Conservative management of ovarian cysts in pregnancy during third trimester and intrapartum

We treated two patients with large ovarian cysts in pregnancy conservatively. In both cases, aspiration of the cysts under ultrasound guidance allowed successful vaginal delivery. In one case, the cyst fluid reaccumulated, and required further aspiration in labour. In both cases, benign ovarian cysts were removed laparoscopically at a later date. Various strategies for dealing with ovarian cysts in pregnancy are discussed.

Origination of chimeric genes through DNA-level recombination

Comparative genomics is rapidly bringing to light the manifold differences that exist within and between species on the molecular level. Of fundamental interest are the absolute and relative amounts of the genome dedicated to protein coding regions. Results thus far have shown surprising variation on both the polymorphism and divergence levels. As a result, there has been an increase in efforts aimed to characterize the underlying genetic mechanisms and evolutionary forces that continue to alter genomic architecture. In this review we discuss the formation of chimeric genes generated at the DNA level. While the formation of chimeric genes has been shown to be an important way in which coding regions of the genome evolve, many of the detailed studies have been limited to chimeric genes formed through retroposition events (through an RNA intermediate step). Here we provide a short review of the reported mechanisms that have been identified for chimeric gene formations, excluding retroposition-related cases, and discuss several of the evolutionary analyses carried out on them. We emphasize the utility chimeric genes provide for the study of novel function. We also emphasize the importance of studying chimeric genes that are evolutionarily young.

Combination therapy with gefitinib and capecitabine in metastatic breast cancer (MBC): A phase I trial

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Background: Preclinical models have suggested synergy between the EGFR tyrosine kinase inhibitor gefitinib (G) and the 5-FU prodrug capecitabine (C), an active treatment for MBC. This phase I study was designed to explore the safety of this all-oral regimen in patients (pts) with MBC. Methods: Pts were treated in sequential cohorts (n = 3–6) using a fixed dose of G (250 mg qd continuously) and escalating doses of C (1500 mg/m2/day, 1750 mg/m2/day, and 2000 mg/m2/day) in a 21-day cycle. An additional 10 pts were enrolled in a validation cohort at the maximum tolerated dose (MTD). Dose limiting toxicity (DLT) was defined during the first cycle as any grade 3/4 toxicity or a delay >3 weeks due to unresolved toxicity. The primary endpoint was safety; secondary endpoints included assessments of tumor response (using RECIST criteria), adherence to the oral regimen, and biomarker measurements. Results: 19 pts were enrolled; the mean age was 49 y, 58% of tumors were hormone receptor positive, and 10% were HER2 positive. The mean number of prior MBC chemotherapy regimens was 1.2 and 74% had visceral spread. No pts in dose escalation cohorts had DLT during cycle 1. The 10 pts in the validation cohort (MTD C 2000 mg/m2) had 3 DLTs in cycle 1 and 1 DLT in cycle 2 (95% CI 12–74%). For all pts at C 2000 mg/m2 (n = 13), there was no grade 4 toxicity, however 5 (38%) had grade 3 toxicity, 7 (54%) required a C dose reduction, and 2 (15%) came off study for persistent toxicity. 3 pts (23%) experienced grade 3 diarrhea, and 4 pts (31%) had moderate to severe hand/foot syndrome. There were no objective responses (PR or CR) observed out of 18 evaluable pts. The mean number of completed cycles of therapy was 4.8, and 3 pts (16%) were treated for > 24 weeks. An exploratory analysis of serum EGFR measurements demonstrated no association of pre- or post-therapy values with lack of progression. Monitoring adherence to oral therapy using a microelectronic monitoring system (MEMS) was feasible, and detailed data will be presented. Conclusions: In this phase I dose escalation trial of G/C therapy in women with MBC, treatment was generally well tolerated, with a confirmed C MTD of 2000 mg/m2. Moderate toxicity and dose reductions were common. In this small cohort, the G/C combination did not appear to have substantial anti-tumor activity.

