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Micturition and Urinary Incontinence
No full textUrinary continence depends on a closed and empty urethra. Two factors keep the urethra closed and empty: one inherent and the second factor is an acquired factor.1.        The inherent: is the presence of an intact healthy internal urethral sphincter (IUS) with strong walls. The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck down to the perineal membrane in both sexes. The collagen forms the strong chassis of the IUS. The muscle fibers are plain muscle fibers that lie on top and intermingle with the collagen fibers in the middle of the cylinder’s thickness. In women, the IUS lies intimately on the anterior vaginal wall.2.        The acquired factor is keeping high alpha-sympathetic tone at the IUS maintaining its closure all the time until there is a desire or a need to void and social circumstances allow. The mother starts to teach and train her child, at about the age of 18-36 months, how to hold up and not to void until suitable circumstances are available. This is achieved by building up high alpha sympathetic tone at the IUS keeping it contracted and the urethra closed and empty all the time until proper social circumstances are available.The urinary bladder (UB) stores the urine, which we void through the urethra. Voiding has two stages: First stage, before training, in infancy and early childhood: As soon as the urinary bladder is full, sensation of bladder fullness travels along the pelvic sacral nerves (S 2, 3 & 4) to the spinal cord. Through spinal cord’s centers, reflex parasympathetic activity leads to contraction of the detrusor muscle voiding the urine through an open urethra irrespective of neither time nor place. The second stage is after training: The mother starts to teach and train her infant-child how to hold up until proper social circumstances are available. The teaching and training leads to learn how to maintain high alpha-sympathetic tone (T 10-L 2) at the IUS keeping it contracted and the urethra closed and empty all the time until favorable social circumstances allow.Both factors (the inherent and the acquired) create high urethral pressure, which is much higher than the pressure in the urinary bladder. Thus, the urethra is closed and empty all the time.Childbirth causes over stretching of the vagina damaging the vaginal chassis, and this will cause injury to the intimately related IUS damaging its collagen chassis. Torn weak IUS cannot stand against sudden rise of abdominal pressure and urine will leak (stress urinary incontinence SUI). The urine leak will embarrass the woman, immediate sympathetic reaction will increase the already present high alpha sympathetic tone at the IUS to confirm its closure and prevent further leak of urine. Imaging with 3-dimension ultra-sound (3DUS) and MRI demonstrate the rupture of the IUS.Â
Relationships between Craniofacial Morphology, Sex, and Deglutitive Hyoid Bone Movement
No full textPurpose: The purpose of this study was to examine the relationship between six craniofacial measures and superior and anterior hyoid bone movement during a liquid swallow.Method: Twelve White adults (6 males, 6 females) between 19-27 years of age participated. Video fluoroscopic recordings were obtained while participants swallowed 7 ml of liquid barium in the upright position. Six craniofacial measures (i.e. Frankfort-mandibular angle, nasion to menton, anterior tubercles C1 to C4, nasion to sella, sella to basion, and nasion-sella-basion angle) were obtained at rest on all participants and used to determine their association with hyoid bone displacement.Results: Males demonstrated larger craniofacial dimensions than females with the exception of nasion-sella-basion angle. Significant sex differences were noted for nasion to menton (p = .05). There were no statistically significant correlations (p < .05) or predictive relationships between maximum anterior and superior hyoid bone displacements and the six craniofacial measures.Conclusion: The present study demonstrated differences in craniofacial morphology related to sex, however, no correlation or predictive relationship between craniofacial measures and hyoid bone movement during swallowing of a 7 ml liquid bolus were observed. Limitations include a small sample size, lack of descriptive anthropometric features (e.g. height and weight), and limited number of swallows per subject. Future studies should include larger sample sizes and investigate the effects of bolus volume and abnormal craniofacial morphology on hyoid bone movement
Case Report of a Missing Dental Implant Discovered Impacted in the Appendix
No full textIngested foreign bodies are rarely impacted in the appendix. They may be clinically silent or cause severe adverse effects like appendicitis or intestinal perforation, requiring emergent surgery. This is a case report of an asymptomatic 61 years old woman, who presented with a missing dental bridge following facial plastic surgery. It was later found to be in the right lower quadrant on plain abdominal radiograph. Conservative management proved ineffective and the patient underwent colonoscopy for retrieval. One end of the dental bridge was found to be impacted in the appendiceal opening. The dental bridge was disimpacted and finally extracted using careful maneuver, described herein.Ingested foreign bodies are rarely impacted in the appendix. They may be clinically silent or cause severe adverse effects like appendicitis or intestinal perforation, requiring emergent surgery. This is a case report of an asymptomatic 61 years old woman, who presented with a missing dental bridge following facial plastic surgery. It was later found to be in the right lower quadrant on plain abdominal radiograph. Conservative management proved ineffective and the patient underwent colonoscopy for retrieval. One end of the dental bridge was found to be impacted in the appendiceal opening. The dental bridge was disimpacted and finally extracted using careful maneuver, described herein
