Diagnostic test accuracy of magnetic resonance imaging and pelvic floor ultrasound for diagnosis of levator ani muscle avulsion.

OBJECTIVE: To estimate the diagnostic test accuracy of magnetic resonance imaging (MRI) and pelvic floor ultrasound for levator ani muscle (LAM) avulsion in a general parous population, with view to establishing if ultrasound could substitute for MRI to diagnose LAM avulsion. METHODS: This was a cross-sectional study of 135 women 4 years after their first delivery. Signs and symptoms of pelvic floor dysfunction were assessed using validated methods. All women underwent four-dimensional transperineal ultrasound (TPUS), three-dimensional endovaginal ultrasound (EVUS) and MRI. Images were acquired at rest, on pelvic floor muscle contraction (PFMC) and on maximum Valsalva maneuver, and analyzed by two blinded observers. Predefined cut-off values were used to diagnose LAM avulsion. In the absence of a reference standard, latent class analysis (LCA) was used to establish diagnostic test characteristics for LAM avulsion as the primary outcome measure. Secondary outcomes were kappa (κ) agreement between imaging techniques, intraclass correlation coefficients (ICC) for hiatal measurements at rest, on PFMC and on maximum Valsalva maneuver, and the association of LAM avulsion with signs and symptoms of pelvic floor dysfunction. RESULTS: The prevalence of LAM avulsion was 23.0% for MRI, 11.1% for TPUS and 17.8% for EVUS. The prevalence of LAM avulsion using LCA was 15.7%. The sensitivity for LAM avulsion of TPUS (71% (95% CI, 50-90%)) and EVUS (91% (95% CI, 74-100%)) was lower than that of MRI (100% (95% CI, 84-100%)). The specificity of TPUS (100% (95% CI, 97-100%)) and EVUS (95% (95% CI, 91-99%)) was higher than that of MRI (91% (95% CI, 85-97%)). MRI and EVUS had high predictive values for the assessment of major LAM avulsion (positive predictive value (PPV), 95% and negative predictive value (NPV), 100%; PPV, 100% and NPV, 98%, respectively), while TPUS had high predictive values for minor LAM avulsion (PPV, 100% and NPV, 95%). Major LAM avulsion on MRI and EVUS was associated with anterior vaginal wall prolapse, which was not found for TPUS. The agreement in the diagnosis of LAM avulsion (κ, 0.69) and hiatal measurements (ICC, 0.60-0.81) was highest between MRI and EVUS. CONCLUSIONS: Pelvic floor ultrasound can be implemented as a triage test to assess parous women for LAM avulsion because of its high specificity. Ultrasound cannot substitute for MRI because of its lower sensitivity. The predictive ability of ultrasound is moderate for the presence, and very good for the absence, of LAM avulsion. A positive test should be confirmed by a different observer or imaging technique. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Parathyroid hormone reference ranges in healthy individuals classified by vitamin D status.

PURPOSE: Parathyroid hormone (PTH) concentrations are routinely measured in the diagnosis and management of bone and kidney diseases, but reference ranges can be overestimated if determined in otherwise healthy individuals for whom vitamin D deficiency was not evaluated. We establish PTH reference ranges in apparently healthy, normocalcemic, normophosphatemic individuals categorized by 25-hydroxyvitamin D (25(OH)D) status using the Elecsys® PTH (cobas e 601) and Elecsys® Vitamin D total II electrochemiluminescence immunoassays (cobas e 411). METHODS: This prospective, non-interventional study measured PTH in serum from 653 apparently healthy adults [56.7% female; 68.2% white/Caucasian; 28.6% African American; median age 44 years (range 21-83)] from three diverse geographic sites across the USA during summer and winter months. Subjects were classified by concomitant vitamin D sufficiency (≥ 30 ng/mL), insufficiency (> 20 to < 30 ng/mL) or deficiency (≤ 20 ng/mL). RESULTS: In vitamin D sufficiency, median PTH was 31.9 pg/mL [range (2.5th-97.5th percentile) 17.9-58.6] compared with 35.5 pg/mL (17.0-60.4) for insufficiency, and 39.8 pg/mL (19.5-86.4) for deficiency. A significant inverse relationship was found between PTH and 25(OH)D (P < 0.001). After accounting for vitamin D, potential effects of race or season as covariates were relatively small or absent. CONCLUSIONS: Upper reference limits (URL) for PTH in vitamin D sufficiency/insufficiency were similar and lower than current values. Clinically important PTH elevations were observed in vitamin D deficiency, where revised reference ranges with a higher URL may be appropriate. These data may help to distinguish vitamin D-related PTH elevations from other causes [e.g., primary (normocalcemic) or secondary hyperparathyroidism].

