Detection of Helicobacter pylori infection in Egyptian patients with chronic calcular cholecystitis

Reports of Helicobacter pylori in biliary tract diseases in humans are very fragmentary, and therefore there is a need for further investigations. This study aims to detect H. pylori in the bile and gall bladder (GB) of patients with chronic calcular cholecystitis (CCC), and to determine the association of H. pylori infection with gallstone type. Thirty patients with CCC admitted for laparoscopic cholecystectomy were investigated, including upper gastro-endoscopy before cholecystectomy. Rapid urease test and histopathological examination were performed on gastric biopsies. The GB specimens were investigated for the presence of H. pylori by immunohistochemistry (IHC). H. pylori antigen in bile was detected by enzyme immunoassay. Chemical analysis of gallstones was performed to determine type. Immunohistochemistry testing showed 73.3% and 66.7% positivity among GB neck and body biopsies, respectively, demonstrating high sensitivity and specificity. A significant association was found between gastric and GB H. pylori positivity (P < 0.01). H. pylori antigen was detected in bile from three CCC cases. The greatest number of stones were of the calcium bilirubinate type. Gall bladder positivity for H. pylori was accompanied by chronic quiescent gastritis (40.9%). In conclusion, H. pylori infection may be an aetiological factor leading to cholecystitis. Gastric colonisation with H. pylori could be a source for GB infection, and the organism may act as a lithogenic component, especially in the context of pure pigmented gallstones.

Serum metabolites, milk yield, and physiological responses during the first week after kidding in Anglo-Nubian, Angora, Baladi, and Damascus goats under subtropical conditions

This study was carried out to determine the level of certain biochemical variables reflecting the energy metabolic statuses during the first week of lactation in goats. A total of 120 Anglo-Nubian, Angora, Baladi, and Damascus does (30 does per breed) were used throughout 5 consecutive parities (30 does per parity) to investigate the effect of breed, parity, day of lactation, and their interaction on serum metabolites including total protein, albumin, globulin, glucose, total lipids, cholesterol, and transaminases. Blood samples were collected every other day during the first week of lactation. Baladi does had the greatest (P < 0.001) values in all measured biochemical variables followed by Anglo-Nubian [in total protein, globulin, and aminotransferase (AST)] and Damascus (in globulin and AST) and then Angora, which had the lowest (P < 0.001) values for all variables. Fifth parity exhibited the greatest (P < 0.001) values in all serum metabolites compared with other parities except for alanine transaminase (ALT) enzyme activity in which the greatest (P = 0.046) values were observed in the first and fourth parties. Serum concentrations of the measured variables increased gradually throughout the first day after kidding until the seventh day for total protein (P < 0.001), albumin (P = 0.013), globulin (P = 0.017), and cholesterol (P = 0.028) whereas serum glucose concentration exhibited an opposite trend. Serum concentrations of total lipids and enzyme activities of AST and ALT were not affected by day (P > 0.05) after kidding. Baladi goats had the least (P < 0.001) serum insulin concentration, which was associated (P < 0.001) with greatest serum glucose concentration. Serum triiodothyronine (T(3)) was inversely correlated (P = 0.032) with milk yield whereas greatest (P = 0.003) T(3) concentrations were associated with least (P < 0.001) milk yield recorded in Angora goats. Animal physiological responses and their indices were not affected (P > 0.05) by breed whereas both rectal temperature and coefficient of heat tolerance were affected (P < 0.001) by parity in an opposite direction. Baladi goats expressed an aspect of adaptability where their rectal temperature decreased and coefficient of heat tolerance increased with increasing parity number.

