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We investigated the effects of milk protein concentrate (MPC) and milk protein concentrate hydrolysate (MPCH) as antioxidant agents in rats. Six groups of healthy (non-diabetic) and type-II diabetic rats were used: (1) healthy rats (control), (2) alloxan-induced rats (diabetic control group), (3) healthy rats treated orally with MPC, (4) diabetic rats treated orally with MPC, (5) healthy rats treated orally with MPCH, and (6) diabetic rats treated orally with MPCH. We concluded that treatment with MPC or MPCH reduced the level of thiobarbituric acid reactive substances in healthy and diabetic rats. Treatment with MPC or MPCH improved activities of antioxidant enzymes (catalase, superoxide dismutase, reduced glutathione, glutathione-S-transferase, and glutathione peroxidase) in healthy and diabetic rats. From the present data, we concluded that both MPC and MPCH contain potent antioxidants and could improve the health of rats or other animals with diabetes mellitus.

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The aim of this study was to investigate the presence of mitochondrial DNA (mtDNA) alterations and metabolic dysfunctions in patients with presbyacusis, and to discover correlations between presbyacusis and the degree of hearing loss and mitochondrial damage. Seventy patients with presbyacusis were examined, including 40 Egyptian patients and 30 Italian patients. Forty eight normal subjects were included as control group, including 24 Egyptians and 24 Italians. There was no common point mutation, and A1555G, A3243G, A7445G not were detected in any patients or controls. Haplogroup U was significantly common in patients in comparison to controls. Mutation of antioxidant genes (GSTT1, GSTM1) were significantly present in only Italian patients compared to Italian controls.

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PURPOSE: We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources. METHODS: Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed. RESULTS: We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months. CONCLUSIONS: Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.

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1. An experiment was conducted to study the effect of naked neck gene (Na) on carcase measurements and some immunological responses of chickens. 2. The presence of naked neck gene in a single or double state increased body weight. 3. The naked neck genotypes (NaNa or Nana) exhibited higher relative weight of dressed carcase, drumstick and breast muscles compared to normally feathered individuals (nana). The proportion of abdominal fat was decreased in both naked neck genotypes compared with normally feathered ones. 4. A higher (non-specific) cell-mediated immune response was evoked in Na gene bearing birds. 5. Higher concentrations of antibodies occurred after injection of sheep red blood cells into naked neck birds, particularly at 14 d post-secondary injection. 6. The NaNa birds had a higher heterophil/lymphocyte ratio than Nana and nana siblings.

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Samples of meat and dairy products taken from the city of Rabat, Morocco, were examined for the presence of Escherichia coli O157 by the selective enrichment procedure followed by plating on cefixime-tellurite-sorbitol MacConkey agar and a latex agglutination test. The ability of isolates to produce Shiga toxins (ST1 or ST2) was also tested by an agglutination test using sensitized latex. Dairy samples (n = 44) included different products commonly consumed in the country. Meat samples (n = 36) were taken from traditional butchers because these products are generally marketed in this way. Random samples were taken from each product during the period of January through May. Of the 80 samples tested, 8 (10%) harbored E. coli O157. Four dairy and four meat samples were contaminated (9.1 and 11.1%, respectively). Of 10 E. coli O157 isolates from contaminated samples demonstrating true antigen-antibody agglutination, 5 (50%) produced either ST2 alone or ST2 plus ST1. Four of the five strains (80%) were meat isolates and produced ST2 with or without ST1, and the fifth was a dairy isolate producing ST2.

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Mutants of Lactococcus lactis producing excess carbon dioxide could be isolated on LDHA-20 agar (described by El Attar et al. Journal of Dairy Research 67 641-646 2000). The use of these mutants in the manufacture of Roquefort cheese has the potential to improve the formation of openings in this cheese. The aim of this work was to examine the stability of these mutants, their enzymic activities and their metabolism of lactose and citrate during growth in milk. They produced less L-lactate than the parent strain and their lactate dehydrogenase activity was lower. Nevertheless none of the mutants produced no L-lactate at all and the most active gas generators among them generally produced 30-50 mM-L-lactate. Unexpectedly, all the strains produced some D-lactate, some > 10 mM. We found that carbon dioxide production by the mutants could be determined indirectly by assaying acetoin, citrate and 2,3-butanediol by high-performance liquid chromatography. Generally, spontaneous mutants were more stable than those obtained after treating with nitrosoguanidine or u.v. irradiation.

