Distal Tibia and Foot Involvement in a Patient With Waldenstrom's Macroglobulinemia

Bone lesions are a rare presentation in Waldenstrom's macroglobulinemia patients. Although lytic bone lesions and generalized osteoporosis have been described variably in literature on Waldenstrom's macroglobulinemia patients, distal long bone and foot involvement has not been described to our knowledge. We report a patient with Waldenstrom's macroglobulinemia with IgM monoclonal spike, plasmacytic infiltration of bone marrow, and symptoms of foot pain, and found to have distal tibia and foot involvement. The symptoms of bone lesions in our patient were significantly improved with radiation treatment. The possibility of distal involvement of long bones in a clinically relevant presentation should be kept in mind in these patients.

The multicomponent Debus–Radziszewski reaction in macromolecular chemistry

The well-known Debus–Radziszewski reaction is over one century old. However, this reaction has only been considered very recently as a new tool to design original imidazole and imidazolium-containing polymers by direct formation of the imidazole ring during the polymerization process. This article reports recent advances concerning the use of this newly emerging reaction in macromolecular chemistry.

Synthesis and Characterization of Aromatic Polyimides Bearing Nonlinear Optical Chromophores

The syntheses and characterizations of two aromatic polyimides with nonlinear optical (NLO) chromophore side chains were investigated through a two-step synthetic route. These two polymers were prepared by polycondensation of 4,4′-(hexafluoroisopropylidene) diphthalic anhydride (6FDA) with 4-(4-amino, 2-hydroxy) phenoxyaniline (HODA) and 2,2-bis(3-amino-4-hydroxyphenyl)hexafluoropropane (6FAP), respectively. First the poly(hydroxy)imides were prepared by direct thermal imidization. The resulting polyimides bearing hydroxy groups were found to react easily with the terminal hydroxy group of the chromophore (Disperse Red1 (DR1)) via the Mitsunobu reaction. The high content of chromophore for the polyimide with 6FAP diamine was confirmed by UV spectroscopy and ellipsometry spectroscopy measures. The resulting NLO polyimides possess high glass transition temperatures ( Tg > 185°C), excellent solubilities and processabilities even though the extent of chromophore grafting is up to 95 mol%. The second harmonic coefficient ( d33) at the wavelength of 1320 nm is close to 30 pm V−1. The thermal and temporal stabilities of the NLO properties were investigated. The relaxation temperature of the SHG signal measured at the 50% decay of the initial SHG signal ( I 2ω/2 at 2°C min−1) was 168°C for the polyimide based on HODA and 157°C for the polyimide based on 6FAP.

The Adsorption of Cement Superplasticizers on to Mineral Dispersions

The adsorption of polymeric sulphonated naphthalene formaldehyde (SNF) and sulphonated melamine formaldehyde (SMF) on to titanium dioxide and calcium carbonate has been measured in aqueous media. The magnitude of these adsorptions is strongly dependent on electrostatic interaction irrespective of the pH value. This result has been established by studying the adsorption of the polyelectrolytes from solutions of different composition. The calcium ion plays a prominent role in the process of adsorption, especially at high pH where electrical interactions do not favour the reaction.

The polymeric nature of the fluidizing agents is demonstrated by an increase in adsorption with molecular weight and by adsorption/desorption experiments where the reaction has been shown to be irreversible. The amount adsorbed at maximum coverage does not depend on the nature of the mineral, but mainly on electrical interactions between the monomer units.

