Laminal fenestration for the treatment of lumbar nerve root foraminal stenosis

A new technique is reported for the treatment of isolated lumbar nerve root foraminal stenosis. Nerve root decompression is performed via a 5-mm drill hole in the lamina immediately below the superior facet. This technique preserves spinal stability even if done at multiple levels. It also provides early mobility of the patient and subsequently shortens the hospital stay. The technical details are described.

The influence of preoperative nutritional status in wound healing after replacement arthroplasty

Patient nutritional status was evaluated preoperatively using the serological parameters serum albumin, serum transferrin, and total lymphocyte count in 40 patients who underwent replacement arthroplasty (33 hips and 7 knees). Using the standard criteria, the overall incidence of malnutrition was 40% (16 cases). Ten percent (4 patients) had a negative value in the Rainey McDonald nutritional index. On follow-up, no patient had delayed wound healing or wound infection. Attention to surgeon-dependent factors can offset the high risk of delayed wound healing imposed by patient-dependent factors.

Comparative strength of three methods of fixation of transverse acetabular fractures

With the advent of percutaneously placed lag screws for fixation of acetabular fractures, this study evaluated the strength of lag screw fixation compared with traditional fixation techniques of transverse acetabular fractures. Ten formalin-treated human, cadaveric pelvic specimens with bilateral, transtectal transverse acetabular fractures were used for this study. The right acetabular fractures were fixed with a five-hole plate and four screws with the central hole spanning the posterior fracture site. The left acetabular fractures were fixed with two lag screws, one each in the anterior and posterior columns, or with a screw and wire construct stabilizing both columns. The specimens were loaded to implant failure. Stiffness, yield strength, maximum load at failure, and site of failure was recorded. The plate and screw construct showed significantly greater yield and maximum strength when compared with the two lag screws. The stiffness of the lag screw method was 39% higher than that of the plating method, but this result was not statistically significant. In addition, the plate and screw method provided significantly greater maximum strength than the screw and wire technique. The quadrilateral plate seemed to be the weakest area of fixation because 83% of the implant failures occurred in this region. In patients in whom the risks of formal open reduction and internal fixation of acetabular fractures outweigh the possible benefits, such as in patients with burns or degloved skin, the advent of computer-assisted and fluoroscopically guided percutaneous surgical techniques have been instrumental. This study showed there is greater strength of fixation with a plate and screw construct, possibly secondary to supplementary fixation distal to the quadrilateral plate. However, lag screw fixation provided relatively greater stiffness, which may account for its clinical success. Percutaneous lag screw fixation of appropriate transverse acetabular fractures is a viable option.

Small intestinal neoplasms

Small intestinal neoplasms are uncommonly encountered in clinical practice. They may occur sporadically, in association with genetic diseases (e.g., familial adenomatous polyposis coli or Peutz-Jeghers syndrome), or in association with chronic intestinal inflammatory disorders (e.g., Crohn's disease or celiac sprue). Benign small intestinal tumors (e.g., leiomyoma, lipoma, hamartoma, or desmoid tumor) usually are asymptomatic but may present with intussusception. Primary malignancies of the small intestine-including adenocarcinoma, leiomyosarcoma, carcinoid, and lymphoma-may present with intestinal obstruction, jaundice, bleeding, or pain. Extraintestinal neoplasms may involve the intestine via contiguous spread or peritoneal metastasis. Hematogenous metastases to the intestine from an extraintestinal primary are unusual and are most typical of melanoma. Because the small intestine is relatively inaccessible to routine endoscopy, diagnosis of small intestinal neoplasms is often delayed for months after onset of symptoms. When the diagnosis is suspected, enteroclysis is the most useful imaging study. Small bowel endoscopy (enteroscopy) is increasingly widely available and may permit earlier, nonoperative diagnosis.

Posterior-only unit rod instrumentation and fusion for neuromuscular scoliosis

STUDY DESIGN

A retrospective study to determine the efficacy of posterior-only unit rod instrumentation and fusion in a skeletally immature neuromuscular scoliosis population.

