Transdiaphragmatic pericardial window: a new approach

A new transdiaphragmatic laparoscope technique is proposed which provides a large window for drainage that is rapid, safe and eliminates the need for one lung ventilation, drainage tubes, and painful incisions.     

Treatment of malignant gliomas: a new approach

The etiology of seizures associated with cocaine use is unclear. Because cocaine seizures are relatively uncommon, they should be diagnosed by exclusion and a neurological workup to rule out central nervous system (CNS) catastrophe should be made. This report describes the clinical findings, treatment, and blood cocaine and metabolite concentrations in a patient who, on two separate occasions, had seizures associated with crack cocaine ingestion. Approximately 1 hour after the ingestion incidents, the patient had multiple, generalized seizures that abated spontaneously. His workup for CNS bleeding, infection, and trauma was negative. Cocaine concentrations on the first incident peaked at 2.48 mg/L and on the second incident peaked at 3.9 mg/L. Other clinical findings included tachycardia, hypertension, diaphoresis, and disorientation. Blood cocaine and metabolite analysis revealed extremely high concentrations. Other than the incident of seizures and transient cardiovascular aberrations, these high concentrations were tolerated by the patient without further sequelae. A review of cocaine-induced seizures and treatment is included.     

Type 2 fractures of the distal clavicle: a new surgical technique

A rare case of frontal sinus carcinoma is reported. The patient developed early recurrence following surgery, and was managed by accelerated hyperfractionated radiation therapy and concurrent cisplatinum-based systemic chemotherapy. The patient has remained disease-free for 30 months following the end of treatment.     

Surgical treatment of Peyronie's disease: a new approach

We treated 12 patients with intractable Peyronie's disease with a new approach based on simple incision of the fibrotic plaque(s) and stenting of the corpora with penile implants. Infection in 1 case necessitated removal of the prostheses, while the remaining 11 patients had satisfactory functional and anatomical results. The procedure is indicated for patients with 1) Peyronie's disease and impotency, 2) normal potency and extensive disease and 3) normal potency and localized disease in selective cases. In this series insertion of the penile prostheses did not change sexual prowess in previously potent patients.     

The therapy of peripheral obstructive arteriopathies: rational bases

The authors underline the relations among the anatomical lesion progression, the appearance of the clinical signs (claudicatio) of tissue ischaemia and the thromboembolic event in vascular districts like myocardium and brain, at high morbidity and mortality risk. They widely state the pathogenetic mechanism of the atherosclerotic arterial disease and the compensative mechanisms that may prevent the ischaemic effects of the vascular obstruction. It has been considered the importance of the hemorheologic changes and their influence on the development of the ischaemic syndrome. The therapeutic choice in relation to physiopathologic and hemorheologic events in the peripheral obstructive arterial disease is considered.     

MULTIFIT: a new approach to risk factor modification

The MULTIFIT system provides an infrastructure for the management of coronary risk factors and associated conditions. It is well integrated into standard medical practice, relying on existing personnel, facilities, and equipment. It integrates cognitive, executive, and organizational aspects of medical care delivery. It addresses an important national health goal: how to substitute relatively inexpensive preventive care for expensive palliative care for patients with established vascular disease.     

RigFit: a new approach to superimposing ligand molecules

If structural knowledge of a receptor under consideration is lacking, drug design approaches focus on similarity or dissimilarity analysis of putative ligands. In this context the mutual ligand superposition is of utmost importance. Methods that are rapid enough to facilitate interactive usage, that allow to process sets of conformers and that enable database screening are of special interest here. The ability to superpose molecular fragments instead of entire molecules has proven to be helpful too. The RIGFIT approach meets these requirements and has several additional advantages. In three distinct test applications, we evaluated how closely we can approximate the observed relative orientation for a set of known crystal structures, we employed RIGFIT as a fragment placement procedure, and we performed a fragment-based database screening. The run time of RIGFIT can be traded off against its accuracy. To be competitive in accuracy with another state-of-the-art alignment tool, with which we compare our method explicitly, computing times of about 6 s per superposition on a common day workstation are required. If longer run times can be afforded the accuracy increases significantly. RIGFIT is part of the flexible superposition software FLEXS which can be accessed on the WWW [http:/(/)cartan.gmd.de/FlexS].     

