Pressure-permeability relationships in basement membrane: effects of static and dynamic pressures

The glomerular basement membrane (GBM) is an important component of the filtration barrier that is the glomerular capillary wall. Previously GBM permeability has been investigated only under static pressures and often within a supraphysiological range. We used Matrigel as a model of GBM and formed membranes at the base of filtration chamber. We measured membrane permeability under static and dynamic pressures. Matrigel membranes were size and charge selective toward neutrally and negatively charged dextrans. Their permeability (as measured by hydraulic conductivity) was found to decrease from 1.61 +/- 0.06 to 0.75 +/- 0.07 x 10(-6) cm.s-1.cmH2O-1 as static pressure increased from 6 to 78 cmH2O, an effect attributed to membrane compression. In comparison to static pressure, sinusoidal pressure waves with a mean pressure of 50 cmH2O decreased membrane permeability, e.g., fluid flux was reduced by a maximum of 2% to a value of 5.47 +/- 0.38 x 10(-5) cm/s; albumin clearance was reduced by a maximum of 5.2% to a value of 9.63 +/- 1.06 x 10(-6) ml.cm-2.s-1. Such changes were affected by the frequency of pressure wave application and could be attributed to a switching on and off of the membrane compression effect.

Carotenoid pigments in seafoods and aquaculture

Color plays a major role in the overall acceptability of food products. It is considered one of man's basic experiences that a particular foodstuff has to be of a distinct color in order to be edible. The color of a seafood is the first characteristic noted by the consumer and is directly related to the subsequent acceptance or rejection of it. Carotenoids contribute to the yellow, orange, and red colors of the skin, shell, or exoskeleton of aquatic animals. Indeed, they are the most widespread pigments found in nature, as they occur in bacteria, yeasts, mold, all green plants, and many animals, and therefore various functions have been attributed to them. From anthropocentric consideration, the most significant aspect of carotenoids is the color they impart to our food and environment. In animals, the carotenoids are also associated with reproductive organs and hence the hatching success and survival of alevins.

Cost-efficient localization of seizures of mesiotemporal onset with foramen-ovale electrodes

Foramen ovale (FO) electrodes can identify mesiotemporal lobe (MTL) seizure onsets but are infrequently used in the USA. Ten patients with presumed MTL ictal onset, unlocalized noninvasively, had FO electrodes inserted during long term monitoring for epilepsy. Placement was facilitated by intraoperative use of oblique submental and modified Caldwell view fluoroscopy. Eighty percent of patients had ictal localization by FO electrodes. This led to anterior temporal lobectomy in six with 83% being seizure free after follow-up of 20-32 months. The mean total costs of placing these electrodes was approximately half that of subdural strips and a quarter that of depth electrodes. Foramen ovale electrodes represent a cost-effective and efficient method of seizure localization when noninvasive workup suggests but is not definitive for MTL origin.

What factors influence primary care physicians' charges for their services? An exploratory study using standardized patients

OBJECTIVE

To determine the extent of variation in physicians' charges for health care encounters with unannounced standardized patients and factors associated with the variation.

DESIGN

Cross-sectional study.

SETTING

Family practices open to new patients within 1 hour's drive of Hamilton, Ont.

PARTICIPANTS

A stratified random sample of 125 physicians who had responded to an earlier survey regarding preventive care were invited to participate. Of the 125, 44 (35.2%) declined to participate, and an additional 19 (15.2%) initially consented but later withdrew because they closed their practices to new patients. Sixty-two physicians thus participated in the study.

INTERVENTION

Unannounced standardized patients posing as new patients to the practice visited study physicians' practices between September 1994 and August 1995, portraying 4 scenarios: 28-year-old woman, 52-year-old woman, 48-year-old man and 70-year-old man.

OUTCOME MEASURES

Physician characteristics, encounter characteristics and charges made for services.

RESULTS

The 62 physicians had 246 encounters with the standardized patients. Charges were made to the health insurance plan for services by 59 physicians for up to 4 encounters (215 encounters in all). Charges varied considerably both within and across patient scenarios. Time spent with the patient was an important factor predicting charges made (p < 0.01), although the effect of time spent on charges varied across scenarios (p < 0.01). Fee-for-service physicians charged more for their services than physicians who usually had alternative billing arrangements (p < 0.01). Female physicians charged more for their services than their male colleagues (p = 0.03). No relation was found between quality of preventive care and charges made (p = 0.15).

CONCLUSIONS

Physician-related factors are better able to account for the variability in charges for their services than patient-related factors. Physicians seeing comparable patients may earn much more or less than their colleagues because of differences in the services they provide and the way they apply the fee schedule. Quality-assurance techniques are likely needed to reduce the variability in charges seen and increase value for money spent in health care.

Provision of preventive care to unannounced standardized patients

OBJECTIVE

To examine the relation between physician, training and practice characteristics and the provision of preventive care as described in the guidelines of the Canadian Task Force on the Periodic Health Examination.

DESIGN

Cross-sectional study.

SETTING

Family practices open to new patients within 1 hour's drive of Hamilton, Ont.

PARTICIPANTS

A total of 125 family physicians were randomly selected from respondents to an earlier preventive care survey. Of the 125, 44 (35.2%) declined to participate, and an additional 19 (15.2%) initially consented but later withdrew when they closed their practices to new patients. Sixty-two physicians thus participated in the study.

INTERVENTION

Unannounced standardized patients posing as new patients to the practice visited study physicians' practices between September 1994 and August 1995, portraying 4 scenarios: 48-year-old man, 70-year-old man, 28-year-old woman and 52-year-old woman.

OUTCOME MEASURES

Proportion of preventive care manoeuvres carrying grade A, B, C, D and E recommendations from the Canadian Task Force on the Periodic Health Examination that were performed, offered or advised. A standard score was computed based on the performance of grade A and B manoeuvres (good or fair evidence for inclusion in the periodic health examination) and the non-performance of grade D and E manoeuvres (fair or good evidence for exclusion from the periodic health examination).

