A rare case of lumbosacrococcygeal mass in newborn: a human tail.

Caudal cutaneous appendage is a rare condition. According to association with underlying spinal dysraphism, it can be classified into true or pseudotails. Management and prognosis depends closely on spinal anomaly. Fewer than 40 cases of true tail were reported. We describe a rare case of true tail in a newborn explored and operated in our unity.

Calculation of gyrotropy coefficients in media with low-pitch helical structures.

Chiral smectic liquid crystals are known for their huge optical activity due to the precession of the anisotropic dielectric tensor around the helicoidal axis. For an oblique direction of the propagating wave, the helix acts as a grating which splits an incident beam in different directions as long as the pitch is not too small with respect to the light wavelength. When the pitch of the helix is smaller than the wavelength, the effect of the helix is a renormalization of the gyrotropic coefficients (g_{⊥} and g_{∥}) of the resulting uniaxial medium. We report here on a method to compute these coefficients in that limit. Resolution of the Maxwell equations, using a perturbative approach, gives expressions for g_{⊥} and g_{∥} as a power development of the ratio (p/λ). The various terms of these developments coincide with the approximate expressions of these coefficients known in the literature.

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia.

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Lack of effects of an acute hepatic vagotomy on insulin and catecholamine responses in rats following exercise.

The purpose of the present investigation was to evaluate the effects of an acute hepatic vagotomy on hormonal responses to hyperglycemic and hypoglycemic challenges in rats previously submitted to an exercise protocol. Two experiments were conducted. In a first experiment, 8-week trained (TR) and untrained (UNTR) rats, subdivided into acutely hepatic vagotomized (HV) and sham-operated (SHM) groups, were submitted to an intraperitoneal glucose tolerance test (0.5 g/kg) under anesthesia. Training was associated with a tendency (P = 0.07) for blood glucose levels to be less elevated (at time point 10 min), and with a significant (P < 0.01) lower glucose/insulin ratio following the glucose injection. The HV did not have any effects on these responses. In a second experiment, non-exercised rats and a group of rats submitted to an acute bout of exercise (treadmill, 60 min, 26 m/min, 5% slope) 24 h before the experiment, each one of these two groups being subdivided into acutely HV and SHM groups, were submitted to an insulin-induced hypoglycemia protocol, under anesthesia. Blood glucose concentrations were decreased significantly (P < 0.01) to approximately 40 mg/dl in all groups 60 and 80 min after the insulin injection. Plasma adrenaline and noradrenaline levels were increased significantly (P < 0.01) in all groups. The catecholamine increase was not influenced by the HV or the acute exercise bout. The present results do not indicate an implication of the hepatic vagus nerve on hormonal responses to hyper and hypoglycemia following exercise.

Role of L-type Ca2+ channel in PACAP-induced adrenal catecholamine release in vivo.

The aim of the present study was to investigate whether the dihydropyridine-sensitive L-type Ca2+ channel is operative in adrenal catecholamine (CA) secretion induced by a novel neuropeptide, pituitary adenylate cyclase-activating polypeptide (PACAP), in anesthetized dogs. Plasma CA concentrations in adrenal venous and aortic blood were determined by a high-performance liquid chromatography method. All drugs tested were locally infused into the left adrenal gland via the left adrenolumbar artery. PACAP, with the isoform consisting of 27 (PACAP-27) and 38 (PACAP-38) amino acid residues, significantly increased CA output in a dose-dependent manner, with doses ranging from 5 to 500 ng and 7 to 700 ng, respectively. However, the amplitude of epinephrine response to PACAP-27 was three times greater than that obtained with PACAP-38 at the highest dose tested. In a separate group, a single dose of PACAP-27 (50 ng) induced highly reproducible CA responses when the same dose was repeated with an interval of 35 min. In dogs treated with nifedipine (50 microg), 5 min before the second administration of PACAP-27, the net CA response was significantly inhibited by approximately 50% compared with that obtained in the presence of vehicle. A similar CA response to BAY K 8644 (5 microg) was completely abolished by the same dose of nifedipine. The present results indicate that both PACAP-27 and PACAP-38 have the direct local secretagogue effect on the adrenal medulla in vivo and that CA responses to PACAP-27 were greater than those observed with PACAP-38 at equivalent mole doses. The study suggests that the dihydropyridine-sensitive L-type Ca2+ channel is functionally involved in PACAP-induced adrenal CA secretion in the canine adrenal medulla in vivo.

Arginine-induced pancreatic hormone secretion during exercise in rats.