Does 4D transperineal ultrasound have additional value over 2D transperineal ultrasound for diagnosing posterior pelvic floor disorders in women with obstructed defecation syndrome?

OBJECTIVE: To establish the diagnostic test accuracy of two-dimensional (2D) and four-dimensional (4D) transperineal ultrasound (TPUS) for diagnosis of posterior pelvic floor disorders in women with obstructed defecation syndrome (ODS), in order to assess if 4D ultrasound imaging provides additional value. METHODS: This was a prospective cohort study of 121 consecutive women with ODS. Symptoms of ODS and pelvic organ prolapse on clinical examination were assessed using validated methods. All women underwent both 2D- and 4D-TPUS. Imaging analysis was performed by two blinded observers. Posterior pelvic floor disorders were dichotomized into presence or absence, according to predefined cut-off values. In the absence of a reference standard, a composite reference standard was created from a combination of results of evacuation proctography, magnetic resonance imaging and endovaginal ultrasound. Primary outcome measures were diagnostic test characteristics of 2D- and 4D-TPUS for rectocele, enterocele, intussusception and anismus. Secondary outcome measures were interobserver agreement, agreement between the two imaging techniques, and association of severity of ODS symptoms and degree of posterior vaginal wall prolapse with conditions observed on imaging. RESULTS: For diagnosis of all four posterior pelvic floor disorders, there was no difference in sensitivity or specificity between 2D- and 4D-TPUS (P = 0.131-1.000). Good agreement between 2D- and 4D-TPUS was found for diagnosis of rectocele (κ = 0.675) and moderate agreement for diagnoses of enterocele, intussusception and anismus (κ = 0.465-0.545). There was no difference in rectocele depth measurements between the techniques (19.9 mm for 2D vs 19.0 mm for 4D, P = 0.802). Interobserver agreement was comparable for both techniques, although 2D-TPUS had excellent interobserver agreement for diagnosis of enterocele and rectocele depth measurements, while this was only moderate and good, respectively, for 4D-TPUS. Diagnoses of rectocele and enterocele on both 2D- and 4D-TPUS were significantly associated with degree of posterior vaginal wall prolapse on clinical examination (odds ratio (OR) = 1.89-2.72). The conditions observed using either imaging technique were not associated with severity of ODS symptoms (OR = 0.82-1.13). CONCLUSIONS: There is no evidence of superiority of 4D ultrasound acquisition to dynamic 2D ultrasound acquisition for the diagnosis of posterior pelvic floor disorders. 2D- and 4D-TPUS could be used interchangeably to screen women with symptoms of ODS. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Stabilization of the Amorphous Ezetimibe Drug by Confining Its Dimension.

The purpose of this paper is to investigate the influence of nanoconfinement on the molecular mobility, as well as on the physical stability, of amorphous ezetimibe drug. Two guest/host systems, ezetimibe-Aeroperl 300 and ezetimibe-Neusilin US2, were prepared and studied using various experimental techniques, such as X-ray diffraction (XRD), differential scanning calorimetry (DSC), and broadband dielectric spectroscopy (BDS). Our investigation has shown that the molecular mobility of the examined anticholesterol agent incorporated into nanopore matrices strongly depends on the pore size of the host system. Moreover, it was found that the amorphous ezetimibe confined in 30 nm pores of Aeroperl 300 has a tendency to recrystallize, while the drug incorporated into the smaller--5 nm--pores of Neusilin US2 is not able to crystallize. It has been shown that this significant stabilization of ezetimibe drug can be achieved by an interplay of three factors: changes in molecular dynamics of the confined amorphous drug, the immobilization effect of pore walls on a part of ezetimibe molecules, and the use of host materials with pores that are smaller than the critical size of the drug crystal nuclei.

