[Carcinoid syndrome: report of a case with heart involvement and primary ovarian tumor]

A patient with a primary ovarian carcinoid tumor with extensive carcinoid heart disease, without hepatic metastases is presents. Literature was revisited, emphasizing that carcinoid heart disease secondary to an ovarian tumor is quite rare. Surgical indications relative to this patient are discussed.

Heterogeneity of Helicobacter pylori cag genotypes in experimentally infected mice

Our aim was to assess whether the Helicobacter pylori population recovered from experimentally infected mice show heterogeneity in cag genotypes. Wild-type FVB/N mice were challenged with strain Hp1 and sacrificed 8 weeks later. Direct PCR on gastric tissue was performed using primers for glmM and cagA, and for these two genes and for cagE and virB11 using DNA from the infecting and the emerging strains. The gastric tissues of two of five mice were PCR+ for glmM but not cagA. For the infecting strain, the PCRs for all four genes studied were strongly positive, but the sweeps from the emerging strains from both mice gave weaker signals for cagA and cagE. Examination of single colonies showed reduced or absent signals for cagA and cagE in relation to glmM and virB11. Serial dilution PCR of sweep isolates from the mice showed a 10- to 100-fold decrease in cagA signal compared to the infecting strain. The decrease of cagA and cagE, but not virB11, amplification and lack of cagA hybridization in Southern blots indicates a selective loss of the right half of the cag island during murine infection. This phenomenon is consistent with host-induced adaptive changes of cag genotype in the population of colonizing H. pylori cells.

Model-independent source imaging using two-pion correlations in (2 to 8)a GeV Au+Au collisions

We report a particle source imaging analysis based on two-pion correlations in high multiplicity Au+Au collisions at beam energies between 2A and 8A GeV. We apply the imaging technique introduced by Brown and Danielewicz, which allows a model-independent extraction of source functions with useful accuracy out to relative pion separations of about 20 fm. The extracted source functions have Gaussian shapes. Values of source functions at zero separation are almost constant across the energy range under study. Imaging results are found to be consistent with conventional source parameters obtained from a multidimensional Hanburg-Brown-Twiss analysis.

Effects of fish farm loadings on seagrass (Posidonia oceanica) distribution, growth and photosynthesis

The spatial extent and timing of the impact of fish farms on the distribution and performance of a Posidonia oceanica meadow were examined in an embayment of the south-eastern coast of Spain (Hornillo Bay, Murcia). Changes in seagrass distribution were determined using available seagrass mapping (from 1988, i.e., before the onset of aquaculture activities and 1998) and by successive sampling in 1994 and 1998. Environmental variables (light attenuation coefficient, water-column dissolved nutrients and organic content of sediments) together with plant performance (shoot biomass, leaf growth rate, photosynthetic activity, carbohydrate reserves, the number of leaves per shoot, epiphyte loads and herbivore pressure) were measured in plants affected by organic discharges, and were compared with those found in reference healthy plants over an annual growth cycle. Since the onset of fish farm activity, 11.29 ha of P. oceanica meadow has been completely lost and 9.86 ha significantly degraded, thus resulting in a total affected area which accounts for about 53% of the former meadow, or 7-fold the fish farming area. Unequal propagation of seagrass die-off or degradation reflects the relevance of local factors such as depth and hydrodynamism on the true extent of fish farm impact. Water transparency decreases and dissolved nutrient and organic content of sediments increases in the vicinity of cages compared to distant reference stations, thus supporting the notion of environmental gradients caused by the organic release from cages, which spreads outwards. Shoot size, leaf growth rate and the number of leaves per shoot in plants close to the fish farm decreased. Moreover, low leaf growth and low rhizome carbohydrate concentration (always relative to that found in an undisturbed area) indicated carbon budget imbalances. Since light reduction in the affected area was only modest (31% of light reaching the sea surface, while at the same depth this figure was 39% at the reference site), and light availability was well above the minimum requirement estimated for this species, neither this factor nor epiphyte overgrowth (epiphyte load was lower in the affected area) seem to explain such carbon imbalances or the observed meadow regression. Alternatively, the high herbivore pressure found in the affected zone suggests that overgrazing is one of the main causes of decreasing shoot sizes and hence of carbon imbalance, reduced growth and shoot mortality. The impact of fish farms on seagrasses, therefore, seems to be highly variable and depends on complex interactions between a large number of processes.