Phase II Study of a Comprehensive Treatment Using Perioperative Chemotherapy Combined with Cytoreductive Surgery for Curatively Resected Gastric Cancer Patients with Positive Peritoneal Wash Cytology
No full textPatients with curatively resected gastric cancer patients with positive peritoneal wash cytology are called P0/Cy1 status. The aim of the present study is to verify the survival benefit of the comprehensive treatment for patients with P0/Cy1 status.Twenty gastric cancer patients were diagnosed as P0/Cy1 by laparoscopy or laparotomy, and were treated with a comprehensive treatment consisting of neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), cytoreductive surgery (CRS) consisting of gastrectomy with lymph node dissection and peritonectomy, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and postoperative systemic chemotherapy. At the second look laparotomy, the peritoneal wash cytology became negative in 15 patients. No grade 3, 4, 5 complications were experienced after second look operations for CRS. Median follow-up time is 3.7 years. Eight patients died of recurrence, but the other 21 patients are alive without recurrence. Five-year survival rate was 42%.The present study demonstrated the efficacy and safety of the comprehensive treatment on the gastric cancer patients in P0/Cy1 status. Â
Medicinal Chemistry Approaches to Neglected Diseases Drug Discovery
No full textThe prevalence of a variety of neglected diseases is an increasing serious public health problem in developing countries, particularly in the poorest and most remote areas with very little or no access to medical care. The consequences in terms of morbidity and mortality due to these infections are devastating and have a major social and economic impact in several relevant aspects. According to the World Health Organization, these diseases are one of the most important scientific and technological challenges that face humankind in the 21st century. Although they affect more than a billion people around the world, there are only a few safe and effective drugs currently available. The urgent need for new drugs has led pharmaceutical and academic R&D centers to employ more knowledge-based platforms, as an unprecedented opportunity to make a significant impact on the lives of disadvantaged people through the discovery of novel therapeutic options. In this perspective we discuss the successful application of modern medicinal chemistry approaches to neglected diseases
Two Novel Triazolo-Thiadiazepines: Synthesis, Stereostructure, Antimicrobial and Cytotoxic Activity
No full textTwo novel triazolo-thiadiazepines, 2-(4-chlorophenyl)-4-[2-(4-chlorophenyl)ethenyl]—7-(9-decenyl)-2,3-dihydro-1,2,4- triazolo [3,4-b] [1,3,4] thiadiazepine (4) and 2,4-bis (4-chlorophenyl)-7-(9-decenyl)-2,3-dihydro-1,2,4-triazolo[3,4-b] [1,3,4]thiadiazepine (7) are synthesized from 3-(9-decenyl)-4-amino-5-mercapto-1,2,4-triazole (1) using 1,5-bis(4-chlorophenyl)pent-1,4-dien-3-one (2) in the former and 4,4’-dichlorochalcone (5) in the latter. The uncyclized adducts, 1,5-bis(4-chlorophenyl)-5-[3-(9-decenyl)-4-amino-5-thio-1,2,4-triazolyl]pent-1-en-3-one (3) and 1,3-bis(4-chlorophenyl)-3-[3-(9-decenyl)-4-amino-5-thio-1,2,4-triazolyl]propan-1-one (6) are also respectively obtained with them. The reaction of (1) with 1,3-bis(2-thienyl)propen-1-one (8) yielded only the uncyclized adduct, 1,3-bis(2-thienyl)-3-[3-(9-decenyl)-4-amino-5-thio-1,2,4-triazolyl]propan-1-one (9) as the sole product. The triazole (1) is prepared from commercially available 10-undecenoic acid by reaction with thiocarbohydrazide at 170oC. The α, β -unsaturated enones, 1,4-dien-3-one (2), dichlorochalcone (5), and thienyl propenone (8) are respectively obtained by condensing acetone with p-chlorobenzaldehyde(molar ratio,1:2), p-chloroacetophenone with p-chlorobenzaldehyde and 2-acetylthiophene with thiophene-2-aldehyde(molar ratios, 1:1) in the presence of 2.5 equivalents of sodium hydroxide.The synthesized compounds (1), (4), (7), and (9) are screened for in vitro antimicrobial and cytotoxic activities. These compounds showed potent antibacterial activity against “Gram negative†bacteria (Escherichia coli and Pseudomonas aeruginosa) but no activity could be demonstrated against Gram positive bacterial strains.Streostuctures are established using IR, DCI-MS, 1H- and 13C- NMR spectra
Effect of Conjugated Linoleic Acid (CLA) in Rats Subjected to Damage Liver Induced by Carbon Tetrachloride
No full textThe conjugated linoleic acid (CLA) consists in a group of positional and geometrical isomers of octadecadienoic acid (18:2 ω-6) in which the two double bonds are conjugated and may have cis or trans configurations. CLAs have been the subject of extensive investigations for their various biological activities, including antiatherosclerotic, anticarcinogenic and antioxidative activities. The aim of this study was to evaluate the antioxidant activity and hepatoprotective properties of CLA in rats subjected to liver injury induced by carbon tetrachloride (CCl4). Eighteen male Wistar rats were divided into three groups: control; CCl4 and CLA. The CLA was administrated daily by gavage for 21 days, and then subjected to liver injury induced by CCl4. The serum and liver were collected and analyzed. CLAs supplementation take to attenuation of the liver damage in treated animals, since the reduction in the levels of thiobarbituric acid reactive substances (TBARS) in the liver suggests hepatoprotective activity of these fatty acids. The levels of catalase (CAT) and glutathione reductase (GR) and reduced glutathione (GSH) levels in liver tissue as a result of reduced oxidative damage induced by CCl4, and increased after treatment with CLA, suggesting antioxidant capacity of CLAs. Moreover the analysis of reverse transcription / polymerase chain reaction (RT / PCR) showed increased expression of the CAT gene, suggesting inducing effects on this enzyme. These results suggest that CLAs can be used as adjuncts to attenuate hepatic damage