The aim of the present investigation was to 1) determine whether arginine-induced pancreatic hormone secretion can be modified during an exercise bout, and 2) verify whether the sectioning of the hepatic branch of the vagus nerve can alter the arginine-induced insulin and glucagon secretion during exercise in rats. To this end, we studied the effects of an intraperitoneal injection of arginine (1 g/kg body mass) during an exercise bout (30 min, 26 m/min, 0% grade) on the pancreatic hormone responses. These effects were determined in one group of sham-operated exercising rats and compared with three control groups: one group of resting rats, one group of saline-injected exercising rats, and one group of hepatic-vagotomized exercising rats. Five minutes after the injection of arginine, significant (P < 0.05) increases in insulin, glucagon, and C-peptide concentrations were observed in exercising as well as in resting rats. These responses were not, however, altered by the hepatic vagotomy and/or by the exercise bout. It is concluded that arginine is a potent stimulus of pancreatic hormone secretion during exercise, even though the sympathoadrenal system is activated. These results also indicate that a hepatic vagotomy does not seem to influence arginine-induced hormonal pancreatic responses and question the role of the putative hepatic arginoreceptors in the control of the pancreatic hormone secretion during exercise.

Nutritional status influences the insulin response produced by acute hepatic vagotomy.

It has been established that the liver, through the afferent pathway of the vagus nerve, can influence insulin secretion. The purpose of the present study was to determine if this influence can be altered by different nutritional status aimed at inducing metabolic changes in the liver. This was carried out by comparing the insulin response 30 min after sectioning of the hepatic vagus branch in five experimental conditions: a normal (NCD) and a medium-fat (MFD) for 3 weeks, both with and without an overnight fast, and after an overloading liver glycogen protocol (normal diet). All experiments were conducted using anesthetized, adrenodemedullated rats. Blood was collected before and after (30 min) the hepatic vagotomy (HV) or a sham operation (SHM). As expected, liver glycogen levels were significantly (p < 0.01) lower in the fasted than in the fed condition, and were approximately 50% higher (p < 0.01) in the overloaded than in the normally fed condition. Basal insulin concentrations were also lower (p < 0.01) in the fasted compared to the fed groups, but were significantly (p < 0.01) increased by the medium-fat diet. Plasma glucose levels were significantly (p < 0.01) decreased by the overnight fast, but were not affected by the hepatic vagotomy. Plasma catecholamine concentrations were similar in all experimental conditions. Insulin concentrations were significantly (p < 0.05) increased by the HV, compared to SHM rats, in all experimental conditions (from 50% to 75%). The extent of this response was altered by the diet manipulations as the HV-induced insulin increase was greater (p < 0.01) in the MFD than in the NCD groups, whether fed or fasted. Furthermore, and contrary to our expectations, high hepatic glycogen contents did not reduce the insulin response to an acute hepatic vagotomy. These results indicate that the insulin increase induced by an acute HV is influenced by the prevailing metabolic conditions, and suggest that the hepatic vagus nerve exerts a constant inhibition on insulin secretion, independently of the hepatic glycogen content.

Impact of single use versus reuse of cellulose dialyzers on clinical parameters and indices of biocompatibility.

Hemodialysis with reprocessed dialyzers has been associated with an increased mortality in patients on chronic dialysis, but the causes for this increased mortality have not been identified thus far. The aim of this study was to compare the qualitative and/or quantitative differences in activation of cellular and plasma elements, intradialytic signs and symptoms, adequacy of dialysis, and serum biochemistry and hematology in patients dialyzed with new or reprocessed cellulose dialyzers. This study measured the plasma levels and production of interleukin-1 receptor antagonist (IL-1Ra) by peripheral blood mononuclear cells (PBMC), indices of cytokine synthesis; plasma C3a levels, an index of complement activation; plasma levels of lipopolysaccharide binding protein (LBP), an acute phase reactant; and plasma levels of bactericidal-permeability increasing factor (BPI), a neutrophil primary granule protein, in 37 patients on chronic hemodialysis with glutaraldehyde and bleach-reprocessed cellulose dialyzers after random assignment to 12 wk of dialysis with new (single use) or reprocessed (reuse) cellulose dialyzers. These indices were studied before dialysis, 15 min after the start of dialysis, and at the conclusion of dialysis in both groups. Intradialytic clinical symptoms and signs, urea reduction ratios, monthly blood chemistry, and hematology were also studied during the 12-wk period. Before randomization, clinical and laboratory characteristics and IL-1Ra production by PBMC were similar in the two groups. During the 12-wk study, the mean number of dialyzer reuses was 7 +/- 1 in the reuse group and there were no breaks in protocol in the single-use group. At the end of the study, plasma levels of IL-1Ra, cell content and production of IL-1Ra by unstimulated, endotoxin-stimulated, and lgG-stimulated PBMC among patients assigned to reuse were not significantly different from those in the single-use group either before dialysis, at 15 min, or at the conclusion of dialysis. Similarly, plasma levels of C3a, LBP, and BPl were not significantly different between groups at any of the three time points. During the 12-wk study, none of the patients in either arm of the study experienced chills, rigors, or fever, and there were no differences in the number of episodes of symptomatic hypotension in patients on reused dialyzers (11 +/- 3) compared with patients on single-use dialyzers (8 +/- 2). The mean monthly urea reduction ratio during the 3 months of the study was 63 +/- 2% and 65 +/- 2% for reuse and single-use dialyzers, respectively (not significant). Similarly, the hematocrit, white blood cell count, serum calcium, phosphorus, cholesterol, triglycerides, total protein, and albumin levels were also not significantly different between the two groups at the end of the 12-wk study period. These results suggest that the reprocessing of cellulose dialyzers with glutaraldehyde and bleach does not affect indices of blocompatibility, intradialytic symptoms and signs, adequacy of dialysis, or serum biochemistry and hematology.

