Costs and effectiveness of extracorporeal gallbladder stone shock wave lithotripsy versus laparoscopic cholecystectomy. A randomized clinical trial. McGill Gallstone Treatment Group

Thirty-five patients were randomized to extracorporeal shock-wave lithotripsy (ESWL) and 25 to laparoscopic cholecystectomy (LC). Stone disappearance occurred in only 12 of 32 ESWL patients [38% (95% CI: 21-56%)] during a 15-month follow-up. Greater incremental gains in quality of life after 6 months were observed among LC patients (p < .01). Total duration of disability was 6.8 +/- 8.5 days for ESWL, and 22.7 +/- 16.6 days for LC (p < .01). Nine (28%) patients crossed over electively to the LC group, but only 44% of these underwent LC within the next 3 years. ESWL cost Can $58.9/ day of disability saved. ESWL is limited by its selective applicability and modest stone disappearance rate. Its cost-effectiveness is largely dependent on patient acceptance of recurrent episodes of biliary colic due to the persistence of stone fragments.     

Healthy aging: guidelines for cancer screening and immunizations

With increasing life expectancy over the past 50 years, screening for treatable illness and active measures to prevent disease and promote a healthy lifestyle have become increasingly important for older patients. In general, the benefits of such efforts have become more apparent, but depend also upon general health and life expectancy of the individual. Tests for malignancies of the breast, cervix, prostate, colon, skin, and oral cavity are considered to meet screening criteria. Immunization guidelines have been recently updated, and good evidence supports the benefit of protecting older patients from influenza and pneumococcal pneumonia. Counseling on prevention of falls and injuries in the home and on the highways can help reduce the risk of accidents.     

Role of glutathione in nitric oxide-mediated injury to rat gastric mucosal cells

Recent studies suggest that in some cell types, the activity of nitric oxide (NO) is influenced by the endogenous antioxidant, reduced glutathione (GSH). The present study has examined the role of GSH in NO-induced cytotoxicity in cells harvested from the rat gastric mucosa. Cell integrity was assessed by Trypan blue exclusion and alamar blue dye absorbance. Pretreatment of rats with bacterial endotoxin lipopolysaccharide increased Ca(2+)-independent NO synthase (iNO synthase) activity (as detected by the radiolabeled conversion of [14C]arginine to [14C]citrulline, lowered GSH content and increased cell injury. Lipopolysaccharide treatment also resulted in a significant increase in the in vitro production of reactive oxygen metabolites as assessed by the fluorescent probe 2',7'-dichlorofluorescein diacetate. Inhibition of iNO synthase activity by dexamethasone and NG-nitro-L-arginine methyl ester prevented these effects. Similarly, the NO donor, S-nitroso acetyl-penicillamine depleted GSH stores and damaged cells in a dose-dependent manner. The effects of S-nitroso acetyl-penicillamine were diminished by the NO scavenger, 2-phenyl-4,4,5,5,-tetramethylimidazoline-1-oxyl-3-oxide. In contrast, incubating cells with N-acetyl-L-cysteine to augment endogenous GSH synthesis, prevented the effects of S-nitroso acetyl-penicillamine. Reduction of GSH stores by pretreatment of rats with buthionine sulfoximine or incubating cells in vitro with diethyl maleate, increased oxidant production and exacerbated NO-induced cell injury. These results suggest that excessive levels of NO alter GSH homeostasis and increase the generation of oxidants leading to increased gastric cellular injury.     

Blood cell transplantation: report from an International Consensus Meeting

An International Consensus Meeting on blood cell transplantation took place in Heemskerk, The Netherlands on 27-29 June 1994. The term 'blood cell transplantation' was preferred to peripheral blood stem cell transplantation. The following issues were addressed: stem cell assessment and ex vivo expansion, techniques for stem cell mobilization, applications of blood cell transplantation, malignant cell contamination and allogeneic blood cell transplantation.     

A tale of two T cells

Berry aneurysms in childhood are rare and have certain characteristics that distinguish them from their adult counterparts. A case of death caused by a ruptured berry aneurysm in a child is presented, and the topic is reviewed.     

