Cerebral laterality in homosexual males: preliminary communication using magnetoencephalography

MEG-based auditory M100 source location in the left and right hemispheres of 8 strictly homosexual and 9 strictly heterosexual males were compared to determine if this measure of interhemispheric laterality varies as a function of sexual orientation. MEG fields evoked by auditory tone pips were recorded from left and right hemispheres in response to contralateral ear stimulation. The source of the 100-msec latency component, generated in the superior temporal gyrus, was estimated using a least squares inverse solution algorithm. Auditory sources in heterosexual men were significantly further anterior in the right hemisphere compared to the left hemisphere. Source locations in the homosexual men did not exhibit significant interhemispheric asymmetry, being similarly located in both hemispheres. Findings suggest an anatomic and/or functional difference in the superior temporal gyrus of at least some homosexual men.

Microsatellite instability in colorectal adenocarcinoma cell lines that have full-length adenomatous polyposis coli protein

Almost 20% of colon cancers are characterized by genomic instability at simple repeated sequences. This instability is the result of a deficient DNA mismatch repair system. Sporadic, as well as hereditary carcinomas of the proximal colon display this effect. In this study, we examined colorectal adenocarcinoma cell lines, with or without wild-type adenomatous polyposis coli (APC) protein, for the presence of microsatellite instability. The three cell lines that maintained full-length APC protein also displayed the highest level of instability, suggesting a negative correlation between APC mutations and microsatellite instability. This data, in addition to other studies that show a negative correlation between microsatellite instability and mutations in p53 and K-ras, support the idea of a second pathway for colorectal cancer development.

Generation of slow wave type action potentials in the mouse small intestine involves a non-L-type calcium channel

Intrinsic electrical activities in various isolated segments of the mouse small intestine were recorded (i) to characterize action potential generation and (ii) to obtain a profile on the ion channels involved in initiating the slow wave type action potentials (slow waves). Gradients in slow wave frequency, resting membrane potential, and occurrence of spiking activity were found, with the proximal intestine exhibiting the highest frequency, the most hyperpolarized cell membrane, and the greatest occurrence of spikes. The slow waves were only partially sensitive to L-type calcium channel blockers. Nifedipine, verapamil, and pinaverium bromide abolished spikes that occurred on the plateau phase of the slow waves in all tissues. The activity that remained in the presence of L-type calcium channel blockers, the upstroke potential, retained a similar amplitude to the original slow wave and was of identical frequency. The upstroke potential was not sensitive to a reduction in extracellular chloride or to the sodium channel blockers tetrodotoxin and mexiletine. Abolishment of the Na+ gradient by removal of 120 mM extracellular Na+ reduced the upstroke potential frequency by 13 - 18% and its amplitude by 50 - 70% in the ileum. The amplitude was similarly reduced by Ni2+ (up to 5 mM), and by flufenamic acid (100 mu M), a nonspecific cation and chloride channel blocker. Gadolinium, a nonspecific blocker of cation and stretch-activated channels, had no effect. Throughout these pharmacological manipulations, a robust oscillation remained at 5 - 10 mV. This oscillation likely reflects pacemaker activity. It was rapidly abolished by removal of extracellular calcium but not affected by L-type calcium channel blockers. In summary, the mouse small intestine has been established as a model for research into slow wave generation and electrical pacemaker activity. The upstroke part of the slow wave has two components, the pacemaker component involves a non-L-type calcium channel.

Mandibular reconstruction and rehabilitation in childhood

The management of a case of osteosarcoma of the mandible in an 7-year-old girl is presented. A variety of reconstructive techniques were used following surgical ablation of the tumour, including the use of a revascularised free bone flap and osseointegrated endosseous implants.

Suspensory ligament desmitis

The gross and functional anatomy of the suspensory ligament (SL) and its ultrasonographic variability are described. Injuries of the suspensory apparatus are divided into lesions confined to the proximal one third of the metacarpus or metatarsus (proximal suspensory desmitis and avulsion fractures), lesions of the body, and branch lesions. Complete breakdown injuries are also discussed. In view of the close association of the SL, the second, third, and fourth metacarpal or metatarsal bones, and the proximal sesamoid bones, associated bony lesions are also considered.

