Extraskeletal osteosarcoma in the duodenum of a cat

A three-year-old, male neutered domestic longhair cat was referred for evaluation of icterus, vomiting, and anorexia. Abdominal ultrasonography revealed a proximal duodenal mass obstructing the common bile duct. The mass was surgically resected, and a cholecystoduodenostomy was performed. The histopathological diagnosis was osteosarcoma. Thoracic radiographs showed no evidence of metastasis, and bone scintigraphy revealed no signs of a primary skeletal osteosarcoma. Four months after surgery, the cat had intermittent vomiting, marked weight loss, and died.

Arsenic-induced skin lesions among Atacameño people in Northern Chile despite good nutrition and centuries of exposure

It has been suggested that the indigenous Atacameño people in Northern Chile might be protected from the health effects of arsenic in drinking water because of many centuries of exposure. Here we report on the first intensive investigation of arsenic-induced skin lesions in this population. We selected 11 families (44 participants) from the village of Chiu Chiu, which is supplied with water containing between 750 and 800 microg/L inorganic arsenic. For comparison, 8 families (31 participants) were also selected from a village where the water contains approximately 10 microg/L inorganic arsenic. After being transported to the nearest city for blind assessment, participants were examined by four physicians with experience in studying arsenic-induced lesions. Four of the six men from the exposed village, who had been drinking the contaminated water for more than 20 years, were diagnosed with skin lesions due to arsenic, but none of the women had definite lesions. A 13-year-old girl had definite skin pigmentation changes due to arsenic, and a 19-year-old boy had both pigmentation changes and keratoses on the palms of his hands and the soles of his feet. Family interviews identified a wide range of fruits and vegetables consumed daily by the affected participants, as well as the weekly intake of red meat and chicken. However, the prevalence of skin lesions among men and children in the small population studied was similar to that reported with corresponding arsenic drinking water concentrations in both Taiwan and West Bengal, India--populations in which extensive malnutrition has been thought to increase susceptibility.

Nodulisporic acid opens insect glutamate-gated chloride channels: identification of a new high affinity modulator

Nodulisporic acid (NA) is an indole diterpene fungal product with insecticidal activity. NA activates a glutamate-gated chloride channel (GluCl) in grasshopper neurons and potentiates channel opening by glutamate. The endectocide ivermectin (IVM) induces a similar, but larger current than NA. Using Drosophila melanogaster head membranes, a high affinity binding site for NA was identified. Equilibrium binding studies show that an amide analogue, N-(2-hydroxyethyl-2,2-(3)H)nodulisporamide ([(3)H]NAmide), binds to a single population of sites in head membranes with a K(D) of 12 pM and a B(max) of 1.4 pmol/mg of protein. A similar K(D) is determined from the kinetics of ligand binding and dissociation. Four lines of evidence indicate that the binding site is a GluCl. First, NA potentiates opening of a glutamate-gated chloride current in grasshopper neurons. Second, glutamate inhibits the binding of [(3)H]NAmide by increasing the rate of dissociation 3-fold. Third, IVM potently inhibits the binding of [(3)H]NAmide and IVM binds to GluCls. Finally, the binding of [(3)H]IVM is inhibited by NA. The B(max) of [(3)H]IVM is twice that of [(3)H]NAmide, and about half of the [(3)H]IVM binding sites are inhibited by NA with high affinity (K(I) = 25 pM). In contrast, [(3)H]IVM binding to Caenorhabditis elegans membranes is not inhibited by NA at 100 nM, and there are no high affinity binding sites for NA on these membranes. Thus, half of the Drosophila IVM receptors and all of the NA receptors are associated with GluCl. NA distinguishes between nematode and insect GluCls and identifies subpopulations of IVM binding sites.

