The impact of an aquatic exercise program on BDNF levels in Parkinson's disease patients: short-and long-term outcomes.

The present study aimed to analyze the short-and long-term effects of an aquatic exercise program on plasma brain-derived neurotrophic factor (BDNF) levels in individuals with Parkinson's disease (PD). The aquatic exercise program lasted one month, and consisted of two sessions per week (1 hour per session). Blood samples were collected at four different timepoints: pre-intervention (T0), immediately after the first session (T1), 48 hours after the first session (T2), and 1 month after the intervention (T3). We found a significant decrease in BDNF levels at T2 vs T1 (p<0.05). However, no changes were observed at the other time-points. Our results demonstrated that the intervention reduced plasma BDNF levels in PD individuals in a time-dependent manner: specifically, we observed acute effects, but no delayed effects.

Intraductal papillary mucinous neoplasms of the pancreas.

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMNs) are neoplasms of the pancreatic duct epithelium characterized by intraductal papillary growth and thick mucin secretion. Quantities of mucin fill the main and/or branches of pancreatic ducts and cause ductal dilatation. This review encompasses IPMNs, including symptoms, diagnosis, management, and prognosis. METHODS: A Pubmed database search was performed. All abstracts were reviewed and all articles in which cases of IPMNs could be identified were further scrutinized. Further references were extracted by cross-referencing. RESULTS: Only one-third of all patients are symptomatic. According to the site of involvement, IPMNs are classified into three types: main duct type, branch duct type, and combined type. Most branch type IPMNs are benign, while the other two types are frequently malignant. The presence of large mural nodules increases the possibility of malignancy in all types. Presence of a large branch type IPMN and marked dilatation of the main duct indicate the existence of adenoma at least. Synchronous or metachronous malignancies may be developed in various organs. Endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, and intraductal ultrasonography clearly demonstrate ductal dilatation and mural nodules, while magnetic resonance pancreatography best visualizes the entire outline of IPMNs. CONCLUSIONS: Prognosis is excellent after complete resection of benign and non-invasive malignant IPMNs. The extent of pancreatic resection and the intraoperative management of resection margins remain controversial. Total pancreatectomy should be reserved for patients with resectable but extensive IPMNs involving the whole pancreas; its benefits, however, must be balanced against operative and postoperative risks. Regular monitoring for disease recurrence is important after surgery.

Lichtenstein tension-free repair of inguinal hernia.

Recurrences have been a significant problem following hernia repair. The purpose of this study was to present our experience of Lichtenstein tension-free repair of inguinal hernia. In this retrospective study, 223 inguinal hernia repairs were performed between September 2000 and August 2003 in 203 patients, using a polypropylene mesh. The main outcome measure was early and late complications and especially recurrences. There were 189 males (93.1%) and 14 females (6.9%). Inguinal hernia was indirect in 70% of cases (n=156), direct in 25% (n=56), and of the mixed type in 5% (n=11). Bilateral inguinal hernia was found in 20 patients (9.8%). 210 (94.2%) of hernias were de novo, while 13 (5.8%) were recurrences. The mean patients age was 54.3 years (range, 32-71 years). The follow-up was completed in 160 patients (78.8%) by clinical examination. The median follow-up period was 3.0 years (range, 1-5 years). Seroma and postoperative neuralgia were observed in one and 5 patients respectively. There was only one recurrence (0.4%) four years later. Lichtenstein tension-free mesh repair of inguinal hernia is a simple and safe method, with no significant early and late morbidity and achieved a method with no recurrence during the follow-up period.

[Value of transesophageal echocardiography in the diagnosis of peripheral embolic event]. / Interet de l'echocardiographie transoesophagienne dans le bilan d'un accident embolique peripherique.

Ischemic cerebro-vascular events are in 15% of cases secondary to a cardiac embolus. The prevalence of echocardiographic anomalies, susceptible of being at the origin of a cerebral embolus may reach 50%. Transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) in the detection of a thrombus of the left atrial appendage, spontaneous echocontrast, intra-aortic atherosclerotic plaque lesion, patent foramen ovale or an atrial septal aneurysm. The high prevalence of these anomalies in a population who presented an ischemic cerebrovascular accident does not suffice to establish a causal relationship between the anomaly and the cerebral event. Further studies seem to be necessary to establish the responsibility of these different anomalies and determine their embolic risk, by defining certain risk factors. Pending the results of such studies, TEE should be indicated more systematically in the case of an ischemic cerebrovascular accident of the young patient without a clinically evident cardiopathy, independently of the results of TTE.

[First Lebanese series of percutaneous mitral commissurotomies]. / La première série libanaise de commissurotomie mitrale percutanée.

From January 1993 to January 1994, we realized at Risk Hospital 11 percutaneous mitral commissurotomies (PMC). This first Lebanese series comprised 9 women and 2 men. The mean age was 36 y (18-73 y). Ten patients were en class III of the NYHA and one in class IV (pregnant woman on the end of the 7th month). The predilatation evaluation was done by transthoracic echocardiography for the just 2 patients and by transthoracic with transesophageal multiplane echocardiography for the 9 others. The mean gradient was at 20 mmHg (10-24 mmHg) and the mean mitral area at 1 cm2 (0.65-1.5 cm2). We used the Inoue balloon for all these procedures with a stepwise technique and a color echo-doppler control between inflations. We obtain bicommissural opening in 8 patients and unicommissural opening in 3 patients. The mean gradient post dilatation was at 4 mmHg (3-8 mmHg) and the mean mitral area at 2.3 cm2 (1.5-2.8 cm2). No mitral regurgitation > 2/4 was noted. After a general review, we concluded the PMC is at present the treatment of choice of non or discrete calcified mitral stenosis and this procedure has to be taken on charge by the Ministry of Health in Lebanon.

Renal injury: 5-year experience and literature review.

INTRODUCTION: Appropriate management of renal trauma is controversial. The purpose of this study is to present our 5-year experience in renal trauma and review the literature. MATERIALS AND METHODS: From 1999 to 2003, 28 patients were identified with renal injuries. 25 (89.3%) of the injuries were caused by blunt trauma, 2 (7.1%) by stab wounds, and 1 (3.6%) by gunshot wound. Methods for diagnosis included ultrasonography (US), computed tomography (CT), diagnostic peritoneal lavage (DPL), combinations of more than one technique or no one of them. The English-language literature about renal trauma was also identified using Medline, and additional cited works not detected in the initial search obtained. RESULTS: 18 patients underwent immediate or during 24 h operation; while 5 nephrectomies were performed. 11 patients with grade I to III injuries were selected for nonoperative management of renal injuries. All complications were noted and studied according to the initial therapeutic management and grade. Follow-up was clinical and radiological. 3 postoperative deaths were observed. CONCLUSION: The goals of treatment of renal injuries include accurate staging and minimal complications. Surgery can be avoided in most cases of blunt renal injury but there is also a trend towards conservative management of penetrating trauma. Nephrectomy is associated with high-grade renal injuries, while minor renal injuries can safely be managed conservatively.