Delayed traumatic aorto-pulmonary artery fistula

Delayed aorto-pulmonary artery fistula represents an uncommon delayed sequelae of penetrating cardiac trauma. A case is presented that demonstrates the need for a high index of suspicion, follow-up, and a complete evaluation of the patient who survives a penetrating heart injury. The mechanisms of delayed presentation, diagnosis, and management of the fistula are discussed.     

Chromosome-specific aneusomy in carcinoma of the breast

Fluorescence in situ hybridization was performed on touch preparations from 55 primary infiltrating ductal carcinomas of the breast to determine numeric chromosome abnormalities. The frequency of aneusomy, measured by both nondisomy and chromosomal gain, was determined for chromosomes X, 4, 6-12, 17, and 18 with the use of chromosome-specific, alpha-satellite DNA probes. The presence of chromosome-specific numeric abnormalities was correlated with established clinicopathological parameters, including tumor size, lymph node involvement, tumor grade, estrogen receptor level, and menopause status. In addition, a case-control study was performed to explore a possible association between chromosome-specific aneusomy and recurrence in lymph-node-negative patients. Although chromosomes 8 and 6 were most frequently aneusomic, numeric abnormalities of chromosomes 4 and 11 were most strongly associated with established prognostic factors. For chromosomes 4 and 11, strong associations were found with tumor involvement of lymph nodes and increased tumor size, along with a weaker association with tumor grade. In addition, numeric abnormalities of the following chromosomes were associated with the corresponding prognostic factors: chromosomes X, 7, and 12 with lymph node status; chromosomes 10, 17, and 6 with tumor size; and chromosomes 7, 12, 17, and X with tumor grade. No correlations were observed with estrogen receptor level or menopause status. In the case-control study performed on isolated nuclei of paraffin-embedded tissue from lymph node-negative breast cancer patients (19 cases and 19 controls), the gain of chromosome 4 was correlated with disease progression. These findings suggest that chromosome-specific aneusomy is associated with certain established prognostic factors and may be associated with disease progression.     

Changes in sputum composition during sputum induction in healthy and asthmatic subjects

BACKGROUND: Home oxygen therapy improves survival and quality of life in adults with chronic obstructive airways disease. The few studies about home oxygen therapy in children show improvements in weight gain, school performance and decreases in hospitalization expenses. AIM: To report our experience in home oxygen therapy in children followed for six months to four years. PATIENTS AND METHODS: Fifty five children, less than 15 years old, discharged from a University hospital with the diagnosis of chronic respiratory failure, were followed up at their homes. RESULTS: Discharge diagnoses were bronchopulmonary dysplasia in 36% of children, postinfectious pulmonary damage in 22%, neonatal distress in 13%, chronic aspiration in 9%, cystic fibrosis in 7% and miscellaneous in 13%. Forty six completed at least 6 months of follow up, five moved to other hospitals, three required ventilatory support and one died. Oxygen was discontinued in 33 patients, and this occurred before the ninth month of follow up in 88% of those children. Neonatal distress and bronchopulmonary dysplasia had the best prognoses, and oxygen was discontinued at 4 +/- 1 and 5.7 +/- 3 months respectively. Patients with postinfectious pulmonary disease had a higher incidence of bronchoneumoniae, and those with bronchopulmonary dysplasia a higher incidence of acute bronchiolitis, that motivated hospital admissions. Expenses due to home oxygen were lower than hospitalization costs. No adverse effects were detected. CONCLUSIONS: Infants and newborns on home oxygen therapy have a good prognosis, specially those with reversible diseases. This type of therapy allows an earlier hospital discharge with considerable cost reductions.     

The regulation of drugs and medicines in horse racing in the United States. The Association of Racing Commissioners International Uniform Classification of Foreign Substances Guidelines

It is proposed that both polar and radical reactions should be considered when discussing radical ion reactivity. The fact that only the polar reactivity has dominated previous discussions is pointed out. It is argued that if the configuration mixing model is applicable for the estimation of radical cation-nucleophile (or cation-nucleophile) combination reaction barriers, the theory should also explain the reactivity of the proton toward anionic nucleophiles. The model severely overestimates reaction barriers for the latter reactions. The discussion is centered around the following hypothesis: In the absence of severe steric effects, the reactivity of radical ions, especially evident in the reactions with radicals (for example very few radical cations react with dioxygen at measurable rates), is dominated by the degree of coupling between charge and radical centers. Evidence from the literature supporting the hypothesis is presented for a number of different classes of radical ion reactions. Further work to test the validity of the hypothesis is proposed for many of the reaction types. Triarylmethyl radicals and carbenium ions are suggested as models to which the radical and polar reactivities of 9,10-diarylanthracene radical cations may be compared. It is concluded that the radical cation/carbenium ion comparison (for the reaction with acetate ion) would show similar reactivities while the radical cation/free radical comparison (for the reaction with dioxygen) would fail, since no reaction at all would be observed with the radical cation while the free radical reacts rapidly.     

Antimicrobial prophylaxis for catheter-associated bacteriuria

We evaluated short-term systemic antimicrobial prophylaxis for catheter-associated bacteriuria in women undergoing elective gynecological operations in a prospective, controlled, double-masked study. Nine of 100 placebo-treated patients acquired bacteriuria during catheterization compared with 3 of 96 of the drug-treated group. However, at the time of hospital discharge, clean-voided urine specimens were positive as frequently in the drug-treated group (8 of 82 patients cultured) as in the placebo group (8 of 75 patients cultured). No difference in febrile morbidity due to bacteriuria was noted between the prophylaxis and placebo groups. The incidence of catheter-associated bacteriuria may be reduced by antimicrobial prophylaxis. However, because the protective effect is transient and is associated with the selection of resistant organisms, prophylaxis is not indicated for patients at low risk for acquired bacteriuria and in whom the sequelae of catheter-associated infections are infrequent.     

Mitral valve prolapse with atrioventricular and sinoatrial node abnormalities of long duration

A 20-hear-old patient with mitral valve prolapse and minimal mitral regurgitation associated with intermittent marked sinus bradycardia and sinus arrhythmia, and atrioventricular block, proximal to the bundle of His, varying from first-degree to high-grade, is described. Both the murmur and the atrioventricular block had been documented since the age of eight years, and probably since the first year of life, and has shown no subsequent progression. The patient's symptoms of chest pain and severe lightheadedness and near syncope have been shown by telemetry electrocardiogrphic monitoring to be unrelated to changes in cardiac rhythm.