Pilot-Scale Production of Traditional Galotyri PDO Cheese from Boiled Ewes’ Milk Fermented with the Aid of Greek Indigenous Lactococcus lactis subsp. cremoris Starter and Lactiplantibacillus plantarum Adjunct Strains

The performance of a mixed thermophilic and mesophilic starter culture consisting of Streptococcus thermophilus ST1 and the Greek indigenous nisin-A-producing Lactococcus lactis subsp. cremoris M78 was evaluated in the absence (A: ST1+M78) or presence (B: ST1+M78+H25) of Lactiplantibacillus plantarum H25—another indigenous ripening strain—under real cheesemaking conditions. Three pilot-scale trials of fresh (6-day-old) Galotyri PDO cheese were made from boiled milk by an artisanal method using simple equipment, followed by cold ripening of the A1–A3 and B1–B3 cheeses at 4 °C for 30 days. All of the cheeses were analyzed microbiologically and for pH, gross composition, proteolysis, sugar and organic acid contents, and sensorial attributes before and after ripening. The artisanal (PDO) Galotyri manufacturing method did not ensure optimal growth of the ST1+M78 starter as regards the constant ability of the thermophilic strain ST1 to act as the primary milk acidifier under ambient (20–30 °C) fermentation conditions. Consequently, major trial-dependent microbial and biochemical differences between the Acheeses, and generally extended to the Bcheeses, were found. However, high-quality Galotyri was produced when either starter strain predominated in the fresh cheeses; only trial A1 had microbiological and sensory defects due to an outgrowth of post-thermal Gram-negative bacterial contaminants in the acidified curd. The H25 adjunct strain, which grew above 7 to 9 log CFU/g depending on the trial, had minor effects on the cheese’s pH, gross composition, and proteolysis, but it improved the texture, flavor, and the bacteriological quality of the Bcheeses during processing, and it exerted antifungal effects in the ripened cheeses.

The effects of microcystin-LR in Oryza sativa root cells: F-actin as a new target of cyanobacterial toxicity

Microcystins are toxins produced by cyanobacteria, notorious for negatively affecting a wide range of living organisms, among which several plant species. Although microtubules are a well-established target of microcystin toxicity, its effect on filamentous actin (F-actin) in plant cells has not yet been studied. Τhe effects of microcystin-LR (MC-LR) and an extract of a microcystin-producing freshwater cyanobacterial strain (Microcystis flos-aquae TAU-MAC 1510) on the cytoskeleton (F-actin and microtubules) of Oryza sativa (rice) root cells were studied with light, confocal, and transmission electron microscopy. Considering the role of F-actin in endomembrane system distribution, the endoplasmic reticulum and the Golgi apparatus in extract-treated cells were also examined. F-actin in both MC-LR- and extract-treated meristematic and differentiating root cells exhibited time-dependent alterations, ranging from disorientation and bundling to the formation of ring-like structures, eventually resulting in a collapse of the F-actin network after longer treatments. Disorganization and eventual depolymerization of microtubules, as well as abnormal chromatin condensation were observed following treatment with the extract, effects which could be attributed to microcystins and other bioactive compounds. Moreover, cell cycle progression was inhibited in extract-treated roots, specifically affecting the mitotic events. As a consequence of F-actin network disorganization, endoplasmic reticulum elements appeared stacked and diminished, while Golgi dictyosomes appeared aggregated. These results support that F-actin is a prominent target of MC-LR, both in pure form and as an extract ingredient. Endomembrane system alterations can also be attributed to the effects of cyanobacterial bioactive compounds (including microcystins) on the F-actin cytoskeleton.

Correction to: Giant nonfunctioning adrenal tumors: two case reports and review of the literature

In the publication of this article [1], there is an error in the Family Name and Given Name of the authors since these were interchanged.

