Lateral hypothalamic leptin receptor neurons drive hunger-gated food-seeking and consummatory behaviours in male mice.

For survival, it is crucial for eating behaviours to be sequenced through two distinct seeking and consummatory phases. Heterogeneous lateral hypothalamus (LH) neurons are known to regulate motivated behaviours, yet which subpopulation drives food seeking and consummatory behaviours have not been fully addressed. Here, in male mice, fibre photometry recordings demonstrated that LH leptin receptor (LepR) neurons are correlated explicitly in both voluntary seeking and consummatory behaviours. Further, micro-endoscope recording of the LHLepR neurons demonstrated that one subpopulation is time-locked to seeking behaviours and the other subpopulation time-locked to consummatory behaviours. Seeking or consummatory phase specific paradigm revealed that activation of LHLepR neurons promotes seeking or consummatory behaviours and inhibition of LHLepR neurons reduces consummatory behaviours. The activity of LHLepR neurons was increased via Neuropeptide Y (NPY) which acted as a tonic permissive gate signal. Our results identify neural populations that mediate seeking and consummatory behaviours and may lead to therapeutic targets for maladaptive food seeking and consummatory behaviours.

Surgical strategy for colonic intussusception caused by a giant colonic lipoma: a report of two cases and a review of the literature.

A colon lipoma is a remarkably rare tumor. In most cases, the tumors are asymptomatic and small in size, need to be differentiated from malignant tumors, and do not need any special treatment. Selection of the right surgical strategy depends on the status of bowel, as well as the size and the location of tumor. We encountered two patients with giant submucosal lipomas that had induced intussusceptions: one with a lipoma in the transverse colon and the other with a lipoma in the ascending colon. The diagnoses were made by using histological examinations. We report the clinical features, diagnoses, and treatments of, as well as our experience with, these two uncommon cases, and we present a review of the literature on this subject.

A stercoral perforation of the rectum.

A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

The efficiency of IV PCA with remifentanil and ketorolac after laparoscopic-assisted vaginal hysterectomy.

BACKGROUND: This randomized, double-blinded clinical study was designed to evaluate the efficiency and safety of remifentanil with ketorolac for IV PCA after laparoscopic-assisted vaginal hysterectomy. METHODS: Eighty patients were randomly allocated into four groups. Group R received IV PCA using only remifentanil at a basal rate of 0.025 µg/kg/min and a bolus of 0.375 µg/kg. Group RK1 received IV PCA using remifentanil at a basal rate of 0.015 µg/kg/min and a bolus of 0.225 µg/kg. Group RK2 received IV PCA using remifentanil at a basal rate of 0.0075 µg/kg/min and a bolus of 0.1125 µg/kg. Group F received IV PCA using fentanyl at a basal rate of 0.3 µg/kg/h and a bolus of 0.075 µg/kg. In addition, ketorolac at a basal rate of 0.04 mg/kg/h and a bolus of 0.01 mg/kg was added to Group RK1, RK2, and F. All PCA conditions had a lock out period of 15 minutes. Pulse rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and PONV score were recorded at 1, 3, 6, 12, and 24 hours after the operation. Total opioid use and the patients' number for rescue analgesic drug were also collected. RESULTS: The groups did not differ in PONV score and hemodynamic changes. The VAS in Group RK2 was high compared with the other groups. In addition, the sedation score was high in Group R. CONCLUSIONS: The additional ketorolac administration in remifentanil IV PCA had remifentanil sparing effects and reduced sedation among the side effects. Further studies will be needed to evaluate the precise and adequate dosage of ketorolac.

Extensive external auditory canal cholesteatoma in the infratemporal area without mastoid involvement: use of a new surgical technique.

The external auditory canal (EAC) is an unusual location for a cholesteatoma. We present the cases of 2 patients with EAC cholesteatoma who experienced extensive damage that extended from the inferior EAC wall to the infratemporal area; there was no mastoid involvement. In both cases, the cholesteatomas were removed under local anesthesia and the inferior canal wall was reconstructed with a technique that involved the placement of a pedicled musculoperiosteal flap, a cartilage graft, and a full-thickness skin graft. This simple procedure preserves a normal EAC contour, middle ear space, and mastoid cavity.

Comparison of ramosetron and ondansetron for preventing nausea and vomiting after middle ear surgery under general anesthesia with sevoflurane and remifentanil.

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) after middle ear surgery. METHODS: Seventy patients of either sex, ASA 1-2, scheduled middle ear surgery (mastoidectomy and tympanoplasty) under general anesthesia with sevoflurane and remifentanil were included. Patients were randomly divided into two groups and received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) before the end of operation (n = 35 each). The incidence and severity of PONV, pain score (VAS), rescue antiemetic, rescue analgesic and side effects were assessed following 6 hr, 24 hr and 48 hr after surgery. RESULTS: The incidence of PONV showed no significant difference between groups at each time points after surgery. There were no difference in the severity of nausea, pain score, rescue antiemetic, analgesic drug usage and side effects between groups. CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in patients undergoing general anesthesia for middle ear surgery.

