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Recurrent hemorrhagic cyst is an uncommon presentation of breast disease. The ordinary imaging could not demonstrate the malignant features of the cyst. However, the non-contrast dedicated breast computerized tomography could support the malignancy concern. Although tissue diagnosis cannot show the malignant cell, Surgical excision could be offered without uncompromising. Eventually, ductal carcinoma in-situ was diagnosed and further adjuvant treatment could be given. We reported the first case report of ductal carcinoma in-situ, hypersecretory type, presented by a hemorrhagic cyst.

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Angiomatosis of the breast is very rare. The presentations are including breast mass, skin discoloration and breast enlargement that mimic to angiosarcoma. The imaging could suggest non-specific vascular tumors. The histology should be obtained for the certain diagnosis. Surgical excision is the standard treatment. To our knowledge, this is the first case that preoperative radiation is given. Currently, radiation is occasionally used in benign condition. This case shows the successful result of preoperative radiation for achieving breast conserving surgery in large angiomatosis of the breast.

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AIM: To evaluate the long-term safety and efficacy of intrajejunal levodopa-carbidopa intestinal gel (LCIG) infusion in the treatment of patients with severe stages of Parkinson disease (PD) who did not respond adequately to treatment with oral drugs. MATERIAL AND METHODS: A large-scale international prospective open-label 54-week study of LCIG in patients with PD with severe motor fluctuations was carried out. A total of 48 patients were enrolled in Russia, 46 patients (95.8%) had PEG-J inserted, and 43 of them completed the study. The safety, including adverse events (AEs), infusion system and pump failures analysis, number of patients completely terminated the study, and efficacy (duration of "off" periods, "on" periods with or without troublesome dyskinesias, UPDRS scores, Clinical Global Impression, Quality of Life (PDQ-39, EQ-5D и EQ-VAS) dynamics, an analysis of patient's diaries) were assessed throughout the whole study. RESULTS: The majority of AEs were mild or moderate with most AEs connected with infusion system application (28.3% patients) including procedure pain. Serious AEs were registered in 8 patients (16.7%). 3 patients (6.3%) discontinued their participation in the study due to AEs. Mean duration of "off" periods by the end of the study decreased by 5.35±2.59 hours (p<0.001), duration of "on" periods without troublesome dyskinesia increased by 5.74±3.91 hours (p<0.001), reduction of "on" periods duration with troublesome dyskinesia became statistically significant by week 36 (p=0.020). The statistically significant improvement of UPDRS (generally and in respect to sub-scales), Clinical Global Impression, and Quality of Life scores was observed throughout the study. Levodopa dose remained stable throughout the 54 treatment weeks. Forty-three patients (93.5%) received LCIG monotherapy throughout the whole study. CONCLUSION: LCIG intrajejunal infusion during 54 weeks showed the favorable safety profile, high tolerability, and efficacy in PD motor symptoms correction.

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BACKGROUND AND PURPOSE: Pregabalin has demonstrated efficacy in controlled trials as adjunctive treatment in patients with refractory seizures. METHODS: This open-label, 21-week study in adults with at least two partial seizures in the last 2 months, who were inadequately controlled with one to three antiepileptic drugs, evaluated pregabalin 150-600 mg/day (dosed twice daily). The study comprised a prospective or retrospective 8-week baseline phase, and 9-week dose optimization and 12-week maintenance periods. The primary assessment was the mean percentage change in 28-day seizure frequency between baseline and end-point (last 12 weeks of treatment, last observation carried forward, modified intention-to-treat population). RESULTS: Four hundred and seventy-six patients from Europe were included in this study (51% men; mean age/epilepsy duration 40.1/24.1 years). The median baseline seizure frequency was 5.5/28 days. Amongst the patient population, 78% completed the 21-week treatment period; 7% discontinued for lack of efficacy and 12% because of adverse events (AEs). The mean last pregabalin dose was 359 mg/day. The mean (95% CI) reduction in seizure frequency was 36% (31%; 41%). The median reduction was 33%, and 39% of patients had a >or=50% reduction in seizure frequency. There were 19% and 8% of patients free of seizures during their last 4 and 12 weeks of treatment, respectively. The three most common AEs were dizziness (17%), somnolence (13%) and weight increase (13%). CONCLUSIONS: This open-label study of pregabalin demonstrated efficacy that was consistent with that observed in previous controlled epilepsy trials. Pregabalin was well tolerated. The AE profile was also consistent with that reported in previous trials.

