Analgesia and pulmonary function after lung surgery: is a single intercostal nerve block plus patient-controlled intravenous morphine as effective as patient-controlled epidural anaesthesia? A randomized non-inferiority clinical trial.

BACKGROUND: Thoracic epidural anaesthesia (EDA) is regarded as the 'gold standard' for postoperative pain control and restoration of pulmonary function after lung surgery. Easier, less time-consuming, and, perhaps, safer is intercostal nerve block performed under direct vision by the surgeon before closure of the thoracotomy combined with postoperative i.v. patient-controlled analgesia with morphine. We hypothesized that this technique is as effective as thoracic EDA. METHODS: The study was designed as a single-centre, open labelled, randomized non-inferiority trial. A total of 92 patients undergoing elective lung surgery were randomly assigned to the epidural (n=47) or intercostal group (n=45), and 83 patients completed the study. Pain scores, inspiratory vital capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and peak expiratory flow rate (PEFR) were assessed during the first four postoperative days. RESULTS: Median treatment differences regarding pain scores at rest failed to demonstrate non-inferiority of the intercostal nerve block at the first postoperative day. Patients of the intercostal group reported significantly higher pain scores on coughing during the first and second postoperative days. The epidural group had a significantly higher median FVC, FEV1, and PEFR values on the second postoperative day. No difference was found in pulmonary complications, length of hospital stay, or in-hospital deaths. CONCLUSIONS: In patients undergoing lung surgery, single intercostal nerve block plus i.v. patient-controlled analgesia with morphine is not as effective as patient-controlled EDA with respect to pain control and restoration of pulmonary function.

Test-positive rate at CT colonography is increased by rectal bleeding and/or unexplained weight loss, unlike other common gastrointestinal symptoms.

PURPOSE: We evaluated the rate of significant colonic and extra-colonic abnormalities at computed tomography colonography (CTC), according to symptoms and age. MATERIALS AND METHODS: We retrospectively evaluated 7361 consecutive average-risk subjects (3073 males, average age: 60.3 ± 13.9; range 18-96 years) for colorectal cancer (CRC) who underwent CTC. They were divided into three groups according to clinical symptoms: 1343 asymptomatic individuals (group A), 899 patients with at least one "alarm" symptom for CRC, including rectal bleeding and unexplained weight loss (group C), and 5119 subjects with other gastrointestinal symptoms (group B). Diagnostic and test-positive rates of CTC were established using optical colonoscopy (OC) and/or surgery as reference standard. In addition, clinically significant extra-colonic findings were noted. RESULTS: 903 out of 7361 (12%, 95% confidence interval (CI) 0.11-0.13) subjects had at least one clinically significant colonic finding at CTC. CTC true positive fraction and false positive fraction were respectively 637/642 (99.2%, 95%CI 0.98-0.99) and 55/692 (7.95%, 95%CI 0.05-0.09). The pooled test-positive rate in group C (138/689, 20.0%, 95%CI 0.17-0.23) was significantly higher than in both groups A (79/1343, 5.9%, 95%CI 0.04-0.07) and B (420/5329, 7.5%, 95%CI 0.07-0.08) (p < 0.001). Aging and male gender were associated to a higher test positive rate. The rate of clinically significant extra-colonic findings was significantly higher in group C (44/689, 6.4%, 95%CI 0.04-0.08) versus groups A (26/1343, 1.9%, 95%CI 0.01-0.02) and B (64/5329, 1.2%, 95%CI 0.01-0.02) (p < 0.001). CONCLUSION: Both test-positive and significant extra-colonic finding rates at CTC are significantly increased in the presence of "alarm" gastrointestinal symptoms especially in older patients.

Relaxation of smooth muscle by cardiodilatin/atrial natriuretic peptide is inhibited by cAMP-dependent phosphorylation.

Cardiodilatins/atrial natriuretic peptides (CDD/ANP) exhibit a common amino acid sequence: Arg101-Arg102-Ser103-Ser104. Cyclic AMP-dependent phosphorylation of Ser104 of atrial peptides with [gamma-32P]ATP enables rapid identification of cardiac hormones. The biological activity of in vitro phosphorylated cardiodilatin (CDD-28/alpha-hANP) is dramatically altered compared to the unphosphorylated peptide: the vaso-relaxant effect of cardiodilatin 28 is inhibited upon phosphorylation.

Urodilatin (CDD/ANP-95-126) is not biologically inactivated by a peptidase from dog kidney cortex membranes in contrast to atrial natriuretic peptide/cardiodilatin (alpha-hANP/CDD-99-126).

Atrial natriuretic peptide (CDD/ANP-99-126) is rapidly inactivated by a membrane preparations from dog kidney cortex. Inactivation occurs by cleavage of the ring structure in the position between Cys-105 and Phe-106. A unique proteolytic product separated by HPLC on reverse-phase column appears as a single peak which elutes prior the intact peptide. In contrast, CDD/ANP-95-126 (urodilatin) which is released from the kidney is not destroyed by proteolysis using an identical membrane preparation.