Accuracy of assessing Pelvic Organ Prolapse Quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: We determined the relationship between clinical assessment of female pelvic organ prolapse (POP) using the validated Pelvic Organ Prolapse Quantification (POP-Q) and dynamic 2D transperineal ultrasound (TPUS). METHODS: Women attending the urogynecology clinics between July and October 2009 were recruited. Prolapse was assessed using the POP-Q. Points Ba, Bp and C (anterior, posterior and middle compartments, respectively) were measured. TPUS was performed at maximum Valsalva by another clinician. As the TPUS probe compresses the prolapse that extends beyond the hymen, these women were excluded. A reference line was drawn parallel to the inferoposterior margin of the pubic symphysis, perpendicular to which the leading edge of descent was measured. The offset measured from the curved array of the probe to the reference line was added to the prolapse quantification on ultrasound (US) scan to make it objectively comparable with the POP-Q reference of the hymen. Points Ba, Bp and C on POP-Q were then compared with points of maximum descent achieved on TPUS. RESULTS: One hundred and fifty-eight women had a POP-Q and TPUS; 20 scans (12.6 %) were not analysable, and 41 women had prolapse beyond the hymen. Ninety-seven women were thus analysed. The correlation between 2D TPUS (with/without the addition of the offset) and POP-Q was statistically significant (p value <0.0001) for all three compartments. The proportion of correct predictions was 59.6 %, 61.5 % and 32.6 % for bladder, bowel and middle-compartment prolapse, respectively. CONCLUSION: These findings suggest that the accuracy of pelvic floor US staging is limited and that clinical assessment remains the gold standard.

Pelvic floor disorders: role of new ultrasonographic techniques.

The paper presents the role of various ultrasound modalities in the diagnostics of female pelvic floor disorders (PFD). It describes the use of two/three/four-dimensional transperineal ultrasound and endocavitary transducers, which, up to now, have been used for proctological examinations and prostate cancer brachytherapy. Ultrasonography is the most widely available imaging modality. As a result of technical progress, novel transducers and more sophisticated software have recently been introduced to the market providing more information about the anatomy of pelvic organs. Some features of these transducers, such as higher frequency and multiplanar imaging, enable better visualisation of pelvic floor organs. In-depth knowledge of the technical and physical properties of modern ultrasonography, as well as its advantages and limitations, could provide an integrated approach to imaging of PFD. Technical modalities, the wide availability of ultrasonographic techniques, and an understanding of the imaging possible with modern ultrasonography could improve our understanding of PFD and allow better assessment in pre- and post-surgical management.

State of the art: an integrated approach to pelvic floor ultrasonography.

Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this region, ultrasonography has emerged as a procedure that is relatively easy to perform, cost-effective and widely available. In this review, pelvic floor ultrasonography, including two-dimensional (2D), three-dimensional (3D) and 4D imaging as well as transvaginal, endoanal and transperineal techniques, is discussed from a global and multicompartmental perspective, rather than using a compartmentalized approach. The role of the different sonographic modalities in the major disorders of the pelvic floor-urinary and fecal incontinence, pelvic organ prolapse and obstructed defecation syndrome-is evaluated critically.

Bioindication of trace metals in Brachythecium rutabulum around a copper smelter in Legnica (Southwest Poland): Use of a new form of data presentation in the form of a self-organizing feature map.

Concentrations of the elements Al, Be, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, V, and Zn were measured in the terrestrial moss Brachythecium rutabulum and the soil on which it grew. Soil and moss plants were sampled at sites situated 1.5, 3, 6, 9 and 15 km to the north, south, east and west of the Legnica copper smelter (SW Poland). The self-organizing feature map (SOFM) or Kohonen network was used to classify the soil and moss samples according to the concentrations of the elements. The self-organizing map yielded distinct groups of B. rutabulum and soil samples, depending on the distance from and direction to the source of pollution. When the map-identified groups of sites with similar soil metal concentrations were combined with the map-identified groups of sites with similar metal concentrations in B. rutabulum, these maps were found to correspond closely. The SOFMs accurately represented the least polluted, moderately polluted and severely polluted sites, reflecting the distribution of metals that is typical of the smelter area, caused by the prevailing westerly and northerly winds.

Beneficial effect of combined spironolactone and quinapril treatment on thrombosis and hemostasis in 2K1C hypertensive rats.

