Assessing the impact of perioperative blood transfusions on the survival of adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal carcinomatosis.

BACKGROUND AND OBJECTIVES: Perioperative red blood cell transfusions (PBT) may be associated with worse survival. In this study of adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), we investigated whether there was an association between PBT and survival. MATERIALS AND METHODS: A retrospective study of adults who had undergone CRS-HIPEC for appendiceal carcinomatosis was conducted. Univariate and multivariate analyses were used to identify factors associated with survival. RESULTS: Of the 270 patients analysed, 170 (63%) received PBT. A PBT was not significantly associated with recurrence-free survival (RFS) (HR = 1·03; 95% CI: 0·7-1·51; P = 0·879) or overall survival (OS) (HR = 0·65; 95% CI: 0·38-1·11; P = 0·116). Higher number of PBT units (≥5) was not associated with worse RFS (P = 0·077) or OS (P = 0·079). Independent predictors of poor survival included as follows: estimated blood loss and high tumour grade for RFS (both P < 0·001), and male gender (P = 0·029) and high tumour grade (P < 0·001) for OS. Higher preoperative haemoglobin was independently associated with better RFS (P = 0·011) and OS (P = 0·006). CONCLUSIONS: In this retrospective study of adults who had undergone CRS-HIPEC for appendiceal carcinomatosis, PBT was not significantly associated with survival.

Biofeedback therapy and home pelvic floor exercises for lower urinary tract dysfunction after posterior urethral valve ablation.

PURPOSE: We sought to determine the effectiveness of biofeedback therapy and home pelvic floor exercises in children presenting with lower urinary tract dysfunction after posterior urethral valve ablation. MATERIALS AND METHODS: Children with urodynamically proved lower urinary tract dysfunction after successful valve ablation were enrolled for biofeedback therapy and home pelvic floor exercises. Detrusor pressure and electromyography findings were visually conveyed to patients on the computer screen. Patients were instructed to interrupt detrusor pressure increments by tensing the pelvic floor musculature in the presence of detrusor overactivity. In the presence of the nonrelaxing pelvic floor patients were first instructed to tighten the pelvic floor musculature and then to relax. RESULTS: A total of 30 children were enrolled for biofeedback therapy and home pelvic floor exercises between October 2005 and December 2006. Median patient age at first session was 5.1 years (range 4.5 to 12). Three patients (10%) had an excellent response, and 18 (60%) had a good response, with an overall consistent response of 70%. Nine patients (30%) had an inconsistent response. Mean number of sessions to achieve consistent urodynamic response was 3.5 (range 2 to 7). Mean baseline cystometric bladder capacity was 65% of normal for age (range 45% to 80%), which improved to a mean of 87.25% (50% to 100%) after treatment (p = 0.001). Of the 21 children who had a consistent response 11 (52%) do not require any further anticholinergics and 15 (71%) are free of clean intermittent catheterization. At a mean followup of 11 months (range 5 to 18) none of the patients had relapse. CONCLUSIONS: Biofeedback therapy and home pelvic floor exercises provide significant and durable relief in post-valve ablation persistent lower urinary tract dysfunction.

Effect of natural cheese characteristics on process cheese properties.

Natural cheese is the major ingredient utilized to manufacture process cheese. The objective of the present study was to evaluate the effect of natural cheese characteristics on the chemical and functional properties of process cheese. Three replicates of 8 natural (Cheddar) cheeses with 2 levels of calcium and phosphorus, residual lactose, and salt-to-moisture ratio (S/M) were manufactured. After 2 mo of ripening, each of the 8 natural cheeses was converted to 8 process cheese foods that were balanced for their composition, including moisture, fat, salt, and total protein. In addition to the standard compositional analysis (moisture, fat, salt, and total protein), the chemical properties (pH, total Ca, total P, and intact casein) and the functional properties [texture profile analysis (TPA), modified Schreiber melt test, dynamic stress rheometry, and rapid visco analysis] of the process cheese foods were determined. Natural cheese Ca and P, as well as S/M, significantly increased total Ca and P, pH, and intact casein in the process cheese food. Natural cheese Ca and P and S/M also significantly affected the final functional properties of the process cheese food. With the increase in natural cheese Ca and P and S/M, there was a significant increase in the TPA-hardness and the viscous properties of process cheese food, whereas the meltability of the process cheese food significantly decreased. Consequently, natural cheese characteristics such as Ca and P and S/M have a significant influence on the chemical and the final functional properties of process cheese.