Isolation and characterization of the bioactive circulating human parathyroid hormone, hPTH-1-37.

The occurrence of hPTH-1-37 as the native bioactive circulating form of PTH-1-84 has now been obtained using a specific purification procedure for circulating parathyroid hormone, which involves a newly developed immunoenzymetric assay for N-terminally intact hPTH. In combination with two different methods of mass spectrometry, the molecular weight of the isolated immunoreactive peptide was shown to be 4401 Da, which corresponds to hPTH-1-37. Synthetic hPTH-1-37 material was tested in the chick bioassay and produced a clearcut increase in serum calcium concentration. We conclude that hPTH-1-37 is the native bioactive fragment of hPTH-1-84 in circulation.

Sonographic assessment of endometrial pattern and thickness in patients treated with clomiphene citrate, human menopausal gonadotropins, and intrauterine insemination.

OBJECTIVE: To analyze the endometrium sonographically in patients undergoing controlled ovarian stimulation with clomiphene citrate (CC) in addition to menotropins to determine the significance of endometrial pattern and thickness on pregnancy rate (PR). DESIGN: A prospective study analyzing patients receiving sequential CC and hMG followed by hCG and IUI. Patients who exhibited homogeneous endometrial patterns were compared with those who had trilaminar patterns visualized by transvaginal sonography at the end of the follicular phase. Endometrial thickness was emphasized in this group of patients. SETTING: Tertiary infertility center. PATIENT(S): All patients receiving sequential CC and hMG therapy at a tertiary infertility center. INTERVENTION(S): All patients received individualized dosing of hMG after 5 days of CC. Transvaginal sonography was performed 15 hours before hCG administration. Intrauterine insemination was performed 36 hours after hCG injection. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy as determined by serially rising beta-hCG titers and sonographic confirmation. RESULT(S): During the study period, 223 patients were analyzed. Fifty patients had a homogeneous endometrium, whereas 173 patients had a trilaminar pattern. In the homogeneous group, the PR was 8%, and in the trilaminar group it was 21%. There was no significant difference in age, parity, diagnosis, peak E2 level, and mature follicle number between the two groups. Although homogeneous patterns were associated with thinner endometrium, no difference in PRs could be discerned within the trilaminar group on the basis of endometrial thickness. CONCLUSION(S): In patients receiving sequential CC and hMG ovarian stimulation, a homogeneous endometrial pattern on the day of hCG administration predicts a significantly decreased PR compared with a trilaminar pattern.

Sonographic assessment of endometrial pattern and thickness in patients treated with human menopausal gonadotropins.

OBJECTIVE: To analyze sonographically the endometrium in patients undergoing controlled ovarian stimulation with menotropins in order to determine the significance of endometrial pattern and thickness on pregnancy rate. DESIGN: This is a prospective, nonrandomized study comparing pregnancy rates in patients with hyperechoic homogeneous patterns with those in patients with isoechoic or hypoechoic trilaminar patterns. SETTING: Tertiary infertility center. PATIENTS: All patients receiving menotropin therapy at a tertiary infertility center. INTERVENTIONS: All patients received individualized dosing of hMG starting on cycle day 3. Transvaginal sonography was performed 15 hours before hCG administration and the endometrium was assessed. MAIN OUTCOME MEASURE: Occurrence of pregnancy as determined by serially rising beta-hCG titers and sonographic confirmation. RESULTS: During the study period, 175 patients were evaluated. Thirty-four (19%) patients had a homogeneous endometrium, whereas 141 (81%) patients had a trilaminar pattern. There was 1 pregnancy (2.9%) among women with a homogeneous endometrial pattern and 33 pregnancies (23%) among those with a trilaminar pattern. No significant differences were found in mean E2 level, follicle numbers, parity, and diagnosis between the two groups. CONCLUSION: In patients receiving menotropins, a homogeneous pattern is a bad prognostic sign, regardless of endometrial thickness.

The right auricle of the heart is an endocrine organ. Cardiodilatin as a peptide hormone candidate.

A new polypeptide hormone candidate regulating vascular smooth muscle function was extracted from porcine atrial tissue. The purification steps were followed by a bioassay. The hormonally active substance has been analyzed and found to be a small polypeptide exhibiting a molecular weight of about 7500 and is named "cardiodilatin" (CDD). Further chemical data on this new hormone will be published elsewhere. A partial amino acid sequence of cardiodilatin is offered and shows that among the well known hormones or neuropeptides, none exhibit a homologue partial sequence.

New treatments of hyperandrogenism and hirsutism.