Giant nonfunctioning adrenal tumors: two case reports and review of the literature

Background

There are an estimated 1–2 cases per million per year of adrenocortical carcinoma in the USA. It represents a rare and aggressive malignancy; it is the second most aggressive endocrine malignant disease after anaplastic thyroid carcinoma. Non-secretory adrenal masses are diagnosed late due to a mass effect or metastatic disease or found incidentally (adrenal incidentalomas).

Case presentation

The first case report describes a 39-year-old Greek woman who presented to our department with complaints of repeated symptoms of flatulence and epigastric discomfort over a few months. The second case report is about a 67-year-old Greek woman who presented to our department after being evaluated for fatigue, mass effect, and epigastric discomfort. Both of them were diagnosed as having a nonfunctioning adrenocortical carcinoma and underwent open adrenalectomy.

Conclusions

Approximately 60% of patients with adrenocortical carcinoma present with symptoms and signs of hormonal secretion. Our cases’ adrenocortical carcinomas were not functional. Hormone secretion is not a discriminating feature between benign and malignant adrenocortical masses. The silent clinical nature of nonfunctioning adrenocortical carcinoma results in late diagnosis, while the majority of patients present with locally advanced and/or metastatic disease.

Adrenocortical carcinoma is a rare endocrine tumor with a poor prognosis that can be diagnostically challenging and demands high clinical suspicion. The work-up for adrenal masses must include determination of whether the mass is functioning or nonfunctioning and whether it is benign or malignant.

All-Mechanical Polarization Control and Anomalous (Electro)Mechanical Responses in Ferroelectric Nanowires

Piezoelectric and ferroelectric nanowires exhibit properties and phases that are not available in the bulk. They are extremely promising for functional nanoscale application. On the basis of atomistic first-principles-based simulations, we predict an all-mechanical polarization control in ferroelectric nanowires. We report that the application of uniaxial compressive stress to ferroelectric nanowires with poor surface charge compensation leads to a reversible phase switching between the polar phase with axial polarization and macroscopically nonpolar flux-closure phase. The phase switching is associated with anomalously large changes in polarization and piezoelectric and mechanical response. In particular, in PbTiO₃ nanowires the values as large as 5400 pC/N and 140 TPa^-1 are predicted for the piezoelectric coefficient and elastic constant, respectively. Remarkably, the effect persists up to the gigahertz frequency which is potentially promising for nanoscale applications, such as nanogenerators, biomedical electronics, monitoring devices, nanosensors, nanotransducers, and nanoactuators.

Thymic pathology and cardiac myxomas: Coincidence or a closer relationship?

Myxomas are the most common benign cardiac tumors and are located more frequently in the left atrium. In the literature there are cases describing the coexistence of thymic tumors and cardiac myxomas. In the case reported herein, during the resection of a cardiac myxoma, an enlarged thymus gland was encountered and resected. The histological exam revealed a thymic hyperplasia. The aim of this case study is to assess the need of conducting further studies in order to identify a common histological pathway between thymic lesions and cardiac myxomas. The diagnosis of a cardiac myxoma could justify a further workup of the anterior mediastinum in order not to overlook a lesion of thymic origin.

Growth, nisA Gene Expression, and In Situ Activity of Novel Lactococcus lactis subsp. cremoris Costarter Culture in Commercial Hard Cheese Production