OBJECTIVE

To determine whether the posterior-only approach to this population adequately addresses the concerns of correction of scoliosis and pelvic obliquity, maintenance of that correction over time, and the incidence of crankshaft phenomenon.

SUMMARY OF BACKGROUND DATA

Controversy exists regarding the need for anterior release to improve curve flexibility and the need to obtain an anterior arthrodesis in those skeletally immature patients at risk for crankshafting with continued anterior growth.

METHODS

From 1992 through 1997, 28 consecutive skeletally immature patients with neuromuscular scoliosis underwent posterior-only unit rod instrumentation and fusion for the treatment of progressive, symptomatic spinal deformities. Preoperative, immediate postoperative, and final follow-up radiographs were analyzed with respect to scoliosis and pelvic obliquity correction, maintenance of that correction over time, and the development of the crankshaft phenomenon as evidenced by loss of correction and/or increased rib-vertebral angle difference. The average age of the patients was 12.8 years and the average follow-up was 58 months with a minimum of 2 years.

RESULTS

Twenty-six patients were available for final follow-up. The initial Cobb angle correction averaged 66%, with 75% of the pelvic obliquity corrected. These corrections were maintained over time. Before surgery 27 of 28 patients were Risser 0, 1, or 2. The triradiate cartilage was open in nine patients, and five patients were < or =10 years of age. At the final follow-up 22 of the 26 patients were Risser 5 and 4 were Risser 4. There was one patient with increased rib-vertebral angle difference over the length of follow-up, with no loss of frontal or sagittal plane alignment.

CONCLUSIONS

These results indicate that even in the very young neuromuscular patient, acceptable amounts of curve correction can be achieved and maintained with posterior-only unit rod instrumentation and fusion. The biomechanical stiffness of this construct seemed to be able to prevent the crankshaft phenomenon in the majority of those patients at risk.

Improving prescribing in the elderly: a study in the long term care setting

OBJECTIVES

To determine the prevalence and predictors of potentially inappropriate prescribing of medications in the long term care setting, and to determine the effectiveness of follow-up pharmacist letters to the prescribing physicians in improving prescribing.

PATIENTS AND METHODS

The Improving Prescribing in the Elderly Tool was applied to the charts of all long term care patients aged 65 years and over at Parkwood Hospital, a rehabilitation hospital/long term care facility in London, Ontario. All potentially inappropriate prescriptions were verified by a consensus panel consisting of a family physician, a geriatric medicine specialist and a geriatric pharmacist. Follow-up letters to the prescribing physicians were developed that briefly described the concerns with the potentially inappropriate prescriptions and suggested safer alternatives. These letters were sent to the prescribing physicians, accompanied by a brief survey. Patient charts in which a potentially inappropriate prescription had been noted were reviewed for prescription changes two months after the prescribing physicians had received the follow-up letters.

RESULTS

A total of 69 potentially inappropriate prescriptions were found in 65 of 355 long term care patients (18.3%). The most common types of potentially inappropriate prescriptions were anticholinergic drugs to manage antipsychotic side effects (17 cases), tricyclic antidepressants with active metabolites (16 cases), and long-acting benzodiazepines (14 cases). The total number of prescription medications (P<0.001), a history of mental illness (P=0.002) and a high minimum data set (MDS) score for depression (P=0.002) were all highly associated with potentially inappropriate prescribing. Variables that were not correlated with increased rates of potentially inappropriate prescribing included age, sex, code status, a diagnosis of dementia (as documented explicitly in the chart), high MDS scores for delirium or cognitive impairment, the date of the prescribing physician's graduation and the total Charlson comorbidity index score. Potentially inappropriate prescriptions were significantly less common in patients seen by a geriatric medicine specialist (P<0.001). In response to the follow-up letter suggesting safer alternatives, 37.9% of potentially inappropriate prescriptions were changed by the prescribing physician. Ninety-two per cent of responding physicians rated the follow-up letter as a "somewhat" or "very" helpful method for improving prescribing in elderly patients.

