Inflammatory responses to platelet-activating factor in human skin

Since its discovery over 20 years ago, platelet- activating factor (PAF) has been the subject of intensive research. In particular, its role in pathophysiology has provoked as much controversy as research interest. The pharmacological profile and ubiquity of PAF have made it a candidate for involvement in a number of inflammatory processes. No clear evidence has been demonstrated however to establish a role in disease in man, although clinical caution about its potential toxic effects has limited the number of available experimental human models. One particular tissue which lends itself to examination of the effects of PAF is the skin. A series of studies has been undertaken to define accurately the characteristics of the acute responses to PAF in human skin and to study the role of histamine in these responses. By way of comparison, the acute responses to other inflammatory mediators (PGE2, substance P, and CGRP) has also been investigated. The effects of histamine antagonism, and depletion on the PAF responses have been examined together with evaluation of local histamine release from the skin after PAF treatment. Additionally, a comparison of the PAF-induced responses in atopic and non-atopic subjects has been undertaken. As a consequence of these studies, quantitative methods have been validated as sensitive and reproducible techniques for evaluating hyperalgesia and histamine-type flare and weal responses in the skin. Using the hyperalgesia model, intradermally injected PAF failed to cause hyperalgesia in the skin. Conversely intradermal PGE2 was shown to provoke dose- related hyperalgesia, which was associated with spreading erythema, lasting for 2-3 hours. Apart from at high doses where the effect was marginal when compared with PGE2, the neuropeptides substance P and CGRP also failed to produce hyperalgesia in the skin. Using the flare and weal model, PAF, substance P and PGE2 were associated with dose-related histamine-like weal and flare responses, although the PGE2 responses were considerably weaker. CGRP did not produce these responses and instead caused a local intense erythema, similar to the later effect of PGE2. Evaluation of the effects of H1-antagonism and histamine depletion, and the quantification of local histamine release have demonstrated that the PAF responses in the skin are largely mediated by histamine. Indomethacin was also found to have a small inhibitory effect on the PAF responses implicating secondary prostaglandin release. The acute inflammatory responses to intradermal PAF have been shown to be similar in atopic subjects compared with non-atopics using the techniques described above. Baseline plasma histamine, however, was found to be higher in atopic subjects

Lill-mużika ta’ Chopin

Ġabra ta’ poeżiji u proża li tinkludi: Talba lil Ġesù Bambin ta’ Ivo Muscat Azzopardi – Il-kewkba tal-Milied ta’ Ġużè Galea – Il-Milied it-tajjeb! ta’ G. Borg Pantalleresco – Lill-mużika ta’ Chopin ta’ John Sciberras.N/

Qalb ommu

Ġabra ta’ poeżiji u proża li tinkludi: Il-għanja tal-ħamsa u tletin sena ta’ Patri Mattew – Meta lbist il-ġlekk ta’ ħija ta’ George Vella – Tliet poeżiji qosra ta’ John Sciberras – Għada jisbaħ xorta waħda – Ġejjin id-dgħajjes – Il-kotra u ż-żmien – Ferħa bla temma ta’ A. Guillaumier – Qalb ommu ta’ Jos. M. Manara.N/

Local survival outcomes in metastatic renal cell carcinoma

A quarter of patients who develop renal cell carcinoma will have metastatic disease at presentation. The role of cytoreductive surgery in these patients is a topic of debate. The aim of this study was to analyse survival outcomes of patients treated in Malta who did and did not receive a nephrectomy. Data was gathered retrospectively from the Malta Cancer Registry and Mortality Data at the Department of Health Information, records of multidisciplinary team meetings held within the urology department at Mater Dei Hospital, hospital imaging and patient records. Data gathered included: patient demographics, date of diagnosis, TNM staging, tumour histology, Fuhrman grade, time to treatment and modality of treatment. Exclusions included: • Localized disease relapsing after surgery • Non-renal cell histological subtypes • Presence of metastasis at diagnosis not certain • Concomitant primary tumours 77 patients diagnosed over 5 years between 04.03.2005 and 13.2.2009 were included. The age at presentation ranged from 30 to 88 years, with a median age of 67 years. 11 were incidental findings and 47 were symptomatic. The most prevalent symptoms were abdominal pain and gross haematuria. Five-year cancer specific survival in patients who received a nephrectomy was significantly better at 65%, compared to patients who did not undergo surgery (32%) P value <0.05, CI 95%. These results where compared favourably with SEER data outcomespeer-reviewe

