Paternity probability when a relative of the father is an alleged father

When scientists use DNA evidence in court, coancestry effects such as population structure and relatedness are usually ignored. In paternity cases, only if a particular man has the child's paternal allele at a certain locus, can he not be excluded in the paternity dispute. However, it is certainly true that close relatives will be far more likely to have the child's paternal allele than will random members of the reference population. In particular, the probability that the true father's brother has the paternal allele is very much greater than that for any other relationship. In this paper, the authors describe a method for inference in a case where the true father may be a relative of the alleged father. This paper also reports that most current methods overstate the probability that the alleged father is the father.

Bcl3, an IκB Protein, Stimulates Activating Protein-1 Transactivation and Cellular Proliferation

Bcl3, an IkappaB protein, was originally isolated as a putative proto-oncogene in a subset of B cell chronic lymphocytic leukemias. Bcl3 was subsequently shown to associate tightly with and transactivate the NFkappaB p50 or p52 homodimer. Herein, we show that Bcl3 stimulates the activating protein-1 (AP-1) transactivation, either alone or in conjunction with transcription integrators steroid receptor coactivator-1 and CREB-binding protein/p300. The C-terminal 158 residues of Bcl3 exhibited an autonomous transactivation function and interacted with specific subregions of the AP-1 components c-Jun and c-Fos, CREB-binding protein/p300, and steroid receptor coactivator-1, as demonstrated by the yeast and mammalian two-hybrid tests as well as glutathione S-transferase pull-down assays. In addition, anti-HA antibody co-precipitated c-Jun from HeLa cells co-expressing c-Jun and HA-tagged Bcl3, consistent with the idea that Bcl3 directly associates with AP-1 in vivo. Furthermore, microinjection of Bcl3 expression vector into Rat-1 fibroblast cells significantly enhanced DNA synthesis and expression of c-jun, one of the cellular target genes of AP-1. These results suggest that Bcl3 may directly participate in the tumorigenesis processes as a novel transcription coactivator of the mitogenic transcription factor AP-1 in vivo.

Left ventricular muscle mass regression after aortic valve replacement

Implanting a valve that will reduce left ventricular mass is critical in aortic stenosis. Regression of left ventricular hypertrophy in 46 aortic valve replacement (AVR) patients receiving a St. Jude Medical (SJM) valve was assessed by serial electrocardiographic and echocardiographic studies during the preoperative, immediate, and late postoperative periods. The patients were divided into three groups according to valve size; 19 mm group (n=9), 21 mm group (n=20), and 23+mm group (n=17). There was no surgical mortality. The NYHA functional class improved from an average of 2.2+/-0.8 preoperatively to 1.3+/-0.5 post-operatively. Left ventricular muscle mass index (LVMI) regression failed to reach statistical significance in the 19 mm group, whereas in the other two groups a steady decrease in the LVMI occurred with follow up. ECG findings were less remarkable showing insignificant differences in voltage among the three groups (p=0.000). In conclusion, the current data suggest that the 19 mm SJM valve may not result in satisfactory left ventricular muscle mass regression despite adequate function, even in small patients. Therefore, additional procedures to accommodate a larger valve may be warranted in the aortic annulus smaller than 21 mm.

The improvement of color and shelf life of ham by gamma irradiation

This study was undertaken to determine if gamma irradiation can circumvent the need for sodium nitrite to obtain and maintain the desired color of pork loin ham. A dose of 5 kGy was observed to be as effective as the use of 200 ppm of sodium nitrite to provide and maintain the desired color of the product for 30 days. Peroxidation of the product was reduced with addition of sodium nitrite but increased with irradiation. However, organoleptic quality of the irradiated ham without added sodium nitrite was acceptable.

Evaluation of developmentally appropriate programs for adolescent tobacco cessation

Despite introduction of numerous smoking prevention programs in schools, tobacco use has not declined among adolescents. Schools face the dilemma of what to do with students who smoke and are not ready to quit. This study evaluated two programs based on the stages of change model. The educational program, the Tobacco Education Group (TEG), was designed for adolescents not yet thinking about quitting. The cessation program, the Tobacco Awareness Program (TAP), was intended for adolescents who want to quit. Evaluation was completed on 351 students at six public high schools. Compared to a control group of adolescent smokers not assigned to programs, both intervention groups significantly decreased tobacco use. Self-reported use was validated biochemically. Self-efficacy for quitting increased in both programs. Posttest use was predicted by posttest self-efficacy, peer support, and parental support, after controlling for initial use and initial self-efficacy.

