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Purpose: This study examines the accuracy of intraoperative electroencephalographic (EEG) monitoring for the detection of cerebral ischemia by comparing EEG with simultaneous mental status evaluation (MSE) during carotid endarterectomy in awake patients., Methods: Between 1994 and 1997, 208 consecutive carotid endarterectomies were prospectively evaluated for cerebral function during surgery with simultaneous MSE and EEG monitoring. Regional anesthesia (RA), which consisted of superficial cervical block, was chosen preferentially in 75% of the cases, with general anesthesia (GA) reserved for the patients who did not fulfill the criteria for RA. When available, 8-channel EEG monitoring was performed (59% with RA and 55% with GA)., Results: The EEG was a reliable predictor in comparison with MSE in most but not all cases of cerebral ischemia. Significant neurologic changes were noted using MSE in 4 of 89 patients (4.5%) that were not detected using EEG (false negative results). Conversely, 6 of 89 cases (6.7%) showed unilateral slowing without associated changes in MSE (false positive results). For the awake patients, 21 of 150 cases (14%) showed MSE changes that required a shunt. By contrast, 9 of 32 GA cases (28%) showed EEG changes that would have led to shunting (P = NS). In the RA group, there were no strokes versus 3 of 58 cases (5.2%) with strokes in the GA group. Two of 150 cases (0.1%) had transient ischemic attacks in the RA group. There was 1 myocardial infarction in the GA group; no deaths occurred in this series., Conclusion: EEG monitoring yielded a significant number of false positive (6.7%) and false negative (4.5%) results in the detection of neurologic deficits when compared with MSE in the awake patients. In this series, the preferential use of RA resulted in less shunt use and was possibly associated with a lower stroke rate.

Objectives: The aim of the study was to evaluate cerebrospinal fluid (CSF) findings in tuberculous meningitis (TBM) and correlate it with severity, radiological features, and outcome of TBM. Materials and Methods: In a retrospective study, data from admitted TBM patients were analyzed, and findings of CSF examinations were recorded. The CSF was categorized as typical (protein 50-500 mg/dL, cells 50-500/mm³, and glucose 50% or lower of blood sugar); those above and below these values were categorized as increased or decreased, respectively. The CSF findings were correlated with stage of TBM, and 3-month outcome and radiological features. Paradoxical response was also noted. Results: There were 111 patients with TBM (definite 34, highly probable 77). On admission, 20 patients were in Stage I, 63 in Stage II, and 28 in Stage III TBM. CSF cells were in typical range in 73, low in 27 and increased in 11 patients. Protein was in typical range in 92 patients decreased in 11 patients and increased in eight patients. Sugar was normal in 41 and reduced in 70 patients. CSF cells, glucose, and protein did not correlate with the severity of meningitis. Fifteen patients had normal initial magnetic resonance imaging (MRI). Tuberculomas were present in 53 patients, hydrocephalus in 43 patients, basal exudates in 43 patients, and infarction in 44 patients. Mixed findings were present in 65 patients. The MRI features did not correlate with CSF. Second CSF was available after a median duration of 26 (13-276) days in 50 patients. The CSF cells were decreased in 20 and increased in 30 patients, protein increased in 30 and sugars decreased in 16 patients. Paradoxical worsening occurred in 27 patients. Fifty-one patients recovered completely, 41 partially, 15 had poor, three patients were lost to follow-up, and one died. CSF parameters did not correlate with 3-month outcome or paradoxical worsening. CSF parameters do not differ significantly between baseline and 1 month CSF, but cells and lymphocytes changed significantly between 1st month and 3rd month CSF. Conclusion: Typical CSF findings were present in 66% and did not correlate severity of TBM, radiological features paradoxical worsening or 3-month outcome. CSF cell count decreased within 3 months of treatment. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to investigate the sequence-dependent anticancer effects of combined treatment with sorafenib (Sora), a Food and Drug Administration-approved multikinase inhibitor drug, and plant-derived phytochemicals (PPCs) on human colorectal cancer (CRC) cell growth, and proteins associated with the control of cell cycle and apoptosis. Methods: The cytotoxic effects of 14 PPCs on CRL1554 fibroblast cells were determined using an MTT assay. Moreover, the cytotoxicity of Sora, PPCs, and a combination of both on CRC cells were also investigated. Cell cycle analysis was performed using flow cytometry, and cell apoptosis was investigated using DNA fragmentation, Annexin V/propidium iodide double staining, and mitochondrial membrane potential analyses. The cell cycle- and apoptosis-associated protein expression levels were analysed using western blotting. Results: Based on their low levels of cytotoxicity in CRL1554 cells at ≤ 20%, curcumin, quercetin, kaempferol, and resveratrol were selected for use in subsequent experiments. The combined treatment of sora and PPCs caused levels of CRC cytotoxicity in a dose-, cell type-, and schedule-dependent manner. Moreover, the combined treatment of CRC cells arrested cell growth at the S and G2/M phases, induced apoptotic cell death, caused extensive mitochondrial membrane damage, and altered the expression of the cell cycle and apoptotic proteins. Conclusions: Results of the present study highlighted a difference in the level of sora efficacy in CRC cells when combined with PPCs. Further in vivo and clinical studies using the combined treatment of sora and PPCs are required to determine their potential as a novel therapeutic strategy for CRCs. [ABSTRACT FROM AUTHOR]

