Patients with aortic coarctation operated during the first year of life, different surgical techniques and prognostic factors--21 years of experience

The authors reviewed the clinical files of all patients with coarctation of the aorta (CoAo) operated during the first year of life, in a tertiary center, in order to assess the outcome of different surgical techniques and prognostic factors.

MATERIAL AND METHODS

The study included all patients operated from 1 June 1980 to 1 June 2001. They were divided into three groups according to diagnosis: Group I--isolated CoAo (with or without persistent ductus arteriosus (PDA), group II--CoAo plus ventricular septal defect (VSD), and group III--CoAo associated with complex heart defects. The surgical techniques were divided into four groups: Group A--resection of the CoAo with end-to-end anastomosis, group B--Waldhausen technique (subclavian flap), group C--enlargement of the aorta with a patch, and group D--Waldhausen technique plus resection of the CoAo with end-to-end anastomosis. Several parameters were analyzed: sex, age at surgery, other surgical procedures during surgery, reoperation, mortality and outcome (good result, recoarctation).

RESULTS

156 patients were operated during the study period (84.5% of them since 1989). 61.5% were male. Surgery was performed between 3 and 336 days of life. 60.9% patients were included in group I, 32.7% in group II and 6.4% in group III. 25.0% of the patients had group A surgery, 60.2% group B surgery, 7.0% group C surgery and 7.7% group D surgery. The PDA was sectioned in 48.0% of the patients. It was necessary to perform banding of the pulmonary artery, during the first surgery, in 19.9% of cases. 18.6% needed a second operation to close the VSD and for debanding or repair of associated defects. Total mortality was 19.2%. Mortality rate per groups was: Group I--15.8%, group II--21.5%, group III--30.0%, group A--18.0%, group B--19.1%, group C--27.2% and group D--16.7%. In 7.6% of the patients recoarctation was found during follow-up. 40% of the patients are doing well with no medication and minor or no residual defects. 29.4% were lost to follow-up.

CONCLUSIONS

Total mortality has decreased over the years with the highest mortality found in Group C and Group III. The best results were achieved in patients with isolated CoAo. Long-term results were generally good with few recoarctations and a good quality of life.

Late oncological occurrences following radical cystectomy in patients with bladder cancer

PURPOSE

To evaluate the prognoses and predictive factors of late oncological occurrences and its impact on follow-up strategy in patients with bladder tumours treated with radical cystectomy.

MATERIALS AND METHODS

Late oncological occurrences were considered when they took place after three years from cystectomy or when early recurrence was controlled with therapy and patients developed recurrence again after a three-year disease-free interval. Univariate and multivariate analysis of predictive factors for late oncological occurrences were carried out on 215 patients at risk of late oncological recurrences.

RESULTS

Among 357 patients treated with cystectomy, 163 (45.6%) relapsed, 149 (41.7%) of them as early recurrence and 17 (4.7%) were considered as late oncological events. This incidence increased up to 8% when patients at risk were considered. Three patients with early recurrence reached a complete response after treatment and relapsed again as late recurrences. Distant metastases and local recurrence represented 78.5% of early recurrence as opposed to 11.7% in late oncological occurrences, whereas, extravesical urothelium recurrences represented 8.6% and 70% respectively (p<0.01). Among patients with late oncological occurrences, nine (53%) were disease-free, seven with urothelial recurrence and two of three with lymph-node recurrence whereas only eight (5.6%) patients with early recurrence were free of tumour (p<0.0001). Multiple tumours, prostate involvement and organ-confined tumours in cystectomy specimen were the independent variables for predicting late oncological occurrences in multivariate analysis.

CONCLUSIONS

Recurrences in the remaining urothelium prevail as the pattern of late oncological occurrences. The prognosis of these events is significantly better than an early recurrence. Patients at risk of late oncological occurrences are those with multiple tumours, prostate involvement and with organ-confined tumours in cystectomy specimen. After three years from cystectomy, the follow-up schedule of these patients be limited to performing an annual CT-scan and urinary cytology to detect essentially upper urinary tract recurrence and extrapelvic lymph-nodal recurrence. Afterwards an annual intravenous urography might replace to CT-scan since lymph-nodal involvement was not detected.