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OBJECTIVE: To find out if giving steroids reduces postoperative swelling in orbital surgery. DESIGN: Prospective, randomized, double-blind trial. SETTING: Regional unit, teaching hospital, UK. SUBJECTS AND INTERVENTIONS: 20 patients who require orbital floor exploration after injuries. Patients were given methylprednisolone 250 mg (or placebo identically packaged) at induction of anaesthesia, with a further three doses at 6-hourly intervals postoperatively. MAIN OUTCOME MEASURE: Differences in interpalpebral width before and after operation. RESULTS: Those given steroids (n=11) had a significantly increased interpalpebral width compared with placebo (n=9) postoperatively (P < 0.01, 95% confidence intervals of the difference = 1 mm-6 mm). CONCLUSION: Short courses of steroids therapy should be considered in orbital surgery for appropriate patients. There is an advantage in being able to assess the globe postoperatively.

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BACKGROUND: Pseudomyxoma peritonei, a tumor which spreads chiefly along peritoneal surfaces, has recently been treated by resection followed by intraperitoneal infusion of 5-fluorouracil (5-FU). Reports on the cardiotoxicity of this drug, given intravenously, indicate an incidence of 1.4-2.9%. Although several deaths have been reported following 5-FU therapy by continuous intravenous infusion, none has apparently been reported following bolus intravenous injection. METHOD: Radical resection of an extensive pseudomyxoma peritonei was performed. Following convalescence, intraperitoneal infusion of 5-FU was initiated in a daily dose of 20 mg/kg body weight (1,440 mg), planned for administration in multiple 5-day cycles. RESULTS: After three uneventful daily infusions of 5-FU, the patient suddenly died, apparently of a sudden cardiac event. Autopsy provided no explanation for his death. The coronary arteries were free of disease and no residual tumor was found. A review of the literature reveals no report of a cardiac death from 5-FU following its intraperitoneal administration. CONCLUSIONS: The fatality suggests the potential toxicity of 5- FU when administered intraperitoneally, a factor to be considered in decisions to use this drug intraperitoneally.

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The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.

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CONCLUSION: The diagnosis of a pancreatic carcinoid should be based on the measurement of serotonin in serum or its demonstration in the tumor and/or by the measurement of its derivative (5-HIAA) in urine. Carcinoid of the pancreas is a rare but definite entity; usually having metastasized by the time of diagnosis. The term "serotonin-producing tumor of the pancreas" has been suggested as an alternative designation for "pancreatic carcinoid." BACKGROUND: The literature on carcinoid tumors of the pancreas is confusing because much of it preceded the development of the more specific immunological, chemical and staining techniques currently available. METHODS: 43 case reports were collected from the world's literature, based on a demonstrable pancreatic neuroendocrine tumor plus a positive finding of at least one of the following without another dominant hormone being demonstrated: elevation of 5-Hydroxytryptamine (5-HT) (serotonin) in the serum or detected in tumor tissue, and/or elevation of 5-Hydroxyindole acetic acid (5-HIAA) in the urine. In addition to these two hormone-specific assays, information was collected on the silver-staining properties of the tumor; properties which have traditionally been associated with carcinoid tumors. Positive silver staining in tumor cells (argyrophilic and/or argentaffin reaction) is strongly indicative of the carcinoid tumor but the findings are less specific than the hormone assays and immunohistologic stains. RESULTS: In this review of 43 cases, including two current ones, the pancreatic carcinoid tumor has the following important features: 1. It is a rare tumor that is usually diagnosed late when the tumor is large and has metastasized. Thirty-eight (88.4%) have been malignant. They are, therefore, associated with a high incidence of the "carcinoid syndrome." 2. To date, prognosis in therapy is poor, based on delayed diagnosis, a resultant low incidence of resectability, and an uncertain duration of survival after resection. 3. Pancreatic carcinoid tumors remain difficult to differentiate from other endocrine tumors. The measurement of urinary 5-HIAA excretion or the demonstration of elevated serotonin level in the tumor or in serum is essential to its distinction. Silver staining of the tumor, although of historic importance, has been superceded by the hormone-specific studies. 4. To distinguish it from other endocrine tumors of the pancreas, the terms "pancreatic serotoninoma" or "serotonin-producing tumor of the pancreas" have been suggested as possible alternatives. Its growth characteristics may be related more to its cell of origin than to its extent of hormone secretion. Not all of the tumors result in recognizable hyperserotoninemia.

