CT-guided fine-needle aspiration of lung nodules: effect on outcome of using coaxial technique and immediate cytological evaluation

PURPOSE

To evaluate the risk of pneumothorax during CT-guided fine-needle aspiration (FNA) of lung nodules with single needle and coaxial needle techniques and to assess the effect on diagnostic accuracy of immediate cytological examination of lung FNA samples.

MATERIALS AND METHODS

This prospective study analysed 53 patients undergoing transthoracic FNA biopsy of lung. 36 cases were performed by a radiologist using a coaxial technique, with 17 cases performed by a radiologist using a direct single-needle method. Effect of technique on occurrence of pneumothorax was recorded. FNA samples from all the patients in the study were examined immediately on-site by a cytologist or MLSO to determine whether sufficient aspirate had been obtained. Provisional diagnosis at immediate examination was compared to final diagnosis following full pathological evaluation.

RESULTS

Coaxial and non-coaxial groups were comparable for age and gender. Number of pleural passes was significantly lower in coaxial group (P < 0.01). Pneumothorax occurred in six (17%) of the 36 patients biopsied by coaxial technique, compared to four (24%) of the 17 patients by non-coaxial method (P = 0.55). Chest tube placement was required in four patients (11%) in the coaxial group, and two patients (12%) in the non-coaxial group (P = 0.85). A provisional cytological diagnosis was recorded for 74% of the patients in the study. 83% of the provisional reports were accurate on comparison with full pathology report. Specimen size was sufficient in 81% of cases.

CONCLUSIONS

The use of coaxial technique for CT-guided lung FNA biopsy reduced the number of pleural passes but did not significantly reduce the occurrence of pneumothorax. Immediate cytological examination of FNA specimens provided an accurate provisional diagnosis in the majority of cases, and should be routinely employed.

Measurements of linear dimensions on fundus photographs: comparison between photographic film and digital systems

PURPOSE

The aim of this study is to compare linear fundal landmarks measurements of standard photographic film with colour digital fundal images.

METHODS

Pairs of fundus fluorescein images were acquired with a digital system and photographic film on 10 patients. Each pair of images was assessed independently by two observers who calculated the distance between two selected points on each image using easily identifiable landmarks. Measurements made using film images were compared to measurements made using the corresponding digital images. Agreement between the two methods of measurements was assessed using a linear correlation and graphical method.

RESULTS

The patients were divided into two groups based on the field setting on the digital software. In Group 1, the correlation coefficient was 0.99 and in Group 2 it was 0.98, indicating a high level of agreement between measurements with the computer measuring tool for digital images compared to photographic films using a standard reticule.

CONCLUSION

On the basis of the strong correlation between linear fundal landmark measurements between standard photographic film and colour digital fundal images, we conclude that the measurements from the digital images are acceptable for diagnostic and therapeutic purposes. Although there was a tendency for the measurements to be less accurate with increasing distances measured.

Fluticasone propionate in asthma: a long term dose comparison study

BACKGROUND

Few dose ranging studies have investigated optimal dosing with inhaled corticosteroids in children with asthma.

AIMS

To compare the efficacy and tolerability of fluticasone propionate 100 or 200 microg twice daily in children with moderate to severe asthma for one year.

METHODS

One year, randomised, double blind, parallel group, multicentre study. Children aged 4-11 years (n = 528) with moderate to severe asthma who had previously received high dose inhaled corticosteroids were given fluticasone propionate 100 or 200 microg twice daily for the 52 week treatment period. Efficacy (exacerbations, lung function, and symptoms) and tolerability (adverse events and cortisol levels) were measured.

RESULTS

There was a non-significant decreased risk of experiencing an exacerbation at any time with fluticasone propionate 200 microg twice daily compared with fluticasone propionate 100 microg twice daily. This difference reached significance among patients with more severe asthma (defined by previous inhaled corticosteroid dose >800 microg/day). Daily record card morning peak expiratory flow (PEF) in the total population improved significantly more with the higher dose of fluticasone propionate (between group difference, weeks 1-52: 11.4 l/min). Clinic visit mean PEF improved from baseline with both doses, but the response was significantly greater with the higher dose (between group difference, week 52: 17.8 l/min). Both doses were equally well tolerated and overnight urinary cortisol concentrations were unchanged or slightly increased during treatment with either dose.

CONCLUSION

This long term dose comparison study shows that treatment with fluticasone propionate 200 micro g twice daily may offer benefits over a lower dose, particularly in children with more severe asthma.

