[O-twist marker for post-interventional marking in imaging of suspected breast lesions]

AIM

The aim of this study was to develop a marker clip for use in minimally invasive diagnostics of breast cancer that can be placed and visualized during ultrasonography, mammography, and magnetic resonance imaging.

METHODS

The newly developed O-twist marker consists of three 0.15-mm biocompatible nitinol wires twisted together to form rings with a diameter of 2.5 mm. These are inserted elongated into a 20G cannula. The marker is ejected into the tissue through a mandrin and reverts to its predetermined ring form.

RESULTS

The multiple curves of the surface render the marker highly visible. Its geometry permits secure anchorage even in larger biopsy cavities and additionally prevents migration within the tissue.

CONCLUSION

The O-twist marker is applicable for all examination modalities and biopsy needles or biopsy systems and represents an important development for breast cancer diagnostics.

[Infection peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: microbiological review during an four-year period]

The purpose of this study was to analyse the microbiological characteristics of infectious peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. This study was conducted at the CHU Nancy from 1999 to 2002. The diagnosis of peritonitis was based on cloudy peritoneal effluent (>100 cells per mm(3)) with an elevated leukocyte count (>50%), on isolation of bacteria or fungi and on symptoms such as abdominal discomfort or pain. The majority of infections associated with continuous ambulatory peritoneal dialysis were caused by Gram-positive bacteria (68%), Gram-negative bacteria (31%), and Candida (1%). The coagulase-negative staphylococci were the most common cause of peritonitis. The antibiotic sensitivity of species corresponded to community-acquired isolation.

[Minimally invasive biopsy and preoperative marking of suspect mammary lesions]

Image-guided minimally invasive needle biopsy is an established method in the diagnosis of breast cancer, which - when indicated correctly and carried out with quality control - equals or even surpasses open diagnostic surgery. Therefore, an open diagnostic biopsy should only be performed as well-founded exception. Depending on the visibility in the various diagnostic techniques of the condition to be clarified histologically, needle biopsy has to be carried out with the image-guided procedure which can identify the mammary lesion most reliably. If a lesion is detectable mammographically as well as sonographically, a high-speed large-core biopsy is preferred, taking the strain on the patient and the costs into account, too. In the case of suspect microcalcifications, the needle biopsy has to be controlled stereotactically. Here, vacuum-assisted procedures [Mammotome, VacuFlash (BIP)/Vacora (Bard)] yield markedly better results when compared with large-core biopsy and are also preferred for lesions which are only visible on magnetic resonance tomography. Without exception, preoperative wire marking should be used in cases of suspect nonpalpable lesions in imaging diagnostics or even more so of lesions which have already been classified histologically as malignant by minimally invasive procedures before surgery. This is the only way to safely find the suspect and nonpalpable lesion during the operation and to excise it with a sufficient safety margin while preserving as much healthy issue as possible. Quality-controlled diagnostics and therapy of breast cancer constitute an interdisciplinary challenge and yield optimal results only when all concerned specialties collaborate in the best possible way.

Early referral to a nephrologist is associated with better outcomes in type 2 diabetes patients with end-stage renal disease

OBJECTIVE

End-stage renal disease (ESRD) requiring renal replacement therapy (RRT) is a late complication of type 2 diabetes. The correlation between pre-ESRD medical care and outcome has been rarely studied in France.

METHODS

Community-based study of case-incIdent ESRD patients. Medical care practices were described retrospectively when starting RRT. Medical status, mortality, morbIdity, and quality-of-life were recorded prospectively.

RESULTS

One hundred and fourty-eight ESRD patients with type 2 diabetes were included. Factors independently correlated with mortality within 3 Months of RRT onset were presence of physical impairment of ambulation at onset of RRT [odd ratio (OR): 5, (95%CI: 1.9-13.3)], and starting RRT in life-threatening circumstances [OR: 3.6, (95%CI: 1.2-10.7)]. Factors independently correlated with "poor outcome" 1 Year after the onset of RRT were BMI less than 20 kg/m2 [OR: 13.4, (95%CI: 1.5-120.2)] and presence of 2 [OR: 2.7, (95%CI: 0.9-8.4)], or 3 or more comorbId conditions [OR: 4, (95% CI: 1.4-11)]. Three Months after the first RRT session, survival was 16.4% better for patients who had had regular nephrological care versus none, and 9.1% better for those who had had late nephrological care versus none. Type 2 diabetes patients starting RRT in an emergency setting had had significant less regular nephrological care. Length of their first hospital stay was significantly longer. They were more likely to have lower resIdual renal function, gastrointestinal symptoms, lower serum albumin, lower hematocrit, lower serum calcium, and higher serum phosphorus.

