Gastric heterotopia with extensive involvement of the small intestine associated with congenital short bowel syndrome and intestinal malrotation

We present a case of extensive gastric heterotopia involving the small intestine associated with congenital short bowel syndrome and malrotation. The infant showed a normal mesenteric artery, without signs of "apple peel" deformity. Gastric heterotopia extended from the duodenum to the mid-ileum involving the short bowel. Gastric mucosa heterotopia may involve any segment of the gastrointestinal tract. It can be associated with pancreatic heterotopia and Meckel diverticulum. However, our case showed involvement of two-thirds of the small intestine without pancreatic heterotopia. To our knowledge, this is the first report of gastric heterotopia with congenital short gut syndrome and malrotation.

Daily Trimethoprim-Sulfamethoxazole Prophylaxis Rapidly Induces Corresponding Resistance Among IntestinalEscherichia coliof HIV-Infected Adults in Kenya

Background. Trimethoprim-sulfamethoxazole (TMP-SMZ) has been recommended by World Health Organization (WHO) as daily prophylaxis for Africans with AIDS to prevent opportunistic infections. Daily TMP-SMZ may reduce its susceptibility to commensal intestinal Escherichia coli (E coli), increasing the burden of TMP-SMZ-resistant pathogens. Methods. Participants received either daily TMP-SMZ (CD4 <350 cells/mm3) or daily multivitamins (MVIs; CD4 ≥350 cells/mm3) for 6 months. Stool was collected at baseline, 2 weeks, 2 months, and 6 months. A random E coli was tested for susceptibility. Results. Baseline prevalence of TMP-SMZ resistance ranged from 71% to 81% and was not different across CD4 strata. At 2 weeks, prevalence of TMP-SMZ-resistant E coli increased significantly from 78% to 98% (P < .001) among persons taking daily TMP-SMZ and did not change among persons taking MVIs. Conclusions. Daily prophylaxis with TMP-SMZ induced in vivo resistance to the drug after 2 weeks. Empiric therapy for diarrhea with agents other than TMP-SMZ should be considered for HIV-infected persons receiving daily TMP-SMZ prophylaxis.

Prevalence of viral erythrocytic necrosis in Pacific herring and epizootics in Skagit Bay, Puget Sound, Washington

Epizootics of viral erythrocytic necrosis (VEN) occurred among juvenile Pacific herring Clupea pallasii in Skagit Bay, Puget Sound, Washington, during 2005-2007 and were characterized by high prevalences and intensities of cytoplasmic inclusion bodies within circulating erythrocytes. The prevalence of VEN peaked at 67% during the first epizootic in October 2005 and waned to 0% by August 2006. A second VEN epizootic occurred throughout the summer of 2007; this was characterized by disease initiation and perpetuation in the age-1, 2006 year-class, followed by involvement of the age-0, 2007 year-class shortly after the latter's metamorphosis to the juvenile stage. The disease was detected in other populations of juvenile Pacific herring throughout Puget Sound and Prince William Sound, Alaska, where the prevalences and intensities typically did not correspond to those observed in Skagit Bay. The persistence and recurrence of VEN epizootics indicate that the disease is probably common among juvenile Pacific herring throughout the eastern North Pacific Ocean, and although population-level impacts probably occur they are typically covert and not easily detected.

Safety and efficacy of high-frequency jet ventilation in neonatal transport

OBJECTIVE

To evaluate the safety and efficacy of high-frequency jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center.

STUDY DESIGN

We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical ventilator or a high-frequency oscillator to a high-frequency jet ventilator+/-inhaled nitric oxide.

RESULT

The pre- and post transport vital signs remained stable, regardless of the type of ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency jet ventilation+/-inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide (P<0.05). The improvement started before transport upon changing the mode of ventilation to a high-frequency jet ventilator.

CONCLUSION

Independent of the use of inhaled nitric oxide, high frequency jet ventilation appears to provide better ventilation than conventional mechanical ventilation and is safe to transport pre-ECMO neonates.

