The association of complete laryngotracheoesophageal cleft with left lung agenesis: pathophysiological clues provided by an experiment of nature

The authors present a patient with complete laryngotracheoesophageal cleft and concurrent left lung agenesis and microgastria. Prenatal ultrasound scan showed polyhydramnios and a hypertrophic right lung. The authors propose that the combination of right lung hypertrophy, polyhydramnios, and microgastria in the absence of a competent laryngeal mechanism may suggest that the preferential path for swallowed amniotic fluid was into the lung, rather than the normal route through the stomach. This case illustrates the prenatal findings suggestive of complete laryngotracheoesophageal cleft and lung agenesis, and suggests a potential causal relationship between shunting of swallowed amniotic fluid into the bronchial tree and prenatal lung hypertrophy and microgastria.     

Flt-3 ligand increases microchimerism but can prevent the therapeutic effect of donor bone marrow in transiently immunosuppressed cardiac allograft recipients

C3H (H2k) mice received 50 x 10(6) B10 (H2b) bone marrow (BM) cells either alone or with flt-3 ligand (FL) (10 microg/day), tacrolimus (2 mg/kg/day), or both agents for 7 days. Donor MHC class II+ (IAb+) cells were quantitated in spleens by immunohistochemical analysis, and donor class II DNA detected in BM by PCR. Donor cells were rare in the BM alone and BM + FL groups, whereas there was a substantial increase in chimerism in the BM + tacrolimus group. Addition of FL to BM + tacrolimus led to a further eightfold increase in donor cells and enhanced donor DNA compared with the BM + tacrolimus group. This increase in donor cells was almost 500-fold compared with BM alone. C3H recipients of B10 heart allografts given perioperative B10 BM and tacrolimus (days 0-13) exhibited a markedly extended median graft survival time (MST, 42 days) compared with those given tacrolimus alone (MST, 22 days). Addition of FL (10 microg/day; 7 days) to BM + tacrolimus prevented the beneficial effect of donor BM (MST, 18 days). BM alone or BM + FL resulted in uniform early heart graft failure (MST < 8 days). Functional studies revealed maximal antidonor MLR and CTL activities in the BM- and BM + FL-treated groups, with minimal activity in the tacrolimus-treated groups. Thus, dramatic growth factor-induced increases in chimerism achieved under cover of immunosuppression may result in augmented antidonor T cell reactivity and reduced graft survival after immunosuppressive drug withdrawal. With FL, this may reflect striking augmentation of immunostimulatory dendritic cells.     

Iatrogenic keratectasia after LASIK in a case of forme fruste keratoconus

We report an iatrogenic corneal ectasia that developed after laser in situ keratomileusis (LASIK) in a case of forme fruste keratoconus. One month postoperatively, corneal topography revealed a central steep area that showed rapid progression. Visual acuity in the eye decreased from 20/20 to 20/80. Corneas with forme fruste keratoconus may have altered biomechanical properties compared with normal corneas. Forme fruste keratoconus may be a contraindication for LASIK.     

Comparative evaluation of National Committee for Clinical Laboratory Standards broth macrodilution and agar dilution screening methods for testing fluconazole susceptibility of Cryptococcus neoformans

A simple screening method for fluconazole susceptibility of Cryptococcus neoformans using 2% dextrose Sabouraud dextrose agar (SabDex) with fluconazole was compared to the National Committee for Clinical Laboratory Standards (NCCLS) broth macrodilution method. By this method, fluconazole-susceptible C. neoformans isolates are significantly smaller on medium with fluconazole than on fluconazole-free medium. Isolates with decreased susceptibility have normal-size colonies on medium containing fluconazole. The 48-h NCCLS broth macrodilution MICs (NCCLS MICs) for isolates with normal-size colonies on 8- or 16-microg/ml fluconazole plates were predicted to be > or =8 or > or =16 microg/ml, respectively. On medium with 16 microg of fluconazole per ml, all strains (84 of 84) for which the NCCLS MICs were <16 microg/ml were correctly predicted, as were all isolates (7 of 7) for which the MICs were > or =16 microg/ml. Agar dilution appears to be an effective screening method for fluconazole resistance in C. neoformans.     

Further evidence for an imprinted gene for neonatal diabetes localised to chromosome 6q22-q23

Transient neonatal diabetes mellitus (TNDM) is a rare form of childhood diabetes which usually resolves in the first 6 months of life but which predisposes to type 2 diabetes of adult onset. We recently reported paternal uniparental isodisomy of chromosome 6 (UPD6) in two children with TNDM and proposed that there may be an imprinted gene important in the aetiology of diabetes on chromosome 6. We now describe two unrelated families which independently suggest that the gene is imprinted, is paternally expressed and maps to 6q22-q23. One family has a duplication while the other, with familial TNDM, shows linkage to a marker in this region.     