A strong correlation between raised aldosterone levels and increased risk of thrombotic disorders has been provided. Clinical studies have demonstrated the benefits of the addition of the aldosterone receptor antagonist to the standard therapy with angiotensin-converting enzyme inhibitor in the reduction of cardiovascular events in patients. We suggest that the benefits of this dual renin-angiotensin-aldosterone system (RAAS) blockade may be related to the drug's effects on the hemostatic and oxidative balance. Thus, we investigated the effect of combined spironolactone (SPIRO) and quinapril (QUIN) administration on thrombosis, hemostasis and oxidative stress in hypertensive rats. A two-kidney, one-clip model of renovascular hypertension in Wistar rats was used. QUIN, SPIRO, or QUIN + SPIRO were administered for 10 days. Venous thrombosis was induced by vena cava ligation. Thrombus weight and incidences of thrombosis were assessed. Bleeding time, platelet adhesion, tissue factor (TF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thrombin activatable fibrynolysis inhibitor (TAFI), malonyl dialdehyde, and hydrogen peroxide plasma levels were assayed. Aortic expression of NADPH oxidase and superoxidase dismutase were measured. We observed significant RAAS activation associated with hypercoagulability and oxidative stress augmentation in renovascular hypertensive rats. Thrombosis was reduced only in rats treated with QUIN + SPIRO. In all groups, decreases in TF, PAI-1, and TAFI levels were observed, however in the QUIN + SPIRO group those changes were more pronounced. The inhibition of platelet adhesion was also stronger in rats treated with QUIN + SPIRO. The oxidative stress parameters were markedly reduced in rats treated with QUIN or SPIRO, although the most evident changes were observed in the QUIN + SPIRO group. Dual RAAS blockade with aldosterone receptor antagonist and angiotensin-converting enzyme inhibitor provides additional benefits for experimental thrombosis associated with the antiplatelet, anticoagulative, profibrinolytic, and antioxidative effects in renovascular hypertensive rats.

Self-organizing feature map (neural networks) as a tool in classification of the relations between chemical composition of aquatic bryophytes and types of streambeds in the Tatra national park in Poland.

Concentrations of the elements Al, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb and Zn were measured in the aquatic bryophytes Fontinalis antipyretica, Platyhypnidium riparioides and Scapania undulata. These bryophytes were sampled from streams flowing through granites/gneisses, limestones/dolomites and sandstones in the Tatra national park in Poland. The Self-organizing feature map (SOFM) or Kohonen network was used to classify the bryophytes according to the concentrations of the elements. This method was verified using principal component analysis (PCA) to check whether this well-known technique would give similar results. Both the self-organizing map and ordination by PCA yielded distinct groups of aquatic bryophytes growing in streams flowing through different types of rock, groups which differed significantly in the concentrations of certain elements. Bryophytes from granites/gneisses were distinguished by higher concentrations of Cd and Pb, while those from sandstones had a higher concentration of Cr and those from limestones/dolomites had higher concentrations of Ca and Mg. The SOFM and PCA ordinations thus yield identical classifications of bryophytes from the Tatra mountains streams.

Nonlinear dielectric properties and temperature stabilization effect near the ferroelectric phase transition in sodium trihydrogen selenite.

The ferroelectric phase transition of crystalline sodium trihydrogen selenite has been characterized by domain observations and measurements of electric permittivity, pyroeffect and spontaneous polarization. The first-order character of the phase transition is clearly demonstrated by the phase coexistence and temperature autostabilization. The considerable heating effect at 50 Hz ac field is described. The electric field effect on the temperature variation of the electric permittivity, in the phase transition region, shows a considerable domain structure contribution to the permittivity value. It is demonstrated that the dielectric properties of x- and y-samples can be described by classical dielectric state equations: the set of coefficients has been determined. It is concluded that the x-component of spontaneous polarization plays a predominant role in the phase transition.

Isolation and regulatory properties of mitochondrial malic enzyme from rat skeletal muscle.