A comparison of homopolymer and block copolymer structure in 6FDA-based polyimides

Two homopolyimides and the corresponding block copolyimide, all based on the 4,4'-(hexafluoroisopropylidene)diphthalic dianhydride (6FDA), have been synthesized and fully atomistic models have been studied using molecular dynamics (MD) simulation. The respective diamines were 1,3-phenylenediamine (mPDA) and 2,3,5,6-tetramethyl-1,4-phenylenediamine (durene). These polyimides are potential candidates for gas separation applications. The synthesized polymers were processed as dense flat membranes. The effects of diamine structure were investigated at the molecular level and an attempt to compare the structural features of homo- and block copolyimides was made. Amorphous models were generated using a hybrid pivot Monte Carlo-MD sampling preparation technique. Average model densities were validated against experimental measurements on the dense films. Cohesive energies, Hildebrand solubility parameters, conformational characteristics, intermolecular interactions and available void spaces were analysed for each system. The durene diamine was found to hinder stacking and increase the available space. This is associated with the steric effect of the methyl substituents. In general, 6FDA-mPDA/durene exhibits an intermediate behaviour with respect to its base polyimides. For most of the examined properties, the differences between different size simulated systems were minor with the exception of the free volume distribution.

ADAMTS13 deficiency and thrombotic thrombocytopenic purpura associated with trimethoprim-sulfamethoxazole

Thrombotic thrombocytopenic purpura (TTP) is a hematological disease characterized by microangiopathic hemolytic anemia and thrombocytopenia. Although the link between ADAMTS13 deficiency and idiopathic TTP has been well-established, the role of trimethoprim-sulfamethoxazole (TMP-SMX) in the pathogenesis of TTP is not yet well elucidated. To the best of our knowledge, there have been only two previous reports linking this medication with the development of TTP. We present the case of a healthy woman, age 26 years, who developed TTP during TMP-SMX therapy for urinary tract infection. She was found to have ADAMTS13 deficiency with anti-ADAMTS13 antibodies. Her condition responded to discontinuation of the TMP-SMX, plasmapheresis, and rituximab therapy. We speculate that the acquired ADAMTS13 deficiency might have been triggered by the TMP-SMX therapy.

An easy protocol for studying chromatin and recombination protein dynamics during Arabidopsis thaliana meiosis: immunodetection of cohesins, histones and MLH1

Plant meiosis studies have enjoyed a fantastic boom in recent years with the use of Arabidopsis thaliana as a model not only for molecular genetics and genomics but also for cytogenetics. In this article we describe a new protocol for immunolabelling meiotic proteins that allows the detection of a large range of proteins on strongly spread chromosomes throughout the entire meiotic process. We used this method to immunodetect MLH1, a crucial component of the meiotic recombination machinery, and found that it can be visualised as foci from pachytene to diakinesis, where it co-localises with chiasmata. The mean MLH1 foci number per meiotic cell at diakinesis was 8.4 for WS-4 and 9.95 for Col-0, with the number of foci per bivalent ranging from 1 to 5. We also analysed MLH1 distribution within bivalents and found that they were not restricted to specific chromosomal regions. The analysis of MLH1 foci formation in the Atzip4 mutant, where class I crossover (CO) formation is prevented, revealed that residual chiasmata were not labelled by MLH1, strongly suggesting that MLH1 antibodies only label class I COs in Arabidopsis. It thus appears that the 'obligatory CO' is systematically labeled by MLH1 and is generated through the class I pathway.

Internal frequency conversion extreme ultraviolet interferometer using mutual coherence properties of two high-order-harmonic sources

We report on an innovative two-dimensional imaging extreme ultraviolet (XUV) interferometer operating at 32 nm based on the mutual coherence of two laser high order harmonics (HOH) sources, separately generated in gas. We give the first evidence that the two mutually coherent HOH sources can be produced in two independent spatially separated gas jets, allowing for probing centimeter-sized objects. A magnification factor of 10 leads to a micron resolution associated with a subpicosecond temporal resolution. Single shot interferograms with a fringe visibility better than 30% are routinely produced. As a test of the XUV interferometer, we measure a maximum electronic density of 3x10(20) cm(-3) 1.1 ns after the creation of a plasma on aluminum target.

