Early U.S. outcomes of laparoscopic gastric bypass versus laparoscopic adjustable silicone gastric banding for morbid obesity

Laparoscopic gastric bypass (LGBP) is the gold standard operation for long-term weight control in the United States. Laparoscopic adjustable silicone gastric banding (LASGB) is the preferred operative method for morbid obesity worldwide. Limited data are available comparing the two procedure in the United States. This study compares weight loss, complications, and early outcome of comorbidity resolution in patients who underwent LGBP versus LASGB. A review of prospectively collected data was performed on 392 patients undergoing primary LGBP (n = 232) and LASGB (n = 160) procedures between February 2001 and July 2004. Differences in percentage excess weight lost (%EWL) at 3, 6, 12, 18, and 24 months postop, improvement or resolution of comorbidities, and complications across procedure types were evaluated. Mean initial body mass index between groups was not significantly different (LGBP 47.2 vs LASGB 47.1, p < 0.53). There were significant differences in age, gender, and self-reported sweet-eating behavior between operative groups. There was a significantly greater %EWL in patients who underwent LGBP compared to patients of the LASGB groups 3, 6, 12, and 18 months after surgery. There were no significant differences in resolution or improvement of comorbidities between the groups. Although LGBP patients experienced more complications compared to LASGB patients (5.6 vs 4.3%, respectively; p < 0.56), this did not reach statistical significance. Early after surgery, LGBP patients lose more weight than LASGB patients but have similar improvements in comorbidities. Further follow-up is needed to determine the relative long-term efficacy of these procedures.

Transtonsillar drainage of parapharyngeal abscess

We report a parapharyngeal abscess in an adult patient that was drained transorally by performing ipsilateral tonsillectomy and aspirating the pus through the tonsillar bed. This approach is unusual as most previous studies report the aspiration of such abscesses through the lateral pharyngeal mucosa. In addition, the majority of these studies are limited to pediatric cases. Our approach was effective and resulted in a rapid resolution of the symptoms. The management and different approaches to parapharyngeal abscess are discussed, and the literature is reviewed.

Antimicrobial properties of Phrygilanthus acutifolius

Ethanol extract of flowers of Phrygilanthus acutifolius (Ruiz & Pav.) Eichler (Loranthaceae) inhibited the growth of both Gram (+) bacteria (Staphylococcus aureus, Staphylococcus saprophyticus and Enterococcus faecalis) and Gram (-) bacteria (Serratia marcescens, Acinetobacter sp. and Pseudomonas aeruginosa). This extract was bactericidal against Staphylococcus aureus and bacteriostatic against Pseudomonas aeruginosa. Morphological evidence suggests that the extract causes the swelling of the bacterial body of Staphylococcus aureus, the disintegration of the cell surface and the cell death. Bactericidal activity was optimal at pH 7.5 and was not affected by different ionic strengths. The presence of Mg2+ in the culture medium of Phrygilanthus acutifolius diminished the sensitivity of Pseudomonas aeruginosa strain against the extract. Test results would tend to corroborate the folk belief that the flowers of this plant are efficacious against respiratory infections and would justify its further investigation.

New drugs in gynecologic cancer

The implementation of new drug treatments has improved the prognosis for advanced cancers of the cervix, uterus, and ovary. Platinum analogs are the most effective drugs in the treatment of ovarian cancer. Other drugs, such as oxaliplatin, have been proposed as a rational treatment of platinum refractory ovarian cancer. Epothilones are also being studied in clinical trials, as are histone deacetylase inhibitors. Several promising agents may soon receive Food and Drug Administration approval.

Intrahepatic stones: the UKM experience

Intrahepatic stones remain a major source of morbidity and mortality. With improving techniques in hepatobiliary surgery, the management and the outcome of intrahepatic calculi is reviewed. Forty-nine cases referred from all over Malaysia between January 1993 to June 1996 were analyzed retrospectively. There were thirty-two females and seventeen males. The median age was 46 years. Biliary diseases encountered in association with intrahepatic calculi included benign strictures (n = 14), ascariasis (n = 3), cholangiocarcinoma (n = 1), Caroli's disease (n = 1), and thalassaemia, (n = 1), fifty-six percent of stones were located in both the intrahepatic ducts while 34% were found in the left intrahepatic duct. Thirty-one patients underwent common bile duct exploration either alone or in combination with liver resection or bilioenteric anastomosis. Despite the various combinations of surgical and non-surgical intervention 28 (57.1%) patients had residual stones. Despite the availability of newer techniques in hepatobiliary surgery, residual stones were common, resulting in higher treatment costs.