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OBJECTIVE: An absorbable pin made from poly-p-dioxanone (Orthosorb, Johnson and Johnson, UK) was used to internally fix osteotomies of the mandibular ramus. We present our initial series of 10 patients. DESIGN: Open study. SETTING: Regional unit, teaching hospital, UK. SUBJECTS AND INTERVENTIONS: 10 patients who required a bilateral sagittal split osteotomy (BSS, n = 3) or a vertical subsigmoid osteotomy (BVSS, n = 6), or both (n = 1). MAIN OUTCOME MEASURE: Jaw functioning and ability to open mouth. RESULTS: 9/10 followed up for 1 year, 1/10 lost to follow up at one month, 1/10 lost to follow up at one year. 7/9 reported the same degree of mouth opening as preoperatively, 2/9 slightly less. 3/10 developed slight anterior open bite problems; 1/10 required no treatment, 1/10 improved with selective grinding, and 1/10 was lost to follow up. No patient complained of discharge from the site of the implant or of any change in sensation of the lip. CONCLUSION: Small absorbable implants undoubtedly have a place in selected maxillofacial operations, but there are still some problems with their use, including complications during the learning curve.

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The lowest tidal volume delivered by most of the pediatric anesthesia ventilators could be large for neonates, and may generate unacceptably high peak airway pressures. The effective tidal volume can however be reduced by connection of a small rubber bag between the ventilator and the expiratory limb of the Ayre's T-piece circuit to divide the delivered gas mixture between the added bag and the neonate's lungs. The delivered tidal volume by the ventilator can then be manipulated to achieve the desired peak inspiratory pressure; 18-20 cm H2O in neonates with normal lung compliance. The modification was found to be simple, safe and convenient.

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Thirty six patients ASA 1 or 2, undergoing surgery that required tracheal intubation, were allocated randomly into three groups of twelve each. Before induction of anesthesia, they received either saline, 10 mg, nifedipine sublingual, or fentanyl 1.5 micrograms.kg-1 IV. Heart rate (HR), systolic blood pressure (SAP), diastolic blood pressure (DBP), and mean blood pressure (MAP), were recorded automatically every minute for 5 minutes before induction of anesthesia, and for 5 minutes after intubation. Nifedipine was better than fentanyl in blocking the pressor response. The fentanyl dose was too small to abolish this response completely. The increase in HR and blood pressure were most evident in the control group, followed by fentanyl, and the least increase was seen with nifedipine.

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Closed circuit coasting after high flow isoflurane-N2O anesthesia was used in 30 patients undergoing operations expected to last more than one hour. Near the end of the operation, the circuit was closed by shutting off anesthetics and reducing oxygen flow to that necessary to maintain constant end-tidal circuit volume throughout the duration of coasting (Tc). End-tidal isoflurane concentration of 0.5% was a safe target for coasting. Good correlation was found between Tc and anesthetic delivery duration (TAD). An adequate TC for the first hour of TAD was 15 minutes followed by 11 minutes more for each subsequent hour of TAD. The technique is safe, simple, economic, predictable and practical.