Small-scale manufacture of process cheese using a rapid visco analyzer.

Numerous formulation and processing parameters influence the functional properties of process cheese. Recently, a small-scale (25 g) manufacturing and analysis method was developed using a rapid visco analyzer (RVA), which was designed to evaluate the functional properties of process cheese when subjected to various formulations and processing conditions. Although this method successfully manufactured process cheese, there was a significant difference in the functional properties of the process cheese compared with process cheese manufactured on a pilot scale. In the present study, adjustments in the RVA methodology involving the RVA processing conditions, preblend preparation, and texture profile analysis (TPA) techniques for the final process cheese were investigated. Fourteen samples of pasteurized processed cheese food (PCF) were manufactured from 14 different preblends. Each pre-blend was prepared using 1 of the 14 different natural cheeses and was balanced for moisture, fat, and salt. Each of these 14 preblends was split into 3 portions and each portion was subjected to 3 different manufacturing treatments. The first treatment was manufactured in a pilot-scale Blentech twin screw (BTS) cooker, and the remaining 2 treatments were manufactured in an RVA with different processing profiles. The RVA treatments were produced in triplicate. The resulting process cheeses were analyzed for moisture and functional properties. Texture profile analysis and RVA melt analyses were performed on all PCF treatments. Additionally, for the RVA treatments, the data for time of emulsification and end apparent viscosity during RVA manufacture were collected and recorded. The functional properties of the PCF manufactured using the RVA treatments showed good correlation with the functional properties of the PCF produced on the pilot scale. Additionally, the end apparent viscosity during RVA manufacture was correlated with the functional properties of the process cheese. Consequently, the RVA can be used as a small-scale manufacturing and analysis tool for predicting the functional properties of process cheese, and for evaluating how various formulations and processing parameters affect these functional properties. Moreover, the adjustments in the RVA methodology produced process cheese with functionality similar to process cheese produced in the BTS.

Emergence of thalamic magnetization transfer ratio abnormality in early relapsing-remitting multiple sclerosis.

While there is now evidence for thalamic abnormality in established secondary progressive and relapsing-remitting multiple sclerosis (MS), it remains unclear when such abnormality begins. This study investigated the emergence of thalamic abnormality in relapsing-remitting MS by assessing the thalamic magnetization transfer ratio (MTR) in a cohort with clinically early disease. Twenty-three patients with early relapsing-remitting MS (mean age 37; mean disease duration 1.9 years; Expanded Disability Status Scale (EDSS) range 0-3) and 19 healthy controls (mean age 34) were imaged yearly with a magnetization transfer imaging sequence. Twenty-two MS patients and 14 controls completed two-year follow-up. Regions of interest were placed in both thalami and mean thalamic MTR calculated. At baseline, significant differences between patient and control thalamic MTR were not observed. However, at years one and two, the thalamic MTR in patients was significantly lower than control MTR. Although baseline lesion volume did not correlate with baseline thalamic MTR, at year one, an association between baseline lesion volume and year one thalamic MTR emerged. There was also a significant inverse correlation between EDSS and thalamic MTR (r = -0.47, P = 0.02). The study suggests that thalamic involvement occurs within the first five years of MS onset, when most patients are still minimally disabled.

Influence of lead in soil on mycorrhizal development and plant growth of Cyamopsis tetragonoloba (Linn.) Taub.

Growth of C. tetragonoloba suffered with increase in concentration of Pb in soil. Plant biomass declined significantly at concentrations above 60 ppm of Pb. Roots showed more pronounced impact as compared to shoots. At highest applied concentration of lead (100 ppm), fresh weight of fruits decreased by 33% and dry weight by 52% as compared to control. No significant impact was noticed on the development of mycorrhiza at lower concentrations (15-45 ppm) of lead contamination. At higher concentrations of Pb (60 and 75 ppm), there was a decrease in VAM colonization. VAM hyphae had irregular size and terminated abruptly in outer cortex of root. Number of VAM fungal spores in rhizosphere also decreased with increase in the edaphic Pb concentration.

Acute urinary retention: defining the need and timing for pressure-flow studies.