Canine leptospirosis infections - clinical signs and outcome with different suspected Leptospira serogroups (42 cases)

OBJECTIVES

The aim of the study was to investigate the presence of serum antibodies to different Leptospira serogroups in dogs with a clinical diagnosis of leptospirosis in southern Germany and to compare seroreactivity to different serogroups with history, clinical signs, laboratory findings and survival rate.

METHODS

In this study, the data of 42 dogs with the diagnosis of leptospirosis were evaluated retrospectively. Dogs were presented to the Small Animal Medicine Teaching Hospital (Medizinische Kleintierklinik) of the Ludwig Maximilians University Munich, Germany, between 1990 to 2003.

RESULTS

Reactivity to the serogroup grippotyphosa (13/42) was most frequently present, followed by reactivity to the serogroup saxkoebing (10/42). There was no difference in the clinical picture and the laboratory changes between dogs whose sera were reactive to different serogroups.

CLINICAL SIGNIFICANCE

Most of the dogs with leptospirosis in southern Germany had sera reacting to serogroups other than icterohaemorrhagiae and canicola, which are contained in the vaccine. Thus, currently available vaccines in Europe do not protect against the most common Leptospira organisms associated with clinical disease.

Immunofluorescent synaptonemal complex analysis in azoospermic men

The molecular cause of germ cell meiotic defects in azoospermic men is rarely known. During meiotic prophase I, a proteinaceous structure called the synaptonemal complex (SC) appears along the pairing axis of homologous chromosomes and meiotic recombination takes place. Newly-developed immunofluorescence techniques for SC proteins (SCP1 and SCP3) and for a DNA mismatch repair protein (MLH1) present in late recombination nodules allow simultaneous analysis of synapsis, and of meiotic recombination, during the first meiotic prophase in spermatocytes. This immunofluorescent SC analysis enables accurate meiotic prophase substaging and the identification of asynaptic pachytene spermatocytes. Spermatogenic defects were examined in azoospermic men using immunofluorescent SC and MLH1 analysis. Five males with obstructive azoospermia, 18 males with nonobstructive azoospermia and 11 control males with normal spermatogenesis were recruited for the study. In males with obstructive azoospermia, the fidelity of chromosome pairing (determined by the percentage of cells with gaps [discontinuities]/splits [unpaired chromosome regions] in the SCs, and nonexchange SCs [bivalents with 0 MLH1 foci]) was similar to those in normal males. The recombination frequencies (determined by the mean number of MLH1 foci per cell at the pachytene stage) were significantly reduced in obstructive azoospermia compared to that in controls. In men with nonobstructive azoospermia, a marked heterogeneity in spermatogenesis was found: 45% had a complete absence of meiotic cells; 5% had germ cells arrested at the zygotene stage of meiotic prophase; the rest had impaired fidelity of chromosome synapsis and significantly reduced recombination in pachytene. In addition, significantly more cells were in the leptotene and zygotene meiotic prophase stages in nonobstructive azoospermic patients, compared to controls. Defects in chromosome pairing and decreased recombination during meiotic prophase may have led to spermatogenesis arrest and contributed in part to this unexplained infertility.

Meiotic studies in two human reciprocal translocations and their association with spermatogenic failure

BACKGROUND

Reciprocal translocations are often associated with infertility in male carriers. However, some carriers present normal semen profiles and are identified because of repetitive pregnancy failures.

METHODS

Here, we report two different cases of reciprocal translocations. The first patient carried a t(10;14) and was normozoospermic. The second patient carried a t(13;20) and was azoospermic. Synaptonemal complexes from both carriers were analysed using immunocytogenetic techniques and multi-centromere fluorescent in situ hybridization (cenM-FISH).

RESULTS

Associations between the quadrivalent and the sex body or other autosomes were seen only in the t(13;20) carrier. Heterosynapsis was observed only in the t(10;14) carrier. Synaptic pairing abnormalities were seen in 71% of the spreads in the t(13;20) carrier and 30% of the spreads in the t(10;14) carrier. Recombination frequency was decreased in the t(13;20) carrier, but not in the t(10;14) carrier.

