In situ hybridization for the detection of telomerase RNA in the progression from Barrett''s esophagus to esophageal adenocarcinoma

AIMS: To compare the value of the proximal flow convergence method and the jet area method for the determination of the severity of tricuspid regurgitation. METHODS AND RESULTS: The proximal isovelocity surface area radius and the jet area/length were measured in 71 consecutive patients with angiographically graded (grade 0/I-III) tricuspid regurgitation. Rank correlation coefficients with the angiographic grade were 0.71 (P < 0.001) for the proximal isovelocity surface area radius (aliasing border of 28 cm.s-1), 0.66 (P < 0.001) for the jet area, and 0.63 (P < 0.001) for the jet length. The proximal isovelocity surface area radius was significantly correlated with the jet area/length (correlation coefficients 0.82/0.77, P < 0.001). Correct differentiation between mild to moderate (grade I-II) and severe (grade III) tricuspid regurgitation was achieved in 62 of 71 patients (87%) by means of the proximal isovelocity surface area radius, in 61 of 71 (86%) by the jet area, and in 62 of 71 (87%) by the jet length. Grade III tricuspid regurgitation was not identified in five of 21 patients (24%) by means of the proximal isovelocity surface area radius, in six of 21 (29%) by the jet area, and in seven of 21 (33%) by the jet length. CONCLUSION: The flow convergence method and the jet area method are of similar value for the determination of the severity of tricuspid regurgitation. Both methods differentiated mild to moderate from severe tricuspid regurgitation in most patients. However, underestimation of severe tricuspid regurgitation in 20-30% of the cases represents a serious limitation of both methods.     

Research award winner: neurodevelopmental assessment of at-risk learners by school nurses and their tools of choice

Coronary artery bypass grafting is a well-established procedure. Less invasive procedures have been developed to provide bypass grafting without median sternotomy, cardiopulmonary bypass, or cross clamping. Using a small anterior thoracic incision, and occasionally with the aid of the thoracoscope, the minimally invasive direct coronary artery bypass graft (MIDCAB) procedure was developed. The MIDCAB procedure results in a decreased length of hospital stay, fewer postoperative complications, and a more rapid recovery for the patient. The MIDCAB, however, has other ramifications, including changes in staffing requirements, bed allocations, and staff training. Advantages and limitations are discussed.     

Nonatheromatous carotid artery disease

Common and uncommon nonatheromatous diseases affecting the cervical carotid artery are discussed. Specifically, the radiographic and pertinent clinical features of cervical carotid artery congenital variants, dissection, fibromuscular dysplasia, Takayasu's arteritis, and infection are described. Catheter angiography continues to have an important role in the diagnosis of many of these conditions. Magnetic resonance imaging techniques are emerging as a useful adjunct to catheter angiography and occasionally may be the primary imaging modality for diagnosis.     

Ovariectomy and estrogen-induced alterations in myocardial contractility in female rabbits: role of the L-type calcium channel

Carnitine is an essential component for mitochondrial beta-oxidation of fatty acid. Using the degenerate primers designed for organic anion transporters and an organic cation transporter, we isolated a novel cDNA encoding a carnitine transporter (CT1) from rat intestine. CT1 encodes a 557-amino-acid protein with 12 putative membrane-spanning domains. When expressed in Xenopus oocytes, CT1 mediated a high-affinity transport of L-carnitine (Km = 25 microM). The replacement of extracellular sodium with Li reduced CT1-mediated L-carnitine uptake to 19.8%. CT1 did not transport typical substrates for either organic anion or organic cation transporters, such as p-aminohippurate and tetraethylammonium. Octanoylcarnitine, acetylcarnitine, and gamma-butyrobetaine showed potent inhibitory effects on CT1-mediated L-carnitine uptake; betaine and d-carnitine showed moderate inhibition. CT1 mRNA was strongly expressed in the testis, colon, kidney, and liver and weakly in the skeletal muscle, placenta, small intestine, and brain. No CT1 expression was detected in the heart, spleen, or lung. The present study provides the molecular basis of carnitine transport in the body.     

Biodegradable interlocking nails for fracture fixation

Serious problems such as stress shielding, allergic reactions, and corrosion are associated with the use of metallic fracture fixation devices in fractured long bones. Metal implants often are removed during a second retrieval operation after fracture healing has completed. A biocompatible implant that degrades slowly during implantation would obviate the need for a second operation and save the patient from considerable physical, psychologic, and financial discomfort. The biodegradable implant must provide the fractured limb sufficient support for a certain time, allowing early loading. A gradual transfer of load from the biodegradable implant to the bone would result in a better product of bone healing and avoid stress shielding. In an animal model using adult sheep, two types of biodegradable polymer interlocking nails were tested in comparison with a stainless steel interlocking nail. Fracture healing, mechanical properties of the bones, degradation behavior in vivo and in vitro, and tissue response were monitored during a 2 1/2-year followup study. To detect shifts in acid base relations caused by the release of acid compounds, pH measurements were performed. Fracture healing was unimpaired, and the mechanical test results of all three groups were excellent. Histologic analysis showed a mild inflammatory response, but no pH shifts were observed. The results of this study justify additional research on these promising materials.     

