Investigation methods of cerebral perfusion

Brain energy metabolism is essentially oxydative, through the glycolysis and the Krebs cycle. Brain tissue cannot survive more than a few minutes if the substrate (glucose, for which there is no endogenous reserve) or oxygen supply is abolished. Otherwise, there is a precise matching between perfusion (cerebral blood flow-CBF) and oxydative (oxygen consumption-CMRO2) and glycolytic regional metabolism. When intraarterial pressure is decreased (due to a systemic arterial pressure impairment or an arterial obstructive lesion), CBF is maintained constant through an increase of the pial vessels caliber and therefore an enhancement of the cerebral blood volume (CBV); this is cerebral circulatory autoregulation. In physiologic conditions, any increase of the local metabolic demand (during a motor, sensory, or cognitive activation) is supplied through a local enhancement of perfusion, and reversely. Therefore, the measurement of brain perfusion is useful not only to assess the consequences of cerebrovascular or some other diseases, but also to observe the functions involved in the normal working brain. This measurement is most frequently focused on CBF (flow) parameter, but in some clinical circumstances the access to CBV will be also of major importance for a correct understanding of the physiological or pathophysiological situation. We shall describe the different methods available both in clinical and experimental practice, and shall indicate for each one its characteristics, advantages and pitfalls.     

Endoscopic surveillance of Barrett's esophagus: a cost-effectiveness comparison with mammographic surveillance for breast cancer

OBJECTIVE: Endoscopic surveillance of Barrett's esophagus is commonly practiced to detect malignancy in an early and curable stage. However, the cost-effectiveness of this practice has been questioned. To clarify this issue, we undertook a cost analysis of endoscopic surveillance to detect adenocarcinoma in Barrett's esophagus compared with mammography used to detect occult carcinoma of the breast, a widely accepted cancer surveillance technique. METHODS: The rate of esophageal adenocarcinoma detected by endoscopic surveillance was calculated for Duluth Clinic patients with Barrett's esophagus seen from 1980 to 1995 and compared with published rates. The rate of occult breast cancer detection was calculated for all women undergoing surveillance mammography at the Duluth Clinic for the year 1994 and compared with published rates. Costs for screening studies and therapy for cancer treatment for both cancers were calculated based on clinical results and assumptions regarding outcomes derived from published reports, and the costs were compared. RESULTS: Endoscopic surveillance of 149 patients with benign Barrett's esophagus was performed for a total of 510 patient-yr, during which time seven patients developed adenocarcinoma, an incidence of one case per 73 patient-yr of follow-up. Occult breast cancer was detected in 50 of 12,537 mammograms, a detection rate of 0.4%. The incidences in both cases were comparable to published figures. The costs of detecting a case of adenocarcinoma in Barrett's esophagus and occult breast cancer were $37,928 and $54,513, respectively, and those for treatment resulting in cure were $83,340 and $83,292. Cost per life-yr saved was $4,151 for adenocarcinoma in Barrett's esophagus and $57,926 for breast cancer. CONCLUSION: Endoscopic surveillance of patients with Barrett's esophagus compares favorably with the common practice of surveillance mammography to detect early breast cancer, and should therefore be considered to be as cost-effective as surveillance mammography.     

Cuticle chirality and body handedness in Caenorhabditis elegans

BACKGROUND AND PURPOSE: Norway has the highest reported incidence of hip fractures in western Europe. Little is known about the epidemiology of falls in Norway where the winter season is long and dark. The objective of this work was to study reported falls and their consequences among elderly Norwegians living at home. METHODS: A cross-sectional design was used for the study. Interviews were performed in the homes of 431 subjects, aged 67-97 years, living at home. Information on falling was gathered through six questions: whether the subject had fallen during the last six months, and if so, how many falls they had, where the last fall occurred, its perceived reason, the activity the subject had been engaged in when the fall occurred, and the resulting injury. RESULTS: In all, 24.1% of subjects reported falling during the last six months, and 9.5% had suffered more than one fall. Falls were most frequently linked to external events (63.1%). Outdoor falls were more frequent (59.0%; 95% CI = 51.2-82.0) than indoor falls. Older subjects were associated with more frequent indoor falls (p < 0.05), but gender was not significant. Fifty-one per cent of subjects had fallen while walking and 53% had suffered an injury from the last fall. In 13.4% of the women and 16.2% of the men, the last fall had resulted in a fracture. CONCLUSIONS: Compared to the results of other studies from industrialized Western countries, a similar crude fall rate, similar frequency and similar type of injury were found. However, in contrast to other studies, no gender difference was observed with regard to falling, place of falling and fracture rate.     

Isolation of acidophilic methane-oxidizing bacteria from northern peat wetlands

Acidic northern wetlands are an important source of methane, one of the gases that contributes to global warming. Methane oxidation in the surface of these acidic wetlands can reduce the methane flux to the atmosphere up to 90 percent. Here the isolation of three methanotrophic microorganisms from three boreal forest sites is reported. They are moderately acidophilic organisms and have a soluble methane monooxygenase. In contrast to the known groups of methanotrophs, 16S ribosomal DNA sequence analysis shows that they are affiliated with the acidophilic heterotrophic bacterium Beijerinckia indica subsp. indica.     

Dermoid cyst of the pancreas: a rare cystic neoplasm

Dermoid cysts of the pancreas, also called cystic teratomas, are a rare entity and are included in the group of neoplasms with a germ cell origin. Only twelve cases have been described in the world literature. The symptomatology is due to tumor compression of the neighboring tissues. Ultrasonography and computed tomography may be helpful, but there are no pathognomonic data for their preoperative recognition. The differential diagnosis should include all other cystic tumors of the pancreas. Complete surgical removal is mandatory. We describe the diagnostic and surgical procedures in a 74 year-old man with a pre-operatively unsuspected dermoid cyst. We review the previously published cases and emphasize the appropriate therapeutical management.     

Psychosocial changes following retirement

This study was designed to: (a) identify the perceptions of retirees about changes in their life patterns during retirement; (b) investigate the kinds of adjustment problems occurring in retirement as a basis for developing prevention oriented pre-retirement programs; and (c) identify extant factors which could demonstrate underlying themes relating to retirement adjustment. A 72-item, multiple response questionnaire was used to gather demographic data, information on use of time, pre-retirement planning, health problems, changing life patterns, and adjustment to retirement. It is the latter which is reported in these findings. The population included 1565 retirees from a designated company living in the south-eastern United States of America, with a response of 764 subjects (48.82%). Findings suggest the respondents were generally healthy and well adjusted; however, numerous adjustment problem areas were identified within the six life patterns. Additional factor analysis (principal components) demonstrated four factors of particular importance: satisfaction with retirement, retirement concerns, spousal relationships, and pre-retirement preparation outcomes.