Multi-centre clinical respiratory research: a new approach?

BACKGROUND: Recruitment to clinical trials organised by the research committee of the British Thoracic Society (BTS) has declined. We suspected that this was due to increasing workloads for consultant physicians in the National Health Service (NHS). We investigated possible causes in study 1 and a possible solution in study 2. METHODS: Study 1--a questionnaire was sent to BTS members listing possible factors that might deter them from entering patients into trials. These were scored on a 0-5 scale. Study 2--we set up 13 panels of experts to cover all major fields of respiratory medicine. They were asked to design projects that would address the most important research questions that could be answered by multi-centre clinical trials. We sent 11 projects for scoring to consultant members of the BTS who were asked to score them on scientific merit and on their ability to contribute patients to the study. RESULTS: Study 1--of the 59% of consultants who responded, 77% said that competition with increasing demands on their time was the major reason for not participating. Study 2--40% of consultants returned project scores. Three projects were subsequently selected for grant application. CONCLUSIONS: Clinical research in the UK is under threat from increasing workloads on consultants. One solution to this problem is a national approach to commission major projects. The most important clinical research questions might then still be answered in the limited time available to consultants.     

Estimating a population in need of alcoholism services: a new approach

A new approach for estimating a population at risk of alcoholism and problem drinking is discussed. Its advantages include specification of planning-relevant social-demographic characteristics of a population at risk and the identification of a population base in terms of which alcoholism programs, services, and resources can be comparatively evaluated.     

Renal proliferative arteriopathies and associated glomerular changes: a light and electron microscopic study

This presentation reports the light and electron microscopic findings relating to the vascular and glomerular changes in the kidney in a series of 25 patients having malignant hypertension, the hemolytic-uremic syndrome, scleroderma, or toxemia of pregnancy. The pathologic changes were generally similar in each of the diseases studied, the changes being related more to the severity and duration of injury than to the specific disease. Vascular narrowing was due mainly to intimal thickening, and by light microscopy the lesions were categorized as onionskin, mucinous, or fibrous with or without associated elastosis. Intimal erythrocyte extravasation, fibrinoid necrosis, and luminal thrombosis were also seen. Electron microscopy provided additional morphologic information: Myointimal cells were found to be the cellular component in each type of intimal thickening; it was possible to distinguish collagen from large intimal accumulations of basement membrane material; mucinous intimal material was characterized ultrastructurally; and fibrinoid necrosis was identified as a lesion inconstantly associated with cellular necrosis and consisting mainly of fibrinoid material and small deposits of fibrin. It seems likely that there is a common pathogenesis for intimal thickening in a variety of diseases and that this involves endothelial cell damage and increased permeability, leakage of serum and erythrocytes into the intima, and a healing reaction of the vessel wall was developing from migration of smooth muscle cells into the intima with subsequent myointimal cell proliferation and fibrogenesis. A common glomerular change in all diseases studied was a striking accumulation of electron lucent material between the endothelium and the lamina densa of the basement membrane. This lesion was interpreted as a manifestation of acute ischemia.     

Nicotine replacement: a new approach to reducing tobacco-related harm

A case of transient abnormal myelopoiesis in a normal newborn without features of Down syndrome is described. The majority of bone marrow cells analysed belonged to a chromosomally abnormal clone with trisomy for chromosomes 18 and 21. Complex intrachromosomal rearrangements of one chromosome 21, demonstrated by fluorescence in situ hybridization using locus-specific probes, were found in a minor population of the clonal cells. These rearrangements involved loci previously shown to be rearranged in the leukaemic cells from patients with Down syndrome and leukaemia. However, the child's myeloproliferation resolved rapidly, with disappearance of the abnormal clone, and 3.5 years later she remains well.     

