Abdominal wall pseudohernia following video-assisted thoracoscopy and pleural biopsy

A rare case of pseudohernia of the abdominal wall following video-assisted thoracoscopy (VAT) and pleural biopsy in a 61-year-old male is presented. The patient presented with a recurrent pleural effusion following fractured ribs after a road traffic accident. Computerised tomography (CT) showed thickened pleura, which was biopsied using VAT. Access to the pleural cavity was obtained with two laparoscopic ports inserted at the 8th intercostal space on the posterior chest wall. Following the procedure, the patient experienced sharp pain over the right hypochondrium, which was followed by the development of a diffuse bulge associated with the loss of skin sensation. Ultrasound and CT disclosed no musculofascial defect. Electromyography showed denervation changes affecting the muscles innervated by the 8th intercostal nerve. With expectant treatment over a year, cutaneous sensation recovered partially; however, the size of the pseudohernia remained unchanged. To the authors' knowledge, this is the first report of a pseudohernia in the English literature following VAT and pleural biopsy.

Behcet's Disease : report of a case and review of the literature

Behcet's disease (BD) is an autoimmune disease of unknown aetiology with multisystem involvement presenting with relapsing orogenital ulcers and uveitis, involvement of central nervous system, joints, lungs, gastrointestinal tract and major blood vessels leading to myriads of presentations, which requires a multidisciplinary approach for satisfactory outcome. We describe a patient with BD, highlight its pathophysiology and management aspects, and present review of pertinent literature.

The alpha isoform of protein kinase C is involved in signaling the response of desmosomes to wounding in cultured epithelial cells

Initiation of reepithelialization upon wounding is still poorly understood. To enhance this understanding, we focus here on changes in the adhesive state of desmosomes of cultured Madin-Darby canine kidney cells in response to wounding of confluent cell sheets. Previous results show that desmosomal adhesion in Madin-Darby canine kidney cells changes from a calcium-dependent state to calcium independence in confluent cell sheets. We show that this change, which requires culture confluence to develop, is rapidly reversed upon wounding of confluent cell sheets. Moreover, the change to calcium dependence in wound edge cells is propagated to cells hundreds of micrometers away from the wound edge. Rapid transition from calcium independence to calcium dependence also occurs when cells are treated with phorbol esters that activate PKC. PKC inhibitors, including the conventional isoform inhibitor Gö6976, cause rapid transition from calcium dependence to calcium independence, even in subconfluent cells. The cellular location of the alpha isoform of PKC correlates with the calcium dependence of desmosomes. Upon monolayer wounding, PKCalpha translocates rapidly to the cell periphery, becomes Triton X-100 insoluble, and also becomes concentrated in lamellipodia. The PKCalpha translocation upon wounding precedes both the increase in PKC activity in the membrane fraction and the reversion of desmosomes to calcium dependence. Specific depletion of PKCalpha with an antisense oligonucleotide increases the number of cells with calcium-independent desmosomes. These results show that PKCalpha participates in a novel signaling pathway that modulates desmosomal adhesion in response to wounding.

Buoyancy-driven, rapid exhumation of ultrahigh-pressure metamorphosed continental crust

Preservation of ultrahigh-pressure (UHP) minerals formed at depths of 90-125 km require unusual conditions. Our subduction model involves underflow of a salient (250 +/- 150 km wide, 90-125 km long) of continental crust embedded in cold, largely oceanic crust-capped lithosphere; loss of leading portions of the high-density oceanic lithosphere by slab break-off, as increasing volumes of microcontinental material enter the subduction zone; buoyancy-driven return toward midcrustal levels of a thin (2-15 km thick), low-density slice; finally, uplift, backfolding, normal faulting, and exposure of the UHP terrane. Sustained over approximately 20 million years, rapid ( approximately 5 mm/year) exhumation of the thin-aspect ratio UHP sialic sheet caught between cooler hanging-wall plate and refrigerating, downgoing lithosphere allows withdrawal of heat along both its upper and lower surfaces. The intracratonal position of most UHP complexes reflects consumption of an intervening ocean basin and introduction of a sialic promontory into the subduction zone. UHP metamorphic terranes consist chiefly of transformed, yet relatively low-density continental crust compared with displaced mantle material-otherwise such complexes could not return to shallow depths. Relatively rare metabasaltic, metagabbroic, and metacherty lithologies retain traces of phases characteristic of UHP conditions because they are massive, virtually impervious to fluids, and nearly anhydrous. In contrast, H2O-rich quartzofeldspathic, gneissose/schistose, more permeable metasedimentary and metagranitic units have backreacted thoroughly, so coesite and other UHP silicates are exceedingly rare. Because of the initial presence of biogenic carbon, and its especially sluggish transformation rate, UHP paragneisses contain the most abundantly preserved crustal diamonds.

Comparison of topical and oral acyclovir in early herpes zoster ophthalmicus

Poor systemic absorption has limited the efficacy of early oral acyclovir in herpes zoster ophthalmicus (HZO). Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir. Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complications (p < 0.02) and anterior uveitis was significantly more frequent (p < 0.01) and severe (p < 0.01). Corneal hypoaesthesia was significantly more frequently (p < 0.05) and severe (p < 0.02) at 1 month. From 2 weeks patients receiving ointment were more likely to have pain and at all times their pain was more severe, but these differences were not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO.