CONCLUSIONS

During the course of chronic renal failure in type 2 diabetes patients, early implementation of nephrological well-established guIdelines is associated with better outcome after starting RRT.

[52-year-old patient with subcutaneous space-occupying lesion in immunosuppression]

We report the case of a 52-years-old male patient, who was diagnosed with subcutaneous alveolar echinococcosis 6 months after liver transplantation for HCV-related cirrhosis. Nether the explanted nor the transplantated liver revealed an echinococcus focus. Therefore a rare primary extrahepatic manifestation was likely. Interestingly, the echinococcal larvae had developed protoscolices. The development of mature tapeworms in human is a rarity, which could be related to the immunosuppressive therapy after liver transplantation. The patient was curatively treated by surgical removal of the subcutaneous tumor and a postoperative therapy with albendazole. Furthermore, HCV reinfection (genotype 2b) was successfully treated with interferone alpha 2b and ribavirine for 6 months.

Transluminal Removal of an Embolized Venous Catheter Fragment with Simple Means: A Case Report

Vascular catheters are associated with complications like infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. This report presents a successful transluminal removal of an embolized catheter fragment in a 87-year-old patient who underwent on operative revision with renewed resection and postoperative multiorgan failure. The patient needed a large-bore catheter due to acute renal failure. By replacing the central venous catheter using the Seldinger technique a catheter fragment embolized in the right ventricle. This catheter fragment was removed with a Dormia basket.

[Cardiovascular disease in terminal end-stage renal failure--epidemiological aspects]

Cardiovascular disease is the leading cause of death in patients with ESRF. Cardiovascular mortality is 10- to 30-fold higher in ESRF patients than in the general population after adjustment for age, gender, ethnic origin and diabetes. Left ventricle hypertrophy, heart failure, and arterial atheroma are the main causes of cardiovascular morbidity-mortality. Among the classical cardiovascular risk factors identified in the Framingham study, only male gender, Caucasian ethnic origin, diabetes, and smoking are found in dialysis patients. Systolic blood pressure and total cholesterol are not associated with cardiovascular morbidity-mortality in the dialysis population. Inversely, low systolic pressure and serum cholesterol are risk factors for death. Since the classical risk factors are insufficient to explain the high cardiovascular morbidity-mortality in the dialysis population, factors related to CRF and its treatment have been proposed. These factors include hydroelectrolytic disorders, anemia, elevated Lp(a) and homocysteine, a state of micro-inflammation, and elevated thrombogenesis factors. Strategies designed to identify and prevent cardiovascular risk factors in the dialysis population should take into consideration the classical risk factors as well as specific risk factors related to CRF, and this well before reaching the state of ESRF.

Breast cancer: monitoring response to neoadjuvant chemotherapy using Tc-99m sestamibi scintimammography

BACKGROUND

Aim of the study was to assess the value of scintimammography using Tc-99m sestamibi in the evaluation of tumor response to neoadjuvant chemotherapy. MATERIAL ANS METHODS: Results were calculated for 9 patients undergoing neoadjuvant chemotherapy. Scintimammography using 740 MBq Tc-99m sestamibi was performed before, during and after chemotherapy, and sestamibi uptake was scored visually and semiquantitatively to evaluate tumor response.

RESULTS

In the case of complete response (n = 3) sestamibi uptake decreased 8 days after beginning neoadjuvant chemotherapy and normalized in the following course. Focal uptake decreased more slowly in patients with partial response (n = 3), who showed clear, persisting tracer accumulation after therapy. The patients without response (n = 3) showed a persisting high tumor activity even after chemotherapy was completed.

CONCLUSIONS

The preliminary data suggest that in contrast to other imaging modalities scintimammography appears to yield early information regarding tumor response to neoadjuvant chemotherapy.

Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study)

BACKGROUND

In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database.

METHODS

The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors.

RESULTS

Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival.

CONCLUSION

Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.

Free radical scavenging and skin penetration of troxerutin and vitamin derivatives

BACKGROUND

By its 'protective function', human skin is a potential target for the production of free radicals. The role played by topically applied antioxidants as inhibitors of oxidative stress damage was felt to be worth investigation.