Ogilvie''s syndrome: a new approach to an old problem

The effect of glucose infusion on renal handling of purine bases and oxypurinol was examined in 6 normal subjects. Five hundred milliliters of 1.1 M glucose solution were administered intravenously in 1 h. Fractional clearances of uric acid, xanthine and oxypurinol were significantly increased during glucose infusion, but that of hypoxanthine was not changed, while a 1-hour infusion of 500 ml of 1.1 M mannitol had no effect on the fractional clearances of purine bases and oxypurinol. These data indicate that the effect of glucose infusion on the renal clearances of uric acid, xanthine and oxypurinol was not related to osmotic diuresis but induced by glycosuria and/or hyperglycemia. Accordingly, the glycosuria- and/or hyperglycemia-induced decrease in the biological half-life of oxypurinol must be considered in the administration of allopurinol to gouty patients with uncontrolled diabetes mellitus.     

CO2 laser inferior turbinectomy: a new surgical approach

Abnormally elevated activity of ornithine decarboxylase (ODC), with subsequent polyamine accumulation are intimately associated with the genesis, development and metastasis of cancer. Therefore, ODC antisense RNA was used to transfect human lung squmous carcinoma cell line LTEP-78. Compared with the parental cells, growth of the antisense transfected LTEP-78 cells arrested in G0/G1 phase and colony formation in soft agar and tumorigenicity in nude mice were significantly reduced. Nucleic acid hybridization demonstrated the expression of ODC antisense RNA and the content of ODC mRNA was markedly reduced. The results suggest that the reversion of malignant phenotypes of human lung squamous carcinoma cells is associated with the control of polyamine biosynthesis.     

Deep cognitive activation: a new approach to the unconscious

Deep cognitive activation occurs when a thought is so accessible as to have measurable effects on behavior or judgement, but is yet not consciously reportable. This state of mind has unique properties mimicking some characteristics of the psychoanalytic unconscious, but following theoretically from a consideration of processes of cognitive activation. The sources and consequences of deep cognitive activation are examined, with a view toward understanding how this state is implicated in the assessment, etiology, and treatment of psychopathology.     

Molecular beacons: a new approach for semiautomated mutation analysis

IDDM is a polygenic and autoimmune disorder in which subsets of white blood cells (WBCs) are engaged in the destruction of beta-cells of the pancreas. The mechanisms that account for the abnormal behavior of these cells in IDDM are not fully understood. By measuring the mean length of telomeres of WBCs from patients with IDDM, we tested the concept that telomeres might play a role in IDDM. We examined the lengths of the terminal restriction fragments (TRFs) of DNA of WBCs from 234 white men comprising 54 patients with IDDM, 74 patients with NIDDM, and 106 control subjects. When adjusted for age, the TRF length from WBCs of patients with IDDM was significantly shorter than that of nondiabetic control subjects (mean +/- SE: 8.6 +/- 0.1 vs. 9.2 +/- 0.1, P = 0.002). No significant difference was observed between the TRF length from WBCs of patients with NIDDM versus nondiabetic subjects. Neither the duration nor the complications of IDDM (i.e., nephropathy and hypertension) had an effect on the TRF length of WBCs from patients with IDDM. The shortened TRF length of WBCs of patients with IDDM likely reflects a marked reduction in the TRF length of subsets of WBCs that play a role in the pathogenesis of IDDM.     

Ready biodegradability test in seawater: a new methodological approach

To estimate the persistence of xenobiotic in the environment, a new ultimate mineralization approach for assessing ready biodegradability in seawater has been developed, based on the OECD 301 B guideline for freshwater. a few changes in the currently accepted procedure have been made to adapt the test to seawater. The assays, realized with seawater as test medium and inoculum, give high variability results of biodegradability. To lower this variability a synthetic marine medium joined to a highly concentrated inoculum from a marine aquarium filter have been used. The results reveal (i) a decrease of variability, together with an increase in degradation rate of the tested chemicals due to a better control of inoculum and test medium, and (ii) no difference in easy biodegradable compound (sodium benzoate) biodegradation rate when two marine aquarium inocula are tested. This study demonstrates that the ready biodegradability test developed on synthetic marine medium and inoculum from marine aquarium filter minimizes the effect of the sample location on the biodegradation results of compounds and allows classifying chemicals as a function of their biodegradability.