The genetics of ivermectin resistance in Caenorhabditis elegans

The ability of organisms to evolve resistance threatens the effectiveness of every antibiotic drug. We show that in the nematode Caenorhabditis elegans, simultaneous mutation of three genes, avr-14, avr-15, and glc-1, encoding glutamate-gated chloride channel (GluCl) alpha-type subunits confers high-level resistance to the antiparasitic drug ivermectin. In contrast, mutating any two channel genes confers modest or no resistance. We propose a model in which ivermectin sensitivity in C. elegans is mediated by genes affecting parallel genetic pathways defined by the family of GluCl genes. The sensitivity of these pathways is further modulated by unc-7, unc-9, and the Dyf (dye filling defective) genes, which alter the structure of the nervous system. Our results suggest that the evolution of drug resistance can be slowed by targeting antibiotic drugs to several members of a multigene family.

Pharyngeal arch patterning in the absence of neural crest

Pharyngeal arches are a prominent and critical feature of the developing vertebrate head. They constitute a series of bulges within which musculature and skeletal elements form; importantly, these tissues derive from different embryonic cell types [1]. Numerous studies have emphasised the role of the cranial neural crest, from which the skeletal components derive, in patterning the pharyngeal arches [2-4]. It has never been clear, however, whether all arch patterning is completely dependent on this cell type. Here, we show that pharyngeal arch formation is not coupled to the process of crest migration and, furthermore, that pharyngeal arches form, are regionalized and have a sense of identity even in the absence of the neural crest. Thus, vertebrate head morphogenesis can now be seen to be a more complex process than was previously believed and must result from an integration of both neural-crest-dependent and -independent patterning mechanisms. Our results also reflect the fact that the evolutionary origin of pharyngeal segmentation predates that of the neural crest, which is an exclusively vertebrate characteristic.

Nonsquamous cell neoplasms of the adult head and neck

The purpose of the article is to describe the magnetic resonance imaging characteristics of the most frequently encountered nonsquamous neoplasms of the adult head and neck. The lesions are divided into those arising from the parapharyngeal or carotid spaces, salivary gland neoplasms, neoplasms of the thyroid and parathyroid glands, mesenchymal neoplasms, and lymphoreticular neoplasms. When appropriate, correlative features of other imaging modalities are included in the discussion. Although magnetic resonance imaging can provide critical information in the evaluation of patients with these neck masses, the imaging features of many of the lesions may be nonspecific and complementary data must be obtained from other modalities or biopsy may be necessary.

Chart documentation of clinical preventive services at 9 Texas clinics

Documentation of clinical preventive services at 9 Texas family practice residency programs, community health centers, and public health regional clinics was examined. Assessment of 11 risks, counseling on those risks, and timeliness of 8 screening tests and immunizations were abstracted. Documentation of clinicians' risk assessment focused on tobacco use (56.4%), alcohol/drug abuse (45.8%), and excess weight (21.6%). Counseling was documented most often for nutrition (20.5%), family planning (11.6%), and physical activity (10.3%). Of the sites studied, public health regional clinics had the highest documentation of assessment and counseling. Community health centers were most up-to-date for diabetes and cholesterol screening. Family practice residencies documented the highest rate of counseling for obesity risk. Clinicians do not document risk assessment, counseling, or up-to-date screening tests and immunizations for most of their adult patients. Texas practitioners may need support or assistance to provide universal access to clinical preventive services.

The effects of indwelling transurethral catheterization and tube cystostomy on urethral anastomoses in dogs

The influence of urinary diversion procedures on urethral healing was studied in 15 male dogs following transection and anastomosis of the intrapelvic portions of their urethras. Dogs were randomly assigned to one of three treatment groups and had urine diverted from the surgical site by indwelling transurethral catheter, cystostomy catheter, or a combination of transurethral catheter and cystostomy catheter. There were no statistically significant differences in urethral healing when considering the different diversion methods, based on clinical, radiographic, and urodynamic parameters evaluated.

Put prevention into practice. Evaluation of program initiation in nine Texas clinical sites

INTRODUCTION

Put Prevention Into Practice (PPIP) is a program designed to improve the delivery of clinical preventive services by primary care providers, through the use of specific office materials for providers and clinic staff, as well as an educational booklet for patients. The purpose of this study was to identify potential predictors of successful initiation of PPIP among 9 Texas public health clinics participating in a demonstration project funded by the Texas Department of Health (TDH).