[Effect of removal of the adrenal medulla on the hormonal response induced by acute hepatic vagotomy]. / Effet d'une médullosurrénalectomie sur la réponse hormonale induite par une vagotomie hépatique aiguë.

The purpose of the present study was to determine the effects of an acute hepatic vagotomy on plasma insulin and catecholamines levels in fasted and fed rats with and without adrenodemedullation. Rats were first divided into two groups: adrenodemedullated (ADM) and non-adrenodemedullated rats, each group being subdivided into a normally fed and a fasted (14 hrs) group. Anesthetized rats were first ADM or sham operated, and a jugular catheter was inserted. The first blood sample was taken 30 min later (time 0). Rats were then hepatic vagotomized (HV) or sham operated, and the second blood sample was taken 30 min after the HV. Results (0 vs 30 min) indicate an increase in plasma glucose, epinephrine, and norepinephrine concentrations in rats non-adrenodemedullated. This effect was independent of the nutritional state and the integrity of the vagus nerve. A weakly significant (P < 0.07) effect of the HV on insulin response was found in ADM rats, independently of the fed or fast state (different levels of hepatic glycogen content). These results indicate the necessity of using ADM animals to study the effects of an acute HV. They also suggest that the hepato-pancreatic axis is not influenced by the level of hepatic glycogen.

Effect of hepatic vagotomy on plasma insulin levels during fasting in rats.

The present investigation was designed to evaluate the effect of a selective hepatic vagotomy (HV) on the insulin response in rats fasted for 24 h when blood glucose levels were or were not maintained by a constant glucose infusion. Rats were divided into three dietary groups: one group of normally fed rats, one group of 24-h fasted rats, and one group of 24-h fasted rats infused with glucose throughout the fasting period. Each of these groups was subdivided into HV and sham-operated (SHM) rats. Fasting without glucose infusion resulted in a significant (p < 0.05) decrease in plasma glucose, liver glycogen, and insulin concentrations and in a significant (p < 0.01) increase in beta-hydroxybutyrate and FFA concentration. Despite the maintenance of plasma glucose concentrations in the glucose-infused groups, the concentrations of liver glycogen and insulin were still decreased (p < 0.01) and the concentrations of beta-hydroxybutyrate were still increased (p<0.05) at the end of the fasting period. However, no significant differences in insulin or in beta-hydroxybutyrate concentration were found between HV and SHM rats. It is concluded that the decline in plasma glucose concentration during fasting does not totally explain the insulinopenic response to fasting, and that the liver, through the mediation of the hepatic vagus nerve, does not seem to contribute to insulinopenia in 24-h fasted rats.

Effect of inhibition of gluconeogenesis on arginine-induced insulin secretion.

It is well known that several amino acids, such as arginine, are potent stimuli for insulin and glucagon secretion from the pancreas. Recently, vagal arginine sensors, which modulate arginine-induced pancreatic hormone secretion, have been reported to exist in the liver. The present investigation was designed to evaluate the role played by gluconeogenesis in this hepatic influence. To this end, we studied the effects of an intraperitoneal injection of 3-mercaptopicolinic acid (3-MPA), a gluconeogenic inhibitor, on the pancreatic hormonal response induced by intraperitoneal administration of arginine (1 g/kg body mass) to hepatic vagotomized and sham vagotomized rats. Fifteen min following the injection of arginine, the increases in glucose and insulin concentrations were significantly lower in rats with an inhibited gluconeogenesis than in rats with an intact capacity for gluconeogenesis. There were no effects of the hepatic vagotomy on the arginine-induced hormonal responses either with or without the 3-MPA injection. The results suggest that gluconeogenesis is implicated in the hepatic modulation of arginine-induced pancreatic hormone secretion.