OBJECTIVE: To investigate the utility of "late" pressure-flow studies in predicting the outcome of prostatectomy for acute urinary retention. PATIENTS AND METHODS: Fifty-eight patients with acute urinary retention were prospectively assessed using the International Prostate Symptom Score and pressure-flow studies at a median (range) of 24 (13-60) days after the episode of retention, and before transurethral resection of the prostate. Bladder outlet obstruction and bladder contractility were graded using a modified adaptation of Schäfer's passive urethral linear resistance relation. RESULTS: Fifty-six (97%) patients generated a voluntary detrusor contraction, with a mean (range) detrusor pressure at maximum flow of 72.7 (5-144) cmH2O, and 43 (75%) patients were deemed to be obstructed. Eight (16%) patients failed to void after prostatectomy and required clean intermittent catheterization. There were statistically significant differences between successful and unsuccessful patients in mean (SD) age, at 66.30 (6.9) vs 78.8 (2.6) years (P = 0.001), detrusor instability (49% vs 0%, P = 0.01), inability to void during pressure study (8% vs 75%, P = 0.001), and maximal detrusor pressure in the voiding phase, at 80 (36.0) vs 19 (11.2) cmH2O (P = 0.001). CONCLUSIONS: In patients with acute urinary retention, pressure-flow studies undertaken after a period of adequate bladder rest (> 3 weeks) are useful in predicting the surgical outcome. Old age, absence of bladder instability, inability to void during the pressure-flow study and a maximal detrusor pressure of < 20 cmH2O are associated with a poor outcome after prostatectomy.

Do prostatic stents solve the problem of retention after transurethral microwave thermotherapy?

Temporary nonmetallic stents offer an alternative to an indwelling catheter for the management of voiding problems after heat-based therapies for benign prostatic hyperplasia. Patient comfort is improved, and they are able to void immediately after the procedure. Unlike a catheter, stents function on the principle of active drainage. Thus, a functioning detrusor muscle is imperative for stent success. Single-center clinical trials have reported encouraging results; however, predictable success criteria are yet to be established. Multicenter trial data are awaited.

Transurethral microwave thermotherapy for the treatment of prostatitis.

The lethal action of microwaves on various microorganisms is well established and has been exploited in various clinical settings. Transurethral microwave thermotherapy (TUMT) has become a recognized modality for the treatment of prostatic diseases. Recently, it has been applied for the treatment of patients with nonbacterial prostatitis unresponsive to traditional therapeutic schemes. We review the current literature and present our recent encouraging experience with the in vitro bactericidal effect of microwaves on bacteria considered possible etiologic agents of prostatitis. Thus, we may consider the application of TUMT in patients with chronic bacterial prostatitis.

Effect of plant fruits--Indian gall nut, bedda nut and gooseberry--on hypercholesterolemic rats.

The effect of supplementation of three fruits, Indian gall nut, bedda nut and gooseberry, on serum lipid levels and excretion of bile acids was investigated. Rats made hypercholesterolemic by feeding hypercholesterolemia inducing diet (HID) for a period of 30 days were used as the test model. Feeding of a dried powder of these fruits along with the HID resulted in significant (p<0.01) reduction in total cholesterol, LDL cholesterol and triglycerides. HDL cholesterol remained unchanged in groups fed gall nut and bedda nut. However, the levels were significantly (p<0.01) higher in groups fed mixed and gooseberry diets in comparison to the control diet. Excretion of bile acids was found to be significantly (p<0.01) higher in animals receiving the three fruits in combination in comparison to those receiving the individual fruits.

Supplementary effect of spirulina on hematological status of rats during pregnancy and lactation.

The effect of Spirulina on iron status was assessed based on hemoglobin, packed cell volume, serum iron, total iron binding capacity and ferritin levels of rats during pregnancy and lactation. Rats were fed 5 different kinds of diets (casein, Spirulina, wheat gluten, Spirulina + wheat gluten, Spirulina without additional vitamins and minerals) each providing 22 percent protein. Diets containing Spirulina alone or in combination with wheat gluten resulted in significantly higher iron storage and hemoglobin contents than casein and wheat gluten diets during the first half of pregnancy and lactation. Wheat gluten diet result in the smallest increase in hemoglobin levels and iron stores compared to other diets. The values of serum iron and iron binding capacity remained unchanged with different diets. Spirulina appears to be effective in improving the iron status of rats during pregnancy and lactation.

Perlecan and basement membrane-chondroitin sulfate proteoglycan (bamacan) are two basement membrane chondroitin/dermatan sulfate proteoglycans in the Engelbreth-Holm-Swarm tumor matrix.