RESULTS

Study physicians performed or offered 65.6% of applicable grade A manoeuvres, 31.0% of grade B manoeuvres, 22.4% of grade C manoeuvres, 21.8% of grade D manoeuvres and 4.9% of grade E manoeuvres. The provision of evidence-based preventive care was associated with solo (v. group) practice and capitation or salary (v. fee-for-service) payment method. Preventive care performance was unrelated to physician's sex, certification in family medicine or problem-based (v. traditional) medical school curriculum.

CONCLUSIONS

Preventive care guidelines of the Canadian Task Force on the Periodic Health Examination have been incompletely integrated into clinical practice. Research is needed to identify and reduce barriers to the provision of preventive care and to develop and apply effective processes for the creation, dissemination and implementation of clinical practice guidelines.

A giant left renal cyst presenting as obesity: a unique presentation

OBJECTIVE

Benign renal cysts are commonly found in adult patients. However, giant renal cysts measuring more than 15 cm in greatest diameter or containing more than 1500 cc of fluid are rarely seen. A giant renal cyst presenting as obesity, a unique form of presentation, is described herein.

METHODS/RESULTS

We report the unique case of 78-year-old male who was diagnosed with a 25 cm left renal cyst after presenting solely with diffuse progressive abdominal distention. He had no other signs or symptoms and had been followed at our institution for seven years with a diagnosis of obesity. The patient was effectively treated by open renal cyst decortication.

CONCLUSIONS

Giant renal cyst measuring > or = 15 cm or containing more than 1500 cc of fluid rarely occur. This case is unique in that unlike other adult patients, this patient presented with no sign or symptom other than diffuse, nonlateralizing, abdominal distension.

Carotenoid pigments in seafoods and aquaculture

Color plays a major role in the overall acceptability of food products. It is considered one of man's basic experiences that a particular foodstuff has to be of a distinct color in order to be edible. The color of a seafood is the first characteristic noted by the consumer and is directly related to the subsequent acceptance or rejection of it. Carotenoids contribute to the yellow, orange, and red colors of the skin, shell, or exoskeleton of aquatic animals. Indeed, they are the most widespread pigments found in nature, as they occur in bacteria, yeasts, mold, all green plants, and many animals, and therefore various functions have been attributed to them. From anthropocentric consideration, the most significant aspect of carotenoids is the color they impart to our food and environment. In animals, the carotenoids are also associated with reproductive organs and hence the hatching success and survival of alevins.

HIV Tat protein requirements for transactivation and repression of transcription are separable

The HIV Tat protein, primarily characterized as a transcriptional activator of the viral long terminal repeat (LTR), is also a potent repressor of major histocompatibility complex (MHC) class I transcription. In the present study, we demonstrate that these two functional activities are distinct and mediated by discrete, but overlapping, structural domains of Tat. Tat repressor activity depends on C-terminal sequences, whereas transactivation depends on N-terminal sequences; both functions require core sequences. The repressor activity requires a domain encompassing the region encoded by the second exon of the Tat gene, beginning at amino acid 73, with a C-terminal limit between amino acids 80 and 83. Tat repressor function also depends on the presence of a lysine at position 41, located within the core of the protein. Tat repressor activity is independent of two N-terminal domains essential for transactivation: the acidic segment and the cysteine-rich region. Conversely, Tat transactivation is independent of the second exon-encoded region of Tat. As further support for this novel model of separable Tat functions, we show that in murine fibroblasts, Tat represses class I promoter activity, but does not transactivate the HIV LTR. We propose that distinct structural domains mediate the two functionally distinct activities associated with the Tat protein.

Delayed cervical epidural hemorrhage associated with silastic dural implant: case report

OBJECTIVE AND IMPORTANCE

This is the first report of delayed cervical epidural hemorrhage caused by an onlay silastic graft placed over the dura after laminectomy. There are several reports of intracranial hemorrhage associated with silastic implants in the literature.

CLINICAL PRESENTATION

A 49-year-old woman suddenly developed severe neck pain and quadriplegia during sexual intercourse. A C5-C7 laminectomy had been performed 17 years earlier for cervical stenosis.

INTERVENTION

Magnetic resonance imaging showed an epidural mass compressing the cord at the level of the previous laminectomy. Laminectomy was performed within 5 hours of symptom onset. Postoperatively, the patient regained leg strength. After 2 months of physical therapy, she had minimal residual leg rigidity and returned to work.

TECHNIQUE

At surgery, the cervical cord was compressed by a solid fibrous scar surrounding a silastic onlay graft and the dura. An epidural hematoma was beneath the silastic implant. The dense scar tissue, hematoma, and silastic implant were removed.

CONCLUSION

Bleeding associated with silastic sheets starts with movement of this nonadherent implant. The movement disrupts the underlying fine vessels on the surface of an encasing connective tissue membrane. Overgrowth of this membrane can cause mass effect and simulate a tumor, even without associated bleeding, within weeks. Delayed hemorrhage is more common. We recommend removal of these implants electively, especially if a thick membrane surrounding the dura is detected with postcontrast-enhanced magnetic resonance imaging.

Simultaneous chromosome 7 and 17 gain and sex chromosome loss provide evidence that renal metanephric adenoma is related to papillary renal cell carcinoma

PURPOSE

Metanephric adenoma has recently been recognized as a unique renal tumor characterized by an unusual degree of cellular differentiation and maturation. We recently studied metanephric adenoma using metaphase analysis and observed concomitant chromosome Y loss and chromosome 7 and 17 gain. To determine if these chromosomal anomalies are consistently present in renal metanephric adenoma, we studied all 11 tumors in the pathology tissue registry at our institution using fluorescence in situ hybridization (FISH).

MATERIALS AND METHODS

FISH, using deoxyribonucleic acid probes for chromosomes 1, 7, 8, 17, X and Y, was performed in isolated nuclei from 11 paraffin embedded renal metanephric adenoma specimens.