METHODS

The PRECEDE model was utilized as a theoretical framework for the study. A qualitative, case study methodology was employed, with structured interviews and open-ended questions asked of each site's PPIP personnel. Information from the sites' report to the TDH on the number of charts containing PPIP forms was also used for purposes of data triangulation.

RESULTS

Sites that initiated PPIP successfully were characterized by a medium patient load, the ability to serve low-resource populations, prior attempts to implement categorical programs, existence of a philosophy of prevention, and pre-implementation planning. Barriers to successful initiation were identified as systems-related, patient-related, and staff-related.

CONCLUSIONS

We identified factors that might predict the successful initiation of PPIP in public health primary care settings. Implications of present findings for implementation of similar health promotion programs in clinical settings are discussed.

Development of internal controls for probe-based nucleic acid diagnostic assays

A method is described for the design, evaluation, and application of internal control targets and probes for use in probe-based nucleic acid diagnostic assays (i.e., PCR-ELISA). The technique is a modified version of oligonucleotide-directed mutagenesis in conjunction with PCR amplification to develop a novel probe-annealing sequence in a cloned IS1111a gene fragment of Coxiella burnetii. The internal control probe-recognition site with its complementary probe was identical to the wild-type-specific probe in length, base composition, location, and annealing temperature. Neither the internal control nor the wild-type probes annealed to the recognition sequence of the other. As both of the amplified nucleic acid fragments, internal control and wild type, were identical in length and base composition, the amplification conditions for the diagnostic assay were not affected. This allowed small copy numbers of the internal control clone to be loaded into a diagnostic assay without negatively affecting it. In a single reaction we were able to differentiate between an assay reporting a true or false-negative signal. A negative signal is defined as the absence of detectable pathogen genetic material (true) or inhibition/failure of the reaction (false).

Midline spinal cord hamartomas: MR imaging features of two patients

Congenital midline spinal hamartomas are relatively rare. Patients harboring this anomaly are generally asymptomatic, but present with an overlying skin anomaly. MR imaging depicts a mass that is isointense with the spinal cord on all sequences, and may show a dermal sinus tract that tethers the cord at the level of the lesion. We report the MR features of congenital midline spinal hamartoma in two children.

Axial pattern flap based on the cutaneous branch of the superficial temporal artery in dogs: an experimental study and case report

OBJECTIVE

To determine the anatomic guidelines and viability of an axial pattern flap based on the cutaneous branch of the superficial temporal artery (STA) in dogs. Application of the flap in a clinical patient is reported.

STUDY DESIGN

Flap viability in control and experimental groups was determined 7 days postoperatively.

ANIMALS

A total of 14 mature, mesaticephalic dogs; 1 clinical patient.

METHODS

The cutaneous branch of the STA and vein were incorporated in the flaps of the experimental groups (group A, n = 5; group B, n = 4) and were ligated in the control group (n = 5). Flap length was extended in experimental group B. Seven days postoperatively, the length and area of tissue that remained viable in each flap was determined and compared with similar measurements performed intraoperatively. Cutaneous fluorescence was also used postoperatively to assess flap perfusion. The flap used in the clinical patient had the same dimensions as flaps developed in group A.

RESULTS

Mean survival length (+/- SD) of STA flaps [group A, 9.1 (0.8) cm], was significantly increased (P < .05) compared with control flaps [7.0 (0.6) cm]. Percentage flap length survival (+/- SD) of STA flaps [group A, 91.8 (8.9)%], was significantly increased (P < .05) compared with control flaps [71.6 (7.0)%]. Mean percentage area of survival (+/- SD) of STA flaps [group A, 93.1 (7.5)%], was significantly increased (P < .05) compared with control flaps [73.5 (7.4)%]. Group B flaps had a mean survival length of 10.4 (1.1) cm, percentage flap length survival of 69.5 (4.8)%, and mean percentage area of survival of 69.1 (6.5)%. There was no positive correlation between the area of flap fluorescence at days 0, 1, and 3, and the area of flap survival. Application of the flap in a clinical patient allowed primary wound reconstruction with 100% survival.

