Scabies associated with a bullous pemphigoid-like eruption

Intramuscular phenol neurolysis is a well-known procedure used to decrease spasticity and improve function in patients who have failed to respond to more conservative forms of intervention. Traditionally, this approach has been limited to spasticity reduction in limb muscles, and its use in managing spasticity of the facial muscles has not been described in the literature. This case report describes a new and previously unreported application of intramuscular neurolysis for managing severe unrelenting facial muscle spasticity in a postanoxic encephalopathic patient. Prior to the procedure, hypertonicity in the orbicularis oris muscle was so profound that it limited speech and affected cosmetic, hygienic, and nutritional status. After intramuscular phenol neurolysis of the orbicularis oris muscle, the patient's level of functioning improved.     

Primary retroperitoneal germ cell tumours: excision via a thoracoabdominal extraperitoneal approach

BACKGROUND: Primary retroperitoneal germ cell tumours usually present as a large abdominal mass in young men. The testes are normal on examination and ultrasonography but there are usually raised serum levels of human chorionic gonadotrophin and/or alpha-fetoprotein. METHODS: Fourteen men (median age 33 years) with primary retroperitoneal germ cell tumours were treated by chemotherapy followed by surgical resection of the primary tumour and metastases via a thoracoabdominal extraperitoneal approach. RESULTS: There was minimal morbidity. The survival rate was 13 of 14 and the disease-free survival rate was 11 of 14 after a median follow-up of 15 months. CONCLUSION: The thoracoabdominal extraperitoneal approach for the removal of retroperitoneal germ cell tumours and their metastases after chemotherapy improves tumour clearance, morbidity and recovery time compared with the transperitoneal anterior approach.     

Effect of Location of Restraint on Fire Response of Steel Beams

Restrained steel beams, when exposed to fire, develop significant restraint forces and often behave as beam-columns. The response of such restrained steel beams under fire depends on many factors including: fire scenario, beam slenderness ratio, location of axial restraint at the supports, and high-temperature properties of steel. A set of numerical studies, using finite element computer program ANSYS, is carried out to study the fire response of steel beam-columns under realistic fire and restraint scenarios. Results from the parametric studies indicate that fire scenario, beam slenderness, location of axial restraint and high-temperature creep have significant influence on the behavior of restrained beams under fire conditions. Severe fires produce high axial forces at early stages of fire exposure; whereas in moderate fires, significant axial force develops only at later stages of fire exposure. Axial restraint enhances the fire resistance due to the development of tensile catenary action in restrained beams. Furthermore, restrained beams with low slenderness ratio exhibit better fire performance when the axial restraint at the support is located at the bottom flange.     

From the Neuroscience of Memory to Psychoanalytic Interaction: Clinical Implications.

The neuroscience of memory enriches and expands our theory of psychoanalytic interaction. There are 2 broad modes of processing memory: implicit (never experienced in symbolic form) and explicit (which is symbolic). Memory is not a thing, but a process, activated by a retrieval cue that is either external or internal. Each memory is an amalgam of the memory itself and the retrieval cue. Using these phenomena derived from the neuroscience of memory, the authors argue that (a) the analyst acts as a retrieval cue making any memory a coconstructed phenomenon; (b) each memory is constructed, transformed, and expanded anew, incrementally leading to new networks and change; and (c) implicit memory, lacking symbolic content, is an underutilized component of psychoanalytic attention. Clinical examples are used as illustrations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single-agent paclitaxel in patients with previously untreated stage IV epithelial ovarian cancer. London Gynaecological Oncology and North Thames Gynaecological Oncology Groups

