Variations in the Course of the Carotid Arteries in Patients with Retropharyngeal Parathyroid Adenomas.

The carotid arteries, classically described as taking a relatively straight course through the neck, deviate medially in a minority of patients. At the extreme, the internal carotid arteries may "kiss" in the midline, coming extremely close to the pharyngeal wall. In this clinical report, we describe 5 patients with primary hyperparathyroidism, all with ectopic retropharyngeal parathyroid adenomas but all with varying carotid artery anatomy. We describe these variations using a previously developed clinical grading system that highlights 1) the relationship between carotid artery location and risk of injury during pharyngeal procedures and 2) the importance of universal, objective criteria to classify carotid anatomy. Radiologists should be familiar with variations in carotid anatomy and communicate them to the operative team.

Intracellular glutathione content of urothelial cancer in correlation to chemotherapy response.

We evaluated the possible correlation between intracellular glutathione (GSH) and drug sensitivity of urothelial cancer. Tissue GSH content of surgical specimens from 20 patients with urothelial cancer was assayed with high performance liquid chromatography (HPLC). GSH levels of cancer tissue (7.887 +/- 6.176 microM/mg protein) were significantly higher than GSH levels of normal mucosa (1.345 +/- 1.252 microM/mg). All patients having measurable lesions were then treated with methotrexate, epirubicin and cisplatin (MEC). These patients were classified into three groups according to clinical response criteria. GSH content in cancer tissue from four patients with complete response was 0.804 +/- 1.183 microM/mg protein. However, the cancer cells from patients with partial response and non-response contained a significantly higher level of GSH (6.295 +/- 2.459 (n = 8) and 12.955 +/- 6.141 microM/mg protein (n = 8), respectively). Intracellular glutathione content may play an important role in intrinsic resistance of urothelial cancer to MEC chemotherapy. It might be potentially used to predict drug sensitivity in urothelial cancer patients before starting chemotherapy.

Catalytic asymmetric coupling of 2-naphthols by chiral tridentate oxovanadium (IV) complexes.

A series of chiral oxovanadium(IV) complexes derived from tridentate N-3,5-substituted and N-3,4-benzo- and N-5,6-benzo-salicylidene-alpha-amino acids can serve as efficient catalysts for the enantioselective oxidative couplings of various 3-, 6-, and 7-substituted 2-naphthols under O(2). The best scenario involves the use of a vanadyl complex arising from 2-hydroxy-1-naphthaldehyde and valine (or phenylalanine) in CCl(4), leading to BINOLs in good yields (75-100%) and with enantioselectivities of up to 68%.

Catalytic nucleophilic acyl substitution of anhydrides by amphoteric vanadyl triflate.

[reaction--see text] Among four vanadyl species examined, vanadyl triflate was the most efficient catalyst to facilitate nucleophilic acyl substitution of anhydrides with a myriad array of alcohols, amines, and thiols in high yields and high chemoselectivity. By using mixed-anhydride technique, one can achieve oleate and peptide syntheses. In marked contrast to common metal triflates, the amphoteric character of the V=O unit in vanadyl species was proven to be responsible for the catalytic profile in this process.

Vitamin E protection of cell morphology and protein thiols in rat hepatocytes treated with tert-butyl hydroperoxide.

Effects of vitamin E on cell morphology and cellular protein thiols under oxidative stress was investigated in cultured rat hepatocytes with different vitamin E status. Hepatocytes were incubated in the presence or absence of 100 microM alpha-tocopherol succinate for 24 h then treated with 1.5 mM t-butyl hydroperoxide (t-BH) for different time intervals. Lipid peroxidation, as determined by thiobarbituric acid-reactive substances, was completely inhibited over 60 min of treatment in cells incubated with alpha-tocopherol. The change of cell morphology, as determined by surface blebs formation, was correlated with cellular vitamin E status. Surface blebs were formed in 25.1 +/- 5.2 min in the presence of alpha-tocopherol in contrast to 11.1 +/- 2.9 min in its absence. In cells with alpha-tocopherol, surface blebs were induced even though lipid peroxidation was inhibited. Comparing the depletion of membrane protein thiols with t-BH treatment, twice as many (40%) thiols were lost over 60 min in the absence of alpha-tocopherol whereas 20% were lost in the presence of alpha-tocopherol. In addition, the extent of thiol modification of carbonic anhydrase III, as determined by combining isoelectric focusing analysis with immunoblotting, further demonstrated that alpha-tocopherol helps maintain protein thiols in the reduced state. Results indicate that vitamin E protects cell morphology and prevents the loss of protein thiols with t-BH treatment, and on cell morphology protection is associated with protein thiols rather than membrane lipids.