RESULTS

Of the 11 tumors (73%) 8 demonstrated chromosome 7 and 17 gain by FISH, and the remaining 3 were found to have an apparently normal chromosomal content. Of the 8 tumors (75%) from men showed 6 chromosome 7 and 17 gain with Y chromosome loss. Of the 3 tumors (33%) from women 1 had chromosome 7 and 17 gain with X chromosome loss, while 1 had chromosome 7 and 17 gain without sex chromosome aneusomy. Metaphase analysis performed on 2 tumors revealed chromosome 7 and 17 gain and Y chromosome loss in 1, and no apparent, chromosome anomaly in the other, confirming the results of FISH analysis.

CONCLUSIONS

FISH analysis of renal metanephric adenoma identified frequent chromosome 7 and 17 gain and sex chromosome loss. These results are consistent with a clonal neoplastic disorder in which chromosomes 7, 17, X and Y are likely to be involved in the pathogenesis of this tumor. These characteristic chromosomal alterations have also been observed in papillary renal cell adenoma and papillary renal cell carcinoma, providing evidence that these tumors may be related.

Regulatory factor X, a bare lymphocyte syndrome transcription factor, is a multimeric phosphoprotein complex

Regulatory factor X (RFX) is a transcription factor that binds the conserved X1 box of MHC class II promoters and is essential for transcription of class II genes. The subunit structure of the native RFX complex was examined by coimmunoprecipitation using polyclonal antisera to the 75-kDa subunit of RFX, RFX5. Two polypeptides with apparent masses of 41 and 36 kDa coimmunoprecipitated with RFX5 and appear to be subunits of the native RFX complex. Metabolic labeling of wild-type and mutant B cells with [32P]orthophosphate demonstrated that each of the RFX subunits was phosphorylated in vivo and that the phosphorylation of the RFX subunits was independent of the essential MHC class II regulatory factor, CIITA. The trimeric RFX complex was also present in fibroblast cells with or without IFN-gamma treatment. Both the p41 and p36 subunits were absent in immunoprecipitations of RFX5 from lysates of independently established B cell lines from bare lymphocyte syndrome complementation groups B and D. Together, these results suggest that RFX complex assembly is required for class II expression and that the mutations in bare lymphocyte syndrome complementation groups B and D result in an inability to assemble the RFX complex.

Regulatory factor X, a bare lymphocyte syndrome transcription factor, is a multimeric phosphoprotein complex

Regulatory factor X (RFX) is a transcription factor that binds the conserved X1 box of MHC class II promoters and is essential for transcription of class II genes. The subunit structure of the native RFX complex was examined by coimmunoprecipitation using polyclonal antisera to the 75-kDa subunit of RFX, RFX5. Two polypeptides with apparent masses of 41 and 36 kDa coimmunoprecipitated with RFX5 and appear to be subunits of the native RFX complex. Metabolic labeling of wild-type and mutant B cells with [32P]orthophosphate demonstrated that each of the RFX subunits was phosphorylated in vivo and that the phosphorylation of the RFX subunits was independent of the essential MHC class II regulatory factor, CIITA. The trimeric RFX complex was also present in fibroblast cells with or without IFN-gamma treatment. Both the p41 and p36 subunits were absent in immunoprecipitations of RFX5 from lysates of independently established B cell lines from bare lymphocyte syndrome complementation groups B and D. Together, these results suggest that RFX complex assembly is required for class II expression and that the mutations in bare lymphocyte syndrome complementation groups B and D result in an inability to assemble the RFX complex.

Use of a surgical sponge facilitates rib resection in flank incisions

Dissection of the rib in a flank incision is often tedious and difficult. Entry into the pleural space and subcostal nerve injury are two frequent complications. In an effort to reduce the frequency of these complications and to facilitate the ease of rib dissection and resection, we describe a technique that uses a moistened surgical sponge to dissect free the posterior surface of the rib.

Genitourinary neurofibromatosis mimicking posterior urethral valves

A 12-year-old boy, examined after an episode of acute urinary retention, was found to have neurofibromatosis of the bladder neck and prostatic urethra. His symptoms of bladder outlet obstruction and radiographic findings of a dilated prostatic urethra mimicked posterior urethral valves. Complete urologic investigation, including cystourethroscopy, revealed that the dilatation of the prostatic urethra was secondary to neural involvement of the external sphincter and posterior urethra without mechanical obstruction or posterior urethral valves.

Plasma and tissue thyroxine and triiodothyronine contents in sublethally stressed, aluminum-exposed brown trout (Salmo trutta)

Immature female brown trout, Salmo trutta, were exposed to pH 5.0 soft water in the presence or absence of aluminum (Al) at 12.5 micrograms liter-1 and their plasma concentrations and tissue contents of thyroxine (T4) and triiodothyronine (T3) were compared with those of a control group of trout held in pH 7.0 soft water. After 120 hr, plasma cortisol, glucose, T4, and T3 concentrations were greater in the Al-exposed trout than in trout exposed to acid conditions alone, indicating that although the Al conditions were sublethal, a significant stress response was elicited. Significant increases in liver T4 content, liver 5'-monodeiodinase activity and liver T3 content indicated increased hepatic T4 to T3 conversion in the Al-exposed trout. The T4 contents of brain, gill filaments, white muscle, heart ventricle, caudal kidney, and ovary were not significantly altered by Al exposure. The T3 content of caudal kidney and ovary were significantly lower in Al-exposed trout than in control fish in neutral water but were unchanged in the brain, gill filaments, heart ventricle, and white muscle of these trout. The present data support previous observations of increased plasma T3 concentrations in sublethally Al-exposed brown trout and indicate that at least part of the increased plasma T3 concentration is due to an increased hepatic uptake of T4 and monodeiodination to T3. However, analysis of nonhepatic tissue T3 content gave no indication of increased T3 production by these tissues.

Selected physical issues in the structure and function of microtubules

The cytoskeleton consists of networks of protein polymers which structurally and dynamically organize interiors of living cells. Microtubules exhibit a complex array of self-organization phenomena which are very sensitive to various laboratory conditions. In this paper we discuss the main features of microtubules focusing our attention on a selection of their physical properties, i.e., the questions of assembly dynamics and energy transfer along their protofilaments, the possible dipolar phases which we predict to exist, and, finally, the hypothesis of current flows associated with the electric field lines produced by cytoskeletal components.