Comparison of the Ca2 + currents induced by expression of three cloned alpha1 subunits, alpha1G, alpha1H and alpha1I, of low-voltage-activated T-type Ca2 + channels

Expression of rat alpha1G, human alpha1H and rat alpha1I subunits of voltage-activated Ca2 + channels in HEK-293 cells yields robust Ca2 + inward currents with 1.25 mM Ca2 + as the charge carrier. Both similarities and marked differences are found between their biophysical properties. Currents induced by expression of alpha1G show the fastest activation and inactivation kinetics. The alpha1H and alpha1I currents activate and inactivate up to 1.5- and 5-fold slower, respectively. No differences in the voltage dependence of steady state inactivation are detected. Currents induced by expression of alpha1G and alpha1H deactivate with time constants of up to 6 ms at a test potential of - 80 mV, but currents induced by alpha1I deactivate about three-fold faster. Recovery from short-term inactivation is more than three-fold slower for currents induced by alpha1H and alpha1I in comparison to alpha1G. In contrast to these characteristics, reactivation after long-term inactivation was fastest for currents arising from expression of alpha1I and slowest in cells expressing alpha1H calcium channels. The calcium inward current induced by expression of alpha1I is increased by positive prepulses while currents induced by alpha1H and alpha1G show little ( < 5%) or no facilitation. The data thus provide a characteristic fingerprint of each channel's activity, which may allow correlation of the alpha1G, alpha1H and alpha1I induced currents with their in vivo counterparts.

Characteristics of acute pancreatitis in University Kebangsaan Malaysia

We analyzed the characteristics of patients presenting with acute pancreatitis to our unit. A total of 71 patients were admitted to the Surgical Department at University Kebangsaan Malaysia (UKM) over a period of seven years, between January 1990 to December 1996 with acute pancreatitis. There was a fourfold increase in incidence of acute pancreatitis in our hospital from January 1990 to December 1996. The commonest identifiable aetiology was gallstones followed by alcohol. There were two deaths. We conclude that acute pancreatitis is increasingly being diagnosed in our local population. This may be due to either greater awareness or changes in lifestyle of the population.

Differential distribution of three members of a gene family encoding low voltage-activated (T-type) calcium channels

Low voltage-activated (T-type) calcium currents are observed in many central and peripheral neurons and display distinct physiological and functional properties. Using in situ hybridization, we have localized central and peripheral nervous system expression of three transcripts (alpha1G, alpha1H, and alpha1I) of the T-type calcium channel family (CaVT). Each mRNA demonstrated a unique distribution, and expression of the three genes was largely complementary. We found high levels of expression of these transcripts in regions associated with prominent T-type currents, including inferior olivary and thalamic relay neurons (which expressed alpha1G), sensory ganglia, pituitary, and dentate gyrus granule neurons (alpha1H), and thalamic reticular neurons (alpha1I and alpha1H). Other regions of high expression included the Purkinje cell layer of the cerebellum, the bed nucleus of the stria terminalis, the claustrum (alpha1G), the olfactory tubercles (alpha1H and alpha1I), and the subthalamic nucleus (alpha1I and alpha1G). Some neurons expressed high levels of all three genes, including hippocampal pyramidal neurons and olfactory granule cells. Many brain regions showed a predominance of labeling for alpha1G, including the amygdala, cerebral cortex, rostral hypothalamus, brainstem, and spinal cord. Exceptions included the basal ganglia, which showed more prominent labeling for alpha1H and alpha1I, and the olfactory bulb, the hippocampus, and the caudal hypothalamus, which showed more even levels of all three transcripts. Our results are consistent with the hypothesis that differential gene expression underlies pharmacological and physiological heterogeneity observed in neuronal T-type calcium currents, and they provide a molecular basis for the study of T-type channels in particular neurons.