Biodegradable polymeric microspheres for nalbuphine prodrug controlled delivery: in vitro characterization and in vivo pharmacokinetic studies.

The objective of this work was to study the in vitro characteristics as well as in vivo pharmacokinetic performance of a series nalbuphine (NA) prodrug-loaded microspheres. An oil-in-water solvent evaporation method was used to incorporate the various NA prodrugs into poly(D,L-lactide-co-glycolide) (PLGA)-based microspheres. The morphology of microspheres under the scanning electron microscopy (SEM) revealed a spherical shape with smooth surface. Drug release rates for the microspheres were found to be a function of prodrug hydrophilicity, with higher drug release rates for microspheres loaded with more hydrophilic prodrugs. The release profiles fit well to the Baker and Lonsdale's spherical matrix model, suggesting the drug release from microspheres was consistent with a diffusion mechanism. The in vivo pharmacokinetic studies after s.c. injection of microspheres into rabbits showed sustained plasma NA-time profiles, with approximately 104.7, 67.2, and 41.0% relative bioavailability for microspheres loaded with nalbuphine propionate (NAP), nalbuphine pivalate (NPI), and nalbuphine decanoate (NDE), respectively. The in vitro release characteristics correlated well with the in vivo pharmacokinetic profiles. The results indicated that the prodrug hydrophilicity had significant effects on the in vitro as well as in vivo drug release kinetics. The present study demonstrates the feasibility of using biodegradable polymeric microspheres for controlled delivery of NA prodrugs.

A comparison of never-hospitalized and previously hospitalized adolescents: self-esteem and locus of control.

Few empirical studies have been conducted to determine the influence of hospitalization on adolescents' psychosocial processes because younger children are regarded as more vulnerable. Therefore, the purpose of this self-report, retrospective study of 115 adolescents was to compare the self-esteem and locus of control of the never hospitalized to that of adolescents hospitalized during adolescence, prior to adolescence, and during and prior to adolescence. Although no significant differences were found, the findings raise questions about long-term effects of early experiences, especially among lower socioeconomic status youth. Also, general measures of self-esteem and locus of control may be unable to determine situation-specific effects.

Vitamin E protection of cell morphology under oxidative stress is related to cytoskeletal proteins in rat hepatocytes.

A significant change in cell morphology was observed in hepatocytes treated with t-butyl hydroperoxide (t-BH). This morphological change of multiple bleb formation on cell plasma membranes was related to cell damage, and the subsequent rupture of these blebs resulted in cell death. In cells incubated with alpha-tocopherol before t-BH treatment, bleb formation was significantly inhibited. Using fluorescence microscopy, actin organization was shown to be related to alpha-tocopherol status as demonstrated by early changes in the actin network of cells in the absence of alpha-tocopherol. Results from SDS-polyacrylamide gel electrophoresis further indicated that, under oxidative stress, actin molecules (45 kDa) decreased in amount and were accompanied by the formation of high molecular weight molecules. In the presence of the thiol reducing agent, dithiothreitol, both the decrease in monomeric actin and formation of high molecular weight molecules disappeared. The loss of actin showed a time-dependent response and could be observed after 15 min with t-BH treatment either in the presence or absence of alpha-tocopherol; however the extent was much more significant in cells with no alpha-tocopherol. Depletion of total membrane protein thiols was also related to vitamin E and was greater in cells with no alpha-tocopherol. The amount of cell damage, as determined by lactate dehydrogenase (LDH) leakage in cells with t-BH treatment over 120 min was decreased in the presence of alpha-tocopherol compared with the rapid increase of LDH leakage in the absence of alpha-tocopherol. These results indicate that vitamin E protection of cell morphology under oxidative stress is related to actin, with thiol groups in actin probably playing a key role.