Dislocation of the polyethylene inlay due to anterior tibial slope in revision total knee arthroplasty

We report a case of dislocation of the polyethylene inlay in revision total knee arthroplasty. Eight days after revision arthroplasty due to a previous infection, the polyethylene inlay of a PCL- retaining cemented total knee arthroplasty dislocated at about 80 degrees of flexion on the CPM machine. Lateral X-ray examination revealed an anterior slope of the tibial cut of 5 degrees. Correction of the tibial slope to a posterior tibial slope of 7 degrees reduced the forces on the posterior aspect of the inlay and no redislocation occurred. The mechanisms causing tibial inlays to dislocate in TKA are analyzed and discussed.

Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings

Our purpose was to compare the accuracy of ultrasonography (US) and magnetic resonance (MR) in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings. Using US and MR, we studied all painful shoulders seen during 1998 in our orthopaedic unit. Diagnosis was confirmed in 61 cases. The diagnosis of full thickness rotator cuff tear was highly specific on both imaging techniques (100% for US and 97.1% for MR) but was not as sensitive on US (57.7%) as on MR (80.8%). The diagnosis of partial tear was acceptably specific (67.9% for US and 75.5% for MR) but was not sensitive (overall, 12.5% for US vs 50% for MR). The specificity of a US diagnosis of a tear allows us to recommend surgery, thus making it a good imaging technique for the initial study of painful shoulders. The low sensitivity makes it necessary to undertake an additional MR study. If the MR also discovers no pathology, the sensitivity based on the US and MR images (92.7%) can be sufficient to avoid a false-negative diagnosis.

Lipophilic extractives in process waters during manufacturing of totally chlorine free kraft pulp from eucalypt wood

The chemical composition of lipophilic extractives from process waters throughout a totally chlorine free (TCF) bleaching sequence after kraft pulping of eucalypt wood has been studied. These compounds are among the most problematic wood constituents for both TCF and zero liquid effluent (ZLE) processes, since they tend to accumulate in circuits resulting in the formation of the so-called pitch deposits causing serious problems in the pulp and paper industry. Pitch deposits collected at different parts of the pulp mill were also characterized and their composition compared with that of lipophilic compounds in process waters and Eucalyptus globulus wood. The identification of these compounds from process waters, wood and pitch deposits was performed by gas chromatography and gas chromatography-mass spectrometry using short- and medium-length high temperature capillary columns. Sterols, sterol esters, steroid ketones and steroid hydrocarbons were the main compounds identified. These chemical species arise from eucalypt wood extractives that survive the pulping and are released from pulp into the process waters during the bleaching process. Finally, they can deposit in pulp and on different parts of the mill or remain suspended in process waters being discharged in effluents.

Color and spectral analysis of daylight in southern Europe

We have analyzed the colorimetric and spectral characteristics of 2600 daylight spectra (global spectral irradiances on a horizontal surface) measured for all sky states during a 2-year period at Granada, Spain. We describe in detail the chromaticity coordinates, correlated color temperatures (CCT), luminous efficacies, and relative UV and IR contents of Granada daylight. The chromaticity coordinates of Granada daylight lie far above the CIE locus at high CCTs (>9,000 K), and a CCT of 5,700 K best typifies this daylight. Our principal-components analysis shows that Granada daylight spectra can be adequately represented by using six-dimensional linear models in the visible, whereas seven-dimensional models are required if we include the UV or near-IR. Yet on average only three-dimensional models are needed to reconstruct spectra that are colorimetrically indistinguishable from the original spectra.

Pteridium aquilinum (bracken fern) toxicity in cattle in the humid Chaco of Tarija, Bolivia

We studied the toxicity caused by chronic ingestion of Pteridium aquilinum (bracken) in cattle in the humid Chaco of Tarija, Bolivia. Bovine enzootic haematuria (BEH) and Carcinoma of the esophagus (CE) affected the herds. Sick animals showed caquexia, anemia, leucopenia and urine that turned from pink to intense red color with the presence of blood clots. Cattle grazed in the humid forests of the mountains where P aquilinum represented more than 50% of the plants. P aquilinum var arachnoideum and P aquilinum var Caudatum were present. Toxic norsesquiterpene, ptaquiloside, was identified in both varieties. Carcinomas were in the urinary bladders and esophagus of 100% and 50% of the cattle, respectively. Control of the intoxication could be difficult due to geographic characteristics of this Bolivian region.