Background: Stroke is common in tuberculous meningitis (TBM), and aspirin has been shown to reduce mortality. A combination of aspirin and corticosteroid may be more useful in this condition.Aim: To evaluate the effect of aspirin and corticosteroid adjunctive therapy alone or in combination in determining the outcome of TBM.Materials and Methods: One hundred and fifty-three patients with TBM were evaluated from a prospectively maintained registry. The diagnosis of TBM was based on the clinical, magnetic resonance imaging (MRI)/computed tomography (CT), and cerebrospinal fluid criteria. The baseline clinical, laboratory, and radiological findings were noted. All patients received the standard 4-drug antituberculous (rifampicin, isoniazid, pyrazinamide, and ethambutol) treatment. Group I patients received in addition, aspirin, in the dose of 150 mg daily; group II patients received aspirin 150 mg plus prednisolone 40 mg daily; and, group III patients received none of these adjunctive therapies. The outcome at 3 months was defined in terms of death or functional disability.Results: Group I had 44, group II had 50, and group III had 41 patients. The baseline characteristics of all these patients were similar, except in group II, where patients had more severe meningitis and focal deficits compared to the patients in group I and III. At 3 months, 32 (23%) patients died; 8 (18.2%) in group I, 9 (18%) in group II, and 14 (34.1%) in group III. There was insignificant survival benefit in group II (hazard ratio [HR], 1.55; 95% confidence interval (CI), 0.96-26.49; P = 0.07). The three-month functional outcome and side effects were not significantly different in the three groups.Conclusion: Aspirin with corticosteroid adjunctive treatment seems to be beneficial in reducing mortality in TBM. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a systemic autoimmune disease whose major characteristics persistent joint inflammation that results in joint destruction and failure of the function. Collagen-induced arthritis (CIA) rat is an autoimmune disease model and in many ways shares features with RA. The CIA is associated with systemic manifestations, including alterations in the metabolism. Nuclear magnetic resonance (NMR) spectroscopy-based metabolomics has been successfully applied to the perchloric acid extract of the joint tissue of CIA rat and control rat for the analysis of aqueous metabolites. GPC (Glycerophosphocholine), carnitine, acetate, and creatinine were important discriminators of CIA rats as compared to control rats. Level of lactate (significance; p = 0.004), alanine (p = 0.025), BCA (Branched-chain amino acids) (p = 0.006) and creatinine (p = 0.023) was significantly higher in CIA rats as compared to control rats. Choline (p = 0.038) and GPC (p = 0.009) were significantly reduced in CIA rats as compared to control rats. Choline to GPC correlation was good and negative (Pearson correlation = -0.63) for CIA rats as well as for control rats (Pearson correlation = -0.79). All these analyses collectively considered as metabolic fingerprinting of the joint tissue of CIA rat as compared to control rat. The metabolic fingerprinting of joint tissue of CIA rats was different as compared to control rats. The metabolic fingerprinting reflects inflammatory disease activity in CIA rats with synovitis, demonstrating that underlying inflammatory process drives significant changes in metabolism that can be measured in the joint tissue. Therefore, the outcome of this study may be helpful for understanding the mechanism of metabolic processes in RA. This may be also helpful for the development of advanced diagnostic methods and therapy for RA. [ABSTRACT FROM AUTHOR]