Mitochondrial malic enzyme (L-malate:NADP+ oxidoreductase (oxalo-acetate-decarboxylating), EC 1.1.1.40) has been isolated from rat skeletal muscle by (NH4)2SO4 fractionation, chromatography on DEAE-cellulose and Ultrogel AcA 34. Specific activity of the purified enzyme was 25 micromol/min per mg of protein which corresponds to about 840-folf purification. The enzyme was shown to carboxylate pyruvate in the presence of high concentrations of KHCO3 and pyruvate at about 15% of the rate of the forward reaction. The Km values determined at pH 7.2 for malate, NADP and Mn2+ were 0.33 mM, 6.8 microM and 7.1 microM, respectively. The Km values for pyruvate, NADPH and KHCO3 were 8.3 mM, 19.6 microM, and 24.4 mM, respectively. Purified enzyme showed allosteric properties at low concentration of malate and this characteristic can be modified by succinate and fumarate which do not affect the maximum velocity of the reaction. The pH optimum for decarboxylation reaction was between 7.2 and 8.4. Possible metabolic role of mitochondrial malic enzyme in skeletal muscle is discussed.

Angiotensin II via AT1 receptor accelerates arterial thrombosis in renovascular hypertensive rats.

Although there are some in vitro evidence that angiotensin II (Ang II) may promote thrombosis, there is still no data concerning effect of Ang II on arterial thrombus formation. In the present study we have investigated the influence of Ang II on electrically induced arterial thrombosis in a common carotid artery of renovascular hypertensive rats. Furthermore, we examined if Ang II effect is mediated via AT1 receptor. We measured some coagulation and fibrinolytic parameters at the same time. Since platelets play crucial role in the initiation of arterial thrombosis their contribution in the mode of Ang II action was also determined. Intravenous infusion of Ang II caused significant increase in arterial thrombus weight, which was reversed by losartan, selective AT1 receptor antagonist. The prothrombotic effect of Ang II was accompanied by increase in haemostatic and decrease in fibrinolytic potential of rat plasma. While number of data has clearly demonstrated that Ang II can augment human platelets aggregation, at least in rats, platelets were not involved in the mechanism of Ang II action. Our study shows that Ang II via AT1 receptor accelerates arterial thrombosis in renovascular hypertensive rat, therefore may be considered as a risk factor of myocardial infarction or stroke.

Report Summary--Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015.

In 2012, Canada and other United Nations (UN) Member States endorsed the "Rio Political Declaration on Social Determinants of Health" (Rio Declaration), a non-binding pledge which calls on World Health Organization (WHO) Member States to improve/influence the working and living conditions that affect health and well-being. The Rio Declaration sets out actions to address health inequities in five themes: to adopt better governance for health and development; to promote participation in policy making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor and increase accountability. In 2013, following the endorsement of the Rio Declaration, the Government of Canada released a report to begin to document Canadian actions related to its five themes. Building on this first report, and in anticipation of WHO reporting on Member State implementation of the Rio Declaration at the May 2015 World Health Assembly, the Government of Canada developed the report, Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015, which showcases Canada's recent actions since 2013 contributing to the advancement of the five Rio Declaration themes. The report provides a current picture of the diverse spectrum of activities undertaken across levels of government and sectors to advance health equity and address social determinants of health in Canada, and intends to stimulate global and domestic exchange and uptake of promising practices to advance health equity.

TITRE: Note de synthèse - Déclaration politique de Rio sur les déterminants sociaux de la santé : aperçu des mesures canadiennes de 2015. INTRODUCTION: En 2012, le Canada et d'autres États membres des Nations unies ont adopté la Déclaration politique de Rio sur les déterminants sociaux de la santé (Déclaration de Rio), un engagement non contraignant par lequel les États membres de l'Organisation mondiale de la santé (OMS) promettent d'améliorer les conditions de travail et de vie qui influent sur la santé et le bien-être. La Déclaration de Rio énonce plus précisément cinq engagements visant à réduire les inégalités en santé : adopter une meilleure gouvernance pour la santé et le développement, promouvoir la participation à l'élaboration et à la mise en oeuvre des politiques, réorienter davantage le secteur de la santé pour réduire les inégalités en santé, renforcer la gouvernance et la collaboration mondiales et enfin suivre les progrès et accroître la responsabilisation. En 2013, à la suite de l'adoption de la Déclaration de Rio, le gouvernement du Canada a publié un premier rapport pour rendre compte des mesures prises. En 2015, en prévision de la présentation d'un rapport par l'OMS sur la mise en oeuvre de la Déclaration de Rio par les États membres à l'Assemblée mondiale de la santé en mai et en s'appuyant sur ce premier rapport, le gouvernement du Canada a rédigé le rapport Déclaration politique de Rio sur les déterminants sociaux de la santé : aperçu des mesures canadiennes de 2015, qui présente les mesures relevant des cinq engagements de la Déclaration et prises depuis 2013 par le Canada. Ce rapport donne un aperçu des activités entreprises par les différents ordres de gouvernement et secteurs pour promouvoir l'équité en santé et agir sur les déterminants sociaux de la santé. Il vise de plus à encourager la mise en commun et l'adoption de pratiques prometteuses visant à promouvoir l'équité en santé à l'échelle nationale et internationale.