[Table: see text]

Cetacean captures, strandings and mortalities in South Australia 1881-2000, with special reference to human interactions

This study summarizes 660 events involving captured, live-stranded and dead cetaceans in South Australia between 1881 and 2000. Emphasis is placed on records (n = 361) during 1985-2000 when an active necropsy programme was underway. Average number of events per year was 30.4 and the most common species were the short-beaked common dolphin (Delphinus delphis) and Indo-Pacific bottlenose dolphin (Tursiops aduncus). Records were assigned to nine categories of circumstance/cause of death. Summarizing the total database, 60% were unknown circumstance, 22% not obviously anthropogenic, 13% unintentional human-related and 5% intentional human-related. In the data set of records for 1985-2000, 50% were unknown, 25% were not obviously anthropogenic, 20% were unintentional humanrelated and 5% were intentional killings. Non-anthropogenic circumstances included neonatal deaths, live strandings, significant diseases, shark attacks and choking. Cornynebacterium ulcerans is recorded for the first time in a cetacean. Unintentional circumstances included entanglement in fishing and aquaculture equipment (17% of necropsied carcasses from 1985-2000) and boat strikes. Intentional human-related circumstances were captures for live display and illegal killing. Five percent of the necropsied carcasses during 1985-2000 were attributed to shootings or stabbings/spearings. There is need for a formal reporting procedure for marine mammal deaths and human interaction involving injury and for steps to be taken to reduce human impacts.

[The relationship between surgical staging, pathologic grading, operative type and postoperative recurrence in giant cell tumor of bone]

Sixty-eight surgical procedures of 58 patients with Giant Cell Tumor of Bone(GCT) were followed up over two years. The recurrence rate of GCT was Stage 1: 0 in 5, Stage 2: 15.4% in 39 and Stage 3: 37.5% in 24. It was significantly higher in Stage 3 than in Stage 2 (P < 0.05). The recurrence rate of GCT in Stage 2 was 30.8% in 13 intralesional curettage, and 0 in 17 wide or radical resection(P < 0.05). We conclude that the surgical staging of GCT has important value in predicting postoperative recurrence, in accurately evaluating the operative efforts and in guiding treatment, and that the operative type is a significant factor effecting on the recurrence of GCT.

[Analysis of complications and deaths in aged patients with obstructive jaundice]

The reasons of complications and deaths in 98 aged patients with obstructive jaundice were analysed in the paper. Among them, 52 cases were diagnosed as benign obstruction, 46 cases as malignant obstruction; 92 patients were treated by surgical management(15 died), 6 patients were treated without operation(4 died). The results showed that effective management on time and intensive perioperative care are important to minimize the mortality rate. Malignant obstructive jaundice was more harmful to the patients' renal function no the mortality rate would be increased. The operations, internal drainage and pressure reduction of biliary duct, were performed on time, thus the survival rate was improve.

ExInt: an Exon Intron Database

The Exon/Intron Database (ExInt) stores information of all GenBank eukaryotic entries containing an annotated intron sequence. Data are available through a retrieval system, as flat-files and as a MySQL dump file. In this report we discuss several implementations added to ExInt, which is accessible at http://intron.bic.nus.edu.sg/exint/newexint/exint.html.

Intravenous tissue-type plasminogen activator therapy for ischemic stroke: Houston experience 1996 to 2000

CONTEXT

Intravenous tissue-type plasminogen activator (tPA) therapy using the National Institute of Neurological Disorders and Stroke criteria has been given with variable safety to less than 5% of the patients who have ischemic strokes nationwide. Our center is experienced in treating large numbers of stroke patients with intravenous tPA.

OBJECTIVE

To report our total 4-year experience in the treatment of consecutive patients who had an ischemic stroke.

DESIGN

Prospective inception cohort registry of all patients seen by our stroke team and an additional retrospective medical record review of all patients treated between January 1, 1996, and June 1, 2000.

SETTING

A veteran stroke team composed of fellows and stroke-specialty faculty servicing 1 university and 3 community hospitals in a large urban setting.