A rural vision of a healthy community

The planimetric Z-plasty proposed by Roggendorf provides elongation by excision of a pair of triangular pieces of tissue. The application of planimetric Z-plasties has been modified by making the vertical angle flexible, and making them continuous in the same or in opposite directions. Continuous planimetric Z-plasties in the same direction elongate an oblique contracture in the longitudinal direction. Continuous planimetric Z-plasties in an alternative direction elongate a disproportioned scar contracture in the longitudinal direction. Both techniques partially reduce unsightly scarring. Furthermore, they can be used in combination with V-Y-plasties. These modifications permit rational planing of the treatment of complicated scars with contracture.     

Comparison of cardiac findings at necropsy in octogenarians, nonagenarians, and centenarians

The Toxoplasma gondii rhoptry protein Rop2 was expressed in Escherichia coli as a fusion protein containing 44 kDa of the 55-kDa mature Rop2, supplied with six histidyl residues at the N-terminal end (Rop2196-561). Humoral response during Toxoplasma infection of humans was analyzed by immunoglobulin G (IgG), IgA, and IgM enzyme-linked immunosorbent assay with Rop2196-561 as the antigen substrate. The analyzed sera were divided according to T. gondii-specific serological tests (IgG, IgA, or IgM indirect immunofluorescence and IgA or IgM immunosorbent agglutination assay) as group A (IgG+ IgA- IgM-; n = 35), group B (IgG+ IgA+ IgM+; n = 21), group C (IgG+ IgA+ IgM-; n = 5), and group D (IgG+ IgA- IgM+; n = 16). Twenty-six T. gondii-seronegative sera from individuals with other infections were also included (group E). Anti-Rop2 IgG antibodies were detected in 82.8% of group A sera and in 97.6% of the sera with acute-phase marker immunoglobulins (groups B, C, and D). The percentage of IgA antibody reactivity against Rop2196-561 was 17.1% in group A, 50% in group D, and 80.8% in groups B and C. The percentage of IgM antibody reactivity was 0% in groups A and C and 62% in groups B and D. Sera from group E failed to show IgA, IgM, or IgG antibody reactivity. Since T. gondii Rop2 elicits a strong humoral response from an early stage of infection, it is suggested that recombinant Rop2196-561 would be suitable for use in diagnostic systems, in combination with other T. gondii antigens, to detect specific IgG, IgA, and IgM antibodies.     

Chronic gypsum fertiliser ingestion as a significant contributor to a multifactorial cattle mortality

A number of high-resolution molecular typing systems have been developed in recent years. Their availability raises the new issues of selecting the method (s) best suited for a particular purpose and interpreting and communicating typing results. Most of the currently available methods are comparative only: they allow testing of a sample of isolates for delineation of those closely related from those markedly different in genomic backgrounds. This approach is adequate for outbreak investigation, allowing determination of clonal spread in a microenvironment and identification of the source of infection. Comparative methods with sufficient resolution for most pathogens include restriction fragment-length polymorphism (RFLP), pulsed-field gel electrophoresis (PFGE), and arbitrarily primed and randomly amplified polymorphic DNA-polymerase chain reaction (PCR) analysis. For surveillance systems, monitoring clonal spread and prevalence in populations over extended periods of time requires library typing systems. These must be standardized, must have a high throughput, and must use a uniform nomenclature. Promising or validated methods include serotyping, insertion sequence fingerprinting, ribotyping, PFGE, amplified fragment-length polymorphism (AFLP), infrequent-restriction-site amplification PCR, interrepetitive element PCR typing (rep-PCR) and PCR-RFLP of polymorphic loci. PCR methods generating arrays of size-specific amplicons (AFLP, rep-PCR) can be more reproducibly analyzed by using denaturing polyacrylamide gel or capillary electrophoresis with automated laser detection. Binary probe typing systems appear optimal and should be enhanced further through use of DNA chip technology. In these systems, amplification of polymorphic regions is followed by solid-phase hybridization with a reference panel of sequence-variant specific probes. The resulting binary type results allow determination of reproducible, numeric profiles. However, interpretation and nomenclature of typing results for large-scale surveillance purposes still require a better understanding of population structure and microevolution of most microbial pathogens.