Diabetic critical ischemia of lower limbs: distal arterial revascularisation.

OBJECTIVES: To evaluate the outcomes of ischemic diabetic foot lesions for which distal arterial bypass grafting was considered as the first-line vascular procedure. PATIENTS AND METHODS: Between November 2004 and November 2006, 19 lower limbs of 17 diabetic patients with lower limb critical ischemia were operated in our department. The bypass grafts included five femoro-popliteal bypass grafts below knee and 14 distal bypass grafts. The 14 distal bypass grafts included; seven venous grafts on the dorsalis pedis artery, four femorotibial PTFE grafts and three femoroperoneal grafts. Arterio-venous fistula was applied to the distal anastomosis site in three limbs. RESULTS: At the time of discharge, the graft patency rate was 93.75%. The mean follow up period was 24 months. The primary cumulative patency rate was 63% at 2 year. The corresponding secondary patency rate was 87%. Among six ischemic ulcers, four ulcers healed within 2 to 12 months (66.6%). At 24 months, the cumulative rate of limb salvage was 76% and that of survival was 74%. CONCLUSION: Distal arterial bypass in diabetic lower limb ischemia improves blood circulation that accelerates foot ulcer healing. It can also avoid amputation or lower its level, and thus improving the patient's quality of life.

Inhibition of methylnitrosourea (MNU) induced oxidative stress and carcinogenesis by orally administered bee honey and Nigella grains in Sprague Dawely rats.

We studied the protective effect of bee honey and Nigella grains as nutraceuticals on the oxidative stress and carcinogenesis induced by methylnitrosourea (MNU) in Sprague Dawely rats. Four groups of animals were used and fed ad-libitum. The first group was a control (n=8), the second (n=8), the third (n=15) and the fourth groups (n=12) were injected MNU (single i.v. dose 50 mg/kg body weight). After one week the third and fourth groups were given orally 0.2 g ground Nigella grains and 0.2 g Nigella with 5 g honey/rat/day, respectively. After six months all animals were sacrificed except two from the second group (MNU-injected rats) that died one-week before the end of the experiment. We observed that MNU injected in the second group produced a variety of oxidative stresses ranging from severe inflammatory reaction in lung and skin to colon adenocarcinoma in four out of six animals. There was an associated elevation of malondialdehyde (MDA) and nitric oxide (NO) in sera obtained from animals of this group compared to the control one. Nigella sativa grains given orally protected against MNU-induced oxidative stress and carcinogenesis by 80% (12/15) and combated this effect by lowering MDA and NO. Whereas honey from bees and Nigella sativa together protected 100% (12/12) against MNU-induced oxidative stress, carcinogenesis and abolished the NO and MDA elevations shown in sera of animals who did not receive these nutrients. These results showed that supplementation of diet with honey and Nigella sativa has a protective effect against MNU-induced oxidative stress, inflammatory response and carcinogenesis.

Cytotoxic quaternary alkaloids from the flowers of Narcissus tazetta.

Intensive chromatographic separation of the polar fraction of an ethanolic extract of the fresh flowers of Narcissus tazetta L. (Amaryllidaceae) yielded two new quaternary alkaloids with a phenanthrene skeleton, N-methyl-8,9-methylenedioxy-phenantridinium methylsulfate (1) and N-methyl-8,9-methylenedioxy-phenantridinium malate (2). The structure determination of the alkaloids was based on one- and two-dimensional NMR studies including HMQC, and HMBC studies, and mass spectroscopic analysis. The existence, in 1, of the methylsulfate group was confirmed by X-ray diffraction analysis. Cytotoxic activities for 1 and 2 against a panel of cancer cell lines are also reported.

The heliangolide dihydrohirsutolide from Arctotis fastuosa and dichloromethyldihydrohirsutolide.

Three of ten sesquiterpene lactones isolated from the herb of Arctotis fastuosa (Asteraceae) belong to the heliangolide series. The first was identified as hirsutolide, the second is new and named dihydrohirsutolide, and the third, dichloromethyldihydrohirsutolide, is an artifact. The known degraded carotenoid loliolide was also isolated. Structures were established by spectroscopic methods including IR, 1D-/2D-1H-NMR, 13C-NMR, GHSQC, GHMBC, HREIMS and CD.

Triterpenoidal saponins from Cornulaca monacantha.