Meiosis in plants: ten years of gene discovery

Plants have always been at the forefront of genetic and cytogenetic studies, but it was only following the explosion of genomic tools linked to the development of Arabidopsis thaliana as a model, that the first genes involved in plant meiosis were cloned in the late 1990s. Since then, in less than 10 years, close to fifty plant meiotic genes have been functionally characterized, mainly in Arabidopsis but also in rice and maize. In this review, we give an overview of this decade of discovery, with emphasis on the strategies that have been used for meiotic gene identification. We also highlight particularly interesting breakthroughs that these mutant and gene screens made possible.

Meiotic recombination and crossovers in plants

Efforts have been made in recent years to clarify molecular meiotic processes in a large variety of higher eukaryotes. In plants, such studies have enjoyed a boom in the last years with the use of Arabidopsis thaliana together with maize, rice and tomato as model systems. Owing to direct and reverse genetic screens, an increasing number of genes involved in meiosis have been characterized in plants. In parallel, the improvement of cytological and genetical tools has allowed a precise description of meiotic recombination events. Thus, it appears that meiotic studies in plants are reaching a new stage and can provide new insights into meiotic recombination mechanisms. In this review, we intend to give an overview of these recent advances in the understanding of meiotic recombination in plants.

Patterns of recombination and MLH1 foci density along mouse chromosomes: modeling effects of interference and obligate chiasma

Crossover interference in meiosis is often modeled via stationary renewal processes. Here we consider a new model to incorporate the known biological feature of "obligate chiasma" whereby in most organisms each bivalent almost always has at least one crossover. The initial crossover is modeled as uniformly distributed along the chromosome, and starting from its position, subsequent crossovers are placed with forward and backward stationary renewal processes using a chi-square distribution of intercrossover distances. We used our model as well as the standard chi-square model to simulate the patterns of crossover densities along bivalents or chromatids for those having zero, one, two, or three or more crossovers; indeed, such patterns depend on the number of crossovers. With both models, simulated patterns compare very well to those found experimentally in mice, both for MLH1 foci on bivalents and for crossovers on genetic maps. However, our model provides a better fit to experimental data as compared to the standard chi-square model, particularly regarding the distribution of numbers of crossovers per chromosome. Finally, our model predicts an enhancement of the recombination rate near the extremities, which, however, explains only a part of the pattern observed in mouse.

A strategy to investigate the plant meiotic proteome

The analysis of meiosis in higher plants has benefited considerably in recent years from the completion of the genome sequence of the model plant Arabidopsis thaliana and the development of cytological techniques for this species. A combination of forward and reverse genetics has provided important routes toward the identification of meiotic genes in Arabidopsis. Nevertheless identification of certain meiotic genes remains a challenge due to problems such as limited sequence conservation between species, existence of closely related gene families and in some cases functional redundancy between gene family members. Hence there is a requirement to develop new experimental approaches that can be used in conjunction with existing methods to enable a greater range of plant meiotic genes to be identified. As one potential route towards this goal we have initiated a proteomics-based approach. Unfortunately, the small size of Arabidopsis anthers makes an analysis in this species technically very difficult. Therefore we have initially focussed on Brassica oleracea which is closely related to Arabidopsis, but has the advantage of possessing significantly larger anthers. The basic strategy has been to use peptide mass-finger printing and matrix-assisted laser desorption ionization time of flight mass spectrometry to analyse proteins expressed in meiocytes during prophase I of meiosis. Initial experiments based on the analysis of proteins from staged anther tissue proved disappointing due to the low level of detection of proteins associated with meiosis. However, by extruding meiocytes in early prophase I from individual anthers prior to analysis a significant enrichment of meiotic proteins has been achieved. Analysis suggests that at least 18% of the proteins identified by this route have a putative meiotic function and that this figure could be as high as one-third of the total. Approaches to increase the enrichment of proteins involved in meiotic recombination and chromosome synapsis are also described.

