Durometer measurements of skin induration in venous disease

BACKGROUND

The degree of skin induration (lipodermatosclerosis) around venous ulcers has prognostic significance; however, objective measurements are needed to assess the induration. The durometer, an engineering instrument used to measure the hardness of metals and plastic, has recently been adapted to assess skin induration.

OBJECTIVE

The purpose of this study was to measure skin induration and its relationship to skin ulceration by the use of a durometer, and to determine the influence of edema, if any, on durometer measurements.

METHODS

The degree of skin induration on the medial leg was determined in six sequential, nonselected patients with lipodermatosclerosis and leg ulcers, and in five normal volunteers by using a blinded observer's clinical score (0 = normal to 3 = maximal induration) and a hand-held Type 0 durometer. In addition, durometer readings in 14 patients with edema and eight control subjects were taken on the tibia, the dorsum of the foot, and behind the ankle.

RESULTS

Durometer readings in patients with leg ulcers and lipodermatosclerosis diminished as one measured from the superior edge of the ulcer to the knee (r = 0.925). The higher the clinical skin score the higher were the durometer readings (P = 0.0062). The presence of edema did not influence durometer measurements.

CONCLUSION

The durometer is an effective and reliable instrument for measuring the degree of skin induration in venous ulceration and its readings are not affected by edema. Ulcers occur in skin most affected by lipodermatosclerosis.

Cooperative effects of mutations in a recombinant Fab on the kinetics of antigen binding

Recombinant Fabs, 57P and 174P, recognizing peptide 134-151 of the coat protein of tobacco mosaic virus, differ by 15 amino acid changes in the sequence of their variable region. Kinetic analysis using BIAcore showed that they recognized five peptide variants in the same ranking order, but that Fab 174P consistently dissociated faster from the peptides compared to Fab 57P. In order to identify amino acid substitutions that are responsible for differences in dissociation rates of the two Fabs, six hybrid Fabs have been constructed by exchanging three DNA segments. Four single and five multiple mutants were obtained by site-directed mutagenesis. All Fabs recognized variant peptides in a similar ranking order. The high precision of biosensor measurements made it possible to detect small contributions to dissociation kinetics of at least five substitutions, as well as the presence of small-magnitude non-additive effects of multiple substitutions. Our results demonstrate the cooperative influence on dissociation kinetics of amino acid residues located away from each other and away from the Fab combining site.

Intraspinal high-grade astrocytoma in a child--rationale for chemotherapy and more intensive radiotherapy?

Intraspinal high-grade astrocytoma in children is an extremely rare tumor entity with disappointingly short survival times despite multimodality treatment. We report on a girl with anaplastic astrocytoma at level T9-11, who was treated with tumor resection, multidrug chemotherapy and irradiation. Local recurrence was diagnosed after 16 months. With reference to other cases reported in the literature, the course of disease, achievements and limitations of currently available therapeutic options, and potential future strategies are discussed.

Nocturnal periodic breathing and the development of acute high altitude illness

We tested the hypothesis that periodic breathing (PB) at high altitude is more frequent and arterial oxygen desaturation more severe during sleep in subjects developing high altitude pulmonary edema (HAPE) or acute mountain sickness (AMS) compared with subjects remaining healthy. We registered thoraco-abdominal movement, electro-encephalogram and oxygen saturation by pulse oximeter (pSao2) in 21 subjects during the first night spent at the altitude of 4,559 m. During the subsequent stay at 4,559 m, eight subjects remained well (controls), five subjects developed AMS and eight subjects developed HAPE. PB was found in all sleep stages and the percentage PB in any sleep stage was not significantly different between groups. There was a trend towards more PB in the HAPE vs. AMS and control group lasting 80 +/- 5 (mean +/- SE), 58 +/- 7, 57 +/- 9% of analyzable time, respectively (p = 0.09). The mean nocturnal decrease of pSao2 for these groups was 8.7 +/- 1.9, 5.4 +/- 2.1, 4.8 +/- 1.2%; (p = 0.36) and the median nocturnal pSao2 was 49 +/- 3, 63 +/- 3, and 63 +/- 4% (p = 0.02). Arterial blood gas analysis before and after sleep recordings indicate that the significantly lower Sao2 in the HAPE group is secondary to gas exchange rather than ventilation. The nocturnal decrease of pSao2 did not correlate with the time of PB nor the number of desaturation events > or = 4%. These findings suggest that more frequent PB in the HAPE group is a consequence of lower Sao2 due to impairment of gas exchange.

