Antibacterial and Anti-Efflux Activities of Cinnamon Essential Oil against Pan and Extensive Drug-Resistant Pseudomonas aeruginosa Isolated from Human and Animal Sources.

Pseudomonas aeruginosa is notorious for its ability to develop a high level of resistance to antimicrobial agents. Resistance-nodulation-division (RND) efflux pumps could mediate drug resistance in P. aeruginosa. The present study aimed to evaluate the antibacterial and anti-efflux activities of cinnamon essential oil either alone or combined with ciprofloxacin against drug resistant P. aeruginosa originated from human and animal sources. The results revealed that 73.91% of the examined samples were positive for P. aeruginosa; among them, 77.78% were of human source and 72.73% were recovered from animal samples. According to the antimicrobial resistance profile, 48.73% of the isolates were multidrug-resistant (MDR), 9.2% were extensive drug-resistant (XDR), and 0.84% were pan drug-resistant (PDR). The antimicrobial potential of cinnamon oil against eleven XDR and one PDR P. aeruginosa isolates was assessed by the agar well diffusion assay and broth microdilution technique. The results showed strong antibacterial activity of cinnamon oil against all tested P. aeruginosa isolates with inhibition zones' diameters ranging from 34 to 50 mm. Moreover, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of cinnamon oil against P. aeruginosa isolates ranged from 0.0562-0.225 µg/mL and 0.1125-0.225 µg/mL, respectively. The cinnamon oil was further used to evaluate its anti-efflux activity against drug-resistant P. aeruginosa by phenotypic and genotypic assays. The cartwheel test revealed diminished efflux pump activity post cinnamon oil exposure by two-fold indicating its reasonable impact. Moreover, the real-time quantitative polymerase chain reaction (RT-qPCR) results demonstrated a significant (p < 0.05) decrease in the expression levels of MexA and MexB genes of P. aeruginosa isolates treated with cinnamon oil when compared to the non-treated ones (fold changes values ranged from 0.4204-0.7474 for MexA and 0.2793-0.4118 for MexB). In conclusion, we suggested the therapeutic use of cinnamon oil as a promising antibacterial and anti-efflux agent against drug-resistant P. aeruginosa.

CCR2 promotes monocyte recruitment and intestinal inflammation in mice lacking the interleukin-10 receptor.

Macrophages are a heterogeneous population of mononuclear phagocytes abundantly distributed throughout the intestinal compartments that adapt to microenvironmental specific cues. In adult mice, the majority of intestinal macrophages exhibit a mature phenotype and are derived from blood monocytes. In the steady-state, replenishment of these cells is reduced in the absence of the chemokine receptor CCR2. Within the intestine of mice with colitis, there is a marked increase in the accumulation of immature macrophages that demonstrate an inflammatory phenotype. Here, we asked whether CCR2 is necessary for the development of colitis in mice lacking the receptor for IL10. We compared the development of intestinal inflammation in mice lacking IL10RA or both IL10RA and CCR2. The absence of CCR2 interfered with the accumulation of immature macrophages in IL10R-deficient mice, including a novel population of rounded submucosal Iba1+ cells, and reduced the severity of colitis in these mice. In contrast, the absence of CCR2 did not reduce the augmented inflammatory gene expression observed in mature intestinal macrophages isolated from mice lacking IL10RA. These data suggest that both newly recruited CCR2-dependent immature macrophages and CCR2-independent residual mature macrophages contribute to the development of intestinal inflammation observed in IL10R-deficient mice.

Antimicrobial and antibiofilm potentials of cinnamon oil and silver nanoparticles against Streptococcus agalactiae isolated from bovine mastitis: new avenues for countering resistance.

