Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass. A Technical Case Report

SUMMARY

A case of a giant aneurysm of the right middle cerebral artery treated with Guglielmi detachable coils is reported. Extracranial to intracranial bypass had previously been performed and surgical trapping had been attempted. During the endovascular procedure, balloon test occlusion of the middle cerebral artery was performed in order to demonstrate clinical and angiographic tolerance to parent vessel occlusion. A previous occlusion test in the right common carotid artery did not show sufficient flow through the bypass to perform safe parent vessel occlusion. Diagnostic imaging, the endovascular procedure, and haemodynamic aspects in cases in which parent vessel occlusion is required after extracranial-intracranial bypass are described and the literature is reviewed.

Treatment of TMJ static disk with arthroscopic lysis and lavage: a comparison between MRI arthroscopic findings and clinical results

Arthroscopic surgery using the lysis and lavage technique was performed on 30 temporomandibular joints (TMJs) of 26 patients with the clinical and radiological (pseudodynamic Magnetic Resonance Imaging) diagnosis of static disk (SD). Parameters of condylar movement, position of the disk in relation to the condyle in open and closed mouth positions and mobility of the articular disk were evaluated both clinically and radiologically using pseudodynamic Magnetic Resonance Imaging (MRI) before and after surgery. Subjective parameters of pain and functional limitation were also evaluated clinically. The results showed that all the clinical and radiological parameters analyzed improved significantly in all the patients included in the study. In view of the results, the authors concluded that SD should be added to the existing categories of TMJ internal derangements. Pseudodynamic MRI is the diagnostic technique of choice in these cases and arthroscopic surgery with lysis and lavage followed by active physical therapy is an effective treatment modality in this type of pathology.

TMJ static disk: correlation between clinical findings and pseudodynamic magnetic resonance images

The aim of this study was to analyze the position and mobility of the temporomandibular joint (TMJ) articular disk by means of pseudodynamic magnetic resonance imaging (MRI) and to compare: clinical features, osseus and muscular degenerative changes, the different types of static and their signs and symptoms. The study was performed on 101 patients with clinical and MRI diagnosis of TMJ internal derangement with closed lock (permanent or episodic). On the MRI survey the following was evaluated: disk displacement, disk mobility, condylar translation, bone, and muscular fatty atrophy. Pain was more frequent in static disks (SD) than in mobile disks (MD) in all types of disk displacements (p < 0.01). Condylar translation was always lower in SD than in MD, independently from the position of the articular disk (p < 0.01). Localized sclerosis was more frequent in joints with SD. There were no statistically significant differences in the incidence of fatty atrophy considering disk mobility. The results of the study indicate that clinical diagnosis of closed lock with high frequency is related to the presence of a static disk. Clinical diagnosis of SD can be confirmed with a pseudodynamic MRI survey.

[Integration of multimodal medical images]

Multimodality analysis is becoming a required tool in medical practice due to the development of different image techniques and new imaging processing tools. This paper is a review of the basis of medical image integration, image fusion techniques, and their clinical applications, especially addressing our experience with brain tomographic studies in nuclear medicine and radiology.

Chromosomal location of PCR fragments as a source of DNA markers linked to aluminium tolerance genes in rye

To identify and locate rye DNA sequences homologous to three wheat c-DNAs (wali1, wali2 and wali5) whose expression is induced by aluminium (Al) stress, we designed three pairs of specific primers. They were used in the amplification of genomic DNA from wheat-rye disomic addition lines. The wali2 pair of primers amplified a 878-bp rye DNA fragment (rali2) located on chromosomes 4R and 7R that showed 79.37% homology with the corresponding wheat c-DNA. RAPD fragments were also used as genetic markers. We located 22 different RAPDs distributed on 11 different rye chromosome arms using wheat-rye disomic and ditelocentric addition lines. Thirteen of these markers were located on the chromosomes 3R, 4R and 6R, which also carry aluminium-tolerance genes. The OPA08 415 and OPR01 600 RAPD markers, located on the 6RL and 6RS chromosome arms, respectively, were converted to SCAR markers (SCA08 415 and SCR01 600 ) and linked to Alt1 gene (SCR01 600 -2.1 cM-Alt1-33.5 cM-SCA08 415 ). We propose that the chromosomal location of RAPDs and SCARs using wheat-rye addition lines is a source of DNA markers linked to aluminium-tolerance loci and offers a valuable strategy in marker-assisted selection for the introgression of tolerance genes in wheat.

Antenatal prediction of fetal pH in growth restricted fetuses using computer analysis of the fetal heart rate