CONCLUSIONS

Potentially inappropriate prescribing in the long term care setting is common and can be improved by the provision of a follow-up letter suggesting safer alternatives.

Mapping the epitope in cadherin-like receptors involved in Bacillus thuringiensis Cry1A toxin interaction using phage display

In susceptible lepidopteran insects, aminopeptidase N and cadherin-like proteins are the putative receptors for Bacillus thuringiensis (Bt) toxins. Using phage display, we identified a key epitope that is involved in toxin-receptor interaction. Three different scFv molecules that bind Cry1Ab toxin were obtained, and these scFv proteins have different amino acid sequences in the complementary determinant region 3 (CDR3). Binding analysis of these scFv molecules to different members of the Cry1A toxin family and to Escherichia coli clones expressing different Cry1A toxin domains showed that the three selected scFv molecules recognized only domain II. Heterologous binding competition of Cry1Ab toxin to midgut membrane vesicles from susceptible Manduca sexta larvae using the selected scFv molecules showed that scFv73 competed with Cry1Ab binding to the receptor. The calculated binding affinities (K(d)) of scFv73 to Cry1Aa, Cry1Ab, and Cry1Ac toxins are in the range of 20-51 nm. Sequence analysis showed this scFv73 molecule has a CDR3 significantly homologous to a region present in the cadherin-like protein from M. sexta (Bt-R(1)), Bombyx mori (Bt-R(175)), and Lymantria dispar. We demonstrated that peptides of 8 amino acids corresponding to the CDR3 from scFv73 or to the corresponding regions of Bt-R(1) or Bt-R(175) are also able to compete with the binding of Cry1Ab and Cry1Aa toxins to the Bt-R(1) or Bt-R(175) receptors. Finally, we showed that synthetic peptides homologous to Bt-R(1) and scFv73 CDR3 and the scFv73 antibody decreased the in vivo toxicity of Cry1Ab to M. sexta larvae. These results show that we have identified the amino acid region of Bt-R(1) and Bt-R(175) involved in Cry1A toxin interaction.

Drosophila RNase H1 is essential for development but not for proliferation

Ribonucleases H (RNases H) recognize and specifically degrade RNA that is bound to complementary DNA and are thought to be involved in DNA replication and transcriptional regulation. Though it was previously shown that bacterial RNases H participate in DNA synthesis, none of the known mutations in RNase H genes in either prokaryotes or lower eukaryotes is lethal. Here, we report the characterization of the first loss-of-function mutation in an RNase H1 gene in a metazoan organism, Drosophila melanogaster. Genetic studies of this mutant showed that this gene is essential for metamorphosis in Drosophila. However, disruption of the RNase H1 gene does not affect proliferation, but probably alters the regulation of gene expression. The lethal phenotype of this mutant also demonstrates that RNase H1 activity in Drosophila cannot be provided by other cellular RNase H activities. Analysis of the developmental and spatial expression profiles of a reporter gene placed under the control of the RNase H1 promoter revealed increased expression in several larval tissues. In salivary glands this increase was shown to be inducible by treatment with ecdysone.

Fractures in transfusion dependent beta thalassemia--an Indian study

AIM OF STUDY

To analyse the incidence of fractures in beta thalassemia patients and to identify causative factors.

METHODS

We examined all cases of transfusion dependent beta thalassemia (TDBT) seen at our institute over a two-year period. The transfusion records, incidence of fractures, cause of fracture and Hb levels were recorded. Radiographs of the involved parts were taken in cases with fractures only.