Psychiatric emergencies

Psychiatric emergencies can arise during pregnancy and the puerperium. When faced with a gravida presenting with the symptoms of an acute psychiatric illness, the obstetrician must consider the possibilities of organic disorders and substance abuse before initiating psychotropic therapy with the consulting psychiatrist. Generally, patients with psychiatric illness have difficulty caring for themselves and hospitalization may be indicated at least initially. Emotional support, a quiet environment, and psychotherapy are often the most important aspects of treatment. Suicide gestures should always be taken seriously. Immediate psychiatric consultation is imperative. Finally, anyone caring for pregnant women should be aware of the possibility of domestic violence. Pregnant women are unlikely to volunteer information about an abusive situation. Detection hinges on willingness of the physician to ask probing questions.

Teaching physiology by combined passive (pedagogical) and active (andragogical) methods

Pedagogy and andragogy are models of education based, respectively, on passive and active learning. This project compared two balanced sections of an undergraduate course in physiology. Both sections used the pedagogical method of didactic lectures to present basic material. Students in section 01 were given multiple-choice examinations, a pedagogical procedure, over the lecture content for the purpose of performance evaluation. In section 02 the lectures were used as an information source, which students combined with other information researched in the library to draft essays on assigned topics, i.e., an andragogical approach. Grading of the essays constituted 75% of a student's performance evaluation, with participation in class discussions making up the remaining 25%. There was no significant difference in overall performance outcome between the two sections (P > 0.47). Students from both sections valued the lectures, even though they served a different purpose in each section. However, overall the student rating of section 02 was significantly higher than that of section 01 (P < or = 0.05). This reflected different teaching methods rather than different teachers, because the ratings of the two instructors were virtually identical (P > 0.98). These results suggest that a combined pedagogical and andragogical approach is an acceptable model for teaching introductory physiology.

Percutaneous anterior discectomy under ultrasound guidance

The object of this experiment was to demonstrate that, by using a peritoneal fluid infusion coupled with ultrasound guidance, a safe anterior entry into the L5-S1 disc of the pig could be made. The goal was to develop a procedure with the advantages of a laparoscopic approach to the disc which has been published to allow removal of extruded herniations, that a neurosurgeon could perform without a general surgeon in attendance. The procedure was carried out under general anesthesia and fluoroscopic control. One liter of normal saline was then infused into the abdomen of a pig. Under ultrasound guidance and laparoscopic confirmation, a Nucleotome was placed into the L5-S1 disc and the disc was aspirated. The results showed that the disc was safely entered in all 5 pigs. The disc was successfully removed in 4 of 5 pigs. In all animals the bowel floated out of the pelvis, obviating the need for bowel manipulation. Laparoscopic ultrasound was needed for visualization in 3 pigs, while external ultrasound was used in two. Our conclusion is that peritoneal fluid infusion and ultrasound guidance, when applied to laparoscopic anterior discectomy, eliminates the need for retroperitoneal dissection and bowel manipulation, significantly simplifying the laparoscopic discectomy procedure.

Postoperative symptomatic internal thoracic artery stenosis and successful treatment with PTCA

From 1988 to 1992, 4,182 coronary bypass grafting procedures were performed at the University of Ottawa Heart Institute. The left internal thoracic artery (ITA) was used in 2,913 patients, the right ITA in 79, and bilateral ITAs in 61 for a total of 3,053 patients with ITAs. This study assessed patients requiring angioplasty for symptomatic ITA stenosis after operation. A total of 29 patients (0.95%) with a mean age of 55.3 +/- 1.9 years underwent angioplasty for ITA stenosis from 4 days to 34 months after operation (mean, 6.5 +/- 1.6 months). Internal thoracic artery stenosis was identified in 18 patients (62.1%) within 3 months after operation. Angina was present in 26 patients (89.7%), a positive stress test in 8 (27.6%), and myocardial infarction in 1 (3.4%). At angiography, a total of 34 stenotic sites were identified in ITA grafts. Angioplasty was successful (< 50% residual stenosis) in 31 sites (91.2%). Follow-up was available for 28 of 29 patients (96.6%) at 24.6 +/- 2.3 months. Four patients (14.3%) returned with restenosis within 3 months, 2 of whom had successful repeat angioplasty, and 1 required reoperation. Canadian Cardiovascular Society anginal class after angioplasty was less than class II in 84.6% of patients. In conclusion, symptomatic postoperative ITA stenosis is uncommon, occurs most frequently at the site of distal anastomosis, and generally presents within 3 months of operation. It may be safely and effectively treated with angioplasty with a low recurrence rate.