Predicting the release of metals from ombrotrophic peat due to drought-induced acidification

Ombrotrophic peats in northern England and Scotland, close to industrial areas, have substantial contents of potentially toxic metals (Al, Ni, Cu, Zn, Cd and Pb) and of pollutant sulphur, all derived from atmospheric deposition. The peat sulphur, ordinarily in reduced form, may be converted to sulphuric acid under drought conditions, due to the entry of oxygen into the peats. The consequent lowering of soil solution pH is predicted to cause the release of metals held on ligand sites of the peat organic matter. The purpose of the present study was to explore, by simulation modelling, the extent of the metal response. Chemical variables (elemental composition, pH, metal contents) were measured for samples of ombrotrophic peats from three locations. Water extracts of the peats, and samples of local surface water, were also analysed, for pH, dissolved organic carbon (DOC) and metals. Metal release from peats due to acidification was demonstrated experimentally, and could be accounted for reasonably well using a speciation code (WHAM/Model VI). These data, together with information on metal and S deposition, and meteorology, were used to construct a simple description of peat hydrochemistry, based on WHAM/Model VI, that takes into account ion-binding by humic substances (assumed to be the "active" constituents of the peat with respect to ion-binding). The model was used to simulate steady state situations that approximated the observed soil pH, metal pools and dissolved metal concentrations. Then, drought conditions were imposed, to generate increased concentrations of H2SO4, in line with those observed during the drought of 1995. The model calculations suggest that the pH will decrease from the initial steady state value of 4.3 to 3.3-3.6 during rewetting periods following droughts, depending upon assumptions about the amount of potentially mobile soil S. The pH decreases will be accompanied by increases in concentrations of dissolved metals (Mg, Al, Ca, Ni, Cu, Zn, Cd, Pb) of an order of magnitude or more, depending upon assumptions about the replenishment of soil metal pools by deposition. In the most realistic scenario for present conditions, the severity of pH depressions will gradually decline due to the relatively slow depletion of the soil S pool by droughts. However, the magnitudes of heavy metal pulses will decline quite rapidly (over two or three droughts) because current and future metal deposition is unable to compensate for leaching losses from the soil pools.

Economic integration and labor flows: stage migration in farm labor markets in Mexico and the United States

"This article examines the probable effects of the North American Free Trade Agreement (NAFTA) on migration from Mexico to the United States, disputing the view that expansion of jobs in Mexico could rapidly reduce undocumented migration. To the extent that NAFTA causes Mexican export agriculture to expand, migration to the United States will increase rather than decrease in the short run. Data collected in both California and the Mexican State of Baja California show that indigenous migrants from southern Mexico typically first undertake internal migration, which lowers the costs and risks of U.S. migration. Two features of employment in export agriculture were found to be specially significant in lowering the costs of U.S. migration: first, working in export agriculture exposes migrants to more diverse social networks and information about U.S. migration; second, agro-export employment in northern Mexico provides stable employment, albeit low-wage employment, for some members of the family close to the border (especially women and children) while allowing other members of the family to assume the risks of U.S. migration."

Eosinophilic gastroenteritis mimicking pancreatic cancer

Eosinophilic gastroenteritis is a condition characterised by eosinophilic infiltration of the gastrointestinal tract. Biliary obstruction is an unusual presentation. A case where the initial investigations were consistent with carcinoma of the head of pancreas but the resection specimen showed no malignancy is presented. The diagnosis was suspected from a review of the patient's past history and confirmed by re-examination of the histology.

Double contrast barium enema sensitivity: a comparison of studies by radiographers and radiologists

PURPOSE

A retrospective study of histologically proven cases of colorectal cancer (CRC) was performed to assess whether the sensitivity of the radiographer-performed double contrast barium enema (DCBE) differed from that of the radiologist-performed study.

MATERIALS AND METHODS

Histologically proven cases of CRC were reviewed over a 3-year period to ascertain whether: the diagnosis had been made by DCBE in the 3 years before histological diagnosis; the lesion had been correctly diagnosed; the examination had been performed by a radiologist or radiographer.

RESULTS

In the 3-year period there were 478 cases with histologically proven CRC. Of these, 239 (50%) had undergone DCBE as the initial radiological investigation of the colon. Sixty-four examinations had been performed by radiographers. A correct diagnosis was made in 58 cases (90.6%), the report was equivocal in one case (1.6%), there were four false-negatives (6.25%), and one case was abandoned (1.6%). One hundred and seventy-five examinations were performed by radiologists. A correct diagnosis was made in 157 cases (89.7%), the report was equivocal in one case (0.6%), there were 16 false-negatives (9.1%), and one case was abandoned (0.6%).