CONCLUSION

A flap based on the cutaneous branch of the STA may be a source of skin for reconstructive procedures of the maxillofacial region in dogs.

CLINICAL RELEVANCE

Knowledge of the anatomic landmarks and expected viability of a STA axial pattern flap is essential before consideration of its use as a reconstructive surgical technique.

Acanthosis nigricans

Acanthosis nigricans is a lesion affecting localized areas of the skin in persons with obesity and/or hyperinsulinemia. Roughening of the skin correlates with histological papilomatosis and the apparent darkening is due to hyperkeratosis. Biochemical mechanisms for developing this hyperplastic lesion are unclear, but likely involve local cutaneous growth factors. Cross sectional surveys of unselected populations have demonstrated that young children have low prevalences of obesity and acanthosis nigricans, but the prevalences of both increase with increasing age until plateaus are reached after the age of ten. Nearly 40% of Native American teenagers have acanthosis nigricans, whereas about 13% of African American, 6% of Hispanic, and less than 1% of white, non-Hispanic children aged 10-19 have clinically apparent acanthosis nigricans. We conclude that the presence of this skin lesion is a clinical surrogate of laboratory-documented hyperinsulinemia. Acanthosis nigricans identifies a subgroup within an ethnic group who have the highest insulin concentration, the most severe insulin resistance, and thus the highest risk for the development of type 2 diabetes.

Psychosocial profile of pregnant adolescents in a large Australian regional area

A psychosocial profile was developed of 122 pregnant adolescents attending a public hospital antenatal clinic in a large regional Australian area. Participants completed the Rosenberg Self-Esteem Scale and the Support Behaviours Inventory and were interviewed to obtain psychosocial and demographic information. Results revealed that those who were most likely to have either or a combination of poor self-esteem, lack of social support, be unemployed or smoke, were more likely to be living alone or with friends, not have a partner or have a partner for a shorter period, have a partner who was older, have previous children, have not planned their pregnancy and have less education. The degree of social support was significantly associated with self-esteem. Over half of the sample smoked, and over half were unemployed. These results underscore the importance of addressing psychosocial factors in the implementation of care for the pregnant adolescent.

Imaging of Bezold's abscess

OBJECTIVE

Our purpose was to describe the CT findings in patients with Bezold's abscesses.

CONCLUSION

Bezold's abscesses are rare complications of mastoiditis. In our series most were seen in adults and were associated with a history of cholesteatoma and mastoidectomy. CT of the neck and temporal bone can help the surgeon determine appropriate treatment.

Management of substernal goiter

OBJECTIVE

To analyze the presentation, evaluation and treatment of patients with large substernal goiters, with emphasis on the radiographic evaluation and the results of treatment.

STUDY DESIGN

A retrospective chart review of 150 patients undergoing thyroidectomy at the Vanderbilt University Department of Otolaryngology-Head and Neck Surgery.

METHODS

Charts of patients undergoing thyroidectomy were reviewed. Those with substernal goiter, defined as a major portion of the goiter within the mediastinum, were included in the study. When available, the radiographic studies were reviewed by a staff neuroradiologist.

RESULTS

Twenty-three patients (15.3%) presented with substernal extension of the goiter. Characteristics of these patients included mean age of 59 years, 78% female, symptoms of compression such as dyspnea, choking, and dysphagia (65%), hoarseness (43%), and previous thyroid surgery (30%). Seventeen percent were asymptomatic. Preoperative radiographs demonstrated tracheal compression (73%), tracheal deviation (77%), esophageal compression (27%), and major vessel displacement (50%). Histology revealed multinodular goiter (16/23, 70%), thyroiditis (3/23, 13%), and malignancy (4/23, 17%). The average size of the resected specimen in greatest dimension was 8.0 cm (range, 3.0-14.0 cm) and weighed 148 g (range, 39-426 g). All were successfully approached through a transcervical incision without the need for sternotomy, and total thyroidectomy was performed in 83% of the cases. No major complications have been documented, and no evidence of tracheomalacia was encountered.