Posttraumatic stress disorder in peers of adolescent suicide victims: predisposing factors and phenomenology

OBJECTIVE

To examine the factors predisposing to posttraumatic stress disorder (PTSD) in peers of adolescent suicide victims.

METHOD

One hundred forty-six adolescents who were the friends of 26 suicide victims were studied. Five percent (n = 8) developed PTSD after exposure to suicide. These 8 subjects with PTSD were compared to the remainder of the exposed subjects (n = 138).

RESULTS

Subjects with PTSD were more likely than those without PTSD to have had a history of substance abuse, agoraphobia, and suicide attempts. Subjects who developed PTSD were more likely to have developed a new-onset depression, to have more severe grief, and to have been closer to the suicide victim. Subjects with PTSD tended to have more severe exposure to suicide and came from discordant households with a history of disruptions in key relationships. The 8 subjects who developed PTSD were compared to 38 subjects who developed new-onset depression but not PTSD. Those with PTSD were more likely to have had past substance abuse, prior suicide attempts, family history of panic disorder, a history of parent-child disruption, and a history of loss. Symptoms of intrusive visual images, hypervigilance, and avoidance of reminders discriminated subjects who had PTSD from new-onset depressives without PTSD.

CONCLUSIONS

PTSD is an expectable outcome in youth exposed to suicide. Further work is required to differentiate symptoms of depression from PTSD.

A predictive model for fetal lung maturity employing gestational age and test results

Most laboratory tests for fetal lung maturity (FLM) are optimized to exclude false-negative predictions of absence of respiratory distress syndrome (RDS), with a reciprocal low predictive value for maturity. The authors employed FLM Surfactant/Albumin Ratio (FLM S/A) test results to construct a predictive model for FLM that included the obstetric estimates of gestational age. The charts of 388 newborns were abstracted and reviewed. The clinical outcome was the gold standard of the multivariate logistic analysis. Both the obstetric estimates of gestational age and the test result were significant predictors of the clinical outcome (P values of < .0002 and .001, respectively). The prediction rule for RDS as a function of both of these variables allows for adjustment of the test cutoffs, so that there is a consistent probability of RDS at the cutoff FLM S/A result for different gestational ages. Fetal lung maturity probability reporting may facilitate clinical decision-making.

Prospective evaluation of extracranial carotid stenosis: MR angiography with maximum-intensity projections and multiplanar reformation compared with conventional angiography

OBJECTIVE

The purpose of this prospective study was to compare MR angiography of the carotid artery from the aortic arch through the circle of Willis using maximum-intensity projection (MIP) and multiplanar reformation (MPR) images with intraarterial angiography in the depiction of extracranial carotid atherosclerosis.

SUBJECTS AND METHODS

The carotid arteries in 20 patients were studied with MR and intraarterial angiography. MR angiography included two-dimensional (2D) time-of-flight (TOF) sequences from the aortic arch through the skull base and three-dimensional (3D) TOF sequences centered at the carotid bifurcation and multiple overlapping thin slab acquisition (MOTSA) from the skull base to above the circle of Willis. Targeted MIP images of the 2D and 3D TOF MR angiograms through each carotid bifurcation were obtained. Last, MPR images of the 3D TOF MR angiograms at the obliquity that showed the greatest stenosis were obtained. All studies were reviewed in a double-blinded fashion by two neuroradiologists. Caliper measurements of MR angiograms and intraarterial angiograms were made by using North American Symptomatic Carotid Endarterectomy Trial criteria. Global MIPs of the aortic arch and common carotid arteries from the 2D TOF MR angiograms and targeted MIPs of the intracranial carotid arteries from the MOTSA MR angiograms were compared with the intraarterial angiogram and graded as normal, mild, moderate, severely stenotic, or occluded.