CONCLUSION

A sensitivity of 90.6% for radiographer-performed studies compared favourably with 89.7% for radiologist-performed studies and supports the practice of radiographers undertaking barium enemas.

Preexisting histologic evidence of prostatitis is unrelated to postimplant urinary morbidity

The presence and extent of prostatitis on the patients' preimplant biopsy slides was correlated with their postimplant course to determine if any relationship exists between histological prostatitis and postimplant morbidity. Biopsy slides from 56 patients treated with I-125 (144 Gy, TG-43), Pd-103 (125 Gy, NIST-1999), or Pd-103 plus supplemental external beam radiation (20-44 Gy) were studied. As part of ongoing prospective protocols, treatment-related morbidity is monitored by mailed questionnaires at 1, 3, 6, 12, and 24 months postimplant, using standard American Urologic Association (I-PSS) and Radiation Therapy Oncology Group criteria. Patient's preimplant biopsies, stained with standard hematoxylin and eosin, were retrieved for review by one uropathologist (LT). Separate evaluations of the degree and extent of inflammation in biopsy cores free of cancer and in cancerous biopsy cores were undertaken. Infiltrates were classified as periglandular if they were within 50 microns of a glandular structure. They were otherwise classified as stromal. Distribution of the inflammation was reported as focal, multifocal, or diffuse. The intensity of inflammation was separately graded as mild if there were fewer than 10 inflammatory cells per high-power field, moderate if there were 10-200 cells per high-power microscopic field, or severe if there were more than 200 cells per field. In all cases the great majority of inflammatory cells were mononuclear, predominantly lymphocytes. Periglandular inflammation was most common, with 18% of patients having focal periglandular and 20% having multifocal periglandular inflammation on their preimplant biopsies. Cancer-related infiltrates were the second most common, with 23% of patients having focal, 13% multifocal, and 13% diffuse cancer-related inflammation on their preimplant biopsies. Eight of the 55 patients developed postimplant urinary retention, requiring catheterization for 2 to 8 days. The overall incidence of postimplant urinary retention was low and there was no obvious relationship between the presence of inflammation on preimplant biopsy and the likelihood of postimplant urinary retention. AUA score changes at 1 and 6 months postimplant were highly variable and unrelated to the presence or severity of periglandular or cancer-related inflammation. Considering the apparent lack of relationship between histological findings and clinical outcomes in the patients reported here, the authors conclude that histologic evidence of prostatitis is not a contraindication to brachytherapy.

Evaluating the effects of asthma therapy on childhood growth: what can be learnt from the published literature?

The difficulties of assessing the effects of asthma therapy on childhood growth were explored in the first part of this review. In this part of the review growth studies with inhaled corticosteroids were selected that included a control group, measured height by stadiometry and were of > or = 1 yr duration. The studies were classified as type 1 (placebo control), type 2 (nonsteroidal therapy control), type 3 (comparator inhaled corticosteroid control) or type 4 ("real-life" studies with dose adjustment). The design attributes of these studies were then compared with the recommendations described in the first part of this review. Of the 18 studies identified, 17 were susceptible to one or more important confounding factors. Nevertheless, the outcomes of all 18 studies were mostly consistent. At recommended doses, beclomethasone dipropionate and budesonide demonstrated a small degree of growth suppression over 1-2 yrs (study types 1 and 2), but there was little evidence of such an effect with fluticasone propionate. Studies comparing different inhaled corticosteroids at recommended doses indicated more rapid growth with fluticasone propionate than with beclomethasone dipropionate or budesonide. However, none of the inhaled corticosteroids appeared to affect final height. In conclusion, the results from the majority of published growth studies with inhaled corticosteroids must be interpreted with a degree of caution owing to their potential susceptibility to important confounding factors. Further well-designed studies are needed to establish whether different inhaled corticosteroids have different effects on growth in the long term.