Characterization of complementary DNA encoding the rat neuromedin U precursor

Neuromedin U (NmU), a peptide originally isolated from porcine spinal cord, is known for its ability to stimulate uterine smooth muscle contraction and to cause selective vasoconstriction. It was subsequently isolated from a number of species. Among the species studied, the five amino acids at the C-terminus of the peptide are totally conserved, suggesting that this region is of major importance. We have cloned and sequenced the cDNA encoding the rat NmU precursor protein using the anchor polymerase chain reaction technique. Sequence analysis revealed that NmU is synthesized as a 174-amino acid precursor. Like the precursors of most other small regulatory peptides, it has a hydrophobic signal peptide and a number of paired dibasic amino acids, which may serve as signals for enzymatic cleavage, to release NmU and a series of other peptides. These predicted flanking peptides of NmU show no significant homology with entries in the protein databases searched, and the cDNA likewise shows no homology with entries in the GenBank database. Northern blot analysis using total RNA extracted from different rat tissues shows high levels of NmU mRNA in the ileum, thyroid, and anterior pituitary. Southern blot analysis of rat genomic DNA demonstrates that NmU is a single copy gene.

RFLP for the human apolipoprotein B gene: II;EcoRI

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RFLP for the human apolipoprotein B gene: III;EcoRV

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RFLP for the human apolipoprotein B gene: I;BamHI

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RFLP for the human apolipoprotein B gene: IV;MspI

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RFLP for the human apolipoprotein B gene: V;XbaI

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Possible applications of recombinant DNA technology to the diagnosis and study of variants of alpha 1-antitrypsin

We describe the basic principles of recombinant DNA technology and how this methodology has been used to isolate and characterise cloned genes coding for alpha 1-antitrypsin. We show how these probes can be used for diagnosis and to study molecular variants of alpha 1-antitrypsin which may predispose individuals to develop lung disease.

Characterisation of mRNAs encoding the precursor for human apolipoprotein CI

cDNA clones encoding human apolipoprotein CI have been isolated from an adult liver cDNA library. Apo CI mRNA was shown to have two species of approximately 580 and 560 bases by RNA blot hybridisation. The intracellular precursor of apo CI was inferred from the cDNA sequence to be an 83 amino acid polypeptide consisting of the 57 residue mature protein and an additional 26 residue amino terminal signal peptide. The 5' untranslated regions of the messages are 63 and 40 bases as determined by primer extension and the 3' untranslated region 111 bases. A polyadenylation signal is situated 10 bases 3' of the poly(A) tall. The mRNA level of apo CI in human liver was significantly greater than that of apo All and apo E.

The isolation of a clone for human alpha 1-antitrypsin and the detection of alpha 1-antitrypsin in mRNA from liver and leukocytes

A recombinant clone containing an insert complementary to alpha 1-antitrypsin (alpha 1-AT) mRNA has been isolated from a human adult liver cDNA library. The clone was selected by direct screening of recombinants with a synthetic oligodeoxynucleotide 17 bases in length corresponding to the known partial DNA sequence of the gene. The insert size of the clone is 250 base pairs. The DNA sequence of the clone has been determined and agrees with the published partial DNA sequence. There is one nucleotide difference from the published sequence, causing a single amino acid change at position 376 where aspartate replaces glutamate. The clone has been used to detect alpha 1-AT mRNA sequences in human liver and in a mixed leukocyte population containing monocytes and lymphocytes. A single mRNA approximately 1,400 nucleotides in length is observed in both leukocytes and liver. Leukocytes contain only 0.15% as much alpha 1-AT mRNA as liver.

[Monitoring therapy by analysis of the drug concentration of saliva]

The distribution of a drug between blood and saliva depends on its physicochemical properties, e.g. binding to plasma proteins, apparent dissociation constant and lipid solubility. The clinical value of measuring salivary drug concentrations in therapeutic drug monitoring is demonstrated using anticonvulsant therapy in children as an example. For carbamazepine and phenytoin there is a close and constant saliva/serum ratio over a wide range of concentrations, which is influenced by the salivary flow rate only to an insignificant degree. Salivary concentrations of carbamazepine account for about 40%, of phenytoin for about 10% of the serum concentrations. In contrast, salivary levels of primidone and phenobarbital are significantly influenced by the rate of saliva flow. In resting saliva primidone levels slightly exceed those in serum and fall significantly below the corresponding serum values during forced stimulation of salivary flow. For phenobarbital in resting saliva the mean saliva/serum ratio is 0.3 and increases significantly during forced stimulation. Provided the conditions of sample collection are standardized saliva is suitable for monitoring primidone and phenobarbital therapy, too.

School achievement and behaviour of children who were small-for-dates at birth

School-teachers were asked to assess the school achievement and behaviour of 45 children who had been small-for-dates (SFD) at birth, and of 19 control children who had had a normal birthweight. The SFD children were divided into groups according to the stage in gestation at which slow head-growth began. Those whose head growth had slowed before 26 weeks gestation achieved less well at school than those who had had no evidence of slow intra-uterine head-growth. Their teachers also thought they were less able to concentrate. Boys (but not girls) whose head growth had slowed between 27 and 34 weeks gestation also had problems at school. The authors conclude that school achievement and behaviour of children who were small-for-dates at birth is related to the severity of slow growth before birth, the sex of the child and the social class of the parents.