Hand-assisted laparoscopic adrenalectomy: An alternative minimal invasive surgical technique for the adrenal gland

Background: Presently the surgical approach to the adrenal gland is in a state of flux. While the traditional approach to the adrenal gland has been the open transabdominal technique, more recently laparoscopic approaches, particularly via the transabdominal route, have increasingly been utilized. However, laparoscopic intervention for the adrenal gland can be problematic in certain circumstances, particularly for large adrenal masses and in instances of adrenal malignancies. Methods: In this report we describe the use of hand-assisted laparoscopic adrenalectomy as an alternative minimal invasive surgical approach to the adrenal gland. Hand-assisted laparoscopic adrenalectomy using the HandPort system (Smith & Nephew, Sydney, Australia) was undertaken in three patients requiring adrenalectomy for mass lesions including one patient with Conn's syndrome. Results: In all three cases, surgery proceeded promptly and uneventfully. In the present paper, the details of the technique of hand-assisted adrenalectomy are described. This is the first report in the world literature of this new technique for the adrenal gland. Conclusions: Hand-assisted laparoscopic adrenalectomy is an easily performed technique, which can be completed within a short operative time span and which has the advantage of providing intraoperative tactile localization for the adrenal gland. It may be particularly applicable for large adrenal tumours, yet only involves the performance of a small abdominal incision. Postoperative recovery is comparable with that reported for the laparoscopic-only technique. Hand-assisted adrenalectomy is a new technique which has great potential and which warrants further evaluation.

Angiotensin AT-1 receptor antagonism: complementary or alternative to ACE inhibition in cardiovascular and renal disease

Both angiotensin-converting enzyme (ACE) inhibitors and AT-1 receptor antagonists reduce the effects of angiotensin II, however they may have different clinical effects. This is because the ACE inhibitors, but not the AT-1 receptor antagonists, increase the levels of substance P, bradykinin and tissue plasminogen activator. The AT-1 receptor antagonists, but not the ACE inhibitors, are capable of inhibiting the effects of angiotensin II produced by enzymes other than ACE. On the basis of the present clinical trial evidence, AT-1 receptor antagonists, rather than the ACE inhibitors, should be used to treat hypertension associated with left ventricular (LV) hypertrophy. Both groups of drugs are useful when hypertension is not complicated by LV hypertrophy, and in diabetes. In the treatment of diabetes with or without hypertension, there is good clinical support for the use of either an ACE inhibitor or an AT-1 receptor antagonist. ACE inhibitors are recommended in the treatment of renal disease that is not associated with diabetes, after myocardial infarction when left ventricular dysfunction is present, and in heart failure. As the incidence of cough is much lower with the AT-1 receptor antagonists, these can be substituted for ACE inhibitors in patients with hypertension or heart failure who have persistent cough. Preliminary studies suggest that combining an AT-1 receptor antagonist with an ACE inhibitor may be more effective than an ACE inhibitor alone in the treatment of hypertension, diabetes with hypertension, renal disease without diabetes and heart failure. However, further trials are required before combination therapy can be recommended in these conditions.

Thermodynamic non-ideality as an alternative source of the effect of sucrose on the thrombin-catalyzed hydrolysis of peptide p-nitroanalide substrates

The inhibitory effect of sucrose on the kinetics of thrombin-catalyzed hydrolysis of the chromogenic substrate S-2238 (D-phenylalanyl-pipecolyl-arginoyl-p-nitroanilide) is re-examined as a possible consequence of thermodynamic non-ideality-an inhibition originally attributed to the increased viscosity of reaction mixtures. However, those published results may also be rationalized in terms of the suppression of a substrate-induced isomerization of thrombin to a slightly more expanded (or more asymmetric) transition state prior to the irreversible kinetic steps that lead to substrate hydrolysis. This reinterpretation of the kinetic results solely in terms of molecular crowding does not signify the lack of an effect of viscosity on any reaction step(s) subject to diffusion control. Instead, it highlights the need for development of analytical procedures that can accommodate the concomitant operation of thermodynamic non-ideality and viscosity effects.

A comparative study of alternative approaches for common factors identification

Preliminary version

Research on using the decision tree method in order to select the best alternative for the pharmacies supply

