Hepatic vein reconstruction in living donor liver transplantation

INTRODUCTION

Living donor liver transplantation has emerged as a response to the cadaveric graft shortage, especially for adult recipients. Both right and left liver grafts are widely used, although some technical problems remain unresolved. Herein we describe our technique for reconstruction of the venous outflow in living donor liver transplantation.

METHODS

From April 1986 to September 2004, 1012 liver transplantations were performed including 30 living donor liver transplantations between April 1995 and September 2004. We have selected the first 28 cases to ensure a mean follow-up of 21.07 +/- 13.11 months. We transplanted 18 right lobe grafts, 7 left lobe grafts, and 3 left lateral segment grafts. A surgical technique is described herein.

RESULTS

No venous outflow obstruction developed among living donor liver transplantation recipients.

CONCLUSION

We recommend reconstruction of the hepatic veins in living donor liver transplantation including joining together the three hepatic veins in the recipient to avoid venous outflow obstruction.

Reconstruction of the medial patellofemoral ligament for painful patellar subluxation in distal torsional malalignment: a case report

Complex two-level rotational malalignment of the lower extremity can cause maltracking of the patella with anterior knee pain. Double derotation osteotomy would correct the underlying pathology. However, it carries a high risk of complications such as nerve and vessel damage. We report a case of rotational malalignment in the femur and the tibia associated with trochlear dysplasia, which causes painful patellar instability. The patient was successfully treated with reconstruction of the medial patellofemoral ligament and lateral release. Although the malrotation was not addressed, the position of the patella was corrected, and no dislocation occurred during a follow-up of 10 months.

Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability

BACKGROUND

Recurrent patellar instability is a common problem after dislocation. The medial patellofemoral ligament (MPFL) contributes 40-80% of the total medial restraining forces. This study assessed the clinical and radiological outcome after a follow-up of 4 years after linear MPFL reconstruction using an ipsilateral Semitendinosus tendon autograft.

STUDY DESIGN AND METHODS

15 knees in 12 patients were examined with a mean of 47 months after linear reconstruction of the MPFL at a mean age of 30 years. 3 knees underwent previous surgery. 3 patients had mild trochlear dysplasia grade I or II, according to the classification of Dejour. If preoperative tibial tuberosity-trochlear groove distance (TTTG) was more than 15 mm, patients underwent additional medialisation of the tibial tuberosity (n=8) creating a similar postoperative situation for all patients. All patients were available for a postoperative evaluation, which consisted of a subjective questionnaire, the Kujala score, and the recording of potential patellar redislocation and apprehension. Patellar height and tilt was measured on plain radiographs. Postoperative CT scans were performed in patients with an additional tibial tuberosity-transfer.

RESULTS

Postoperatively, one patient reported on recurrent bilateral redislocation. Physical examination however revealed no findings. Three knees presented with persistent patellar apprehension. Thirteen knees had improved subjectively after surgery. The mean Kujala score improved significantly from 55.0 to 85.7 points. The patellar tilt decreased significantly from 11.3 degrees to 9.2 degrees. Four knees had patella alta preoperatively, but only two at the latest follow-up visit. Previous surgery or additional trochlear dysplasia had no influence on the clinical outcome.

CONCLUSION

MPFL reconstruction improves clinical symptoms, reduces the patellar tilt substantially, and may correct patella alta. Additional mild trochlear dysplasia did not compromise the outcome; however, this fact needs further attention in a larger study group.

Effect of gamma irradiation on the microbiological quality of minimally processed vegetables

The initial microflora of minimally processed celery and cabbage packaged under a modified atmosphere was determined. The samples came from the same producer and were sold in a supermarket chain of Santiago, Chile. Although neither E. coli nor Salmonella spp. were detected, initial total plate and Enterobacteriaceae counts were high (= 10(5) cfu/g), not meeting in most cases the specifications of the Chilean legislation. The D10 value for two strains of E. coli (ATCC 8739 and a wild type) inoculated as indicator microorganisms was determined. After irradiating with 5 D10 doses (1kGy), the variation of the microbial population and sensory quality during a 7 days storage period at 5 degrees C was studied. In irradiated celery, a reduction of 4.7 and 3.8 logs for total plate and Enterobacteriaceae counts respectively was observed. There was a decrease of 3.8 and 3.6 logs in cabbage for total plate and Enterobacteriaceae counts respectively. In both irradiated and non-irradiated vegetables, neither E. coli nor Salmonella spp. were detected. An increase of 1.6 - 1.7 logs in both microbiological parameters in non-irradiated samples was observed during storage. In irradiated products, only celery showed an increase of 1.2 log in total plate count. Both Enterobacteriaceae count in the two vegetables and Total plate count in cabbage presented essentially no variation in time. No significant differences (p = 0.05) were detected in sensory total quality between the control and the irradiated vegetable and between days of storage.

Hyperhomocysteinemia in patients with mild chronic renal failure

BACKGROUND

The aim of this study was to evaluate the prevalence of high plasma levels of homocysteine in patients with mild renal failure.

METHODS

Forty-six chronic renal failure patients (25 males and 21 females, mean age 55.6+/-14.4 years) were recruited for the study. Mean plasma creatinine was 2.1+/-1.0 mg/dl and mean creatinine clearance was 50.6+/-26.3 ml/min. Patients with severe renal failure were excluded. Patients were compared with a control group with normal renal function (n=35, 22 men and 13 women, mean age 50.0+/-11.5 years). Plasma homocysteine values were measured in both groups at baseline and after an oral overload of methionine.