Cloning and characterization of alpha1H from human heart, a member of the T-type Ca2+ channel gene family

Voltage-activated Ca2+ channels exist as multigene families that share common structural features. Different Ca2+ channels are distinguished by their electrophysiology and pharmacology and can be classified as either low or high voltage-activated channels. Six alpha1 subunit genes cloned previously code for high voltage-activated Ca2+ channels; therefore, we have used a database search strategy to identify new Ca2+ channel genes, possibly including low voltage-activated (T-type) channels. A novel expressed sequence-tagged cDNA clone of alpha1G was used to screen a cDNA library, and in the present study, we report the cloning of alpha1H (or CavT.2), a low voltage-activated Ca2+ channel from human heart. Northern blots of human mRNA detected more alpha1H expression in peripheral tissues, such as kidney and heart, than in brain. We mapped the gene, CACNA1H, to human chromosome 16p13.3 and mouse chromosome 17. Expression of alpha1H in HEK-293 cells resulted in Ca2+ channel currents displaying voltage dependence, kinetics, and unitary conductance characteristic of native T-type Ca2+ channels. The alpha1H channel is sensitive to mibefradil, a nondihydropyridine Ca2+ channel blocker, with an IC50 of 1.4 micromol/L, consistent with the reported potency of mibefradil for T-type Ca2+ channels. Together with alpha1G, a rat brain T-type Ca2+ channel also cloned in our laboratory, these genes define a unique family of Ca2+ channels.

Molecular characterization of a neuronal low-voltage-activated T-type calcium channel

The molecular diversity of voltage-activated calcium channels was established by studies showing that channels could be distinguished by their voltage-dependence, deactivation and single-channel conductance. Low-voltage-activated channels are called 'T' type because their currents are both transient (owing to fast inactivation) and tiny (owing to small conductance). T-type channels are thought to be involved in pacemaker activity, low-threshold calcium spikes, neuronal oscillations and resonance, and rebound burst firing. Here we report the identification of a neuronal T-type channel. Our cloning strategy began with an analysis of Genbank sequences defined as sharing homology with calcium channels. We sequenced an expressed sequence tag (EST), then used it to clone a full-length complementary DNA from rat brain. Northern blot analysis indicated that this gene is expressed predominantly in brain, in particular the amygdala, cerebellum and thalamus. We mapped the human gene to chromosome 17q22, and the mouse gene to chromosome 11. Functional expression of the channel was measured in Xenopus oocytes. Based on the channel's distinctive voltage dependence, slow deactivation kinetics, and 7.5-pS single-channel conductance, we conclude that this channel is a low-voltage-activated T-type calcium channel.

Recognition of Mycobacterium leprae recombinant 18-kDa proteins in leprosy

Three different, purified, Escherichia coli-derived, recombinant preparations of the Mycobacterium leprae 18K protein were compared for their immunological recognition in leprosy. The preparations tested were 18K fusion proteins containing 70% (amino acids 38-148) of the full 18K protein fused to either a short leader sequence containing six asparagine residues or to beta-galactosidase, and the full length 18K protein. All three recombinant antigens were recognized by IgG antibodies which were restricted mostly to lepromatous leprosy patients. The 18K antigen with the asparagine leader sequence showed better reactivity with IgG antibodies compared with the other two 18K preparations. In lymphocyte proliferation assays, the truncated 18K and the full-length 18K showed equivalent responses in the same donors with strongest recognition in donors who were also strongly responsive to the M. leprae soluble sonicate. These results indicate that the major human B- and T-cell epitopes are located within the segment 38-148, although some individuals may recognize additional epitopes at the NH2-terminal end.

Disseminated histoplasmosis presenting as penile ulcer

A 59-year-old Chinese man presented with a three month history of penile ulcers and abdominal pain. Syphilis and a gastric malignancy were diagnosed clinically. Biopsy of the genital and stomach ulcers revealed histiocytic granulomata containing numerous intracellular fungal bodies. Histoplasma capsulatum was subsequently cultured from the penile ulcer. Antifungal therapy was instituted. However the patient's general condition deteriorated rapidly and he died within two weeks of admission. A post-mortem liver biopsy showed numerous intracellular fungi.

Ipsilateral craniofacial uptake of Tc-99m MDP in nasopharyngeal carcinoma: incidence and implication

A five year review of 224 Tc-99m methylene diphosphonate (MDP) scintiscans of 194 patients with proven nasopharyngeal carcinoma revealed evidence of craniofacial asymmetry in 73.7 per cent. In virtually all instances tracer accumulation corresponded to the side of the primary lesion, cervical node enlargement and or cranial nerve dysfunction. It was concluded that the high frequency of asymmetric ipsilateral MDP accumulation about the face may be attributed to one or all of the following; tumour extension into contiguous structures, localised inflammatory or necrotic changes or even tracer uptake by the tumour itself.