Introduction / Aims: Adopting the important decisions represents a specific task of the manager. An efficient manager takes these decisions during a sistematic process with well-defined elements, each with a precise order. In the pharmaceutical practice and business, in the supply process of the pharmacies, there are situations when the medicine distributors offer a certain discount, but require payment in a shorter period of time. In these cases, the analysis of the offer can be made with the help of the decision tree method, which permits identifying the decision offering the best possible result in a given situation. The aims of the research have been the analysis of the product offers of many different suppliers and the establishing of the most advantageous ways of pharmacy supplying. Material / Methods: There have been studied the general product offers of the following medical stores: A&G Med, Farmanord, Farmexim, Mediplus, Montero and Relad. In the case of medicine offers including a discount, the decision tree method has been applied in order to select the most advantageous offers. The Decision Tree is a management method used in taking the right decisions and it is generally used when one needs to evaluate the decisions that involve a series of stages. The tree diagram is used in order to look for the most efficient means to attain a specific goal. The decision trees are the most probabilistic methods, useful when adopting risk taking decisions. Results: The results of the analysis on the tree diagrams have indicated the fact that purchasing medicines with discount (1%, 10%, 15%) and payment in a shorter time interval (120 days) is more profitable than purchasing without a discount and payment in a longer time interval (160 days). Discussion / Conclusion: Depending on the results of the tree diagram analysis, the pharmacies would purchase from the selected suppliers. The research has shown that the decision tree method represents a valuable work instrument in choosing the best ways for supplying pharmacies and it is very useful to the specialists from the pharmaceutical field, pharmaceutical management, to medicine suppliers, pharmacy practitioners from the community pharmacies and especially to pharmacy managers, chief – pharmacists.

Chitosan-alginate microparticulate delivery system for an alternative route of administration of BCG vaccine

Immunisation against M. tuberculosis with current available BCG vaccine lacks efficacy in preventing adult pulmonary tuberculosis. Targeting nasal mucosa is an attractive option for a more effective immunization. The delivery of BCG via the intranasal route involves overcoming barriers such as crossing the physical barrier imposed by the mucus layer and ciliar remotion, cellular uptake and intracellular trafficking by antigen presenting cells. Due to its biodegradable, immunogenic and mucoadhesive properties, chitosan particulate delivery systems can act both as vaccine carrier and adjuvant, improving the elicited immune response. In this study, different combinations of Chitosan/Alginate/TPP microparticles with BCG were produced as vaccine systems. The developed microparticle system successfully modulates BCG surface physicochemical properties and promotes effective intracellular uptake by human macrophage cell lines Preliminary immune responses were evaluated after s.c. and intranasal immunisation of BALB/c mice. BCG vaccination successfully stimulated the segregation of IgG2a and IgG1, where intranasal immunisation with chitosan/alginate particulate system efficiently elicited a more equilibrated cellular/humoral immune response.

Determination of chitin content in fungal cell wall: an alternative flow cytometric method

The conventional methods used to evaluate chitin content in fungi, such as biochemical assessment of glucosamine release after acid hydrolysis or epifluorescence microscopy, are low throughput, laborious, time-consuming, and cannot evaluate a large number of cells. We developed a flow cytometric assay, efficient, and fast, based on Calcofluor White staining to measure chitin content in yeast cells. A staining index was defined, its value was directly related to chitin amount and taking into consideration the different levels of autofluorecence. Twenty-two Candida spp. and four Cryptococcus neoformans clinical isolates with distinct susceptibility profiles to caspofungin were evaluated. Candida albicans clinical isolate SC5314, and isogenic strains with deletions in chitin synthase 3 (chs3Δ/chs3Δ) and genes encoding predicted Glycosyl Phosphatidyl Inositol (GPI)-anchored proteins (pga31Δ/Δ and pga62Δ/Δ), were used as controls. As expected, the wild-type strain displayed a significant higher chitin content (P < 0.001) than chs3Δ/chs3Δ and pga31Δ/Δ especially in the presence of caspofungin. Ca. parapsilosis, Ca. tropicalis, and Ca. albicans showed higher cell wall chitin content. Although no relationship between chitin content and antifungal drug susceptibility phenotype was found, an association was established between the paradoxical growth effect in the presence of high caspofungin concentrations and the chitin content. This novel flow cytometry protocol revealed to be a simple and reliable assay to estimate cell wall chitin content of fungi.

Alternative regimens for prostate cancer treatment using radiation therapy

Purpose/Objective: The purpose of this work was to determine biologically equivalent alternative regimens for the treatment of prostate cancer using External Beam Radiotherapy (EBRT) and Low Dose-Rate Brachytherapy (LDRBT) with 125I implants and to evaluate the sensitivity of these regimens to different sets of radiobiological parameters of the Linear-Quadratic (LQ) model.

Pour une approche contrastive du présent simple en français et en portugais

Les temps du passé ont toujours constitué une pierre d’achoppement aussi bien dans l’enseignement du français aux étudiants lusophones que dans celui du portugais aux francophones. Le flot continu d’articles sur ce sujet attesterait, à lui seul, la difficulté du problème. Mais aussi étonnant que cela puisse paraître, il n’existe à ce jour aucune étude systématique qui aborde sur une base théorique le présent simple dans le passage du français vers le portugais et/ou vice-versa. Or, une telle étude nous paraît une voie de recherche intéressante et fructueuse qui ouvre de nombreuses perspectives de recherche, dont les possibilités d’application, que ce soit au domaine de l’enseignement des langues étrangères ou celui de la traduction, ne sont pas négligeables. Cette réflexion est d’autant plus urgente que l’emploi du présent simple pose de sérieux problèmes aux élèves lusophones plus inexpérimentés. En effet, ces derniers ont parfois beaucoup de peine à trouver les bonnes correspondances du présent simple en portugais. Afin d’aboutir à des conclusions fiables sur les similarités et les divergences entre le français et le portugais quant aux conditions d’apparition et au mode de fonctionnement du présent simple, nous nous attacherons, dans l’étude contrastive qui suit, à examiner des échantillons de textes littéraires français traduits en portugais et des extraits de textes littéraires portugais traduits en français1. Il s’agira essentiellement de montrer, en recourant à la Théorie des Opérations Énonciatives d’Antoine Culioli (Culioli, 1990; Campos & Xavier, 1991; Campos, 1997, 1998, entre autres), par quels moyens linguistiques le portugais exprime les valeurs aspectuo-temporelles associées au présent simple en français.