CONCLUSIONS

By comparing these two different translocation carriers with different fertility outcomes, we discuss the possible mechanisms by which translocations might cause the spermatogenesis process to fail.

Discovering How Students Search a Library Web Site: A Usability Case Study

Have Internet search engines influenced the way students search library Web pages? The results of this usability study reveal that students consistently and frequently use the library Web site’s internal search engine to find information rather than navigating through pages. If students are searching rather than navigating, library Web page designers must make metadata and powerful search engines priorities. The study also shows that students have difficulty interpreting library terminology, experience confusion discerning difference amongst library resources, and prefer to seek human assistance when encountering problems online. These findings imply that library Web sites have not alleviated some of the basic and long-range problems that have challenged librarians in the past.

Ambient pCO2 modulates intracellular pH, intracellular oxidant generation, and interleukin-8 secretion in human neutrophils

Although neutrophils are a critical component of the inflammatory process, their functional regulation is incompletely understood. Of note, although pCO2 varies physiologically and pathologically in the neutrophilic milieu, its affect on neutrophil biological processes is unresolved. We demonstrate here that neutrophils respond to hypo- and hypercarbia, (0.04% and 10%) by increasing and decreasing, respectively, intracellular oxidant production (basally and in response to opsonized Escherichia coli and phorbol esters). Further, hypo- and hypercarbia increase and decrease, respectively, the release of IL-8 from LPS-stimulated cells; both effects are attenuated by the carbonic anhydrase inhibitor, acetazolamide. Anion exchange did not restore pH(i) under hypocarbic conditions, however partial restoration of pH(i) under hypercarbic conditions was achieved by Na+/H+ exchange and vacuolar ATPases. Abrogation of pCO2-induced changes in pH(i) prevented hypocarbia-induced generation of reactive oxidant species. These observations suggest that CO2 modifies neutrophil activity significantly by altering pH(i).

Chromosome analysis of spermatozoa extracted from testes of men with non-obstructive azoospermia

Infertile men with azoospermia now have the possibility of fathering children by testicular sperm extraction combined with intracytoplasmic sperm injection. However, there are concerns about the risk of chromosomal abnormalities in their spermatozoa. We have studied aneuploidy frequencies for chromosomes 13, 21, X and Y by multicolour fluorescence in-situ hybridization (FISH) in testicular spermatozoa extracted from three men with non-obstructive azoospermia. The men were 34-37 years of age and had normal follicle-stimulating hormone (FSH) concentrations and normal 46,XY somatic karyotypes. A total of 3324 spermatozoa was analysed. The infertile patients had an elevated frequency of disomy for chromosomes 13, 21, XY disomy compared to controls but none of these reached statistical significance. Also there was no significant difference in the sex ratio or the frequency of diploidy in azoospermic patients compared to normal control donors. This first report on chromosomal aneuploidy in spermatozoa extracted from testes of patients with non-obstructive azoospermia suggests that some azoospermic men do not have a substantially increased risk of chromosomally abnormal spermatozoa.

Interleukin-1 receptor-associated kinase and TRAF-6 mediate the transcriptional regulation of interleukin-2 by interleukin-1 via NFkappaB but unlike interleukin-1 are unable to stabilise interleukin-2 mRNA