PATIENTS

Consecutive patients with ischemic stroke treated within the first 3 hours of symptom onset.

INTERVENTION

According to the National Institute of Neurological Disorders and Stroke protocol, 0.9 mg/kg of intravenous tissue-type plasminogen activator was administered.

MAIN OUTCOME MEASURES

Number and proportion treated, patient demographics, time to treatment, hemorrhage rates, and clinical outcome.

RESULTS

A total of 269 patients were treated between January 1, 1996, and June 1, 2000. Their mean age was 68 years (age range, 24-93 years); 48% were women. This represented 9% of all patients admitted with symptoms of cerebral ischemia at our most active hospital (over the final 6 months, 13% of all patients with symptoms of cerebral ischemia and 15% of all acute ischemic stroke patients). Before treatment the mean +/- SD National Institutes of Health Stroke Scale (NIHSS) score was 14.4 +/- 6.1 points (median, 14 points; range, 4-33 points). A tPA bolus was given at 137 minutes (range, 30-180 minutes); 28% of the patients were treated within 2 hours. The mean door-to-needle time was 70 minutes (range, 10-129 minutes). The symptomatic intracerebral hemorrhage rate was 5.6% of those patients with a second set of brain scans (4.5% of all patients), with a declining trend from 1996 to 2000. Protocol violations were found in 13% of all patients; the symptomatic intracerebral hemorrhage rate in these patients was 15%. At 24 hours, the NIHSS score was 10 +/- 8 points (median, 8 points; range, 0-36 points). In-hospital mortality was 15% and the patients' discharge NIHSS scores were 7 +/- 7 points (median, 3 points; range, 0-35 points).

CONCLUSIONS

Intravenous tPA therapy can be given to up to 15% of the patients with acute ischemic stroke with a low risk of symptomatic intracerebral hemorrhage. Successful experience with intravenous tPA therapy depends on the experience and organization of the treating team and adherence to published guidelines.

Evolution of novel genes

Much progress in understanding the evolution of new genes has been accomplished in the past few years. Molecular mechanisms such as illegitimate recombination and LINE element mediated 3' transduction underlying exon shuffling, a major process for generating new genes, are better understood. The identification of young genes in invertebrates and vertebrates has revealed a significant role of adaptive evolution acting on initially rudimentary gene structures created as if by evolutionary tinkers. New genes in humans and our primate relatives add a new component to the understanding of genetic divergence between humans and non-humans.

Kinetic measurements of cell surface E-selectin/carbohydrate ligand interactions

Selectin/ligand interactions initiate the multistep adhesion and signaling cascades in the recruitment of leukocytes from circulation to inflamed tissues and may also play a role in tumor metastasis. Kinetic properties of these interactions are essential determinants governing blood-borne cells' tethering to and rolling on the vessel wall. Extending our recently developed micropipette method, we have measured the kinetic rates of E-selectin/ligand interactions. Red cells coated with an E-selectin construct were allowed to bind HL-60 or Colo-205 cells bearing carbohydrate ligands. Specific adhesions were observed to occur at isolated points, the frequency of which followed a Poisson distribution. These point attachments were formed at the same rate with both the HL-60 and Colo-205 cells (0.14 +/- 0.04 and 0.13 +/- 0.03 microm2 s(-2) per unit density of E-selectin, respectively) but dissociated from the former at a rate twice as fast as did from the latter (0.92 +/- 0.23 and 0.44 +/- 0.10 s(-1), respectively). The reverse rates agree well with those measured by the flow chamber. The forward rates are orders of magnitude higher than those of Fcgamma receptors interacting with IgG measured under similar conditions, consistent with the rapid kinetics requirement for the function of E-selectin/ligand binding, which is to capture leukocytes on endothelial surfaces from flow.