RESULTS

Baseline homocysteine levels of patients were higher than those of controls (16.5+/-7.3 vs. 10.4+/-4.2 micromol/l, p<0.0001). Some 34 patients and 4 controls had increased plasma homocysteine levels at baseline. After the oral overload, 4 more patients had abnormally increased homocysteine levels, meaning that 83% of the patients with chronic renal failure had hyperhomocysteinemia.

CONCLUSIONS

Hyperhomocysteinemia is a very common finding among patients with mild renal failure. The need for vitamin supplementation should be evaluated in the first stage of chronic renal failure.

Epidemiología del carcinoma hepatocelular en un área rural: Papel de los virus hepatotropos en la supervivencia

BACKGROUND

Chronic hepatitis C and B are the main causes of hepatocellular carcinoma (HCC) worldwide. It is not clear whether chronic hepatitis C or B virus (HCV or HBV) infection is a prognostic factor for HCC. This study aimed to asses epidemiology of HCC in a rural area and to determine if chronic HCV or HBV infection had any impact on survival after the diagnosis of HCC.

MATERIAL AND METHODS

Fifty-one consecutive patients were retrospectively studied. All of them were diagnosed of HCC between january 1994 and december 2002 in a First Level Hospital. The following variables were analysed: age, sex, HCV and HBV infection, chronic alcohol abuse (daily intake upper 80 g), clinical presentation, Child stage, number ol liver nodules, therapeutic options and survival.

RESULTS

The mean age at diagnosis of HCC was 68,5 years old (age range 45-90) and 45 patients (88,6%) were male. Heavy alcohol intake (66%) and chronic HCV infection (42,8%) were the most prevalent etiologic factors. Chronic HBV was found in 11,9%. Chronic HCV or HBV infection was present in 48,9%. Twenty-five percent were asymptomatic and 66% were in Child stage A. The rate single lesion / multilobular HCC was 52/48. Only 6% of all patients could be treated with a curative intention. The mean survival was 10,9 +/- 9,1 months, and there were no differences in age, sex, Child stage and number of nodules. There was a significantly higher survival in patients with chronic HCV or HBV infection (16,7 +/- 13,1 months versus 4,75 +/- 5,3 months in seronegative patients; p=0.02). On multivariate analysis, only chronic HCV or HBV infection was associated with survival longer than 10 months (OR 22,3; CI 95% 1,8-277,9).

CONCLUSIONS

In our area, heavy alcohol abuse and HCV infection were the most prevalent etiologic factors of HCC. Chronic HCV or HBV infection was associated with longer survival in patients with HCC.

Impact of Seasonal Changes in Ovine Milk on Composition and Yield of a Hard-Pressed Cheese

A hard-pressed, brined cheese was produced from frozen ovine milk collected in February, May, and August. Solids in the milk decreased as the season progressed. This was a result of high solids in early-lactation milk and low solids in August milk because of hot weather and poorer quality pastures. Casein as a percentage of true protein and the casein to fat ratio were higher in May and August milk. Fat in the cheese from February milk was higher and total protein was lower than in May and August. Milk, whey, and press whey composition were influenced by season and followed the trends of milk composition. Fat recovery in the cheeses ranged from 83.2 to 84.2%. Protein recovery in the cheeses was not affected by season. Cheese yield from February milk was higher than from May and August milk and was a result of higher casein and fat in the milk.

The value of capsule endoscopy in pediatric patients with a suspicion of Crohn's disease

BACKGROUND AND STUDY AIMS

The aim of this study was to assess the safety and usefulness of capsule endoscopy (CE) in pediatric patients with a suspicion of Crohn's disease.

PATIENTS AND METHODS

CE was used in 12 patients (four girls, eight boys; age 12-16; weight range 43-87 kg). The indication was a clinical suspicion of Crohn's disease not confirmed with traditional methods. Gastroscopy, colonoscopy, and small-bowel follow-through examinations were carried out in all of the patients, without any diagnostic findings. Ileoscopy was possible in 50 % of the patients, and the ileal mucosa and biopsies were normal in all cases.

RESULTS

The capsule was easily swallowed by all of the patients. They all excreted the capsule normally, and no complications were observed in any case. CE identified lesions suggestive of Crohn's disease in seven of the 12 (58.3 %), and the majority of the lesions were in the ileum.

CONCLUSIONS

CE is safe in pediatric patients over 12 years of age. The procedure appears to be a very useful diagnostic tool in children with Crohn's disease.

Role of the endocannabinoid system in Alzheimer's disease: New perspectives

The role of the endocannabinoid system in several diseases is currently under intense study. Among these, Alzheimer's disease may be a new promising area of research. We have recently reported the existence of profound changes in the location and density of several elements of this system in Alzheimer's disease tissue samples, indicating that a non-neuronal endocannabinoid system is up-regulated in activated glia. Additional data from other groups suggest that glial cells may be important elements in the regulation of endocannabinoid system activity, both in health as in disease. Some of these aspects are briefly discussed in the present review.