Purification and mass spectroscopic analysis of human CB1 cannabinoid receptor functionally expressed using the baculovirus system

The cannabinoid receptor 1 (CB1) cannabinoid receptor is an essential component of the cannabinergic system. It has been recognized as a therapeutic target for treating numerous diseases and is currently receiving considerable attention by the pharmaceutical community. Target-based drug design, utilizing three-dimensional information of receptor structure and ligand-binding motifs, requires significant amounts of purified protein. To facilitate the purification of CB1, we have expressed the receptor fused to various epitope tags using the baculovirus expression system. In addition, expression levels and ligand-binding profiles corresponding to the expressed fusion proteins have been compared. C-terminal histidine (His)-tagged CB1 gave a Bmax higher than most other systems previously reported in the literature, and was selected for subsequent metal affinity chromatography purification and mass spectroscopic (MS) analysis. Moreover, cells expressing C-terminal His-tagged CB1 were shown to inhibit forskolin-stimulated cyclic adenosine 3',5'-monophosphate (cAMP) production in a concentration-dependent manner in the presence of CP-55,940, confirming the expressed receptor's functional characteristics. A Western blot analysis of the purified receptor showed several forms of CB1, the most abundant being a 57 kDa monomeric protein. The purified CB1 preparations were subjected to protein digestion followed by MS. Fragments corresponding to >70% of the receptor were identified by this method, confirming the identity and purity of the expressed protein. The work presented here demonstrates that epitope-tagged CB1 can be expressed in sufficient amounts and purified to homogeneity for MS analysis. Moreover, these results will serve as a basis for future experiments aimed at characterizing the ligand-binding domains using covalently reacting receptor probes.

Purification and mass spectroscopic analysis of human CB2 cannabinoid receptor expressed in the baculovirus system

The cannabinergic system is present in a variety of organs and tissues that perform a wide range of essential physiologic functions making it an inherently important therapeutic target for drug discovery. In order to augment our knowledge regarding the interactions between cannabinoid receptors (CBs) and their ligands, efficient and effective tools are essential for robust expression and purification of these membrane-bound proteins. In this report, we describe a suitable method for purification of the human cannabinoid receptor 2 (CB2) to a qualitative and quantitative level sufficient for mass spectral analysis. We utilized a baculovirus expression system, incorporating several epitope tags to facilitate purification and to ameliorate the effect the tags have on CB2 expression and function. Expressed protein encoded by a carboxy (C)-terminal His-tagged CB2 construct displayed a B(max) value of 9.3 pmol/mg with a K(D) of 7.30 nM using [3(H)]CP-55(940), a standard cannabinoid radioligand, and was selected for subsequent purification experiments. Western blot analysis of purified membrane protein yielded several forms of CB2, the most abundant being a 41 kDa peptide. A second protein species was observed with an apparent molecular weight of 46 kDa representing a glycosylated form of CB2. In addition, a CB2 homodimer was also identified. The purified receptor was subjected to mass spectroscopic analysis to confirm its identity and purity. Mass spectra corresponding to the intracellular, extracellular and transmembrane domains were obtained. These experiments exemplify the importance of high-level expression systems when developing membrane-bound protein purification strategies. This work will aid in the identification of receptor-ligand binding sites, the characterization of molecular features involved in receptor activation, and the elucidation of the CB2 receptor tertiary structure.

Phase III study of matrix metalloproteinase inhibitor prinomastat in non-small-cell lung cancer

PURPOSE

Matrix metalloproteinases (MMPs) degrade extracellular proteins and facilitate tumor growth, invasion, metastasis, and angiogenesis. This trial was undertaken to determine the effect of prinomastat, an inhibitor of selected MMPs, on the survival of patients with advanced non-small-cell lung cancer (NSCLC), when given in combination with gemcitabine-cisplatin chemotherapy.

PATIENTS AND METHODS

Chemotherapy-naive patients were randomly assigned to receive prinomastat 15 mg or placebo twice daily orally continuously, in combination with gemcitabine 1,250 mg/m2 days 1 and 8 plus cisplatin 75 mg/m2 day 1, every 21 days for up to six cycles. The planned sample size was 420 patients.

