Spontaneous esophageal perforation in an acute burn patient

Spontaneous perforation of the esophagus is an uncommon and catastrophic event accompanied by extremely high morbidity and mortality. In a burn patient, diagnosis may be delayed because of painful burns that may mask the underlying problem. Diagnosis is dependent on a high index of suspicion and by inclusion of this entity in the differential diagnosis of chest pain. The authors report on a 45-year-old male who developed a spontaneous perforation of the esophagus while hospitalized for treatment of an 11% total body surface area burn. Diagnosis and initiation of appropriate treatment resulted in salvage of this patient. The pathophysiology of this disease and a review of the literature are presented.     

Regulation and regulatory role of gamma-carboxyglutamic acid containing clotting factors

Several investigators have recently reported that significant numbers of appropriately adapted mutants can be induced in bacterial and yeast strains by exposing stationary phase cells to specific environmental challenges. The resulting mutants are said to be both selection-induced and demonstrably non-random in origin; if this interpretation is correct, it is in direct conflict with the conventional neo-Darwinian view, which is that spontaneous mutants are truly random in origin and arise without the intervention of any overtly adaptive forces. We believe that there are alternative ways of accounting for the appearance of many (and probably all) of the additional mutants which proponents of the adaptive mutation theory claim are observed only after they applied the appropriate selective pressure. Having reviewed the available evidence, we consider that most (if not all) of the sorts of mutants which are said to have been induced following exposure of stationary-phase cells to intense selective pressure are equally likely to have been generated during the operation of certain well-known, conventional (and essentially random) cellular DNA repair processes. Evidence in support of our view can be found in the mainstream literature on the origins of spontaneous mutations. We also note that some of the molecular models which have recently been proposed to explain the production of selection-induced mutations preferentially (or even only) in genes of adaptive significance may turn out to be of considerable interest in their own right, even although the mutants whose origins they were intended to explain may turn out to have arisen in a manner which is totally independent of the conditions used for their selection.     

Hypertensive cardiac hypertrophy--is genetic variance the missing link?

1. Hypertensive cardiac hypertrophy is a major independent predictor of adverse cardiovascular events. In man the cardiac response to increased afterload is very variable, even when ambulatory blood pressure monitoring is used. Analysis of breeding experiments using normotensive and hypertensive rat strains, human twin studies and other data indicate that genetic factors play a significant role in regulating cardiac mass; in other words, a large component of total variability is accounted for by genetic variance. 2. The observation that some patients with only mild-to-moderate hypertension exhibit gross left ventricular hypertrophy (LVH) similar to the inherited hypertrophic cardiomyopathies such as familial hypertrophic cardiomyopathy (FHC) and Friedreich's ataxia (FA) has prompted us to investigate the hypothesis that genetic factors associated with excessive myocardial hypertrophy, viz. mutations in FHC and FA genes alter the hypertrophic response of the heart to pressure overload. Here we review briefly three lines of study: (i) association analysis to test whether the allele frequencies differ in hypertensive patients with or without left ventricular hypertrophy; (ii) characterization of the cardiac manifestations of FA to understand the mechanism by which the heart is affected in a disease associated with pathology in a subgroup of neurons, and (iii) creation of transgenic models to facilitate the investigation of the interaction between hypertrophic stimuli and underlying genetic predisposition. 3. Information on the nature of the cardiac-mass-modifying genes involved may be useful not only for selecting high risk patients in strategies aimed at preventing the development of LVH, but also in opening new avenues of research on the reprogramming of cardiac myocytes to encourage them to hypertrophy in situations where cardiac muscle has been damaged or is hypoplastic.     

Quantifying psychological victimization: scientific uncertainty, legal necessity

Quantifying psychological victimization presents a formidable conundrum for psychiatry and the law. On the one hand, the task is fundamentally uncertain, due to causal complexity that includes disparity between projected image and inner reality, context dependence, volition, and conflicting interests. On the other hand, the task is necessary for just determination in such areas of law as disability assessment, victim impact, compensation, and psychological crimes such as harassment. A multiaxial protocol is proposed to meet this problematic charge. The five dimensions of this protocol are (1) gross estimate of victimization, including severity of the stressor, the degree of resulting impairment, and variably, the degree of the victim's nonresponsibility; (2) reliability; (3) other conditions; (4) conflicts of interest; and (5) evaluator bias. Intuitive estimates are used widely here instead of operationalized criteria, to enhance flexibility and widen relevance. Evaluators are asked to determine and explain the weighting that should be given to different factors and to give a self-statement of their own biases.     