Restructured meat products are popular among consumers, because of its resemblance with intact cuts with low cost. Different vegetative extenders in meat products has been incorporated to increase its product attributes such as yield, juiciness, slicability and added functionality with cost reduction. Present study was conducted to develop restructured chicken meat blocks (RCMB) extended with different combination of vegetative extenders. The extenders viz. lentil flour, sorghum flour, potato and water chestnut flour were mixed in different combination to yield three types of blends viz: A, B and C, to be used as replacer of the lean meat at 15 % level in prestandardized restructured meat block formulation. Both control and extended RCMB were evaluated for physico-chemical properties such as cooking yield, pH, moisture, protein, fat, moisture protein ratio, ash, shear force value and sensory attributes. Cooking yield and ash percentages was significantly higher ( P < 0.05) and protein percentage was significantly lower ( P < 0.05) than control for all the treatment products. Shear force value of product with extender blend C was significantly higher ( P < 0.05) than control. General appearance and flavour score for all three treatment products were significantly lower ( P < 0.05) than control but overall acceptability score for blend C was quite comparable to control. On the basis of physico-chemical properties and sensory attributes, the most acceptable combination of extenders was found to be blend C. The product with extender blend C was further assessed for texture profile analysis and shelf life for 15 days at refrigeration temperature (4 ± 1 °C). Texture profile analysis revealed that treated RCMB had significantly lower ( P < 0.05) adhesiveness value than control but hardness, springiness, cohesiveness, gumminess and chewiness values were comparable to control. TBARS values for test product as well as control almost increased significantly ( P < 0.05) throughout the storage period. Counts for mesophilic, psychrotrophic did not exceed log 3.12 and 2.93 cfu/g, log 2.43 and 2.65 cfu/g, for control and test RCMB, respectively. In spite of decrease in sensory scores with time of storage for both control and test RCMB, the scores was rated above good throughout storage period and it was concluded that RCMB were acceptable for at least 15 days in cold storage (4 ± 1 °C) under aerobic conditions in polyethylene bags. [ABSTRACT FROM AUTHOR]

Brain derived neurotrophic factor (BDNF) has been known to play an important role in various mental disorders or diseases such as Alzheimer's disease (AD). The aim of our study was to assess whether BDNF promoter methylation in peripheral blood was able to predict the risk of AD. A total of 44 AD patients and 62 age- and gender-matched controls were recruited in the current case-control study. Using the bisulphite pyrosequencing technology, we evaluated four CpG sites in the promoter of the BDNF. Our results showed that BDNF methylation was significantly higher in AD cases than in the controls (CpG1: p = 10.021; CpG2: p = 0.002; CpG3: p = 0.007; CpG4: p = 0.005; average methylation: p = 0.004). In addition, BDNF promoter methylation was shown to be significantly correlated with the levels of alkaline phosphatase (ALP), glucose, Lp(a), ApoE and ApoA in males (ALP: r = −0.308, p = 0.042; glucose: r = −0.383, p = 0.010; Lp(a): r = 0.333, p = 0.027; ApoE: r = −0.345, p = 0.032;), ApoA levels in females (r = 0.362, p = 0.033), and C Reactive Protein (CRP) levels in both genders (males: r = −0.373, p = 0.016; females: r = −0.399, p = 0.021). Our work suggested that peripheral BDNF promoter methylation might be a diagnostic marker of AD risk, although its underlying function remains to be elaborated in the future. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Cardiovascular Surgery is the property of Sociedade Brasileira de Cirurgia Cardiovascular and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study was conducted to evaluate the utilization of skin in the preparation of meat balls. The meat balls were prepared by incorporating skin at different levels viz. 25%, 50%, 75% and 100% replacing lean meat in the formulation. The meat balls were further enrobed to see the effect of coating on the quality characteristics of meat balls. Parameters namely emulsion stability, cooking yield, proximate composition and sensory parameters of meat balls decreased significantly ( P < 0.05) with the increasing skin level. Based on various sensory parameters, meat balls containing 50% skin were optimized as best among coated as well as non-coated meat balls. Both coated as well as control meat balls were aerobically packaged in low density polyethylene (LDPE) pouches and were analyzed at a regular interval of 0, 7 and 14 days for various quality parameters during refrigerated storage at 4±1°C. TBARS value, total plate count and psychrophilic count increased significantly ( P < 0.05) whereas the scores for various sensory attributes decreased significantly ( P < 0.05) during storage. Coliforms were not detected throughout the period of storage. Thus, meat balls utilizing chicken skin were stored for a period of 14 days at refrigerated temperature (4±1°C) with changes in the quality parameters under acceptable limits. [ABSTRACT FROM AUTHOR]