Can cochlear function be preserved after a modified translabyrinthine approach to eradicate a huge cholesteatoma extending to the petrous apex?

The objective of the present study was to show that the modified translabyrinthine approach with partial ablation of the labyrinths is useful for preserving hearing in our experience involving three clinical cases with huge cholesteatomas extending to the petrous apex. A retrospective analysis of patient medical records was done in a tertiary referral medical center. All three patients studied had huge cholesteatomas extending to the petrous apex and were treated surgically with a modified translabyrinthine approach between October 2005 and December 2006. The modified translabyrinthine approach was used in all patients. Long-term hearing results were obtained. The cholesteatoma sac was removed completely in all patients. Pure tone audiometry demonstrated that the hearing had been saved in two patients. We concluded that the modified translabyrinthine approach is useful for preserving hearing postoperatively when a huge cholesteatoma exists involving the petrous region or a vestibular schwannoma in the internal auditory canal or cerebellopontine angle.

Bilateral promontory fistula due to noncholesteatomatous chronic otitis media.

The authors describe a case of bilateral promontory fistula due to noncholesteatomatous chronic otitis media in a 46-year-old male. We performed both open cavity mastoidectomy and left staged ossiculoplasty. One year postoperatively, the audiogram showed an improved left air conduction threshold and maintenance of bone conduction. We suggest that noncholesteatomatous chronic otitis media can induce various destructive changes via the chronic inflammatory reaction.

Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket.

OBJECTIVE: To evaluate the surgical outcome in patients who have undergone mastoid and epitympanic obliteration technique. STUDY DESIGN: : Retrospective review. SETTING: Tertiary care referral center. PATIENTS: The study group included 151 patients with cholesteatoma who underwent mastoid and epitympanic obliteration technique. This technique was applied to cases who had a strong chance of recurrent retraction pocket and cholesteatoma formation, including those patients with an adhesive drum indicating poor eustachian tube function (n = 52) and patients with a destructive scutum (n = 68). Thirty-one patients had both an adhesive drum and a destructive scutum. INTERVENTION: The connection between the mastoid cavity and the middle ear was blocked by obliterating the epitympanum and antrum with bone pate and the remaining mastoid cavity with abdominal fat. MAIN OUTCOME MEASURES: The postoperative drum state, the incidence of retraction pocket formation and cholesteatoma recurrence, the surgical complications of obliteration, and the hearing outcome. RESULTS: In 114 of 151 patients (75.4%), the middle ear was well healed and well aerated. The retraction pocket formation or cholesteatoma recurrence did not develop in any subject. Postauricular skin depression was the most common complication of this technique (n = 31 [20.5%]). In three patients (2.0%), the bone pate used for obliteration was infected. Of the 56 cases who underwent a staged operation to regain their hearing, 37 resulted in a postoperative air-bone gap less than 20 dB hearing level. CONCLUSION: Mastoid and epitympanic obliteration is an effective option for preventing a retraction pocket and cholesteatoma recurrence in patients with a poorly functioning eustachian tube or a defective scutum, while preserving the same advantage of the canal wall up technique.

P2Y2 agonist induces mucin secretion via Ca2+- and inositol 1,4,5-triphosphate-dependent pathway in human middle ear epithelial cells.

Purinergic agonists regulate mucin secretion in the airway epithelial cells. This study examined the effects of the apical application of purinergic agonists on Ca(2+) influx ([Ca(2+)](i)), and mucin secretion along with their underlying signaling pathway in normal human middle ear epithelial (NHMEE) cells. The apical membrane of NHMEE cells were stimulated with various purinergic agonists, including UTP, and the [Ca(2+)](i) was measured using a miniature Ussing double perfusion chamber. P2Y(2) receptor in NHMEE cells was also localized by immunohistochemistry. UTP-induced mucin secretion was quantified by an immunoblotting assay. The order of the purinergic agonist potency with respect to [Ca(2+)](i) determined in this study was ATP = UTP > 2-MeSATP > UDP >> adenosine which is consistent with that obtained from P2Y(2) receptor activation. The P2Y(2) receptor is expressed in the apical membrane of monolayered cultured NHMEE cells. Apical UTP-induced [Ca(2+)](i) was inhibited by 2-aminoethoxydiphenyl borate (2-APB) but not by ryanodine. UTP-induced mucin secretion was inhibited by a Ca(2+) chelating agent, BAPTA-AM, and was stimulated by ionomycin. UTP-induced mucin secretion was also suppressed by U73122 and 2-APB, while Calphostin C suppressed it to a small extent and PD98059 was ineffective. Caffeine also inhibited the UTP-induced [Ca(2+)](i) and mucin secretion. These results suggest that the P2Y(2) receptor is expressed in NHMEE cells, and plays a major role in modulating the [Ca(2+)](i) from the IP(3)-sensitive intracellular Ca(2+) store. UTP-induced mucin secretion in NHMEE cells is strongly dependent on Ca(2+)- and IP(3).