Scapular neck fracture--the influence of permanent malalignment of the glenoid neck on clinical outcome

A scapular neck fracture is considered unstable if it is associated with an ipsilateral clavicular fracture or an acromioclavicular (AC) joint dislocation. Currently, it is recommended that stabilization of a disrupted shoulder girdle must be achieved through open reduction and internal fixation of the clavicular fracture or by reduction of the AC joint, without addressing the scapular neck. However, if the displaced glenoid neck is not simultaneously reduced, malalignment of the glenoid neck may persist. The purpose of this retrospective study was to analyze the effect of associated shoulder girdle injury on glenoid displacement and the influence of glenoid malalignment on clinical outcome. Nineteen patients with scapular neck fractures were reviewed clinically and radiologically at a mean of 8 years (range 2-21 years) after injury. None of them has developed nonunion of the scapular neck, and only one showed radiological signs of mild degenerative joint disease. The glenopolar angle (GPA), which assesses the rotational malalignment of the glenoid about an anteroposterior axis perpendicular to the scapular plane on plain X-rays was measured less than 20 degrees in six patients. Three of them had sustained an associated clavicular fracture or AC joint dislocation. The other 3 patients had permanent severe malalignment of the glenoid neck in the absence of an associated shoulder girdle injury. Five patients with GPA less than 20 degrees complained of moderate or severe pain, whereas of the 13 patients with mild or no glenoid rotational displacement or medial displacement alone, 11 patients had no or mild pain, and only 2 had moderate or severe pain (P = 0.0095). Five patients presented with reduced activities of daily living, 4 of them had severe glenoid rotational displacement (P = 0.0173). Loss of motion was found in only 2 patients, and both had a severely displaced glenoid neck (P = 0.088). In conclusion, severe displacement of the glenoid neck may occur with or without associated fracture of the clavicle or dislocation of the AC joint and can be identified as a GPA less than 20 degrees. Scapular neck fractures with such malalignment have a less favorable long-term outcome compared with otherwise comparable cases with absence of glenoid malalignment as measured with the glenopolar angle.

Expression of an endothelial-type nitric oxide synthase isoform in human neutrophils: modification by tumor necrosis factor-alpha and during acute myocardial infarction

OBJECTIVES

The purpose of this study was to determine whether human neutrophils express an endothelial-type nitric oxide synthase (eNOS), and to study the effect of tumor necrosis factor-alpha (TNF-alpha) on its expression.

BACKGROUND

Several studies have demonstrated the presence of a constitutively expressed nitric oxide svnthase (NOS) in neutrophils. Cardiovascular disease is characterized by increased levels of plasma TNF-alpha, a cytokine that has demonstrated eNOS messenger ribonucleic acid (mRNA) destabilization in cultured endothelial cells.

METHODS

Neutrophils were obtained from healthy volunteers and from patients with acute myocardial infarction (AMI).

RESULTS

Human neutrophils express eNOS mRNA and eNOS protein. Stimulation of neutrophils with TNF-alpha decreased eNOS protein expression by reducing eNOS mRNA stabilization. In the present study, we also show that the cytosol of human neutrophils contains proteins that bind to a specific region within the 3'-untranslated region (3'-UTR) of eNOS mRNA. Tumor necrosis factor-alpha increased the binding of the cytosolic proteins to the 3'-UTR of eNOS mRNA. Simvastatin reduced the TNF-alpha-related binding activity of neutrophil cytosolic proteins to eNOS mRNA, which was associated with its protective effect on eNOS protein expression. The in vivo reproduction of the in vitro findings was performed in neutrophils obtained from patients with AMI and showed a diminished expression of eNOS protein, which was associated with increased binding of the cytosolic proteins.

CONCLUSIONS

These observations demonstrate that human neutrophils express eNOS, which is downregulated by TNF-alpha and during AMI. This effect is associated with increased binding of neutrophil cytosolic proteins to the 3'-UTR of eNOS mRNA.