OBJECTIVE

To investigate the free radical scavenging (superoxide, hydroxyl and peroxyl radicals) and skin penetration of troxerutin in association with ascorbyl palmitate and alpha-tocopheryl succinate, esters of two vitamins commonly used in skin care products.

METHODS

The compounds' scavenging activities, in a concentration-dependent manner, were as follows: hydroxyl radicals in a Fenton-based assay; superoxide radicals in a hypoxanthine/xanthine oxidase system; and lipid peroxidation inhibition of liver microsomes was induced by 2,2'-azobis-(2-amidinopropane) dihydrochloride (ABAP).

RESULTS

A synergic action was observed between alpha-tocopheryl succinate and troxerutin for hydroxyl radical scavenging, between the three compounds for superoxide scavenging and between troxerutin and ascorbyl palmitate in lipid peroxidation inhibition.

CONCLUSION

Using a stripping method, it was shown that the three substances, incorporated in a pharmaceutical preparation, permeated through human epidermis. Thus, this association can improve skin care products for preventing free radical-mediated damage.

Intravenous iron administration does not significantly increase the risk of bacteremia in chronic hemodialysis patients

BACKGROUND

Correction of iron deficiency is critical in chronic hemodialysis patients, and intravenous administration is superior to the oral route in this goal. Recently, concern was raised that intravenous iron administration might promote infection in dialysis patients.

METHODS

We reviewed the data from a recent prospective study of 985 patients in which no link between iron therapy and bacteremia had been found. We tested the potential role of the administration route of the iron (intravenous vs. oral), the weekly amount of iron administered and the administration rate on the risk for bacteremia in these patients.

RESULTS

were 4-fold: in multivariate analysis, neither intravenous iron administration in the whole population nor the weekly amount of iron in the subgroup of i.v. iron-treated patients were significant risk factors for bacteremia; iron was not given more frequently intravenously in bacteremic than in non-bacteremic patients; among patients treated with intravenous iron, the frequency and the amount of iron administered were significantly higher in those who developed bacteremia than in those who did not; and in patients receiving i.v. iron, there was an increased risk of bacteremia associated with concurrent administration of erythropoietin, which was not observed in patients receiving iron orally.

CONCLUSION

This study failed to demonstrate a significant association between intravenous iron administration and the risk of bacteremia in dialysis patients. However, there might be a slightly increased risk of bacteremia in patients given high-frequency, high-dose intravenous iron.

Kinetics in one-dimensional lattice gas and Ising models from time-dependent density-functional theory

Time-dependent density-functional theory, proposed recently in the context of atomic diffusion and nonequilibrium processes in solids, is tested against Monte Carlo simulation. In order to assess the basic approximation of that theory, the representation of nonequilibrium states by a local equilibrium distribution function, we focus on one-dimensional lattice models, where all equilibrium properties can be worked exactly from the known free energy as a functional of the density. This functional determines the thermodynamic driving forces away from equilibrium. In our studies of the interfacial kinetics of atomic hopping and spin relaxation, we find excellent agreement with simulations, suggesting that the method is also useful for treating more complex problems.

[Breast scintigraphy using 99mTc-sestamibi--use and limitations]

AIM

Until now scintimammography did not achieve any definite role in the assessment of breast lesions. Purpose of this study was to elaborate its use as well as the limitations of scintimammography after 500 examinations completed.

METHODS

Scintigraphic findings were correlated with the histopathologic outcome of 219 patients, who underwent surgery or biopsy for histopathological confirmation. The results were determined with respect to palpability of the lesion and tumour size. Additionally, a distinct analysis was performed for the patient subpopulation with indeterminate results of previously performed physical examination, mammography, and sonography.

RESULTS

Overall sensitivity for scintimammography was 82.1% at a specificity of 87.5%. For palpable lesions sensitivity was 91.7% which was evidently higher as compared to 64.9% for non palpable lesions. For palpable lesions specificity was 81.1% and 88.6% for non palpable lesions. According to tumour size sensitivity ranged between 65.2% for carcinoma with a diameter < 1 cm and 93.7% for carcinoma > 1 cm. In the patients subgroup with indeterminate preliminary diagnosis (n = 143) sensitivity decreased to 71.7% at a specificity of 87.8%. Patients undergoing neoadjuvant chemotherapy showed decreasing sestamibi uptake as early as 8 days after therapy if tumour response was evident. However, small residual invasive tumours in patients with complete remission could not be visualised.