[Trihalomethanes in the drinking water of Carabobo State, Venezuela]

OBJECTIVE

Disinfection of water with chlorine in water treatment plants leads to the formation of trihalomethanes (THMs). These compounds are associated with adverse health effects. The aim of this study was to analyze THM concentrations in the water provided for human consumption in the two main water treatment systems of Carabobo State: the Alejo Zuloaga plant and the Pao-Cachinche reservoir, which form the Central Regional System I (CRS I), and the Lucio Baldo Soules plant and the Pao-La Balsa reservoir, which form the Central Regional System II (CRS II).

METHODS

We analyzed 144 water samples collected in 6 samplings carried out in 2000 and 2001. THM concentrations were determined by gas chromatography using the headspace technique. The concentrations of the following THMs were measured: chloroform (CHCl3), bromoform (CHBr3), chlorodibromomethane (CHBr2Cl) and bromodichloromethane (CHCl2Br).

RESULTS

The concentration of total THMs was between 47.84 g/l and 94.23 g/l. CHCl3 was the most commonly formed compound representing 83% of all THMs in the CRS I and 82% in the CRS II. The concentrations of total THMs in the CRS I, specifically in the Baja and San Diego networks, were significantly higher (p < 0.05) than permissible levels set by the American Environmental Protection Agency (80 g/l) for the sum of all four THMs.

CONCLUSIONS

The results show that in the area studied there is a risk of adverse health effects due to THMs in drinking water, especially in the Baja and San Diego networks.

Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression

PURPOSE

We evaluate the safety and efficacy of conservative elective treatment of upper urinary tract tumors, and determine predictive factors for recurrence and progression to optimize indications of this type of treatment.

MATERIALS AND METHODS

Since 1984 we have performed a prospective study of conservative treatment of single, low grade and stage, less than 3 cm. upper tract tumors. The study includes 54 patients with a normal contralateral kidney who had been followed for more than 36 months. Open conservative surgery was performed in 31 cases and endourological surgery in 23. Minimum followup was 36 months, maximum 210 and mean 84.8. Univariate and multivariate analyses of recurrence and progression were performed in relation to age, sex, association with a bladder tumor, bladder tumor stage and grade, sequence of bladder tumor in relation to upper urinary tract tumor, number of previous bladder tumor recurrences, association with bladder carcinoma in situ, upper urinary tract tumor grade, stage, location, size and therapy, and upper urinary tract cytology.

RESULTS

Of the 54 patients 19 (35%) had recurrence, which was bilateral recurrence in 4, and progression occurred in 9 (16%). At the end of analysis 44 (62.9%) patients were disease-free and alive at a mean time of 92.88 months, 13 (24%) died disease-free at a mean of 72.7 months and 7 (12.9%) died of disease at a mean of 97.85 months. Cause specific mortality occurred in 7 (12.9% cases). Among the 54 initially conservatively treated units 42 (77.7%) kidneys were ultimately preserved. On univariate and multivariate analysis tumor location in the renal pelvis and association with a previous multi-recurrent bladder tumor were variables significantly related to recurrence and progression, as well as bilateral recurrence.

CONCLUSIONS

Conservative treatment is an optional approach for select upper urinary tract tumors. The strongest risk factors for recurrence and progression were association with a previous multi-recurrent bladder tumor and tumor location in the renal pelvis but these conditions were also the strongest risk factors for bilateral recurrence. Conservative treatment can also be recommended in these cases but only with compliant patients and close followup.

Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression

PURPOSE

We evaluate the safety and efficacy of conservative elective treatment of upper urinary tract tumors, and determine predictive factors for recurrence and progression to optimize indications of this type of treatment.