Iris yellow spot virus on Onion in New Mexico

Onions are an important crop for New Mexico with 7,700 acres (3,116 ha) harvested in the state in 2003 (3). In 2002, onions of several cultivars were first noticed with diamond-shaped chlorotic or bleached lesions on seed stalks or leaves, typical of those reported for Iris yellow spot virus (IYSV). A more widespread survey of breeding stocks and commercial onion fields revealed similar symptoms on thrips-infested onions in Dona Ana and Rio Arriba counties. Incidence of disease symptoms ranged from <0.5 to nearly 30%. Symptomatic leaves were assayed for the presence of IYSV using enzyme-linked immunosorbent assay (ELISA; Agdia, Elkhart, IN) and antisera acquired from Agdia. Symptomatic leaves from breeding and commercial fields tested positive for IYSV. The virus was transmitted by Thrips tabaci from symptomatic onions to three onion cvs. New Mex Mesa, New Mex Vado, and New Mex Cryspy in growth chamber tests. All three cultivars showed symptoms of IYSV and tested positive for the disease using ELISA. However, New Mex Vado and New Mex Cryspy cultivars each showed 24% infection (4 infected plants of 17 tested) compared with 59% infection (10 infected plants of 17 tested) for New Mex Mesa, suggesting that not all cultivars are equally susceptible to the virus. To our knowledge, this is the first report of IYSV in onions in New Mexico, which has also been reported in the western United States in Idaho, Oregon, Colorado, and Washington (1,2,4). References: (1) L. J. du Toit et al. Plant Dis. 88:222, 2004. (2) J. M. Hall et al. Plant Dis. 77:952, 1993. (3) National Agricultural Statistics Service, On-line publication. USDA, 2004. (4) H. F. Schwartz et al. Plant Dis. 86:560, 2002.

Understanding the Burden of Stress Urinary Incontinence in Europe: A Qualitative Review of the Literature

OBJECTIVE

This study was undertaken to better define the prevalence, risk factors, as well as the economic and human burden of stress urinary incontinence (SUI) in Europe that will help health care providers better understand the impact of this condition.

METHODS

A literature search was performed using MEDLINE, EMBASE, BIDS, HealthStar, HSRProj, and HSTAT databases to review the European literature (France, Germany, Italy, Spain, UK) on SUI between 1990 and 2001. Clinical experts on UI provided advice on this review.

RESULTS

In all European countries studied SUI was identified as a distinct and highly prevalent form of urinary incontinence, and in some countries, as many as 80% of all incontinent women were diagnosed with SUI. However, epidemiological figures varied widely between studies, due to different definitions of diagnostic criteria and disease states and study designs used. Parity and vaginal birth were identified as major risk factors for developing SUI. Only a few studies have examined the economic burden of SUI, but have found it to be significant on patients and society. SUI also significantly affects the quality of women's lives.

CONCLUSION

There is a clear need for harmonisation in defining SUI, standardising survey methods and validation criteria, and outcome measures, if results are to be compared with any validity. A better understanding of the burden of SUI is essential for future research.

[Venlafaxine extended release for the treatment of chronic pain. A series of 50 cases]

INTRODUCTION

The objective of this study is to investigate analgesic effectiveness and safety of venlafaxine extended release in chronic pain of any etiology.

METHODS

Six month, observational, open study, carried out in two pain units. Initially, a daily dose of 75 mg of venlafaxine extended release was administered, increasing it to 150 mg, following clinical criteria. Treatment response was measured using the Visual Analogue Scale (VAS), rest and mobilization, Hospital Anxiety and Depression Scale (HAD) and Eastern Cooperative Oncology Group (ECOG) and an adverse event sheet to record adverse events occurring during the study.

RESULTS

The study was carried out in a 50 patient sample with a mean age of 57.1 +/- 1.8 years, with chronic pain. A total of 85-90 % of the patients was maintained with a daily dose of 75 mg of venlafaxine extended release. This produced a gradual reduction of the VAS scores at rest (significant reduction of 5.2 +/- 1.1 to 2.7 +/- 1.5 points; (p<0.0005) and mobilization (significant reduction of 5.5 +/- 0.8 to 3.1 +- 1.6 points; p<0.0005). Pain relief increased progressively. Regarding physical activity measured by the ECOG scale, there was a reduction of the percentage of patients and increase of outpatients. Tolerability to venlafaxine was "excellent", "very good" or "good" for 72% of the patients.

CONCLUSIONS

Extended release venlafaxine can be an effective and well-tolerated treatment in patients with chronic pain of any etiology, although it must be investigated in depth.

Infections by Neisseria meningitidis serogroup X in Spain

We describe an atypical presentation of bacteremia caused by N. meningitidis serogroup X. By multilocus sequence typing the isolate was characterized to the sequence type 2139, which is not related with the clonal complex recently isolated in Africa. Since 1984, only six cases of serogroup X N. meningitidis infections have been diagnosed in Spain. Nevertheless, after the application of the conjugated vaccine, attention should be paid to the emergence of infections caused by unusual serogroups of N. meningitidis.