Approximately 5% to 8% of the female population demonstrates some form of hirsutism, the presence of prominent facial and body hair caused by excessive androgen effect. Treatment methods are classified into three categories: (1) hormonal suppression consisting of medical therapy to decrease androgen production, (2) the administration of antiandrogens to block the androgen effect at the hair follicle, and (3) physical methods of hair removal. Most patients require a combination of medical and physical therapy.

Secretion of a urodilatin-like immunoreactive (URO-like-IR) substance from a human kidney cell line (HEK-293).

The aim of this study was to explore whether sodium chloride is involved in the release of urodilatin from epithelial human embryonic kidney cells (HEK-293). Using a highly specific urodilatin radioimmunoassay combined with HPLC, gel chromatography, and a cyclic GMP generating bioassay, we demonstrate that HEK-293 cells release a biologically active 3.5 kD, urodilatin-like immunoreactive substance. To show the effect of sodium on urodilatin release, HEK-293 cells were incubated with cell culture buffer containing 120, 130, 140, and 150 mmol/l sodium, respectively. Urodilatin secretion from HEK-293 cells is increased to 176% when extracellular sodium is raised to 150 mmol/l (control: 120 mmol/l = 100%). There was no significant difference when exposing the cells to 140 mmol/l or 150 mmol/l sodium. It is suggested, that beside the known extrarenal factors influencing urodilatin secretion, high cephalic sodium and cardiac volume load, urodilatin secretion might also be regulated by an intrarenal sodium sensitive mechanism.

Urodilatin secretion in salt-loaded Wistar rats.

The aim of our study was to investigate whether urodilation (URO, INN: ularitide) is present in rat urine and if URO excretion in the rat is influenced by dietary sodium intake. Therefore, three groups of Wistar rats were placed in metabolic cages where they received different sodium diets for 9 days (0.05%, 0.4%, and 8.0% NaCl, respectively). Food and water intake were determined by weight. At days -4, 2, 5, and 8 blood pressure was measured non invasively using the tail cuff method. After nine days rats were anesthetized and blood was drawn for serum electrolyte, plasma A-type natriuretic peptide (CDD/ANP-99-126), and plasma aldosterone concentration measurements. Using a highly specific antibody against URO combined with high performance liquid chromatography and gel chromatography, we were able to show that a URO-like substance of approx. 3.5 kD that is distinct from CDD/ANP-99-126, brain natriuretic peptide, and C-type natriuretic peptide, is present in rat urine. Sodium chloride loaded rats showed significantly increased urinary excretion rates of URO (p < 0.001), chloride (p < 0.001), sodium (p < 0.001), and the fractional excretion of sodium (p < 0.001). In the plasma, sodium (p < 0.01) and chloride (p < 0.001) increased, while potassium, hematocrit, osmolality, plasma CDD/ANP-99-126, as well as glomerular filtration rate (GFR), and systolic blood pressure did not change. Since CDD/ANP-99-126 is believed to be a natriuretic peptide, it is suggested that CDD/ANP-99-126 might participate in the natriuresis due to high dietary sodium intake. In sodium-loaded rats, however, plasma CDD/ANP-99-126 remains unchanged, while URO excretion increases with sodium excretion, independent of GFR and blood pressure. We conclude that URO secretion is stimulated by dietary salt loading and might be involved in the regulation of water and electrolyte metabolism in the rat.

Contribution of diminished ovarian reserve to hypofertility associated with endometriosis.

OBJECTIVE: To determine if ovarian reserve, as measured by day 3 levels of E2 and FSH, was different in patients with endometriosis as compared to controls. STUDY DESIGN: Case-control study of 75 women with laparoscopically staged endometriosis and 75 age-matched controls undergoing in vitro fertilization/embryo transfer for male factor infertility. RESULTS: In women with stage III/IV endometriosis (revised American Fertility Society staging), day 3 E2 and FSH levels were significantly higher than control levels (51.9 pg/mL and 12.6 mIU/mL versus 34.7 pg/mL and 9.7 mIU/mL, P < .03). In contrast, women with stage I/II endometriosis did not differ significantly when compared to controls (36.8 pg/mL and 10.4 mIU/mL versus 34.0 pg/mL and 10.2 mIU/mL). The total group showed significantly higher E2 levels (41.8 pg/mL versus 34.1 pg/mL, P < .03), but no significant differences in FSH levels were observed. CONCLUSION: These data show that women with stage III/IV endometriosis have relatively diminished ovarian reserve, while this situation is not noted in women with stage I/II endometriosis. This observation is consistent with progressive loss of ovarian reserve in women with increasing stages of endometriosis independent of age.

Suicidal contact gunshot wounds to the head with .38 Special Glaser Safety Slug ammunition.