Atypical facial pain and other pain syndromes. Differential diagnosis and treatment

Knowledge of each differential diagnosis of prosopalgia is important to any neurosurgeon who treats facial pain. Pain control is possible with treatment specific to the diagnosis, including those forms of facial pain known to be the most difficult to treat. An outline for the management of atypical facial pain, anesthesia dolorosa, and postherpetic neuralgia is presented with a review of the correlative anatomy for each surgical procedure.

Anatomic considerations for uncovertebral involvement in cervical spondylosis

Morphometric analysis of 54 dry cervical spines from C3 to C7 (a total of 270 cervical vertebrae) and bilateral dissection of 10 anatomic specimen cervical spines were performed. The uncinate processes were significantly higher at C4 to C6 (5.8 +/- 1.1 mm to 6.1 +/- 1.3 mm) levels than at C3 or C7 levels. The anteroposterior diameter of the intervertebral foramina was smaller at the C4, C5, and C6 levels compared with that at the C3 or C7 levels. The length of nerve root between the lateral border of dural tube and medial border of vertebral artery gradually increased from C3 (3.3 +/- 1.1 mm) to C7 (8.1 +/- 2.1 mm). A combination of higher uncinate process, smaller anteroposterior diameter of intervertebral foramina, and longer course of nerve roots in close proximity of the uncovertebral joints at the C4 to C6 levels may explain the predilection of nerve root compression by uncovertebral osteophytes at these levels. The distance from apex of the uncinate process to medial border of the transverse foramen gradually increased from C3 (1.7 +/- 0.8 mm) to C7 (3.3 +/- 1.0 mm), which may predispose the midcervical level to compression of the vertebral artery by laterally projecting uncovertebral osteophytes.

The trigeminal complex. Anatomy and physiology

The many procedures performed for the treatment of trigeminal neuralgia require an extensive knowledge of the brainstem and spinal nuclei anatomy and physiology, their projections, central and peripheral connections, the trigeminal autonomic elements, and autonomic effects of trigeminal injury. Recent advances in the understanding of the anatomy and physiology complex as presented in the neuroscience literature are reviewed.

Percutaneous balloon compression of the trigeminal nerve

Balloon compression is a simple and effective percutaneous approach for the treatment of classic trigeminal neuralgia or trigeminal neuralgia secondary to multiple sclerosis. The operation injures large myelinated fibers, removing the "trigger" to the presumed ephaptic transmission of pain. Because unmyelinated fibers, which mediate the corneal reflex, are preserved, compression may be of advantage in the treatment of first division pain, since the corneal reflex is mediated by the small unmyelinated fibers. In the author's series of 141 consecutive patients treated by balloon compression, overall recurrence rate was 26%, with 80% of patients experiencing mild numbness postoperatively.

Blockade of CD86 ameliorates Leishmania major infection by down-regulating the Th2 response

The costimulatory molecules CD80 and CD86 affect the differentiation of Th1 and Th2 subsets in experimental allergic encephalomyelitis, an autoimmune disorder. It is reported that the CD86 costimulator significantly affects disease outcome in Leishmania major infection, a classic model of Th subset polarization. Treatment of both L. major-resistant (C57BL/6) and susceptible (BALB/c) strains of mice with anti-CD86 substantially decreased parasite burden. This was accompanied, in BALB/c mice, by a decrease in Th2 cytokines. In contrast, anti-CD80 treatment did not affect parasite burden or cytokine levels in either strain. These data illustrate that in L. major infection, anti-CD86 can abrogate Th2 differentiation in a Th2-dominated susceptible mouse and can ameliorate disease in a Th1-dominated resistant strain, although the mechanism involved in the latter is not clear. It is concluded that in L. major infection, Th2 subset differentiation is critically dependent on interaction with the CD86 costimulatory molecule.

Effectiveness of ranitidine 150 mg at bedtime as maintenance therapy for healed gastric ulcers

As many as 89% of gastric ulcer patients experience ulcer recurrences within 1 year of successful healing with conventional antiulcer therapies. Because ranitidine is effective in the healing of gastric and duodenal ulcers and the maintenance of healed duodenal ulcers, we hypothesized that ranitidine would also be effective in the maintenance of healed gastric ulcers. A 48-week, placebo-controlled, randomized, double-blind, multicenter trial was conducted to compare ranitidine 150 mg administered at bedtime with placebo for the maintenance of healed gastric ulcers. Endoscopies were performed at baseline and repeated after 12, 24, 36, and 48 weeks of treatment. Gastric ulcer recurrence rates at each scheduled endoscopy were significantly lower in patients receiving ranitidine (5%, 13%, 16%, and 19%, respectively) compared with those receiving placebo (20%, 30%, 40%, and 50%, respectively). Compared with placebo, ranitidine was more effective in maintaining healed gastric ulcers regardless of previous gastric ulcer history, smoking status, age (< 65 vs > or = 65 years), or sex. There were no significant differences between the two treatment groups in the number of patients experiencing adverse events or laboratory abnormalities. Ranitidine 150 mg administered at bedtime provides safe and effective treatment for the maintenance of healed gastric ulcers.

Anatomic considerations of halo pin placement

In the present study, the anatomic location of supraorbital and greater occipital nerves and their branches was quantitatively determined with regard to halo pin placement, and a safe zone for anterolateral and posterolateral halo pins was defined to minimize neurologic damage. The mean distance between the midline and the lateral branches of supraorbital nerve and greater occipital nerve was 3.9 +/- 0.4 cm and 4.8 +/- 0.6 cm on the left side and 3.9 +/- 0.5 cm and 4.8 +/- 0.6 cm on the right, respectively. The mean angles of lateral branches of supraorbital and greater occipital nerves with respect to sagittal plane were 26.0 degrees +/- 6.0 degrees and 38.0 degrees +/- 5.0 degrees on the left side and 25.0 degrees +/- 4.0 degrees and 38.0 degrees +/- 4.0 degrees on the right, respectively. The supraorbital and greater occipital nerves and their branches are safe when the halo pins are placed at sites 4.5 cm and 6.0 cm lateral to the anterior and posterior midlines.