BACKGROUND: Streptococcus agalactiae (S. agalactiae) is a contagious pathogen of bovine mastitis. It has financial implications for the dairy cattle industry in certain areas of the world. Since antimicrobial resistance increases in dairy farms, natural antimicrobials from herbal origins and nanoparticles have been given more attention as an alternative therapy. Hence, this study reported the antimicrobial and antibiofilm potentials of cinnamon oil, silver nanoparticles (AgNPs), and their combination against multidrug-resistant (MDR) S. agalactiae recovered from clinical bovine mastitis in Egypt. RESULTS: Our findings revealed that 73% (146/200) of the examined milk samples collected from dairy cows with clinical mastitis were infected with Streptococci species. Of these, 9.59% (14/146) were identified as S. agalactiae and categorized as MDR. S. agalactiae isolates expressed four virulence genes (Hyl, cylE, scpB, and lmb) and demonstrated an ability to produce biofilms. Cinnamon oil showed high antimicrobial (MICs ≤0.063 µg /mL) and antibiofilm (MBIC50 = 4 µg/mL) potentials against planktonic and biofilms of S. agalactiae isolates, respectively. However, AgNPs showed reasonable antimicrobial (MICs ≤16 µg/mL) and relatively low antibiofilm (MBIC50 = 64 µg/mL) activities against screened isolates. Synergistic antimicrobial or additive antibiofilm interactions of cinnamon oil combined with AgNPs were reported for the first time. Scanning electron microscope (SEM) analysis revealed that biofilms of S. agalactiae isolates treated with cinnamon oil were more seriously damaged than observed in AgNPs cinnamon oil combination. Moreover, reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) showed that cinnamon oil exerted a remarkable down-regulation of pili biosynthesis genes (pilA and pilB) and their regulator (rogB) against S. agalactiae biofilms, meanwhile the AgNPs cinnamon oil combination demonstrated a lower efficacy. CONCLUSIONS: This is an in vitro preliminary approach that documented the antibiofilm potential of cinnamon oil and the inhibitory activity of cinnamon oil and its combination with AgNPs against MDR S. agalactiae recovered from clinical mastitis. Further in vivo studies should be carried out in animal models to provide evidence of concept for implementing these alternative candidates in the treatment of dairy farms infected by streptococcal mastitis in the future.

Anti-Inflammatory and Immunomodulatory Role of Bone Marrow-Derived MSCs in Mice with Acute Lung Injury.

Recently, studies suggested that the mesenchymal stem cells (MSCs) have anti-inflammatory and immune-modulatory roles in the induced acute lung injury in mice via controlling innate, humoral, and cell-mediated immunity. Sixty adult male mice were divided equally into three groups. Group A (control group) received an intraperitoneal (IP) phosphate-buffered saline. Group B was injected IP with lipopolysaccharide (LPS). Group C was injected IP with LPS, followed after 2 h by intravenous labeled bone marrow-derived MSCs (BM-MSCs). The plasma and bronchioalveolar lavage (BAL) fluid were collected at 12, 24, and 72 h postinjection. Estimation of total cell and neutrophils count and immunoglobulin M (IgM) in BAL fluid was performed. Enzyme-linked immunosorbent assay (ELISA) was used to analyze tumor necrosis factor-α (TNF-α) that is a proinflammatory cytokine and interleukin-10 (IL-10), which is an anti-inflammatory cytokine, in plasma. Lung samples were collected for histopathological examination at 12, 24, 72 h, and 1 week postinjection. Decreased TNF-α and increased IL-10 levels in the plasma of MSC-treated group compared to the LPS-infected group were observed. Also, decreased IgM level in BAL fluid of the MSC-treated group after 72 h compared to the LPS-infected group was detected with a resolution of inflammation and improvement in lung injury. Moreover, MSC-treated group showed a reduction in total leukocyte count and neutrophil percentage in comparison to control and LPS-infected groups. Histopathological improvement was detected in MSC-treated group as well. In conclusion, systemic MSCs injection has an anti-inflammatory and immune-modulatory effect in LPS-induced acute lung injury in mice.

