Evaluation of an extremely flatulent patient: case report and proposed diagnostic and therapeutic approach

We recently encountered a patient with severe flatulence who previously had been subjected to innumerable diagnostic tests and ineffective therapies based on the belief that his rectal gas was produced in the colon. Analysis of three flatus samples demonstrated that nitrogen (N2) was the predominant flatus gas whereas the three gases produced in the gut (CO2, H2 [hydrogen], and CH4 [methane]) comprised <16% of rectal gas. This result plus a series of other diagnostic tests clearly indicated that the patient's flatus was derived almost entirely from swallowed air. Based on this case, the present report summarizes available data on excessive flatulence and suggests a rational approach to the patient complaining of this problem. Particular emphasis is placed upon a sequential strategy consisting of: 1) a count of flatus passages to determine if the subject truly is abnormal (normal: <20 passages/day); 2) an analysis of flatus to determine if the flatus originates from swallowed air (predominantly nitrogen) or intraluminal production (predominantly CO2, H2, and CH4); and 3) treatment based upon the origin of the rectal gas.     

Report of the first case of invasive fungal sinusitis caused by Scopulariopsis acremonium: review of scopulariopsis infections

Scopulariopsis acremonium is a species of saprophytic fungus not previously reported to cause invasive disease in humans, although invasive infections from other species of Scopulariopsis have been reported and are reviewed. Deep infection with this fungus is associated with a high mortality rate. Invasive fungal sinusitis, in general, is a potentially fatal disease that typically affects immunocompromised patients, such as those receiving intensive chemotherapy or undergoing bone marrow transplantation. We report a case of invasive fungal sinusitis caused by Scopulariopsis acremonium in a patient with leukemia, who was successfully treated with amphotericin B, itraconazole, endoscopic sinus surgery, and granulocyte colony-stimulating factor.     

Transduction of human trophoblastic cells by replication-deficient recombinant viral vectors. Promoting cellular differentiation affects virus entry

We investigated the transfer of the lacZ reporter gene into human trophoblastic cells using herpes simplex virus and adeno-associated virus vectors. We used an established choriocarcinoma cell line (BeWo cells) that can be induced to terminally differentiate after treatment with cyclic-AMP. Our results demonstrate that transduction of trophoblastic cells by the herpes simplex virus vector, HSV.CMVlac, and the adeno-associated virus vector, AAV.CMVlac, is affected by cellular differentiation. Treatment of BeWo cells with cyclic-AMP reduced transduction by HSV.CMVlac but increased transduction by the AAV vector. In contrast, when BeWo cells were transfected with herpes simplex virus and adeno-associated virus plasmids, lacZ expression was not affected by treatment with cyclic-AMP. Southern blot analysis demonstrated 2.75 times less herpes simplex virus DNA in cyclic-AMP treated BeWo cells, but 2.0 to 7.4 times more adeno-associated virus DNA in treated cells. We conclude that inefficient transduction of differentiated trophoblastic cells with HSV.CMVlac is because of diminished viral entry, whereas cellular differentiation is associated with increased entry of AAV.CMVlac. These observations suggest that adeno-associated virus vectors may be used to modify trophoblast function and study placental physiology. Additionally, trophoblast differentiation leads to alterations in the mechanisms of virus uptake that may affect maternal-to-fetus transmission.     

Randomized trial of an oral platelet glycoprotein IIb/IIIa antagonist, sibrafiban, in patients after an acute coronary syndrome: results of the TIMI 12 trial. Thrombolysis in Myocardial Infarction

In fMRI studies, Gaussian filtering is usually applied to improve the detection of activated areas. Such lowpass filtering enhances the signal to noise ratio. However, undesirable secondary effects are a bias on the signal shape and a blurring in the spatial domain. Neighboring activated areas may be merged and the high resolution of the fMRI data compromised. In the temporal domain, activation and deactivation slopes are also blurred. We propose an alternative to Gaussian filtering by restoring the signal using a spatiotemporal Markov Random Field which preserves the shape of the transitions. We define some interaction between neighboring voxels which allows us to reduce the noise while preserving the signal characteristics. An energy function is defined as the sum of the interaction potentials and is minimized using a simulated annealing algorithm. The shape of the hemodynamic response is preserved leading to a better characterization of its properties. We demonstrate the use of this approach by applying it to simulated data and to data obtained from a typical fMRI study.     

Built-in getter-ion pumps

It is shown that theory of the Penning discharge essentially involves taking into account the collective interaction of the electrons in the near-anode region. Following investigations of the Penning discharge in a strong magnetic field (density up to 12 kOe) empirical formulae are proposed for calculating the pumping speed and the minimum operating pressures of getter-ion pumps. Methods of calculation for built-in getter-ion pump parameters and design peculiarities are considered.     

E. L. Thorndike and the immediacy of reinforcement.

The earliest reference to the immediacy of reinforcement in E. L. Thorndike's writings is found in Animal Intelligence (1911), not in Volume 1 of Educational Psychology as previously stated in an earlier article by L. T. Benjamin and R. Perloff (1982). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reversal of renal failure and paraplegia after thoracoabdominal aneurysm repair

Repair of ruptured thoracoabdominal aortic aneurysms is complicated by high rates of perioperative paraplegia, renal insufficiency, and mortality. This report describes a patient with a ruptured thoracoabdominal aortic aneurysm in whom preoperative acute renal failure was reversed with hemodialysis, aortic replacement, and renal revascularization. Prompt cerebrospinal fluid drainage reversed delayed-onset postoperative paraplegia and led to immediate, complete neurologic recovery.