Comparison of fluorescence in situ hybridization analysis of isolated nuclei and routine histological sections from paraffin-embedded prostatic adenocarcinoma specimens

Fluorescence in situ hybridization (FISH) is a powerful tool for quantitative analysis of chromosomes and genes and can be applied in a variety of specimens, including cell cultures, isolated nuclei from fresh and fixed tissues, and histological tissue sections. However, the results of FISH analysis of isolated nuclei in prostate cancer have not been previously compared with those from histological sections from the paraffin-embedded tissue blocks. To compare these methods, we studied isolated nuclei derived from 50-microns sections and adjacent 5-microns tissue sections from 10 cases of benign nodular hyperplasia of the prostate and 16 cases of prostatic carcinoma. FISH analysis employed centromere-specific probes for chromosomes 7, 8, 11, and 12. In benign tissue, the percentage of nuclei with three or more signals for chromosomes 7, 8, 11, and 12 was less than 3% for both isolated nuclei and tissue sections. However, the percentage of nuclei with no and one signals was less than 8% for isolated nuclei and more than 24% for tissue sections. In prostatic carcinoma, numeric chromosomal anomalies were found in 75% of cases by both FISH methods. However, isolated nuclei had more chromosomal tetrasomy than tissue sections (mean, 9.2 to 11.0% versus 5.1 to 5.6%, respectively). Conversely, intratumor heterogeneity of chromosomal anomalies was identified in 5 cases by FISH analysis of tissue sections but not in isolated nuclei. Cancer ploidy analysis by FISH correlated well with ploidy analysis by flow cytometry, although FISH was more sensitive for aneuploidy. We conclude that FISH analysis of isolated nuclei and histological tissue sections from paraffin blocks are reliable methods for detection of chromosomal anomalies in archival tissue of prostate cancer, although each method has advantages and disadvantages.

A symptomatic testicular cyst in a patient with von Hippel-Lindau disease

Von Hippel-Lindau disease (VHL) is an autosomal-dominant condition that often involves cystic changes within many organs, including the epididymis. However, no previous report of a patient with VHL and a benign intratesticular cyst has been published. We report on a 28-year-old man with otherwise stable VHL who presented with a symptomatic 3-cm intratesticular benign cyst. The cyst was successfully treated by partial orchiectomy.

Metaphase analysis of metanephric adenoma reveals chromosome Y loss with chromosome 7 and 17 gain

A 61-year-old man underwent wedge excision of a 3-cm right renal metanephric adenoma. This recently recognized tumor has been considered benign, although no genetic studies have been reported. Metaphase analysis demonstrated a 47,X,-Y,+7,+17 karyotype. These results are consistent with a clonal neoplastic disorder.

Vulnerability of great medullary artery

STUDY DESIGN

The present study describes anatomic observations on great medullary artery and intercostal arteries pertinent to thoracolumbar spinal surgery.

OBJECTIVES

This study reveals the vulnerable course of the great medullary artery and its relationship to the lateral or posterolateral approach to thoracic spine.

SUMMARY OF BACKGROUND DATA

There are no previous anatomic data on the length of the great medullary artery, its intradural course, its relationship with the anterior spinal artery, and the distance between two adjacent intercostal arteries.

METHODS

The location of the intercostal arteries was defined, and the distance between two adjacent arteries was measured at a point on the lateral surface of the vertebra midway between its anteroposterior diameter. The intradural length of the great medullary artery and the angle it formed with the anterior spinal artery at the point of anastomosis were also measured.

RESULTS

The mean intradural length of the great medullary artery was 3.6 cm (range, 1.7-8.1 cm), and it passed over 1-3 disc spaces before joining the anterior spinal artery at a mean angle of 20.1 degrees (range, 12-28 degrees). The average distance between two adjacent intercostal arteries from T6 to L2 was 3.6 cm (range, 2.8-4.0 cm), which provides a safe window through which a herniated thoracic disc may be approached if surgery is indicated.

CONCLUSIONS

The acute angle between the great medullary artery and anterior spinal artery indicates that these two arteries are in close proximity for considerable length and are liable to be compressed together with the intervening vascular collaterals by a space-occupying lesion, such as disc herniation or a fractured fragment. The longer the intradural course of the great medullary artery, the more vulnerable it is to compression by disc herniation or fracture. The intercostal and lumbar arteries are located at the midportion of the lateral aspect of the vertebral bodies rather than at the level of intervertebral discs. Discectomy or decompression of the anterior thoracic canal may be accomplished through a lateral or posterolateral extracavitary approach between two intercostal or lumbar arteries.

An anatomic study of the thickness of the occipital bone. Implications for occipitocervical instrumentation

STUDY DESIGN

The authors measured the thickness and quality of occipital bone regions to determine screw placement during occipitocervical fusion and described the projection of the posterior dural venous sinuses.

OBJECTIVE

This study provides anatomic data relevant to areas of screw placement into the occiput during occipitocervical fixation.

SUMMARY OF BACKGROUND DATA

Few reports exist regarding the morphometrics of the occipital bone and intracranial structures relevant to occipitocervical fusion.

METHOD

The thickness of the posterior inferior occipital bone was measured relative to a 10 x 5 cm grid. Sections were evaluated grossly and histologically. The projections of the posterior dural venous sinuses were determined by direct measurements.

RESULTS

The maximum thickness of the occipital bone, which ranged from 11.5 to 15.1 mm in males and from 9.7 to 12.0 mm in females, was at the level of the external occipital protuberance. The occipital bone was thicker than 8 mm in an area extending laterally from the external occipital protuberance for 23 mm and consisted of dense cortical bone with little or no diploic bone. The projection of most of the torcula on the external surface of the occipital bone was located superior to the center of the external occipital protuberance (mean, 12.6 mm superior and 4.7 mm inferior to external occipital protuberance), whereas that of the transverse sinus was distributed more evenly above and below the external occipital protuberance (mean, 7.3 mm superior and 6.5 mm inferior).

