Early outcomes of patients transferred with ruptured suprarenal aneurysm or dissection.

Objective Despite centralisation of the provision of vascular care, not all areas in England and Wales are able to offer emergency treatment for patients with acute conditions affecting the aorta proximal to the renal arteries. While cardiothoracic centres have made network arrangements to coordinate care for the repair of type A dissections, a similar plan for vascular care is lacking. This study investigates early outcomes in patients with ruptured suprarenal aortic aneurysm or dissection (rSRAD) transferred to a specialist centre. Methods Retrospective observational study over a five-year period (2009-2014) assessing outcomes of patients with ruptured sRAD diagnosed at their local hospital and then transferred to a tertiary centre capable of offering such treatment. Results Fifty-two patients (median age 73 years, 32 male) with rSRAD were transferred and a further four died during transit. The mean distance of patient transfer was 35 miles (range 4-211 miles). One patient did not undergo intervention due to frailty and two died before reaching the operating theatre. A total of 23 patients underwent endovascular repair, 9 hybrid repair and 17 open surgery. Median follow-up was 12 months (range 1-43 months). Complications included paraplegia (n = 3), stroke (n = 2), type IA endoleak (n = 4); 30-day and in-hospital mortality were 16% and 27%. For patients discharged alive from hospital, one-year survival was 67%. Conclusions Although the number of patients with rSRAD is low and those who are transferred alive are a self-selecting group, this study suggests that transfer of such patients to a specialist vascular centre is associated with acceptable mortality rates following emergency complex aortic repair.

Role of nitric oxide in catalepsy and hyperthermia in morphine-dependent rats.

The possible involvement of nitric oxide (NO) in morphine-induced catalepsy and hyperthermia was studied in morphine-dependent rats. Four days repeated injection regimen was used to induce morphine dependence, which was assessed by naloxone challenge (0.5 mg x kg(-1), s.c.). Pretreatment of rats with the NO synthase inhibitor, N(G)-nitro-L-arginine (L-NA, 8 mg x kg(-1) twice daily, i.p.) potentiated the cataleptic response of morphine as shown by a rightward shift in the morphine-log dose-response curve. Prior treatment of rats with the NO precursor, L-arginine (200 mg x kg(-1), twice daily, i.p.) abolished the potent effect of L-NA and restored the cataleptic scores to levels similar to those of morphine-dependent rats. The same dose of L-NA significantly blocked morphine-induced hyperthermia at the dose levels of morphine (15-105 mg x kg(-1)) and this effect was reversed by L-arginine. These data provide the first experimental evidence that NO is involved in morphine induced catalepsy and hyperthermia and demonstrated that blockade of NO synthesis may suggest a dangerous interaction with opioids in the control of motor function.

Testosterone facilitates the baroreceptor control of reflex bradycardia: role of cardiac sympathetic and parasympathetic components.

Reported clinical and experimental findings have shown that baroreflex control of heart rate is attenuated in women compared with men. This study investigated whether the sexual dimorphism in baroreflex function relates to the ability of the male hormone testosterone to facilitate baroreflex responsiveness. Relative contributions of the vagal and sympathetic autonomic components to testosterone modulation of baroreflex function were also investigated. Baroreflex curves relating changes in heart rate to increases or decreases in blood pressure evoked by phenylephrine and sodium nitroprusside, respectively, were constructed in sham-operated rats and castrated rats with and without testosterone replacement. Slope of the curves was taken as an index of baroreflex sensitivity (BRS PE and BRS NP ). Castration (for 10 days) significantly reduced plasma testosterone levels and attenuated reflex bradycardia, as indicated by significantly smaller BRS PE in castrated rats compared with values in sham-operated rats (-0.85 +/- 0.07 vs. -1.51 +/- 0.10 beats/min per mm Hg). Testosterone replacement in castrated rats restored plasma testosterone and BRS PE to levels similar to those of sham-operated rats. Muscarinic blockade by atropine caused 55% reduction in BRS PE in sham-operated rats, an effect that was significantly (p < 0.05) attenuated in castrated rats and restored to intact levels after testosterone supplementation. beta-Adrenergic blockade by propranolol caused slight and insignificant decreases in BRS PE. Castration and testosterone supplementation had no effect on BRS NP, ruling out a modulatory effect of testosterone on reflex tachycardia. These data provide the first experimental evidence of a favorable role for testosterone in baroreceptor control of reflex bradycardia. Further, baroreflex modulation by testosterone appears to be autonomically mediated and involves an enhancement of cardiomotor vagal activity.

Demodex folliculorum causing pathological lesions in immunocompetent children.

Scabies and pediculosis are the vast major ectoparasites infesting man. Demodex folliculorum is unreported ectoparasite, since it is considered harmless. Marked pathologic infestations caused by D. folliculorum were diagnosed in five immunocompetent children, The infestations are successful treated with 2% permethrin cream.

Role of carboxyl terminus of mu-and delta-opioid receptor in agonist-induced down-regulation.