Laboratory ascertainment of Cryptosporidium and local authority policies for investigating sporadic cases of cryptosporidiosis in two regions of the United Kingdom

To discover laboratory ascertainment and reporting practice for cases of cryptosporidiosis in two health authority regions, we surveyed laboratories serving Wales and the North West of England for faecal screening policies and methods for detection of Cryptosporidium. Forty-eight of the 49 laboratories responded, of which 39 (81%) screen all stool specimens from symptomatic individuals for Cryptosporidium and 9 (19%) screen selected specimens. Although laboratory screening is more complete than has been reported in other regions, we identified discrepancies where patient age was used as a selection criterion, and we make suggestions to amend this. Forty-two (88%) responding laboratories report confirmed cases to the regional Communicable Disease Surveillance Centre (CDSC) and 45 (94%) report to the local authority environmental health department. We also surveyed local authorities in both regions for policy and practice concerning the investigation of reported cases of cryptosporidiosis in the same regions. All 59 local authorities responded, of which 57 (97%) investigate cases by completion of an exposure questionnaire as well as providing advice on the prevention of spread of infection. Variation in case ascertainment may influence perception of incidence, clusters and outbreaks of cases of cryptosporidiosis.

Evaluating the effects of asthma therapy on childhood growth: principles of study design

Inhaled corticosteroids have been established as the most effective treatment for childhood asthma. However, concerns persist regarding their potential effects on growth and, most importantly, final height. To assess their effects on growth, inhaled corticosteroids can be compared with placebo (type 1 study), nonsteroidal anti-asthma therapy (type 2 study), another inhaled corticosteroid (type 3 study) or "real-life" anti-asthma therapy (type 4 study). Owing to the difficulties in obtaining final height data, several different surrogate measures have often been used: short-term lower leg growth, longer-term statural height growth velocity, childhood height and predicted final height. This paper discusses the choice of end point, key trial design issues (including selection and number of subjects in the active and control populations) duration of assessments and methods for measuring height and data analysis, in the context of the different study types. Specific study design recommendations have been developed after consideration of these factors, and these principles will be used to guide the interpretation of previously published growth studies.

Do continence aids help to maintain skin integrity?

The third of our back to basics series reviews the efficacy of continence aids such as pads and barrier creams, and their role in maintaining skin integrity. Many studies had flaws and new research is needed to avoid subjective choice of products.

Phosphorus in soils and field drainage water in the Thame catchment, UK

Field drains were sampled at five farms in a catchment in south-central England. The farms were selected to include the main soil types present in the catchment, stagnogleys and pelosols. The phosphorus content of field drainage water was measured on several occasions from 1999 to 2000, under varying flow conditions. The components measured were soluble reactive phosphorus (SRP), total dissolved phosphorus (TDP) and total phosphorus (TP). SRP concentrations in drainage water were lower than in streams in the catchment which had no apparent point source. This indicated that many streams were receiving unidentified point sources of SRP. Measurements of P in field drainage water samples under high flow conditions showed concentrations of particulate phosphorus and SRP up to 1300 and 300 microg l(-1), respectively, these being associated with high suspended sediment concentrations. Comparison of field drain and soil phosphorus contents at the locations sampled did not provide evidence of an inter-relationship. The equilibrium phosphorus content (EPC0) of surface soil was generally higher than the SRP content of drainage water, at one farm by 1 order of magnitude. The variability in measurements suggested a larger-scale and more focussed survey would be required to characterise catchment-scale phosphorus losses from commercial farms by land use and soil type.

The phosphorus budget of the Thame catchment, Oxfordshire: 2. Modelling

The phosphorus budget of the River Thame was modelled at a daily time scale, using estimates of diffuse and point source contributions of discharge. The model simulated suspended sediment (SS), soluble unreactive phosphorus (SUP), soluble reactive phosphorus (SRP) and particulate phosphorus (PP) concentrations within the main river and major tributaries. Diffuse source estimates of phosphorus loads were based on characteristic losses from identified main landscape classes, with hydrology described by a simple conceptual storage model. In-stream flow was modelled using a kinematic wave equation. Transfer of suspended sediment and phosphorus components was approximated by advection. In-stream sources and sinks included uptake and release of soluble reactive phosphorus by bed sediment, instant equilibration between SRP and the PP concentration on suspended sediment, and flow-related entrainment and deposition of suspended sediment. Simulations at sites within the catchment were compared with measurements made in 1998-1999. Results showed the P budget is dominated by mixing of diffuse and point source water, but some within-river processes have been shown to be capable of significantly influencing SRP concentrations. The development of a sediment entrainment and deposition component of the model has proved particularly valuable in emulating the hysteretic relationship between discharge and suspended sediment concentration in the river. It also provides a measure of available bed sediment.

How much do rural Hispanics know about the adverse health risks of smoking?