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One hundred and thirty two patients who underwent aortic surgery at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000 were studied. Twenty three patients (17.4%) were aged less than 60 years, 102 (77.3%) aged 60-80 years, and 7 (5.3%) were older than 80 years. Ninety eight patients (74.2%) underwent elective operations and 34 (25.8%) underwent emergency operations. Elective abdominal aortic aneurysms (AAA) repair was the most common indication for abdominal aortic surgery (56.0%). Eighteen patients (13.6%) underwent surgery for infected AAA. The incidence of infected AAA was 16.1 per cent among patients with AAA. Fifteen patients (11.4%) had ruptured AAA and 19 patients (14.4%) had aortoiliac occlusive disease. The overall mortality rate was 15.2 per cent. The mortality of elective aortic surgery was 5.1 per cent and of emergency aortic surgery was 44.1 per cent. The mortality of elective AAA repair was 4 per cent. Multiple system organ failure was the most common cause of death (80%), followed by acute myocardial infarction (10%) and exsanguination (10%). The authors conclude that elective surgery on the abdominal aorta is safe and should be performed when indicated to prevent the development of complications requiring emergency surgery which carries a much higher risk.

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BACKGROUND: The role of laparoscopic inguinal hernia repair is controversial. The aim of this study was to find out whether it is justified to switch from the predominantly modified Bassini repair which the authors had been using to laparoscopic repair. METHODS: Randomized controlled trial in 120 eligible patients admitted for elective hernia repair in a university hospital. RESULTS: Sixty patients underwent laparoscopic transabdominal preperitoneal mesh repair; the other 60 patients had an open repair, mostly with the modified Bassini technique. Operative time for laparoscopic repair was significantly longer, mean (s.d.) 95 (28) min vs 67 (27) min (p < 0.001). The mean analogue pain score during the first 24 h after surgery was 36.2 (20.2) in the laparoscopic group and 49.3 (24.9) in the open group (p = 0.006). The requirement for narcotic injections and postoperative disability in walking 10 m and getting out of bed were also significantly less following laparoscopic repair. The postoperative hospital stay was not significantly different, mean 2.6 (1.2) days for laparoscopic repair and 3.0 (1.5) days for open repair (p = 0.1). Patients were able to perform light activities without pain or discomfort sooner after laparoscopic repair, median interquartile range 8 (5-14) days vs 14 (8-19) days (p = 0.013). Patients also resumed heavy activities sooner, but not significantly, after laparoscopic repair, median 28 (17-60) days vs 35 (20-56) days (p = 0.25). The return to work was not significantly different, median 14 (8-25) days after laparoscopic repair and 15 (11-21) days after open repair (p = 0.14). After a mean follow-up of 32 months one patient developed a recurrent hernia 3 months after a laparoscopic repair. Laparoscopic repair was more costly than open repair by approximately $400. CONCLUSIONS: Laparoscopic inguinal hernia repair was associated with less early postoperative pain and disability and earlier return to full activities than open repair, but there were no benefits regarding postoperative hospital stay and return to work; laparoscopic repair was also more costly.

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The damage done to Langendorff perfused guinea-pig hearts by initiation of a calcium paradox, as assessed by the loss of myoglobin, is significantly reduced if inhibitors of Na(+)-Ca2+ exchange (Mn2+, Ni2+, bepridil and dodecylamine) are present when Ca2+ is repleted. This protection is not, to any major extent, due to secondary effects of these agents on the L-type Ca2+ channels, because more specific inhibitors of the Ca2+ channels are much less effective. These results suggest that the principal route for Ca2+ entry during the calcium paradox is Na(+)-Ca2+ exchange.

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The thymus atrophied rapidly in rats rendered diabetic by a single injection of streptozotocin. The weight of the gland was reduced to one-fifth of its original weight within three weeks. Histologically there was a great loss of cortical thymocytes and a marked increase in mast cells lying in the thickened fibrous tissue. These findings may have a bearing on the state of immune deficiency observed in animals with diabetes induced by streptozotocin.