CONCLUSIONS

Screws that are 8-mm long may be inserted in the region of the superior nuchal line (Level 0) extending 2 cm laterally from the center of the external occipital protuberance, 1 cm from the midline at a level 1 cm inferior to the external occipital protuberance (Level 1), and 0.5 cm from the midline at a level 2 cm inferior to the external occipital protuberance (Level 2). The major dural venous sinuses are situated immediately beneath the thickest regions of the occiput and are at risk of penetrative injury during screw placement.

Percutaneous balloon compression of the trigeminal nerve for treatment of trigeminal neuralgia

The technique of percutaneous balloon compression for treatment of trigeminal neuralgia is demonstrated by using embedded audiovisual kernels. A text-based description with linked images is also provided to accomodate varying computer hardware capabilities. A new needle system for guiding the balloon catheter to the entrance of Meckel's cave and a balloon pressure monitoring system for the procedure is described and demonstrated. Results from a series of 141 consecutive patients treated during the period between 1983 and 1995 indicate an initial success rate of 92%. Fifty-seven percent of patients have postoperative numbness, which is described as mild to moderate by 94% of them. Sixteen percent have ipsilateral masseter-pterygoid weakness after compression. The overall recurrence rate is 26%. A Kaplan-Meier survival curve indicates that 60% of patients are pain free 8 years after surgery without recurrence requiring reoperation. The recurrence rate does not significantly differ from patients with first division pain to patients without first division involvement. An absent corneal reflex has not occurred, nor has anesthesia dolorosa. Balloon compression injures the myelinated fibers that mediate the “trigger” to the lancinating pain of trigeminal neuralgia. Because the corneal reflex is mediated by unmyelinated fibers, selective, monitored compression of myelinated fibers should preserve the corneal reflex when first division pain is present.

Fluorescence in situ hybridization analysis of renal oncocytoma reveals frequent loss of chromosomes Y and 1

PURPOSE

Cytogenetic studies of a small number of renal oncocytomas have indicated that loss of chromosomes 1 and Y may be involved in the pathogenesis of this tumor. To evaluate these observations further we selected paraffin embedded renal oncocytoma specimens from 20 male and 10 female patients for fluorescence in situ hybridization analysis.

MATERIALS AND METHODS

Isolated nuclei were prepared from paraffin embedded specimens, and fluorescence in situ hybridization was performed with enumeration probes for chromosomes 1, 12, X and Y.

RESULTS

Tumors from 10 male (50%) and 4 female (40%) patients demonstrated chromosomal alterations. Loss of chromosome Y was observed in specimens from all 10 male patients, and loss of chromosome 1 or gain of chromosome 12 was noted in 5 and 2 of these specimens, respectively. Of the 4 female patients with chromosomal abnormalities 2 had loss of chromosome 1, 1 had gain of chromosome 1 and 1 had gain of chromosome 12.

CONCLUSIONS

Our results confirm that loss of chromosomes Y and 1 is common in renal oncocytoma, and that the alterations are probably involved in the pathogenesis of this tumor.

Laparoscopic marsupialization of symptomatic polycystic kidney disease

PURPOSE

Although laparoscopic unroofing of simple renal cysts has proved to be an effective form of therapy, its use for treatment of multiple renal cysts or symptomatic autosomal dominant polycystic kidney disease only recently has been investigated.

MATERIALS AND METHODS

The results of laparoscopic marsupialization of symptomatic renal cysts in 13 patients was determined 12 to 28 months postoperatively by assessing subjective pain relief, and comparing preoperative and postoperative computerized tomography (CT). Eight patients had autosomal dominant polycystic kidney disease. Multiple dominant (more than 3 cm.) cysts were marsupialized in 11 patients and 1 dominant cyst was treated in 2.

RESULTS

Of 13 patients with symptomatic renal cysts and 8 with autosomal dominant polycystic kidney disease 8 (62%) and 4, respectively, were pain-free 12 to 28 months postoperatively. Two patients had persistent pain, while 3 had recurrent pain 7 to 16 months postoperatively. All 5 patients had persistent or recurrent dominant cysts on followup CT. Followup CT demonstrated resolution or a significant decrease of the largest and all or all but 1 of the other dominant cysts in 6 of 7 pain-free patients. Intraoperative ultrasound detected unidentified cysts during an open and laparoscopic procedure. No deleterious effects on serum creatinine were observed.

CONCLUSIONS

Laparoscopic marsupialization is a safe, relatively successful technique for providing persistent pain relief in patients with autosomal dominant polycystic kidney disease. Although the 2-year pain-free rate approaches the 62% rate reported for open surgical cyst resection, continued efforts to improve current laparoscopic techniques are clearly indicated. Persistence or recurrence of dominant cysts on CT correlated with persistent or recurrent symptoms. Intraoperative ultrasound is effective in identifying dominant cysts.

Self-reports on the Eating Disorder Inventory by female aerobic instructors

This study examined the possibility of eating disorders in 30 female aerobic dance instructors. All subjects completed a biographical questionnaire and the Eating Disorder Inventory. The results showed that the aerobic instructors yielded scores which were comparable to similarly aged female weight lifters but tended to be lower than those of women distance runners (also of similar age). Interestingly, 23% (n = 7) of the subjects reported a previous history of bulimia and 17% (n = 5) reported a previous history of anorexia. Thus, 40% of the instructors indicated a previous experience with eating disorders. Based on all 30 participants, the mean scores associated with Body Dissatisfaction, Drive for Thinness, Ineffectiveness, and Perfectionism were quite comparable to those previously established for anorexic groups. In addition, a relatively high percentage of the sample yielded scores which were actually greater than mean values associated with anorexia patients on nine of the 11 subscales. Based on these results, a number of the aerobic dance instructors possessed scores suggesting behaviors and attitudes consistent with female athletes whose sports emphasize leanness and comparable to those who have eating disorders.