CONCLUSION

Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning.

Periodontal healing of canine experimental grade-III furcation defects treated with autologous fibrinogen and absorbable barrier membrane

OBJECTIVE

To determine the effects of autologous fibrinogen (AF) and absorbable barrier membrane (ABM) on periodontal healing of canine experimental grade-III furcation defects.

ANIMALS

18 conditioned, laboratory-source, adult Beagles.

PROCEDURE

Defects were developed bilaterally at the second and fourth premolars and maintained for 12 weeks. Defects were treated with AF, ABM, AF and ABM, or debridement. Digital subtraction radiography, histologic evaluation, and histomorphometric analysis of defect healing was done at 1, 3, and 6 months after treatment to determine percentage increases in bone volume, height, area, and length of periodontal regeneration along the perimeter of the defect.

RESULTS

Comparison of defects at post-treatment intervals indicated significantly greater healing of debridement and AF-treated defects, compared with ABM-treated defects at 3 months; however, by 6 months, there were no significant differences in defect healing for all histomorphometric variables. Defects treated with ABM were associated with significantly less root ankylosis than other treatments. Defects treated with debridement had significantly greater increases in bone volume at 6 months after treatment, compared with groups treated with ABM. There was a significant correlation between regenerated bone area, bone volume, and periodontal regeneration for all treatments at 3 and 6 months after treatment.

CONCLUSION AND CLINICAL RELEVANCE

Use of AF and ABM did not enhance the amount of periodontal healing, compared with debridement only. The ABM-treated defects were essentially devoid of root ankylosis. Grade-III furcation defects may respond equally well to conservative periodontal surgery or guided tissue regenerative techniques. The prevention of root ankylosis is a substantial benefit favoring this latter method of treatment.

Cse4p is a component of the core centromere of Saccharomyces cerevisiae

Histones are fundamental structural components of chromatin and are expected to play important roles in chromosome dynamics. Here, we present direct evidence that Cse4p, a histone H3 variant, is a structural component of the core centromere of S. cerevisiae. In histone H4 and Cse4p mutants, the core centromere chromatin structure is disrupted at restrictive temperature. Overexpression of Cse4p suppresses this defect in the H4 mutant, implying that the two proteins act together in centromere structure. We show by chromatin immunoprecipitation experiments that Cse4p is specifically cross-linked to centromeric DNA. Furthermore, by immunofluorescence microscopy, Cse4p is found in discrete foci consistent with that expected for centromeres. These results suggest the kinetochore is assembled on a specialized centromeric nucleosome containing Cse4p.

Substrate specificity of prostate-specific antigen (PSA)

BACKGROUND

The serine protease prostate-specific antigen (PSA) is a useful clinical marker for prostatic malignancy. PSA is a member of the kallikrein subgroup of the (chymo)trypsin serine protease family, but differs from the prototypical member of this subgroup, tissue kallikrein, in possessing a specificity more similar to that of chymotrypsin than trypsin. We report the use of two strategies, substrate phage display and iterative optimization of natural cleavage sites, to identify labile sequences for PSA cleavage.

RESULTS

Iterative optimization and substrate phage display converged on the amino-acid sequence SS(Y/F)Y decreases S(G/S) as preferred subsite occupancy for PSA. These sequences were cleaved by PSA with catalytic efficiencies as high as 2200-3100 M-1 s-1, compared with values of 2-46 M-1 s-1 for peptides containing likely physiological target sequences of PSA from the protein semenogelin. Substrate residues that bind to secondary (non-S1) subsites have a critical role in defining labile substrates and can even cause otherwise disfavored amino acids to bind in the primary specificity (S1) pocket.