Cathepsin A activity of normal bovine ocular tissues and pathological human intraocular fluids.

Cathepsin A activity assayed with N-Cbz-Phe-Ala, N-Cbz-Glu-Tyr and N-Cbz-Glu-Phe as substrates, was measured in fresh corneas, lenses, aqueous humor, vitreous humor and choroid plus retinal pigment epithelium taken from normal bovine eye balls and in human intraocular fluids from the eye balls in various ocular diseases (cataract, glaucoma, diabetes, intraocular tumors). Cathepsin A exhibited a pH optimum at 5.0 and showed the highest specificity towards N-Cbz-Phe-Ala as a substrate. In bovine ocular tissues high cathepsin A activity was found in the choroid plus retinal pigment epithelium and in cornea. The lens and the vitreous humor showed low enzyme activity and the aqueous humor none at all. In the human aqueous humor of the eye with cataract cathepsin A activity was more than three times higher then in the eye with choroid tumor. In human vitreous humor in absolute glaucoma the activity was twice as high as in melanoma and almost three times higher than in the case of lung metastatic tumor. Diabetes in glaucoma increased seven fold cathepsin A activity in the vitreous humor.

Antioxidant status and proteolytic-antiproteolytic balance in colorectal cancer.

Free radicals participate in the development of cancer. When the antioxidant defence system is not longer capable to destroy free radicals they may cause lipid and protein oxidation. Lipid peroxidation products also modify proteins. In such a situation the proteolytic-antiproteolytic balance existing in the blood may be changed. Therefore the aim of this study was to examine the correlation between antioxidant status and activity of proteolytic enzymes and their inhibitors in cases of colorectal cancer. This study included 55 patients with colorectal cancer. The blood was taken before surgery and plasma was collected. Total antioxidant status, the levels of lipid peroxidation products (malondialdehyde and 4-hydroxynonenal) and activity of cathepsin G, elastase and their inhibitors (alpha-1-antitrypsin and alpha-2-macroglobulin) were determined in plasma. It was shown that during the development of cancer total antioxidant status was signficantly decreased while lipid peroxidation products were increased. Activity of alpha-2-macroglobulin was decreased and activity of determined enzymes was not significantly changed. The observed changes indicate a shift in proteolytic-antiproteolytic balance which may enhance carcinogenesis.

Antioxidant status and lipid peroxidation in colorectal cancer.

Colon carcinogenesis is a multistep process where oxygen radicals were found to enhance carcinogenesis at all stages: initiation, promotion, and progression. Since insufficient capacity of protective antioxidant system can result in cancer, the aim of this study was to examine the activity of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase) and the levels of reduced glutathione, vitamin C, and vitamin E. The lipid peroxidation products were also determined by measuring malondialdehyde and 4-hydroxynonenal levels in colorectal cancer tissue collected from 55 patients. In these cases the activity of superoxide dismutase, glutathione peroxidase, and glutathione reductase was significantly increased while the activity of catalase was significantly decreased in cancer tissue. However, the level of nonenzymatic antioxidant parameters (glutathione, vitamin C, and vitamin E) was significantly decreased in cancer tissue. Further lipid peroxidation was enhanced during cancer development, manifested by a significant increase in malondialdehyde and 4-hydroxynonenal levels. The obtained results indicate significant changes in antioxidant capacity of colorectal cancer tissues, which lead to enhanced action of oxygen radicals, resulting in lipid peroxidation.

Cranial nerve II-VII injuries in fatal closed head trauma.