RESULTS

MPR of the 3D TOF MR angiograms was highly correlated with intraarterial angiograms for both observers 1 and 2 (0.94/p < .001, 0.96/p < .001 [Pearson correlation/p value]). No statistically significant difference between 3D TOF MPR and intraarterial angiography was seen with a paired t-test. With an alpha = 0.05 (5% probability of type 1 error), the power to detect a difference as small as +/- 5% stenosis between 3D TOF MPR and intraarterial angiogram was 80% for observer 1 and 90% for observer 2. Although both MIPs of the 2D and 3D TOF MR angiograms showed high Pearson correlation coefficients (0.83, 0.90) with intraarterial angiography, the paired t-test revealed a statistically significant difference in the estimation of carotid stenosis. Both observers thought the global MIPs of the 2D TOF MR angiogram allowed good to excellent visualization of the common carotid arteries. The aortic arch was seen in 70% of patients; most of the missed cases occurred early in our experience, when the 2D axial images were not placed sufficiently inferior to include the arch. No stenosis of the great vessel origins was seen in this study. All four stenoses of the intracranial internal carotid artery identified with intraarterial angiography were seen with the MOTSA MR angiogram but with a tendency to overestimate stenosis. Only one carotid siphon was thought to show severe stenosis on the MR angiogram. Intraarterial angiography showed a 50% stenosis.

CONCLUSION

It is possible to image the entire carotid artery from the aortic arch through the circle of Willis with MR angiography in a clinically acceptable time. MPR of the 3D TOF MR angiogram reliably shows the percentage of carotid stenosis with no statistically significant difference compared with intraarterial angiography. The role of MR angiography in showing lesions in the circle of Willis or the aortic arch is promising, but the limited number of tandem lesions in this study makes it difficult to draw any conclusions.

A comparison of HIV risk between women and men who inject drugs

Although there is growing evidence of differences between women and men who inject drugs (IDUs) in terms of level of risk for HIV infection, very little research has been conducted specifically addressing the risk practices of women IDUs. This study formed part of a national study of HIV infection risks in IDUs and the purpose of the present analysis was an exploration of gender differences in HIV risk practices, focusing on the HIV risk practices of IDU women. 1,245 IDUs from the inner city area of Sydney took part in this study. Of these, 908 were men and 331 were women. Notable results were that female respondents were more likely to report sharing needles, they injected heroin more times in a typical using month and were more likely to have shared with someone they later found out was HIV seropositive. Female respondents also reported more sexual partners than men, were more likely to engage in prostitution, and were more likely to have sexual partners who were themselves IDUs. The results provide support for the proposition that women who inject drugs may be at greater risk of HIV infection through both their drug taking and their sexual practices. Further research is needed to explore the reasons underlying the risk practices of women who inject drugs and an understanding of these factors needs to be incorporated into HIV risk-reduction and drug harm-reduction policies and programs.

Auditory M100 component 1: relationship to Heschl's gyri

This study was designed to localize the neuroanatomic generator of the 100 ms latency magnetic auditory evoked field (EF) component (M100) activated by an unattended tone pip. Magnetic EFs in response to 25 ms duration, 90 dB, 1 kHz tone pips were recorded from both hemispheres of nine normal adults, five males and four females, using a seven-channel second-order gradiometer. The source of the M100 was estimated, with confidence intervals, by a least squares based inverse solution algorithm. Magnetic resonance (MR) images of the brain were acquired with a 1.5 T system using a standard head coil. The superior temporal gyri (STG) were manually segmented from 1.7 mm thick coronal images, and the superior surfaces were then rendered from the 3-D volume data. Translation and rotation matrices were identified to locate the magnetoencephalography (MEG) determined sources within the reconstructed STGs. This population of 18 STGs in 9 individuals demonstrated two transverse gyri in 4 of 9 left hemispheres, and 5 of 9 right hemispheres. All 9 left hemisphere M100 sources were in or included Heschl's gyrus(i) in the confidence intervals. Seven of the 9 included Heschl's gyrus(i) on the right: the remaining two, both males, had sources slightly anterior to Heschl's gyrus(i). We conclude that all M100 source location estimates were compatible with an auditory koniocortex source in or adjacent to Heschl's gyri.

African-American physicians' views on health reform: results of a survey

Little is known about African-American physicians' health system experience or their opinions on health reform. In an attempt to obtain socioculturally relevant data quantifying these experiences and opinions, the National Medical Association administered a 38-question, 80-item survey instrument in August 1993. The questionnaire was completed by 236 physicians. The results indicate that African-American physicians feel health care is a right and that the health system needs fundamental change. Although there was no consensus on the type of health reform needed, approximately 35% cited availability and access to care to be the greatest problem facing the system with high costs of care (18.2%) ranking second. Unique findings in the survey indicated respondents felt that the needs and concerns of most African Americans will not be fairly addressed in the reform of the health-care system, that African-African physicians are not included in the formation of health-care policies, and that African-American physicians are facing high levels of professional and healthcare system racial discrimination. More than 99% of African-American physicians reported some degree of racial discrimination in the practice of medicine including peer review, obtaining practice privileges at hospitals, hospital staff promotions, Medicaid and Medicare reimbursements, malpractice suits, private insurance oversight and reimbursements, and referral practices of white colleagues. These findings have profound health policy, health financing, and health service delivery implications and should be included in debates and deliberations on health reform.