RESULTS

Study results at an interim analysis and lack of efficacy in another phase III trial prompted early closure of this study. There were 362 patients randomized (181 on prinomastat and 181 on placebo). One hundred thirty-four patients had stage IIIB disease with T4 primary tumor, 193 had stage IV disease, and 34 had recurrent disease (one enrolled patient was ineligible with stage IIIA disease). Overall response rates for the two treatment arms were similar (27% for prinomastat v 26% for placebo; P = .81). There was no difference in overall survival or time to progression; for prinomastat versus placebo patients, the median overall survival times were 11.5 versus 10.8 months (P = .82), 1-year survival rates were 43% v 38% (P = .45), and progression-free survival times were 6.1 v 5.5 months (P = .11), respectively. The toxicities of prinomastat were arthralgia, stiffness, and joint swelling. Treatment interruption was required in 38% of prinomastat patients and 12% of placebo patients.

CONCLUSION

Prinomastat does not improve the outcome of chemotherapy in advanced NSCLC.

Anandamide transport is independent of fatty-acid amide hydrolase activity and is blocked by the hydrolysis-resistant inhibitor AM1172

The endogenous cannabinoid anandamide is removed from the synaptic space by a high-affinity transport system present in neurons and astrocytes, which is inhibited by N-(4-hydroxyphenyl)-arachidonamide (AM404). After internalization, anandamide is hydrolyzed by fatty-acid amide hydrolase (FAAH), an intracellular membrane-bound enzyme that also cleaves AM404. Based on kinetic evidence, it has recently been suggested that anandamide internalization may be mediated by passive diffusion driven by FAAH activity. To test this possibility, in the present study, we have investigated anandamide internalization in wild-type and FAAH-deficient (FAAH(-/-)) mice. Cortical neurons from either mouse strain internalized [(3)H]anandamide through a similar mechanism, i.e., via a rapid temperature-sensitive and saturable process, which was blocked by AM404. Moreover, systemic administration of AM404 to either wild-type or FAAH(-/-) mice enhanced the hypothermic effects of exogenous anandamide, a response that was prevented by the CB(1) cannabinoid antagonist rimonabant (SR141716A). The results indicate that anandamide internalization in mouse brain neurons is independent of FAAH activity. In further support of this conclusion, the compound N-(5Z, 8Z, 11Z, 14Z eicosatetraenyl)-4-hydroxybenzamide (AM1172) blocked [(3)H]anandamide internalization in rodent cortical neurons and human astrocytoma cells without acting as a FAAH substrate or inhibitor. AM1172 may serve as a prototype for novel anandamide transport inhibitors with increased metabolic stability.

The interrater reliability of a functional capacity evaluation: the physical work performance evaluation

The purpose was to evaluate the interrater reliability of the Dynamic Strength, Position Tolerance, and Mobility tasks of the Physical Work Performance Evaluation (PWPE), a Functional Capacity Evaluation often used with workers disabled due to back pain. For each worker's evaluation, two raters were preselected among five trained raters. One of the raters administered the PWPE while the other functioned as a silent rater. A convenience sample of 40 workers disabled due to back pain and referred to an occupational rehabilitation center was used. In general, the reliability was "substantial" (0.61 < or = kappa < or = 0.80) to "almost perfect" (0.81 < or = kappa < or = 1.00) for most of the 21 tasks and three sections of the PWPE evaluated with the exception of three tasks in the Mobility section (ladder climbing (kappa = 0.47), repetitive trunk rotation--standing (kappa = 0.54), and repetitive trunk rotation--sitting (kappa = 0.37)) task and the Mobility section itself (kappa = 0.54). Several reasons could explain the lower agreement on the observation of the physical signs associated with these tasks. Since these tasks involve rotation movements or complex neuromuscular integration, it seemed difficult for the raters to define what are the normal physical signs and when physical signs of maximal functional capacity are present. The criteria for establishing the presence of the physical signs in the PWPE should be improved.