Storage quality of chicken seekh kababs extended with different legumes at optimum level viz. 15% cowpea, 15% green gram and 10% black bean were assessed in terms of physico-chemical, proximate, microbiological and sensory properties under aerobic packaging conditions at refrigeration temperature (4 ± 1°C). The chicken seekh kababs were prepared from spent hens meat by low power microwave method and extended with optimum level of different legume (hydrated 1:1 w/w) pastes replacing lean meat in the formulation. The chicken seekh kababs formulated without any extender served as control and were compared with extended chicken seekh kababs. The kababs were aerobically packaged in low density polyethylene (LDPE) pouches and were analyzed at a regular interval of 0, 7, 14 and 21 days during refrigerated storage at 4 ± 1°C. The results indicated a significant ( p < 0.05) decrease in moisture content of the kababs whereas the fat and ash content increased significantly ( p < 0.05) over the period of storage. Protein percentage showed a non-significant ( p > 0.05) increase and almost all the sensory attributes showed a declining trend with advancement of storage. Total plate count and psychrophillic count also increased significantly ( p < 0.05) whereas coliforms were not detected throughout the period of storage. The products were acceptable throughout the storage period. [ABSTRACT FROM AUTHOR]

Background: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the longterm outcome of the disease is unknown. Methods: Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability. Results: 545 patients were randomised to receive either dexamethasone (274 patients) or placebo (271 patients). 50 patients (9.2%) were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07) but five-year survival rates were similar (0.54 versus 0.51, p = 0.51) in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36). The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7%) and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32). Conclusions: Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM. [ABSTRACT FROM AUTHOR]

study was planned to develop restructured chicken product by incorporating optimum level of gizzard and fat and evaluate their quality attributes under refrigerated storage condition (4 ± 10 C). Incorporation of gizzard did not show any change in pH, but cooking yield reduced significantly ( P < 0.05) at 40% level. There was a significant ( P < 0.05) decrease in fat content and increase in protein and ash content with increase in the level of gizzard in the formulation. Significant ( P < 0.05) improvement in the sensory attributes of chicken blocks was noticed by addition of gizzard. Incorporation of fat resulted in no change in pH, significant ( P < 0.05) reduction in cooking yield, moisture and protein content and increase in fat and total ash content. Products incorporated with fat rated better than control for various sensory attributes. Significant ( P < 0.05) increase in thiobarbituric acid reactive substance (TBARS), tyrosine value, stand plate count and psychrophilic count was observed during refrigerated storage (4 ± 10 C) in both control (no gizzard and fat) and test chicken blocks incorporated with gizzard and fat. The restructured chicken products were found acceptable up to 10 days under refrigerated storage condition (4 ± 10 C). [ABSTRACT FROM AUTHOR]

Diverticular hemorrhage is the most common cause of lower gastrointestinal bleeding in Westernized cultures. Fortunately, the majority of diverticular bleeds will spontaneously resolve; however, 20% of patients will require therapeutic interventions to obtain hemostasis. The diagnostic and therapeutic options for the management of diverticular hemorrhage are discussed. [ABSTRACT FROM AUTHOR]

