Co-existence of ethanol-related respiratory and motivational learning processes based on a tactile discrimination procedure in neonatal rats.

In rats, high ethanol doses during early postnatal life exert deleterious effects upon brain development that impact diverse social and cognitive abilities. This stage in development partially overlaps with the third human gestational trimester, commonly referred to as the brain growth spurt period. At this stage in development, human fetuses and rat neonates (postnatal days [PD] 3-9) exhibit relatively high respiratory rates that are affected by subteratogenic ethanol doses. Recent studies suggest conditioned breathing responses in the developing organism, given that there are explicit associations between exteroceptive stimuli and the state of ethanol intoxication. Furthermore, studies performed with near-term rat fetuses suggest heightened sensitivity to ethanol's motivational effects. The present study was meant to analyze the unconditioned effects of ethanol intoxication and the possible co-occurrence of learning mechanisms that can impact respiratory plasticity, and to analyze the preference for cues that signal the state of intoxication as well as the effects of the drug, related with motor stimulation. Neonatal rats were subjected to differential experiences with salient tactile cues explicitly paired or not paired with the effects of vehicle or ethanol (2.0 g/kg). A tactile discrimination procedure applied during PDs 3, 5, 7, and 9 allowed the identification of the emergence of ethanol-derived non-associative and associative learning processes that affect breathing plasticity, particularly when considering apneic disruptions. Ethanol was found to partially inhibit the disruptions that appeared to be intimately related with stressful circumstances defined by the experimental procedure. Tactile cues paired with the drug's effects were also observed to exert an inhibitory effect upon these breathing disruptions. The level of contingency between a given tactile cue and ethanol intoxication also resulted in significant changes in the probability of seeking this cue in a tactile preference test. In addition, the state of intoxication exerted motor-stimulating effects. When contrasting the data obtained via the analysis of the different dependent variables, it appears that most ethanol-derived changes are modulated by positive and/or negative (anti-anxiety) reinforcing effects of the drug. As a whole, the study indicates co-existence of ethanol-related functional changes in the developing organism that simultaneously affect respiratory plasticity and preference patterns elicited by stimuli that signal ethanol's motivational effects. These results emphasize the need to consider significant alterations due to minimal ethanol experiences that argue against "safe" levels of exposure in a critical stage in brain development.

Primary neuroendocrine carcinoma of the liver: difficult diagnosis of a rare neoplasm.

Primary neuroendocrine neoplasms of the liver are extremely rare: about 30 cases only have been described in the literature. We report the case of a 42-year-old woman with a ten-year evolution. According to the previously reported cases, primary neuroendocrine carcinoma of the liver is usually multicentric, often mimicking liver metastases. The demonstration of the hepatic origin of a neuroendocrine carcinoma is often arduous. A careful surgical exploration and a prolonged follow-up are mandatory. The treatment of choice is surgical resection when possible. For progressive and unresectable disease, hepatic arterial chemoembolization may be considered. However, the prognosis of liver neuroendocrine tumours is much more favorable than that of hepatocellular carcinoma and progression has to be demonstrated before instauration of potentially harmful therapies.

[Treatment of complex anal and rectovaginal fistulas using the endorectal mucosal flap technique]. / Trattamento delle fistole anali e rettovaginali complesse con la tecnica del lembo mucoso endorettale.

BACKGROUND: Aim of the study is to evaluate the advantages of the surgical technique for the treatment of complex anal and rectovaginal fistulas by means of an endorectal mucosal flap and the removal of the fistular tract. The surgical removal of a fistular tract can lead to incontinence troubles, mostly for high complex transsphincteric fistulas. The endorectal mucosal flap technique involves the meticulous care of the sphincterial structures and of the mucosa of the anal canal, and is, in personal opinion, the best technique for the treatment of such fistulas. METHODS: The procedure used involves: meticulous study of the anatomic characteristics of the fistula; excision of the secondary opening up to the sphincters level with an elliptic excision of the skin by avoiding keyhole deformities; excision of the primary opening from inside the anal canal, with the interruption of the muscular fibers and their reconstruction; the preparation of an endorectal mucosal flap that is transposed to cover the primary opening of the fistula. 21 patients were treated with this technique, 17 were complex anal fistulas, two were associated to Crohn's disease, and of two rectovaginal fistulas, one was found in a patient with Crohn's disease. RESULTS: Recurrences were found in five patients (24%), after a median follow-up of 20 months. The delay of fistular healing, over a month, was found in 50% of the cases. No patient had continence troubles. CONCLUSIONS: The mucosal flap technique is a simple procedure, adequate in preserving the sphincteric function and in preventing deformities of the anal canal. However, it has not demonstrated clear benefits in terms of recurrences compared to other techniques, but it is highly considered for the treatment of complex anal fistulas, in terms of continence and for the earlier and better healing of the wounds and for the better tolerance of the patient.