Activation of the budding yeast spindle assembly checkpoint without mitotic spindle disruption

The spindle assembly checkpoint keeps cells with defective spindles from initiating chromosome segregation. The protein kinase Mps1 phosphorylates the yeast protein Mad1p when this checkpoint is activated, and the overexpression of Mps1p induces modification of Mad1p and arrests wild-type yeast cells in mitosis with morphologically normal spindles. Spindle assembly checkpoint mutants overexpressing Mps1p pass through mitosis without delay and can produce viable progeny, which demonstrates that the arrest of wild-type cells results from inappropriate activation of the checkpoint in cells whose spindle is fully functional. Ectopic activation of cell-cycle checkpoints might be used to exploit the differences in checkpoint status between normal and tumor cells and thus improve the selectivity of chemotherapy.

The Saccharomyces cerevisiae spindle pole body duplication gene MPS1 is part of a mitotic checkpoint

M-phase checkpoints inhibit cell division when mitotic spindle function is perturbed. Here we show that the Saccharomyces cerevisiae MPS1 gene product, an essential protein kinase required for spindle pole body (SPB) duplication (Winey et al., 1991; Lauze et al., 1995), is also required for M-phase check-point function. In cdc31-2 and mps2-1 mutants, conditional failure of SPB duplication results in cell cycle arrest with high p34CDC28 kinase activity that depends on the presence of the wild-type MAD1 checkpoint gene, consistent with checkpoint arrest of mitosis. In contrast, mps1 mutant cells fail to duplicate their SPBs and do not arrest division at 37 degrees C, exhibiting a normal cycle of p34CDC28 kinase activity despite the presence of a monopolar spindle. Double mutant cdc31-2, mps1-1 cells also fail to arrest mitosis at 37 degrees C, despite having SPB structures similar to cdc31-2 single mutants as determined by EM analysis. Arrest of mitosis upon microtubule depolymerization by nocodazole is also conditionally absent in mps1 strains. This is observed in mps1 cells synchronized in S phase with hydroxyurea before exposure to nocodazole, indicating that failure of checkpoint function in mps1 cells is independent of SPB duplication failure. In contrast, hydroxyurea arrest and a number of other cdc mutant arrest phenotypes are unaffected by mps1 alleles. We propose that the essential MPS1 protein kinase functions both in SPB duplication and in a mitotic checkpoint monitoring spindle integrity.

[Doppler sonographic flow measurements of the middle cerebral artery in end-diastolic zero flow in the umbilical arteries in relation to fetal outcome]

Absent or reverse end-diastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress. We studied 74 fetuses with AREDFV with respect to the resistance index of the middle cerebral artery (MCA). The change in the resistance index of MCA was applied to the fetal outcome. The fetuses were retrospectively divided into 3 groups: 1) The fetuses in the first group did not show any changes in the course of observation of the MCA. 2) In the second group a drop followed by an increase in the resistance index of the MCA was confirmed. This is known in literature as "cerebral oedema". 3) The third group showed only a drop in the resistance index, described in literature as "brain-sparing-effect". The increase in the resistance index of the MCA points to a danger for the fetus, since the incidence of fetal acidosis, low birth weight, severe idiopathic respiratory distress syndrome in these fetuses was extremely high. In particular every second fetus in this group showed neurological complications. The change in the cerebral perfusion known as "cerebral oedema" which is extremely dangerous for the fetus has to be avoided.