The aim of the study was to estimate the functional contribution of the arterial inflow pathways to the pelvic circulation during walking in patients with stage 2 lower extremity arterial disease. Transcutaneous oxygen pressure (PtcO2) changes during exercise can be used to estimate the severity of regional blood flow impairment while walking. Seventy patients with stable lower limb claudication were studied using a multivariate linear regression model. The relationship between exercise-induced buttock PtcO2 changes, the ipsilateral calf PtcO2 changes, and the arterial diameters of the pelvic arteriographic pathways were analyzed. The ipsilateral hypogastric and lumbar pathway, as well as the ipsilateral calf PtcO2 changes, were the only variables significantly related to buttock PtcO2 changes (r = 0.47; P < 0.001). Their normalized respective contribution to the regressive model was 39%, 19%, and 18%. None of the contralateral hypogastric, mesenteric, and sacral pathways or pathways stemming from the external iliac artery showed significant correlation to buttock PtcO2 changes. The ipsilateral hypogastric and ipsilateral lumbar pathways are the major pathways responsible for the functional buttock blood flow supply during walking. The role of contralateral hypogastric, inferior mesenteric, and median sacral pathways and arteries distal to the internal iliac trunk is negligible in the normal or compensatory blood flow supply. Distal PtcO2 decrease at exercise aggravates proximal PtcO2 decrease, possibly through the occurrence of a "steal phenomenon" of distal over proximal circulation during walking. [ABSTRACT FROM AUTHOR]

Several recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding.The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower gastrointestinal bleeding, based on this literature review.Publications pertaining to lower gastrointestinal bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed.Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower gastrointestinal bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower gastrointestinal bleeding after localization by either colonoscopy or angiography.There is limited high-quality research in the area of lower gastrointestinal bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper gastrointestinal bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

The ability of gene transfer with the poreforming subunit of the human maxi-K channel (hSlo) to ameliorate the decline in erectile capacity commensurate with 12-24 wk of streptozotocin (STZ)-diabetes was examined in 181 Fischer-344 rats. A 2-mo period of STZ-diabetes was induced before gene transfer, and erectile capacity was evaluated by measuring the intracavernous pressure response (ICP) to cavernous nerve (CN) stimulation (ranging from 0.5 to 10 mA). In the first series of experiments, ANOVA revealed increased CN-stimulated ICP responses at 1 and 2 mo postinjection of 100 µg pcDNA-hSlo compared with control values. A second series of experiments further examined the dose dependence and duration of gene transfer. The ICP response to submaximal (0.5 mA) and maximal (10 mA) nerve stimulation was evaluated 3 or 4 mo postinjection of a single dose of pcDNA-hSlo ranging from 10 to 1,000 µg. ANOVA again revealed that hSlo overexpression was associated with increased CN-stimulated ICP responses compared with responses in corresponding control animals. Histological studies revealed no immune response to the presence of hSlo. PCR analysis documented that expression of both plasmid and transcript were largely confined to the corporal tissue. In the third series of pharmacological experiments, hSlo gene transfer in vivo was associated with iberiotoxin-sensitive relaxation responses to sodium nitroprusside in corporal tissue strips in vitro. The latter data indicate that gene transfer produces functional maxi-K channels that participate in the modulation of corporal smooth muscle cell tone. Taken together, these observations suggest a fundamental diabetes-related change in corporal myocyte maxi-K channel regulation, expression, or function that may be corrected by expression of recombinant hSlo. [ABSTRACT FROM AUTHOR]

Aims to guide the treatment of tuberculosis in settings where mycobacterial cultures, drug susceptibility testing, radiographic facilities and second-line drugs are routinely available. Overall goals for treatment of tuberculosis; Discussion on the organization and supervision of tuberculosis treatment; Recommended treatment regimens; Identification and management of patients at increased risk of treatment failure and relapse.