The clinical experience of gaseous retroperitoneoscopic and gasless retroperitoneoscopy-assisted unroofing of renal cyst.

BACKGROUND: The aim of this study is to compare the application of gaseous retroperitoneoscopic (GR) and gasless retroperitoneoscopy-assisted (GLRA) unroofing of renal cysts. METHODS: Fourteen patients with symptomatic simple renal cysts had undergone unroofing of the cyst with GR in seven cases and GLRA in seven others. Three trocars (10 mm, 10 mm and 5 mm) were inserted in the GR procedure. A 3 cm flank muscle-split incision was made and retroperitoneoscopy was performed through the same incision in the GLRA procedure. Then, the cyst was unroofed. RESULTS: The mean operative time was 104.3 minutes in the GR group and 52.1 minutes in the GLRA group, respectively (p = 0.001). The mean requirement of postoperative meperidine hydrochloride injection was 21.4 mg in the GR group and 71.4 mg in the GLRA group, respectively (p = 0.017). In the GR group, the mean postoperative stay was 3.7 days, and the time needed for return to normal activity was 7 days. In the GLRA group, the mean postoperative stay was 4.6 days, and the time needed for return to normal activity was 8 days. CONCLUSIONS: GR and GLRA techniques for unroofing of renal cysts are safe, effective and minimally invasive. GLRA is easy to perform and a more time-saving procedure when compared to GR, however, the patients of GLRA suffered more postoperative pain than after GR. GLRA is recommended in patients who had received retroperitoneal surgery or who have multiple renal cysts.

Incidental renal cell carcinoma: pathologic features and survival rate.

BACKGROUND: The aim of this study was to compare outcomes in patients with symptomatic and incidental renal cell carcinoma (RCC). METHODS: From October 1982 to December 1996, 200 patients with RCC were enrolled in this study. Their medical records were reviewed for symptoms, tumor stage, and lymph node and metastatic status. Symptomatic and incidental RCCs were compared by the overall survival rate of patients. The survival rate was determined by the Kaplan Meier method. Log rank testing was used to analyze the statistical difference in the survival period between both groups. RESULTS: The proportion of incidental RCC was 21% (42/200). The majority of cases (73.8%) were diagnosed primarily by abdominal ultrasonography. Incidental RCCs were smaller in size than symptomatic RCCs (5.1 +/- 2.0 cm vs. 7.5 +/- 1.8 cm, p = 0.001). Incidental RCCs were of a lower stage, and patients with incidental RCCs had significantly longer overall survival rates than those with symptomatic RCCs (p < 0.001). CONCLUSIONS: Ultrasonography is a useful tool for the detection of incidental RCC. Improvement in the overall survival rate of incidental RCC patients suggests that when these tumors are identified earlier, treatment results are better.

Effect of hydroxyzine on the transport of etoposide in rat small intestine.

Etoposide, an anti-neoplastic agent and a substrate of P-glycoprotein (P-gp), exhibits variable oral bioavailability. P-gp, the multidrug resistance gene (mdr1) product, has been considered as an absorption barrier against intestinal drug absorption. Terfenadine, an antihistamine, has been shown to be a P-gp inhibitor. The current study was designed to assess the effect of hydroxyzine, an antihistamine, on the transport of etoposide in the small intestine. Everted rat gut sacs were used to determine the absorption and exsorption of etoposide under different conditions, as rhodamine 123 was chosen to evaluate the role of P-gp in the drug interaction. The results showed that the transport of etoposide was significantly increased from the luminal site to the serosal site in the jejunum by 2- and 4-fold after 90 min in the presence of hydroxyzine and quinidine, respectively. A similar trend was observed in the ileal sacs. This in vitro exsorption study also demonstrated that hydroxyzine could reduce the efflux of etoposide to the luminal site in either jejunum or ileum. The effect of hydroxyzine on the pharmacokinetics of etoposide differed by the in vivo route of administration, thus assuming clinical importance for chemotherapeutic treatment.