Felodipine use in pregnancy. Report of three cases

BACKGROUND: Calcium channel blockers are effective agents for the management of chronic hypertension and are being used with increasing frequency. If their safety and efficacy during pregnancy can be documented, women can be counseled to continue their antihypertensive agent during pregnancy. To our knowledge, the use of felodipine, a calcium channel blocker of the dihydropyridine group, during pregnancy has not been described. CASES: We report three cases of felodipine use in pregnancy by women with chronic hypertension. CONCLUSION: In women with severe hypertension (diastolic blood pressure > 100 mm Hg) who require pharmacologic treatment of it during pregnancy, felodipine appears to be an acceptable option.     

Dissociation of proteasomal degradation of biosynthesized viral proteins from generation of MHC class I-associated antigenic peptides

To study the role of proteasomes in Ag presentation, we analyzed the effects of proteasome inhibitors Cbz-Leu-Leu-Leucinal and lactacystin on the ability of mouse fibroblast cells to present recombinant vaccinia virus gene products to MHC class I-restricted T cells. The effects of the inhibitors depended on the determinant analyzed. For influenza virus nucleoprotein (NP), presentation of the immunodominant Kk-restricted determinant (NP(50-57)) was marginally inhibited, whereas presentation of the immunodominant Kd-restricted determinant (NP(147-155)) was enhanced, particularly by lactacystin. Biochemical purification of peptides confirmed that lactacystin enhanced the generation of Kd-NP(147-155) complexes fourfold. Lactacystin also enhanced the recovery of one Kd-restricted vaccinia virus determinant from HPLC fractions, while inhibiting recovery of another. The inhibitors were used at sufficient concentrations to block presentation of biosynthesized full-length OVA and to completely stabilize a rapidly degraded chimeric ubiquitin-NP fusion protein. Strikingly, presentation of antigenic peptides from this protein was unaffected by proteasome inhibitors. We also observed that proteasome inhibitors induced expression of cytosolic and endoplasmic reticulum stress-responsive proteins. These data demonstrate first that the processes of protein degradation and generation of antigenic peptides from cytosolic proteins can be dissociated, and second that effects of proteasome inhibitors on Ag presentation may reflect secondary effects on cellular metabolism.     

Primary study of neovasculature correlating with metastatic nasopharyngeal carcinoma using computer image analysis

The significance of neoangiogenesis in the metastasis of nasopharyngeal carcinoma (NPC) was investigated to clarify the role neovascularity in the prognosis of NPC and the probability of antiangiogenesis preventing NPC from distant metastasis. A group of 52 patients presenting with metastatic NPC were selected and strictly paired one-to-one, in sex, age, T stage, and N stage, with another 52 patients with non-metastatic NPC, who had survived for a long time after therapy. The tumor tissues of all 104 patients were retrieved for computer-assisted, immunohistochemical analysis of tumor vasculature. Counts of the microvessels and the relative area of all microvessels per image were significantly higher in metastatic NPC than they were in curable, non-metastatic NPC, while the average area of the microvessels and their average perimeter of in metastatic NPC were smaller than in non-metastatic disease. No significant difference in any microvessel parameter was found among the various types of metastasis. The alterations of microvessel parameters were significantly linked to the metastasis of NPC. Evaluation of neovascularity by computer image analysis may be helpful in estimating the prognosis of NPC and in determining the indicators for aggressive multimodal treatments.     

Simple renal cysts in children with AIDS

Simple renal cysts are very uncommon among children. Of 50 children with AIDS that underwent computed tomography at our hospital, 4 had radiographically simple cysts. The incidence of simple renal cysts in this group of children is thus approximately 45 times that seen in normal children. To our knowledge, simple renal cysts have never been reported as a manifestation of AIDS in children. It is unknown whether or not these cysts are a manifestation of HIV nephropathy (HIVN), in which microcysts are seen pathologically. We suggest that simple renal cysts may be a finding compatible with the diagnosis of HIVN.     

Does transovarial transmission of dengue virus occur in Malaysian Aedes aegypti and Aedes albopictus?

PURPOSE: We assessed the relative difficulty with which radical perineal and retropubic prostatectomy operations are learned. MATERIALS AND METHODS: The first 10 radical perineal and retropubic prostatectomies performed by 6 graduating urology residents were reviewed for patient and tumor characteristics, duration of surgery and hospitalization, and complication rates. RESULTS: A total of 120 patients was reviewed. Mean hospital stay was 2.5 days less after radical perineal prostatectomy, and estimated blood loss, number of transfusions and complication rates were also less for this procedure. All parameters used to estimate the outcome of the procedure indicated that radical perineal prostatectomy was learned more quickly than radical retropubic prostatectomy. CONCLUSIONS: In a residency training program radical perineal prostatectomy was learned at least as easily as retropubic prostatectomy. Due to expanding indications for this procedure, these findings should encourage urological surgeons to develop their skill with this approach.     

Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime volume

BACKGROUND: Despite recent advances in blood conservation techniques, up to 30% to 80% of patients undergoing open heart operations require allogeneic blood transfusions. A prospective, randomized study was performed to test the effect of lowering cardiopulmonary bypass prime volume (as an additional component of an integrated blood conservation strategy) on clinical outcome and allogeneic blood transfusion. METHODS: One hundred fourteen patients undergoing open heart operations were randomized to either full prime (FP) volume (1,400 mL of Plasmalyte solution) or reduced prime (RP) volume (600 to 800 mL). The reduction of prime volume was achieved by slowly draining the cardiopulmonary bypass circuit into a cell-saving device before the initiation of bypass. Firm transfusion thresholds were observed. RESULTS: There were no significant differences between the groups with respect to baseline characteristics, body surface area, type and urgency of the procedures, perfusion technique, and hematologic profile. Mortality (FP, 1.7%; RP, 0%; p approximately 1.0) and overall morbidity (FP, 28.1%; RP, 22.8%; p = 0.53) were similar. However, transfusion requirements were significantly lower in the RP group: total donor exposure, 3.8 +/- 10.1 versus 1.0 +/- 2.4 units (p = 0.044); percentage of patients transfused, 54% (n = 31) versus 35% (n = 20) (p = 0.036). Twenty-four-hour chest tube drainage was similar: 455 +/- 223 mL for FP versus 472 +/- 173 mL for RP (p = 0.66). The lowest hematocrit on bypass was significantly higher in the RP group: 29.3% +/- 4% versus 26.3% +/- 5.3% (p = 0.009). CONCLUSIONS: Lowering cardiopulmonary bypass prime volume resulted in a significant decrease in allogeneic blood product use. Because postoperative 24-hour chest tube drainage was similar in both groups, and hematocrit during bypass was higher in the RP group, the reduction in allogeneic blood transfusions appears to be related to a decrease in prime-induced hemodilution. This technique is effective, simple, and safe. It therefore should be strongly considered for patients undergoing operations using normothermic or near-normothermic cardiopulmonary bypass who are at high risk for allogeneic blood transfusion.     

Through a glass darkly: Questions about truth and memory.

Narratives of sexual abuse are always social constructions. They are shaped by developmental and relational factors, as well as by historical events. Because psychodynamic therapy places highest value on subjective, inner truth, it is poorly adapted to the task of determining "historical" truth as required by the legal system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic study on the neuronal excitability of the cochlear nuclei of the cat following electrical stimulation

OBJECTIVES: To determine: (i) the prevalence, reasons for, and demographic and psychosocial predictors of prostate cancer screening among a randomly selected sample of men; and (ii) to estimate the community expenditure involved in the screening of asymptomatic men. SUBJECTS AND METHODS: A random sample of men aged 40-79 years was selected from the State Electoral Register of New South Wales, Australia, and asked to complete a computer-assisted telephone interview. The questions determined their demographic characteristics, their subjective health rating compared with others of the same age (5-point scale), the prevalence and reasons for any screening for prostate cancer ('ever screened' and 'screened within the last 12 months'), whether they had undergone a digital rectal examination (DRE), a blood test for prostate-specific antigen (PSA) or transrectal ultrasonography (TRUS), and the prevalence of urinary symptoms. Those who had been screened were then asked to nominate the single most important factor in the decision to undergo prostate cancer screening. To estimate community expenditure, the costs for prostate cancer screening were estimated by applying Medicare schedule charges to the screening and subsequent diagnostic tests performed. Two scenarios were developed to estimate costs: the first used guidelines which do not recommend the use of routine screening for all asymptomatic men, and the second was based on guidelines where the routine use of PSA or TRUS as part of a periodic health examination is not recommended, but the use of DRE in asymptomatic men aged 50-70 years is. RESULTS: Of the 551 eligible participants, 86% completed the interview; 44% of participants reported that they had 'ever' been screened, whilst 23% had been screened in the year before the study. Among those who had been screened, the reason reported most often for screening, apart from symptoms and family history, was the doctor's recommendation after a medical assessment of their prostate cancer risk status. Screening status was predicted both by the age of the man and his symptom score. As a result, the community expenditure in New South Wales for screening among asymptomatic men was estimated to be A$6.4 million and A$5.2 million for the first and second scenarios, respectively. CONCLUSIONS: The results of this study suggest that, despite the recommendations of primary bodies that asymptomatic men not be screened for prostate cancer, screening is occurring at a high level and with significant costs to the healthcare system.