PURPOSE: To study the distribution and mechanism of traumatic injuries to the nerves supplying the eye and muscles protecting the visual apparatus. METHODS: Brain autopsy was carried out in 12 consecutive patients who died within three days after closed head injury. A segment of the brainstem with the entire intracranial portion of nerves II-VII was dissected out in each case and fixed in formalin. The specimens were stripped of the leptomeninges and inspected thoroughly under magnification. RESULTS: Injuries to the nerves were seen in nine subjects. The oculomotor nerve was completely torn off from the midbrain unilaterally in three and bilaterally in two cases. In one patient only a portion of the superficial fibres on the medial aspect of the nerve was ripped out from the brainstem. In two patients the fourth nerve was ruptured. The root of the fifth cranial nerve was contused and the fibres between the brainstem and Gasserian ganglion crushed and separated in one case. Bilateral avulsion of the root of the sixth nerve from the brainstem was found in two cases. The initial segment of the facial nerve was crushed in two subjects. No visible injury to the optic nerves was found. CONCLUSIONS: Cranial nerves related to the visual system are subject to serious injury in a large proportion of cases of severe head trauma resulting from automobile accidents. In the majority of cases damage results from ripping the roots of these nerves out of the brainstem.

[Remote results of conservative treatment of traumatic optic neuropathy]. / Odlegle wyniki leczenia zachowawczego pourazowych obrazen nerwu wzrokowego.

The problem of pathogenesis and effective treatment of traumatic optic neuropathy (TON) is still an open question. According to current opinions the immediate results of conservative treatment with megadose corticosteroids are similar to those obtained with surgical decompression. No data on late results of both modes of treatment are at present available. This study was undertaken to assess the late results of conservative treatment of traumatic optic neuropathy. The clinical material comprised 15 patients (3 women and 12 men, age 14-64 years), who developed clinical symptoms of TON as a consequence of closed head trauma. All were treated conservatively with megadose steroid therapy. 10 patients presented to follow-up examination performed 3-11 years after the injury. A full ophthalmologic survey and colour-coded Doppler (CCD) examination of the orbital vessels were performed in all subjects. In 6 patients there was full blindness of the affected eye since the injury. Their visual acuity did not improve despite vigorous treatment and their eyes were still blind at the late follow-up examination. No flow found with CCD in their central retinal arteries at follow-up might suggest structural disruption of the nerve. In 5 of these patients ocular atrophy evolved between the injury and follow-up examination. 4 patients, who on admission displayed merely light sensation, responded to 2-3 weeks of steroid therapy with improvement of visual acuity to 3/50, 5/50, 5/10, 5/7. After 4-6 years however, visual acuity of all these patients deteriorated again to mere light perception in three and 1/50 in another one. Optic atrophy was diagnosed in all the affected eyes. Our results indicate that conservative treatment of TON, even if giving satisfactory relief of the symptoms, may not be reliable in permanent restrainment of the sequela of traumatic optic neuropathy.

[Erythrocyte protoporphyrin IX in occupational exposure to asbestos]. / Protoporfiryna IX erytrocytów w przemyslowym narazeniu na azbest.

Analysis of the dependence of protoporphyrin IX in erythrocytes upon non-exposed populations age. The study was performed in 246 persons (104 women and 142 men) who were not occupationally exposed to toxic agents. The women were aged 19-72, the men 19-76. The mean concentrations of protoporphyrin IX for those groups do not differ significantly. To test the dependence of protoporphyrin IX concentration upon age, the women and men were divided into three age subgroups: under 30, 31-40, and over 40. The statistical analysis indicated different distribution of mean protoporphyrin IX concentrations at those age intervals in both test groups, no significant difference between those values being found. Effects of asbestos upon protoporphyrin IX concentrations in erythrocytes in occupational exposure. Sixty three persons were examined (27 women and 36 men), workers of the Plant of Asbestos Seals and Products, "POLONIT", Lódz. The exposure lasted 1-35 years. Age intervals: women 25-64, men 25-63. The estimated mean protoporphyrin IX concentrations both for women (51.2 mg%) and men (47.6 mg%) differ significantly from the mean values of relevant control groups (39.3 and 37.6). In addition, ferrum concentration in serum and hemoglobin concentration in blood in the mentioned groups were analysed. All the findings were within the physiological values.