CONCLUSION

Scintimammography is neither suited for screening, nor early diagnosis of breast cancer, nor for the further evaluation of small and unclear mammographic findings. Scintimammography should not be used whenever histopathological clarification of a suspicious lesion is necessary. It is useful to further investigate patients with unclear or probably benign findings in physical examination and/or mammography and to monitor tumour response to neoadjuvant chemotherapy.

[Hydro-MRI for abdominal diagnostics in children]

PURPOSE

A clinical evaluation of hydro-MRI as an alternative method to barium studies in children with abdominal pain of unknown origin is presented.

PATIENTS AND METHODS

20 children with abdominal pain of unknown origin aged from 9 - 16 years were examined after oral bowel opacification using 1000 ml of 2.5 % mannitol solution with a 1.0 T MRI system. The investigation was done in 2 planes (coronal and axial) under breath-hold conditions. Imaging procedures included various sequences (T2W HASTE + FS, contrast-enhanced T1W FLASH FS). Suspicious findings in bowel segments and extra-intestinal changes were assessed.

RESULTS

In 21/24 examinations the small bowel was completely visualized, in 15/24 cases colon segments were identified. An accurate assessment of the terminal ileum was not possible in 3/24 procedures. Breathing artefacts occurred in 3/24 examinations. Signs of Crohn's disease were found in 4 examinations, inflammatory changes of the ileum were detected in 3 cases. Inflammation of the colon was demonstrated in 2 children. Furthermore, pathological findings included constipation in one child and inflammation of the ileo-colic and mesenterial lymph nodes were found in another child. Extra-intestinal changes in 3 children were caused by ovarian cysts, and in one case by pleural effusion. In 4 examinations we detected ascites in the absence of other pathological findings. In 5 children there was no pathological correlation in the bowel or extra-intestinal region for the complaints. The children tolerated the hydro-MRI very well. There were no side effects using oral mannitol.

CONCLUSION

Hydro-MRI is a valuable non-invasive method in the diagnosis of abdominal pain of unknown origin. In children it should be the method of choice because it further offers the advantage of the absence of ionizing radiation. Patient compliance is a prerequisite for this new examination. In our experience this requirement was met in children older than 9 years. Further studies should prove the necessity of conventional radiology following negative hydro-MRI.

Induction versus noninduction in renal transplant recipients with tacrolimus-based immunosuppression

BACKGROUND

The aim of this study was to compare the efficacy and safety of induction treatment with antithymocyte globulins (ATG) followed by tacrolimus therapy with immediate tacrolimus therapy in renal transplant recipients.

METHODS

This 12-month, open, prospective study was conducted in 15 centers in France and 1 center in Belgium; 309 patients were randomized to receive either induction therapy with ATG (n=151) followed by initiation of tacrolimus on day 9 or immediate tacrolimus-based triple therapy (n=158). In both study arms, the initial daily tacrolimus dose was 0.2 mg/kg. Steroid boluses were given in the first 2 days and tapered thereafter from 20 mg/day to 5 mg/day. Azathioprine was administered at 1-2 mg/kg per day.

RESULTS

At month 12, biopsy-confirmed acute rejections were reported for 15.2% (induction) and 30.4% (noninduction) of patients (P=0.001). The incidence of steroid-sensitive acute rejections was 7.9% (induction) and 22.2% (noninduction)(P=0.001). Steroid-resistant acute rejections were reported for 8.6% (induction) and 8.9% (noninduction) of patients. A total of nine patients died. Patient survival and graft survival at month 12 was similar in both treatment groups (97.4% vs. 96.8% and 92.1% vs. 91.1%, respectively). Statistically significant differences in the incidence of adverse events were found for cytomegalovirus (CMV) infection (induction, 32.5% vs. noninduction, 19.0%, P=0.009), leukopenia (37.3% vs. 9.5%, P<0.001), fever (25.2% vs. 10.1%, P=0.001), herpes simplex (17.9% vs. 5.7%, P=0.001), and thrombocytopenia (11.3% vs. 3.2%, P=0.007). In the induction group, serum sickness was observed in 10.6% of patients. The incidence of new onset diabetes mellitus was 3.4% (induction) and 4.5% (noninduction).

CONCLUSION

Low incidences of acute rejection were found in both treatment arms. Induction treatment with ATG has the advantage of a lower incidence of acute rejection, but it significantly increases adverse events, particularly CMV infection.