The presence of proteoglycans bearing galactosaminoglycan chains has been reported, but none has been identified previously in the matrix of the Engelbreth-Holm-Swarm tumor, which is a source of several basement membrane components. This tumor matrix contains perlecan, a large, low buoyant density heparan sulfate proteoglycan, widespread in many basement membranes and connective tissues. We now identify two distinct proteoglycan species from this tumor source, which are substituted with galactosaminoglycans and which show basement membrane localization by immunohistochemistry. One species is perlecan but, in addition to being present as a heparan sulfate proteoglycan, it is also present as a hybrid molecule, with dermatan sulfate chains. A minor population of perlecan apparently lacks heparan sulfate chains totally, and some of this is substituted with chondroitin sulfate. The second species is immunologically related to basement membrane-chondroitin sulfate proteoglycan (BM-CSPG) and bears chondroitin sulfate chains. No BM-CSPG was detectable which was substituted with heparan sulfate chains. A combination of immunological and molecular approaches, including cDNA cloning, showed that perlecan and BM-CSPG are distinct in core protein structure. Both are, however, basement membrane components, although there are tissue-specific differences in their distribution.

A new endoscopic technique for non deflating Foley balloon.

OBJECTIVE: To describe a new technique to deflate impacted Foley balloon. METHOD: A total endourologic method using urethrotome sheath, ureteric catheter, stylet, sedoanalgesia needle and cold cup biopsy forceps is described. The technique involves minimal maneuverability of urethra. RESULTS: The technique is non traumatic, simple, and successful in almost all cases. This technique requires urology instruments which are easily available at any centre. CONCLUSION: The described technique is safe, effective non traumatic and can easily be used in cases of impacted Foley balloon. There is no damage to the posterior urethra.

Thyrotropin-releasing hormone: inhibitory function on growth hormone through both somatostatin and growth hormone-releasing factor neurons.

Double labelling immunohistochemistry using antibodies to thyrotropin releasing hormone (TRH) and somatostatin (SS) was undertaken in the anterior hypothalamus in 6 rats. Light microscopic quantitation revealed that 94.5% of SS immunopositive perikarya in the preoptic anterior hypothalamic area (PO/AHA) and 97.5% in the paraventricular nucleus appeared to be contacted by one or more TRH immunopositive terminals. In the chronically cannulated unanaesthetised male rat, unilateral microinjections of a range of doses of TRH were made in the PO/AHA, where SS neurons are located, or in the medial basal hypothalamus, where growth hormone (GH)-releasing factor (GRF) neurons are located. Transient reductions in GH plasma levels occurred only after injections of the highest (10 nmol) dose of TRH in both sites. The function of TRH inputs to both somatostatin and GRF neurons appears to be inhibitory for GH. The physiological conditions in which these inputs function remain to be defined.

Autonomic functions and audiovisual reaction time in heroin addicts.

Radial pulse rate, systolic BP (SBP), diastolic BP (DBP), initial GSR0), GSR after 5 minutes of relaxation (GSR5), auditory reaction time (ART) and visual reaction time, (VRT) were measured in 30 male heroin addicts and compared with 25 male control subjects of similar age group. In heroin addicts DBP was significantly low (71.73 mmHg +/- 7.42, P < 0.05); while SBP although being low (106.13 mmHG +/- 10.08) was not significant. However, radial pulse was significantly higher. GSR0 was significantly higher (P < 0.001) but GSR5 was not significantly higher in these addicts, suggesting less sympathetic activity. In a separate group of ten heroin addicts effect of change in posture from supine to erect on BP was studied. This did not produce any rise in SBP or DBP at 1 and 2 min, suggesting probably inhibition of baroreceptor reflex. Auditory reaction time (ART) and visual reaction time (VRT) were significantly prolonged (P < 0.001 for each) in addicts, indicating deterioration of processing capability of CNS, or poor sensory-motor performance, or both.

Interactions between the effects of opioid, serotonin and alpha-2-adrenergic receptor agonists on growth hormone release in the male rat. Intrahypothalamic administration.