Role of nitric oxide in the response of capillary blood flow in the rat tail to body heating

This study tested whether or not nitric oxide (NO) is involved in mediating the response of cutaneous capillary blood flow to an indirect heat stress. Blood cell velocity (BCV) in capillaries within the subepidermal plexus of the tail of anesthetized Sprague-Dawley rats was measured by videomicroscopy while the animals' trunk was exposed to a 35 degrees environment. Vascular conductance, estimated as the ratio of BCV to mean arterial pressure (MAP), increased by 259% in saline (placebo)-treated rats. Intravenous administration of 32 mg/Kg of the NO synthesis inhibitor NG-nitro-L-arginine (NNA) attenuated the response of vascular conductance (BCV/MAP) to body heating regardless of whether NNA was given before or during the heat stress procedure. In a subset of NNA-treated animals, infusion of the NO substrate L-arginine restored the BCV/MAP response to heat stress. In summary, the results of this study support the hypothesis that NO is involved in the response of cutaneous capillary blood flow to heat stress. Possible mechanisms mediating the local release of NO are discussed.

The effect of the iron(III) chelator, desferrioxamine, on iron and transferrin uptake by the human malignant melanoma cell

The mechanism of action of the clinically used iron(III) chelator, desferrioxamine (DFO), on preventing iron (Fe) uptake from transferrin (Tf) has been investigated using the human melanoma cell line SK-MEL-28. This investigation was initiated due to the paucity of information on the mechanisms of action of DFO in neoplastic cells and because recent studies have suggested that DFO may be a useful antitumor agent. The effect of DFO was dependent on incubation time. After a 2-h incubation, DFO acted like the extracellular chelators, EDTA and diethylenetriaminepentaacetic acid, because there was little inhibition of 59Fe uptake from Tf. In contrast, after a 24-h incubation, DFO (0.5 mM) efficiently reduced internalized 59Fe uptake from Tf to 18% of the control value. These observations suggested the existence of a kinetic block to the entry of the apochelator to intracellular Fe pools and/or to the exit of the DFO-59Fe complex. Indeed, cellular fractionation demonstrated that, in contrast to the decrease in the percentage of 59Fe in the ferritin and membrane fractions, a marked increase in the percentage of 59Fe present in the ferritin-free cytosol occurred. These observations suggested an accumulation of the DFO-59Fe complex within the cell. The highly lipophilic Fe chelator, pyridoxal isonicotinoyl hydrazone, was far more effective than DFO at preventing 59Fe uptake from Tf, illustrating the importance of membrane permeability for effective Fe chelation. Desferrioxamine at a concentration of 1 mM decreased internalized 125I-Tf uptake to 70% of the control. However, the decrease in 59Fe uptake observed could only be partially accounted for by a decrease in Tf uptake, and it appeared that DFO was chelating 59Fe at an intracellular site consistent with the transit Fe pool. The results are discussed in the context of the use of Fe chelators as effective antineoplastic agents.

Estrogen antibodies reduce vulnerability to stress-induced failure of intrauterine implantation in inseminated mice

In Experiment 1, inseminated mice were randomly assigned to either an undisturbed control condition or four conditions involving exposure to restraint stress on days 1 through 5 of pregnancy. Restrained animals received one of three doses of estrogen antibodies or just vehicle injections on each day of restraint. Restrained animals receiving vehicle only showed significantly fewer uterine implantation sites than did unrestrained controls, while restrained animals given estrogen antibodies showed more implantation sites than did vehicle-treated restrained animals. In Experiment 2, varied dosages of refined estrogen antibodies were administered to inseminated females concurrent to restraint-stress on days 1 through 5 of pregnancy. More females receiving the higher dosages of antibodies produced litters than did restrained females with just vehicle injections, and at the highest dose the number of litters was similar to that produced by undisturbed control females. These results converge with other evidence to suggest that stress-induced pregnancy blocks are mediated by estrogens.