Chronic exposure of mu-and delta-opioid receptors to their agonists leads to different rates in receptor down-regulation. In order to analyze the role of the carboxyl terminus of mu-and delta-opioid receptors in the difference in the rate of down-regulation, two chimeras of these receptors were generated by swapping the carboxyl termini; MORTAGDT and DORTAGMT. These chimeras were tagged at the N-terminus with hemagglutinin (HA) epitope (YPYDVPDYA), which can be recognized by the monoclonal antibody 12CA5, and then stably expressed in Neuro 2A (N2A) cells. The swapping of the carboxyl termini did not alter the ligand selectivity of these receptor chimeras. However, they did exhibit a reduction in agonist potency to inhibit forskolin-stimulated adenylyl cyclase activity for all agonists tested except etorphine which had a potency comparable to that of wild type receptors. Treatment of the N2A cells expressing MORTAGDT with 50 nM etorphine produced a faster rate of receptor down-regulation when compared to the wild type mu-opioid receptor. Immunofluorescence microscopy of the MORTAGDT chimera using a monoclonal antibody against HA confirmed internalization of the receptors after treatment with etorphine for 1 and 6h. There was a reduction in the HA-immunoreactivity at the cell surface of the MORTAGDT chimera concurrent with more noticeable HA-immunoreactivity inside the cell compared to the wild type receptor. On the other hand, the rate of down-regulation of DORTAGMT receptors was seen to be the same as the wild type delta-opioid receptor after etorphine treatment. Immunofluorescence studies showed more reduction in cell surface staining of the DORTAGMT chimera compared to the wild type receptor. These data suggest the involvement of the carboxyl terminus in agonist-induced down-regulation and internalization of the nu-opioid receptor. However, different mechanisms that are unrelated to the carboxyl terminus may operate in the down-regulation of delta-opioid receptor.

Immunohistopathological status of the skin in cases infested with three species of mites.

This study was performed on eighty patients with clinical manifestations of scabies. Sarcoptes scabiei adult or larva was isolated from 39 patients (48.8%). Dermanyssus gallinae (red poultry mite) and Dermatophagoides sp. were isolated from 6 and 5 patients respectively. Punch biopsies were taken from the patients, stained with haematoxylin and eosin and direct immunofluorescence stain to study the immunopathological status of the skin infested with three species of mites. The results declared that the pathological changes and the immunoglobulin deposition in the skin were nearly similar regardless of the type of the causative mite with the except of the presence of burrows in Sarcoptes scabiei.

Antibodies against toxoplasma in children and adults with malignancy.

Twenty five children and adults with different types of malignancies were picked up from the attendants of Mansoura University Hospital and Ain Shams University Paediatrics Hospital. Their sera were examined for anti-Toxoplasma IgG and IgM antibodies by the micro-ELISA before and after chemotherapy treatment. Ten normal cross-matched individuals were selected as a control group. The results revealed seropositive IgG in 22 (88%) of patients before treatment and in 23 (92%) after treatment. The anti-Toxoplasma IgM was positive in three (12%) patients before treatment and in six (24%) after treatment. On the other hand, two of the control group showed a seropositive Toxoplasma IgG (20%) but negative anti-Toxoplasma IgM. The results were discussed.

Response of Egyptian infants with protein calorie malnutrition to hepatitis B vaccination.

The response to recombinant hepatitis B vaccine was assessed in 31 seronegative infants (2-26 months old) with protein calorie malnutrition (PCM), compared with 13 seronegative age- and sex-matched healthy infants. Both groups received three 10 micrograms vaccine doses at 0, 1, and 6 months. At month 8, all healthy infants and 87 per cent (27 out of 31) of PCM infants were seroprotected. Thus, hepatitis B vaccination (Engerix-B, SmithKline Beecham Biologicals) can be used effectively in PCM for mass vaccination in developing communities.

Effect of Luffa aegyptiaca (seeds) and Carissa edulis (leaves) extracts on blood glucose level of normal and streptozotocin diabetic rats.

The present study investigates the effect of oral administration of the ethanolic extracts of Luffa aegyptiaca (seeds) and Carissa edulis (leaves) on blood glucose levels both in normal and streptozotocin (STZ) diabetic rats. Treatment with both extracts significantly reduced the blood glucose level in STZ diabetic rats during the first three hours of treatment. L. aegyptiaca extract decreased blood glucose level with a potency similar to that of the biguanide, metformin. The total glycaemic areas were 589.61 +/- 45.62 mg/dl/3 h and 660.38 +/- 64.44 mg/dl/3 h for L. aegyptiaca and metformin, respectively, vs. 816.73 +/- 43.21 mg/dl/3 h for the control (P < 0.05). On the other hand, in normal rats, both treatments produced insignificant changes in blood glucose levels compared to glibenclamide treatment.

Thermal modeling of the malignant woman's breast.

In this paper the conceptual three-dimensional model of the normal woman's breast presented in Osman and Afify, is developed into a detailed quantitative model of the malignant woman's breast. This model takes into consideration the effect of tumor size and location on the metabolic heat production, blood perfusion rate, and thermal contour plot of the malignant breast for each tumor size, depth, and location. Also the results of this investigation show that a hot spot in the malignant woman's breast thermal contour plot may not be directly related to an embedded tumor beneath the breast surface.

Thermal modeling of the normal woman's breast.

A comprehensive thermal model of the normal woman's breast is presented. The model is developed taking into consideration metabolic heat production, tissue perfusion with capillary blood, arterial and venous blood thermal interaction and change of arterial blood temperature with position. A series of computer programs are written using a 3-dimensional finite-element technique to evaluate the surface temperature distribution of the breast. Comparison between the results obtained for the model and those from thermograms of a woman's breast are in good agreement.

An experimental study of velocity distribution in a human lung cast.

A mechanical lung model with branching up to five generations, developed from an actual human lung, is used to study experimentally the velocity profiles in the trachea and the main branches. Three different flow rates representing light, medium, and heavy breathings have been simulated for both inhalation and exhalation. The velocity profiles, except for the one in the trachea in the frontal direction due to exhalation, are in good agreement with the velocity profiles in simplified models of published literature.