We tested the accuracy of a mathematical model based on computer analysis of the fetal heart rate tracing in predicting umbilical artery pH at birth. In a previous report based on data on 38 growth-restricted fetuses, the second-order polynomial regression equation, umbilical artery pH = 7.28 + 0.002 (duration of episodes of low variation in minutes) + 0.00009 (duration of episodes of low variation in minutes), was retrospectively found to be the best model for the prediction of umbilical artery pH at birth. In the present study, this formula was prospectively tested in 29 growth restricted fetuses between 26 and 37 weeks of gestation from pregnancies with abnormal uterine and/or umbilical artery Doppler velocimetry. Computer analysis of the fetal heart rate tracing of 1 hour duration was performed within 1.5-6 hours of cesarean birth prior to the onset of labor. Umbilical artery cord blood was collected at birth with pH determined within 5 minutes of collection. Acidemia was defined as umbilical artery pH < 7.20, preacidemia pH 7.20-7.25 and nonacidemia pH > 7.25. Then, the data on all 67 growth-restricted fetuses were pooled to generate a new formula that was retrospectively assessed against the entire group. Values are reported as median (range). In the 29 prospectively evaluated cases, there was no statistical difference between the predicted and actual umbilical artery pH at birth [7.28 (7.1-7.29) vs. 7.28 (7.18-7.37), P = 0.57]. The median difference between the paired predicted and actual umbilical artery pH values was -0.001 (-0.10-0.08). The difference between the predicted and actual umbilical artery pH was zero and within +/- 0.04 in 17% (5/29) and 76% (22/29) of the cases, respectively. When the data on the 67 growth-restricted fetuses were pooled together the formula did not change. There was no difference between the predicted and actual umbilical artery pH at birth when the formula was applied to all 67 growth-restricted fetuses [7.28 (7.08-7.29) vs. 7.27 (6.97-7.37), P = 0.41]. The median difference between the paired predicted and actual pH values was -0.001 (-0.12-0.12). The difference between the predicted and actual umbilical artery pH was zero and within +/- 0.04 in 15% (10/67) and 74% (49/67) of the cases, respectively. The accuracy of the formula in correctly categorizing the umbilical artery pH at birth was: acidemia 67% (8/12), preacidemia 28% (8/29) and nonacidemia 80% (37/46), P < 0.0001. A mathematical formula using the computer analysis index of duration of episodes of low variation reliably predicted umbilical artery pH at birth. This type of noninvasive monitoring may allow for the antepartum estimation and continuous tracking of fetal pH.

Enzyme-linked immunosorbent assay of autoantibodies against mitochondrial glycerophosphate dehydrogenase in insulin-dependent and non-insulin-dependent diabetic subjects

The mitochondrial enzyme FAD-linked glycerophosphate dehydrogenase (mGDH) plays a key role in the recognition of glucose as a stimulus for insulin release from the pancreatic islet B-cell. In the present study, an ELISA procedure was used for the measurement of mGDH antibodies in both insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients. Positive readings, exceeding the upper limit of the normal range, were recorded in 7 out of 12 IDDM patients, as distinct (P < 0.01) from 2 out of 12 nondiabetic subjects of comparable age. The study conducted in 41 NIDDM patients and 15 control subjects of similar age indicated that the incidence of mGDH-positive cases was not significantly different in the diabetic (4/41) and control (1/15) groups, the measurement of optical density in the positive cases barely exceeding the upper limit of the normal range. These findings indicate that the mitochondrial enzyme mGDH often acts as an antigenic determinant in IDDM, but not in NIDDM, patients.

Effects of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate tracings as measured by computer analysis

OBJECTIVE

To evaluate the effect of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate (FHR) tracings as measured by computer analysis.

METHODS

We studied 37 women with uncomplicated pregnancies at term with reactive FHR tracings. The women were randomized to receive epidural anesthesia with either bupivicaine with fentanyl or bupivicaine alone. One-hour FHR tracings were obtained before epidural anesthesia. Thirty minutes after the initial bolus of the epidural a repeat computer analysis of 60-minute FHR tracing was obtained. Median values are reported for FHR parameters with statistical analysis performed by the Mann-Whitney U and Wilcoxon signed rank tests where appropriate. A power calculation was performed using a power of 90% to determine a required sample size of 28 patients. Statistical significance was set at P < .05.

RESULTS

In early first stage of labor, there was no significant difference in pre- and postepidural anesthesia FHR baseline, accelerations of 10 and 15 beats per minute, episodes of high and low variation, and short- and long-term variation when using either narcotic or non-narcotic anesthetic agents.

CONCLUSIONS

Thus, the clinician can consider the use of narcotic as well as non-narcotic continuous epidural anesthesia in the dosages used in our study with its attendant advantages without fear of obscuring the fetal heart rate tracing.

Fulminant inflammatory demyelination: long-term course and magnetic resonance imaging findings

The course and prognosis of adult patients who recover from acute and extensive inflammatory demyelination, variously termed fulminant or Marburg's type of multiple sclerosis (MS), is poorly known. We report long-term magnetic resonance imaging (MRI) and neuropsychological findings in two patients who developed acute psychosis and a state resembling akinetic mutism, with CT scan evidence of extensive cerebral white matter damage. Both patients ultimately recovered, but were left with a severe, non-progressive dementia with prominent frontal lobe signs unassociated with motor impairment. Extensive residual MRI lesions with evidence of tissue destruction in the white matter and callosal atrophy were visible many years after the initial event One of the patients developed a single relapsing-remitting episode with multifocal neurological deficits several years after the onset, whereas the condition remained monophasic in the other patient during an 8 year follow-up. Our observations suggest that while patients with so-called "fulminant" demyelinating disorders may nowadays survive with supportive measures, the disorder may remain stabilized for many years following disease onset.

Immunodetection of mitochondrial glycerophosphate dehydrogenase (mGDH) by a polyclonal antibody raised against a recombinant mGDH fragment product

The mitochondrial enzyme glycerophosphate dehydrogenase (mGDH) plays an essential role in the B-cell glucose-sensing device and its activity in islet homogenates is impaired in several animal models of type 2 diabetes. We have now developed a polyclonal antibody, raised against a recombinant mGDH fragment product, that could be used for the immunodetection of mGDH. Total RNA was isolated from rat pancreatic islets and used in the synthesis of cDNA. Specific primers were designed that corresponded to the FAD binding domain of mGDH. The PCR product was purified and cloned into an appropriate expression vector used for transformation of Escherichia coli cells. The fusion protein was extracted from the transformed cells, further purified, and used for immunization of rabbits. The antibody recognized a single band of 72 kDa in rat islets and testis. The recombinant mGDH product was also recognized as a single band with the expected 65-kDa reference. An ELISA procedure was designed for detection of antibodies against the recombinant mGDH fragment product. The availability of the mGDH antibody opens the way to a number of further applications such as immunocytochemis- try and mGDH quantification in biological material.