MATERIALS AND METHODS

Since 1984 we have performed a prospective study of conservative treatment of single, low grade and stage, less than 3 cm. upper tract tumors. The study includes 54 patients with a normal contralateral kidney who had been followed for more than 36 months. Open conservative surgery was performed in 31 cases and endourological surgery in 23. Minimum followup was 36 months, maximum 210 and mean 84.8. Univariate and multivariate analyses of recurrence and progression were performed in relation to age, sex, association with a bladder tumor, bladder tumor stage and grade, sequence of bladder tumor in relation to upper urinary tract tumor, number of previous bladder tumor recurrences, association with bladder carcinoma in situ, upper urinary tract tumor grade, stage, location, size and therapy, and upper urinary tract cytology.

RESULTS

Of the 54 patients 19 (35%) had recurrence, which was bilateral recurrence in 4, and progression occurred in 9 (16%). At the end of analysis 44 (62.9%) patients were disease-free and alive at a mean time of 92.88 months, 13 (24%) died disease-free at a mean of 72.7 months and 7 (12.9%) died of disease at a mean of 97.85 months. Cause specific mortality occurred in 7 (12.9% cases). Among the 54 initially conservatively treated units 42 (77.7%) kidneys were ultimately preserved. On univariate and multivariate analysis tumor location in the renal pelvis and association with a previous multi-recurrent bladder tumor were variables significantly related to recurrence and progression, as well as bilateral recurrence.

CONCLUSIONS

Conservative treatment is an optional approach for select upper urinary tract tumors. The strongest risk factors for recurrence and progression were association with a previous multi-recurrent bladder tumor and tumor location in the renal pelvis but these conditions were also the strongest risk factors for bilateral recurrence. Conservative treatment can also be recommended in these cases but only with compliant patients and close followup.

Essential oil composition and antimicrobial activity of three Zingiberaceae from S.Tomé e Príncipe

The essential oil composition of three Zingiberaceae widely used as medicinal aromatic plants from S. Tomé and Príncipe: Aframomum danielli (Hook. f.) K. Schum., Curcuma longa L. and Zingiber officinale Rosc. was studied. Two samples of the essential oils from fruit of A. danielli and from rhizomes of the other two species, were obtained by hydrodistillation and analyzed by GC, GC-MS, and (13)C-NMR. The essential oil from fruits of A. danielli has been studied for the first time and was characterised by its high content of monoterpenes, with 1,8-cineole (25.5 - 34.4 %) the major constituent, followed by beta-pinene (14.1 - 15.2 %) and alpha-terpineol (9.9 - 12.1 %). Essential oils from the rhizomes of C. longa contained a lower content of ar-turmerone (4.0 - 12.8 %) than those reported in the literature for C. longa from other origins (24.7 - 31.4 %), whereas the results for Z. officinale essential oils were in accordance with the literature data. The essential oils of A. danielli and Z. officinale showed antimicrobial activity against all Gram-positive and Gram-negative bacteria tested, as well as against yeasts and filamentous fungi, using the agar diffusion method.

Composition and chemical polymorphism of the essential oils from Piper lanceaefolium

Essential oils obtained by hydrodistillation from leaves and spikes of Piper lanceaefolium H.B.K. of Costa Rica were analysed by GC-FID, GC-MS and 13C-NMR methods. Main constituents found in the oil from leaves were sesquiterpene hydrocarbons - especially beta-caryophyllene and germacrene D - and phenylpropanoids, of which elemicin and parsley apiol were the major ones. The volatile oil from spikes showed monoterpene hydrocarbons, namely alpha- and beta-pinene, and the same phenylpropanoids as in the oil from leaves as the major constituents. Results obtained in the analysis by GC-FID and GC-MS of the essential oils from individual plants of different geographic origin were submitted to chemometric cluster analysis and principal component analysis, showing the presence of three different types of oils (i) parsley apiol/elemicin, (ii) elemicin/parsley apiol/dill apiol, and (iii) parsley apiol/dill apiol.