CONCLUSION

The importance of secondary subsites in defining both the specificity and efficiency of cleavage suggests that substrate recognition by PSA is mediated by an extended binding site. Elucidation of preferred subsite occupancy allowed refinement of the structural model of PSA and should facilitate the development of more sensitive activity-based assays and the design of potent inhibitors.

Exodontics

Exodontic therapy may be challenging and difficult especially if the involved tooth has minimal or no periodontal disease. Surgical methods aid the clinician's ability to perform exodontic therapy for the maxillary fourth premolar, mandibular first molar, maxillary canine, and mandibular canine. Complications of exodontic therapy may include fracture, ocular trauma, and infection.

Genetic dissection of histone function

Mutational analysis is an essential tool for understanding the functions of genes within a living organism. The budding yeast Saccharomyces cerevisiae provides an excellent model system for dissecting the genetics of histone function at the molecular and cellular levels. A simple gene organization, plus a wide variety of genetic strategies, makes it possible to directly manipulate a specific histone gene in vitro and then examine the expression of mutant alleles in vivo. Recent methods for manipulating the yeast histone genes have been designed to facilitate both side-directed analysis of structure/function relationships and unbiased screens targeted at specific functional pathways. The conservation of histone and nucleosome structure throughout evolution means that the principles discovered through genetic studies in yeast will be broadly applicable to the chromatin of more complex eukaryotes.

Pulp remains viable following vital amputation of the mesio-buccal root of the maxillary fourth premolar in dogs

Vital amputation of the mesio-buccal root of the maxillary fourth premolar (P4) was performed bilaterally in 8 dogs. Histopathologic evaluation of the tooth structure revealed normal pulp in the remaining mesio-buccal, mesio-palatal, and distal roots and crown during a mean follow-up period of 3.5 +/- 1.9 months. Amputation site healing was characterized by a reparative dentin bridge produced by odontoid cells. Tunnel defects were observed in 13 of 16 (81%) dentin bridges. It is concluded that the pulp of a tri-rooted, periodontal disease-free tooth remains viable during a 6-month period following vital root amputation. These results point to the intriguing possibility that this may also occur in humans, however, this needs to be directly tested in man.

Regional peripheral vascular supply based on the superficial temporal artery in dogs and cats

Cutaneous arterial blood supply to the temporal region was evaluated in 8 dogs and 8 cats. Subtraction radiography and angiography of the carotid and superficial temporal arteries were used in 4 dogs and 4 cats to determine arterial blood supply to the temporal region and frontalis muscle. A myocutaneous axial pattern flap based on the superficial temporal artery and frontalis muscle may be indicated for cosmetic reconstruction in dogs and cats following surgical resection of neoplastic lesions or traumatic wounds in the maxillofacial region. The frontalis muscle was identified as the thin subcutaneous continuation of the platysma muscle extending cranially and rostrally. Dissection of the temporal region in 4 dogs and 4 cats revealed the subcutaneous location of the superficial temporal artery as it continues rostrally from the caudal aspect of the zygomatic arch.

Copper, iron, zinc, and manganese in dietary supplements, infant formulas, and ready-to-eat breakfast cereals

High intakes of iron, zinc, or manganese can interfere with copper absorption. Thus, the purpose of this study was to determine whether the amounts and chemical forms of iron, zinc, manganese, and copper added to food products and nutritional supplements might pose a threat to copper status. More than 25% of the vitamin and mineral supplements examined contained no copper, 40% contained the poorly absorbed cupric oxide, and < 30% contained a highly bioavailable form of copper such as cupric sulfate or cupric chloride. Nearly 40% of the prenatal supplements examined contained both iron and zinc without a nutritionally significant amount of copper. More than 80% of the infant formulas examined had ratios of iron to copper exceeding 20:1, which is higher than the recommended ratios of 10-17:1. None of the 40 ready-to-eat breakfast cereals examined were fortified with copper or manganese although 50% of these cereals contained > or = 25% of the reference daily intake for both iron and zinc. Copper availability could be improved by reformulation of several food products and supplements.