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Male Wistar rats of about 300 g body weight were fasted from 1 to 7 d. They were weighed and had their temperature taken daily. At the end of the experimental period, they were anaesthetized and blood was taken for measurement of the glucose content. The animals were killed and various organs were taken and weighed. Over the first 24 h there were striking reductions in body weight, core temperature and level of blood glucose. Throughout the succeeding days of fasting, there was a gradual decrease in body weight and core temperature, while the level of the blood glucose was maintained at about 3 mmol X l-1. The decrease in body weight and core temperature was matched by the weight loss of the liver and skeletal muscles. The heart and the kidney and spleen were not affected over the first day, but thereafter their weight declined steadily. The brain, the testes and the lungs retained their mass throughout.

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The production of experimental cirrhosis in the rat, most commonly by multiple doses of carbon tetrachloride (CCl4), is a difficult process with a low yield of 'cirrhosis' of widely varied histology. This is due to an unpredictable variation in the response of the rat liver to CCl4. Using a method of monitoring the body weight change of the rat in response to intragastric CCl4 has produced a high yield (76%) of cirrhosis with 8-10 doses of CCl4. This improved control over liver damage has now made it possible to produce a 'standardized' type of decompensated micronodular cirrhosis. A simple non-invasive method of determining when this point has been reached, using a visual grading of ascites during light halothane/oxygen anaesthesia, is described.

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The production of experimental cirrhosis in the rat, most commonly by multiple doses of carbon tetrachloride (CCl4), is a difficult process with a low yield of "cirrhosis" of widely varied histology. This is due to an unpredictable variation in the response of the rat liver to CCl4, and the lack of a reliable method of monitoring the rapidly changing liver damage with each dose. A simple non-invasive method is described in which the daily body weight change of the rat in response to weekly intragastric doses of CCl4 has been shown empirically to sufficiently reflect the state of the liver as to enable each dose of CCl4 to be calibrated by the weight change of the previous dose. The death rate is markedly reduced and a critical level of liver damage can be maintained. This improved control over liver damage has made it possible to produce a high yield (72%) of a standardized decompensated micronodular cirrhosis with 8-10 doses of CCl4. Under these weight-calibrated conditions this point is determined non-invasively by using a visual grading of a critical level of ascites estimated during light halothane/oxygen anaesthesia to relax the abdominal musculature.

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Although studied for most of this century there is still no reliable model of severe decompensated micronodular cirrhosis that can be predictably produced in reasonable quantity. The current most successful model, inhalation of carbon tetrachloride vapor in the phenobarbitone-induced rat, has a low yield of severe cirrhosis and a high death rate because there is no way to determine both the variation in response to carbon tetrachloride and the maintenance of a constant critical level of liver damage. A new approach to this old problem is described in which both variation and level of critical damage are monitored by the daily weight change of the rat in response to intragastric carbon tetrachloride given during light halothane/oxygen anesthesia; the response each time being used to calibrate the subsequent dose of carbon tetrachloride to fit the individual rat. The method is effective in producing cirrhosis with ascites in about 75% of rats after 8-10 doses of carbon tetrachloride.

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We have studied some haemodynamic consequences of vascular grafts of less than 8 mm diameter by animal studies on dogs before and after aortofemoral bypass with either knitted Dacron 5 mm internal diameter (6 dogs) or Goretex 6 mm internal diameter (7 dogs) prostheses between 17 and 24 cm in length. Both materials gave an increased velocity of pulse wave transmission for pressure and flow and an increase in resistance to pulsatile flow. The effects were more severe with Dacron than with Goretex. Pressure index and pressure pulsatility were not significantly altered, but flow pulsatility index, peak flow rate, and peak flow acceleration were all significantly reduced after both implants. These results are due to mismatching of mechanical properties leading to an increased impedance to pulsatile flow.

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The yield of severe cirrhosis of the liver (defined as a shrunken finely nodular liver with micronodular histology, ascites greater than 30 ml, plasma albumin less than 2.2 g/dl, splenomegaly 2-3 times normal, and testicular atrophy approximately half normal weight) after 12 doses of carbon tetrachloride given intragastrically in the phenobarbitone-primed rat was increased from 25% to 56% by giving the initial "calibrating" dose of carbon tetrachloride at the peak of the phenobarbitone-induced enlargement of the liver. At this point it was assumed that the cytochrome P450/CCl4 toxic state was both maximal and stable. The optimal rat size to begin phenobarbitone was determined as 100 g, and this size as a group had a mean maximum relative liver weight increase 47% greater than normal rats of the same body weight. The optimal time for the initial dose of carbon tetrachloride was after 14 days on phenobarbitone.

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