Nutrition and physical activity program to attenuate obesity and promote physical and metabolic fitness in elementary school children

Obesity and low levels of physical and metabolic fitness are risk factors for cardiovascular disease and diabetes. The purpose of this investigation was to attenuate obesity and improve physical and metabolic fitness in elementary school children. Schools have the opportunity, mechanisms, and personnel in place to deliver nutrition education, fitness activities, and a school food service that is nutritious and healthy. Cohorts from grades 3 to 5 in two school districts in rural Nebraska (Intervention/Control) participated in a 2-year study of physical activity and modified school lunch program. Data collection for aerobic capacity, body composition, blood chemistry, nutrition knowledge, energy intake, and physical activity was at the beginning and end of each year. Int received enhanced physical activity, grade specific nutrition education, and a lower fat and sodium school lunch program. Con continued with a regular school lunch and team sports activity program. At year 2, Int lunches had significantly less energy (9%), fat (25%), sodium (21%), and more fiber (17%). However, measures of 24-hour energy intake for Int and Con showed significant differences for sodium only. Physical activity in the classroom was 6% greater for Int compared to Con (p < 0.05) but physical activity outside of school was approximately 16% less for Int compared to Con (p < 0.05). Body weight and body fat were not different between schools for normal weight or obese children. No differences were found for cholesterol, insulin, and glucose; however, HDL cholesterol was significantly greater and cholesterol/HDL was significantly less for Int compared to Con (p < 0.05). It appears that compensation in both energy intake and physical activity outside of school may be responsible for the lack of differences between Int and Con.     

The surgical importance of coronary sinus orifice atresia

Coronary sinus orifice atresia is rare. We describe two cases, one with an atrioventricular septal defect and another with supracardiac totally anomalous pulmonary venous drainage. The association with the latter has not been described previously. The importance of diagnosing the defect is emphasized and surgical treatment is discussed.     

Compilation Methods for the Address Calculation Units of Embedded Processor Systems

An essential component of today's embedded system is an instruction-set processor running real-time software. All variations of these core components contain at least the minimum data-flow processing capabilities, while a certain class contain specialized units for highly data-intensive operations for Digital Signal Processing (DSP). For the required level of memory interaction, the parallel executing Address Calculation Unit (ACU) is often used to tune the architecture to the memory access characteristics of the application. The design of the ACU is performance critical. In today's typical design flow, this design task is somewhat driven by intuition as the transformation from application algorithm to architecture is complex and the exploration space is immense. Automatic utilities to aid the designer are essential; however, the key compilation techniques which map high-level language constructs onto addressing units have lagged far behind the emergence of these units. This paper presents a new retargetable approach and prototype tool for the analysis of array references and traversals for efficient use of ACUs. In addition to being an enhancement to existing compiler systems, the ArrSyn utility may be used as an aid to architecture exploration. A simple specification of the addressing resources and basic operations drives the available transformations and allows the designer to quickly evaluate the effects on speed and code size of his/her algorithm. Thus, the designer can tune the design of the ACU toward the application constraints. ArrSyn has been successfully used together with a C compiler developed for a VLIW architecture for an MPEG audio decoding application. The combination of these methods with the C compiler showed on average a 39% speedup and 29% code size reduction for a representative set of DSP benchmarks.     

Tumor necrosis factor-alpha enhances antitumor effects of radiation against glioma xenografts

Benzodiazepine discontinuation is characterized by a syndrome of increased activity and reduced seizure threshold that is similar to effects mediated by the glutamatergic system. To elucidate the involvement of the glutamatergic system in benzodiazepine tolerance and discontinuation, we administered lorazepam, the NMDA antagonist CPP, and the combination of these compounds either concomitantly or consecutively to mice via osmotic pumps and evaluated pentylenetetrazole-induced seizure threshold, open-field activity, and benzodiazepine receptor binding during and after chronic administration. Animals receiving lorazepam alone developed partial tolerance at 7 days and complete tolerance at 14 days to the anticonvulsant effects of lorazepam. This effect was partly attenuated by CPP coadministration with lorazepam. This combination produced only partial tolerance. A reduction in seizure threshold was observed 4 days after discontinuation of lorazepam alone. This effect was abolished by coadministration of CPP with lorazepam and by CPP administration during the withdrawal period. Benzodiazepine binding in most structures examined was significantly reduced at 14 days during chronic lorazepam administration (versus 1 day), and coadministration of CPP did not alter this decrement. After lorazepam discontinuation, binding was increased at 4 and 7 days versus chronically treated animals and versus vehicle within the cerebral cortex. This effect was abolished by coadministration of CPP as well as by CPP administration during the lorazepam withdrawal period. These data support the involvement of the glutamatergic system in benzodiazepine tolerance and discontinuation.     

Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography

PURPOSE: To compare blood flow velocity changes within the middle cerebral artery (MCA) during hyperventilation, as measured with by both transcranial Doppler sonography and MR imaging, with the diameter of the MCA as measured with MR imaging alone. METHODS: The studies were performed in six healthy volunteers ranging in age from 22 to 31 years (mean, 27 years). Transcranial Doppler sonography was carried out with a range-gated 2-MHz transducer. MR examinations were done on a 1.5-T imaging unit. MR angiography was performed using the time-of-flight technique. MR flow measurements were carried out by using the phase-mapping technique with an ECG-triggered phase-contrast sequence. RESULTS: During hyperventilation, the mean blood flow velocity of the proximal MCA declined by 49.6% +/- 5.7 (mean +/- standard deviation) as measured with Doppler sonography, and by 47% +/- 4.6 as measured with MR flow calculation. The diameter of the MCA (3.4 +/- 0.3 mm) remained unchanged on MR imaging studies (3.3 +/- 0.3 mm). CONCLUSION: We found a good correlation between relative flow velocity changes measured by transcranial Doppler sonography and MR techniques. MR imaging revealed no significant changes in the diameter of the proximal MCA during normal versus hyperventilation. Relative changes in flow velocity in the MCA would thereby reflect relative changes in cerebral blood flow, at least during hyperventilation.