Specific tracheal migration is mediated by complementary expression of cell surface proteins

Migration of the Drosophila tracheal cells relies on cues provided by nearby cells; however, little is known about how these signals specify a migratory path. Here we investigate the role of cell surface proteins in the definition of such a pathway. We have found that the PS1 integrin is required in the tracheal cells of the visceral branch, whereas the PS2 integrin is required in the visceral mesoderm; both integrins are necessary for the spreading of the visceral branch over its substratum. This is the first identification of a cell surface molecule with expression restricted to a subset of tracheal cells that all migrate in a given direction. We have also found that expression of PS1 in the visceral branch is regulated by the genes that direct tracheal cell migration, showing that integrin expression is part of the cell-fate program that they specify. These results support a model in which signal transduction determines the tracheal migratory pathways by regulating the expression of cell surface proteins, which in turn interact with surface molecules on the surrounding cell population.

Chemical composition of the essential oil from the leaves of Piper fulvescens, a plant traditionally used in Paraguay

The essential oil from the leaves of the aromatic aniseed smelling plant Piper fulvescens, obtained by hydrodistillation, was investigated by GC and GC-MS, as well as by 13C-NMR after fractionation of the oil by column chromatography. A total of 37 constituents, representing 78.2% of the oil were identified. The main compounds were trans-anethole (26.4%) and ishwarane (12.1%), an unusual sesquiterpene hydrocarbon.

The spatial control of Torso RTK activation: a C-terminal fragment of the Trunk protein acts as a signal for Torso receptor in the Drosophila embryo

Regulated activation of receptor tyrosine kinases depends on both the presence of the receptors at the cell surface and on the availability of their ligands. In Drosophila, the torso tyrosine kinase receptor is distributed along the surface of the embryo but it is only activated at the poles by a diffusible extracellular ligand generated at each pole that is trapped by the receptor, thereby impeding further diffusion. Although it is known that this signal depends on the activity of several genes, such as torso-like and trunk, it is still unclear how is generated. The identification of the signal responsible for the torso receptor activation is an essential step towards understanding the mechanism that regulates the local restriction of torso signalling. Here we report that a fragment containing the carboxy-terminal 108 amino acids of the trunk protein retains trunk activity and is sufficient to activate torso signalling. We also show that this fragment bypasses the requirements for the other genes involved in the activation of the torso receptor. These results suggest that a cleaved form of the trunk protein acts as a signal for the torso receptor. We therefore propose that the restricted activation of the torso receptor is defined by the spatial control of the proteolytic processing of the trunk protein.

Nd isotopes and water mixing phenomena in groundwaters from Palmottu (Finland)

The Palmottu uranium ore deposit, located within a granitic host rock in southern Finland, is an excellent setting for conducting analogue studies to assess radionuclide transport from the uranium deposit fractured crystalline host rock. In this context, Nd isotope ratios are used to establish the degree of water-rock interaction (WRI) and to clarify mixing processes within the groundwaters. Variations in Nd isotopes in selected water types from the Palmottu hydrosystem provide new information on the mixing history.

U-series disequilibria in a groundwater flow route as an indicator of uranium migration processes

U-series data relating to groundwater, fracture coatings and the adjoining rock matrix in a groundwater flow system at the Palmottu natural analogue site was examined. The aim was to obtain an experimental reference for migration modelling in a transport section defined within the flow system. The U-series reference obtained turned out to be a very useful tool for fine tuning the flow route and for migration mechanism considerations. The U-series data are well in line with other interpretations of the migration system.

Identification and quantitative determination of furanodiene, a heat-sensitive compound, in essential oil by 13C-NMR

A method based on 13C-NMR has been used as a tool for the identification and quantitative determination of two furanic sesquiterpenes: a heat-sensitive compound, furanodiene, and its rearrangement product, furanoelemene. Following a preliminary study using artificial mixtures which permitted the construction and verification of calibration curves for each compound, the method was used for the qualitative and quantitative analysis of furanodiene and furanoelemene in the essential oil of Smyrnium olusatrum.

Chemical variability of peel and leaf essential oils of 15 species of mandarins

Peel and leaf oils of 58 mandarin cultivars, belonging to 15 different species were obtained from fruits and leaves collected on mandarin-trees submitted to the same pedoclimatic and cultural conditions. Their chemical composition was investigated by capillary GC, GC/MS and 13C NMR and the results were submitted to a cluster analysis and a discriminant analysis. Three major chemotypes, limonene, limonene/gamma-terpinene and linalyl acetate/limonene, were distinguished for peel oils while three other chemotypes, sabinene/linalool, gamma-terpinene/linalool and methyl N-methylanthranilate, were observed for leaf oils.