RESULTS AND CONCLUSIONS

Amongst 105 cases of TDBT assessed, 14 sustained a total of 28 fractures. Seven patients sustained more than one fracture. Two thirds of these fractures were caused by trivial trauma. All fractures, except one, were of the closed type. Radiologically, fractures frequently showed minimal or no displacement. All fractures were successfully treated by closed modalities of treatment. Majority of the fractures healed within normal union time for a given bone. Permanent deformities and gross limb length discrepancies were uncommon. On reviewing the literature, we noted that the incidence of fractures in our series and in the latest reports was lesser than previously reported. We postulate that this is a result of better and earlier control of hemoglobin status by improved transfusion techniques, and earlier recognition of the disease. Difficulties arise due to inadequate blood transfusion facilities in developing countries.

Glutamate receptors in peripheral tissues: current knowledge, future research, and implications for toxicology

We illustrate the specific cellular distribution of different subtypes of glutamate receptors (GluRs) in peripheral neural and non-neural tissues. Some of the noteworthy locations are the heart, kidney, lungs, ovary, testis and endocrine cells. In these tissues the GluRs may be important in mediating cardiorespiratory, endocrine and reproductive functions which include hormone regulation, heart rhythm, blood pressure, circulation and reproduction. Since excitotoxicity of excitatory amino acids (EAAs) in the CNS is intimately associated with the GluRs, the toxic effects may be more generalized than initially assumed. Currently there is not enough evidence to suggest the reassessment of the regulated safety levels for these products in food since little is known on how these receptors work in each of these organs. More research is required to assess the extent that these receptors participate in normal functions and/or in the development of diseases and how they mediate the toxic effects of EAAs. Non-neural GluRs may be involved in normal cellular functions such as excitability and cell to cell communication. This is supported by the wide distribution in plants and animals from invertebrates to primates. The important tasks for the future will be to clarify the multiple biological roles of the GluRs in neural and non-neural tissues and identify the conditions under in which these are up- or down-regulated. Then this could provide new therapeutic strategies to target GluRs outside the CNS.

The transporter-like protein inebriated mediates hyperosmotic stimuli through intracellular signaling

We cloned the inebriated homologue MasIne from Manduca sexta and expressed it in Xenopus laevis oocytes. MasIne is homologous to neurotransmitter transporters but no transport was observed with a number of putative substrates. Oocytes expressing MasIne respond to hyperosmotic stimulation by releasing intracellular Ca(2+), as revealed by activation of the endogenous Ca(2+)-activated Cl(−) current. This Ca(2+) release requires the N-terminal 108 amino acid residues of MasIne and occurs via the inositol trisphosphate pathway. Fusion of the N terminus to the rat gamma-aminobutyric acid transporter (rGAT1) also renders rGAT1 responsive to hyperosmotic stimulation. Immunohistochemical analyses show that MasIne and Drosophila Ine have similar tissue distribution patterns, suggesting functional identity. Inebriated is expressed in tissues and cells actively involved in K(+) transport, which suggests that it may have a role in ion transport, particularly of K(+). We propose that stimulation of MasIne releases intracellular Ca(2+) in native tissues, activating Ca(2+)-dependent K(+) channels, and leading to K(+) transport.

Tuberculous anal sepsis: report of clinical features in 20 cases

INTRODUCTION

Tuberculosis is a neglected cause of anal sepsis, often is not recognized, and therefore is not treated properly.

METHOD

All patients were reviewed who had tuberculous anal sepsis diagnosed by histology reports of fistulectomy specimens or abscess scrapings from January 1990 to April 1999.

RESULTS

Twenty patients (median age, 53 years; 18 males) with anal tuberculous sepsis were identified. They presented with abscesses (n = 2), abscesses and fistulas (n = 6), or fistulas (n = 12). All patients had a long history of anal complaints (3 months to 20 years), for which 15 patients were operated on previously. Nearly all fistulas (17/18) were complex, and secondary tracks or additional complicating features were common, even at first presentation. Eight patients had active concurrent pulmonary tuberculosis, and six showed evidence of previous pulmonary tuberculosis. Six patients had no signs of concurrent or previous tuberculosis elsewhere. Recurrence was observed only in cases where tuberculosis was initially not recognized, and antitubercular treatment therefore was not started.