Levator scapulae and rhomboid transfer for paralysis of trapezius. The Eden-Lange procedure

Spinal accessory nerve palsy leads to painful disability of the shoulder, carrying an uncertain prognosis. We reviewed the long-term outcome in 16 patients who were treated for pain, weakness of active elevation and asymmetry of the shoulder and the neck due to chronic paralysis of the trapezius muscle, as a result of nerve palsy. Of four patients who were treated conservatively, none regained satisfactory function, although two became pain-free. The other 12 patients were treated operatively with transfer of the levator scapulae to the acromion and the rhomboid muscles to the infraspinatus fossa (the Eden-Lange procedure). At a mean follow-up of 32 years, the clinical outcome of the operatively treated patients was excellent in nine, fair in two, and poor in one patient, as determined by the Constant score. Pain was adequately relieved in 11 and overhead function was restored in nine patients. Pre-operative electromyography had been carried out in four patients. In two, who eventually had a poor outcome, a concomitant long thoracic and dorsal scapular nerve lesion had been present. The Eden-Lange procedure gives very satisfactory long-term results for the treatment of isolated paralysis of trapezius. In the presence of an additional serratus anterior palsy or weak rhomboid muscles, the procedure is less successful in restoring shoulder function.

Effects of disturbances caused by coastal constructions on spatial structure, growth dynamics and photosynthesis of the seagrass Posidonia oceanica

The light-limitation hypothesis was tested to assess whether water turbidity had caused the decline of a Mediterranean Posidonia oceanica (L.) Delile meadow in an area affected by a harbor. The annual growth, photosynthesis and rhizome starch concentrations of seagrass were measured and related to changes in light availability and dissolved nutrient concentration along a gradient of meadow degradation from areas close to the harbor outwards. Environmental and plant variables were measured in three stations placed along this gradient and compared with a reference station at an undisturbed meadow. The light attenuation coefficient (k) increased toward the inner harbor area, mainly due to sediment resuspension. The shoot density and leaf productivity of P. oceanica shoots were much lower in disturbed stations of the inner harbor area than in the outer, less disturbed station and the reference meadow. However, daily leaf carbon gains, calculated from the photosynthetic rates at saturating irradiance (P(max)) and the daily period in which seagrass receives light higher than its saturating irradiance (H(sat)), suggested positive C-balance in all stations. This was partly explained by photo-acclimatization of seagrass to the reduced light availability at the disturbed harbor stations (inner and intermediate), as indicated by the lengthening of H(sat) and the decrease in saturating irradiance (I(sat)) and respiratory demands. Despite photo-acclimatization, disturbed harbor stations showed less positive C-balance, seen not only in their lower leaf growth and biomass but also in a decrease in rhizome carbohydrate reserves (starch). Our results suggest that light reduction account for the reduced seagrass productivity and abundance. However, meadow decline (in terms of shoot mortality) in the harbor area is well above that predicted from similar light environments of nearby meadows or simulated in shading experiments. Thus, there are other factors than light limitation involved in seagrass mortality, most probably through more complex interactions (e.g. nutrient-epiphytes-grazers, water quality--siltation).

[Brain perfusion SPECT in the prognostic assessment of stroke]

PURPOSE

To compare the diagnostic yield of CT scan and perfusion SPECT on admission and its prognostic value in clinical outcome.

METHODS

25 ischemic stroke cases were studied on admission (<24 h) and at 30-60 days by CT scan, 99mTc-HMPAO-SPECT and neurological scales. Infarct size and severity on SPECT were assessed: visually "Total Weighted Score," added value in 22 areas, and by several semiquantitative count-based indices.

RESULTS

Sensitivity: the first CT scan was positive in 24% patients, initial SPECT in 75% (73% of pure subcortical infarcts and 91% of those with cortical involvement). Localization: kappa: 0.725 between SPECT findings on admission and those in control-CT at 5 days. Extent and severity: correlations between count-based and visual indices (r: >0.719), the latter correlated slightly better with clinical scales. Both predicted similarly (Rho>0.739) infarct size in CT diagnostic scan. Early Outcome: There were statistical differences between deceased and survivors in SPECT (<24h) indices and CT-infarct size (mean 5 days), but not in neurological scores on admission. Long term Outcome: Correlation of initial SPECT indices with follow-up functional scores (SNSLP, Barthel index; mean 37 days) was only significant for visual SPECT indices (Rho:0.560 to 0.620). Nevertheless the best predictor of functional status on discharge was the Barthel Index on admission.

CONCLUSIONS

1) Early SPECT has good sensitivity and accurate infarct size prediction so it can be a useful tool for deciding thrombolytic therapy; 2) Visual scores perform as well as more complex indices; 3) Infarct volume seems to be a critical determinant in vital outcome; other factors (strategic localization, etc.) might influence long term functional status.

Osteonecrosis diagnosed on MR images of the knee. Relationship to reduced bone mineral density determined by high resolution peripheral quantitative CT

PURPOSE

To evaluate if osteonecrosis diagnosed on MR images of the knee relates to reduced bone mineral density (BMD) and may be caused by an insufficiency fracture.

MATERIAL AND METHODS

Thirty-two consecutive patients (8 men, 24 women; age range 27-82 years, mean 62 years) with MR findings of osteonecrosis of the femoral or tibial condyle were prospectively included. Trabecular and cortical BMD were measured with high resolution peripheral quantitative CT in the non-dominant distal radius and the tibia of the involved extremity. One tibia was not measured due to posttraumatic deformity.

RESULTS

The mean trabecular BMD of the radius was 81% of the young-adult average peak BMD (range 19-160%). The mean cortical BMD in the radius was 86% (range 63-108%). The mean trabecular BMD in the tibia was 92% (range 28-160%). The mean cortical BMD in the tibia was 86% (range 49-132%). The values of the trabecular bone of the distal radius (tibia) were normal in 11 (15) patients, osteopenic in 12 (4), and osteoporotic in 9 (12), respectively. The cortical bone values of the distal radius (tibia) were normal in 12 (13) patients, osteopenic in 12 (12), and osteoporotic in 8 (6), respectively.

