Hepatic TNF-α production following gram-negative bacteremia or hypovolemic shock predisposes to acute lung injury. However, TNF-α expression may be modified by the manner in which the hepatic O2 supply is reduced and equally important, its timing relative to bacteremia. Brief secondary hypoxic stress of buffer-perfused rat livers downregulates E. Coli (EC)-induced TNF-α expression whereas low-flow ischemia preceding EC increases subsequent TNF-α production owing to reactive O2 species (ROS). Here we determined whether 30 min of constant-flow hypoxia preceding 109 intraportal EC likewise increases antigenic and bioactive TNF-α protein concentrations during reoxygenation via production of ROS. Multiple groups (n＝38) were studied over 180 minutes, circulation antigenic TNF-α decreased in H/R+EC vs. EC controls (1 939±640 vs. 12 407±2 476 μg/L at t＝180 min; P＜0.01, along with TNF-α bioactivity). TNF-α protein were not restored to control levels in ALLO+H/R+EC. Thus, EC-induced hepatic TNF-α production and export is strongly O2-dependent in intact liver regardless of the generation of ROS or the sequence of bacteremia and modest hypoxic stress.

No abstract available.
Echocardiography* ; Tricuspid Valve Insufficiency*

Aged ; Clostridium difficile ; Diarrhea ; microbiology ; Enterocolitis, Pseudomembranous ; complications ; diagnosis ; Humans ; Male

Background: Decision analysis (DA) is commonly used to perform economic evaluations of new pharmaceuticals. Using multiples of Malaysia’s per capita 2010 gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), DA was used to estimate a price per dose for bevacizumab, a drug that provides a 1.4-month survival benefit in patients with metastatic colorectal cancer (mCRC). Methods: A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without bevacizumab. Costs for chemotherapy and management of side effects were obtained from public and private hospitals in Malaysia. Utility estimates, measured as quality-adjusted life years (QALYs), were determined by interviewing 24 oncology nurses using the time trade-off technique. The price per dose was then estimated using a target threshold of US$44 400 per QALY gained, which is 3 times the Malaysian per capita GDP. Results: A cost-effective price for bevacizumab could not be determined because the survival benefit provided was insufficient According to the WHO criteria, if the drug was able to improve survival from 1.4 to 3 or 6 months, the price per dose would be $567 and $1258, respectively. Conclusion: The use of decision modelling for estimating drug pricing is a powerful technique to ensure value for money. Such information is of value to drug manufacturers and formulary committees because it facilitates negotiations for value-based pricing in a given jurisdiction.

Several anatomical variables critically influence therapeutic strategizing for anterior choroidal artery (AChA) aneurysms, and specifically, the safety of flow diversion for these lesions. We review the microsurgical anatomy of the AChA, discussing and detailing these considerations in the treatment of AChA aneurysms, theoretically and in the light of our recent findings.
Aneurysm* ; Arteries* ; Choroid*

To establish the prevalence, patterns and risk factors of animal-related injuries among veterinarians, self-administered questionnaires were given to 60 veterinarians practicing in metropolitan Kampala. The prevalence of animal-related injuries in metropolitan Kampala was 72% (95%CI, 57~84). Some veterinarians (34%) suffered multiple injuries with a mean and median of 2.1 and 2.0 injuries per veterinarian, respectively. Of a total of 70 self-reported animal related injuries, cattle accounted for 72%, cats for 25%, dogs for 23%, self inoculation for 15% and birds for 13%. Injuries associated with poultry did not require hospital treatment. The upper limb was the most the frequently (68%) injured anatomical body part of veterinarians, and vaccination of animals (25%) was the major activity associated with injury. Animal-related injuries are common among practicing veterinarians in metropolitan Kampala; however, they did not differ significantly based on the veterinarian's gender, experience or risk awareness.
Accidents, Occupational/*statistics & numerical data ; Animals ; Female ; Humans ; Male ; Prevalence ; Risk Factors ; *Self Report ; Uganda ; Veterinarians/*statistics & numerical data ; Wounds and Injuries/*epidemiology

Awareness of anatomical variations in lungs is essential during segmental or lobar resections of lungs. We studied the variations of fissures, lobes and hilar structures in 65 right and 73 left isolated lungs from the dissection hall. Horizontal fissure was absent in 3.07% and incomplete in 35.38% of right lungs. Four point six one percentage of right lungs had 3 fissures and 4 lobes. Three point zero seven percentage of right lungs had 3 arteries, 67.69% had 2 arteries, and 29.23% had only one artery in the hilum. Sixty-three point zero seven percentage of right lungs had two veins in the hilum; 32.30% had 3 veins in the hilum; and 4.61% had more than 3 veins in the hilum. Ninety-eight point four six percentage of right lungs showed 2 bronchi in the hilum, and 1.53% of them showed 3 bronchi in the hilum. Two of the right lungs (3.07%) had an artery passing across the oblique fissure. Fifteen point zero six percentage of left lungs showed incomplete oblique fissure and 2.73% showed 2 fissures and 3 lobes. Five point four seven percentage of left lungs showed 2 arteries and 94.52% had only one artery in the hilum. Eighty point eight two percentage of left lungs had two veins in the hilum and 19.17% had 3 veins in the hilum. Twenty-one point nine one percent of left lungs had 2 bronchi and 78.08% had only one bronchus in the hilum. The knowledge of variations in the lobar and hilar anatomy of the lung presented in this study is clinically important while interpreting the radiological images and performing surgical procedures.
Arteries ; Bronchi ; Cadaver* ; Lung* ; Veins

PURPOSE: This research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies. METHODS: Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies. RESULTS: A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001). CONCLUSION: Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.
Adenocarcinoma ; Crohn Disease ; Diverticulitis ; Female ; Fistula ; Hernia ; Humans ; Intestinal Fistula* ; Length of Stay ; Male ; Mortality ; Pelvic Exenteration ; Postoperative Complications ; Retrospective Studies ; Urinary Bladder

No abstract available.
Prostatic Hyperplasia*

No abstract available.