Interleukin-1 receptor-associated kinase, IRAK, has been shown to activate NFkappaB in response to interleukin-1. We have explored the involvement of IRAK in regulation of the interleukin-2 gene in the murine thymoma cell line EL4.NOB-1 by examining its effect on interleukin-2 promoter-linked reporter gene expression, interleukin-2 gene transcription and interleukin-2 protein production. Cells transfected with IRAK displayed high levels of phosphorylated IRAK, increased interleukin-2 promoter-linked reporter gene expression (which was dependent on NFkappaB) and interleukin-2 gene transcription. IRAK was unable, however, to increase interleukin-2 protein production. Overexpression of TRAF-6 induced similar responses and again failed to increase interleukin-2 protein production. A dominant negative TRAF-6 inhibited reporter gene expression and interleukin-2 protein production in response to both interleukin-1 and IRAK transfection. Interleukin-1 treatment and IRAK or TRAF-6 transfection increased interleukin-2 mRNA production. Only interleukin-1 treatment stabilised the induced transcripts with 50% being detectable at 20 h post induction. The interleukin-2 mRNA induced in IRAK- or TRAF-6-transfected cells was depleted by >90% at 6 h post induction. These data implicate IRAK and TRAF-6 in transcriptional regulation of interleukin-2 gene expression via NFkappaB, and provide direct evidence that IRAK lies upstream from TRAF-6. Neither IRAK nor TRAF-6 participates in stabilisation of interleukin-2 mRNA which is required for interleukin-2 protein production.

Cryosurgery for prostate cancer: improved glandular ablation by use of 6 to 8 cryoprobes

OBJECTIVES

To describe and assess the efficacy for increased glandular destruction by using 6 to 8 cryoprobes in place of the traditional 5 probes.

METHODS

In April 1996, a revised method for cryosurgery was begun that uses 6 to 8 cryoprobes, and by July 1997, 81 men had been treated. This group was compared retrospectively to our last 82 cases done before April 1996 using 5 cryoprobes. All cases were consecutive. To ensure that the groups were similar, comparison was performed of entrance prostate-specific antigen (PSA), clinical stage, and Gleason score. Six months after cryosurgery, PSA and residual epithelial acini were compared between the two groups.

RESULTS

The two groups were comparable for all the above parameters (P >0.05). The degree of overall glandular kill was greater for the 6 to 8-probe method (P = 0.023). Complete glandular ablation for the 5-probe and 6 to 8-probe methods was 39% and 53%, respectively, and the difference was not significant (P = 0.072). However, when one combined the complete glandular ablation group with the none to few residual acini group, 67.5% for the 5-probe method and 88.9% for the 6 to 8-probe method, a significant difference was found (P = 0.001). The odds of having many remaining acini versus having none to few were 3.5 times greater in the 5-probe group than in the 6 to 8-probe group. The mean and median PSA for the 5- and 6 to 8-probe groups were 0.19 and 0.1 versus 0.11 and 0.07 ng/mL, respectively, a significant difference (P = 0.02). No difference was found in rates of tumor persistence or complications.

CONCLUSIONS

A revised method for cryosurgery using 6 to 8 cryoprobes has proved to be more effective for near-glandular ablation than the traditional 5-probe method. It was easily applied, had a wide margin of safety, and even shortened learning time. These innovations have permitted a closer approach to the goal of complete glandular destruction.

Hepatitis C in state correctional facilities

BACKGROUND

No previous studies have examined the extent to which correctional facilities in the United States screen for and treat hepatitis C (HCV) infection.

METHODS

Medical directors of state correctional facilities responded to a survey assessing the degree to which prisons screen for and treat hepatitis C. To estimate numbers of inmates eligible for interferon treatment and to examine costs associated with HCV management, we constructed a feasibility model that incorporated screening criteria used in California and Rhode Island.

RESULTS

Thirty-six states and Washington, DC, responded, resulting in a survey response rate of 73%, representing 77% of all inmates in state facilities nationwide. Colorado alone reported routine screening. Only California reported conducting a systematic seroprevalence study, which found that 39.4% of male inmates were hepatitis C antibody positive in 1994. Seventy-three percent of the respondents sometimes consider treating with interferon. Four states follow a standard protocol. The feasibility model suggests that treating suitably screened inmates is a reasonable expenditure for correctional systems.

CONCLUSION

Prison may be an appropriate setting for treatment of hepatitis C. If accompanying substance abuse issues are addressed, instituting HCV treatment for certain eligible incarcerated individuals may be a worthy target for public health dollars.