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Countless studies have been devoted to the scientific evaluation of the safety and/or efficacy of botanical natural products. Investigators involved in such studies face a unique set of challenges. Natural products differ from their pharmaceutical counterparts in that they are typically complex mixtures, for which the identities and quantities of components present are not known. To further complicate matters, the composition of these mixtures will vary depending on source material and method of preparation. Investigators conducting clinical trials with complex botanical natural products must choose from a myriad of potential preparations, which may vary greatly in composition. In making such decisions, it is extremely useful to know which components of the mixture are most likely to be responsible for its purported biological activity (the ″active constituents″). The gold standard approach for identifying active constituents of botanical natural products is bioassay-guided fractionation, in which the mixture is subjected to successive rounds of purification and bioassays until an active compound is identified. Bioassay guided fractionation has historically played a critical role in drug discovery, but is, nonetheless, fraught with challenges. The process is biased towards the most abundant and easily isolatable mixture components, which may not be the most biologically active. Furthermore, if multiple compounds contribute either additively, antagonistically, or synergistically to the observed biological activity of the mixture, activity may be lost upon isolation. As a complementary strategy to bioassay-guided fractionation, our research group has developed untargeted metabolomics strategies to aid in the identification of bioactive mixture components. These strategies involve profiling botanical mixtures using ultraperformance chromatography coupled to high resolving power mass spectrometry. The resulting chemical data is then integrated with biological assay data using bioche?mometric data analysis strategies. Several case studies will be presented illustrating how this approach can be applied, including for the identification of compounds from the botanical green (Camellia sinensis) that inhibit drug metabolizing enzymes. Such studies are being conducted as part of the Center for Excellence in Natural Product Drug Interaction Studies (NaPDI), which is supported by a cooperative agreement with the National Center for Complementary and Integrative Health, a component of the National Institutes of Health.

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BACKGROUND: Laparoscopic resection of colorectal carcinoma is now a well-established surgical technique with oncology treatment outcome similar to open surgery, yet performing better in some short-term variables. The technique, however, does not allow palpation of intra-abdominal organs and the liver in particular. This prospective study aims to assess the performance of laparoscopic intra-operative ulrasonography of the liver (L-IOUS) and compare its findings with pre-operative staging data. METHODS: In total 70 patients, 53 men and 17 women, who were recruited into the study, were indicated for primary laparoscopic resection for colorectal carcinoma, with laparoscopic intra-operative ulrasonographic examination of the liver (L-IOUS) being used during the initial part of the operation. Before surgery, all patients underwent abdominal and pelvic contrast CT examinations. Ultrasonographic examination of the liver was included. RESULTS: In 14 patients L-IOUS detected a synchronous metastatic lesion of the liver as opposed to only six patients with pre-operative CT-positive findings. Furthermore, CT-positive metastases in three patients were not confirmed by L-IOUS. Several patients were diagnosed with benign lesions not disclosed during pre-operative assessment, e.g. haemangioma in 5 vs 2 patients, focal nodular hyperplasia in 3 vs 1 patient and liver cysts in 7 vs 5 patients. CONCLUSION: Results of the presented prospective study substantiate the use of laparoscopic intra-operative ultrasound of the liver (L-IOUS) within the standard staging protocol, as this seems to appropriately supplement the results of the pre-operative staging. In cases of colorectal carcinoma the method allows highly sensitive detection of occult synchronous liver metastases that could finally alter a therapeutic strategy.

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The authors present a report on their initial experience with the use of a Freka Trelumina probe. It is a nasal triluminal special probe for duodenal or jejunal nutrition and concurrent decompression of the stomach in case of its impaired motility and impossible oral nutrition. They draw attention in particular to the use in conservative treatment of acute pancreatitis and inform on favourable experience with the use of the probe under X-ray control.

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The method of digital subtraction is based on the ability to eliminate interfering shadows from the X-ray picture, which makes it possible to make the parts of the picture containing contrast substance more visible. Digital subtraction dacryocystography makes better and more detailed imaging of the lacrimal pathways possible, in particular in the proximal part of the efferent lacrimal pathways, as compared with conventional dacryocystography. This is important for more detailed assessment of the necessary surgical intervention on the lacrimal pathways and its prognosis. The advantage is the possibility to deposit the image in the memory of the instrument as well as its digital processing and the smaller radiation load to which the lens is exposed. The authors examined by the method of digital subtraction dacryocystography 25 patients with disorders of the efferent lacrimal system and present some normal and pathological findings of the lacrimal pathways.

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The authors submit a report on four patients with urothelial carcinomas of the upper urinary pathways, as in each of them the development of the disease was interesting. They draw attention to the fact that it is important to consider other possible causes of complaints of these patients, although the urologist thinks in these dispensarised patients, due to the nature of their disease, above all of the development of another urothelial tumour or spread of the original tumour.

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During the past 15 years we treated at the ENT department and ophthalmological department of the hospital with policlinic type III in Nitra 10 patients with orbital phlegmons or an abscess of the eyelid after an eye injury treated and cured by antibiotic treatment and external drainage. Twelve patients had a rhinogenic phlegmon or abscess in the orbit (one patient had a dentogenic aetiology of the inflammation). This group of 12 patients were treated in addition to antibiotics in different combinations also surgically (in one case also by drainage of the abscess from a lateral quadrant of the orbit). In five instances the authors found in addition to the phlegmon of the periorbital tissue also an abscess in the depth of the orbit and six times an abscess of the eyelid. Despite the radical approach to the inflammation of the paranasal sinuses and inflammation of the orbit, two patients developed blindness of the damaged eye and one patient died from rhinogenic suppurative meningitis.

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In the course of eight years the authors made several types of myringoplasties. In 97% a fascial graft was used with a premyringeal or retromyringeal approach. In small central perforations stepp plasty proved useful, in major defects a combination of stepp plasty and placement of the graft beneath the tympanomeatal lobe or beneath the skin of the auditory meatus resp. Anatomical healing was achieved in a total of 90%. Eight per cent of the patients were re-operated with satisfactory results. After simple myringoplasties the auditory gain was 15-20 dB in 90%, after reconstruction of the entire conduction system hearing improved markedly in 64%. Hearing did not deteriorate after operation in any of the patients.

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