Background: Diabetes Mellitus is a chronic metabolic disorder which may lead to various complications, the important being dyslipidemia leading to Coronary Heart Disorders (CHD), the major cause for morbidity and mortality in diabetic patients. Diabetes Mellitus could be treated by nutritional therapy/drug therapy and others. But the drug therapy would have its own limitations and side effects. To overcome from this an herbal extract is recommended, such as Diallyl Disulphide (DADS) a principle compound of Garlic oil. Aim: To assess the hypolipidemic effect of Diallyl Disulphide (DADS) in alloxan induced diabetic rats. Materials and Methods: Healthy adult wistar strain male albino rats weighing around 100-150 grams were randomly selected from the animal house at BLDE University’s Shri B.M.Patil Medical College, Hospital and Research Centre, Bijapur, India. Diabetes was induced using alloxan and was treated with DADS. After a stipulated time the rats were anesthetised and sacrificed to collect the blood and liver tissue. Various Lipid parameters, HMG CoA Reductase, Fecal bile acids were estimated in the blood, feces and homogenised liver tissue using standard procedures. Statiscal Analysis: One-way ANOVA followed by post-hoc t-test is done. Result: There was significant decrease in the blood and liver tissue lipid parameters of DADS treated alloxan induced diabetic rats when compared to the alloxan induced diabetic rats. Conclusion: From this study it can be concluded that the DADS a principle compound of garlic, definitely has the hypolipidemic effect in diabetic rats, which is reducing the morbidity in diabetic cases due to dyslipidemia without the adverse effects. [ABSTRACT FROM AUTHOR]

Copyright of Langenbeck's Archives of Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The investigation and treatment of 131 patients with 'obscure' gastrointestinal bleeding has been reviewed. One hundred and six patients were assessed electively for recurrent haemorrhage, 25 presented as emergencies. The major presenting feature was melaena (55 patients), anaemia (35), rectal bleeding (34), haematemesis (six) and ileostomy bleeding (one). The lesions responsible for haemorrhage were colonic angiodysplasia (52 patients), small bowel vascular anomalies (16), Meckel's diverticula (nine), small bowel smooth muscle tumours (seven), gastric vascular anomalies (four), chronic pancreatitis (three), colonic diverticular disease (three) and 16 other miscellaneous lesions. No lesion was found in 21 cases. Lesions were first shown by visceral angiography (69 patients), at laparotomy (23), on endoscopy (11), on gastrointestinal contrast radiological studies (four), and at ERCP (three). Lesions which were undetectable at operation increased markedly with age (p less than 0.0001). Expert visceral angiography is strongly recommended before surgery in patients over 45 years of age and after laparotomy when no cause has been found. Exploratory laparotomy is recommended at an early stage for younger patients, and for older patients after non-diagnostic angiography. [ABSTRACT FROM PUBLISHER]

An extensive, although largely forgotten, literature addresses the utility of adjunctive corticosteroid therapy in the management of tuberculosis. Corticosteroid therapy probably improves neurological outcomes of, and decreases mortality due to, tuberculous meningitis of moderate severity. Although therapy for tuberculous pericarditis is simplified (with less need for operative intervention) by adjunctive corticosteroid administration and there are fewer deaths, the incidence of subsequent constriction is not changed. The signs and symptoms of typical reactivation tuberculous pneumonia, tuberculous pleurisy, and probably primary tuberculous disease (with lymphadenopathy) seem to decrease rapidly with corticosteroid therapy, although no differences in final outcomes have been observed. Corticosteroid regimens used in most studies varied greatly in duration and dosage and generally caused significant side effects. Corticosteroids do not appear to diminish the efficacy of adequate antimycobacterial therapy. Adjunctive corticosteroid therapy appears to offer significant short-term but (other than for tuberculous meningitis and effusive pericarditis) minimal long-term benefit for patients with tuberculosis. [ABSTRACT FROM PUBLISHER]