The object of this study was to measure knowledge in a rural Hispanic community about the adverse health effects of smoking and to compare knowledge between current smokers and nonsmokers. A survey was administered to waiting room patients (n =137) over 16 years old at three predominantly Hispanic rural community health centers in the central San Joaquin Valley of California. Proportions of respondents who believed that smoking caused a specific consequence were calculated and compared between smokers and nonsmokers by chi-square tests. Likelihood of attributing negative health consequences to smoking was determined and compared between smokers and nonsmokers. A majority of all participants (smokers and nonsmokers) knew that smoking causes lung cancer (93 percent) and emphysema (91 percent). Many fewer participants knew that smoking contributes to problems such as osteoporosis (39 percent) or sexual dysfunction (33 percent). Current smokers were less likely than nonsmokers (P=0.01) to say that smoking causes any adverse health outcome, including those not known to be related to smoking. Although this is a culturally, ethnically and geographically unique group, knowledge of smoking risks among smoking and nonsmoking rural Hispanics is similar to that found in the general population. When compared with nonsmokers, current smokers underestimate the risk that smoking poses to health.

Increased throughput for fragment analysis on an ABI PRISM 377 automated sequencer using a membrane comb and STRand software

This manuscript outlines our protocol for using a freely downloadable fragment analysis software package (STRand) together with a 96+4 RapidLoad membrane comb to increase throughput of samples for fragment analysis on ABI sequencers without costly upgrades from the manufacturer. We outline how using these products allows one to score 90 lanes of sample per gel on an ABI PRISM 377XL (64-lane sequencer), saving both time and money in the processing of samples. This protocol is a major modification to those suggested by the manufacturer. This protocol gives more consistent results that are easier to score than standard protocols, and it reduces reagent costs. Interest in fragment analysis (primarily microsatellites and AFLPs) is steadily increasing among both population ecologists and geneticists, and methods that simultaneously increase sample throughput while reducing costs associated with these analyses by over 50% per gel should prove useful to anyone using an ABI, MJ Basestation, or LI-COR automated sequencer for fragment analysis.

Genetic diversity among Mycobacterium bovis isolates: a preliminary study of strains from animal and human sources

Mycobacterium bovis has the broadest host range of species in the Mycobacterium tuberculosis complex and is responsible for disease in humans and diverse animal species. We report on genotypic differences at multiple loci among 13 isolates derived from a range of human and animal infections. All isolates were classified as M. bovis by phenotypic analysis but could be subdivided into five distinct genotypes based on polymorphisms at the pncA and oxyR loci, the status of the RD5 deletion region, and the spoligotype pattern. These findings suggest the existence of a spectrum of strains with genotypic characteristics between those of M. tuberculosis and M. bovis.

Identification, mapping, and phylogenetic analysis of three novel chicken CC chemokines

We have identified three novel chicken CC chemokine genes among cDNA clones derived from lipopolysaccharide-stimulated cells of the chicken macrophage cell line HD11. Two of these chemokines show DNA sequence homology to the mammalian genes SCYA20 (MIP-3alpha) and SCYA5 (RANTES), while the third shows similar levels of homology to several mammalian CC chemokines. Sequencing of genomic DNA showed that all three chicken chemokines possess the three-exon structure and conserved intron positions typical of mammalian CC chemokines. Genetic mapping of the three chicken chemokines locates them in three chromosomal regions which correspond to regions containing homologous chemokines in humans. Phylogenetic analysis of the currently known chicken and human chemokines suggests that individual chicken and human chemokines derive from common ancestral genes in patterns that reflect their genomic positions, indicating that the diversity of chemokine genes pre-dated avian-mammalian divergence. Since the function of the chemokines is principally to act as intermediates between stimulated cells and specific subsets of responding immune cells, this suggests that the complex organization of the immune system and diversity of responding cells were largely in place at that time.