CONCLUSION

Contrary to views held previously, anal tubercular sepsis seems to have characteristic clinical features. It should be considered in cases of known pulmonary or extrapulmonary tuberculosis or if anal sepsis is persistent, recurrent, or complex in nature.

New approach to cervical flexion deformity in ankylosing spondylitis. Case report

The treatment of cervical fixed flexion deformity in ankylosing spondylitis presents a challenging problem that is traditionally managed by a corrective cervicothoracic osteotomy. The authors report a new approach to this problem that involves performing a two-level osteotomy at the level of maximum spinal curvature, thereby achieving complete anatomical correction in a one-stage procedure. This 48-year-old woman with ankylosing spondylitis presented with a 30-year history of progressive neck deformity that left her unable to see ahead and caused her to experience difficulty eating, drinking, and breathing on exertion. On examination, she exhibited a 90 degrees fixed flexion deformity of the cervical spine, which was maximum at C-4; this was confirmed on imaging studies. A two-level osteotomy was performed at C3-4 and C4-5 around the area of maximum spinal curvature, and the deformity was corrected by extending the head on its axis of rotation through the uncovertebral joints. The spine was stabilized using a Ransford loop. An excellent anatomical position was achieved, as was complete correction of the deformity. A two-level midcervical osteotomy performed at the level of maximum spinal curvature in ankylosing spondylitis enables complete correction of severe fixed flexion deformity in a single procedure. Preservation of the uncovertebral joints allows smooth and safe correction of the deformity about their axis of rotation.

Temporal and spatial expression of the cell-cycle regulator cul-1 in Drosophila and its stimulation by radiation-induced apoptosis

Cul-1 protein is part of the ubiquitin ligase complex that is conserved from yeast to humans. This complex specifically marks cell-cycle regulators for their subsequent destruction. Two null mutations of the cul-1 gene are known, in budding yeast and in nematodes. Although in both these organisms the cul-1 gene executes essentially the same function, the manifestation of its lack-of-function mutations differs considerably. In yeast the mutation causes arrest at the G(1)/S-phase transition, whereas in nematodes excessive cell divisions occur because mutant cells are unable to exit the mitotic cycle. We isolated cul-1 orthologues from two model organisms, Drosophila melanogaster and mouse. We show that the Drosophila full-length cul-1 gene restores the yeast mutant's inability to pass through the G(1)/S-phase transition. We also characterize expression of this gene at the transcript and protein levels during Drosophila development and show that cul-1 gene is maternally supplied as a protein, but not as an RNA transcript. Zygotic transcription of the gene, however, resumes at early stages of embryogenesis. We also found an increase in cul-1 transcription in cultured cells treated with a lethal dose of gamma-irradiation.

Tuberculous osteomyelitis of the cuboid: a report of four cases

Osteoarticular tuberculosis, although rare, has shown a resurgence in recent times, especially in immunocompromised patients. Involvement of the foot is infrequent, and the differential diagnosis is confusing, leading to diagnostic delays. We reviewed four cases of tuberculosis of the cuboid where the infection was limited to the bone without articular involvement. All four cases were adults and diagnostic delays were observed in all. Three of the cases had an osteolytic lesion on radiographs resembling a space-occupying lesion. Magnetic resonance imaging (MRI) or Computed tomography (CT) scans were helpful in three cases, and post-treatment MRI helped in evaluating outcome in one case. Antitubercular chemotherapy was sufficient to cause resolution of the lesion in three cases, while in one case surgical intervention was necessary. Since isolated osteomyelitis is usually seen only in the early stages of the disease process, early diagnosis and appropriate therapy are imperative to get good long-term results. Concomitant extraskeletal lesions are not always seen, nor is the organism cultured in a majority of the cases. Thus a high index of suspicion is mandatory in high-risk groups (immigrants, immunocompromised cases or those with history of contact); clinical and radiologic features, along with histopathologic evidence of granulomatous pathology should be sufficient to initiate therapy.