Effects of therapeutic amniocentesis on uterine and umbilical artery velocimetry in cases of severe symptomatic polyhydramnios

The objective of this study was to determine the effects of removal of amniotic fluid in cases of symptomatic severe polyhydramnios on Doppler waveform indices of the uterine and umbilical arteries and flow velocities of the uterine arteries. Nine women underwent therapeutic amniocentesis during ten pregnancies for symptomatic polyhydramnios due to Beckwith-Wiedemann Syndrome (n = 1), esophageal atresia (n = 2), chorioangioma (n = 1), twin-twin transfusion syndrome (n = 3), a presumed autosomal recessive syndrome (n = 2), and an unbalanced double translocation (n = 1; partial dup 3q and partial del 9p syndrome). An average of 2.78 +/- 0.9 (range 1-4) 1 of fluid were removed at each procedure between the gestational ages of 18 and 34 weeks (mean of 28 weeks). The systolic/diastolic (S/D) ratio, pulsitility index (PI), and resistance index (RI) of the uterine and umbilical arteries were obtained before and after the procedure using color and pulsed Doppler. After angle correction, the peak systolic velocity (PSV) and mean velocity (MV) in centimeters/second (cm/s) of the uterine arteries were also determined. The presence or absence of a uterine artery waveform notch was determined. Dominant uterine arteries were defined as those with lower impedance indices or higher flow velocities. Statistical analysis was performed with the Wilcoxon signed-rank test. Significance was set at P < 0.05. There was a significant increase in the median value of the uterine artery MV (43.8 vs. 81.1 cm/s, P = 0.005) and PSV (74.2 vs. 125.5 cm/s, P = 0.007) after amniocentesis. The uterine S/D (3.0 vs. 1.84, P = 0.007), PI (1.12 vs. 0.68, P = 0.008), and RI (0.60 vs. 0.45, P = 0.005) impedance indices significantly decreased following amniocentesis. When uterine arteries were categorized as dominant vs. nondominant, there were greater improvements in impedance indices and flow velocities in the nondominant uterine arteries. There were three cases of unilateral and one case of bilateral early diastolic notches of the uterine artery waveforms which either resolved (n = 4) or improved (n = 1). There was no effect on the umbilical artery impedance indices. Therapeutic amniocentesis significantly improved uterine artery impedance indices and resulted in improved flow velocities, while there was no effect on umbilical artery waveform indices. The procedure resulted in the disappearance or improvement of the uterine waveform notch. Our findings suggest that in cases of severe polyhydramnios abnormal uterine artery velocimetry may not be due to lack of trophoblastic invasion of the spiral arteries but to increased intrauterine pressure secondary to polyhydramnios.

Sex influence on recombination frequency in Secale cereale L

The variation in recombination frequency (rf) is important to plant breeders since their major objective is to obtain favorable recombinants of linked genes. One source of variation in rf is sex. Sex differences for recombination frequencies were studied in four of the seven chromosomes of Secale cereale L. cv 'Ailés' using isozyme and storage protein loci and were determined on the basis of reciprocal crosses between heterozygous plants of cv. 'Ailés' and homozygous plants of the inbred line 'Riodeva'. The differences were found to be strongly segmentspecific. In some cases the level of crossing-over in male and female meiosis was about the same (between Pgm1 and Ndh1 loci on chromosome arm 4RS). However, for most of the chromosome segments in 1R, 3RL and 6RL the male rf was significantly higher than the female rf. Different hypotheses about the mechanisms of plant sex differences for recombination are discussed.

[Percutaneous femoro-porto-jugular venovenous shunt in orthotopic liver transplantation]

Veno-venous bypass (VVB) by the percutaneous introduction of cannulas in the right internal jugular vein during liver transplantation may reduce the complications derived from the classical method of axillary vein dissection. The results and complications observed over a two and a half year period in 126 consecutive patients submitted to liver transplantation in whom preparation for femoral-portal-jugular veno-venous bypass was carried out are reported. Twelve complications (9.5%) were observed in the 126 patients. All the complications were due to jugular cannulation and were divided as follows: in 7 patients (5.5%) some of the guide introductions were unsuccessful following multiple punctures; in 2 patients (1.6%) the right carotid artery was punctured; 2 hemothorax (1.6%) were observed and one pneumothorax (0.8%). Forty patients required veno-venous bypass. The blood flows obtained during VVB were suffice in all the cases with a mean +/- standard deviation of 2.21 +/- 0.44 l/min-1. The technique of femoral-portal-jugular veno-venous bypass is a good alternative to the classical method of the axillary approach. It has advantages such as in the speed of installation of VVB and the utility of the large jugular vein during the remainder of the surgery for rapid fluid transfusions. Although the number of complications is low, they may be important thereby hindering intra management and post operative of the patients.

The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage

OBJECTIVE

Our purpose was to determine whether perioperative transvaginal ultrasonographic evaluation of the incompetent cervix treated with emergency cerclage is predictive of pregnancy outcome.