Proposal for Guidelines for the Treatment of Vitiligo in Croatia
No full textVitiligo, an acquired depigmentation disorder, because of its impressive clinical presentation has a large impact on psychosocial life of patients. Although the exact etiopathogenesis still remains uncertain, several therapeutic options are available for treatment of this condition. Unfortunately, patients are often confronted with difficulties regarding to receiving suitable therapy. Because of the fact that vitiligo is not contagious and not life-threatening disease, physicians usually do not recognize patients’ problems and consider vitiligo as only a cosmetic problem, which should be treated only by camouflage and sun protection products. On the other hand, because of the lack of the accurate information for patients, a widely open market for different kind of alternative questionable therapies occurs so patients are often experimenting with different types of unproven medications. The need for widely accepted consensus concerning vitiligo treatment and establishment of the therapeutic guidelines exists worldwide. Our aim was to introduce for the first time vitiligo therapy guidelines in Republic of Croatia, based on the evidence-based accepted vitiligo therapy world recommendations and our experience. We present a review of therapy for vitiligo regarding to various vitiligo types and severity of lesions as well adequate therapeutic options. Also, our intention is to improve social component of patient’s life through rising awareness of this condition which affects over 35 million people worldwide
Structural Changes on the Brain MRI and Cognitive Function in Parkinson Disease
No full textPurpose: Cognitive impairment in Parkinson disease (PD) related with the fronto-striatal dysfunction as one cause of subcortical dementia. However, cognitive impairment in PD might be associated with medial temporal lobe atrophy in recent studies. We carried out this study to know whether structural changes on brain MRI are responsible for cognitive dysfunction in PD.Materials and Methods: We recruited 183 patients who were newly diagnosed with PD from January, 2007 to February, 2012. All patients were undertaken brain MRI and neuropsychological assessment. Structural changes of the brain images were evaluated with visual rating scales. We analyzed clinical and neuro-imaging data to assess a relation between cognitive function and brain structural changes in the total patients and did subanalysis with PD-cognitively declined (PD-CD) and PD-cognitively preserved (PD-CP) subgroup.Results: Total scores of the MMSE and 3MS was worsened as havingsevere white matter change (WMC), ventricular enlargement (VE), medial temporal lobe atrophy (MTA), and cortical atrophy in PD patients. PD-CD showed more severe WMC, VE and MTA than those in PD-CP patients even after adjustment of age and durations of education. Degree of the MTA among the brain structural changes was the most relevant factor for cognitive dysfunction in PD patients.Conclusions: Although cognitive dysfunction in PD is suggestive of subcortical origin, medial temporal structure also may have an important role for cognition in PD. Therefore, clinicians need thorough evaluation of the structural changes in the brain MRI as well as neuropsychological assessment to define cognitive function in PD
Knowledge Gain by Psychoeducation for Patients with Schizophrenia: Associations with Sociodemographic Data, Psychopathology, Insight and Global Neurocognitive Performance
No full textPurpose: In the psychiatric hospital of the Technische Universität München a prospective intervention study (PIP II) was conducted from the year 2004 to 2006 with schizophrenic patients to investigate the knowledge gain of patients after psychoeducation.Methods: Psychoeducation was performed standardized by APES manual with eight meetings for a period of four weeks. A psychiatric and a neuropsychological assessement were carried out before and after psychoeducation. In addition, two questionnaires (Knowledge of Illness Questionnaire, Illness Concept Scale) were used. They were analysed to see to what extent the soziodemographic data, the psychopathology, the participation rate of the patients in psychoeducation, the neurocognition and the insight of the patients influence the knowledge gain.Results: Comparison of pre and post data of 62 patients showed CGI declined from 5.0 to 3.2 (p<0.000), PANSS decline from 81.8 to 54.7 (p<0.000). The knowledge increased (0–107 points possible) from 82.6 to 88.5 points (p<0.000). Severely cognitively impaired patients had a knowledge increase from 77.4 to 86.3 points and mildly cognitively impaired patients from 86.8 to 92.8 points (p=0,106). Regression analysis showed that the knowledge score before psychoeducation (p<0,000) is the strongest predictor for knowledge gain.Conclusion: Psychopathology does not limit knowledge gain. Insight into illness is not absolutely necessary for the participation in a psychoeducational group. In this study even cognitively impaired patients have been able to benefit from psychoeducation