Impairment and disability: their relation during stroke rehabilitation

Migration of non-volatile and volatile compounds from 'microwave and roasting bags' (MRB), made of Nylon 6,6 (and some Nylon 6), into chicken meat, skin, and juices during roasting (200 degrees C/2 h) in a conventional oven was determined. For measurement of migration of non-volatile compounds, cooked chicken was freeze-dried, extracted with methanol after addition of 2-azacyclononane (internal standard) and the extract cleaned-up using liquid-solid adsorption chromatography (silica gel). High performance liquid chromatography (HPLC) in the reverse phase mode using a linear gradient of methanol in water was used to quantify seven Nylon 6 and Nylon 6,6 cyclic monomers and oligomers of molecular mass up to 678 daltons. Migration into chicken was 7.48 micrograms/g (8.26 mg/bag; 3.94 micrograms/cm2), 16% of the total non-volatile compounds contained in the MRB material. Individual migrants were also quantified. Migration of one volatile compound, 2-cyclopentyl cyclopentanone, into the roast chicken parts was measured. Extraction with diethyl ether, using a modified Likens-Nickerson system of concurrent steam distillation-solvent extraction with an internal standard (cyclohexanone) was performed for 10 h. Gas chromatography/mass spectrometry (GC/MS) in the selected ion mode (SIM) was used for quantification. An average of 14.0 (+/- 4.36) micrograms/bag (or micrograms/chicken) migrated, being 0.08% of the total 2-cyclopentyl cyclopentanone present in MRB. Loss of volatile compounds to the atmosphere is believed to have occurred since there was another, more volatile compound (cyclopentanone), present in MRB, at levels higher than 2-cyclopentyl cyclopentanone, but this was not detected in roast chicken. In general, the transference of MRB components into roast chicken can be considered not to present a hazard.     

Visualization of agonist-induced sequestration and down-regulation of a green fluorescent protein-tagged beta2-adrenergic receptor

To date, the visualization of beta2-adrenergic receptor (beta2AR) trafficking has been largely limited to immunocytochemical analyses of acute internalization events of epitope-tagged receptors in various transfection systems. The development of a beta2AR conjugated with green fluorescent protein (beta2AR-GFP) provides the opportunity for a more extensive optical analysis of beta2AR sequestration, down-regulation, and recycling in cells. Here we demonstrate that stable expression of beta2AR-GFP in HeLa cells enables a detailed temporal and spatial analysis of these events. Time-dependent colocalization of beta2AR-GFP with rhodamine-labeled transferrin and rhodamine-labeled dextran following agonist exposure demonstrates receptor distribution to early endosomes (sequestration) and lysosomes (down-regulation), respectively. The observed temporal distribution of beta2AR-GFP was consistent with measures of receptor sequestration and down-regulation generated by radioligand-receptor binding assays. Cells stimulated with different beta-agonists revealed time courses of beta2AR-GFP redistribution reflective of the intrinsic activity of each agonist.     

Identification and synthesis of altered peptides modulating T cell recognition of a synthetic peptide antigen

In studies of T cell responses to synthetic peptides we have observed agonist and antagonist activities associated with contaminants identified within the parent synthesis. The synthesis of two candidate analogues implied by a peptide contaminant formed during the synthesis of La 51-58 (IMIKFNRL) has been carried out. The peptide contaminant was 17-18 Da smaller than the parent peptide consistent with a modified asparagine residue at position 6 and so we synthesised both an aspartimide and a nitrile analogue, representing cyclisation or dehydration of the asparagine residue. The candidate aspartimide and nitrile analogues both bound empty MHC class I molecules to form allo determinants recognised by monoclonal antibodies. These results demonstrate that altered synthetic peptides can bind class I MHC molecules and prompt caution in the use of synthetic peptides as a source of immunising antigen.     

Transient ischemic attacks not produced by extracranial vascular disease: a plea for complete and early angiographic investigation

Six patients with classical transient ischemic attacks that were not directly related to extracranial carotid disease are presented. These cases were selected to include a variety of pathologic conditions: one case each of brain tumor, arteriovenous malformation, chronic subdural hematoma, cervical spondylosis, and two cases of giant intracranial aneurysms. These case histories are significant because they illustrate that without complete angiographic investigation, tragic results could have and did occur in some cases. Transient ischemic attacks should be considered as a symptom of various possible pathologic conditions, and a careful search for the cause must be pursued aggressively.