Plasma prolactin, cortisol, and thyroid responses of the brown trout (Salmo trutta) exposed to lethal and sublethal aluminium in acidic soft waters

Brown trout, with indwelling dorsal aortic cannulae, were exposed to various concentrations of aluminium (Al; 50 micrograms liter-1, 100% mortality over 48 hr; 25 micrograms liter-1, 50% mortality over 120 hr; 12.5 micrograms liter-1, 0% mortality over 120 hr) in acidic (pH 5.0) soft water. The plasma concentrations of prolactin (PRL), cortisol, thyroxine (T4), and triiodothyronine (T3) were monitored. Plasma PRL concentrations were transiently depressed (to less than 20% of resting concentrations) after 12 hr in trout in the two highest water Al concentrations, but were unchanged in the trout exposed to 12.5 micrograms liter-1 Al. Plasma cortisol concentrations were elevated in response to all water Al levels and remained elevated in trout in the lethal conditions. The sublethally exposed trout showed a recovery in plasma cortisol concentrations by 120 hr. Plasma T4 concentrations were significantly elevated in trout exposed to both the lethal and the sublethal Al concentrations (from mean resting concentrations of 1-2 ng ml-1 to peaks of 8.9 and 9.0 ng ml-1 in the 50 and 12.5 micrograms liter-1 Al groups, respectively), although a recovery in plasma concentrations was evident in the sublethally exposed trout from 72 hr onwards. Plasma T3 concentrations were relatively stable in the trout exposed to the two highest doses of Al, whereas the trout under the lowest, sublethal, Al conditions exhibited a sustained (12-72 hr) elevation in plasma T3 concentrations (from a mean resting concentration of 0.9 ng ml-1 to a peak of 4.2 ng ml-1 at 48 hr). No clear relationship was apparent between the plasma PRL concentrations and the previously reported ionoregulatory status of the trout.

Axon and ganglion cell injury in rabbits after percutaneous trigeminal balloon compression

New Zealand white rabbits were used to determine whether the changes in the Vth cranial nerve sensory root after compression were associated with the loss of a specific subclass of Vth cranial nerve ganglion cells, the disappearance of a distinct subset of primary afferent terminals in Vth cranial nerve nucleus caudalis, and/or injury to a specific axonal fiber type. There was no significant difference in the size of surviving ganglion cells after Vth cranial nerve compression, as measured 2 to 3 months after injury (P > 0.5, n = 4). Densitometric analysis of the nerves of rabbits that survived > 2 months after compression showed no significant difference in the immunoreactivity of substance P and calcitonin gene-reactive protein between compressed and control sides (P > 0.1, n = 4). Fink-Heimer staining of the Vth cranial nerve subnucleus caudalis revealed that transganglionic degeneration was most dense in the deeper layers, which are the sites of termination of large myelinated fibers. Ultrastructural evaluation of the type of myelinated axons injured by Vth cranial nerve compression in rabbits killed 7, 14, 37, and 270 days after injury was studied, and morphometric analysis was performed. The frequency distribution of axon diameters was significantly different for injured and control areas. The injured areas had higher ratios of small (< 3-microns diameter) to large-diameter axons compared to control distribution. These data indicate that balloon compression results in loss of fibers from the Vth cranial nerve sensory root and extensive transganglionic degeneration in the Vth cranial nerve brain stem complex. Cell size measurements and immunocytochemical data suggest that there is no specific loss of small ganglion cells or fine-caliber primary afferents. These experiments suggest that balloon compression relieves trigeminal pain by injuring the myelinated axons involved in the sensory trigger to the pain.

The physiological effects of bench/step exercise

Recent investigation of acute cardiorespiratory responses to the current 'popularised' style of bench/step exercise has validated its use in improving aerobic physical fitness, particularly in women. However, no marked differences in relative measures of cardiorespiratory demand have been reported between men and women. Instructor data and training investigations further substantiate the effectiveness of bench/step exercise in promoting physical fitness, including upper body strength. However, the energy cost of bench/step exercise can vary dramatically. Important factors include, the selected step height, exercise rate, imposed step manoeuvre, routine format and use of hand-held weights. Hand-held weights may be more useful for men than woman. During training, bench/step exercise has been reported to yield a high incidence of grade I injury complaints, particularly in the calf and shoulder region. However, nearly 90% of these complaints were attributable to acute muscle soreness. Few serious injuries have been associated with the activity. Biomechanical research has shown that the ground reaction forces (GRF) experienced during bench stepping are lower than running and directly related to the step height and type of manoeuvre. In addition, compared with novices, instructors exhibit a moderation in the GRF pattern generated during landing. This suggests that a learning effect has occurred and that teachers yield a more consistent landing pattern. Finally, the activity may be effective in improving body composition, but a consideration of factors related to energy expenditure (e.g. exercise duration and dietary control) appear to be important in regimens prescribed for modifying body fat.

In vivo metabolic response of glucose to dichloroacetate in humans

Hyperglycemia is common in severely ill patients and is related principally to an increase in glucose production. Dichloroacetate (DCA), which is known to increase the rate of pyruvate oxidation, has been shown to lower plasma glucose concentrations in normal fasting subjects and in diabetics and thus may be efficacious in treating stress induced hyperglycemia. However, the mechanism by which DCA lowers the plasma glucose concentration in humans has not been elucidated. To examine the human in vivo metabolic alterations induced by DCA, six fasting volunteers were infused with 6,6-D2-glucose and indirect calorimetry was performed prior to and following DCA administration. Glucose, lactate, and alanine net balance across the leg were also quantitated. Following DCA administration, plasma glucose concentrations decreased by 9% due to a proportional decrease in the rate of glucose production (P < 0.05). DCA had no affect on glucose clearance or leg net balance; however, the rate of glucose oxidation increased by 24% from baseline (P < 0.05). This increase in glucose oxidation without a compensatory change in peripheral glucose consumption suggests an improved efficiency in peripheral glucose utilization induced by DCA. Plasma concentrations of lactate and alanine were also lowered by DCA (56% for lactate, 66% for alanine, P < 0.05) without a significant alteration in leg net balance. These results suggest that DCA may decrease gluconeogenesis by limiting the availability of the precursor substrates lactate and alanine. Thus dichloroacetate may be an appropriate alternative to insulin in correcting mild elevations in plasma glucose concentrations. Furthermore, DCA may be especially effective in severely ill patients where hyperglycemia is largely due to increases in gluconeogenesis.