Comparative interaction kinetics of two recombinant Fabs and of the corresponding antibodies directed to the coat protein of tobacco mosaic virus

Two recombinant Fab fragments, 57P and 174P, recognizing peptide 134-146 of the coat protein of tobacco mosaic virus have been cloned, sequenced and expressed in Escherichia coli. They differ by 15 amino acid changes in the sequence of their variable region. The interaction kinetics of the Fabs with the wild-type and four mutant peptides have been compared using a BIAcoreTM biosensor instrument. The recombinant Fab 174P had the same reactivity as the Fab fragment obtained by enzymatic cleavage of monoclonal antibody 174P. The two recombinant Fabs recognized the various peptides in the same ranking order but Fab 174P consistently dissociated somewhat faster from the peptides compared to Fab 57P. The two whole antibodies showed the same relative differences in reactivity as the two recombinant Fabs. The location of amino acid changes was visualized on a model structure of the Fab. Differences in dissociation rates of the two antibodies are most likely due to changes located at the periphery of the antigen-combining site and/or at the interface between the light and heavy chain domains. Our results demonstrate the feasibility of detecting very small differences in binding affinity by the biosensor technology, which is a prerequisite for assessing the functional effect of limited structural changes.

[Prognostic value of Doppler flow measurement of the middle cerebral artery for morbidity of premature infants with null or negative flow in umbilical arteries]

We analysed 78 fetuses with absent or reverse endiastolic flow velocities (AREDFV) of the umbilical arteries with respect to fetal acidosis, resistance index of the middle cerebral artery (MCA) and abnormal neurological evaluations. A control group was matched for gestational age and normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed an increased incidence of fetal acidosis. The number of fetuses with abnormal neurological signs was significantly increased compared to the control group. Most of these fetuses (86%) showed abnormal blood flow velocity waveforms of the middle cerebral arteries called "brain-sparing effect". The combination of premature delivery in the 30th week of gestation, severe idiopathic respiratory distress syndrome, and a resistance index under the 10th percentile in the middle cerebral arteries seems to be a risk factor of the early neurological morbidity in fetus with AREDFV.

Antibacterial activity of three dental liners

PURPOSE

The purpose of the present study was to assess the antibacterial activity of the following three dental liners: Vitrebond (3M, St Paul, MN), Dycal (LD Caulk, Dentsply International, Milford, DE), and Life (Kerr, Romulus, MI).

MATERIALS AND METHODS

The test was based on a modification of the agar diffusion test in which samples were placed on agar plates previously inoculated with Streptococcus mutans and were removed after predetermined time periods. The material's effect on bacterial growth was evaluated.

RESULTS

Results show that Vitrebond has a strong antibacterial effect that was evident after 1 minute of direct contact with the inoculated bacteria. It was significantly more effective (P<.0001) than Dycal or Life.

CONCLUSIONS

This method allows for the evaluation of the antibacterial effect of dental materials.

Laparoscopic-assisted perineal rectosigmoidectomy for rectal prolapse

One of the important surgical principles in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is to ensure the complete resection of the redundant rectosigmoid colon to avoid recurrence of the prolapse. We present a new technique of laparoscopic assistance during this procedure, which helps achieve maximal mobilization and resection of the prolapsed portion.

Virilizing stromal Leydig cell tumor (Leydig cell-containing thecoma) of the ovary in pregnancy. A case report with extensive immunohistochemical investigation of the tumor cells

The rare case of a stromal Leydig cell tumor of the ovary occurring in a 21-year-old woman who developed signs of virilization during pregnancy is reported. Serum androgen levels were markedly elevated. At cesarean section, a slightly hypotrophic, but otherwise normal, female infant was delivered and a tumor of the right ovary measuring 12 cm in maximum diameter was resected. Histologic examination revealed a sex cord-stromal tumor consisting of spindle-shaped, thecomatous cells and a large number of loosely scattered clusters of large polygonal cells with abundant eosinophilic cytoplasm. Both types of tumor cells were strongly immunoreactive for vimentin, but exhibited no proliferative activity and no overexpression of p53 protein. A few of the polygonal cells contained typical crystalloids of Reinke. Cellular atypia was not a prominent feature, and a diagnosis of benign stromal Leydig cell tumor was established. As expected, 20 months after diagnosis the patient exhibits no signs of recurrence or dissemination. To the best of our knowledge this is only the second case of a stromal Leydig cell tumor occurring in pregnancy to be described.