Mutations in a conserved enteroviral RNA oligonucleotide sequence affect positive strand viral RNA synthesis

We showed earlier that a transition mutation U234C, located within the completely conserved 5 nucleotide (nt) tract 5'-CGUUA (nt232-236) in the 5' non-translated region (NTR) of the coxsackievirus B3 (CVB3) genome, attenuated CVB3 cardiovirulence in mice. To further explore the role of the sequence, we induced two single and one double transversion mutations in the conserved 5mer in a cardiovirulent CVB3 genome. The mutated sites partially or totally reverted to parental wild-type when progeny viruses were passaged at 37 degrees C, but remained stable when transfection and subsequent passages were performed at 33.5 degrees C. Viral replication in cell culture was attenuated at 37 degrees C or 39.5 degrees C relative to replication at 33.5 degrees C. While Western blot analysis demonstrated the level of protein translation consistent with virus replication, the ratios of positive to negative strand viral RNA at 37 degrees C in murine cells demonstrated a 2-5 fold diminution from those measured at 33.5 degrees C. Mutant CVB3 strains failed to replicate productively when inoculated into mice. The biological data are consistent with an hypothesis that proposes a lesion with primary effects at the level of positive strand viral RNA synthesis that results in attenuation of viral replication at physiologic temperature.

Colorimetric and spectroradiometric characteristics of narrow-field-of-view clear skylight in Granada, Spain

As part of our ongoing research into the clear daytime sky's visible structure, we analyze over 1,500 skylight spectra measured during a seven-month period in Granada, Spain. We use spectral radiances measured within 3 degrees fields of view (FOV's) to define colorimetric characteristics along four sky meridians: the solar meridian and three meridians at azimuths of 45 degrees, 90 degrees, and 315 degrees relative to it. The resulting clear-sky chromaticities in 44 different view directions (1) are close to but do not coincide with the CIE daylight locus, (2) form V-shaped meridional chromaticity curves along it (as expected from theory), and (3) have correlated color temperatures (CCT's) ranging from 3,800 K to infinity K. We also routinely observe that sky color and luminance are asymmetric about the solar meridian, usually perceptibly so. A principal-components analysis shows that three vectors are required for accurate clear-sky colorimetry, whereas six are needed for spectral analyses.

Analysis of discrimination threshold on the tritan axis

Discrimination thresholds on the tritan axis were obtained for an extensive group of 66 stimuli: in some of the stimuli, S-cone trolands were held constant by keeping the product of the S-cone excitation level and the luminance unchanged, while in others only the luminance was changed to establish various S-cone troland values. These thresholds depended clearly on the S-cone value of the stimuli, while they remained almost constant against the retinal illumination. Thus, we noted that the excitation of the L - 2M channel had practically no influence over the discrimination threshold on the tritan axis, although this independence of delta S from L - 2M was not so obvious when the S value was high. With our data, we performed different fits, and found that the fit including the terms S, (L - 2M) and (L + M) adapted better to our results.

Enteroviral meningitis. Cost of illness and considerations for the economic evaluation of potential therapies

With limited financial resources available, it is now becoming more acceptable to evaluate medical innovations in terms of incremental economic value. The purpose of this paper is to provide an overview of enteroviral meningitis and to summarise the economic literature to identify relevant costs and outcomes. Enteroviral meningitis is the most common cause of aseptic meningitis, and occurs in 4.5 to 30 per 100,000 population annually with a duration of illness lasting between 1 and 2 weeks after onset of initial symptoms. The major resource categories that contribute to the overall direct costs of management of enteroviral meningitis include physician visits, hospital admissions, emergency room visits, medications, procedures such as lumbar puncture and computed tomography scans, re-hospitalizations and follow-up physician visits. Indirect costs are incurred in terms of school or work days missed or restrictions in daily activities. The total direct costs of an episode of enteroviral meningitis range from $US450 for outpatients to $US5093 for inpatient management (1996 values). The total indirect costs of an episode of enteroviral meningitis are estimated to be equivalent to 5 to 7 activity-restricted days. Interventions that improve early diagnosis or decrease the duration and need for hospitalisation will significantly affect the cost of managing enteroviral meningitis. Additional prospective studies are needed to study the impact of interventions on the burden of enteroviral meningitis.