Sancta Maria

Ġabra ta’ poeżiji u proża li tinkludi: Bidla ta’ John Sciberras – Mysterium conjunctionis ta’ V. J. Galea – Lill-bilbla ta’ Dwardu Zammit – Sancta Maria ta’ Carmel Gatt.peer-reviewe

Mid-djarju tat-tarzna

Ġabra ta’ poeżiji u proża li tinkludi: Destin ta’ Charles Coleiro – Uċuħ – Xewqat – Għar Dalam ta’ Ġorġ Borg – Poeżija ta’ Ġorġ Borg – Wirt battal ta’ P. Sciberras – Naf tifel ta’ Ġorġ Borg – Mħabba sewda – Durham 11.5.96 ta’ Joe Friggieri – Data base ta’ P. Sciberras – Ipokrezija ta’ John Buttigieg – Mid-djarju tat-tarzna ta’ P. Sciberras.peer-reviewe

Immorru....

Ġabra ta’ poeżiji u proża li tinkludi: Doqqu ja qniepen ta’ C. Cassar – Xenqet iż-żgħożija ta’ Dun Frans Camilleri – Inżul ix-xemx tat-2 ta’ Mejju 1952 ta’ John Sciberras – Siġġijiet ta’ Vincent Caruana – Immorru.... ta’ Vincent Ungaro.N/

Assessing referrals to urology outreach in cases of acute urinary retention

INTRODUCTION: Acute Urinary Retention (AUR) is the sudden and often painful inability to pass urine characterised by a palpable or percussible bladder. It constitutes 45% of all lower urinary tract consultations and is encountered in different medical specialties. A local guideline was set up to delineate the management of acute urinary retention (AUR) in July 2018. It describes the clinical features, investigations and treatment required according to the severity of the episode. The aim of this audit is to assess the demographics of patients making use of the Urology Outreach Unit (cases of AUR), and trends in investigations done, treatment chosen and outcomes on such patients.METHOD: All patients older than 16 years of age who presented with AUR between March 2018 and September 2018 were included. Data was obtained from Urology TWOC forms and corroborated with the hospital online system.RESULTS: 89 (37.6%) of the referrals were done from Accident and Emergency Department (A&E), and 86 (36.3%) were referred from Urology firms. Urinalysis and Microscopy was sent in 45.1% of cases. Renal profile (serum) was taken in 70.5% of cases. The most commonly used catheter type used was silicone (89.6%). Catheter size of 16F was used in 83.8% of the cases. The average days spent with the catheter in situ was 11.7 days. The average attempts at TWOC was 1.1 times (max of 3). 83.5% of patients were then advised to continue their medical therapy with appropriate follow up following a successful TWOC. The rest were scheduled for a repeat TWOC (13.1%), fitted with a long-term catheter (1.69%), advised regarding self-intermittent catheterisation (1.27%), or referred for TURP (0.42%).CONCLUSION: This audit shows variable compliance to clinical guidelines. An active role of the clinician in the management and treatment of AUR might improve treatment and reduce the risk of further episodes of AUR.peer-reviewe

Epigrammi

Ġabra ta’ poeżiji u proża li tinkludi: Bidla ta’ Val. V. Barbara – Is-sardinella ta’ George Zammit – Għasfur ta’ Ariel Fiorini – Il-qawsalla ta’ l-imħabba ta’ Vincent Caruana – Lil omm in-niket ta’ Pawlu Aquilina – X’jiswew? ta’ John Sciberras – Epigrammi ta’ John Sciberras.N/