Uric acid and didanosine compliance in AIDS clinical trials: an analysis of AIDS Clinical Trials Group protocols 116A and 116B/117

An analysis is presented that promotes the use of uric acid levels as an indicator of patients didanosine (ddI) use. Logistic regression techniques were used on data from two test groups that best represent patients entered on ACTG protocols 116A and 116B/117. Two classification functions resulted that are based on serial uric acid measurements and were used to classify patients to one of two groups: those treated with zidovudine (ZDV) and those treated with ddI. These functions correctly classified well over 70% of the patients in each of these two studies. Implications of these results with respect to the assessment of ddI compliance and limitations in the use of these classification functions are discussed.

Facial nerve reconstruction following ablative parotid surgery

Sacrifice of the facial nerve during surgery for parotid malignancy is rarely necessary, but the sequelae of facial nerve paralysis necessitates some form of facial re-animation. The technique which achieves the best results is that of immediate nerve grafting. This paper records our experience with 14 cases of extra temporal reconstruction of the facial nerve, utilizing the cutaneous branch of the radial nerve as an autograft.

Dudley and Griswold: the development of fracture treatment in Kentucky

The surgical record of the great state of Kentucky is impressive and one to be admired. Two Kentucky physicians helped pave the way to the modern treatment of fractures. Doctors Benjamin Dudley and R. Arnold Griswold contributed unique ideas and opinions to the practice of orthopaedic surgery. Their techniques and practices were ahead of their times, and today we see a little of each in our everyday treatment of fractures.

Vascular access devices--management of common complications

Developments in vascular access technology, along with advances in therapy, have created specific challenges for the intravenous nurse caring for patients with indwelling vascular access devices. The nurse clinician must be aware of clinical and technical complications that may occur, as well as the nursing management of those complications.

On the pharmacological and physiological role of glibenclamide-sensitive potassium channels in colonic smooth muscle

Actions of activators of glibenclamide sensitive K+ channels on canine colonic circular muscle were investigated. Cromakalim as well as its (-) enantiomer lemakalim caused inhibition of spontaneous phasic contractile activity (EC50's 4.4 +/- 0.1 x 10(-7) M and 2.3 +/- 0.4 x 10(-7) M, respectively) and of carbachol induced activity (EC50's: 9.4 +/- 5.1 x 10(-7) M and 4.3 +/- 1.4 x 10(-7) M, respectively). Cromakalim and lemakalim effects were completely inhibited by glibenclamide. Additive effects between K+ channel activators and other drugs relaxing colonic muscle (the L-type calcium channel blocker D600 and forskolin) were seen. A physiological role for specific glibenclamide sensitive K+ channels, if existing, remains unresolved. The present study indicates that the non-adrenergic inhibitory nerves do not act through these channels, neither does stimulation of muscarinic or beta-adrenergic receptors.

Attenuation of the cutaneous vasoconstrictor response to cold in elderly men

This study tested the hypothesis that the cutaneous vasoconstrictor response to cold is reduced in elderly individuals. We measured laser Doppler flux (LDF) in the fingertip and blood cell velocity (CBV), via videodensitometry, in individual capillaries of the finger nailfold both before and during submersion of the contralateral arm in a 15 degrees C water bath. Subjects were 10 young (M = 25 years) and 10 old (M = 71 years) male adults. During the first minute of cooling, both the young (Y) and old (O) groups experienced a significant (p < .004) decrease in LDF. Over the subsequent 4 minutes of cold stress, LDF remained significantly depressed in the Y group, whereas LDF returned to values not significantly different from pre-cooling control in the O subjects. During the cold stress, CBV significantly decreased in the Y (p < .03) subjects; however, the degree of change was much less than that of LDF (49% decrease in LDF versus 14% decrease for CBV). In contrast to the Y subjects, the O group showed no significant change in CBV during cooling (p > .28). These results indicate that indirect cooling elicits a reflex decrease in cutaneous bloodflow, which is more pronounced in the deep vessels than in the superficial capillaries, and that these effects are attenuated with advancing age.

Palliative removal of a giant polypoid 'carcinosarcoma' of the oesophagus by YAG laser photocoagulation of the tumour stalk

Dysphagia in a 79 year old lady was caused by a giant polypoid tumour in mid-oesophagus. Surgery was not appropriate. Shrinkage of the tumour and its eventual detachment were achieved by stopping its blood supply by YAG laser photocoagulation of the tumour stalk. Good, temporary palliation of the dysphagia was achieved.