The alternative migratory pathways of the Drosophila tracheal cells are associated with distinct subsets of mesodermal cells

The Drosophila tracheal system is a model for the study of the mechanisms that guide cell migration. The general conclusion from many studies is that migration of tracheal cells relies on directional cues provided by nearby cells. However, very little is known about which paths are followed by the migrating tracheal cells and what kind of interactions they establish to move in the appropriate direction. Here we analyze how tracheal cells migrate relative to their surroundings and which tissues participate in tracheal cell migration. We find that cells in different branches exploit different strategies for their migration; while some migrate through preexisting grooves, others make their way through homogeneous cell populations. We also find that alternative migratory pathways of tracheal cells are associated with distinct subsets of mesodermal cells and propose a model for the allocation of groups of tracheal cells to different branches. These results show how adjacent tissues influence morphogenesis of the tracheal system and offer a model for understanding how organ formation is determined by its genetic program and by the surrounding topological constraints.

Changes in the structure and ultrastructure of the intestine of Spadella cephaloptera (Chaetognatha) during feeding and starvation experiments

Ultrastructural changes in the intestinal epithelium of fed and starved specimens of Spadella cephaloptera are described. Animals were maintained in a circulating natural sea water system and fed with Artemia salina nauplii. After a period of acclimation, they were individually isolated, deprived of food for 24 h and submitted to controlled feeding experiments. The absorption develop in the intestinal absorptive cells (A-cells) 5 min after the ingestion of prey and consist in the formation of endocytotic vesicles and endosome-like vacuoles. During the following steps up to 10 h, a second type of digestive vacuole containing electron-dense material, and probably corresponding to a lysosome-like compartment, appears. Throughout this time, the vacuoles progressively arrange in columns, the youngest at the top and the oldest at the bottom of the A-cells. In addition, large lipid inclusions appear in the apical cytoplasm. The ultrastructural changes of the intestinal secretory cells (S-cells) is less marked, but the number of granules largely diminishes during the first 30 min after the ingestion of prey. In starved specimens, major changes in A-cells occur between the sixth and tenth day of starvation and consist in the increase of endosome-like vacuoles. Lysosome-like vacuoles containing dense material are not observed. At the same time, necrosis features are evident in S-cells. After 30 days of starvation, necrosis features are observed in the totality of the intestinal epithelium and the specimens die few days later.

Antimicrobial activity and chemical composition of the bark oil of Croton stellulifer, an endemic species from S. Tomé e Príncipe

The composition and the antimicrobial activity of the bark oil of Croton stellulifer, an endemic and rare species of these islands (S. Tomé and Príncipe) are reported. Analysis was carried out by GC, GC/MS and 13C-NMR. The major constituents were alpha-phellandrene (15.4-18.6%), p-cymene (14.4-17.7%), linalool (12.0-12.6%) and alpha-pinene (8.1-9.1%). Kessane, a sesquiterpenoid oxide, not yet reported in the genus Croton, was identified by NMR. The essential oil of C. stellulifer was active against both bacterial and fungal strains, except Aspergillus niger.

The GAGA factor of Drosophila interacts with SAP18, a Sin3-associated polypeptide

SAP18, a polypeptide associated with the Sin3-HDAC co-repressor complex, was identified in a yeast two-hybrid screen as capable of interacting with the Drosophila GAGA factor. The interaction was confirmed in vitro by glutathione S-transferase pull-down assays using recombinant proteins and crude SL2 nuclear extracts. The first 245 residues of GAGA, including the POZ domain, are necessary and sufficient to bind dSAP18. In polytene chromosomes, dSAP18 and GAGA co-localize at a few discrete sites and, in particular, at the bithorax complex where GAGA binds some silenced polycomb response elements. When the dSAP18 dose is reduced, flies heterozygous for the GAGA mutation Trl67 show the homeotic transformation of segment A6 into A5, indicating that GAGA-dSAP18 interaction contributes to the functional regulation of the iab-6 element of the bithorax complex. These results suggest that, through recruitment of the Sin3-HDAC complex, GAGA might contribute to the regulation of homeotic gene expression.