Sonic hedgehog enhances somite cell viability and formation of primary slow muscle fibers in avian segmented mesoderm

Primary skeletal muscle fibers first form in the segmented portions of paraxial mesoderm called somites. Although the neural tube and notochord are recognized as crucial in patterning myogenic cell lineages during avian and mammalian somitic myogenesis, the source, identities, and actions of the signals governing this process remain controversial. It has been shown that signals emanating from the ventral neural tube and/or notochord alone or Shh alone serve to activate MyoD expression in somites. However, beyond a role in initiating MyoD expression, little is known about the effects of Shh on primary muscle fiber formation in somites of higher vertebrates. The studies reported here investigate how the ventral neural tube promotes myogenesis and compare the effects of the ventral neural tube with those of purified Shh protein on fiber formation in somites. We show that purified Shh protein mimics actions of the ventral neural tube on somites including initiation of muscle fiber formation, enhancement of numbers of primary muscle fibers, and particularly, the formation of primary fibers that express slow myosin. There is a marked increase in slow myosin expression in fibers in response to Shh as somites mature. The effects of ventral neural tube on fiber formation can be blocked by disrupting the Shh signaling pathway by increasing the activity of somitic cyclic AMP-dependent protein kinase A. Furthermore, it was demonstrated that apoptosis is a dominant fate of somite cells, but not somitic muscle fibers, when cultured in the absence of the neural tube, and that application of Shh protein to somites reduced apoptosis. The block to apoptosis by Shh is a manifestation of the maturity of the somite with a progressive increase in the block as somites are displaced rostrally from somite III forward. We conclude that purified Shh protein in mimicking the effects of the ventral neural tube on segmented mesoderm can exert pleiotropic effects during primary myogenesis, including: control of the proliferative expansion of myogenic progenitor cells, antagonism of cell death pathways within the precursors to muscle fibers, and during the crucial process of primary myogenesis, can exert an effect on diversification of muscle fiber types.

Induction of negative regulators of haematopoiesis in human bone marrow cells by HLA-DR cross-linking

Tumour necrosis factor-alpha (TNF alpha) is up-regulated by cross-linking of major histocompatibility complex (MHC) class II [human leucocyte antigen (HLA)-DR] antigens on monocytes. This is done by a bacterial superantigen or anti-HLA-DR monoclonal antibody (MAb). We have previously shown that HLA-DR cross-linking results in inhibition of haematopoiesis and apoptosis. TNF alpha acts as a negative regulator of haematopoiesis. Here we investigated whether HLA-DR-mediated inhibition of haematopoiesis involved TNF alpha and TNF alpha-dependent secondary signals. Anti-HLA-DR MAb H81.9 up-regulated TNF alpha, as well as transforming growth factor beta, interleukin (IL)-1beta and IL-6 in human marrow cells at the ribonucleic acid (RNA) and protein level. The effect on TNF alpha was investigated further. Up-regulation was blocked by herbimycin A, consistent with a tyrosine kinase-dependent mechanism. Up-regulation was also blunted by the soluble TNF-receptor fusion protein TNFR:Fc, suggesting an autocrine amplification loop. Following TNF alpha up-regulation, there was increased expression of Fas (CD95) and Fas-ligand (Fas-L). Up-regulation of Fas and Fas-L was blocked by TNFR:Fc. Furthermore, MAb H81.9-induced apoptosis was prevented by anti-TNF alpha MAb and by the soluble Fas receptor, Fas-Ig, providing further evidence that the TNF effect was mediated via Fas. At the transcriptional level, cross-linking of HLA-DR by MAb H81.9 affects nuclear localization of NFkappaB, which is involved in the transcription of TNF alpha. NFkappaB activity is modified by changes in cellular redox potential, and we have shown that H81.9 affects redox potential as determined by the generation of nitric oxide. These data show that HLA-DR-initiated signals are able to trigger a cascade of negative regulators of haematopoiesis. This model provides an opportunity to dissect signalling pathways that may be involved in the development of spontaneous marrow failure, and to devise interventions aimed at protecting haematopoiesis.