STUDY DESIGN

Twenty-nine women who underwent emergency cerclage at 16 to 26 weeks of gestation had transvaginal ultrasonographic evaluation of the cervix within 48 hours before and after surgery and at least three times thereafter until 28 weeks of gestation. The following measurements were obtained: (1) funnel width, (2) funnel length, (3) endocervical canal length, (4) the distance between the internal and external os, (5) upper cervix (length of closed endocervical canal above the cervical cerclage), (6) lower cervix (endocervical canal length below suture), and (7) cervical index (1+ Funnel length/Endocervical canal length). Values are reported as the median in millimeters, and statistical analysis was performed by use of the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman rank correlation, 2 x 2 contingency tables, and multiple regression analysis with significance set at p < 0.05.

RESULTS

Cerclage procedures resulted in significant improvement in postoperative median measurements of funnel width (15 vs 4.0 mm, p < 0.0001), funnel length (29 vs 3 mm, p < 0.0001), and endocervical canal length (2 vs 27 mm, p < 0.0001). There was a significant relationship between gestational age at delivery and the following measurements: preoperative funnel width (r = -0.51, p = 0.007), postoperative endocervical canal length (r = 0.39, p = 0.04), length of the lower cervix (r = 0.39, p = 0.038), and the cervical index (r = -0.39, p = 0.038). An upper cervical length < 10 mm was a good predictor of delivery before 36 weeks of gestation, sensitivity 85.7% (12/14), specificity 66.7% (10/15), positive predictive value 70.6% (12/17), negative predictive value 83% (10/12), and Fisher's exact p = 0.008. Postoperatively all patients had upper cervical lengths < 10 mm by 28 weeks of gestation. Preoperative digital assessments of cervical dilatation before surgery did not correlate with gestational age at birth (r = -0.031, p = 0.36).

CONCLUSIONS

In cases of cervical incompetence treated with emergency cerclage, perioperative transvaginal ultrasonographic assessment of the cervix reveals that the procedure results in improved ultrasonographic status of the cervix and that the ultrasonographic cervical findings before and after surgery correlate with pregnancy outcome.

The efficacy of individual computer heart rate indices in detecting acidemia at birth in growth-restricted fetuses

OBJECTIVE

To determine the efficacy of individual fetal heart rate (FHR) indices, as determined by computer analysis of the FHR tracing, in detecting fetal acidemia at birth in growth-restricted fetuses.

METHODS

The study population consisted of 38 growth-restricted fetuses at 26-37 weeks' gestation from pregnancies with abnormal uterine and/or umbilical artery Doppler velocimetry. The 1-hour FHR tracing was analyzed by computer within 4 hours of cesarean birth before the onset of labor. Umbilical artery cord blood was collected at birth, and pH was determined within 5 minutes of collection.

RESULTS

On linear regression, the duration of episodes of low variation in minutes (r = -0.77, r2 = 0.59) and short-term (r = 0.72, r2 = 0.52) and long-term (r = 0.69, r2 = 0.47) variation in milliseconds were significantly related to umbilical artery pH at birth, and more so than the number of accelerations of ten (r = 0.57, r2 = 0.32) and 15 (r = 0.38, r2 = 0.14) beats per minute. There were significant differences in computer measurements of FHR accelerations and variation between the umbilical artery pH categories of acidemia (pH less than 7.20), preacidemia (7.20-7.25), and nonacidemia (greater than 7.25). Stepwise regression revealed that episodes of low variation best described the model for predicting umbilical artery pH at birth (P < .001), with no improvement provided by the addition of other computer-analyzed FHR characteristics.

CONCLUSION

In this population of growth-restricted fetuses delivered by elective cesarean, the computer indices of duration of episodes of low variation and short-term and long-term variation were significantly associated with umbilical artery pH and predicted umbilical artery acidemia at birth.

Sonography in the evaluation of the cervix during pregnancy

Sonographic techniques have been developed to study the biometry and behavior of the cervix during pregnancy which have led to a better understanding of the pathogenesis of pregnancy loss and preterm birth. Nomograms have been developed for singleton and twin gestations, and associations between cervical sonographic characteristics and various adverse pregnancy outcomes have been observed. The new concept of 'relative' cervical incompetence suggests that the cervix may be an independent contributor to preterm birth. The incorporation of cervical sonography in management schemes for the prevention of pregnancy loss or preterm delivery has the potential to impact favorably on perinatal outcome.

Pancreatic islet GLUT2 glucose transporter mRNA and protein expression in humans with and without NIDDM

GLUT2 glucose transporter mRNA has been shown to be underexpressed in pancreatic islets of numerous animal models of non-insulin-dependent diabetes mellitus (NIDDM). It has been proposed that this molecular defect contributes to the pathogenesis of diabetes, although information concerning the expression of GLUT2 in human pancreatic islet tissue is lacking. In contrast to the high abundance of GLUT2 in rat islets, human islets were found to express distinctly low levels of this glucose transporter mRNA and protein. Thus, a sensitive competitive reverse transcription-polymerase chain reaction assay was developed to quantify human GLUT2 mRNA. We obtained pancreases from 4 human organ donors with previously diagnosed NIDDM and 11 nondiabetic donors and found no significant differences in GLUT2 mRNA between the two groups. GLUT2 mRNA was 0.24 +/- 0.08 amol/micrograms RNA (mean +/- SE) in pancreases from humans with diabetes and 0.27 +/- 0.06 amol/microgram RNA in those without this diagnosis. Similarly, human pancreatic islet GLUT2 protein was measured by immunoblot and found to be present at similar levels in two individuals with diabetes relative to six control samples. These results thus demonstrate the existence of species differences in the abundance of islet GLUT2 mRNA and protein. Furthermore, the analysis of islet GLUT2 in a small sample of human organ donors with and without diabetes raises the possibility that decreased beta-cell GLUT2 may not represent a widespread feature of humans with NIDDM.