The influence of experience and training in a group of novice observers: a jackknife alternative free-response receiver operating characteristic analysis

Purpose - The study evaluates the pre- and post-training lesion localisation ability of a group of novice observers. Parallels are drawn with the performance of inexperienced radiographers taking part in preliminary clinical evaluation (PCE) and ‘red-dot’ systems, operating within radiography practice. Materials and methods - Thirty-four novice observers searched 92 images for simulated lesions. Pre-training and post-training evaluations were completed following the free-response the receiver operating characteristic (FROC) method. Training consisted of observer performance methodology, the characteristics of the simulated lesions and information on lesion frequency. Jackknife alternative FROC (JAFROC) and highest rating inferred ROC analyses were performed to evaluate performance difference on lesion-based and case-based decisions. The significance level of the test was set at 0.05 to control the probability of Type I error. Results - JAFROC analysis (F(3,33) = 26.34, p < 0.0001) and highest-rating inferred ROC analysis (F(3,33) = 10.65, p = 0.0026) revealed a statistically significant difference in lesion detection performance. The JAFROC figure-of-merit was 0.563 (95% CI 0.512,0.614) pre-training and 0.677 (95% CI 0.639,0.715) post-training. Highest rating inferred ROC figure-of-merit was 0.728 (95% CI 0.701,0.755) pre-training and 0.772 (95% CI 0.750,0.793) post-training. Conclusions - This study has demonstrated that novice observer performance can improve significantly. This study design may have relevance in the assessment of inexperienced radiographers taking part in PCE or commenting scheme for trauma.

Activités d’écriture approchée et entrée dans l’écrit des jeunes enfants: analyse comparative de démarches didactiques en première primaire en france

Nous présentons le suivi d’une cohorte d’élèves, de la grande section (troisième année de maternelle en France -5 ans) à la fin du CE1 (deuxième année de primaire –7/8 ans). La population est constituée d’un groupe contrôle et d’un groupe expérimental pratiquant des séances hebdomadaires d’écriture approchée, observées et filmées à différentes périodes de l’année (octobre, mars et juin). Dans notre contribution, nous analysons les séances filmées en fin de CP (première primaire), dans une perspective essentiellement comparatiste. L’objectif est de décrire la démarche didactique mise en œuvre par les enseignantes lors de séances d’enseignement de l’écriture. L'analyse des productions d'écrit et des verbalisations des élèves nous permet également d'évaluer ces démarches d’enseignement et de caractériser celle qui semble le plus propice au développement de compétences métalinguistiques des apprentis scripteurs

Habiter l’enfance approche de l’habitat dans les premiers récits d’Eugène Savitzkaya

L‘auteur entreprend l‘approche de l‘importance particulière du rapport aux espaces habités ou inhabités dans l‘imaginaire et la construction narrative des textes fictionnels de l‘écrivain belge francophone contemporain Eugène Savitzkaya de Mentir (1977) jusqu‘à En vie (1994). Il s‘agit de souligner la pertinence de l‘habitat en tant que support des imaginaires de l‘enfance et de la poétisation du quotidien. L‘espace s‘avère en effet un repère symbolique et poétique chez Savitzkaya ; ce qui lui permet de s‘exprimer et d‘exprimer son enfance sur un mode autofictionnel.

Evaluation of enzyme-linked immunosorbent and alternative assays for detection of HIV antibodies using panels of Brasilian sera

Sera from 472 Brazilian subjects, confirmed to be either positive or negative for HIV antibodies and comprising the total clinical spectrum of HIV infection, were utilized in the evaluation of six commercially available enzyme-linked immunosorbent assays (ELISA), as well as of four alternative assays, namely indirect immunofluorescence (IIF), passive hemagglutination (PHA), dot blot and Karpas AIDS cell test. The sensitivities ranged from 100% (Abbott and Roche ELISA) to 84.2% (PHA) and the specificities ranged from 99.3% (IIF) to 80.2% (PHA). The sensitivity and specificity of the PHA and the sensitivity of the Karpas cell test were significantly lower than those of the other tests. Although the IFF and dot blot had good sensitivities and specificities, the six ELISA were more attractive than those tests when other parameters such as ease of reading and duration of assay were considered.

Anatase as an alternative application for preventing biodeterioration of mortars: evaluation and comparison with other biocides

International Biodeterioration & Biodegradation 64(2010)388 e 396