Activating signal cointegrator 1, a novel transcription coactivator of nuclear receptors, and its cytosolic localization under conditions of serum deprivation

Activating signal cointegrator 1 (ASC-1) harbors an autonomous transactivation domain that contains a putative zinc finger motif which provides binding sites for basal transcription factors TBP and TFIIA, transcription integrators steroid receptor coactivator 1 (SRC-1) and CBP-p300, and nuclear receptors, as demonstrated by the glutathione S-transferase pull-down assays and the yeast two-hybrid tests. The ASC-1 binding sites involve the hinge domain but not the C-terminal AF2 core domain of nuclear receptors. Nonetheless, ASC-1 appears to require the AF2-dependent factors to function (i.e., CBP-p300 and SRC-1), as suggested by the ability of ASC-1 to coactivate nuclear receptors, either alone or in cooperation with SRC-1 and p300, as well as its inability to coactivate a mutant receptor lacking the AF2 core domain. By using indirect immunofluorescence, we further show that ASC-1, a nuclear protein, is localized to the cytoplasm under conditions of serum deprivation but is retained in the nucleus when it is serum starved in the presence of ligand or coexpressed CBP or SRC-1. These results suggest that ASC-1 is a novel coactivator molecule of nuclear receptors which functions in conjunction with CBP-p300 and SRC-1 and may play an important role in establishing distinct coactivator complexes under different cellular conditions.

Alteration of the NAD+/NADH ratio in CHO cells by stable transfection with human cytosolic glycerol-3-phosphate dehydrogenase: resistance to oxidative stress

The intracellular level of the NAD+/NADH ratio plays a vital role in sustaining and coordinating the catabolic reaction of the cell, and reflects the redox state of cytosol. Antioxidants play a role to protect cytosol and membrane from free radicals. This role of antioxidants involves sustaining cell viability and the procedure is thought to be regulated by the equilibrium of the redox state of the cell. However, there is very little known about how the NAD+/NADH level is set and changed. To alter the ratio, human NAD-dependent glycerol-3-phosphate dehydrogenase (cGPDH) cDNA was transfected stably in CHO dhfr- cells. When compared to parental CHO cells, cGPDH activities of the transfected cells were increased 8-12 fold, but the NAD+/NADH ratio was decreased. Specific growth rate of the transfected cells was similar to or slight lower than that of wild type CHO cells. Cell viability of the stable transformants against H2O2 was increased without change of either catalase or glutathione peroxidase activity. However, the increase of cell viability was correlated with the decrease of NAD+/NADH ratio in transfectants. From these results, it is suggested that the overexpression of cGPDH changes the NAD+/NADH ratio toward a decrease, and by this change in the redox state the cell confers more resistance against H2O2.

Preparation and characterization of Japanese encephalitis virus vaccine loaded poly(L-lactide-co-glycolide) microspheres for oral immunization

Japanese encephalitis virus (JEV) vaccine loaded biodegradable poly(L-lactide-co-glycolide) (PLGA) microspheres (MSs) were prepared by W/O/W solvent evaporation method to study the possibility for oral vaccination. The influence of several preparation parameters as stirring rate, types and concentration of emulsifier, PLGA concentration, etc. has been observed on size, size distribution and biodegradation. The mean MSs size decreased when the agitation speed and the concentration of emulsifier were increased, and when the PLGA concentration was decreased. The surface morphology of porous and nonporous JEV vaccine loaded PLGA MSs was prepared from polyvinylalcohol and sodium dodecyl sulfate as used emulsifiers, respectively. From the assay of lactic acid and scanning electron microscope observation, it can be suggested that the rate of biodegradation of nonporous MSs was slower than that of porous surface morphology due to lower the surface area. Mechanisms of the formation of porous and nonporous surface by different types of emulsifier, and the biodegradation of MSs have been proposed. Also, the size and size distribution of JEV vaccine loaded PLGA MSs were discussed to apply oral vaccination through the Peyer's patches across the gastrointestinal tract.