The effect of replacement of fish meal with Amino Acids and Optimized Protein Levels in the diet of the Nile Tilapia Oreochromis niloticus / O efeito da substituição da farinha de peixe por Aminoácidos e Níveis Otimizados de Proteína na dieta da tilápia do Nilo Oreochromis niloticus

Abstract This study was conducted to determine an appropriate replacement of fishmeal with amino acids (AAs) and optimized protein levels in practical diets for Oreochromis niloticus with mean initial body weight 12.52±0.63g. Six experimental and a control diet (total 7 diets) divided into two groups, and a control diet (D1) containing 32% protein. The first group contained three diets that included different dietary protein levels, viz. 20 (D2), 25 (D3), and 30% (D4) with AAs when replacing fishmeal by plant protein sources. In the second group, the diets were contained 20 (D5), 25 (D6), and 30% (D7) without AAs. The best growth performance was achieved in fish fed with diet D1. Total feed intake was increased with an increase in dietary protein level with AAs. The specific growth rate showed a similar pattern with a significant difference between control, D4 and D7 compared to other groups. The feed conversion ratio decreased when protein levels in the diets increased. The protein efficiency ratio showed a similar performance, with a slight increase between the control diet and diets with AAs. However, insignificant differences (P>0.05) were observed between diets with and without AAs. An economic evaluation indicated that inclusion of low fishmeal in tilapia diets reduced the price/kg of diets compared to control.

Resumo Este estudo foi realizado para determinar uma substituição adequada de farinha de peixe com aminoácidos (AA) e níveis otimizados de proteína em dietas práticas para Oreochromis niloticus com peso corporal inicial médio de 12,52 ± 0,63 g. Seis dietas experimentais e controle (total de 7 dietas) divididas em dois grupos, e uma dieta controle (D1) contendo 32% de proteína. O primeiro grupo continha três dietas que incluíam diferentes níveis de proteína na dieta, viz. 20 (D2), 25 (D3) e 30% (D4) com AAs ao substituir a farinha de peixe por fontes de proteína vegetal. No segundo grupo, as dietas continham 20 (D5), 25 (D6) e 30% (D7) sem AAs. O melhor desempenho de crescimento foi alcançado em peixes alimentados com dieta D1. O consumo total de ração foi aumentado com o aumento do nível de proteína na dieta com AAs. A taxa de crescimento específico mostrou um padrão semelhante com uma diferença significativa entre o controle, D4 ​​e D7 em comparação com outros grupos. A taxa de conversão alimentar diminuiu quando os níveis de proteína nas dietas aumentaram. A taxa de eficiência protéica apresentou desempenho semelhante, com discreto aumento entre a dieta controle e as dietas com AAs. Entretanto, diferenças insignificantes (P> 0,05) foram observadas entre dietas com e sem AAs. Uma avaliação econômica indicou que a inclusão de farinha de peixe baixa em dietas de tilápia reduziu o preço / kg de dietas em relação ao controle.

The effect of replacement of fish meal with Amino Acids and Optimized Protein Levels in the diet of the Nile Tilapia Oreochromis niloticus

Abstract This study was conducted to determine an appropriate replacement of fishmeal with amino acids (AAs) and optimized protein levels in practical diets for Oreochromis niloticus with mean initial body weight 12.52±0.63g. Six experimental and a control diet (total 7 diets) divided into two groups, and a control diet (D1) containing 32% protein. The first group contained three diets that included different dietary protein levels, viz. 20 (D2), 25 (D3), and 30% (D4) with AAs when replacing fishmeal by plant protein sources. In the second group, the diets were contained 20 (D5), 25 (D6), and 30% (D7) without AAs. The best growth performance was achieved in fish fed with diet D1. Total feed intake was increased with an increase in dietary protein level with AAs. The specific growth rate showed a similar pattern with a significant difference between control, D4 and D7 compared to other groups. The feed conversion ratio decreased when protein levels in the diets increased. The protein efficiency ratio showed a similar performance, with a slight increase between the control diet and diets with AAs. However, insignificant differences (P>0.05) were observed between diets with and without AAs. An economic evaluation indicated that inclusion of low fishmeal in tilapia diets reduced the price/kg of diets compared to control.