[Screening lowers breast cancer mortality. Motivate your patients for mammography]

Breast cancer is the most common malignant disease in women under 70, and the most common cause of death in those under 50. Causal prophylaxis is unknown. Only early diagnosis prior to the onset of lymphogenic or hematogenic metastasization improves the prognosis. Since the early nineteen-sixties, large-scale studies have shown that screening mammography can reduce mortality. Furthermore, early diagnosis enables breast-conserving treatment in up to 70% of cases. Disadvantages of screening mammography currently under discussion are the radiation burden, the number of false-positive diagnoses prompting biopsy and incurring costs. In Germany, the cost of screening mammography in women with no relevant history or clinical symptoms is not borne by the state-affiliated health insurance carriers. Currently, ongoing pilot projects are investigating quality-controlled early diagnosis with mammography.

The bone-vacuum cementing technique for the fixation of the stem in total hip arthroplasty

The bone-vacuum cementing technique is a promising method developed to obtain reliable fixation of the femoral component. Previous studies showed that intraoperative embolic complications, cardiopulmonary impairment, and deep venous thrombosis can be prevented when this technique is used. The specific aims of the present investigation were to provide additional treatment outcome information, to identify risk factors for poor results, and to define the need of surgical technique improvement by risk factor analysis. The first 118 consecutive patients (121 hips) who had primary total hip arthroplasty using the bone-vacuum cementing technique and an anatomical stem were followed-up for a mean of 2.5 years (1 to 4 years). The mean age of patients at index operation was 73 years. Current criteria were used for clinical and radiological assessment. At the time of the latest follow-up, 3 patients (3 hips, 2.5%) had been lost, and 9 patients (9 hips, 7.5%) had died. However, the status of the hip joint at the time of death could be verified in all patients. Thus, the clinical outcome of 115 patients (118 hips, 97.5%) was known. Radiographs were available for 102 patients (104 hips) who were alive for the entire follow-up period. The mean preoperative Harris Hip Score was rated 51, and it had improved to 92 at the time of follow-up. The score was good for 70 hips and excellent for 42 hips, so the rate of clinical success was 95%. Six patients (6 hips, 5%) had a fair result. Two of them had a fracture of the greater trochanter after the index operation, requiring internal fixation. Four hips with severe acetabular dysplasia had persistent limp and limited motion. The quality of the cement mantle was rated good (grade A and B) in 108 of 121 hips (89.5%). Nineteen of the 108 hips presented at least one small void in the cement mantle (grade C1). Insufficient thickness of the cement mantle (grade C2) was present in 10 hips (8%). Failure of cement to extend below the tip of the stem (grade D) was observed in the remaining 3 hips (2.5%). In the present series no femoral component required revision because of aseptic loosening, and there was no radiographic evidence of aseptic loosening at follow-up. Radiolucencies without progression were found in Gruen zone 1 in 11 of 104 hips (10.6%), and in zone 7 in 7 hips (6.7%). In one hip (0.9%) ballooning osteolysis was observed in zone 7. Seventy-five hips (72%) had either no change in femoral bone density or only patchy loss of bone density isolated to Gruen zones 1 and 7. Twenty-nine hips (28%) had some reduction of bone density isolated to zones 1 and 7. A slight cortical hypertrophy was seen in 4 hips (3.8%). Of the whole series, one hip required revision surgery because of septic loosening 2 years after the index operation. At an average of 2.5 years postoperatively, the femoral component inserted using the bone-vacuum technique functioned well overall, and patient satisfaction was high. Clinical and radiological results do not contrast with those achieved using contemporary cementing techniques.

Increased reproductive success of MHC class II heterozygous males among free-ranging rhesus macaques

Gene conversion and balancing selection have been invoked to explain the ubiquitous diversity of the antigen-presenting proteins encoded in the vertebrate major histocompatibility complex (MHC). In the present study, direct evidence for over-dominant selection promoting MHC diversity in primates is provided by the observation that, in a large free-ranging population of rhesus macaques, males heterozygous at MHC class II locus Mamu-DQB1 sired significantly more offspring than homozygotes (the male-specific selection coefficient s equals 0.34). This heterozygote advantage appeared to be independent of the actual male Mamu-DQB1 genotype. No similar effect emerged for a captive group of monkeys of similar genetic background but under veterinary care.