MR imaging and CT of central nervous system tuberculosis in the patient with AIDS

CNS TB represents a disease that complicates AIDS with an increasing incidence in endemic areas as well as in developed countries in those patients who have some risk factors such as intravenous drug abuse. Although TB infection of the CNS in AIDS patients may follow a rapidly progressive course, the imaging findings otherwise are similar to those of the nonimmunosuppressed population. Meningeal enhancement, hydrocephalus, parenchymal granulomata, and infarcts are seen frequently and are often observed in combination with one another. Nevertheless, the differential diagnosis in AIDS patients must include other opportunistic infections and primary or metastatic lymphoma of the CNS. Spinal TB usually is seen in the form of epidural abscess secondary to tuberculous spondylitis, although it may be seen in isolation of spinal column involvement. The differential diagnosis includes spinal lymphoma or pyogenic abscess formation. Radiculomyelitis or isolated spinal cord tuberculomata are much less frequently observed and can be suspected on imaging only if there is concomitant evidence of the classic findings of intracranial TB.

Once-a-month administration of intravenous pentamidine to patients infected with human immunodeficiency virus as prophylaxis for Pneumocystis carinii pneumonia

We reviewed the charts of 52 patients infected with human immunodeficiency virus (HIV) who received at least three consecutive doses of intravenous pentamidine as prophylaxis for Pneumocystis carinii infections. Pentamidine isethionate was administered intravenously over 60-90 minutes once a month, at a dosage of 4 mg/kg, in 250 mL of 5% dextrose in water. During 387 months of administration of primary prophylaxis to 37 patients, no cases of P. carinii pneumonia were observed. During 200 months of administration of secondary prophylaxis to 15 patients, only one case of P. carinii pneumonia was diagnosed (6.0 cases per 100 patient-years). Side effects associated with the intravenous pentamidine were mild and did not necessitate withdrawal of the drug. Once-a-month administration of intravenous pentamidine is a valid alternative as prophylaxis for P. carinii pneumonia for patients who are intolerant of sulfonamides.

A map of rye chromosome 4R with cytological and isozyme markers

The progeny of two crosses between a structural heterozygote for a reciprocal translocation (4RL/5RL) and a homozygote for the standard chromosome arrangement and of four crosses between standard chromosome homozygotes were analysed in rye (Secale cereale L. cv 'Ailés') for the electrophoretic patterns of five different leaf and endosperm isozymes (LAP, PGM, NDH, ADH and EPER). The presence or absence of the quadrivalents at metaphase I (MI) was also tested. Loci Adh-1, Pgm-1 and Ndh-1 were located on chromosome arm 4RS, and locus Eper-1 on chromosome arm 4RL. Locus Lap-2 was located on the 4RS chromosome arm. The estimated distances among the different linked loci support the following gene order: Eper1¨ (breakpoint-centromere)¨Lap-2¨ ¨Adh-1 ¨Pgm-1¨Ndh-1. These results provide evidence for the chromosomal location of Lap-2 locus on chromosome arm 4RS in cv 'Ailés'. A high negative interference was detected between the zones delimited by centromere and Lap-2, and Lap-2 and Pgm-1 in plants with the 4RL/5RL translocation.

Progressive supranuclear palsy and corticobasal ganglionic degeneration: differentiation by clinical features and neuroimaging techniques

To assess the extent of overlap between clinically diagnosed patients with progressive supranuclear palsy (PSP) and corticobasal ganglionic degeneration (CBGD) we compared clinical scores for rigidity, bradykinesia, supranuclear gaze abnormalities, hemineglect and limb apraxia, postural instability, neck rigidity, and limb dystonia in 15 patients with a degenerative rigid-akinetic syndrome at presentation and at follow-up 3 to 120 months later. Only the presence of hemineglect, usually in combination with limb apraxia, was a reliable and early clinical factor for discriminating between these two conditions. These symptoms were present at admission in all 4 CBGD patients but not in any of the 11 PSP patients either at presentation or later during serial examinations. Though supranuclear ophthalmoplegia, neck rigidity, and postural instability were already observed in most CBGD patients at presentation, their scores remained low compared to those for PSP patients over the longterm. CT-scans and MRI were helpful in supporting clinically-based diagnoses made at presentation in that the vast majority of the PSP patients exhibited various degrees of midbrain atrophy and 50 percent of the CBGD patients exhibited asymmetric pericentral cortical atrophy.

The complications of central venous access systems: a study of 218 patients

OBJECTIVE

To evaluate the safety and usefulness of systems for obtaining central venous access.

DESIGN

Prospective open study.

SETTING

Clinica Universitaria de Navarra, Spain.

SUBJECTS

218 consecutive patients who required long term venous access either for chemotherapy or for total parenteral nutrition, and who had no evidence of infection, a platelet count of over 40 x 10(9)/l, and a life expectancy of three months or more, had 234 devices inserted.

INTERVENTIONS

Insertion of either a silicone rubber (Port-A-Cath) or a polyurethane (Implantofix) catheter into the cephalic, jugular or subclavian vein, leaving the tip in the superior vena cava.