The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer

PURPOSE

We analyzed the 3-month clinical response to intravesical therapy as a factor predictive of progression in patients with high risk superficial bladder cancer.

MATERIAL AND METHODS

We evaluated 191 patients with high risk superficial bladder cancer, 111 with secondary or associated bladder carcinoma in situ and 80 with stage T1 grade 3 disease who were treated with intravesical therapy. We considered only clinically complete and no responses at the 3-month endoscopic study. To determine the predictive value of the 3-month clinical response we differentiated progression into superficial and invasive types.

RESULTS

At a median followup of 73 months 91 patients (47.6%) had progression, which was superficial in 48 (25. 1%) and invasive in 43 (22.5%). Invasive progression was associated with significantly higher cause specific mortality than superficial progression (p = 0). In the latter cases cause specific mortality was higher than in those without progression (p = 0.001). Although cystectomy significantly decreased the cause specific mortality rate in patients with invasive progression (p = 0.0001), this rate was high at 46.3%. Univariate and multivariate analyses revealed that the 3-month clinical response was a significant predictive factor for progression. Moreover, stratifying this variable showed that this response was the only independent factor predictive of invasive progression in cases of no response with stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement (p = 0). In our series 41 patients (21.5%) did not respond after intravesical therapy at the 3-month evaluation, including 29 with stage T1 grade 3 disease, bladder carcinoma in situ, or prostate mucosa or duct involvement. Progression in 24 of these 29 patients (82.3%) was classified as invasive in 21 (73.6%).

CONCLUSIONS

Invasive progression threatens the cause specific survival of patients with high risk superficial bladder cancer even when cystectomy is performed. The 3-month clinical response was an excellent predictive factor for invasive progression. Early cystectomy should be considered when stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement is present at the 3-month clinical evaluation.

Cross-regulatory interactions among tracheal genes support a co-operative model for the induction of tracheal fates in the Drosophila embryo

The Drosophila tracheal system arises from clusters of ectodermal cells that invaginate and migrate to originate a network of epithelial tubes. Genetic analyses have identified several genes that are specifically expressed in the tracheal cells and are required for tracheal development. Among them, trachealess (trh) is able to induce ectopic tracheal pits and therefore it has been suggested that it would act as an inducer of tracheal cell fates; however, this capacity appears to be spatially restricted. Here we analyze the expression of the tracheal specific genes in the early steps of tracheal development and their cross-interactions. We find that there is a set of primary genes including trh and ventral veinless (vvl) whose expression does not depend on any other tracheal gene and a set of downstream genes whose expression requires different combinations of the primary genes. We also find that the combined expression of primary genes is sufficient to induce some downstream genes but not others. These results indicate that there is not a single master gene responsible for the appropriate expression of the tracheal genes and support a model where tracheal cell fates are induced by the co-operation of several factors rather than by the activity of a single tracheal inducer.

Femtosecond observation of benzyne intermediates in a molecular beam: Bergman rearrangement in the isolated molecule

In this communication, we report our femtosecond real-time observation of the dynamics for the three didehydrobenzene molecules (p-, m-, and o-benzyne) generated from 1,4-, 1,3-, and 1, 2-dibromobenzene, respectively, in a molecular beam, by using femtosecond time-resolved mass spectrometry. The time required for the first and the second C-Br bond breakage is less than 100 fs; the benzyne molecules are produced within 100 fs and then decay with a lifetime of 400 ps or more. Density functional theory and high-level ab initio calculations are also reported herein to elucidate the energetics along the reaction path. We discuss the dynamics and possible reaction mechanisms for the disappearance of benzyne intermediates. Our effort focuses on the isolated molecule dynamics of the three isomers on the femtosecond time scale.