Evaluation of leukergy test as an indicator of infection in hip joint in children

This new blood test (leukergy) for infection is based on the fact that white cells agglomerate in peripheral blood of patients with inflammatory diseases. We evaluated leukergy in 25 children with proven septic arthritis of hip. It was found to be the efficient and earliest indicator of septic arthritis than the erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), polymorphs and C-reactive protein (CRP). It also correlated well with the clinical severity of infection and the prognosis of disease. Thus leukergy is a simple, rapid and inexpensive slide test which was found as the best indicator profile for the presence of septic arthritis.

Cognitive functioning after subthalamic nucleotomy for refractory Parkinson's disease

OBJECTIVE

To evaluate whether subthalamic nucleotomy produces adverse cognitive effects in patients with Parkinson's disease.

METHOD

Twelve patients with Parkinson's disease underwent stereotactic surgery to the subthalamic nucleus. Presurgical and postsurgical neuropsychological assessment of attention, memory, executive function, language, and verbal intellect were undertaken with a battery of tests designed to minimise potential contamination of cognitive effects by motor symptoms.

RESULTS

There was no statistically significant difference in the cognitive tests results after operation for the group as a whole. Reliable change indexes were generated for the cognitive tests. Reliable change postoperatively was found on specific tests of verbal memory, attention, and planning. Left sided operations were associated with greater incidence of deterioration postsurgery.

CONCLUSIONS

Preliminary data on the first reported cognitive changes after subthalamic nucleotomy suggested few adverse cognitive effects of the surgery although discrete neuropsychological changes were seen in some patients. These effects were consistent with current theories on the cognitive functions of the basal ganglia.

Transpedicular approaches to cervical uncovertebral osteophytes causing radiculopathy

OBJECT

The anterolateral and posterior transpedicular foraminotomies were developed to enhance the treatment of cervical spondylotic radiculopathy secondary to uncovertebral osteophytes. These novel surgical approaches may be advantageous because they allow direct decompression of the nerve root while preserving normal movement and stability of the motion segment. The use of the pedicle to obtain access to compressive uncovertebral osteophytes, without causing damage to the motion segment, has not been previously reported.

METHODS

The authors present the early outcome data obtained in 27 patients who underwent an anterolateral or posterior foraminotomy. Eighty-eight percent of patients who underwent anterolateral foraminotomy and 94% of those who underwent a posterior transpedicular procedure experienced complete or significant relief of brachialgia. Postoperatively none of the patients were symptomatically or neurologically worse.

CONCLUSIONS

The transpedicular approach is an effective and potentially improved method of treating symptomatic cervical uncovertebral osteophytes compared with techniques previously described.

Fractures of the medial humeral condyle in adults

BACKGROUND/AIM OF STUDY

Fractures of the medial condyle of humerus are uncommon in adults. The aims of this study were (i) to highlight the rarity of this injury, (ii) to focus on the problems in management of cases which present late, and (iii) to compare the results of surgical excision of medial condyle with those of internal fixation.

METHODS

Seven adult medial humeral condyle fractures were seen over a 10-year period. Four cases were surgically fixed within three weeks of the injury; one case refused operation. Two cases which presented late, one with an isolated trochlear fracture, and another Milch type I fracture comminution and compounding, were treated by excision of the condyle and supervised post excision physiotherapy.

RESULTS

All six operated cases regained good function. The two patients with excised condyle had no significant instability and had good range of movements. The results were comparable to those managed by open reduction and internal fixation.

CONCLUSIONS

Medial condyle fractures presenting early (within 3 weeks), should be managed by accurate open reduction and rigid fixation: non operative management leads to relatively poor results. In late/neglected cases, or those with extensive comminution, open reduction and fixation may lead to stiff and painful elbow, whereas excision of the condylar fragment does not lead to instability.