RESULTS

Between February 1985 and December 1990, 234 devices were implanted in 218 patients aged from 0.9 to 78 years. The median (range) length of time that the catheters functioned was 277 (7-1887) days. The overall incidence of complications was 0.09/100 days inserted, and the complication rates for infection and thrombosis were 0.02 and 0.03/100 days, respectively. Thirty two devices were removed because of complications, and 19 because the treatment had finished. Five of the 218 patients (2%) were lost to follow up.

CONCLUSIONS

These devices have a long working life, and a low rate of complications, and are of great value to patients who require long term or cyclical intravenous treatment.

[Malignant fibrous histiocytoma of the pancreas]

Malignant fibrous histiocytoma (MFH), a frequent sarcoma in retroperitoneal mesenchimal tissues, has also been reported, although in a few cases, in digestive viscera. We present a case of a primary MFH of the pancreas in a 37-year-old male, treated with a 90% distal pancreatectomy, plus external and intraoperative radiotherapy over the tumoral bed, and polychemotherapy. Response to treatment was poor, with early local recurrence, liver and bone metastases and a survival of 7 months. Only 4 other cases of MFH of the pancreas have been reported. We analyze these 5 cases: they have been usually diagnosed in young adults, with vague symptoms and large tumoral masses without jaundice. Local recurrence seems to be frequent; they develop liver metastases rather than lung metastases. Even when they are resectable, the anatomical relations of the pancreas with vital vascular structures make broad resection difficult, and local recurrences frequent. Analysis of these five reported cases of MFH of the pancreas, allows to expect a local recurrence rate higher than 50% and a 5-year-survival rate lower than 30% due to distant metastases. Only radiotherapy seems to play a role as an adjuvant treatment after surgery for pancreas and other retroperitoneal sarcoma as it significantly increases survival.

Rapid identification of Triticeae genotypes from single seeds using the polymerase chain reaction

An easy and quick protocol has been developed for DNA analysis via PCR. Single cereal endosperm or small leaf pieces can be separately processed in several PCR reactions. The resultant PCR patterns are equivalent to those obtained with standard DNA extraction protocols using either specific or random primers. Intra- and inter-specific variability can be detected. This method allows the analysis of a large number of individuals in early stages prior to the plant sowing.

[Cancer of the esophagus (I): its epidemiological, clinical and diagnostic assessment according to histological type]

From 1975 to 1991, sixty-eight patients were treated with surgery for esophageal cancer at the Clínica Universitaria de Navarra. This study involves an analysis of epidemiologic and predisposing risk factors in relation with the histologic type of tumor: epidermoid carcinoma vs. adenocarcinoma. The difference in mean age of males (60.5 yrs.) as compared with that of females (48.7 yrs.) was statistically significant (p < 0.05). Likewise, the mean age of patients with epidermoid carcinoma (57.8 yrs.) was significant lower (p < 0.01) as compared with that of those with adenocarcinoma (66.3 yrs.). Smoking and alcoholism were common in the group of patients with epidermoid carcinoma, while Barrett's esophagus and hiatal hernia were frequently seen in patients with adenocarcinoma. Dysphagia was the most frequent symptom both at the start of disease (75%) and with the diagnosis established (96.7%). There was no significant difference in the symptomatology of patients with one type of tumor or the other. The efficacy of ancillary diagnostic procedures such as barium swallow, esophagoscopy, computerized tomography and biopsy were likewise assessed. The most frequent site of tumor was at the middle third, with majority of patients being at clinical stage 1-2 of disease at the time of diagnosis.

[Implantable devices for central venous access in cancer patients. Our experience in 217 cases]

BACKGROUND

The need of having a venous via available for infusion of chemotherapy treatment along with the difficulty of repeated venous access in oncological patients has lead to the ever more frequent placement of central venous access systems (CVAS) implanted into subcutaneous tissue.

METHODS

From February 1985 to December 1990 217 CVAS were implanted in 205 oncological patients. Twenty-six were Port-a-Cath and 191 were Implantofix.

RESULTS

The average of complications was 0.08/100 days of implantation with an incidence of catheter thrombosis obstruction of 0.03/100 days and system infection of 0.02/100 days. Currently 81 devices continue functioning with 23 having been withdrawn due to complications and 17 for completion of the treatment to which they had been submitted. Ninety-one patients died during this follow up.

CONCLUSIONS

The CVAS are devices which are of easy placement, simple handling, requiring minimum care and few complications. Their efficacy is confirmed by the analysis of the data presented in the present study.

Plasma and gastric juice levels of prostaglandins in critically ill children

The levels of prostaglandin (PG) E2 and 6-keto-PGF1 alpha (stable metabolite of prostacyclin) in plasma and gastric juice were determined in 113 critically ill children and adolescent, and compared to those registered in a plasma control group of 24 children and a gastric juice control group of 15. The gastric juice concentration of PGE2 is our patients [9.2 +/- 3.1 (SEM) pg/ml] was significantly lower (p = 0.001) than in the control group [81.1 +/- 18.1 (SEM) pg/ml]. There were no differences in plasma levels of PGE2 and plasma gastric juice levels of 6-keto-PGF1 alpha between the patients and the control groups. Children who died had lower plasma levels of PGE2 [6.2 +/- 2.2 (SEM) pg/ml] and gastric juice levels of PGE2 [2.3 +/- 0.8 (SEM) pg/ml] than the survivors (p less than 0.05). The gastric juice concentration of PGE2 was also lower in children who suffered important upper gastrointestinal bleeding, although the difference did not reach statistical significance.

