Classification of hemodynamic changes in renal artery stenosis using cine magnetic resonance phase contrast flow measurements

PURPOSE: To evaluate the use of high-temporal resolution cine MR phase-contrast flow measurements for assessment of flow dynamics in renal artery stenosis (RAS). MATERIAL AND METHODS: In a dog model, cine MR flow measurements were validated by comparing the MR flow data to an invasive transit-time ultrasound reference technique for different degrees of RAS. Cardiac-gated MR flow curves were recorded in 56 renal arteries of 28 patients with a temporal resolution of at least 32 ms. In all cases RAS was confirmed by digital subtraction angiography (DSA). Abnormalities of flow dynamics were assessed in the calculated flow curves using the MR parameters mean flow, maximum velocity, and time to systolic maximum. RESULTS: By means of the MR blood flow parameters high-grade stenoses (> 50%, n = 23) were detected with sensitivity of 100% and specificity of 94% with reference to DSA. The overall differentiation between stenoses (n = 37) and non-stenosed vessels (n = 19) revealed a sensitivity of 87% and a specificity of 100%. CONCLUSION: Analysis of cardiac-gated MR flow curves provides a non-invasive method to assess the hemodynamic significance of RAS and thus allows a functional evaluation in relation to the morphologic characteristics of the stenosis.     

Persistence of hepatitis C virus in newborn mice brain cell culture

A model of chronic infection of primary cultures of suckling mouse brain (SMB) cells actively producing hepatitis C virus (HCV) is developed. Destruction and repopulation of cells was observed for at least 6 months; this phenomenon was paralleled by virus release in culture medium. Persistent HCV contained in SMB cultures induced a cytopathogenic effect in PS, BHK-21, Vero, HAK, and click embryo cell cultures, its infective titers being 10.0-12.0 lg TCD50/0.2 ml. Persistent HCV formed heterogeneous plaques under agar in chick embryo cells. The polymerase chain reaction (PCR) regularly detected the HCV RNA at the stage of cell destruction in the culture fluid of HCV-infected cell cultures. The cytopathogenic activity of persistent HCV was neutralized by anti-HCV positive patients' sera with the neutralization index of 8.0-9.0 lg. The results of persistent HCV neutralization were confirmed by PCR. Immunofluorescence detected virus-specific HCV antigens in 15-40% of infected cells. Hence, the SMB-HCV system realized the cytopathogenic potential of HCV circulating in the blood of patients with hepatitis C. This system is promising for the study of the pathogenesis of HCV infection at a cellular level, for screening for specific and nonspecific antiviral agents, and for preparing native virus-specific proteins and RNA.     

Chimeric bispecific OC/TR monoclonal antibody mediates lysis of tumor cells expressing the folate-binding protein (MOv18) and displays decreased immunogenicity in patients

The current environment in which medicine is taught and practiced requires that medical schools pay increased attention to the faculty member's roles, rewards, career development, and productivity. Medical schools must make strategic decisions about the allocation of resources that can nurture their faculties and support the activities in academic and community settings in which faculty are involved. From 1993 to 1995 Allegheny University of the Health Sciences (formerly Medical College of Pennsylvania and Hahnemann University) designed a comprehensive system for the professional development of faculty. This system is based upon expanded categories of faculty academic activity and scholarship. New programs were implemented to reorient faculty toward conducting and documenting the expanded array of scholarly activities. The main characteristics of the new system are the establishment of formally defined performance expectations, the vertical alignment of the individual faculty member's objectives with the department's mission and the school's mission, and an increasing emphasis upon faculty interdependence, accountability, and use of sound business practices. The authors describe these and other aspects of the design of the new system in detail and report initial results and lessons learned from the system's implementation, evaluation, and dissemination throughout the university. The long-term success of this comprehensive professional development program will be assessed over time by observing how this institution advances its mission in a well-planned and cost-effective manner that retains talented, productive, and professionally fulfilled faculty.     

Differential accumulation and tissue distribution of mosquito hexamerins during metamorphosis

We report on 30 cases where we have used cortical stimulation mapping to define the areas representing sensorimotor, language and speech functions under local anesthesia to facilitate resection of space-occupying lesions near these areas. Under the simplistic concept that Broca's area lies in the frontal operculum (inferior frontal gyrus) and that Wernicke's area is located in the posterior perisylvian area (superior temporal, angular and supramarginal gyri), we found language and speech function to be represented outside these areas in up to 4 stimulation sites of 15 patients. The results of cortical stimulation mapping were therefore essential to decide on the optimal access route to the lesions that were located subcortically and on the optimal resection plane in gliomas. After the limits of these areas and of the lesions had been established with stimulation mapping and with intrasurgical microscopic smear preparations, respectively, lesions were safely removed under continuous monitoring of sensorimotor, language and speech function. Immediately after surgery we encountered language and speech deficits in 9 patients (30%), which resolved completely in 5 and incompletely in 4 instances. Thus, language functions were normal in 26 patients (87%) at the end of the follow-up period. It is concluded that use of this technique allows safe and extensive resection of lesions that would otherwise have been considered hazardous to remove or inexcisable.     

Determination of ofloxacin in human aqueous humour by high-performance liquid chromatography with fluorescence detection

This unusual pathology has not been described in the medical literature of the last ten years. A 39-year-old patient, affected by unilateral cryptorchidism, on the right side, and congenital inguinal hernia, reached the operating theatre suffering from occlusive intestinal syndrome, due to a clogged hernial sac. This clog was caused by a retracting testicle which in turn stopped the ileal ansa from slipping back in to the peritoneum. Through this case we can underline the excursus of such pathology, which isn't very frequent in the adult but can, nevertheless create a fairly serious pathology, often leading to neoplan.     