Pathogenesis of ischemia reperfusion injury of the kidney after transient renal arterial clamping in rats

Renal function can be severely impaired through injuries sustained after both short and prolonged periods of complete ischemia. The magnitude of renal dysfunction resulting from these conditions and their reversibility depend on the duration of anoxia. In this study, we used a Sprague-Dawley rat model (5 to 7 rats in each group) to study the pathogenesis of short-term ischemia (30, 60, and 120 min)/reperfusion (2, 4, 24 h, 1 wk, and 3 wk) injury of the kidney under warm (room temperature) or cold (4 degrees C) conditions. Ischemia was induced by clamping the renal artery. Changes in kidney weight, histopathology, concentrations of serum thromboxane and leukotriene, and tissue malonyldialdehyde (MDA) concentration, numbers of apoptotic bodies, and p53 expression in the kidney were compared with those of sham-operated rats. The results showed that the immediate increase in kidney weight due to inflammatory swelling was associated with simultaneous elevation of serum thromboxane and leukotriene levels. The changes in mediator levels were closely related to the duration of ischemia and temperature. Histologic structures were preserved better when renal artery clamping was done at 4 degrees C. MDA peroxidation products from the ischemic tissue prominently increased 1 week following ischemia; this paralleled a secondary increase in leukotriene levels. Flow cytometric detection of p53 oncoprotein showed a marked increase at 1 week following ischemia, which was accompanied by the development of apoptotic bodies in ischemic tissues. These changes were also closely related to the ischemic time and temperature during ischemia. This animal model may be useful for future studies of the prevention of ischemia/reperfusion injury of the kidney and for selection of effective antioxidants.     

A survey of the content of BSc courses in pharmacology in UK universities--is it time for a core curriculum?

The 18 UK universities offering three--of four--year BSc pharmacology courses were surveyed by questionnaire to determine course content, laboratory-practical content and project or dissertation requirements. In this article David Dewhurst and Clive Page provide an overview of the study, which highlighted the fact that there is no core curriculum. There was considerable variation in course content [only a limited number of common topics were taught in depth (> 15 h timetabled time)] and the time spent doing 'wet' laboratory practicals varied considerably (range 0-145 h). A research project in the final year was the norm (although the time allocation varied considerably), but some universities used a library-based dissertation as an alternative.     

Abdominoinguinal incision in adenocarcinoma of the sigmoid or cecum: report of two cases

PURPOSE: This study illustrates a technique allowing resection of a sigmoid adenocarcinoma with lateral fixation and a cecal adenocarcinoma with involvement of the psoas muscle and ureter. METHODS: The abdominoinguinal incision, an incision used in the resection of a sarcoma of the lower abdominal quadrants, was applied in the case of a sigmoid adenocarcinoma with posterolateral fixation and infiltration of the anterior abdominal wall and in a case of a cecal adenocarcinoma involving the right psoas muscle and ureter. RESULTS: In the first case, resection of the tumor mass en bloc with resection of the sigmoid and lower anterior abdominal wall muscles, including the inguinal ligament, was performed. Reconstruction of the muscular fascial defect was done with the rotation of a right rectus abdominis flap. The patient was well 12 months later. In the second case, the cecal carcinoma was resected en bloc with the right psoas and ureter; a right nephrectomy was also performed. This patient was well eight months later. CONCLUSIONS: The abdominoinguinal incision may provide the exposure needed to allow the resection of a sigmoid or a cecal adenocarcinoma with posterolateral fixation, often considered unresectable with conventional abdominal incisions.     

Value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis

To objectively assess the value of examining multiple sputum specimens in maximizing the sensitivity of detection of Mycobacterium tuberculosis, we retrospectively reviewed the acid-fast bacillus smear and culture results of patients diagnosed with culture-proven pulmonary tuberculosis (TB) at Hennepin County Medical Center between 1986 and 1996. Two hundred and forty six persons were diagnosed with pulmonary TB in the time period analyzed. In 93% of these cases (229 of 246) the laboratory diagnosis was made by detection of M. tuberculosis in sputum specimens; however, only 52% (120 of 229) of these patients had at least three sputum specimens submitted to the laboratory at the time of diagnosis. Of the patients from whom at least three specimens were collected, 47% (56 of 120) had at least one smear-positive specimen; the third or later specimen submitted was the first smear-positive specimen for 13% (7 of 56) of these persons but was the first culture-positive specimen for only 7% (4 of 56). Of the 64 patients with smear-negative specimens, for only 5% (3 of 64) was the third or subsequent specimen submitted the first from which M. tuberculosis was recovered. This data indicates that, in our institution, the overwhelming majority of culture-proven pulmonary TB cases are diagnosed from the first or second sputum specimen submitted to the laboratory and that only rarely is a third specimen of diagnostic value.     

Left-right asymmetry of fly wings and the evolution of body axes

The body plan of Drosophila, and presumably that of other insects, develops under the control of anterio-posterior and dorsal ventral axes, but no evidence for a left-right axis has yet been found. We used geometric morphometrics to study the wings in three species of flies: Drosophila melanogaster, Musca domestica and Glossina palpalis gambiensis. In all three species, we found that both size and shape showed subtle, but statistically significant directional asymmetry. For size, these asymmetries were somewhat inconsistent within and between species, but for shape, highly significant directional asymmetry was found in all samples examined. These systematic left-right differences imply the existence of a left-right axis that conveys distinct positional identities to the wing imaginal discs on either body side. Hence, the wing discs of Drosophila may be a new model to study the developmental genetics of left-right asymmetry. The asymmetries of shape were similar among species, suggesting that directional asymmetry has been evolutionarily conserved since the three lineages diverged. We discuss the implications of this evolutionary conservatism in conjunction with results from earlier studies that showed a lack of genetic variation for directional asymmetry in Drosophila.