From the aerial parts of Cornulaca monacantha, three new triterpenoidal saponins have been isolated and their genuine structures were identified as 3-O-[beta-xylopyranosyl-(1-->3)-beta- glucuronopyranosyl]-30-methylphytolaccagenate (2), 3-O-[beta-xylopyranosyl- (1-->3)-beta-glucuronopyranosyl]-30-methylphytolaccagenate 28-O-beta-gluco-pyranoside (3) and 3-O-[beta-xylopyranosyl-(1-->3)-beta- glucurono-pyranosyl]-30-methylserjanate 28-O-beta glucopyranoside (4) together with nine known saponins of oleanolic acid (5-9), hederagenin (1, 10, 11) and 30-methyl phytolaccagenate (12).

Chronic Plasmodium falciparum infections in an area of low intensity malaria transmission in the Sudan.

Chronic Plasmodium falciparum malaria infections in a Sudanese village, in an area of seasonal and unstable malaria transmission, were monitored and genetically characterized to study the influence of persistent infection on the immunology and epidemiology of low endemicity malaria. During the October-December malaria season of 1996, 51 individuals out of a population of 420 had confirmed and treated P. falciparum malaria in the village of Daraweesh in eastern Sudan. In a cross-sectional survey carried out in December 1996, an additional 6 individuals were found to harbour a microscopically negative but polymerase chain reaction (PCR)-positive P. falciparum infection. On 1 January 1997, a cohort of 43 individuals aged from 9 to 53, recruited from this group of recently malaria-infected individuals agreed to donate fortnightly blood samples for the next 9 months, the first 6 of which constitute the long Sudanese dry season when transmission falls to undetectable levels. Each blood sample was tested for the presence of persistent malaria infection by microscopy and PCR. Parasite-positive samples were genotyped using PCR assays that detect allelic polymorphism at the MSP-1, MSP-2 and GLURP marker gene loci. Of 43 individuals 16 were found to maintain chronic P. falciparum infections which were continuously genetically characterized.

Evaluation of risk factors for intrafamilial transmission of HCV infection in Egypt.

The objectives of this study were to define the prevalence of intrafamilial transmission of HCV and evaluate the risk factors in this setting. A cross-sectional, family-based seroepidemiological study was performed in Cairo Liver Center and Oncology Diagnostic Unit, Ain Shams University. A total of 102 index patients (72 males and 30 females) with type C chronic liver disease and their 305 family contacts were studied. Only 265 family contacts were eligible for the study as they showed no previous history of exposure to risk factors. Overall, 15 family contacts (5.7%) were positive for anti-HCV, indicating a lower anti-HCV prevalence among family contacts than the general population in Egypt. Spouses were at higher risk of infection (16.7%) than family members (2.6%). Among the repeatedly positive samples for anti-HCV, only 3 samples were HCV-RNA positive (1.1%), all were spouses. Logistic regression analysis revealed that spouses reporting promiscuous sexual relations were at higher risk than those with normal sexual relations. Contacts sharing personal objects were also at higher risk to develop HCV infection. Index cases reporting previous blood transfusion (18.6%), i.v. antibilharzial therapy (33.3%), multiple sex partners (1.0%) or advanced liver diseases were more infective to their family contacts. The contacts of index cases had increasing risk of HCV infection with increase in age and duration of contact. The prevalence rate of intrafamilial spread of HCV infection is low compared to the rate among general population, emphasizing its limited role in transmitting HCV infection. Long duration of sexual contact and promiscuous sexual activities were major risk factors in this setting.

Leiomyosarcoma of the rectum. Report of a case and review of the literature.

A case of leiomyosarcoma of the rectum is presented and followed by a review of 135 cases from the literature. The five- and ten-year survival figures were the same whether the patient was treated by radical or local excision; however, local excision was followed by 67.5 percent recurrence. Abdominoperineal resection is still the procedure of choice. Local excision might be considered for small tumors of low-grade malignancy in a poor-risk patient.

Collagen production by cultured retinal capillary pericytes.

The cells that proliferate from microvessels isolated from calf retinas and placed in tissue culture have been found to derive from the intramural pericytes. When these cells were cultured in medium supplemented with ascorbate and pulsed for 24 hr with [14C]proline, about 2% of the [14C]proline in the nondialyzable protein secreted into the culture medium by these cells was hydroxylated, and about 10% of the incorporated [4C]proline was solubilized by purified collagenase. Agarose gel chromatography of the postculture media showed that unreduced [14C]collagen polypeptides were recovered in large-molecular-weight aggregates (greater than 300,000 daltons) which were largely converted to chains of approximately 95,000 molecular weight and some dimers and trimers of MW approximately 180,000 and 270,000 when the medium was subjected to reduction and alkylation prior to chromatography. The findings indicate that cultured retinal pericytes elaborate collagen and suggest the production of type III collagen. Retinal microvessel cells in culture may facilitate study of abnormalities in retinal pericyte function and collagen synthesis that occur in retinal vascular diseases.