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The efficacy of flumazenil in the reversal of midazolam sedation was assessed in double-blind placebo controlled study. Thirty patients undergoing oral surgical procedures were included. Flumazenil administration was followed by immediate rise of the CNS functions scores to almost the baseline awake values. Compared to control group, patients were significantly more oriented and had better comprehension up to 15 minutes, more alert for 30 minutes and had better memory function up to 60 minutes. Peripheral oxygen saturation was significantly higher up to 15 minutes. Flumazenil allows better utilization and higher turn over rate where space and nursing resources are scarce.

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Fractures of the mid-face are commonly accompanied by injury to the visual system. Three hundred and sixty three patients who had sustained mid-facial fractures were assessed prospectively for evidence of such injury. The data have been used to devise a scoring system for the maxillofacial surgeon in order to help identify those patients at risk of eye injury. The scoring system has been evaluated on a further cohort of 100 patients with a similar spectrum of injury and the sensitivity and specificity of the system have been determined. The results of these studies have been reported in the maxillofacial literature. This paper reviews the data and results obtained. In summary, impaired visual acuity with a comminuted or out blow fracture, a motility abnormality, or facial fracture combined with head injury, sufficient to cause both retrograde and post-traumatic amnesia, emerged as major risk factors which are indicative of an adverse ophthalmic outcome deemed to warrant referral. The scoring system which was developed from this data was found to have a sensitivity of 94.4% and a specificity of 89% for the detection of patients thought to merit ophthalmic assessment. Failure to assess central visual function as objectively as practicable in patients who have sustained mid-facial fractures may lead to potentially treatable ophthalmic pathology not being identified.

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Twenty-six patients undergoing middle ear surgery were anaesthetised using a completely closed circuit into which liquid isoflurane was injected using a syringe pump. The injection rate was guided by a table of calculated rates of isoflurane uptake, utilising the square root of time principle, at succeeding time intervals in different weight groups. A constant alveolar concentration of 1.3 MAC was aimed for. The injection rate was changed to that for the higher or lower weight group appropriate to the time interval whenever clinical signs indicated inappropriate depth of anaesthesia. A mean of 10.3 ml liquid isoflurane was used to maintain anaesthesia for a mean of 82.3 minutes. Blood pressure was maintained at 75% of the pre-operative value. Mean arterial blood gas data and changes in plasma catecholamine levels were within the normal range. The mean recovery time was 10.5 minutes. Syringe pump delivery of liquid isoflurane avoided fluctuations that result from bolus injections of unit dose. The implemented injection rate table, working as a therapeutic window, guided redosing, reduced calculation time and served as a record. The technique is safe, economic and adaptable to variations in uptake and response to inhalational anaesthetics.

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Maxillofacial trauma is often complicated by injury to the eye. Such injuries may be difficult to detect and may therefore be missed. Detailed ophthalmic examinations were carried out prospectively on 363 patients who had sustained midfacial fractures. Fifty four parameters comprising maxillofacial, radiological and ophthalmic data were recorded and coded for each patient. All encoded data were divided into predictors (the data potentially available to the maxillofacial surgeon) and outcome (the data potentially available to the ophthalmologist). Statistical methods of regression, and the analysis of contingency tables, led to the identification of the principal predictors indicative of underlying ophthalmic injury and thence to a scoring system which predicts the severity of such injuries. Impaired visual acuity is the principal predictor and when employed alone gives a sensitivity value of 80%. Pure blow-out fracture or comminuted facial fracture, double vision and amnesia emerged as additional factors which yielded an efficient scoring system with a sensitivity of 89% and specificity of 90% for the population upon which it was based. A score sheet is provided in the paper. These predictors can be remembered from the acronym Blow-out fracture, Acuity, Diplopia, Amnesia, Comminuted Trauma. As many such injuries result from a BAD ACT, it is easily remembered. This scoring system requires to be tested upon a new population of individuals in order to determine its efficacy.

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