Spontaneous splenic rupture two days after laparoscopic sleeve gastrectomy.

IntroductionSleeve gastrectomy is a common bariatric procedure to manage morbid obesity. Splenic injury such as splenic rupture after sleeve gastrectomy is a rare complication which can be treated both with a splenectomy or conservative approach, called spleen-preserving surgery.Patients and methodsA 42 year old male, in whom we performed a sleeve gastrectomy, presented with splenic rupture, within 48 hours postoperative, for which spleen-preserving surgery was performed. As splenic rupture is a very rare complication, we performed an extensive literature search in PubMed database. After obtaining patient informed consent, we aim to describe a sixth presentation of this rare surgical complication.ResultTo the best of our knowledge, only five cases of splenic rupture after laparoscopic sleeve gastrectomy have been described before, all treated with a splenectomy. Furthermore, we are the first to describe spleen-preserving surgery.ConclusionWe present the sixth case of spontaneous splenic rupture after laparoscopic sleeve gastrectomy, and the first to treat it with spleen-preserving surgery.

Acute chest pain while exercising: a case report of Bochdalek hernia in an adolescent.

We present the case of a 17-year old male patient with a symptomatic congenital posterolateral diaphragmatic hernia with acute onset of symptoms. He was admitted to our emergency department a few days after the onset of symptoms. A large thoracic herniation on the left side was seen on chest X-ray. Further investigation by computed tomography showed the presence of stomach, spleen and colon in the herniation. Semi-urgent surgery was performed by a laparoscopic approach. The diaphragmatic defect was closed with interrupted sutures. The operation and postoperative recovery were uneventful.

Evaluation of a mucoadhesive tablet for ocular use.

The present study investigates the use of a polymer mixture containing Carbopol 974P and drum dried waxy maize starch to obtain prolonged drug release to the anterior eye segment. Two dosage forms with this composition are compared: a hydrated polymer dispersion and a minitablet. A model fluorescent tracer is used to study the ocular release and diffusion from the two dosage forms in humans. To evaluate the prolongation in the cornea/tearfilm compartment, the Apparent Fluorescein TurnOver (%/min) is calculated. The parameters Cmax, tmax, and C9h are used to characterize the pharmacokinetics of Na-fluorescein in the anterior chamber. Furthermore, the swelling behavior of the minitablet is evaluated macroscopically, while the degree of interaction with mucin is characterized by rheological measurements. Calculation of an acceptability score and a slug irritation potential is performed to evaluate user acceptability. In contrast to the hydrated dispersion, the minitablet significantly decreases the Apparent Fluorescein TurnOver (%/min) (P<0.05) and increases the apparent fluorescence in the anterior chamber 9 h after application of the preparation. Rheological data demonstrate the presence of elastic interactions between the polymer and mucin. The dry core of the minitablet becomes fully hydrated after approximately 2 h and is subsequently transformed into a highly concentrated gel. The acceptability of the minitablet is comparable to that of the polymer dispersion. Prolonging the release of Na-fluorescein to the anterior eye segment is only feasible with the dry preparation.

Steric effect and effect of metal coordination on the reactivity of nitric oxide with cysteine-containing proteins under anaerobic conditions.

A comparison is made between the reactivity of nitric oxide (NO) with cysteine, bovine serum albumin (BSA) and metallothionein-1 (MT1) at pH 7 under strictly anaerobic conditions. The rate of reaction of NO with these amino acid/proteins was found to be of the order: cysteine > BSA >> MT1, in clear disparity with the size of the reactants. The difference in the reaction rates is attributed to steric effects due to the high molecular size in the case of BSA and to effects of metal coordination proper as well as to steric effects associated with the closed dual shell-like structure resulting from the tight coordination of the thiolate groups with Zn2+ in MT1. The mechanisms of the reaction of NO with cysteine, BSA and MT and its possible implication for the rate of the respective reactions are discussed.

Rheological study on mucoadhesivity of some nasal powder formulations.

Various powder mixtures were used to administer insulin via the nasal route: a co-spray dried mixture of Amioca starch and Carbopol 974 P (1/3), drum dried waxy maize starch and Carbopol 974 P (9/1), maltodextrin DE38/Carbopol 974 P (9/1) and pure drum dried waxy maize starch. Oscillatory rheology is performed to study and compare the viscosity, elasticity and mucoadhesivity of these powder formulations. There was no rheological synergism detectable with the co-spray dried mixture of Amioca starch and Carbopol 974 P (1/3), drum dried waxy maize starch and Carbopol 974 P (9/1) and maltodextrin DE38/Carbopol 974 P (9/1). Interaction due to entanglements was seen with drum dried waxy maize starch (100%). The differences in nasal bioavailability between the different carriers could be explained by differences in G' (storage modulus, elasticity) and G" (loss modulus, viscosity) values. The formulation giving the highest bioavailability, provided also the highest G' and G" values.