Two mechanisms of iron uptake from transferrin by melanoma cells. The effect of desferrioxamine and ferric ammonium citrate

The effects of ferric ammonium citrate (FAC) and desferrioxamine (DFO) on iron (Fe), and transferrin (Tf) uptake have been investigated using SK-MEL-28 human melanoma cells, which express the Tf homologue, melanotransferrin, in high concentrations. Previously we demonstrated two separate Fe uptake mechanisms from Tf, viz. a specific process mediated by the transferrin receptor (TfR) and a nonspecific process (Richardson, D. R., and Baker, E. (1990) Biochim. Biophys. Acta 1053, 1-12). Cells exposed to DFO demonstrated up-regulation of the TfR with a concurrent increase in the rate of Fe uptake. Desferrioxamine also stimulated the nonspecific process of Fe uptake, resulting in a further increase in accumulation of Fe over Tf after saturation of the specific TfR. Ferric ammonium citrate had two effects. First, it resulted in down-regulation of the TfR. Second, and paradoxically, it markedly stimulated the rate of Fe uptake from Tf by the nonspecific process without increasing the rate of nonspecific Tf uptake. These data conclusively demonstrate that two entirely different mechanisms of iron uptake from Tf exist in melanoma cells and that ferric ammonium citrate may be a useful experimental tool to further characterize the specific and nonspecific mechanisms of Fe uptake from Tf.

Women, AIDS and reproduction

Relatively little has been written about how Aids affects women. When women are mentioned it is primarily as carers of people with Aids or as possible transmitters of the HIV virus, with the focus largely on prostitutes and pregnant women. The concern overwhelmingly is about how to protect the health of men and children, writes Diane Richardson. Here she examines the implications of Aids and HIV infection for women's health and reproductive rights.

Evaluation of the iron chelation potential of hydrazones of pyridoxal, salicylaldehyde and 2-hydroxy-1-naphthylaldehyde using the hepatocyte in culture

A range of new analogues of the promising iron chelator pyridoxal isonicotinoyl hydrazone was prepared and assessed for activity in reducing hepatocyte iron, mechanism of action and potential in iron-chelation therapy. A total of 45 compounds were synthesized by condensation of aromatic aldehydes (pyridoxal, salicylaldehyde and 2-hydroxy-1-naphthylaldehyde) with various acid hydrazides prepared by systematic substitutions on the benzene ring or by the replacement of the ring with an acetyl, pyridyl, furoyl or thiophene moiety. The effects of these compounds on 59Fe uptake and intracellular distribution in hepatocytes in culture and on 59Fe mobilization from prelabeled hepatocytes were assessed. Toxicity, lipophilicity and the ability to chelate plasma transferrin-bound 59Fe were also evaluated. Several compounds were much more active than pyridoxal isonicotinoyl hydrazone and may have clinical potential. These included pyridoxal benzoyl hydrazone, pyridoxal p-methoxybenzoyl hydrazone, pyridoxal m-fluorobenzoyl hydrazone and pyridoxal 2-pyridyl hydrazone. All were more effective at reducing iron uptake than mobilizing hepatocyte iron; they also may act primarily on the transit iron pool rather than on storage iron. Other compounds (e.g., salicylaldehyde p-t-butyl-benzoyl hydrazone) redistributed ferritin-59Fe to different intracellular sites but had little net effect on hepatocyte iron levels.

Effects of kwashiorkor malnutrition on measured capillary filtration rate in forearm

This study investigated the effects of kwashiorkor malnutrition on blood tissue fluid exchange by measuring the rate of capillary filtration (CFR) in response to a 60-mmHg increment in venous pressure in the forearms of 1- to 3-yr-old native African children within the Transkei Homeland. They were divided into the following subject groups: kwashiorkor patients (K); kwashiorkor patients who were at various stages of recovery (RK); marasmus patients (M); patients with edema of nonkwashiorkor origin (E); and control children (C). Measurements of CFR were significantly lower in the K subjects compared with any of the other groups (P less than 0.05), whereas, the RK, M, E, and C subjects were not significantly different from each other. This latter finding indicates that the lower CFR of the K patients is reversible and is not due to malnutrition or edema per se. Measurements of forearm cutaneous blood flow by laser Doppler flowmetry (LDF) in C and K subjects showed only a slightly lower value for the K patients (P greater than 0.20), and there was no relationship between CFR and LDF for either group (r = 0.073). These results suggest that the lower CFR of the K patients is not secondary to peripheral vasoconstriction.