CONCLUSION

Osteoporosis and osteopenia are commonly found in patients with osteonecrosis of the knee as diagnosed on MR images. This indicates that for some patients an insufficiency mechanism may be responsible for the MR findings. However, in the patients with normal bone density other reasons for osteonecrosis may be present.

[Significance of axial rotation alignment of components of knee prostheses]

Increased internal malrotation of the tibial and femoral components affects kinematics of the patellofemoral joint and the flexion gap. A combined tibial and femoral malrotation may lead to maltracking of the patella. Isolated internal malrotation of the femoral component results in an asymmetric flexion gap. Clinically, the patients suffer from either lateral instability or medial stiffness in flexion. Lateral flexion instability leads to medial tibial pain,difficulties standing up from a chair,or instability during descending stairs or walking downhill. Medial stiffness in flexion may lead to secondary arthrofibrosis. There are three methods for determining femoral rotation by bony landmarks: (1) posterior condyles with 3 degrees of external rotation, (2) anterior-posterior axis according to Whiteside, and (3) transepicondylar axis. The transepicondylar axis approximates the flexion axis of the knee. All three bony landmarks have the disadvantage that they will not create a symmetric flexion gap in all cases. The balanced flexion gap technique seeks to achieve a perfectly balanced extension gap first, and then aligns the femoral component parallel to the tibial resection plane when the knee is under symmetric distraction in 90 degrees of flexion. The soft tissue releases for varus or valgus contraction have to be performed in extension first until the mechanical axis passes through the center of the knee, the center of the femoral head, and the center of the ankle. Using these methods, both,extension and flexion gap will become rectangular. The balanced flexion gap method has the disadvantage that the femoral component will not be aligned parallel to the epicondylar axis in some cases. It is not known which of the two methods will produce better clinical results. Rotational positioning of the tibial component referenced on the tibial tuberosity represents the most reliable method. Placing the tibial component according to the femoral component using the floating technique may increase an internal malrotation problem of the femur if present.

[Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty]

Rotational alignment of the tibial and femoral component plays an important role in modern total knee replacement surgery. After correct frontal alignment and proper soft tissue balancing, the rotational placement of the components represents the "third dimension" in knee endoprosthetic surgery. Improved surgical techniques with modified instruments and better rotational component positioning will lead to better functional outcomes. Patients with painful total knee arthroplasties (TKA) or early failure without evident classic implantation failures or signs of infection should be evaluated for malrotation of the components. In a prospective study in 26 patients with painful TKA and malrotation of the tibia and/or femur component, revision surgery with exchange of the components was performed. Twenty-five cases showed clinically relevant internal malrotation of the tibial component (ø 8.4 degrees ) and/or femoral component (ø 5.6 degrees ). Only one patient had 10 degrees of external malrotation of the femoral component. Combined malrotations of the tibia and femur were found in ten knees (38%). After revision surgery and correction of malrotations, 20 patients (78%) were scored with excellent and good results. Patients with painful TKA resistant to conservative therapy and evident malrotations of the component should be considered for revision surgery with change of the malrotated components.

Impact of preimplantation genetic diagnosis on IVF outcome in implantation failure patients

Implantation failure (IF) is defined as three or more failed IVF attempts, and preimplantation genetic diagnosis (PGD) is being used in these patients to improve IVF outcome. PGD was performed in 49 implantation failure patients with a mean number of 4.2 +/- 1.6 previous IVF failures, and in nine fertile controls. Fluorescence in-situ hybridization (FISH) on blastomeres from biopsied day 3 embryos was performed for chromosomes 13, 16, 18, 21, 22, X and Y. There was a significantly higher rate of chromosomal abnormalities (67.4%) compared with controls (36.3%). In 57 cycles, a pregnancy rate of 34.0% and an implantation rate of 19.8% was observed in implantation failure patients compared with controls (33.3 and 24.1% respectively), with all the pregnancies in the implantation failure group coming from the transfer of at least one chromosomally normal blastocyst on day 5. It is concluded that in IVF patients, use of PGD along with blastocyst transfer improves IVF outcome.

Prior aspirin use in unstable angina patients with modified plasma inflammatory markers and endothelial nitric oxide synthase in neutrophils

BACKGROUND

Prior use of aspirin in patients with acute coronary syndrome has been associated with a lower incidence of acute myocardial infarction. The aim of this study was to explore if prior aspirin therapy in unstable angina (UA) patients could modify systemic inflammatory markers such as interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and intercellular adhesion molecule-1 (ICAM-1) and the expression of endothelial nitric oxide synthase (eNOS) in neutrophils.

MATERIALS AND METHODS

Unstable angina was defined as transient S-T segment changes without significant increases in CK and CK-MB. We studied 50 consecutive patients admitted to hospital within 24 h after the onset of chest pain. The number of patients with prior aspirin was significantly higher (n = 32) than those not taking aspirin (n = 18) on admission.

RESULTS

Plasma levels of IL-6 and ICAM-1 were significantly increased in the UA patients when compared with the healthy control volunteers (n = 20) used as a reference for normal values. Plasma levels of both IL-6 and ICAM-1 were reduced in patients taking aspirin. There were no differences in the plasma levels of TNF-alpha between the UA patients and the control volunteers. The eNOS protein expression was also higher in neutrophils from the UA patients taking aspirin than in those not taking aspirin.