Growth differentiation factor 15 acts anti-apoptotic and pro-hypertrophic in adult cardiomyocytes

Growth differentiation factor 15 (GDF15) is induced during heart failure development, and may influence different processes in cardiac remodeling. While its anti-apoptotic action under conditions of ischemia-reperfusion have been shown, it remained unclear if this is a broadly protective effect applicable to other apoptotic stimuli. Furthermore, effects on cardiac hypertrophy remained obscure. Therefore, we investigated the effects of GDF15 on induction of hypertrophy and apoptosis in ventricular cardiomyocytes. GDF15 (3 ng/ml) enhanced hypertrophic growth of cardiomyocytes as determined by an increase in cell size by 27 +/- 5% and rate of protein synthesis by 47 +/- 15%. In addition, a time and dose-dependent increase in SMAD-binding affinity was found, as well as enhanced phosphorylation of R-SMAD1. Inhibition of SMADs by transformation of cardiomyocytes with SMAD-decoy oligonucleotides abolished the hypertrophic growth effect. Specific inhibitors of PI3K (10 microM LY290042 or 10 nM wortmannin) or ERK (10 microM PD98059) also blocked GDF15-induced hypertrophy and SMAD activation. Apoptosis induction by three different agents, 100 nM angiotensin II, 1 ng/ml TGFbeta(1), or the NO-donor SNAP (100 microM) was blocked by addition of GDF15 (3 ng/ml). Scavenging of SMADs by transformation of cardiomyocytes with SMAD-decoy oligonucleotides abolished the anti-apoptotic effect of GDF15. In conclusion, GDF15 protects ventricular cardiomyocytes against different apoptotic stimuli and enhances hypertrophic growth. Hypertrophic signaling is thereby mediated via the kinases PI3K and ERK and the transcription factor R-SMAD1. Thus, GDF15 may influence cardiac remodeling via two different mechanisms, apoptosis protection and induction of hypertrophy.

Colonoscopy completion rates--are we prepared for a national screening programme?

Colonoscopy is a difficult technique to learn. There are international standards regarding its completion rates. An audit of colonoscopy completion rates was carried out using computerized data in which the compliance with international standards was assessed. Of 909 patients overall crude and adjusted (excluding incompletion due to poor preparation and disease) caecal intubation rates were 88% and 94.1% respectively. Of those who were considered eligible for terminal ileal intubation, the crude and terminal ileal intubation rates were 47.3% and 50.3% respectively. The results indicated completion rated as per recommendations and were adequate for any colon screening programme to be successful.

European evidence based consensus on the diagnosis and management of Crohn's disease: special situations

This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on definitions and diagnosis reports on the aims and methods of the consensus, as well as sections on diagnosis, pathology, and classification of Crohn's disease. The second section on current management addresses treatment of active disease, maintenance of medically induced remission, and surgery of Crohn's disease.

Inhibitory effects of melatonin on vascular reactivity: possible role of vasoactive mediators

Melatonin (MEL), the principal hormone of the vertebral pineal gland, elicits several neurobiological effects. However, the effects of MEL on vascular tissues are still vague. The first goal of this study was to investigate the effect of MEL on isolated rabbit aortic rings and its role in the vascular reactivity to contractile agents, noradrenaline (NA) and phenylephrine (PHE) and relaxant agents (acetylcholine and sodium nitroprusside). In addition, the levels of nitric oxide (NO), cGMP, total calcium, lipid peroxides, superoxide dismutase (SOD) and glutathione (GSH) were also investigated in tissue homogenates of rabbit aortic rings preincubated (20 min) in MEL with and without contractile agents. Our results revealed that MEL has an endothelium-dependent vaso-relaxant effect and potentiated significantly the vaso-relaxant effect of acetylcholine. Moreover, MEL (10(-4) M) had a significant inhibitory effect on the contractile responses of aortic rings to both NA and PHE. In comparison with control tissue rings, the levels of lipid peroxides were significantly increased while the levels of GSH, and SOD activities were significantly decreased in tissue homogenates of aortic rings pre-incubated (20 min) in NA or PHE. In addition, the levels of NO and cGMP were significantly lower in tissue rings pre-treated with NA and PHE, respectively. Also, the levels of total calcium were significantly increased only in tissue rings pre-treated with NA. The levels of lipid peroxides were significantly decreased, while the levels of GSH, NO and cGMP and SOD activities were significantly increased in tissue homogenates of aortic rings incubated (20 min) in MEL (10(-4) M) in comparison to ring tissues incubated in NA or PHE alone. In aortic rings incubated in MEL+PHE, the levels of lipid peroxides were significantly lower while the levels of GSH and cGMP and SOD activities were significantly higher than their levels in ring tissues incubated in PHE. In aortic rings incubated in MEL+NA, the levels of lipid peroxides and total calcium were significantly lower while the levels of NO were significantly higher than their levels in ring tissues incubated in NA alone. We conclude that MEL has an endothelium dependent vasorelaxant effect and potentiates the endothelium dependent vasorelaxation induced by acetylcholine. MEL inhibits the contractile responses of aortic rings to NA and PHE. These effects may be, in part, due to re-balancing the pro-oxidant/antioxidants system, lowered calcium content and elevated NO and cGMP levels in vascular tissue.