Cannabis use in psychotic patients

OBJECTIVE

The purpose of this study was to examine the level of cannabis use in psychotic patients admitted to two acute admission wards in New Zealand. Symptomatology was investigated using the Brief Psychiatric Rating Scale (BPRS).

METHOD

During a 1 -month period, all acute admissions to Tokanui Hospital with psychosis were interviewed and symptoms rated on the BPRS (n = 35). Cannabis use was recorded with a questionnaire and urine test. Those positive for cannabis were compared to those negative.

RESULTS

Thirty patients (86%) had tried cannabis at least once and 11 (31%) were positive on urine screen. Those with positive urine tests were significantly more likely to use cannabis most days (p < 0.001). This positive urine test group was less likely to be thought disordered, suspicious or deluded (as measured by the BPRS).

CONCLUSIONS

Cannabis use was widespread in this sample of patients with psychosis and may affect their symptomatology. Larger studies are needed to examine these associations in more detail.

Reduction of azides to primary amines in substrates bearing labile ester functionality. Synthesis of a PEG-solubilized, "Y"-shaped iminodiacetic acid reagent for preparation of folate-tethered drugs

[formula: see text] Anhydride 3 is a useful reagent for the synthesis of triply linked drug conjugates. Examples using paclitaxel are provided. Conversion of the azido moiety to a primary amine in the presence of substrates bearing labile ester functionality requires the use of tin/mercaptan reducing system which includes methanol exchange equilibration to effect nitrogen-tin bond scission.

Purification and characterization of brevinase, a heterogeneous two-chain fibrinolytic enzyme from the venom of Korean snake, Agkistrodon blomhoffii brevicaudus

A fibrinolytic enzyme, designated as brevinase, was purified from the venom of Korean snake, Agkistrodon blomhoffii brevicaudus. Brevinase cleaved both the Aalpha- and Bbeta-chains of fibrinogen but did not affect the gamma-chain. It showed beta-fibrinogenase activity devoid of fibrinogen clotting and caseinolytic activity. The fibrinolytic activity was completely inhibited by PMSF, DFP, Pefabloc, and DTT, indicating brevinase is a serine protease requiring disulfide bridge(s) for its activity. It kept 80% of the initial activity after heating at 100 degrees C for 3 min, showed an equal maximum activity in the pH range from 5.5 to 8.5, and was inactivated by Zn(2+). Brevinase consists of two polypeptide chains of 16.5 and 17 kDa linked by disulfide bridge(s). The N-terminal amino acid sequences of 16.5 and 17 kDa chains showed homology to the N-terminal and the internal (central region) amino acid sequences of single-chain fibrinolytic enzymes in snake venom, respectively.

Quantitation of efletirizine in human plasma and urine using automated solid-phase extraction and column-switching high-performance liquid chromatography

A heart-cut column-switching, ion-pair, reversed-phase HPLC system was used for the quantitation of efletirizine (EFZ) in biological fluids. The analyte and an internal standard (I.S.) were extracted from human EDTA plasma by C18 solid-phase extraction (SPE) using a RapidTrace workstation. The eluent from the SPE was evaporated, reconstituted and injected onto the HPLC column. Urine samples were diluted and injected directly without the need of extraction. The compounds of interest were separated from most of the extraneous matrix materials by the first C18 column, and switched onto a second C18 column for further separation using a mobile phase of stronger eluting capability. Linearity range was 10-2000 ng ml(-1) for plasma and 0.05-10 microg ml(-1) for urine. The lower limit of quantitation (LOQ) was 10 ng from 1 ml of plasma, with a signal-to-noise ratio of 15:1. Inter-day precision and bias of quality control samples (QCs) were <5% for plasma and <7% for urine. Selectivity was established against six other antihistamines, three analogs of efletirizine, and on 12 control plasma lots and nine control urine lots. Recovery was 90.0% for EFZ and 89.5% for I.S. from plasma. One hundred samples can be processed in every 2.75 h on a 10-module RapidTrace workstation with minimal human attention. Method ruggedness were tested on three brands of SPE and six different lots of one SPE brand. Performance ruggedness was demonstrated by different analysts on multiple HPLC systems. Analyte stability through sample storage, extraction process (benchtop, freeze-thaw, refrigeration after extraction) and chromatography (on-system, reinjection) was established.