Development of a rheometric technique to measure the mucoadhesive capacity of a dry powder formulation.

In the present study, the use of an in vitro technique applying oscillatory shear rheology to determine the interaction between a dry polymer powder and mucin is investigated. The polymers examined are Carbopol 974P, Noveon AA1 and a polymer mixture containing Carbopol 974P and Drum Dried Waxy Maize Starch. The degree of interaction is assessed by analysing the variation of the elastic and viscous modulus as a function of oscillation stress. Both moduli are used to calculate a mucoadhesive index at a selected single stress/frequency combination. The contribution of physical entanglements and secondary bond formation to the interaction can be derived from the mathematical analysis of the relation between the moduli and the oscillation frequency. When considering the stress sweep data, the interaction between mucin and the various polymers investigated seems very similar. This similarity is also observed when calculating the mucoadhesive indexes. On the contrary, the mathematical analysis of the frequency sweep data clearly indicates that the secondary bond formation between the polymer powder particles and mucin can be obtained only in the case of Carbopol 974 P.

Nitric oxide induces Zn2+ release from metallothionein by destroying zinc-sulphur clusters without concomitant formation of S-nitrosothiol.

The reaction of nitric oxide (NO) with metallothionein (MT) has been investigated at neutral pH under strictly anaerobic conditions. It is observed that NO mediates zinc release from MT by destroying zinc-sulphur clusters, but that it does not by itself S-nitrosylate MT in contrast to common belief. Zinc release and loss of thiolate groups under anaerobic conditions is found to be much slower than under aerobic conditions. The observed percentage loss of Zn(2+) and thiolate groups after 3 h of NO treatment are 62 and 39%, respectively. The reaction of NO with cysteine is reinvestigated and it is found that cysteine is quantitatively converted to cystine after 5 min of NO treatment at pH 7.3. At lower pH, a much lower rate of conversion is observed confirming the base-catalysed nature of the reaction of NO with thiols. On the basis of these results, a reaction mechanism involving electrophilic attack of NO on thiolate groups and subsequent formation of a nitrogen-centred radical, MTSN(. )OH, as intermediate is proposed for the reaction of NO with MT that leads to zinc release.

Congenital parenchymatous malformations of the lung.

Congenital lung malformations, primary and secondary, contribute to an important portion of pediatric thoracic surgery. One purpose of this report is to outline the close relation in terms of embryology and clinical presentation of congenital parenchymatous pulmonary malformations. In a retrospective study we also aim to evaluate our experience with the diagnosis and surgical management of congenital parenchymatous bronchopulmonary malformations and to compare our data with the literature. From January 1979 to December 1996 a series of 48 patients, 30 males (62.5%) and 18 females (37.5%), were operated on for congenital bronchopulmonary malformations. Pulmonary sequestration, bronchogenic cysts, congenital lobar emphysema, and congenital cystic adenomatoid malformation were seen in 16, 13, 5, and 14 patients, respectively. The first clinical symptoms occurred at a mean age of 8.8 years (1 day to 62 years), and the mean age at the time of surgical intervention was 9.3 years (1 day to 62 years). The maximum time between first symptoms and surgical treatment was 27 years. A lobectomy was performed in 22 cases; in the other patients more lung-preserving surgery such as enucleation or sequestrectomy was performed. Only one postoperative death occurred following lobectomy for pulmonary sequestration, and it was due to pulmonary hypoplasia and pulmonary hypertension. Eleven other patients presented with postsurgical complications: pneumothorax (n = 5), pleural effusion (n = 3), prolonged air leak (n = 2), portal vein thrombosis (n = 1), and hemorrhage requiring reintervention (n = 1). We conclude that any thoracic cystic lesion expanding on chest radiography should be an indication for surgical resection, even if asymptomatic, because of the risk of pulmonary compression, infection, or malignant degeneration. In the few cases of a fetal intrathoracic mass, prenatal diagnosis and intrauterine intervention may be indicated, and these indications are also discussed.