Aspartyl proteinase genes from apicomplexan parasites: evidence for evolution of the gene structure

Aspartyl proteinases are a widely distributed family of enzymes. All vertebrate aspartyl proteinases share a conserved nine-exon gene structure, but in other organisms the structure of aspartyl proteinase genes varies considerably. The exon-intron patterns generally reflect phylogeny based on amino acid sequences. However, close comparison of these gene structures reveals some striking features, such as the conservation of intron positions and intron phases between aspartyl proteinases from nematodes and apicomplexans. Here, we discuss the implications of gene structure for the possible evolution of the aspartyl proteinase family, with particular reference to the plasmepsins of Plasmodium falciparum and eimepsin from Eimeria tenella.

[Studies on transference of hydrogenase genes of Rhizobium arachis]

The hydrogen-uptake genes were transferred into wild Rhizobium arachis Ra strains (Hup-, Nif+, Apr) by triparental mating using pRK2013 as help plasmid. A transconjugant R. arachis Rz34-2(Hup+, Nif+, Apr, Tcr) which expressed high activities of hydrogenase and nitrogenase under free-living and symbiotic state was screened. Peanut inoculation test with recipient R. arachis Ra34, transcojugant Rz34-2 and control strain R. arachis L8-3 (Hup+, Nif+) was carried out respectively. The results showed that, compare to treatment without inoculation, inoculation with R. arachis Ra34 and R. arachis L8-3, the dry weight of leaf inoculated with transconjuant Rz34-2 increased 6.2%, 7.6% and 6.3% respectively; the N-content of seed increased 8.8%, 10.0% and 6.0%; the output increased 18.8%, 10.5% and 10.7%. This suggested that legume plants inoculated with Rhizobium strains (Hup+) were more efficient to accumulate N and to increase its output.

An outcome study of breast reconstruction: presurgical identification of risk factors for complications

BACKGROUND

Breast reconstruction following mastectomy has been shown to have a salutary effect on the overall psychological well-being of women being treated for breast cancer. Unfortunately, however, not every patient is an ideal candidate for reconstruction. Complications stemming from reconstructive surgery can cause significant morbidity, the most important of which may be the delay of subsequent adjuvant antineoplastic therapies, and therefore may not be in the best interests of the patient.

METHODS

A retrospective study was performed on a consecutive series of 123 breast reconstructions in 98 patients, performed by one of two plastic surgeons, in a university setting over a 5-year period, for all surgical outcomes. Specifically, wound-healing complications, infections, and reoperations leading to the potential delay of subsequent chemotherapy or radiotherapy were recorded, and possible risk factors leading to these were sought.

RESULTS

Three presurgical risk factors were found to have a statistically significant influence on the development of complications following breast reconstruction. These were: (1) increasing obesity, defined by the body mass index, (2) an active or recent (<5 year) history of cigarette smoking, and (3) a history of previous radiation exposure. Odds ratios were used to describe the magnitude of the effect of each factor for the development of complications. An ordinal regression analysis was used to create a nomogram based on this information that can be used to calculate any individual patient's presurgical risk for developing major complications following breast reconstruction, based on the presence of these factors.

CONCLUSIONS

It is possible, based on the presence of specific presurgical risk factors, to predict the probability of developing major complications following breast reconstruction. This information can be useful to the referring physician and plastic surgeon alike in determining which patients are the best candidates for breast reconstruction and which type of reconstruction would be best suited for each individual patient.

A comparison of the Ameroid constrictor versus ligation in the surgical management of single extrahepatic portosystemic shunts

Twenty-two dogs were managed surgically for a single extrahepatic portosystemic shunt; 12 with surgical ligation and 10 with an Ameroid constrictor. Utilization of the Ameroid constrictor significantly decreased surgery time to approximately half that of the ligation technique. A decreased intraoperative and postoperative complication rate was noted with the Ameroid constrictor group. Follow-up evaluation demonstrated comparable efficacy when comparing surgical techniques. The Ameroid constrictor offered a surgical occlusion technique for management of a single extra-hepatic portosystemic shunt that was equally effective to ligation while shortening surgical time and minimizing the risks that are commonly associated with ligation of the shunting vessel.