Resumo Este estudo foi realizado para determinar uma substituição adequada de farinha de peixe com aminoácidos (AA) e níveis otimizados de proteína em dietas práticas para Oreochromis niloticus com peso corporal inicial médio de 12,52 ± 0,63 g. Seis dietas experimentais e controle (total de 7 dietas) divididas em dois grupos, e uma dieta controle (D1) contendo 32% de proteína. O primeiro grupo continha três dietas que incluíam diferentes níveis de proteína na dieta, viz. 20 (D2), 25 (D3) e 30% (D4) com AAs ao substituir a farinha de peixe por fontes de proteína vegetal. No segundo grupo, as dietas continham 20 (D5), 25 (D6) e 30% (D7) sem AAs. O melhor desempenho de crescimento foi alcançado em peixes alimentados com dieta D1. O consumo total de ração foi aumentado com o aumento do nível de proteína na dieta com AAs. A taxa de crescimento específico mostrou um padrão semelhante com uma diferença significativa entre o controle, D4 e D7 em comparação com outros grupos. A taxa de conversão alimentar diminuiu quando os níveis de proteína nas dietas aumentaram. A taxa de eficiência protéica apresentou desempenho semelhante, com discreto aumento entre a dieta controle e as dietas com AAs. Entretanto, diferenças insignificantes (P> 0,05) foram observadas entre dietas com e sem AAs. Uma avaliação econômica indicou que a inclusão de farinha de peixe baixa em dietas de tilápia reduziu o preço / kg de dietas em relação ao controle.

Polypropylene vs silicone Ahmed valve with adjunctive mitomycin C in paediatric age group: a prospective controlled study.

PURPOSE: To compare the results of silicone and polypropylene Ahmed glaucoma valves (AGV) implanted during the first 10 years of life. METHODS: A prospective study was performed on 50 eyes of 33 patients with paediatric glaucoma. Eyes were matched to either polypropylene or silicone AGV. In eyes with bilateral glaucoma, one eye was implanted with polypropylene and the other eye was implanted with silicone AGV. RESULTS: Fifty eyes of 33 children were reviewed. Twenty five eyes received a polypropylene valve, and 25 eyes received a silicone valve. Eyes implanted with silicone valves achieved a significantly lower intraocular pressure (IOP) compared with the polypropylene group at 6 months, 1 year, and 2 years postoperatively. The average survival time was significantly longer (P=0.001 by the log-rank test) for the silicone group than for the polypropylene group and the cumulative probability of survival by the log-rank test at the end of the second year was 80% (SE: 8.0, 95% confidence interval (CI): 64-96%) in the silicone group and 56% (SE: 9.8, 95% CI: 40-90%) in the polypropylene group. The difference in the number of postoperative interventions and complications between both groups was statistically insignificant. CONCLUSION: Silicone AGVs can achieve better IOP control, and longer survival with less antiglaucoma drops compared with polypropylene valves in children younger than 10 years.

Complex formation, thermal behavior and stability competition between Cu(II) ion and Cu(0) nanoparticles with some new azo dyes. Antioxidant and in vitro cytotoxic activity.

Four triazole and thiadiazole-based azo chromophores namely [(E)-4-((1H-1,2,4-triazol-3-yl)diazenyl)benzene-1,3-diol.(HL(1)), (E)-4-((5-(methylthio)-1H-1,2,4-triazol-3-yl)diazenyl)benzene-1,3-diol.(HL(2)), (E)-4-((1,3,4-thiadiazol-2-yl)diazenyl)benzene-1,3-diol.(HL(3)) and (E)-4-((5-mercapto-1,3,4-thiadiazol-2-yl)diazenyl)benzene-1,3-diol.(HL(4))] were synthesized and characterized by elemental analyses, IR, UV-Vis as well as mass spectroscopy. Cu(II) complexes of the investigated azo dyes have been synthesized and characterized by elemental analyses, IR, electronic and ESR spectra, magnetic susceptibility and thermogravimetric analyses. The bond lengths and bond angles have been calculated to confirm the geometry of the ligands and their Cu(II) complexes. The mode of interaction of the azodyes to copper nanoparticles was described as coordination mode of charged dye molecules on the colloidal Cu(0) surface through anchoring OH(-) group. The apparent association constants of the colloidal copper nanoparticles azodye complexes in solution were evaluated using the spectral method and compared with the formation constant of the Cu(II) azo complexes. The antitumor and antioxidant activities of the synthesized azo dyes and their Cu(II) azo complexes have been evaluated.

