El paciente de 35 anos presentaba una disminucion de la libido siendo el resto de la anamnesis y exploracion fisica general y genital normal, salvo un pequeno varicocele izdo. El estudio del eyaculado mostro un escaso volumen y un recuento bajo con aumento de los espermatozoides inmaduros. La FSH era normal y la LH baja. La testosterona plasmatica y su produccion fueron bajas. Se efectuo cura del varicocele y biopsia testicular bilateral. El estudio histopatologico mostro una disminucion en el numero de espermatides maduros y las celulas de Leydig aparecian hipertroficas y formando acumulos. Otro fragmento de tejido testicular se incubo con progesterona tritiada de la que solo un 1′2% y un 2% respectivamente se transformaron en testosterona y androstenediona. Un gran cantidad de substrato (33%) se convirtio en 5α pregnano, 3β-al-20 ona. Este hecho es sugestivo de una excesiva actividad de la 5α reductasa. Se adminostro 2.000 VI de HCG, 3 veces por semana y posteriormente se anadio2 ampollas a la semana de HMG. Con HCG aumento la testosterona pero no con el recuento espermatico. Con la HMG aumento el recuento, la motilidad y por ultimo la testosterona. Seis meses despues de esta terapia discontinua, la esposa quedo embarazada. Se ha demostrado que la testosterona es esencial para la espermatogenesis. Los gonadotrofinas actuarian aumentando la esteroidogenesis total del testiculo o disminuyendo la actividad de la 5α reductasa. Es interesante que la testosterona y el recuento espermatico no se normalizaron hasta que se adminostro HMG. Desafortunadamente no se pudo efectuar una rebiopsia para re-evaluar los pasos de la biosintesis esteroidea. Segun los autores es el primer caso reportado de alteracion enzimatica en la esteroidogenesis testicular asociado a oligospermia y baja produccion de testosterona. Quizas, postulan los autores, los pacientes oligozoospermicos que han respondido al tratamiento gonadotrofico, tenian una anormalidad similar en las enzimas involucradas en la esteroidogenesis testicular.

Determinants of Health Disparities in Italian Regions

Abstract: There is an extensive literature on regional disparities in health, but much of thisliterature focuses on the United States. Among European countries, Italy is the country whereregional health disparities contribute the most to socioeconomic health disparities. In this paper,we report on regional differences in self-reported poor health and explore possible determinantsat the individual and regional levels in Italy. We use data from the “Indagine Multiscopo sulle Famiglie”, a survey of aspects ofeveryday life in the Italian population, to estimate multilevel logistic regressions that model poorself-reported health as a function of individual and regional socioeconomic factors. Next we usethe causal step approach to test if living conditions, healthcare characteristics, social isolation,2and health behaviors at the regional level mediate the relationship between regionalsocioeconomic factors and self-rated health. We find that residents living in regions with more poverty, more unemployment, andmore income inequality are more likely to report poor health and that poor living conditions andprivate share of healthcare expenditures at the regional level are determinants of socioeconomicdisparities in self-rated health among Italian regions. The implications are that regional contexts matter and that regional policies in Italyhave the potential to reduce health disparities by implementing interventions aimed at improvingliving conditions and access to quality healthcare.

The incidence and complications of methicillin-resistant Staphylococcus aureus in a community Level I trauma center.

Abstract: Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a growing cause of infections among hospitalized trauma patients. We examined the incidence and infectious consequences of MRSA among trauma patients admitted to our Level I Trauma Center during 24 months. Methods: Nasal swab cultures were obtained at admission and on hospital day 5. Patient demographics and infectious complications were recorded and compared. Differences with p values less than 0.05 were considered significant. Results: Admission MRSA screening was positive in 71 patients, yielding a carrier prevalence rate of 5.8% (95% CI 4.5―7.1%). No admission characteristic was associated with positive MRSA screening. Twelve patients (1.7%, 95% CI 0.7―2.6%) who were MRSA negative at admission tested positive for MRSA on hospital day 5. The clinical MRSA infection incidence rate was 1.4% (95% CI 0.7―2.0%). The screening test for MRSA at admission demonstrated a sensitivity of 23.5% (95% CI 6.8―49.9%) and specificity of 94.5% (95% CI 93―95.7%) for predicting MRSA infection. MRSA infections were associated with increased lengths of stay: intensive care unit 17.7 versus 5.1 days, p < 0.001, hospital 23.1 versus 8.6 days, p < 0.001. Conclusions: MRSA infections affect a minority of our trauma patients yet prolong length of stay. Admission MRSA screening of trauma patients does not sufficiently identify patients at risk for infectious complications and should not be practiced.

Imaging in oncological urology

Abstract: Imaging in oncological urology / , Imaging in oncological urology / , کتابخانه دیجیتال جندی شاپور اهواز