CONCLUSION

Patients taking aspirin before UA showed a lower systemic inflammatory response and higher eNOS protein expression in their neutrophils

Treatment of conjunctival lymphomas by beta-ray brachytherapy using a strontium-90-yttrium-90 applicator

We reviewed the outcome of the 10 patients (13 eyes) with localized, biopsy-proven, low-grade lymphoma of the conjunctiva treated at our Department between 1988 and 1997. All patients were treated by beta-ray brachytherapy using a bidirectional 90Sr-90Y ophthalmic applicator (Applicator SIA 2, Amersham plc). Total doses, prescribed at the surface of the applicator, varied between 40 Gy and 80 Gy. With a median follow-up of 78 months (range: 14 to 146 months), seven patients remained with no evidence of relapse (67.5% 10 year disease free survival). Local control was achieved in 10 out of 13 eyes (76.9%). Two of the three local relapses were marginal. One of these three patients also developed a metachronous lymphoma in the contralateral conjunctiva. These three patients underwent a second course of brachytherapy with 90Sr/90Y and remained free of second relapse 109, 68 and 33 months after salvage therapy. No cases of systemic relapse were observed. Late (LENT-SOMA) complications were of grade 2 in five eyes, of grade 3 in one eye and of grade 4 in one eye. Late complications of grade 2 or higher were observed in one out of five patients (20%) treated with doses lower or equal to 50 Gy and in six out of eight patients (75%) treated with doses higher than 50 Gy (P=0.086). Our data indicates that beta-ray brachytherapy was ultimately able to control most conjunctival lymphomas but carried a risk of late complications and marginal relapses that was possibly higher than the rates reported for other radiotherapy techniques.

Bacterial 16S rRNA gene analysis revealed that bacteria related to Arcobacter spp. constitute an abundant and common component of the oyster microbiota (Tiostrea chilensis)

To explore the bacterial microbiota in Chilean oyster (Tiostrea chilensis), a molecular approach that permits detection of different bacteria, independently of their capacity to grow in culture media, was used. Bacterial diversity was assessed by analysis of both the 16S rDNA and the 16S-23S intergenic region, obtained by PCR amplifications of DNA extracted from depurated oysters. RFLP of the PCR amplified 16S rDNA showed a prevailing pattern in most of the individuals analyzed, indicating that a few bacterial species were relatively abundant and common in oysters. Cloning and sequencing of the 16S rDNA with the prevailing RFLP pattern indicated that this rRNA was most closely related to Arcobacter spp. However, analysis by the size of the amplified 16S-23S rRNA intergenic regions revealed not Arcobacter spp. but Staphylococcus spp. related bacteria as a major and common component in oyster. These different results may be caused by the absence of target for one of the primers employed for amplification of the intergenic region. Neither of the two bacteria species found in large abundance was recovered after culturing under aerobic, anaerobic, or microaerophilic conditions. This result, however, is expected because the number of bacteria recovered after cultivation was less than 0.01% of the total. All together, these observations suggest that Arcobacter-related strains are probably abundant and common in the Chilean oyster bacterial microbiota.

[Sporadic Creutzfeldt-Jakob disease: phenotypic variability]

Prion disease are characterized by cerebral deposition of an abnormal protease-resistant isoform of a membrane-bound glycoprotein called prion protein. Sporadic Creutzfeldt-Jakob disease (CJDs) is the most frequent, accounting for approximately 85% of all human prion disease. The identification of a new variant of Creutzfeldt-Jakob disease has reinforced the need for a detailed analysis of phenotypic variability of CJDs. CJDs is typically characterized by rapidly progressive dementia, myoclonus, periodic sharp-wave electroencephalographic activity, and wide-spread spongiform degeneration. However, variations in clinical presentation, disease duration, as well as type and distribution of lesion have been consistently observed. The physicochemical properties of PrPsc in conjunction with the PRNP codon 129 genotype largely determine this phenotypic variability. Continued attention to clinically atypical cases is required to monitor the real incidence of CJDs. To reach this goal neuropathological examination, including the search for PrPsc, and molecular genetic analysis of human prion protein gene (PRNP) should be increasingly applied to atypical neurodegenerative diseases.

Fatty acid amide hydrolase localization in the human central nervous system: an immunohistochemical study

Recent discoveries have opened new fields for research on the biochemistry and pharmacology of cannabinoids. Among them, and most importantly, are the characterization and molecular cloning of central and peripheral cannabinoid receptors as well as the isolation of the first putative endogenous ligands that bind to them, anandamide and 2-arachidonylglycerol. The enzyme that degrades these so-called "endocannabinoids" is an integral membrane protein, fatty acid amide hydrolase. Its distribution and biochemistry in rat brain suggest that it plays a critical role in the regulation of the endocannabinoid system. However, few data exist regarding its distribution and mechanism of action in human tissues. To that end, we have studied its cellular distribution in the human central nervous system by immunohistochemistry. Using an affinity-purified antibody, we report that fatty acid amide hydrolase is localized to specific and well-delimited cell populations, including cortical pyramidal neurons, subcortical white matter astrocytes, striatal and striatoefferent projecting neurons, hypothalamic and midbrain nuclei, granular and molecular layers of the cerebellum, Purkinje neurons, dentate cerebellar nucleus, inferior olivary nuclei and others. This distribution resembles that of the central cannabinoid receptors as well as that of the enzyme distribution in the rat brain. In summary, the cellular localization of the degradative enzyme of the endogenous cannabinoid ligands in human central nervous system reveals its presence on both neuronal and glial elements and shows a significant overlapping with that of central cannabinoid receptors, mainly in areas related with motor control, confirming the notion that the endocannabinoid system plays a critical role in the control of movement.