Evaluation of breast lesions by power Doppler sonography

The aim of this study was to determine the value of power Doppler sonography in the detection of tumor vascularity in breast lesions and to find new diagnostic criteria for differential diagnosis. Power Doppler sonography was prospectively performed in 102 patients with 118 histologic (n = 116) and cytologic (n = 2) results. A semisubjective scoring system for the intratumoral increase in blood flow compared with the flow in normal breast parenchyma (reference structure) was introduced and the flow pattern registered. The difference in the flow increase for benign and malignant breast disease was highly significant (p < or = 0.0001). This applied especially to invasive cancer above a maximum tumor diameter of 5 mm excluding cancer stage Tis and T1a. A positive correlation between cancer size and flow increase were found. The flow pattern was an additional feature. The sensitivity was calculated to be between 74.5 and 78.8%, and the specificity between 74.6 and 77.8%. The level of flow increase in Power Doppler sonography is an important feature in the differential diagnosis of breast lesions and should be considered together with the established criteria in B-mode ultrasound. The flow pattern might also add some important information.

Electrical impedance measurement of the breast: effect of hormonal changes associated with the menstrual cycle

The purpose of this study was to evaluate the influence of hormonal factors on electrical impedance measurement with a new device TS2000, which is a new method in diagnosis of breast disease. Twenty-one healthy pre-menopausal women volunteers (aged 24-39 years) were examined with the TS2000 once/week for two menstrual cycles. On average, at least one spot was present in 47% of images of women not taking oral contraceptives and in 44% of women taking oral contraceptives (OC). The number of spots varied over the menstrual cycle and had a maximum in week 3 and week 5. We found that after 1 week only 15% of spots were present and no spots persisted for three consecutive weeks. These data, if further supported by observations on other populations of women, show that false-positive results are common in pre-menopausal women; however, these false-positive spots do not persist for long periods of time. This information may provide a basis for discrimination between true-positive and false-positive spots on the TS2000 image, since the latter would be expected to disappear on short-term follow up.

[Respiratory manifestations of hemorrhagic fever with renal syndrome. Retrospective study of 129 cases in Champagne-Ardenne and Lorraine]

OBJECTIVES

The contradiction between airborne transmission of Puumala virus and the low rate of airway manifestations reported in hemorrhagic fever with renal syndrome (HFRS) caused by this virus led us to conduct this study to check whether the incidence of respiratory manifestations may have been underestimated.

PATIENTS AND METHODS

We retrospectively reviewed 129 consecutive cases of HFRS diagnosed between 1983 and 1995 in the eastern France.

RESULTS

Clinical manifestations of airway involvement and chest X-ray abnormalities were observed in 30% and 50% of the patients respectively. Analysing the radiological anomalies by serum creatinine level showed that in two-thirds of the cases (33% of all the HFRS cases) they were concomitant with acute renal failure and probably related to pulmonary edema, and that in one-third (17% of the HFRS cases) they were compatible with pneumonia. These cases of pneumonia could correspond to specific manifestations of the hantavirus Puumala at the site of penetration.

CONCLUSION

Although minimally expressive, respiratory manifestations were found to be more frequent than expected in hemorrhagic fever with renal syndrome. Incidence may have been formerly underestimated.

[Improvement in diagnosis of liver metastases with the multi-detector CT]

The introduction of multidetector computed tomography in clinical routine creates a new dimension of increased spatial and temporal resolution in CT scanning. On the basis of the very short acquisition time, the whole liver can now be scanned within one breathhold. Multidetector-CT allows the examination of the liver with nearly isotropic data sets. This is the prerequisite for the optimal assessment of very small liver lesions in all planes and excellent enhancement of liver lesions in defined organic perfusion phases. The speed of multidetector-CT can either be used to reduce the time to cover a given volume, or to use narrower beam collimation to increase the resolution of details along the z-axis and to reduce volume averaging. We report our clinical experiences in hepatic multidetector-CT examinations and optimized examination protocols in the assessment of hepatic metastases. Multidetector-CT and the use of interactive multiplanar reconstructions improve the detection and characterization of liver metastases. However, new problems in data management may arise from the large amount of data generated by multidetector-CT.