Yeast spindle pole body duplication gene MPS1 encodes an essential dual specificity protein kinase

The MPS1 gene has been previously identified by a mutant allele that shows defects in spindle pole body (SPB) duplication and cell cycle control. The SPB is the centrosome-equivalent organelle in the yeast Saccharomyces cerevisiae, and it nucleates all the microtubules in the cell. We report the isolation of the MPS1 gene, which encodes an essential protein kinase homolog. The MPS1 open reading frame has been fused to those that encode the LexA protein or the GST protein and both of these constructs function in yeast. The fusion proteins have been affinity-purified from yeast extracts and the GST chimeric protein has been found to be a phosphoprotein. Both proteins have been used to demonstrate intrinsic in vitro protein kinase activity of Mps1p against exogenous substrates and itself (autophosphorylation). A mutation predicted to abolish kinase function not only eliminates in vitro protein kinase activity, but also behaves like a null mutation in vivo, suggesting that kinase activity contributes to the essential function of the protein. Phosphoamino acid analysis of substrates phosphorylated by Mps1p indicates that this kinase can phosphorylate serine, threonine and tyrosine residues, identifying Mps1p as a dual specificity protein kinase.

[Post-unification changes in inpatient psychiatric treatment in a Berlin treatment clinic]

In the present report the authors reach the conclusion that concerning the pathological picture no essential alterations can be observed. Patients, however, presently often enter therapy in a worse condition than before. Thus the tendency to arrive at a chronic stadium increases. In our opinion this development is partly owing to the fact, that the continuity of treatment is interrupted and partly to changes concerning the framework of conditions of live in society. We regard it as our task, also with the modified conditions of life, to render possible the dialogue between all participating in the treatment. Our purpose and wish remain to put all our available abilities to the disposition of the patients.

One of the two common mutations causing factor XI deficiency in Ashkenazi Jews (type II) is also prevalent in Iraqi Jews, who represent the ancient gene pool of Jews

In recent years four mutations causing factor XI deficiency have been identified in Jews of Ashkenazi (European) origin. Two of them, type II (a nonsense mutation) and type III (a missense mutation), were found to prevail among 125 unrelated Ashkenazi Jews with severe factor XI deficiency. A finding of type II mutation in four unrelated Iraqi-Jewish families raised the possibility that this mutation is also common in Iraqi Jews, who represent the ancient gene pool of the Jews. A molecular-based analysis performed in 1,040 consecutively hospitalized patients disclosed the following results: Among 531 Ashkenazi-Jewish patients, the type II allele frequency was 0.0217 and among 509 Iraqi-Jewish patients, 0.0167 (P = .50). The type III allele frequency in the Ashkenazi-Jewish patients was 0.0254, whereas none of 502 Iraqi-Jewish patients examined had this mutation. These data suggest that the type II mutation was present in Jews already 2.5 millenia ago. The data also indicate that the estimated risk for severe factor XI deficiency in Ashkenazi Jews (due to either genotype) is 0.22% and in Iraqi Jews, 0.03%, and that the estimated risk of heterozygosity in Ashkenazi Jews is 9.0% and in Iraqi Jews, 3.3%. As patients with severe factor XI deficiency are prone to bleeding after injury and patients with partial deficiency may have similar bleeding complications when an additional hemostatic derangement is present, the observed high frequencies should be borne in mind when surgery is planned for individuals belonging to these populations.