[Results of a psychotherapeutic program for smoking after 12 months of follow-up]

OBJECTIVE

To compare the efficacy of psychological counseling for smokers in a cessation program in comparison with treatment based only on providing information about damage caused by tobacco and advice for quitting, and to determine the reasons patients started to smoke.

PATIENTS AND METHODS

We studied 249 patients who came to a preliminary interview; 226 began treatment for smoking cessation. The average level of dependence, quantified the Fagerstrom test was 7.26 +/- 1.85 points. Two treatment groups were formed: the first patients seen made up the control group (n = 37), which received information about the dangers of tobacco and strategies for quitting, and the psychological counseling group (n = 189). Follow-up examinations were performed three, six and twelve months after treatment, with abstinence checked by measurement of CO in exhaled air. Only patients with CO levels less than 5 ppm (particles per million) in exhaled air were considered non-smokers.

RESULTS

Most patients of both sexes named social pressure as the reason for starting to smoke. The rate of abstinence in the information and strategies group was 8.1% at all three follow-up visits, whereas the rate was 37%, 25.4% and 24.3% at three, six and twelve months, respectively, in the group receiving counseling. The differences between the two groups were significant at all visits.

CONCLUSIONS

Social pressure is the main reason for starting to smoke. We observed a success rate of 24.3% after one year of follow-up after psychological treatment only, a rate that was significantly higher than that of the group that received only information. We believe that psychological counseling is an effective alternative for smokers who want to quit.

Intracytoplasmic sperm injection with cryopreserved testicular spermatozoa

To assess if testicular sperm cryopreservation is a valid alternative to repetition of testicular sperm retrieval techniques, results of a cryopreservation technique in pills have been retrospectively analyzed. Enough motile spermatozoa for ICSI were obtained in 172 from 190 (90.5%) frozen-thawed testicular sperm samples. Overall, 249 couples underwent 390 ICSI cycles, 156 using fresh and 234 using cryopreserved testicular sperm. Mean two-pronuclear fertilization rates per cycle were not significantly different after ICSI with fresh (62.0%) or with cryopreserved (63.2%) spermatozoa. Mean embryo cleavage rate per cycle was higher in the fresh (90.6%) than in the cryopreserved (84.6%) group (P = 0.016). However, clinical pregnancy rates per cycle (28.2% with fresh vs 27.8% with cryopreserved), implantation rates (12.2% vs 13.1%) and ongoing pregnancy rates per cycle (22.4% vs 21.8%) were not significantly different. Cryopreservation of testicular spermatozoa is an effective technique that can be used both in obstructive and in non-obstructive azoospermia.

Therapeutic decision tree for patients with sustained ventricular tachyarrhythmias or aborted cardiac arrest: a critical review of the Antiarrhythmics Versus Implantable Defibrillator trial and the Canadian Implantable Defibrillator Study

Antiarrhythmic drugs, mainly amiodarone and sotalol, radiofrequency catheter ablation, and the implantable cardioverter defibrillator (ICD) are the 3 therapeutic options in patients with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Idiopathic VT, incessant VT, frequently recurring, hemodynamically stable VT, and VT based on bundle branch reentry, are candidates for radiofrequency catheter ablation. Patients with high-risk ventricular tachyarrhythmias should receive ICDs as initial therapy. Two studies, the Antiarrhythmics Versus Implantable Defibrillator trial (AVID) and the Canadian Implantable Defibrillator Study (CIDS) have tried to approach the problem of these high-risk ventricular tachyarrhythmias. Although at 3 years, the ICD in AVID demonstrated a significant relative risk reduction over amiodarone of 31.5%, CIDS could not duplicate this finding. At 3 years, the relative risk reduction conferred by the ICD over amiodarone in CIDS was only 13.7%. A careful analysis of both studies suggests that CIDS was insufficiently powered to demonstrate statistically significant benefits similar to those shown by AVID, and furthermore, seemed to include an undetermined number of low-risk VT patients. The problem in the CIDS trial in this regard was the recruitment of patients in whom the inclusion criteria were met by the arrhythmias induced during the electrophysiology stimulation study, but which did not exist in real life. In addition CIDS included 14% of patients with (1) undocumented syncope and inducible monomorphic sustained VT; or (2) long runs of spontaneous nonsustained VT. Under these circumstances, the therapeutic implications of AVID remain unchallenged.