Effects of the potent ampakine CX614 on hippocampal and recombinant AMPA receptors: interactions with cyclothiazide and GYKI 52466

R,S-alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor up-modulators of the benzamide type ("ampakines") have previously been shown to enhance excitatory synaptic transmission in vivo and in vitro and AMPA receptor currents in excised patches. The present study analyzed the effects of an ampakine (CX614; 2H,3H, 6aH-pyrrolidino[2",1"-3',2']1,3-oxazino[6',5'-5,4]benz o[e]1, 4-dioxan-10-one) that belongs to a benzoxazine subgroup characterized by greater structural rigidity and higher potency. CX614 enhanced the size (amplitude and duration) of field excitatory postsynaptic potentials in hippocampal slices and autaptically evoked excitatory postsynaptic currents in neuronal cultures with EC(50) values of 20 to 40 microM. The compound blocked desensitization (EC(50) = 44 microM) and slowed deactivation of responses to glutamate by a factor of 8.4 in excised patches. Currents through homomeric, recombinant AMPA receptors were enhanced with EC(50) values that did not differ greatly across GluR1-3 flop subunits (19-37 microM) but revealed slightly lower potency at corresponding flip variants. Competition experiments using modulation of [(3)H]fluorowillardiine binding suggested that CX614 and cyclothiazide share a common binding site but cyclothiazide seems to bind to an additional site not recognized by the ampakine. CX614 did not reverse the effect of GYKI 52466 on responses to brief glutamate pulses, which indicates that they act through separate sites, a conclusion that was confirmed in binding experiments. In sum, these results extend prior evidence that ampakines are effective in enhancing synaptic responses, most likely by slowing deactivation, and that their effects are exerted through sites that are only in part shared with other modulators.

[Severe chronic renal failure subsequent to acute pyelonephritis in alcoholic patients]

BACKGROUND

Chronic alcoholism and malnutrition are uncommon causes of complicated acute pyelonephritis (APN).

CASE REPORTS

Since 1997, we have seen 5 patients with chronic alcoholism (3 women and 2 men, mean age 53.4 +/- 13 years) without cirrhosis, diabetes or renal failure who developed severe APN in a state of malnutrition (albumin 22 +/- 3 g/l, total cholesterol 0.86 +/- 0.2 g/l). Diagnosis was made 14.6 +/- 9 days after onset of atypical symptoms which the patients neglected. There was a major bacterial inoculum: Escherichia coli 10(6.2 +/- 2) (3 multisusceptible and 2 amoxicillin-resistant strains); positive blood cultures in 3 cases. The imaging study showed bilateral diffuse lesions with focal swelling and kidney enlargement, without obstacle, abscess, or papillary necrosis. All patients had severe acute renal failure (maximum serum creatinine: 582 +/- 210 mumol/l; 3 patients underwent dialysis). Mean duration of antibiotic therapy was 40 +/- 7 days (i.v.: 22 +/- 3 d). Renal scarring occurred since creatinine clearance was 33 +/- 22 ml/min 2 months after the initial episode. One patient progressed to end-stage renal failure.

CONCLUSION

In malnourished alcoholic patients, APN may be unusually severe due to late diagnosis leading to the risk of irreversible renal damage and severe chronic renal failure.

A conservative femoral replacement for total hip arthroplasty

Between 1985 and 1993, 146 patients (162 hips) had total hip replacement (THR) using a conservative uncemented femoral component. The mean age of the patients was 50.8 years and the mean follow-up was 6.2 years (2 to 13). One patient was lost to follow-up, one died within two years of surgery and one had a revision procedure after a fracture sustained in a road-traffic accident.

For the remaining 159, Kaplan-Meier survival analysis was calculated for the incidence of revision because of mechanical loosening or osteolysis. Survival without mechanical loosening at both five and ten years was 98.2%. Survival without osteolysis was 99% at five and 91% at ten years. The Harris hip score improved from a mean of 66.3 before to 90.4 at follow-up. Of particular note is the lack of thigh pain in this group. Radiological analysis showed that 139 stems (88%) had no measurable subsidence, 8 (5%) had less than 2 mm and 12 (7%) had more than 2 mm. Two of the eight and one of the 12 were revised for mechanical loosening. Nine hips were revised for late loosening associated with osteolysis. No reaming of the femoral canal was associated with statistically significant less blood loss compared with a comparable control group of uncemented implants (p < 0.0001).

Our study suggests that using a conservative femoral implant does not protect against wear debris but the reliable mechanical stability (98.2%) makes this an attractive design of implant particularly for young patients.