[Arnold-Chiari malformation with multiple paroxysmal manifestations induced by coughing]

We present a 66-year old woman suffering from a chronic disorder characterized by multiple paroxysmal symptoms precipitated by coughing. These included cephalalgia, syncope, binocular photopsia phenomena with blurred vision, and an "electric-like" paroxysmal tingling of the hands. In addition to a central spinal cord cavity and hindbrain herniation, magnetic resonance imaging showed multiple skeletal anomalies and the craniospinal junction which included a narrow clivo-axial angle, basilar impression of the skull and a tight foramen magnum. Resonance magnetic imaging showed a high-signal intensity lesion on T2-weighted images at the posterior medullo-spinal junction suggesting focal demyelination. We propose that paroxysmal symptoms induced by coughing in patients bearing hindbrain ectopia and skeletal anomalies at the foramen magnum region may involve different pathogenetic mechanisms, including ectopic axonal activity and ephaptic transmission at the sensory pathways. This caused a Lhermitte-like phenomenon precipitated by coughing, rather than by forward flexion of the neck. However, increased pressure at the posterior fossa presumably underlies all these phenomena, and may therefore be potentially relieved by suboccipital decompressive craniotomy.

Role of leukotrienes B4 and C4 in liver allograft rejection

Previous studies have shown that eicosanoids may act in vitro as immunoregulatory substances. In this study, the concentrations of leukotriene B4 (LTB4) and leukotriene C4 (LTC4) were measured in a model of allograft rejection. Six orthotopic allotransplants of the liver were performed in dogs without the administration of immunosuppressives. LTB4 levels showed an increase coinciding with the start of rejection, significant differences being present between the basal levels and those measured 24 h post-revascularization (P < 0.05), and every day from the 3rd postoperative day (P < 0.01). LTB4 rose before the parameters generally used in evaluating rejection. LTC4 levels increased significantly (P < 0.001) in the first 24 h, and experienced no further variations. LTB4 may play an important role in the mechanisms which bring about the response to the allograft. This substance could be a specific and early marker for rejection.

High mutability in rye (Secale cereale L.)

Analysis of the rye cultivar Ailés of several descents derived from crosses between plants carrying specific genotypes and/or chromosome constitutions resulted in the detection of high chromosome (2.05 x 10(-2)) and gene (9.3 x 10(-3)) mutation frequencies. The existence of a transposon system responsible for this instability is suggested.

NADH dehydrogenase: a new molecular marker for homoeology group 4 in Triticeae. A map of the 4RS chromosome arm in rye

Structural gene loci encoding the monomeric isozymes nicotin adenin dinucleotide dehydrogenase (NADH dehydrogenase or NDH) have been located on the 4AL, 4Bα, and 4DS chromosome arms of Triticum aestivum cv "Chinese Spring", on the 4RS chromosome arm of Secale cereale cultivars "Imperial", "King II", "Dakold," and "Ailes," on the 4S(1) S/7S(1) chromosome of Aegilops longissima, the 4E of Elytrigia elongata, and the CSU-A of Aegilops umbellulata. All the results support the homoeologous relationships among these chromosomes in the five species studied. In addition, a map of the 4RS chromosome arm in cv "Ailes" has been realized, linking loci Pgm-1 (located on the 4RS chromosome arm) and Ndh-1 (17.91 cM), with an estimated distance between both loci and the centromere of 20.00 cM and 32.12 cM, respectively.

[Spontaneous rupture of a hepatic adenoma associated with hepatic peliosis]

Benign hepatic tumors, although rare, are each time encountered more frequently, occasionally posing diagnostic and therapeutic problems. Within this group of tumors, hepatic adenomas are the least common, although its increasing incidence could be attributed to the use of contraceptives or to the availability of newer diagnostic methods. A hepatic adenoma presenting with spontaneous rupture at diagnosis is associated with a mortality of 20%, for which emergency hepatectomy is indicated and usually carried out under unstable hemodynamic conditions. In this report, we present the case of a 30 year old female with three previous pregnancies carried to term, without any history of intake of contraceptive or hepatotoxic drugs, who presented with spontaneous rupture of a large hepatic adenoma associated with hepatic peliosis.

Biochemical evidence of a translocation between 6 RL/7 RL chromosome arms in rye (Secale cereale L.). A genetic map of 6R chromosome

The segregation of different isozymic loci was investigated in backcrosses and F2s in rye. The leucin aminopeptidase-1 (Lap-1), Aconitase-1 (Aco-1), Esterase-6 (Est-6), Esterase-8 (Est-8), and Endopeptidase-1 (Ep-1) loci were linked. The Aco-1, Est-6, and Est-8 loci have been previously located on the 6RL chromosome arm. The Lap-1 locus has been located on the 6RS chromosome arm. The results favor the gene order: Lap-1... (centromere)... Aco-1... Est-8... Est-6... Ep-1. The isoelectric focusing separations of aqueous extracts from mature embryo tissue of wheat-rye addition and substitution lines involving the chromosomes of cereal rye Secale cereale L. confirmed the gene location of locus Ep-1 on the 6RL chromosome arm. Screening of wheat-rye addition lines involving the chromosomes of Secale montanum revealed that Ep-1 locus is not located on chromosome 6R of S. montanum. These results are the first biochemical evidence of the translocation between chromosome arms 6RL/7RL in the evolution of S. cereale from S. montanum.