OBJECTIVES: Prostate-specific antigen (PSA) is a widely used serum marker for human prostate cancer (PCa). The majority of PSA in serum is present as a complex with alpha-1-antichymotrypsin (ACT). In recent years, the ratio of free (uncomplexed) to total PSA has shown improved discrimination of PCa from benign prostatic hyperplasia. This study examines the nature of the free PSA from detected in PCa serum and shows that some of the uncomplexed PSA is an inactive precursor of PSA (pPSA). METHODS: Western blot analysis was used to detect clipped, fragment forms of PSA in sera and seminal fluid. Hydrophobic interaction chromatography-high performance liquid chromatography (HIC-HPLC) was used to identify forms of PSA present in the free PSA population. Pooled sera was passed over a PSA immunoaffinity column, and the eluted PSA components were further resolved by HIC-HPLC. RESULTS: Western blot analysis of whole sera showed complexed PSA and the intact, approximately 34 kilodalton free PSA. Only negligible levels of clipped or degraded forms of PSA, as found in seminal fluid, were detected. Column fractions measured for uncomplexed PSA using the Tandem-MP free PSA assay showed that about 25% of the free PSA eluted as pPSA beginning at the [-4]amino acid. Studies with purified recombinant [-4]pPSA showed that this proenzyme form is inactive and does not complex with ACT. CONCLUSIONS: These results suggest that the uncomplexed PSA in PCa serum is primarily unclipped PSA that contains a significant fraction of pPSA.     

Fire Endurance of High Strength Concrete Columns

In buildings, fire represents one of the most severe environmental conditions, and therefore, should be properly accounted for in the design of high strength concrete (HSC) structural members. The increased use of HSC in buildings has raised concerns regarding the behavior of such concrete in fire. In particular, spalling at elevated temperatures, as identified in studies by a number of laboratories, is a main concern.In this paper, results from an experimental program on the fire resistance of HSC columns are presented. The factors that influence the thermal and structural behavior of HSC concrete columns under fire conditions are discussed. Data from this study indicate that the type of aggregate, concrete strength, load intensity, and detailing and spacing of ties have an influence on the fire resistance performance of HSC columns. Further, the test results show that tie configuration (bending of ties at 135°, ties and provision of cross ties) and closer tie spacing has a significantly beneficial effect on the fire resistance of HSC columns. The results presented will generate data on the fire resistance of HSC columns, and contribute to identifying the factors that influence the behavior of HSC columns.     

三面及四面受火钢骨混凝土柱的耐火性能

在标准火灾条件下进行钢骨混凝土柱的耐火试验。以几何尺寸、三面或四面受火、荷载大小及偏心为参数,研究其对钢骨混凝土耐火性能的影响。结果表明:钢骨混凝土柱三面受火条件下的耐火性能高于四面受火;载荷比和荷载偏心的影响可以忽略;混凝土的剥落降低了柱耐火性能。将试验结果与现有规范进行对比可知,某些条件下,按规范计算的耐火性能可能偏高。     

Mutations in the SDHB gene are associated with extra-adrenal and/or malignant phaeochromocytomas

Germ-line mutations in the genes encoding succinate dehydrogenase complex subunits B (SDHB) and D (SDHD) have been reported in familial paragangliomas and apparently sporadic phaeochromocytomas (ASP), but the genotype-phenotype relationships of these mutations are unknown. Eighty-four patients (all but 2 followed up for 8.8 +/- 5.7 years) with ASP (57 with adrenal tumors, 27 with extra-adrenal, multiple, malignant, or recurrent tumors) were screened for the major susceptibility genes for phaeochromocytoma (RET, VHL, SDHD, and SDHB). Thirty-three tumors were available for molecular analysis, enzyme assays, and immunohistochemistry. No (0%) RET and 2 (2.4%) VHL mutations were detected. Only two coding single nucleotide polymorphisms in the SDHD gene (G12S and H50R) were found in 6 patients (7%). Conversely, six deleterious mutations in the SDHB gene were identified in 8 patients (9.5%). Ectopic site and recurrence or malignancy were strongly associated with SDHB mutations (7 of 8, 87%, versus 20 of 76, 26%; P = 0.001). Somatic DNA analysis indicated a loss of heterozygosity at chromosome 1p36 (SDHB locus) in 16 of 33 cases (48%). A loss of heterozygosity at the SDHB locus was found in all tumors with SDHB mutation, and assays of respiratory chain enzymes showed a complete loss of complex II catalytic activity. The vascular architecture of tumors with SDHB mutations displayed features typical of malignancy. These data strongly suggest that SDHB gene is a tumor suppressor gene and that the identification of germ-line mutations in SDHB gene in patients with ASPs should be considered as a high-risk factor for malignancy or recurrence.