Lipid and lipoprotein changes in women following 6 months of exercise training in a worksite fitness program

It was the purpose of this investigation to examine the influence of a worksite aerobic training program on serum lipid and lipoproteins and cardiovascular fitness in female employees. Thirty-seven healthy but previously untrained, female employees (Ss) from Westinghouse Corporation, (College Station, Texas) volunteered for the study. Ss were randomly assigned to either an exercise group (Ex) (n = 20) or control group (C) (n = 17). Prior to training (PRE) and following training (POST), all Ss were measured for weight (WT), body composition (%FAT) and tested for maximal oxygen consumption (VO2 max). PRE and POST Lipid analysis included: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TG). Following PRE testing, the Ex group aerobically trained by walking, jogging and/or cycling, at least 3 days per wk for 24 wks. Exercise training resulted in an improvement in VO2 max (p < 0.0006) and a 2 kg WT loss in Ex (p < 0.025) with no change in C. Both Ex and C Ss exhibited a loss in %-FAT (p < 0.0001), and a decrease in TC (p < 0.0001) and LDL-C (p < 0.0001). No differences were observed between groups or over the training period for VLDL-C or TG. Although HDL-C increased 6 mg/dl in the Ex group but not in C, this difference did not reach statistical significance (p < 0.0625). These results demonstrate that aerobic training by females in a worksite fitness program significantly improves cardiovascular fitness without altering lipids or lipoproteins.

Regulation of the E beta gene in vivo: lessons from E beta d transgenic mice

We have examined the expression and regulation of the MHC class II E beta d gene in both cell lines and in transgenic mice. In transient transfection assays, as little as 192 bp of the E beta d proximal promoter was sufficient to direct constitutive expression of a reporter gene in a B cell line and to confer inducibility by IFN-gamma in a macrophage cell line. To determine if the same E beta d promoter sequences were also sufficient to direct correct expression in vivo, E beta d transgenes bearing either 4.1 or 0.2 kb of upstream sequence were introduced into an inbred mouse strain with a non-expressed endogenous E beta gene. Expression of both transgenes mirrored the expression of the endogenous I-A protein in thymus, B cells and macrophages with regard to both constitutive and cytokine-inducible expression. These results indicate that for the E beta gene only 200 bp of proximal promoter sequence are required to achieve tissue-specific and cytokine-inducible expression. This is in striking contrast to the E alpha gene, the only other murine class II gene whose promoter has been analyzed in vivo, which has been shown to require 2.0 kb of upstream sequence for appropriate expression. These data demonstrate, therefore, that the location of critical regulatory elements for the E beta and E alpha genes may differ.

Aneusomies of chromosomes 8 and Y detected by fluorescence in situ hybridization are prognostic markers for pathological stage C (pt3N0M0) prostate carcinoma

In an attempt to identify new prognostic markers, we performed fluorescence in situ hybridization (FISH) ploidy analysis of tumor tissue from patients with a targeted stage and histological grade of prostate carcinoma. We identified all 227 patients from the Mayo Clinic radical prostatectomy data base who had a high histological grade pathological stage C (pT3N0M0) tumor removed between 1966 and 1987. After histological review of the paraffin-embedded specimen blocks, 181 cases were suitable for FISH analysis using chromosome enumeration probes for chromosomes 7, 8, 10, 12, X, and Y. FISH detected 80 (44%) diploid, 22 (12%) tetraploid, and 79 (44%) aneuploid tumors. The common aneusomies were of chromosomes 7 and 8, which were present in 51 (28%) and 46 (25%) tumors, respectively. Aneusomies of chromosomes 10, 12, X, and Y were observed in 11 (6%), 15 (8%) 12 (7%) and 16 (9%) tumors, respectively. FISH aneuploid tumors showed a trend of more frequent systemic prostate cancer progression than nonaneuploid tumors (P = 0.060). For individual chromosome anomalies, gains of chromosome 8, aneusomy of chromosome 8, and aneusomy of chromosome Y correlated highly with systemic cancer progression (P = 0.006, 0.013, and 0.021, respectively). Gains of chromosome Y and aneusomy of chromosome Y were associated with an increased prostate cancer death rate (P < 0.001 for both). Multivariate analysis showed that gains of chromosome 8 and aneusomy of chromosome Y were significant independent "predictors" of systemic cancer progression (P = 0.008) and cancer death (P < 0.001), respectively. These results demonstrate that aneuploidy and specific aneusomies detected by FISH are potential markers for a poor prognosis in histological high-grade pathological stage C (pT3N0M0) prostate carcinoma.

Teaching efficacy of a medical education module on genetic testing for cancer

BACKGROUND

With the identification of the breast cancer susceptibility genes BRCA1 and BRCA2, clinical testing for detection of the mutated genes may be available in the near future. Primary care physicians increasingly serve as full-service providers and gatekeepers and must be aware of presymptomatic testing in order to counsel their patients appropriately. To address this educational need, a new module was incorporated into the genetics course taken by first-year medical students at the Medical College of Virginia.

METHODS

The module used small groups, led by genetics faculty and members of the Virginia Breast Cancer Foundation, for discussion of case examples. The medical students' knowledge of and attitudes toward cancer and predictive genetic testing were assessed by a pretest and a posttest.

RESULTS

After the module, knowledge scores increased by 27%, and significant changes were seen in the students' attitudes toward issues such as the regulation of testing availability and the psychological effect of testing. Most students consistently felt that predictive genetic testing is beneficial, that they would have the testing themselves, that genetic counseling should be required for testing, and that insurers' access to genetic testing results should be limited. Overall, the module was received favorably by all participants.

CONCLUSIONS

Small-group discussion of relevant case examples increases knowledge and awareness of issues regarding presymptomatic genetic testing for breast cancer.