Therapeutic effects of date palm (Phoenix dactylifera L.) pollen extract on cadmium-induced testicular toxicity.

Cadmium (Cd) is a well-known testicular toxicant. This study was designed to explore the long-term effects of a single low dose of Cd on spermatogenesis, and testicular dysfunction and oxidative stress, and the therapeutic potential of date palm pollen extract (DPP) in averting such reproductive damage. Adult male Wistar rats received a single intraperitoneal injection of CdCl2 (0 or 1 mg kg(-1) ). Twenty-four hours later, they started receiving DPP (0 or 40 mg kg(-1) ) orally, once daily for 56 consecutive days. Cd exposure caused significant reproductive damage via reduced weight of the reproductive organs, which includes spermatological damage (decreased sperm count and motility and increased rates of sperm abnormalities), increased oxidative stress (increased malondialdehyde and decreased reduced glutathione levels), histological alterations (necrosis, inefficient to completely arrest spermatogenesis and a reduced Johnsen's score) and decreased serum testosterone level. DPP restored spermatogenesis and attenuated the toxic effects of Cd on the reproductive system to the levels observed in the control animals. These findings support the hypothesis that the testis is particularly sensitive to Cd, which can cause testicular damage and infertility. Treatment with DPP can ameliorate the deleterious effects of Cd, probably by activating testicular endocrine and antioxidant systems.

Utilization of available prenatal screening and diagnosis: effects of the California screen program.

OBJECTIVE: In 2009, the California Genetic Disease Branch introduced an aneuploidy screening program allowing Medi-Cal (state insured) patients access to state-sponsored first-trimester screening. The objective of this study was to assess the effect of greater access to prenatal screening on available resources at a single center. STUDY DESIGN: Data of prenatal screening and diagnostic procedures performed 4 months before the introduction of the program were compared with those of 12 months following the introduction. RESULT: Between December 2008 and March 2010, 7689 women underwent first trimester screening, 1286 underwent amniocentesis and 398 underwent chorionic villus sampling. When a comparison was made between the 4 months before and the 12 months after the program's introduction, a greater number of nuchal translucency (NT) examinations was seen to have been performed (384 per month vs 513 per month, P=0.001). Prenatal diagnostic procedures did not increase, but a greater proportion was performed for positive screen results. CONCLUSION: Introduction of the California screening program was associated with increased NT procedures and fewer invasive procedures for advanced maternal age.

Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions.

OBJECTIVE: To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary caesarean delivery and subsequent adhesion formation. DESIGN: A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. SETTING: Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. POPULATION: One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. METHODS: Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher's exact tests and multivariable logistic regression. MAIN OUTCOME MEASURE: Prevalence rate of pelvic and abdominal adhesions. RESULTS: Of the 127 women, primary hysterotomy closure was single layer in 56 and double layer in 71. Single-layer hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72-28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions. CONCLUSIONS: Primary single-layer hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.

Spectral properties and inclusion of 3-(4'-dimethylaminophenyl)-1-(2-furanyl)prop-2-en-1-one in organized media of micellar solutions, beta-cyclodextrin and viscous medium.