The cases of 48 adult patients with tuberculous meningitis who were admitted to an intensive care unit (ICU) between 1982 and 1993 were reviewed. An underlying disease was present in 24 patients (50%), including 10 with human immunodeficiency virus infection. Forty-seven patients were referred to the ICU because of neurological deterioration; 22 were comatose at admission. Forty-six patients received antituberculous treatment; 36 required mechanical ventilatory support, and 16 underwent neurosurgery. Thirty-one patients died within 4 months after admission, and the remaining 17 were alive at a I-year follow-up. Univariate prognostic analysis selected three variables, all assessed at admission, associated with outcome: time to onset of treatment of ⩾3 days (P = .003), coma (P = .006), and simplified acute physiology score of >11 (P = .03). Thus, the outcome of tuberculous meningitis is mainly determined by the clinical stage at admission and the delay in starting treatment. These findings underscore the need to initiate early therapy as soon as the diagnosis of tuberculous meningitis is suspected. [ABSTRACT FROM PUBLISHER]

Intracranial tuberculomas can sometimes develop or increase in size despite administration of appropriate therapy. We report the case of a child whose intracranial tuberculomas paradoxically enlarged while therapy was being administered, and we review 23 other cases in which tuberculomas increased in size or number and 17 cases in which tuberculomas appeared during therapy. These phenomena generally occurred within 3 months of the start of therapy. All but four patients had neurological deterioration that prompted obtaining a repeated computed tomographic scan. One patient died, about one-fourth of patients had residual neurological symptoms, and less than one-third of the patients required surgical intervention. Most patients received a 12–18 month course of antituberculous therapy. Adjunctive therapy with steroids appears to diminish neurological symptoms and may improve outcome. Paradoxical enlargement or development of tuberculomas usually does not represent failure of antituberculous therapy; the most likely explanation for these phenomena is an interaction between the host's immune response and the direct effects of mycobacterial products. [ABSTRACT FROM PUBLISHER]

Tuberculous meningitis remains an important illness that can be difficult to diagnose in a timely fashion and carries significant morbidity. We present a retrospective review of the cases of tuberculous meningitis diagnosed and treated at a single institution. Fifty-eight cases were identified and stratified according to stage of disease at presentation. Four patients (7%) died; three (5%) developed severe neurological sequelae. Poor outcomes were largely confined to cases presenting in an advanced stage and at the extremes of age. Corticosteroids were administered to 56 patients and may have contributed to the comparatively good outcome in these cases. [ABSTRACT FROM PUBLISHER]

Eighteen patients with neurobrucellosis are described. Eleven patients had meningitis alone or with papilledema, optic neuropathy, or radiculopathy. Four patients had meningovascular complications manifested by stroke or intracerebral hemorrhage from a presumed mycotic aneurysm. Two patients had parenchymatous dysfunction, including a child who had a cerebellar syndrome without evidence of direct infection of the central nervous system. One patient presented with polyradiculopathy. Twelve of 16 patients had pleocytosis; none had cell counts >419 × 106/L. Most patients had hypoglycorrhachia and elevated levels of protein in the cerebrospinal fluid (CSF). Results of an agglutination test for Brucella in serum were positive for all patients. Six of 16 patients had positive blood cultures, and four of 14 had positive CSF cultures. Antimicrobial treatment included concurrent administration of two or more of the following drugs: streptomycin, tetracycline (or doxycycline), rifampin, and trimethoprim-sulfamethoxazole. Eleven patients fully recovered. Five patients were left with residual neurological deficits. Four of these patients suffered permanent hearing loss, one of whom also had significant loss of vision in one eye. One elderly senile patient with meningovascular brucellosis remained in a vegetative state despite receiving antimicrobial therapy for 6 months. One patient died due to rupture of a mycotic aneurysm within 7 days of initiation of therapy. One other patient was treated after sustaining an intracerebral hemorrhage, but this patient's condition was diagnosed only after discharge. [ABSTRACT FROM PUBLISHER]

Low fat pork sausages were prepared with minced pork, spices, salt and tetra sodium pyrophosphate. Milk co-precipitate (MCP) obtained from skim milk was added at 0-2% levels as fat replacer and a suitable formulation was arrived at by evaluating physico-chemical and sensory parameters. The formulation with 1% MCP had higher flavour, juiciness and overall acceptability scores than others. The sausage with 1% MCP also had better emulsion stability, lower fat content, better cooking yield and lower cholesterol content compared to control. [ABSTRACT FROM AUTHOR]