Differentiation and migration of astrocyte precursor cells and astrocytes in human fetal retina: relevance to optic nerve coloboma

The presence of astrocyte precursor cells (APCs) and time course and topography of astrocyte differentiation during development were investigated by triple-label immunohistochemistry with intact fetal and adult human retinas. Throughout retinal development and adulthood, expression of Pax2 was restricted to cells of the astrocytic lineage. Three distinct stages of astrocytic differentiation were identified during development: i) Pax2+/vimentin+/GFAP- APCs; ii) Pax2+/vimentin+/GFAP+ immature perinatal astrocytes; and iii) Pax2+/vimentin-/GFAP+ mature perinatal astrocytes. In adult, cells with the antigenic phenotype of mature perinatal astrocytes were restricted to a region surrounding the optic nerve head (ONH), whereas cells at a fourth stage of differentiation, adult astrocytes (Pax2-/vimentin-/GFAP+), were apparent throughout the vascularized retina. APC appearance was centered around the ONH and preceded the appearance of perinatal astrocytes. A cluster of Pax2+ somas was also present in a small region surrounding the ONH at the ventricular surface of the developing retina, which suggests the existence of two distinct sites of astrocytic differentiation. The coincidence in the location of APCs and perinatal astrocytes at the ventricular zone with that of optic nerve colobomas, together with the association of Pax2 gene mutations with this condition, suggests that coloboma formation may result from impaired astrocyte differentiation during development.

Nurses' and physicians' assessment of mother-infant mental health at the first postnatal visits

OBJECTIVE

To examine the degree to which physicians and nurses use their first postnatal contact with mothers and babies to learn about their psychosocial strengths and problems.

METHOD

Forty-two consecutively born infants and their mothers were observed during their initial postnatal visit with a public health nurse and their physician in Montreal. Both visits were audiotaped. Tapes were analyzed for the number of physical and psychosocial topics discussed during the visits. Observers also rated the professionals' communication skills. During a later home visit, mothers were given the Edinburgh Postnatal Depression Scale, the Symptom Checklist-90-Revised, and the Working Model of the Child Interview (WMCI).

RESULTS

Nurses spent more time with families, discussed more psychosocial issues, and were rated to be more sensitive interviewers than physicians. They were also concerned about the psychological well-being and psychological difficulties of more mothers than were the physicians. In contrast, physicians were more sensitive to pregnancy complications in younger mothers. Mothers' satisfaction correlated with the number of psychosocial issues discussed by both professional groups. WMCI data suggest that recent non-Western immigrants are overrepresented among insecurely attached mothers.

CONCLUSIONS

Nurses and physicians obtain different data from the same patients and should increase their collaboration.

High evolutionary rates in nuclear genes of squamates

We compared nonsynonymous substitution rates (Ka) of nuclear coding genes between four major groups of living sauropsids (reptiles): birds, squamates, crocodiles, and turtles. Since only 9 orthologous genes are known in all the four taxonomic groups, we searched for orthologous genes known in chicken and at least one of any representative of poikilotherm sauropsids. Thus, we analyzed three additional data sets: 28 genes identified in chicken and various squamates, 24 genes identified in chicken and crocodilians, and 20 genes identified in chicken and turtles. To compare nonsynonymous substitution rates between all lineages of sauropsids, we used the relative-rate test with human genes as the outgroup. We show that 22/28 nuclear coding genes of squamates, especially snakes (15/16), have an higher evolutionary rate than those in chicken (in mean, 30-40% faster). However, no such difference is detected between crocodiles, turtles and chicken. Higher substitution rate in squamates nuclear coding genes than in chicken, and probably than in other sauropsids, could explain some of the difficulties in resolving the molecular phylogeny of reptiles.

Overexpression of petunia chalcone isomerase in tomato results in fruit containing increased levels of flavonols

Tomatoes are an excellent source of the carotenoid lycopene, a compound that is thought to be protective against prostate cancer. They also contain small amounts of flavonoids in their peel ( approximately 5-10 mg/kg fresh weight), mainly naringenin chalcone and the flavonol rutin, a quercetin glycoside. Flavonols are very potent antioxidants, and an increasing body of epidemiological data suggests that high flavonoid intake is correlated with a decreased risk for cardiovascular disease. We have upregulated flavonol biosynthesis in the tomato in order to generate fruit with increased antioxidant capacity and a wider range of potential health benefit properties. This involved transformation of tomato with the Petunia chi-a gene encoding chalcone isomerase. Resulting transgenic tomato lines produced an increase of up to 78 fold in fruit peel flavonols, mainly due to an accumulation of rutin. No gross phenotypical differences were observed between high-flavonol transgenic and control lines. The phenotype segregated with the transgene and demonstrated a stable inheritance pattern over four subsequent generations tested thus far. Whole-fruit flavonol levels in the best of these lines are similar to those found in onions, a crop with naturally high levels of flavonol compounds. Processing of high-flavonol tomatoes demonstrated that 65% of flavonols present in the fresh fruit were retained in the processed paste, supporting their potential as raw materials for tomato-based functional food products.