The effect of melatonin on eye lens of rats exposed to ultraviolet radiation

We investigated the influence of exogenously administered melatonin on adult rats eye lenses exposed to ultraviolet radiation (UV) A and B ranging from 356-254 nm irradiation at 8 microW/cm(2). Rats exposed to this range of UV for 15 min for one week showed a significant (P<0.05) reduction in antioxidant enzymes activities; superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and elevated (P<0.001) lipid peroxidation served as an index of cellular damage by free radicals. UV-radiation significantly (P<0.001) elevated calcium ions (Ca(2+)) and lactate dehydrogenase (LDH) activity in lenses. Depleting animals of their stores of important intracellular antioxidant and elevating lenticular Ca(2+) by UV irradiation, may be the main cause of lens opacification. Melatonin injection with radiation significantly reduced (P<0.05) lipid peroxidation, Ca(2+) and (P<0.001) for LDH. When melatonin was injected after radiation, SOD and GSH-Px enzyme activities increased significantly (P<0.01), and lipid peroxidation, Ca(2+) levels and LDH activities were reduced significantly. Melatonin injection after UV radiation was as effective as melatonin treatment concurrent with UV irradiation. We conclude that melatonin may protect the eye lens from the damaging effects of UV exposure, and its actions protect lens from oxidative stress, elevating Ca(2+) levels, which are considered as an important causes of cataractogenesis.

Effect of propofol on perception of pain in mice: mechanisms of action

The latencies of pain threshold to different subhypnotic doses (12.5, 25 and 50 mg kg-1) of propofol, an anaesthetic, administered intraperitoneally (i.p.) into male mice were measured using a hot plate method. The possible mechanism of pain control by propofol was also investigated through blocking beta-endorphin receptors and measuring serum level of beta-endorphin. Morphine (1.5 mg kg-1; i.p.) was used as a reference of reduction of pain sensation. The results showed that propofol in doses of 25 and 50 mg kg-1 significantly (P < 0.01) increased the latency of pain threshold but a lower dose (12.5 mg kg-1) failed to produce any significant change. This indicates that propofol reduced pain and this effect is dose-dependent. Propofol prevents hyperalgesia produced by prostaglandin PGE2, (0.5 mg kg-1, i.p.; P < 0.01). Pretreatment with naloxone (1.0 mg kg-1, i.p.) abolished significantly (P < 0.01) the antinociceptive action of propofol. Furthermore, serum level of beta-endorphin was increased (P < 0.01) after propofol injection particularly at the peak time of propofol action. The serum level of corticosterone was also increased (P < 0.01) at the time of beta-endorphin release. It was concluded that propofol can control pain and this action may be centrally modulated through the opioid system rather than at the level of the spinal cord.

