Mammographic screening. A key examination for the early diagnosis of breast cancer

The insufficiency of the tricuspid valve developed due to blunt chest trauma is a rare and an insidiously progressing clinical incident. In this article we present a case which showed tricuspid insufficiency because of the rupture of the anterior papillary muscle due to trauma and which was treated surgically.     

An Algebra for Pomsets

We study languages for manipulatingpartially orderedstructures withduplicates(e.g., trees, lists). As a general framework, we consider thepomset(partially ordered multiset) data type. We introduce an algebra forpomsets, which generalizes traditional algebras for (nested) sets, bags, and lists. This paper is motivated by the study of the impact of different language primitives on the expressive power. We show that the use of partially ordered types increases the expressive power significantly. Surprisingly, it turns out that the algebra when restricted to both unordered (bags) and totally ordered (lists) intermediate types, yields the same expressive power as fixpoint logic with counting on relational databases. It therefore constitutes a rather robust class of relational queries. On the other hand, we obtain a characterization of PTIME queries on lists by considering only totally ordered types.     

Effect of grass vs. concentrate feeding on the fatty acid profile of different fat depots in lambs

The aim of this study was to produce high‐quality meat from lambs under different feeding conditions, as measured by the accumulation of n‐3 fatty acids and conjugated linoleic acids (CLA) in muscle and subcutaneous fat. In total, 13 male crossbred lambs (Black Head×Gotland), each at 24 kg live weight, were divided into two feeding groups. Lambs were kept either on pasture (pasture grazing, n = 6) or in the stable (concentrate feeding, n = 7). The linolenic acid (C18:3n‐3) contained in the grass was absorbed and deposited into the different lipid classes of muscle and subcutaneous fat. The proportion of total n‐3 fatty acids in the different lipids of grazing lambs was significantly (p = 0.05) higher compared to that in concentrate‐fed lambs. The n‐6/n‐3 ratio (mean ± SEM) in muscle of grazing lambs was 1.2 ± 0.09 in contrast to 2.3 ± 0.09 (p = 0.05) of the animals kept in the stable. In subcutaneous fat, this ratio was 0.9 ± 0.2 in lambs kept on pasture versus 3.5 ± 0.2 (p = 0.05) after indoor keeping. The relative concentration of C18:1trans‐11 in total muscle lipids, phospholipids, triacylglycerols and subcutaneous fat was significantly increased by grass feeding compared to concentrate feeding. Significant influences of feeding were shown for saturated fatty acids. In concentrate‐fed lambs, a lower content of saturated fatty acids was detected. The proportion of CLAcis‐9,trans‐11 (1.9 ± 0.2% vs. 1.1 ± 0.1% in muscle, 2.5 ± 0.2% vs. 1.4 ± 0.2% in subcutaneous fat, 0.7 ± 0.04% vs. 0.4 ± 0.04% in phospholipids) in lambs was significantly (p = 0.05) higher after grazing than after concentrate feeding, respectively.     

A syndrome of female pseudohermaphrodism, hypergonadotropic hypogonadism, and multicystic ovaries associated with missense mutations in the gene encoding aromatase (P450arom)

We report the features of a new syndrome of aromatase deficiency due to molecular defects in the CYP19 (P450arom) gene in a 46,XX female. At birth, the patient presented with a nonadrenal form of female pseudohermaphrodism. At 17 months of age, laparotomy revealed normal female internal genital structures; the histological appearance of the ovaries was normal. FSH concentrations were markedly elevated at 9.4 ng/mL LER 869, and estrone and estradiol levels were undetectable (< 37 pmol/L). By 14 yr of age, she had failed to exhibit breast development. The clitoris had enlarged to 4 x 2 cm, and pubic hair was Tanner stage IV. The plasma concentration of testosterone was elevated at 3294 pmol/L, as was androstenedione at 9951 pmol/L. Plasma estradiol levels were below 37 pmol/L. ACTH and dexamethasone tests indicated a nonadrenal source of testosterone and androstenedione. Plasma gonadotropin levels were in the castrate range. Pelvic sonography and magnetic resonance imaging showed multiple 4- to 6-cm ovarian cysts bilaterally. Despite increased circulating androgens and clitoral growth, the bone age was 10 yr at chronologic age 14 2/12 yr. Estrogen replacement therapy resulted in a growth spurt, breast development, menarche, suppression of gonadotropin levels, and resolution of the cysts. The clinical findings suggested the diagnosis of P450arom deficiency. Analyses of genomic DNA from ovarian fibroblasts demonstrated two single base changes in the coding region of the P450arom gene, one at 1303 basepairs (C-T), R435C, and the other at 1310 basepairs (G-A), C437Y, in exon 10. The molecular genetic studies indicate that the patient is a compound heterozygote for these mutations. Expression of these mutations showed that the R435C mutation had 1.1% the activity of the wild-type P450arom enzyme, whereas the C437Y mutation demonstrated no activity. The cardinal features of this syndrome are a consequence of P450arom deficiency: 1) the fetal masculinization in this syndrome can be ascribed to defective placental conversion of C19 steroids to estrogens, leading to exposure of the female fetus to excessive amounts of testosterone; 2) the pubertal failure, mild virilization, multicystic ovaries, and hyperstimulation of the ovaries by FSH and LH are the result of the inability of the ovary to aromatize testosterone and androstenedione to estrogens; and 3) the striking delay in bone age at 14 2/12 yr supports the notion that estrogens, in contrast to androgens, are the major sex steroid driving skeletal maturation during puberty. Familial P450arom deficiency, although rare, may be more common than previously suspected.(ABSTRACT TRUNCATED AT 400 WORDS)     

Torsion of intraperitoneal renal transplants: imaging appearances

OBJECTIVE: Torsion of a renal transplant is a rare complication with nonspecific clinical manifestations. Prompt detection is necessary to allow surgical treatment and to preserve renal function. We describe the radiologic appearances of torsion of intraperitoneal renal transplants in patients who have undergone simultaneous renal and pancreatic transplantation or dual renal transplantation. CONCLUSION: Renal transplant torsion should be suspected when a change in renal axis associated with abnormal perfusion occurs in an intraperitoneal kidney.     

Independent practice association physician groups in California

Hemispatial neglect is a neurological disorder which entails a spatial bias that penalizes events occurring in the hemispace contralateral to a brain lesion. Mechanisms operating upon various stages ranging from perception to action have been invoked to explain neglect. The present study explores the contribution of a defective programming of arm movements towards the neglected hemispace to neglect behaviour. Two reaction time tasks -- a "perceptual" task and a "motor" task -- were performed by right brain-damaged (RBD) patients with left hemispatial neglect, RBD patients without signs of neglect and control subjects. The perceptual task consisted of lateralized visual stimuli and central motor responses, whereas the motor task consisted of visual stimuli presented on the vertical midline and hand responses to be produced in either hemispace. Neglect patients showed a rightward bias on the perceptual task, but only two RBD patients (showing no signs of severe neglect) were consistently slowed in producing leftward motor responses. Different reference frames may thus be used in perceptual tasks and tasks involving arm movements. We conclude that hemispatial neglect commonly results from attentional impairments operating upon a visual perceptual frame of reference; additional deficits appear to be necessary to produce a directional motor disorder.