Effect of inhibition of hepatic fatty acid oxidation on metabolic and hormonal responses to exercise in rats.

The purpose of the present study was to assess the effects of 2-mercaptoacetate (MA), an inhibitor of hepatic fatty acid oxidation, on the metabolic and pancreatic hormone response to a prolonged (3 h) swimming exercise. All rats were first adrenodemedullated and were either submitted for 3 weeks to a normal (5% fat) or a medium-fat diet (MF; 18% fat). After being submitted to an exercise swimming habituation programme for one week, rats under both dietary conditions were either injected with a bolus dose of MA (600 mumol/kg; ip) or with a saline solution. MA and saline injected rats were either sacrificed after a 3-h swimming exercise or after a 3-h resting period. Administration of MA was associated with a lower level of beta-hydroxybutyrate after exercise in rats fed the MF diet, higher resting and exercising blood glucose levels in rats fed the MF diet, and higher resting and exercising levels of hepatic glycogen in rats fed a normal diet. There were, however, no significant effects of MA on free fatty acid, insulin, glucagon, epinephrine, and norepinephrine concentrations in both dietary conditions either at rest or after exercise. Therefore, the present data do not provide any evidence that the administration of MA, an inhibitor of hepatic fatty acid oxidation, influences the pancreatic hormonal response to exercise. There was also no evidence of a lowering effect of MA on blood glucose levels during exercise.

Combined effect of 2-deoxy-D-glucose and exercise on plasma catecholamine response.

2-Deoxy-D-glucose (2-DG) is a nonmetabolizable analogue of glucose that, by competitive inhibition of glucose utilization, produces a central neuroglucopenia and a peripheral hyperglycemia. This glucopenic agent was used to gain more insight into the combined effects of central glucopenia and exercise on plasma catecholamine response. This was carried out by comparing one group of exercising (26 m/min, 0% grade) rats injected with 2-DG (2-DG-EX; 250 mg/kg iv) with two control groups: one group of exercising rats injected with a saline solution (SAL-EX) and one group of resting rats injected with 2-DG (2-DG-RE). Significant (P less than 0.05) increases in blood glucose levels were observed 10 min after administration of 2-DG (7.2-13.8 and 7.3-12.4 mmol/l in 2-DG-EX and 2-DG-RE groups, respectively). These elevated blood glucose levels were maintained throughout the experiment in the 2-DG-RE condition but decreased in 2-DG-EX rats to levels observed in the SAL-EX group after 45 min of running (13.8-8.0 mmol/l). The combination of 2-DG-induced neuroglucopenia and exercise resulted in an additive response of norepinephrine (0.59 vs. 0.34 and 0.34 ng/ml; t = 12 min) and an amplified epinephrine response (1.4 vs. 0.37 and 0.31 ng/ml; t = 12 min) compared with the responses to each stimulus alone (2-DG-EX vs. 2-DG-RE and SAL-EX, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of hepatic vagotomy on hormonal response to exercise in gluconeogenesis-inhibited rats.

The liver, through the afferent pathway of the hepatic vagus nerve, has been reported to influence the hormonal response to exercise in adrenodemedullated rats. The present investigation was designed to evaluate the role played by gluconeogenesis in this hepatic influence. To this end, we studied the effects of a selective hepatic vagotomy on the hormonal response to a 30-min treadmill run (26 m/min, 0% grade) in adrenodemedullated rats injected with 3-mercaptopicolinic acid, a gluconeogenic inhibitor. Hepatic vagotomy was associated with small but significant higher (P less than 0.05) elevations of peripheral blood glucose levels at rest and after exercise. No significant differences were observed between hepatic-vagotomized and sham-operated rats in either resting or exercising levels of liver glycogen, portal glucose, portal and peripheral insulin and glucagon, and peripheral epinephrine and norepinephrine. All hormonal responses, with the exception of epinephrine, were either decreased or increased similarly in the two experimental conditions after exercise. These data indicate that contrary to what has been reported in rats with an intact capacity for gluconeogenesis, hepatic-vagotomized and sham-operated rats with an inhibited gluconeogenesis had similar hormonal responses to exercise. It is concluded that gluconeogenesis plays a role in the afferent neural influence exerted by the liver via the hepatic vagus nerve in the regulation of hormonal response to exercise.

[Subcapsular hematoma of the liver secondary to pregnancy toxemia]. / Hématome sous-capsulaire du foie secondaire à une toxémie gravidique.

We are reporting a case of spontaneous liver rupture, occurring in a para V, and secondary to gravidic toxemia.