In a previous study, we identified a number of negative interactions between the growth hormone (GH)-releasing effects of opioid, alpha 2 and serotonin agonists when given intravenously together to male rats. To further characterise these interactions, conscious male rats were given unilateral intrahypothalamic injections of clonidine, the serotonin agonist quipazine and a mu opioid agonist (DAGO), and plasma GH levels were measured. Injection of all three drugs separately into the mediobasal hypothalamus (MBH) increased GH release. Combinations of DAGO-clonidine (p = 0.04), clonidine-quipazine (p = 0.04) and DAGO-clonidine-quipazine (p = 0.04) produced significantly less than additive GH release, whereas DAGO-quipazine produced additive release. MBH injection of the alpha 2 antagonist idazoxan 10 nmol prevented the GH rise due to clonidine, but did not inhibit release due to DAGO. Injection of DAGO and clonidine but not quipazine into the preoptic-anterior hypothalamic area (PO/AHA) increased GH release, and combination injections of DAGO and clonidine produced additive release. PO/AHA idazoxan 10 nmol prevented GH release caused by both clonidine and DAGO, suggesting that idazoxan prevents opioid-induced as well as clonidine-induced suppression of somatostatin release. The inability of MBH idazoxan to block DAGO-induced GH release suggests that opioid-adrenergic interactions here are not due to an opioid GH-releasing action exerted through catecholaminergic pathways. The negative interaction previously identified between intravenous opioids and quipazine probably occurs outside the hypothalamus.

Local hypothalamic adrenoceptor activation in rat: alpha 1 inhibits and alpha 2 stimulates growth hormone secretion.

We made stereotaxic microinjections of adrenoceptor agonists and the catecholamine-releasing agent, tyramine, into the preoptic anterior hypothalamic area (PO/AHA) or the medial basal hypothalamus (MBH) of unstressed rats. Growth hormone (GH) plasma concentrations were measured serially before and after intrahypothalamic injections. Noradrenaline and phenylephrine inhibited GH secretion wherever injected but were effective at lower doses in the PO/AHA. Clonidine stimulated GH secretion at both sites, at several doses in the MBH and only at one dose in the PO/AHA. Tyramine inhibited GH when injected in the PO/AHA, but not in the MBH. We conclude: (a) alpha 1 inhibition is predominant over alpha 2 stimulation of GH on or near somatostatin neurons; (b) alpha 2 stimulation predominates over alpha 1 inhibition of GH on or near GRF neurons, and (c) endogenous catecholamines in the PO/AHA have a predominantly inhibitory effect on GH secretion.

Endogenous catecholamines modulate growth hormone release in the conscious rat during hypoglycaemia but not in the basal state.

To investigate the role of endogenous catecholamines and 5-hydroxytryptamine in the control of growth hormone (GH) secretion, secretory profiles of GH and prolactin were measured in conscious, male rats following intravenous administration of either 1) alpha 2 antagonist idazoxan 2 mg/kg, a dose that blocked alpha 2 agonist induced GH rise, 2) alpha 1 antagonist prazosin 1 mg/kg, 3) non-specific beta-blocker propranolol 1.5 mg/kg, a dose that prevented beta 2 agonist (salbutamol) induced inhibition, 4) serotonin antagonist cyproheptadine 0.5 mg/kg, a dose that inhibited serotonin agonist quipazine induced GH rise, or 5) control. No drug altered mean GH or prolactin levels and pulsatile GH release persisted. Unilateral injections of prazosin, propranolol and idazoxan were made into the medial basal hypothalamus and preoptic-anterior hypothalamic area and of cyproheptadine into the medial basal hypothalamus, all with no effect on short-term GH release. GH and prolactin secretory profiles were measured after giving rats 6 units/kg intravenous insulin. Blood glucose levels fell to less than 50% basal. Hypoglycaemia caused a non-significant 30% fall in mean 2 h GH. Intravenous idazoxan, prazosin, propranolol and cyproheptadine (doses as in first study) did not modify the blood glucose fall, but idazoxan produced a significant reduction of mean GH compared to insulin alone (4 +/- 1.1 ng/ml SEM, idazoxan/insulin versus 16 +/- 5.6 ng/ml, saline/insulin). The lack of an effect of alpha- and beta-blockers on normal, pulsatile GH release is against a role for endogenous catecholamines in controlling this release.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of supplementation of blue green alga (Spirulina) on outcome of pregnancy in rats.

To study the supplementary effect of Spirulina, pregnant rats were fed 5 different kinds of diets (casein, Spirulina, wheat gluten, Spirulina + wheat gluten, Spirulina-without additional vitamins and minerals), each providing 22% protein during the period of pregnancy. The outcome of pregnancy was assessed from litter and dams' weight and litter size. Maternal weight gain was found to be maximum with Spirulina + wheat gluten and least with the wheat gluten diet. Rats receiving Spirulina containing diets produced significantly (p < 0.05) higher litter size than those receiving casein and wheat gluten. In spite of having higher litter size, Spirulina containing diet groups produced pups with birth weights comparable to those of casein. Spirulina appears to be a good dietary supplement during pregnancy.