Nd:glass diode-pumped regenerative amplifier, multimillijoule short-pulse chirped-pulse-amplifier laser

We have built a diode-pumped Nd:glass regenerative amplifier that is able to produce energies up to 20 mJ within a 470-fs pulse duration at a 1-Hz repetition rate. We obtained this amplifier by using specific intracavity components such as a phase mirror and a birefringent filter to generate a large spatial mode and a large spectral width.

How to characterize meiotic functions in plants?

Our understanding of plant meiosis is rapidly increasing thanks to the model Arabidopsis thaliana. Here we present the results of a screening for meiotic mutants carried out with a library containing 30,719 T-DNA insertion lines. An average of one mutant per 1000 lines was recovered. Several phenotypic classes could be distinguished and are presented. In parallel, 39 proteins known to be involved in meiosis in non-plant organisms were chosen and a search was performed for homologue sequences in the completed Arabidopsis thaliana genome. Approximately 30% of the meiotic related sequences showed similarities with one or several Arabidopsis putative genes. The relevance of forward versus reverse genetics in order to characterize meiotic functions is discussed.

SWITCH1 (SWI1): a novel protein required for the establishment of sister chromatid cohesion and for bivalent formation at meiosis

We have characterized a new gene, SWI1, involved in sister chromatid cohesion during both male and female meiosis in Arabidopsis thaliana. A first allele, swi1.1, was obtained as a T-DNA tagged mutant and was described previously as abnormal exclusively in female meiosis. We have isolated a new allele, swi1.2, which is defective for both male and female meiosis. In swi1.2 male meiosis, the classical steps of prophase were not observed, especially because homologs do not synapse. Chromatid arms and centromeres lost their cohesion in a stepwise manner before metaphase I, and 20 chromatids instead of five bivalents were seen at the metaphase plate, which was followed by an aberrant segregation. In contrast, swi1.2 female meiocytes performed a mitotic-like division instead of meiosis, indicating a distinct role for SWI1 or a different effect of the loss of SWI1 function in both processes. The SWI1 gene was cloned; the putative SWI1 protein did not show strong similarity to any known protein. Plants transformed with a SWI1-GFP fusion indicated that SWI1 protein is present in meiocyte nuclei, before meiosis and at a very early stage of prophase. Thus, SWI1 appears to be a novel protein involved in chromatid cohesion establishment and in chromosome structure during meiosis, but with clear differences between male and female meiosis.

Platelet surface p-selectin, platelet-granulocyte heterotypic aggregates, and plasma-soluble p-selectin during plateletpheresis

BACKGROUND

Plateletpheresis components have been shown to contain p-selectin-positive platelets after collection and storage. P-selectin mediates binding of activated platelets to granulocytes and monocytes. This study was undertaken to assess platelet activation, granulocyte activation, platelet-granulocyte heterotypic aggregate formation, and the plasma-soluble p-selectin level during plateletpheresis performed on a particular instrument (MCS+, Haemonetics).

STUDY DESIGN AND METHODS

Flow cytometry was used to assay platelet surface p-selectin, granulocyte iC3b receptor, and platelet-granulocyte aggregates in the platelet component, residual blood in the disposable polycarbonate bowl of the MCS+, and in the donor blood with and without the addition of in vitro agonists before, during, and after plateletpheresis. The plasma-soluble p-selectin levels in the platelet component, disposable bowl, and donor venous blood were measured by an enzyme-linked immunosorbent assay.

RESULTS

Levels of p-selectin-positive platelets, activated granulocytes, and platelet-granulocyte aggregates were greater in the disposable bowl than in the preapheresis donor blood. Levels of p-selectin-positive platelets, activated granulocytes, and platelet-granulocyte aggregates in the postapheresis donor blood were similar to those in the preapheresis donor blood. The platelet components contained no activated granulocytes or detectable platelet-granulocyte heterotypic aggregates, and only about 10-percent activated platelets. The plasma-soluble p-selectin level in the platelet component was significantly greater than that in the preapheresis donor blood, the residual blood in the disposable bowl, or the postapheresis donor blood.