In vivo MR evaluation of Gd-DTPA conjugated to dextran in normal rabbits

A dextran-Gd-DTPA compound has been recently synthesized utilizing 70,800 Da molecular weight dextran. This polymeric contrast agent for magnetic resonance imaging has been found chemically to be very stable and to demonstrate in vitro improved relaxivities of 1.5 to 2.3 times that of monomeric Gd-DTPA at 100 MHz. This MR experiment examines the in vivo distribution and relaxivity of the 70,800 Da molecular weight dextran-Gd-DTPA compound in a rabbit model by measuring the change in signal-to-noise ratio of a variety of organs (renal cortex, renal medulla, liver, brain, and torcula herophile) compared to the preinjection state. Results demonstrate prolonged (beyond 60 min) enhancement of the renal cortex, renal medulla, liver and torcula, and no enhancement of brain parenchyma.

Anterior maxillary osteoplasty to broaden the narrow maxillary ridge

The application of endosseous implants has extended the range of options and effectiveness of reconstructive preprosthetic surgery. Placement of endosseous implants in the edentulous maxilla is often restricted due to lack of available bone. Exposure of the underlying anterior maxillary bone frequently reveals a ridge form which is adequate in height but too narrow to accommodate endosseous implants. A horseshoe type osteotomy extending from the ridge crest into the floor of nose has been developed which allows advancement of the outer cortex to restore lost facial form and placement of an interpositional bone graft and endosseous implants to restore lost function.

Effects of invariant sympathetic activity on cutaneous circulatory responses to heat stress

This study investigated the role of sympathetic withdrawal on blood flow responses in cutaneous arteriovenous anastomoses (AVAs) and capillaries to direct and indirect heat stress. This was achieved by clamping sympathetic activity (SC) to the tail of anesthetized rats so that constrictor tone remained invariant during exposure of either the animal's tail (direct heating) or body (indirect heating) to a 35 degrees C environment. Flow through the AVAs in the tail was evaluated by laser-Doppler flowmetry (LDF), while capillary flow was investigated by videodensitometry measurements of blood cell velocity (CBV) in single capillaries within the subepidermal vascular plexus. Both direct and indirect heating significantly increased LDF and CBV. In comparison to blood flow responses in sham-operated control rats, the SC procedure resulted in significantly lower LDF responses to both direct and indirect heat stress. By contrast, the response of CBV was not significantly affected by SC during either mode of heating. These results indicate that the withdrawal of sympathetic constrictor tone plays a role in the response of cutaneous AVAs, but not precapillary arterioles, to direct as well as indirect heat stress. Additional studies on unanesthetized animals showed that superimposing body heating on a base of local heating elicited a further increase in LDF, suggesting that local heating does not deplete neural mediated dilatory reserve.

The uptake of inorganic iron complexes by human melanoma cells

The human melanoma cell line, SK-MEL-28, expresses high levels of melanotransferrin. The uptake of inorganic iron (Fe) complexes compared to transferrin-bound Fe by these cells has been investigated to determine whether melanotransferrin has a role in Fe uptake. The mechanisms of Fe uptake have been characterised using 59Fe complexes of citrate, nitrilotriacetate, desferrioxamine, and 59Fe added to Eagle's minimum essential medium (MEM) and compared with human transferrin (Tf) labelled with 59Fe and iodine-125. Iron uptake from the Fe complexes of citrate, nitrilotriacetate and MEM were similar, and far greater than that from Tf at the same Fe concentration (2.5 microM). Ammonium chloride and a monoclonal antibody to the transferrin receptor (42/6), had no effect on the uptake of Fe from inorganic Fe complexes, suggesting that receptor-mediated endocytosis of Tf was not involved. The monoclonal antibody, 96.5, specific for melanotransferrin did not alter total Fe uptake but slightly increased the proportion of Fe internalised, possibly due to the modulation of the antigen by the antibody. However, from the time required for modulation to occur (approximately 2 h), the small increase in internalisation observed and the fact that no increase in total cell Fe occurred, it is suggested that melanotransferrin has little role in Fe uptake.