Glaser Safety Slug TM ammunition is a uniquely designed, essentially prefragmented ammunition. Tests performed by the U.S. Justice Department demonstrated that the ammunition possesses high kinetic energy, high relative incapacitation index (RII) and poses a very low risk to bystanders because of its total loss of kinetic energy in the target. Despite having been manufactured since 1974, no deaths from this ammunition have been previously reported. The authors herein describe the first three reported human deaths.

[Virtual colonoscopy: a new hope for colorectal cancer screening]. / La colonoscopie virtuelle: un espoir dans le dépistage du cancer du côlon.

Colon cancer is the second most common cause of cancer death and the first one in non-smoking persons. None of the current colorectal caner screening options is ideal. As for mammography in breast cancer screening, virtual colonoscopy, although still in clinical evaluation, promises to become a primary screening method as it is performant, quick, non-invasive and cheaper than conventional colonoscopy.

[State of the art of pancreatic cancer imaging]. / Actualités en imagerie du cancer du pancréas.

Ultrasonography and CT-scanner remain the first choice nowadays concerning detection and preoperative work-up of pancreatic cancer. MRI offers interesting options for the detection of liver metastases, and high quality of ductal and vascular examination. Actually, while we await a larger diffusion of MR systems and radiological expertise this technique is preferentially indicated as a third-step procedure when ultrasonography and CT-scanner are normal despite a real suspicion. Otherwise, MRI permits with a single non-invasive examination a complete work-up useful to prepare palliative therapy in case of unresectable tumor.

Screening for colorectal cancer in asymptomatic average risk patients: role of imaging.

Early detection of colorectal cancer or advanced adenomas is a public health priority in many industrialized countries. There are various methods of screening average risk individuals for colorectal cancer, and their effectiveness may depend on subjective parameters like local expertise and patient's preferences. This paper reviews these tests with special emphasis regarding imaging techniques that aim to provide less-invasive alternatives to optical colonoscopy (OC) which is the standard of reference. Both Double-Contrast Barium Enema (DCBE) and Virtual Colonoscopy (VC) have >90% sensitivity compared to OC in the detection of clinically relevant colonic lesions. Nevertheless, VC may have an edge over DCBE for technical and reproductivity reasons, as well as greater learning opportunities. Imaging techniques criticisms regarding diminutive and flat lesions, cost, radiation exposure and effects on gastroenterological practice are addressed.

Coexistence of rocksalt and wurtzite structure in nanosized CoO films.

Cobalt oxide (CoO) films epitaxially grown on Ir(100) in (111) orientation were investigated by means of quantitative low-energy electron diffraction and scanning tunneling microscopy. We find with high crystallographic precision that in the bulk of the films the rocksalt structure prevails while near the surface there is a switch towards the wurtzite structure. As a consequence, nanosized CoO cannot be considered as a single structural phase. The film surfaces prove to be metallic, apparently connected with polarity compensation.

The use of the maxillary interocclusal splint as a mouthpiece for the mouthstick prosthesis.

In the past, the maxillary and mandibular teeth have been firmly indexed on the mouthpiece prosthesis, which can produce significant occlusal discrepancies. The construction of a mouthpiece consisting of a maxillary interocclusal splint is described. The two advantages for this type of mouthpiece are (1) it can be adjusted clinically to accommodate errors in the mounting of the casts and the laboratory processing of the prosthesis, and (2) the use of the maxillary interocclusal splint will reduce the likelihood of the development of masticatory muscle spasms.

Flow microfluorometric monitoring of the interaction of lipid vesicles with cells.

Flow microfluorometric techniques have been applied to experiments concerned with the penetration of cells by lipid vesicles. The high sensitivity of laser flow systems enables to measure the weak fluorescence emitted by individiual liposomes tagged with perylene, inserted into their multilamellar layer. The total fluorescence of cells which habe incorporated such perylene-loaded liposomes could be measured and well separated from that unbound liposomes. Significant differences in the incorporation rates of cationic and anionic liposomes were shown by means of time-course analyses of cellular fluorescence spectra. The advantages of the rapid data analysis by flow fluorescence techniques is discussed in comparison with conventional radio-isotopic methods.

Cardiac hormones: morphology and biochemistry.

The heart contains, in addition to its myocardial working cells and the conductive system, a specialized endocrine part localized mainly in the atrial appendage which is predominantly made up by myoendocrine cells. The ultrastructural and immunocytochemical analysis of myoendocrine cells show a specialized secretory apparatus involved in the synthesis and secretion of cardiac hormones. These cardiac hormones are synthesized and processed in the myoendocrine cells as follows: a preprohormone is found in the rough endoplasmic reticulum, the prohormone cardiodilatin/gamma-atrial natriuretic polypeptide (CDD/ANP) is processed in the Golgi apparatus and stored in the secretory granules. The circulating peptide, cardiodilatin 99-126/alpha-ANP, is the C-terminus of this preprohormone which is released as the active circulating form into the blood stream.