Potential protective effects of melatonin on bone marrow of rats exposed to cytotoxic drugs

Myelosuppression is the most serious, dose limiting, toxicity of cytotoxic drugs. Efforts to protect the bone marrow have been only variably successful, and no agreement exists on how to approach this problem. Melatonin, the major hormonal product of the pineal gland, is supposed to have both chemoprotective and myelostimulatory effects. This experimental study was carried out to test these two effects on the bone marrow of rats, daily intraperitoneally injected with 100 microg melatonin. Injection of 10 mg aracytin for 10 days produced a significant (P < 0.01) decrease in red blood cells count (RBCs), total leucocytic count, as well as platelets count. When melatonin was injected along with aracytin, it would significantly increase (P < 0.05) RBC count and (P < 0.01) blood platelet count. Injection of melatonin after aracytin treatment would significantly increase (P < 0.01) RBC, total leucocytic and platelet counts in comparison with rats treated with aracytin only. The effects of melatonin were more clear in rats treated with it after aracytin injection than those treated with melatonin and aracytin at the same time. Furthermore, it was found that aracytin produced a significant (P < 0.01) decrease in serum total proteins, albumin, and significantly increased the (P < 0.01) albumin/globulin ratio. Melatonin injection would significantly increase (P < 0.01) total protein, globulin, and significantly decrease (P < 0.01) the albumin/glubulin ratio when injected either with aracytin or after aracytin treatment. These results indicate that melatonin protects bone marrow, lymphoid tissues from damaging effect of cytotoxic drugs, as well as stimulating the suppressed bone marrow.

The cervical spine in athetoid cerebral palsy. A radiological study of 180 patients

We have reviewed the cervical spine radiographs of 180 patients with athetoid cerebral palsy and compared them with those of 417 control subjects. Disc degeneration occurred earlier and progressed more rapidly in the patients, with advanced disc degeneration in 51%, eight times the frequency in normal subjects. At the C3/4 and C4/5 levels, there was listhetic instability in 17% and 27% of the patients, respectively, again six and eight times more frequently than in the control subjects. Angular instability was seen, particularly at the C3/4, C4/5 and C5/6 levels. We found a significantly higher incidence of narrowing of the cervical canal in the patients, notably at the C4 and C5 levels, where the average was 14.4 mm in the patients and 16.4 mm in normal subjects. The combination of disc degeneration and listhetic instability with a narrow canal predisposes these patients to relatively rapid progression to a devastating neurological deficit.

THE CERVICAL SPINE IN ATHETOID CEREBRAL PALSY

We have reviewed the cervical spine radiographs of 180 patients with athetoid cerebral palsy and compared them with those of 417 control subjects.

Disc degeneration occurred earlier and progressed more rapidly in the patients, with advanced disc degeneration in 51%, eight times the frequency in normal subjects. At the C3/4 and C4/5 levels, there was listhetic instability in 17% and 27% of the patients, respectively, again six and eight times more frequently than in the control subjects. Angular instability was seen, particularly at the C3/4, C4/5 and C5/6 levels.

We found a significantly higher incidence of narrowing of the cervical canal in the patients, notably at the C4 and C5 levels, where the average was 14.4 mm in the patients and 16.4 mm in normal subjects.

The combination of disc degeneration and listhetic instability with a narrow canal predisposes these patients to relatively rapid progression to a devastating neurological deficit.

Modified bovine type I collagen membrane as a wound graft material in oral surgery (an experimental study)

The use of collagen biomaterials in various types, structures and forms to aid in wound healing and in reconstructive surgery has been reported in several occasions in the literature. This paper evaluates the biocompatibility and effectiveness of a modified bovine type I collagen membrane as a graft material in experimental oral wounds in dogs. 2.5 x 2.5 cm wounds were prepared bilaterally in the labial mucosa of nine dogs. Bovine type I atelopeptide reconstituted collagen membrane was placed over the surgery site on one side of the labial mucosa. The contralateral sides served as controls. Clinical and histopathologic evaluation were done at 1, 2 and 3 weeks post-operatively, comparing the experimental side with the control side. Results demonstrated an improved rate of wound healing on the experimental side. The collagen membrane had a topical hemostatic effect at the time of its application and did not cause any adverse reaction post-operatively. It is concluded that the modified collagen membrane used in this study is biologically acceptable to the oral mucosa and is, from the clinical point of view, an excellent wound graft material. The clinical utilization of these collagen sheets offers exciting applications in the field of oral surgery.