Extended latissimus dorsi musculocutaneous flap for breast reconstruction: experience in Oriental patients

Unilateral breast reconstruction with an extended latissimus dorsi musculocutaneous flap was carried out for 12 women in the National Cheng Kung University Hospital. Eleven patients acquired a good or fair result cosmetically. We analysed the net weight of the flap as well as various anthropometric data to see what effect they have on the final aesthetic outcome. The weight of the flap ranged from 180 to 610 g, and the resected specimen weighed from 160 to 635 g. The flap weight was equivalent to 61%-113% of the specimen weight. A satisfactory result could be achieved when the bulk of the flap attained 70% of the mass resected. We also observed that the aesthetic quality is better when the breast is less ptotic. All of the muscle transfers survived completely without any flap loss. The only complications included one minor wound edge slough and another modest seroma formation at the donor site. This reconstructive method is a viable option for young women with small or medium-sized breasts who anticipate pregnancy in the future. It is especially advisable in Oriental society, since the breast size of the patients is generally smaller and the donor scar is hidden, given the hypertrophic tendency of the lower abdominal scar in Asian people undergoing TRAM flap reconstruction.

Left ventricular rupture after mitral valve replacement

BACKGROUND

What are the immediate and long term outcomes of patients who had rupture of the left ventricle after mitral valve replacement?

METHODS

EXPERIMENTAL DESIGN

A retrospective study with a 20-year follow-up.

SETTING

Experience in a single tertiary referral cardiothoracic surgery hospital.

PARTICIPANTS

20 out of 3105 patients that received mitral valve replacement.

INTERVENTION

All these 20 patients received re-exploration for a trial of repair of left ventricular rupture either by an internal or an external or a combined repair.

MEASURES

Operative mortality and long term outcome of the survivals.

RESULTS

Most patients (16.80%) were female and had rheumatic mitral valve disease. The mean age of the patients was 58.1 years. All patients underwent attempted repair, usually by removal of the prosthesis and reconstitution of the ventricle from within the left atrium (75%). Thirteen (65%) patients died. Two late deaths were of unrelated cause. One surviving patient developed a late ventricular false aneurysm but did not undergo repeat surgery. One patient developed severe mitral regurgitation due to tissue failure of the bioprosthesis 12 years after surgery and she underwent a successful reoperation.

CONCLUSIONS

We believe that all patients should be placed back on cardiopulmonary bypass for an internal repair. The long term outcome of the survivals is satisfactory.

Partial cross-resistance between Strongyloides venezuelensis and Nippostrongylus brasiliensis in rats

Rats were immunized through an initial infection with 1,000 filariform larvae (L3) of Nippostrongylus brasiliensis and after complete expulsion of worms they were challenged with 1,000 L3 of Strongyloides venezuelensis to investigate whether cross-resistance developed against a heterologous parasite. Nippostrongylus brasiliensis-immunized rats developed a partial cross-resistance against S. venezuelensis migrating larvae (MSL3) in the lungs and adult worms in the small intestine. The population of MSL3 in the lungs were significantly lower (P < 0.05) in immunized rats (22.0 +/- 7.4) compared with controls (105.0 +/- 27.6). The populations of adult worms, egg output and fecundity were initially decreased but from day 14 post-challenge they did not show any significant difference between immunized and control rats. However, the length of worm in immunized rat was revealed as retardation. Peripheral blood eosinophilia was significantly decreased (P < 0.05) on day 7 post-challenge and then gradually increased, which peaked on day 42 post-challenge when most of the worms were expelled. These results suggest that peripheral blood eosinophilia is strongly involved in the worm establishment and expulsion mechanisms.