On the line of a previous work on the spectral properties of some of heteroaryl chalcone, the absorption and fluorescence emission spectral properties of 3-(4'-dimethylaminophenyl)-1-(2-furanyl)prop-2-en-1-one (DMAFP), have been investigated in organized media of aqueous micellar and beta-cyclodextrin (beta-CD) solutions. While the absorption spectra are less sensitive to the nature of the added surfactant or beta-CD, the characteristics of the intramolecular charge transfer (ICT) fluorescence are highly sensitive to the properties of the medium. The ICT maximum is strongly blue-shifted with a great enhancement in the fluorescence quantum yield on adding micellar or beta-CD. This indicates the solubilization of DMAFP in the micellar core and formation of an inclusion complex with beta-CD. The critical micelle concentrations (CMC) as well as the polarity of the micellar core of SDS, CTAB and TX-100 have been determined. The CMC values are in good agreement with the reported values while the polarity is lower indicating that DMAFP molecules are incorporated in the micellar core not at the micellar interface. The inclusion constants of binding of DMAFP in micellar or beta-CD have been also determined. The thermodynamic parameters of formation of DMAFP:CD inclusion complex have been calculated from the temperature dependence of the fluorescence spectra of the formed complex. The highly negative value of formation entropy (DeltaS=-98.0Jmol(-1)K(-1)) reflects the high restrictions imposed on the movement of both the host and included guest molecules which is consistent with the increase of the fluorescence yield and blue shift of the fluorescence maximum.

Spectral and thermal studies of 4-(1H-pyrazolo (3,4-d) pyrimidin-4-ylazo) benzene-1,3-diol complexes of cobalt(II), nickel(II) and copper(II).

4-(1H-Pyrazolo (3,4-d) pyrimidin-4-ylazo) benzene-1,3-diol was synthesized and characterized by various spectral and analytical techniques. Semiempirical quantum calculations using the AM1 method have been performed in order to evaluate the geometry and electronic structure of the title azodye in the ground state. The complex formation between Co(II), Ni(II) and Cu(II) ions and the title azodye was studied conductometrically and spectrophotometrically. The spectrophotometric determination of the title metal ions and titration using EDTA are reported. Co(II), Ni(II) and Cu(II) complexes of the title azodye have been synthesized and characterized by elemental analysis, conductivity, magnetic susceptibility, IR, UV-Vis and thermal analysis (TGA and DTA).The spectral and magnetic data suggested the octahedral geometry for Co(II) and Ni(II) complexes while Cu(II) complexes have square planar geometry. The thermal studies confirmed the chemical formulations of the title complexes. The thermal degradation takes place in two or three steps depending on the type of the metal and the geometry of the complexes. The kinetics of the decomposition was examined by using Coats-Redfern relation. The activation energies and other activation parameters (DeltaH, DeltaS and DeltaG) were computed and related to the bonding and stereochemistry of the complexes.

Spectroscopic studies of 4-(4,6-dimethylpyrimidin-2-ylazo) benzene-1,3-diol and its Cu(II) complexes.

The electronic absorption spectra of 4-(4,6-dimethylpyrimidin-2-ylazo)benzene-1,3-diol have been studied in organic solvents of different polarities as well as in buffer solutions of varying pH. The observed UV-vis absorption bands are assigned to the corresponding electronic transitions. The effect of methanol ratio on the pK-value is discussed. Also, semiemperical molecular orbital calculations at the AM1 level have been performed to investigate the molecular and electronic structures of the free ligand in the ground state. According to these calculations, an intramolecular hydrogen bond leads to increasing of the molecular stability. The important bands in the IR spectrum as well as the main signals in the (1)H NMR spectrum are also assigned. The interaction of Cu(II) ion with the titled azo-dye in solution is studied spectrophotometrically and conductometrically. Optimization of the various experimental conditions is also described. Beer's law is obeyed in the range 0-11.43 ppm while that obtained applying Ringbom is 1.26-6.61 ppm. The use of the titled azo-dye as an indicator for determination of Cu(II) is considered. The solid Cu(II) complexes are synthesized and characterized by spectral, magnetic, conductance and thermal studies (TGA and DTA). The results indicate the formation of 1:1 and 1:2 (M:L) complexes. The kinetic parameters (n, E, A, DeltaS, DeltaH and DeltaG) of the thermal decomposition stages were computed and discussed.

Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.

OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. Postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: Uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.

Bone conduction impairment in uncomplicated chronic suppurative otitis media.

PURPOSE: To study the effect of uncomplicated chronic suppurative otitis media on bone conduction thresholds and its relationship to the disease type and duration. PATIENTS AND METHODS: The differences in bone conduction thresholds of diseased and contralateral ears were compared in 218 patients with unilateral uncomplicated chronic suppurative otitis media. Pure tone audiometry was carried out after successful surgery on 93 patients. RESULTS: The study showed bone conduction threshold elevations ranging in frequency from 9.2 to 14.1 dB in the diseased ears. Approximately 39% of the patients had an average difference of more than 10 dB for bone conduction, and 12% had an average difference of 20 dB or more. Significant relationships were found between threshold elevation and the disease type and its duration. Postoperative audiograms showed no significant improvement in the bone conduction thresholds in most of the tested patients. CONCLUSION: This study suggests that chronic otitis media may result in clinically significant bone conduction threshold elevations that should be considered when managing uncomplicated chronic suppurative otitis media.

Acquired medial canal fibrosis.

Acquired medial canal fibrosis is a discrete clinicopathological entity characterized by formation of fibrous tissue in the bony external auditory meatus. Over a seven-year period, a total of 14 operative procedures were performed on 12 ears involving 10 patients. Four cases had followed otitis externa, two were complications of suppurative otitis media, and three cases were iatrogenic. The cause could not be identified in three ears involving two patients. Treatment entails excision of all the fibrous tissue and involved skin, a wide canaloplasty, a meatoplasty, and then reconstruction by split skin graft. Two cases of canal cholesteatoma were encountered. Average follow-up of two years showed hearing improvement in all patients. The only complication was a recurrence of the stenosis in two ears. The paper discusses terminology, aetiology, pathophysiology, diagnosis, and principles of treatment of this condition.

Otological manifestations of primary ciliary dyskinesia.

Primary ciliary dyskinesia is a hereditary defect in the ultrastructure of cilia, leading to poor ciliary motility. The sinonasal and the bronchial manifestations of the disease are well documented; whereas its otological aspects have received less attention. In this report, we describe the clinical profile of 16 patients with primary ciliary dyskinesia laying particular emphasis on the otological manifestations. All children (11 patients) had bilateral otitis media with effusion. Of the five adults, three had tympanosclerosis; one had bilateral cholesteatoma; and one patient had bilateral keratosis obturans in combination with tympanosclerosis. Hearing improvement and a dry ear was achieved in all the children treated by tympanostomy tube insertion. The study suggests that otitis media is a prominent feature of this disorder. Most subjects suffer from protracted bilateral otitis media with effusion throughout childhood.

Lobular capillary haemangioma (pyogenic granuloma) of the nose.

OBJECTIVE: To present a number of cases with lobular capillary haemangioma (pyogenic granuloma) of the nose; and to discuss the clinical and histopathological diagnosis of this disorder. METHODS: A clinicopathological study of patients diagnosed with nasal lobular capillary haemangioma who were treated at King Abdel Aziz University Hospital, Riyadh from 1986 to 1995. RESULTS: The study group consisted of 12 patients (four males and eight females ranging in age from 17 to 65 years; mean 30.1 years). Clinically, most patients presented with epistaxis and a rapidly growing unilateral haemorrhagic mass. Most lesions were located on the septal mucosa. The clinical impression was misleading in some cases. The histological diagnosis was based on the lobular arrangement of capillaries. One case was initially misdiagnosed as angiofibroma. Excisional biopsy was the mainstay of treatment. One instance of recurrence was recorded. CONCLUSION: This uncommon lesion should be considered in the differential diagnosis of a rapidly growing haemorrhagic lesion within the nasal fossa. Clinical and histological diagnostic pitfalls occur frequently.