Total hip arthroplasty in the neglected congenital dislocation of the hip. A five- to 14-year follow-up study

A retrospective study was performed on 34 hips of 28 patients with neglected congenital dislocation of the hip after cemented total hip arthroplasty (THA) using a straight-stem prosthesis in 21 and a curve-stem prosthesis in 13 hips. The mean age at operation was 49 years (28-72 years) and the mean follow-up period was 9.4 years (5.6-14 years). Functional evaluation using Merle d'Aubigné Hip Score showed 71% success rate. Radiographic loosening occurred in three femoral and eight acetabular components attributable to poor cementing in all stems and three sockets, and to dislocation due to trauma and graft collapse in two sockets. Marked acetabular deficiency showed increased incidence of socket loosening. Both types of prostheses showed the same statistical results. Localized endosteal osteolysis appeared in five hips at the sites of less than 1-mm cement thickness. Greater trochanter nonunion reduced the functional status evidenced by pain, limping, and a statistically significant Trendelenburg sign. Proper cementing, effective acetabular reconstruction, and prevention of trochanter nonunion can produce excellent long-term results.

Analysis of heterokaryon incompatibility between heterokaryon-compatibility (h-c) groups R and GL provides evidence that at least eight het loci control somatic incompatibility in Aspergillus nidulans

Protoplast fusion was used to hybridize strains 99-6 (h-cR) and 7-141 (h-cGL) in the Birmingham collection of Aspergillus nidulans. A sparsely conidiating, brown-pigmented diploid strain (MA7) was isolated. Inocula from MA7 were haploidized on medium containing Benlate and a haploid progeny sample collected. Heterokaryon compatibility testing of selected progeny strains assayed each linkage group in turn and established that h-cR and h-cGL were hetero-allelic for heterokaryon incompatibility (het) loci located on linkage groups III and V. Two selected MA7 progeny strains were sexually crossed to an h-cGL strain. Compatibility classification of the progenies of these crosses indicated that three het genes were located on linkage group III and two on linkage group V. Combination of these results with previous work using h-c groups A, B and Q in comparison with h-cGL indicates that a minimum number of eight and a maximum number of 18 het loci, spread over five linkage groups, are necessary to explain the compatibility relationships among these five h-c groups.

The lumbar spine in spastic diplegia. A radiographic study

Some radiological features of the lumbar spine of 84 patients with spastic diplegia were compared with 50 control subjects. The average age of the patients was 20.1 years (3 to 39). Spondylolysis of the fifth lumbar vertebra was found in 21%, four times more frequently than in normal subjects. No patient under nine years of age had spondylolysis and the frequency increased with age. The average angle of lumbar lordosis in spastic patients in the standing position was greater than in normal subjects, and increased with age. The patients had a decreased sacrofemoral angle which caused an increase in Ferguson's angle and explained the increased angle of lumbar lordosis.

Dome osteotomy of the pelvis for osteoarthritis secondary to hip dysplasia. An over five-year follow-up study

We performed Kawamura's dome osteotomy of the pelvis, with simultaneous distal transfer of the greater trochanter on 101 hips in 91 patients with osteoarthritis secondary to hip dysplasia. The mean age at operation was 30 years (15 to 55), and follow-up was for a mean of 8.3 years (5 to 14). Clinical evaluation using the Merle d'Aubigné score showed 92% excellent or good results. Radiologically, 91 hips had good acetabular remodelling and showed no signs of progression of osteoarthritis. In ten hips the osteoarthritic process progressed despite the osteotomy and six of these eventually underwent total hip replacement. Factors which were significantly associated with a poor outcome included an advanced stage of osteoarthritis, valgus deformity of the proximal femur, old age at the time of operation and postoperative persistence of abductor insufficiency.