Effects of antioxidants and gamma irradiation on the shelf life of beef patties

To improve the storage safety of two types of ground beef patty popular in Korea (general beef patties and bulgogi patties), we added various antioxidants (200 ppm; including butylated hydroxyanisole, ascorbyl palmitate, alpha-tocopherol, and beta-carotene) to typical formulations of patties, cooked the patties to 70 degrees C, and irradiated them at a dose of 1.5 or 3 kGy. During 30 d of storage at 5 degrees C, the number of aerobic bacteria and lactic acid bacteria were determined using total aerobic plate count and phenyl ethyl alcohol-sucrose agar, respectively. The concentration of thiobarbituric acid was also determined in each type of patty. No colonies were observed in patties irradiated at 3 kGy regardless of which antioxidant was added. In control patties and patties with butylated hydroxyanisole that were irradiated at a dose of 1.5 kGy, growth of microorganisms appeared to be more rapid than in patties with natural antioxidants. The microbiological safety of nonirradiated patties could not be ensured for a period of 20 d. Lipid oxidation was retarded in both types of patty when an antioxidant was added. Ascorbyl palmitate had the strongest antioxidant effect among the natural antioxidants. However, butylated hydroxyanisole was more effective than ascorbyl palmitate when used in an equal amount.

Explosive burns during abusive inhalation of butane gas

Explosion burns during abusive inhalation of butane gas rarely occurred in the past, but recently it has become a social problem among groups of teenagers. This cause constitutes 1.6% of admissions due to flame burn at the burn unit of Hallym Medical Center. A retrospective review during a five-year period identified 48 patients. The male to female ratio was 3:1. The mean age of patients was 16 years and 8 months. The places where the accidents occurred were commonly bedrooms or motel rooms. There were nine group settings of 27 patients at the time of the accident. Inhalation injury (n = 12) was noted on admission. The average burn size was 28.5 percent of the total body surface area. All patients sustained burn injury on the face, arms and hands and 24 patients among them had extended burn areas on the trunk and/or lower extremity. 22 patients (mean hospital stay; 51.6 d) required skin grafting and 12 patients (mean hospital stay; 22.3 d) were treated with conservative management. The mortality rate was 10.4 percent. Explosion burns during abusive inhalation of butane gas can result in mortality as well as major burn injuries.

Seizure associated with olanzapine

OBJECTIVE

To report a case of seizures in a patient who started receiving olanzapine, and to review seizure risk associated with antipsychotic use.

CASE SUMMARY

A 31-year-old African-American woman with multiple psychiatric and medical disorders, including generalized seizure disorder, experienced seizure activity when switched from haloperidol to olanzapine. Olanzapine was discontinued, haloperidol was quickly titrated to the previous dose, and the patient was started on oral phenytoin with no further seizure activity noted. The patient remained seizure free and phenytoin was discontinued without complications.

DISCUSSION

Determining causality in this case is complicated by the number of confounding factors that may have contributed to the occurrence of seizures in this patient. These factors include: (1) diagnosis of generalized seizure disorder, (2) diagnosis of organic mental disorder, (3) concurrent pharmacotherapy with medications implicated in lowering the seizure threshold, and (4) abrupt change in pharmacotherapy. The likelihood that a significant drug interaction precipitated seizure activity is doubtful.

CONCLUSIONS

Considering all factors related to causality, the likelihood that olanzapine was responsible for precipitating seizure activity in this patient was judged possible. Although premarketing studies have indicated that olanzapine may be associated with minimal seizure liability, this case serves as a reminder that postmarketing surveillance of newly released medications is essential.

Hemosiderin deposition on the renal cortex by mechanical hemolysis due to malfunctioning prosthetic cardiac valve: report of MR findings in two cases

We present two cases of mechanical hemolysis due to malfunctioning prosthetic cardiac valves in which MRI was characteristic. The signal intensity of the renal cortex was much lower than that of the medulla on T2-weighted images due to deposition of hemosiderin in proximal convoluted tubules by intravascular hemolysis. These MR findings are identical to those in paroxysmal nocturnal hemoglobinuria.

Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A comparison of clinical results

STUDY DESIGN

Clinical and radiographic results were assessed in adult patients who had undergone operation for isthmic spondylolisthesis.

OBJECTIVES

To compare the results between anterior interbody fusion and posterolateral fusion with those of transpedicular fixation for the treatment of isthmic spondylolisthesis in adults.

BACKGROUND DATA

Successful clinical results after fusion can be expected in adolescents, but the adult type differs in that stability through fusion alone fails to ensure satisfactory outcomes. The role of decompression in the surgical treatment of adult isthmic spondylolisthesis remains controversial. Anterior interbody fusion has an indirect effect of nerve root decompression through widening of the intervertebral space, whereas posterolateral fusion with transpedicular fixation provides direct decompression.