A conservative femoral replacement for total hip arthroplasty. A prospective study

Between 1985 and 1993, 146 patients (162 hips) had total hip replacement (THR) using a conservative uncemented femoral component. The mean age of the patients was 50.8 years and the mean follow-up was 6.2 years (2 to 13). One patient was lost to follow-up, one died within two years of surgery and one had a revision procedure after a fracture sustained in a road-traffic accident. For the remaining 159, Kaplan-Meier survival analysis was calculated for the incidence of revision because of mechanical loosening or osteolysis. Survival without mechanical loosening at both five and ten years was 98.2%. Survival without osteolysis was 99% at five and 91% at ten years. The Harris hip score improved from a mean of 66.3 before to 90.4 at follow-up. Of particular note is the lack of thigh pain in this group. Radiological analysis showed that 139 stems (88%) had no measurable subsidence, 8 (5%) had less than 2 mm and 12 (7%) had more than 2 mm. Two of the eight and one of the 12 were revised for mechanical loosening. Nine hips were revised for late loosening associated with osteolysis. No reaming of the femoral canal was associated with statistically significant less blood loss compared with a comparable control group of uncemented implants (p < 0.0001). Our study suggests that using a conservative femoral implant does not protect against wear debris but the reliable mechanical stability (98.2%) makes this an attractive design of implant particularly for young patients.

Paternity assessment in rhesus macaques (Macaca mulatta): multilocus DNA fingerprinting and PCR marker typing

Establishing kinship relations in primates using modern molecular genetic techniques has enhanced the ability to scrutinize a number of fundamental biological issues. We screened 51 human short tandem repeats (STRs) for cross-species PCR amplification in rhesus macaques (Macaca mulatta) and identified 11 polymorphic loci with heterozygosity rates of at least 0.6. These markers were used for paternity testing in three social groups (M, R, and S) of rhesus macaques from Cayo Santiago, Puerto Rico. Several consecutive birth cohorts were analyzed in which approximately 200 males were tested for paternity against more than 100 mother/ infant pairs. Despite a combined exclusion rate of more than 99.9% in all three groups, some cases could not be solved unequivocally with the STR markers and additional testing of the MHC-associated DQB1 polymorphism. A final decision became possible through multilocus DNA fingerprinting with one or more of the oligonucleotide probes (GATA)4, (CA)8, and (CAC)5. Paternity assessment by multilocus DNA analysis with probe (CAC)5 alone was found to have limitations in rhesus macaques as regards the number of potential sires which might be involved in a given case. Multilocus DNA fingerprinting requires large amounts of DNA, and the ensuing autoradiographic patterns present difficulties in comparisons across gels and even within the same gel across remote lanes. Computer-assisted image analysis was incapable of eliminating this problem. Therefore, a dual approach to DNA typing has been adopted, using STR markers to reduce the number of potential sires to a level where all remaining candidates can be tested by multilocus DNA fingerprinting on a single gel, preferably in lanes adjacent to the mother/infant pair.

Targeting exposed RNA regions in crystals of the small ribosomal subunits at medium resolution

Within the framework of ribosomal crystallography, the small subunits are being analyzed, using crystals diffracting to 3 A resolution. The medium resolution electron density map of this subunit, obtained by multiple isomorphous replacement, show recognizable morphologies, strikingly similar to the functional active conformer of the small ribosomal subunit. It contains elongated dense features, traceable as RNA chains as well as globular regions into which the structures determined for isolated ribosomal proteins, or other known structural motifs were fitted. To facilitate unbiased map interpretation, metal clusters are being covalently attached either to the surface of the subunits or to DNA oligomers complementary to exposed ribosomal RNA. Two surface cysteines and the 3' end of the 16S ribosomal RNA have been localized. Targeting several additional RNA regions shed light on their relative exposure and confirmed previous studies concerning their functional relevance.

The norbornenyl moiety of cyclothiazide determines the preference for flip-flop variants of AMPA receptor subunits

Cyclothiazide and two analogs in which the norbornenyl part was replaced with a cyclohexyl or a cyclohexenyl moiety were examined with regard to their preference for flop vs. flip splice variants of the (+/-)-alphaamino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor subunits GluR2, 3 and 4. The studies were carried out by measuring the effects of the drugs on the binding of [(3)H]AMPA or [(3)H]fluorowillardiine to membranes from HEK293 cells that stably express the AMPA receptor subunits. Cyclothiazide had four to nine times lower EC(50) values at flip than at flop receptors, as previously reported. In contrast, the two analogs showed little discrimination for GluR3 or GluR4 splice variants and a clear preference for the flop variant in the case of GluR2. These results indicate that it is the norbornenyl component of cyclothiazide which confers the selectivity vis-a-vis flip-flop variants.