A map of rye chromosome 2R using isozyme and morphological markers

The segregation of isozymic loci for leaf peroxidases (L2Per) has been investigated in backcrosses and F2 offspring of rye lines having purple seeds (Ps) and monstrosum ears (mo). The Ps, L2Per-3b, mo, and L2Per-2 loci were linked. The Ps and mo loci have been previously located on the 2R chromosome, and the L2Per-3b and L2Per-2 loci have been located on the 2RS chromosome arm. The results favor the gene order Ps ... L2Per-3b ... mo ... L2Per-2 or Ps ... mo... L2Per-3b ... L2Per-2. The position of the loci relative to the centromere is still not known, but the obtained results suggest that the mo locus could be located on the 2RS chromosome arm. On the basis of previously reported linkage groups, the most probable arrangement of the loci located on chromosome 2R is: dw2 ... Ps ... (L2Per-3a ... L2Per-3b ... mo) ... L2Per-2. It has not been possible to know the position of L2Per-4 loci (also located on 2RS chromosome arm) relative to L2Per-3a and L2Per-3b loci.

Lymphoma of the gastric stump: report of a case

We report a case of primary lymphoma on a previously resected stomach in a 62-year-old man. The patient was treated 22 years earlier with a partial gastrectomy and Billroth II reconstruction for a benign gastric ulcer. The rarity of this entity and its possible relationship with pseudolymphoma or lymphoid nodular hyperplasia is discussed, and the literature is reviewed.

Linkage and cytogenetic maps of genes controlling endosperm storage proteins and isozymes in rye (Secale cereale L.)

An F1 plant fromSecale cereale ssp.ancestrale xtelocentric substitution lines3R of the cultivated rye "Petkus spring" was used as female in a cross with the inbred line Riodeva (I28), which has the standard chromosome arrangement. Single plants from this backcross progeny were analyzed for chromosome constitution, storage protein, and isozymic patterns. The seed protein loci were identified asSec-1a andSec-1b loci controlling 40-Kγ-secalins andω-secalins, respectively. These loci are located on the short arm of chromosome1R. TheSec-3 locus controlling high-molecular-weight secalins is located on the long arm of chromosome1R. A further seed protein locus,Pr-3 (55-K protein), was located on the short arm of chromosome1R. A linkage was found between the6Pgd-2 isozyme locus controlling 6-phosphogluconate dehydrogenase isozymes located on the long arm of chromosome1R and the four seed protein loci. The results favor the gene order:6Pgd-2 ...Sec-3 ... [centromere] ...Pr-3 ...Sec-1b ...Sec-1a. Other linkages detected werePer-3a andPer-3b (0.33±0.33 cM),Est-8 andEst-12 (0.33±0.33 cM), andGot-3 and centromere (20.57±2.42 cM). The proxidase (Per), glutamate oxaloacetate transaminase (Got), and esterase (Est) loci were located on chromosome arms2RS,3RL, and6RL, respectively. The distances and the maps obtained are compared with data available in the literature.

[Villous adenoma of the duodenum. Presentation of a case]

A case of villous adenoma of the duodenum is presented; the wide implantation of the tumor imposed a cephalic duodenopancreatectomy. The endoscopic examination plays an important role in the diagnosis of these tumors, but it frequently; does not exclude the possibility of a malignant lesion, this fact renders difficult the choice of adequate treatment. We review the surgical approach of these tumors, which ranges from local resection to duodenopancreatectomy, depending on the pathological study and intraoperative findings.

Chromosomal location of adenylate kinase isozymes in Triticeae species

One system of monomeric adenylate kinase isozymes, designated ADK, was observed in Triticum aestivum and in five diploid Triticeae species. The gene loci Adk-a, Adk-b and Adk-d were located on 7AL, 7BL and 7DL Triticum aestivum cv "Chinese Spring" chromosomal arms, respectively. Adk gene loci were also located on the 7RL chromosomal arm of Secale cereale cv "Ailés", the 7H chromosome of Hordeum vulgare cv "Betzes", 7X of Agropyron intermedium, 7E of Elytrigia elongata and CSU-E of Aegilops umbellulata. The results suport the notion of the conservation of gene synteny groups within Triticeae species.

Association of four isozyme loci with a reciprocal translocation between 1R/4R chromosomes in cultivated rye (Secale cereale L.)

The progeny of four crosses between a structural heterozygote for a reciprocal translocation and a homozygote for the standard chromosome arrangement were analyzed in rye (Secale cereale L. cv "Ailés") for the electrophoretic patterns of eight different leaf and endosperm isozymes and also for the meiotic configuration at metaphase I. The Pgi-1, 6-Pgd-2 and Mdh-1 loci are linked to each other and also to the reciprocal translocation. These loci have been located on chromosome 1R. The Mdh-1 locus is located in the interstitial segment of chromosome 1R, between the centromere and the breakpoint. The Pgm-1 locus has been located on chromosome arm 4RS and is linked to Pgi-1, 6-Pgd-2, Mdh-1 and the reciprocal translocation. The estimated distance between the Pgm-1 locus and the centromere is 14.98 ± 2.27 cM. Therefore, the reciprocal translocation involves the 1R and 4R chromosomes. Other linked loci detected have been Mdh-2b and Est-2 (7.40 ± 2.90 cM) and Got-3 and Est-2 (5.62 ± 3.07 cM). These three last loci are located on chromosome 3R and their order most probably is Mdh-2b - Est-2 - Got-3.