METHODS

The clinical data of 40 adult patients who had undergone operations for isthmic spondylolithesis from June 1977 through June 1994 were reviewed. Anterior interbody fusion was performed in 20 patients (Group I) and posterolateral fusion with transpedicular fixation in 20 patients (Group II). The mean age of Group I was 44.1 years (range, 21-62 years), and that of Group II was 41.3 years (range, 21-57 years). Group I contained B men and 12 women, Group II contained 5 men and 15 women. The symptoms and signs in Groups I and II were similar. The duration of follow-up averaged 3.6 years (range, 1.1-16 years) in Group I and 2.3 years (range, 1.1-6 years) in Group II.

RESULTS

The anterior slippage in Group I, assessed by the Taillard method, was 16.1% and was corrected to 10.4% after surgery. Anterior slippage in Group II was 15.2% and was corrected to 9.8% after surgery. The fusion rate 12 months after surgery was 90% in Group I and 95% in Group II. The clinical results were analyzed by Kim's criteria, according to variables on the improvement of clinical symptoms. Satisfactory results were obtained in 85% of Group I and 90% of Group II.

CONCLUSIONS

There was no statistically significant difference in clinical results between anterior interbody fusion and posterolateral fusion with transpedicular fixation for the treatment of isthmic spondylolisthesis in adults (P < 0.05).

Surgical management of blunt traumatic rupture of the descending thoracic aorta

Acute rupture of the descending thoracic aorta following blunt trauma is a life-threatening injury that requires emergent operative intervention. From February 1989 to January 1997, 4 patients with multiple injuries including traumatic rupture in the region of the aortic isthmus were surgically treated at our institution. Diagnosis was confirmed in all patients by aortogram prior to aortic repair. One patient had preoperative paraplegia secondary to an unstable spinal fracture. All patients underwent repair under cardiopulmonary bypass (3 partial, 1 total with hypothermic arrest). The site of rupture was resected and replaced with an interposition artificial graft. There was no perioperative mortality and no additional occurrence of paraplegia. Our experience and a review of the literature indicate that for survivors of traumatic aortic rupture, excellent outcomes can be achieved only if the diagnosis is made early and the surgical treatment is prompt.

Polypoid endobronchial Hodgkin's disease with pneumomediastinum

We report a 23-year-old man with polypoid endobronchial Hodgkin's disease which presented with intermittent multilobar atelectasis and spontaneous pneumomediastinum. Chest radiograph and CT findings are demonstrated.

Fluoxetine inhibits L-type Ca2+ and transient outward K+ currents in rat ventricular myocytes

The most common cardiovascular side effects of antidepressants are cardiac arrhythmias and orthostatic hypotension. Little is known, however, about the mechanisms by which these adverse reactions may occur, especially with regard to newer drugs such as fluoxetine. We hypothesized that these side effects may have an electrophysiological basis at the level of the cardiac myocyte. Thus, we investigated the effects of fluoxetine and other antidepressants on action potentials and ionic currents of rat ventricular myocytes using the amphotericin B perforated patch clamp technique. Fluoxetine (10 microM) prolonged the action potential duration (APD50) to 146.7 +/- 12.9% of control value without altering resting membrane potential. Fluoxetine and sertraline potently inhibited the L-type Ca2+ current (IC50 = 2.82 and 2.31 microM, respectively), but did not significantly modify the steady-state inactivation. Amitriptyline and imipramine had similar, but slightly weaker, effects (IC50 = 3.75 and 4.05 microM, respectively). Fluoxetine attenuated the peak transient outward K+ current and also altered current kinetics, as shown by accelerated decay. Fluoxetine did not change the voltage-dependence of the steady-state inactivation. Sertraline, amitriptyline and imipramine inhibited the transient outward K+ current with potencies very similar to fluoxetine. In contrast to the other antidepressants tested, trazodone weakly inhibited the Ca2+ and K+ currents and moclobemide had no detectable effect. Our comparative pharmacology data suggest that selective serotonin reuptake inhibitors, such as fluoxetine, are as potent as tricyclic antidepressants in inhibiting L-type Ca2+ and transient outward K+ currents. These inhibitory effects may contribute to cardiovascular complications such as arrhythmias and orthostatic hypotension.