CONCLUSIONS

Measurements of platelet surface p-selectin, platelet-granulocyte heterotypic aggregates, and plasma-soluble p-selectin can be used to detect platelet activation during plateletpheresis.

TPDC-FuHu chemotherapy for the treatment of recurrent metastatic brain tumors

PURPOSE

To evaluate a combination of thioguanine, procarbazine, dibromodulcitol, CCNU (CCNU), fluorouracil, and hydroxyurea (TPDC-FuHu), designed to improve the efficacy of CCNU, in the treatment of recurrent metastatic brain tumors.

PATIENTS AND METHODS

One hundred fifteen patients with progressive or recurrent metastatic brain tumors that failed to respond to surgery and/or radiation therapy were enrolled onto a multicenter prospective study between 1989 and 1995. Patients received TPDC-FuHu in a repeated cycle every 6 weeks until recurrence or until they completed six courses.

RESULTS

Ninety-seven patients were assessable at the end of the study. Forty-eight had lung cancer (39 non-small-cell [NSCLC] and nine small-cell [SCLC]), 28 had breast cancer, nine had melanoma, and 12 had adenocarcinoma of different origins (three colon, two kidney, one bladder, one stomach, and five of unknown origin). The response and stable disease (SD) rate (overall response rate) was 52%, 66%, 60%, and 22% in patients with NSCLC, SCLC, breast cancer, and melanoma, respectively. Median time to progression (MTP) was 12, 26, 12, and 6 weeks, respectively, for the four groups. Side effects were mild to moderate in the majority of patients. Severe myelosuppression (grade 4) occurred in only 11% of the patients.

CONCLUSION

TPDC-FuHu chemotherapy is an active treatment against recurrent brain metastases from breast cancer and SCLC, and to a lesser extent from NSCLC. This regimen is well tolerated and has acceptable toxicity.

Photorefractive beam-steering system that uses energy transfer in a BaTiO(3) crystal for a fiber-array interconnect

A beam-control system to write gratings on a holographic plane is studied. The arrangement is designed to interconnect two 1024 monomode fiber arrays. The beam-control system is composed of two subsystems: a beam steerer, which deflects one incident beam toward 1024 positions, and a collimating system, which adapts the shape of the deflected beam to the holographic plane. The collimating system was studied only after the beam steerer had been fully built and tested. It is based on the photorefractive amplification of a beamlet selected by a shutter array. The deflection efficiency is enhanced by a factor 1500 with the photorefractive crystal, and the signal-to-noise ratio is larger than 5500. The influence of the optical aberrations on the coupling losses of the infrared beams in the monomode fibers are evaluated.

Treatment of external gastrointestinal fistulas by a combination of total parenteral nutrition and somatostatin

Thirty-seven patients with external gastrointestinal fistulas were treated with a combination of total parenteral nutrition (TPN) and somatostatin (ST). There was a significant fall in fistula output within the first day of treatment (p less than 0.001). On the first day of combined therapy, the reduction of fistula output was 70%, and in 68% of the cases, the fistula output fell to less than 50% of the initial level. Spontaneous closure was observed in 82% of the cases, and the time taken to close the fistula ranged between 1 and 14 days of starting therapy [5.4 +/- 0.7 days (mean +/- SEM)]. The response to TPN-ST treatment occurred, irrespective of age and sex of patients, duration and daily output of the fistulas before ST use, and their location in the gastrointestinal tract. Infection of fistula output was a factor of adverse prognosis. In all cases, and in the absence of mechanical obstacles, treatment that combines TPN and ST could be tried and continued up to 14 days in cases in which the fistula output falls more than 50% on the first day of treatment.