A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure. Vesnarinone Trial Investigators

BACKGROUND: Vesnarinone, an inotropic drug, was shown in a short-term placebo-controlled trial to improve survival markedly in patients with severe heart failure when given at a dose of 60 mg per day, but there was a trend toward an adverse effect on survival when the dose was 120 mg per day. In a longer-term study, we evaluated the effects of daily doses of 60 mg or 30 mg of vesnarinone, as compared with placebo, on mortality and morbidity. METHODS: We enrolled 3833 patients who had symptoms of New York Heart Association class III or IV heart failure and a left ventricular ejection fraction of 30 percent or less despite optimal treatment. The mean follow-up was 286 days. RESULTS: There were significantly fewer deaths in the placebo group (242 deaths, or 18.9 percent) than in the 60-mg vesnarinone group (292 deaths, or 22.9 percent) and longer survival (P=0.02). The increase in mortality with vesnarinone was attributed to an increase in sudden death, presumed to be due to arrhythmia. The quality of life had improved significantly more in the 60-mg vesnarinone group than in the placebo group at 8 weeks (P<0.001) and 16 weeks (P=0.003) after randomization. Trends in mortality and in measures of the quality of life in the 30-mg vesnarinone group were similar to those in the 60-mg group but not significantly different from those in the placebo group. Agranulocytosis occurred in 1.2 percent of the patients given 60 mg of vesnarinone per day and 0.2 percent of those given 30 mg of vesnarinone. CONCLUSIONS: Vesnarinone is associated with a dose-dependent increase in mortality among patients with severe heart failure, an increase that is probably related to an increase in deaths due to arrhythmia. A short-term benefit in terms of the quality of life raises issues about the appropriate therapeutic goal in treating heart failure.     

Postcatheterization retroperitoneal hematoma due to spontaneous lumbar arterial hemorrhage

Non-traumatic stereotyped postictal purpura is rare. A 25-year-old woman presented with right facial, cheek and periorbital purpuric eruptions that occurred after secondarily generalized tonic-clonic seizures. The stereotyped, invariably right-sided facial skin eruption, which resolved in 48 hours, falsely raised concerns of spousal abuse. Possible pathophysiological mechanisms include: (a) valsalva-induced capillary hypertension with secondary purpura, (b) ictal corticolimbic stimulation of the autonomic nervous innervation of facial vasomotor structures, and (c) trigeminal-mediated local release of vasoactive substances. Although rare, such stereotyped patterns of purpura should be recognized to avoid incorrect attribution of spousal abuse.     

Tunneled hemodialysis catheters: use of a silver-coated catheter for prevention of infection--a randomized study

OBJECTIVE: The purpose of this study was to determine the feasibility of high-resolution sonography for the detection of meniscal cysts and associated meniscal tears and for the differentiation of meniscal cysts from other masses at the knee joint. SUBJECTS AND METHODS: Fifty consecutive patients (51 knees) with a palpable mass at the knee joint were examined prospectively using a 7.5-MHz annular array transducer. Mass consistency and location and meniscal integrity were evaluated. Sonographic findings were correlated with surgery (46/51) and histopathology (15/51). Five patients did not undergo surgery. RESULTS: At surgery, 32 masses appeared to be meniscal cysts, whereas 19 were other types of masses. Sonographically, 31 of the 32 meniscal cysts were diagnosed correctly. Sonographic differentiation of the other types of masses from meniscal cysts could reliably be made in 17 of 19 cases; two masses were falsely interpreted as meniscal cysts. Sensitivity, specificity, and accuracy of sonography in the depiction of meniscal cysts were 97%, 86%, and 94%, respectively. The positive predictive value was 94% and the negative predictive value was 92%. Meniscal tears (31/46) and meniscal tears concomitant with meniscal cysts (26/32) were detected with an accuracy of 83% and 88%, respectively. CONCLUSION: Sonography is an accurate imaging technique for the detection of meniscal cysts and associated meniscal tears. Differentiation of meniscal cysts from other cystic and solid masses at the knee joint can be reliably made with sonography.     

Percutaneous radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis

p27kip1 (p27) protein is an inhibitor of cyclin and cyclin-dependent kinase complexes and prevents progression of cells from G1 to the S phase of the cell cycle. p27 might have tumor suppressor activity, and decreased p27 expression is associated with aggressive tumor behavior in several human malignancies. The object of this study was to evaluate p27 expression in prostatic adenocarcinoma treated by radical prostatectomy and to assess its association with numerous morphologic and clinical features. One hundred thirty-eight prostatic adenocarcinomas were evaluated for p27 expression by quantifying nuclear immunohistochemical staining. p27 expression was tested for association with patient age, family history of prostate cancer, preoperative serum prostate-specific antigen level, Gleason score, extraprostatic extension, seminal vesicle involvement, lymph node metastases, tumor-node-metastasis stage, DNA ploidy by flow cytometric analysis, and subclinical biochemical failure. p27 expression was analyzed as a continuous variable, and we also classified the tumors as low expressors (< 50% of cells p27 positive) or high expressors (> 50% of cells p27 positive) for comparison. Patients with adenocarcinomas that exhibited low p27 expression had higher mean Gleason scores than did high expressors (7 vs. 6.2, respectively; P = .002). Low p27 expression correlated with positive surgical margins (P = .05), seminal vesicle involvement (P = .007), lymph node metastasis (P = .03), and aneuploid cancers (P = .003), but it did not correlate with subclinical biochemical failure. p27 expression correlated with a number of prognostic morphologic features in prostatic adenocarcinoma, and the evaluation of p27 expression might provide additional prognostic information.