A novel type of RNase III family proteins in eukaryotes

The RNase III family of double-stranded RNA-specific endonucleases is characterized by the presence of a highly conserved 9 amino acid stretch in their catalytic center known as the RNase III signature motif. We isolated the drosha gene, a new member of this family in Drosophila melanogaster. Characterization of this gene revealed the presence of two RNase III signature motifs in its sequence that may indicate that it is capable of forming an active catalytic center as a monomer. The drosha protein also contains an 825 amino acid N-terminus with an unknown function. A search for the known homologues of the drosha protein revealed that it has a similarity to two adjacent annotated genes identified during C. elegans genome sequencing. Analysis of the genomic region of these genes by the Fgenesh program and sequencing of the EST cDNA clone derived from it revealed that this region encodes only one gene. This newly identified gene in nematode genome shares a high similarity to Drosophila drosha throughout its entire protein sequence. A potential drosha homologue is also found among the deposited human cDNA sequences. A comparison of these drosha proteins to other members of the RNase III family indicates that they form a new group of proteins within this family.

Potential target sites in peripheral tissues for excitatory neurotransmission and excitotoxicity

Glutamate receptors (GluRs) are ubiquitously present in the central nervous system (CNS) as the major mediators of excitatory neurotransmission and excitotoxicity. Neural injury associated with trauma, stroke, epilepsy, and many neurodegenerative diseases such as Alzheimer's, Huntington's, and Parkinson's diseases and amyotrophic lateral sclerosis may be mediated by excessive activation of GluRs. Neurotoxicity associated with excitatory amino acids encountered in food, such as domoic acid and monosodium glutamate, has also been linked to GluRs. Less is known about GluRs outside the CNS. Recent observations suggest that several subtypes of GluRs are widely distributed in peripheral tissues. Using immunochemical and molecular techniques, the presence of GluR subtypes was demonstrated in the rat and monkey heart, with preferential distribution within the conducting system, nerve terminals, and cardiac ganglia. GluR subtypes NMDAR 1, GluR 2/3, and mGluR 2/3 are also present in kidney, liver, lung, spleen, and testis. Further investigations are needed to assess the role of these receptors in peripheral tissues and their importance in the toxicity of excitatory compounds. Therefore, food safety assessment and neurobiotechnology focusing on drugs designed to interact with GluRs should consider these tissues as potential target/effector sites.

STANDARDIZATION OF CERVICAL/VAGINAL CYTOPATHOLOGY REPORTING: THE BETHESDA SYSTEM (TBS) FOR REPORTING CERVICAL/VAGINAL CYTOLOGIC DIAGNOSES

The complex detection system leading to the discovery and treatment of precancerous lesions and early cancers of the uterine cervix is touched upon. By far the most difficult and underestimated component of this system is the screening and interpretation of cervical smears. Emphasis on the latest system of reporting, The Bethesda system is highlighted upon. Weaker points of the previous systems and the need for a newer system for reporting are stressed upon. The classification of the precursors of invasive squamous cancers is not easy, and various groups have advocated several schemes, none is yet perfect or universally accepted. The variation in nomenclature become less significant when the cytopathologist is a full member of a team made up of a clinician, histopathologist, colposcopist, and oncologist. As long as all members speak to each other frequently and use the same language and terminology, they will be able to determine the best treatment for the patient.

Molecular cloning and biological activity of ecdysis-triggering hormones in Drosophila melanogaster

Ecdysis-triggering hormones (ETH) initiate a defined behavioral sequence leading to shedding of the insect cuticle. We have identified eth, a gene encoding peptides with ETH-like structure and biological activity in Drosophila melanogaster. The open reading frame contains three putative peptides based on canonical endopeptidase cleavage and amidation sites. Two of the predicted peptides (DrmETH1 and DrmETH2) prepared by chemical synthesis induce premature eclosion upon injection into pharate adults. The promoter region of the gene contains a direct repeat ecdysteroid response element. Identification of eth in Drosophila provides opportunities for genetic manipulation of endocrine and behavioral events underlying a stereotypic behavior.