Characterization of paint samples used in drinking water reservoirs: identification of endocrine disruptor compounds

Several migration tests are performed from various epoxy paint samples that, according to the regulation, can be used in food reservoirs such as drinking water reservoirs. The level of the organic compounds capable of producing migrations to water with special attention to endocrine disruptor compounds (EDCs) are identified and estimated by closed loop-stripping analysis (CLSA) and liquid-liquid extraction (LLE) methods coupled with gas chromatography (GC)-mass spectrometry (MS). Bisphenol A, a strong endocrine disruptor, is found in all migration experiments. Its concentration level reaches between 0.02 and 0.03 mg/cm2. The higher concentration corresponds with benzylic alcohol, which is used as a solvent and curing agent in epoxy paint. Other EDCs identified in the migration tests are phthalates, 4-nonylphenol, and t-butylphenol. The main non-EDCs identified are solvents, antioxidants, and rubber-like compounds. No great differences are found in the use of metallic plates or concrete slabs for migration experiments; only additional compounds related with the pretreatment of the concrete wall have been identified, too. In the study of a drinking water sample the same organic compounds identified in the migration test is not seen. This is probably because of the dynamic situation in a drinking water reservoir. Finally, a GC profile of a direct epoxy paint analysis is shown. The main peak identified is bisphenol A diglycidyl ether, monomer, and an active principle of the polymerization of epoxy resins based on bisphenol A. In addition, we report the recoveries of a selected group of EDCs using CLSA and LLE methods coupled with GC-MS.

[Disinfection treatment for lettuces (Lactuca sativa) and strawberries (Fragatia Chiloensis)]

The disinfection of vegetables and fruits is a treatment applied in order to reduce their natural contamination or processes to the product along the different steps of the food chain until its consumption. In the present work the effect of two disinfectants products was studied: grapefruit seed extract (400 ppm) for 10 min and peracetic acid (2000 ppm) for 1 min (action times assayed according to the manufacturer recommendations) and other additional times. The germicidal action was carried out against the natural contaminants of lettuces and strawberries, through the determination of the germicidal efficiency (%). Treated and untreated strawberries were also evaluated for flavor changes through a sensorial difference test, triangular test. None of the assayed products reached the 99.999% destruction of the natural contaminants according to the Chambers test. Peracetic acid was the most effective disinfectant, reaching the highest destruction percentages at a time lower than that for grapefruit seed extract. Sensory analysis showed no significant differences (p = .05) between strawberries with and without disinfection treatments, at the conditions suggested by the manufacturer.

Renal vascular injuries

Even today, most renal vascular injuries result in loss of renal function. Kidney salvage is not possible because of late diagnosis and the presence of severe associated injuries. Physical exam and basic laboratory tests are not sensitive; thus, a high index of suspicion is required. Repair should be attempted for all solitary kidneys and for patients sustaining bilateral injuries. All viable kidneys should be revascularized in order to increase the chances of obtaining adequate functional renal tissue. In the event that revascularization is not feasible, nephrectomy can be performed at a later time, if hypertension develops. In some cases, delayed return of function is possible, but in most cases the kidney will atrophy without producing hypertension. Most importantly, maintaining a high index of suspicion, prompt diagnostic evaluation, and judicious treatment can optimize outcome lowering the significant morbidity and mortality of renal vascular injuries.

[Carcinoid syndrome: report of a case with heart involvement and primary ovarian tumor]

A patient with a primary ovarian carcinoid tumor with extensive carcinoid heart disease, without hepatic metastases is presents. Literature was revisited, emphasizing that carcinoid heart disease secondary to an ovarian tumor is quite rare. Surgical indications relative to this patient are discussed.

Heterogeneity of Helicobacter pylori cag genotypes in experimentally infected mice

Our aim was to assess whether the Helicobacter pylori population recovered from experimentally infected mice show heterogeneity in cag genotypes. Wild-type FVB/N mice were challenged with strain Hp1 and sacrificed 8 weeks later. Direct PCR on gastric tissue was performed using primers for glmM and cagA, and for these two genes and for cagE and virB11 using DNA from the infecting and the emerging strains. The gastric tissues of two of five mice were PCR+ for glmM but not cagA. For the infecting strain, the PCRs for all four genes studied were strongly positive, but the sweeps from the emerging strains from both mice gave weaker signals for cagA and cagE. Examination of single colonies showed reduced or absent signals for cagA and cagE in relation to glmM and virB11. Serial dilution PCR of sweep isolates from the mice showed a 10- to 100-fold decrease in cagA signal compared to the infecting strain. The decrease of cagA and cagE, but not virB11, amplification and lack of cagA hybridization in Southern blots indicates a selective loss of the right half of the cag island during murine infection. This phenomenon is consistent with host-induced adaptive changes of cag genotype in the population of colonizing H. pylori cells.

Model-independent source imaging using two-pion correlations in (2 to 8)a GeV Au+Au collisions

We report a particle source imaging analysis based on two-pion correlations in high multiplicity Au+Au collisions at beam energies between 2A and 8A GeV. We apply the imaging technique introduced by Brown and Danielewicz, which allows a model-independent extraction of source functions with useful accuracy out to relative pion separations of about 20 fm. The extracted source functions have Gaussian shapes. Values of source functions at zero separation are almost constant across the energy range under study. Imaging results are found to be consistent with conventional source parameters obtained from a multidimensional Hanburg-Brown-Twiss analysis.

Effects of fish farm loadings on seagrass (Posidonia oceanica) distribution, growth and photosynthesis

The spatial extent and timing of the impact of fish farms on the distribution and performance of a Posidonia oceanica meadow were examined in an embayment of the south-eastern coast of Spain (Hornillo Bay, Murcia). Changes in seagrass distribution were determined using available seagrass mapping (from 1988, i.e., before the onset of aquaculture activities and 1998) and by successive sampling in 1994 and 1998. Environmental variables (light attenuation coefficient, water-column dissolved nutrients and organic content of sediments) together with plant performance (shoot biomass, leaf growth rate, photosynthetic activity, carbohydrate reserves, the number of leaves per shoot, epiphyte loads and herbivore pressure) were measured in plants affected by organic discharges, and were compared with those found in reference healthy plants over an annual growth cycle. Since the onset of fish farm activity, 11.29 ha of P. oceanica meadow has been completely lost and 9.86 ha significantly degraded, thus resulting in a total affected area which accounts for about 53% of the former meadow, or 7-fold the fish farming area. Unequal propagation of seagrass die-off or degradation reflects the relevance of local factors such as depth and hydrodynamism on the true extent of fish farm impact. Water transparency decreases and dissolved nutrient and organic content of sediments increases in the vicinity of cages compared to distant reference stations, thus supporting the notion of environmental gradients caused by the organic release from cages, which spreads outwards. Shoot size, leaf growth rate and the number of leaves per shoot in plants close to the fish farm decreased. Moreover, low leaf growth and low rhizome carbohydrate concentration (always relative to that found in an undisturbed area) indicated carbon budget imbalances. Since light reduction in the affected area was only modest (31% of light reaching the sea surface, while at the same depth this figure was 39% at the reference site), and light availability was well above the minimum requirement estimated for this species, neither this factor nor epiphyte overgrowth (epiphyte load was lower in the affected area) seem to explain such carbon imbalances or the observed meadow regression. Alternatively, the high herbivore pressure found in the affected zone suggests that overgrazing is one of the main causes of decreasing shoot sizes and hence of carbon imbalance, reduced growth and shoot mortality. The impact of fish farms on seagrasses, therefore, seems to be highly variable and depends on complex interactions between a large number of processes.

Dislocation of the polyethylene inlay due to anterior tibial slope in revision total knee arthroplasty

We report a case of dislocation of the polyethylene inlay in revision total knee arthroplasty. Eight days after revision arthroplasty due to a previous infection, the polyethylene inlay of a PCL- retaining cemented total knee arthroplasty dislocated at about 80 degrees of flexion on the CPM machine. Lateral X-ray examination revealed an anterior slope of the tibial cut of 5 degrees. Correction of the tibial slope to a posterior tibial slope of 7 degrees reduced the forces on the posterior aspect of the inlay and no redislocation occurred. The mechanisms causing tibial inlays to dislocate in TKA are analyzed and discussed.

Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings

Our purpose was to compare the accuracy of ultrasonography (US) and magnetic resonance (MR) in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings. Using US and MR, we studied all painful shoulders seen during 1998 in our orthopaedic unit. Diagnosis was confirmed in 61 cases. The diagnosis of full thickness rotator cuff tear was highly specific on both imaging techniques (100% for US and 97.1% for MR) but was not as sensitive on US (57.7%) as on MR (80.8%). The diagnosis of partial tear was acceptably specific (67.9% for US and 75.5% for MR) but was not sensitive (overall, 12.5% for US vs 50% for MR). The specificity of a US diagnosis of a tear allows us to recommend surgery, thus making it a good imaging technique for the initial study of painful shoulders. The low sensitivity makes it necessary to undertake an additional MR study. If the MR also discovers no pathology, the sensitivity based on the US and MR images (92.7%) can be sufficient to avoid a false-negative diagnosis.

Lipophilic extractives in process waters during manufacturing of totally chlorine free kraft pulp from eucalypt wood

The chemical composition of lipophilic extractives from process waters throughout a totally chlorine free (TCF) bleaching sequence after kraft pulping of eucalypt wood has been studied. These compounds are among the most problematic wood constituents for both TCF and zero liquid effluent (ZLE) processes, since they tend to accumulate in circuits resulting in the formation of the so-called pitch deposits causing serious problems in the pulp and paper industry. Pitch deposits collected at different parts of the pulp mill were also characterized and their composition compared with that of lipophilic compounds in process waters and Eucalyptus globulus wood. The identification of these compounds from process waters, wood and pitch deposits was performed by gas chromatography and gas chromatography-mass spectrometry using short- and medium-length high temperature capillary columns. Sterols, sterol esters, steroid ketones and steroid hydrocarbons were the main compounds identified. These chemical species arise from eucalypt wood extractives that survive the pulping and are released from pulp into the process waters during the bleaching process. Finally, they can deposit in pulp and on different parts of the mill or remain suspended in process waters being discharged in effluents.