This study evaluated in situ expression of the nisA gene by an indigenous, nisin A-producing (NisA+) Lactococcus lactis subsp. cremoris raw milk genotype, represented by strain M78, in traditional Greek Graviera cheeses under real factory-scale manufacturing and ripening conditions. Cheeses were produced with added a mixed thermophilic and mesophilic commercial starter culture (CSC) or with the CSC plus strain M78 (CSC+M78). Cheeses were sampled after curd cooking (day 0), fermentation of the unsalted molds for 24 h (day 1), brining (day 7), and ripening of the brined molds (14 to 15 kg each) for 30 days in a fully controlled industrial room (16.5°C; 91% relative humidity; day 37). Total RNA was directly extracted from the cheese samples, and the expression of nisA gene was evaluated by real-time reverse transcription PCR (qRT-PCR). Agar overlay and well diffusion bioassays were correspondingly used for in situ detection of the M78 NisA+ colonies in the cheese agar plates and antilisterial activity in whole-cheese slurry samples, respectively. Agar overlay assays showed good growth (>8 log CFU/g of cheese) of the NisA+ strain M78 in coculture with the CSC and vice versa. The nisA expression was detected in CSC+M78 cheese samples only, with its expression levels being the highest (16-fold increase compared with those of the control gene) on day 1, followed by significant reduction on day 7 and almost negligible expression on day 37. Based on the results, certain intrinsic and mainly implicit hurdle factors appeared to reduce growth prevalence rates and decrease nisA gene expression, as well as the nisin A-mediated antilisterial activities of the NisA+ strain M78 postfermentation. To our knowledge, this is the first report on quantitative expression of the nisA gene in a Greek cooked hard cheese during commercial manufacturing and ripening conditions by using a novel, rarely isolated, indigenous NisA+ L. lactis subsp. cremoris genotype as costarter culture.

Agreement between Rheumatologist and Patient-reported Adherence to Methotrexate in a US Rheumatoid Arthritis Registry

OBJECTIVE

Rheumatologists have limited tools to assess medication adherence. The extent to which methotrexate (MTX) adherence is overestimated by rheumatologists is unknown.

METHODS

We deployed an Internet survey to patients with rheumatoid arthritis (RA) participating in a US registry. Patient self-report was the gold standard compared to MTX recorded in the registry.

RESULTS

Response rate to the survey was 44%. Of 228 patients whose rheumatologist reported current MTX at the time of the most recent registry visit, 45 (19.7%) had discontinued (n = 19, 8.3%) or missed ≥ 1 dose in the last month (n = 26, 11.4%). For the subgroup whose rheumatologist also confirmed at the next visit that they were still taking MTX (n = 149), only 2.6% reported not taking it, and 10.7% had missed at least 1 dose.

CONCLUSION

MTX use was misclassified for 13%-20% of patients, mainly because of 1 or more missed doses rather than overt discontinuation. Clinicians should be aware of suboptimal adherence when assessing MTX response.

Identification of BACH2 and RAD51B as rheumatoid arthritis susceptibility loci in a meta-analysis of genome-wide data

Objective

A recent high-density fine-mapping (ImmunoChip) study of genetic associations in rheumatoid arthritis (RA) identified 14 risk loci with validated genome-wide significance, as well as a number of loci showing associations suggestive of significance (P = 5 × 10⁻⁵ < 5 × 10⁻⁸), but these have yet to be replicated. The aim of this study was to determine whether these potentially significant loci are involved in the pathogenesis of RA, and to explore whether any of the loci are associated with a specific RA serotype.

Methods

A total of 16 single-nucleotide polymorphisms (SNPs) were selected for genotyping and association analyses in 2 independent validation cohorts, comprising 6,106 RA cases and 4,290 controls. A meta-analysis of the data from the original ImmunoChip discovery cohort and from both validation cohorts was carried out, for a combined total of 17,581 RA cases and 20,160 controls. In addition, stratified analysis of patient subsets, defined according to their anti–cyclic citrullinated peptide (anti-CCP) antibody status, was performed.

Results

A significant association with RA risk (P < 0.05) was replicated for 6 of the SNPs assessed in the validation cohorts. All SNPs in the validation study had odds ratios (ORs) for RA susceptibility in the same direction as those in the ImmunoChip discovery study. One SNP, rs72928038, mapping to an intron of BACH2, achieved genome-wide significance in the meta-analysis (P = 1.2 × 10⁻⁸, OR 1.12), and a second SNP, rs911263, mapping to an intron of RAD51B, was significantly associated in the anti-CCP–positive RA subgroup (P = 4 × 10⁻⁸, OR 0.89), confirming that both are RA susceptibility loci.

Conclusion

This study provides robust evidence for an association of RA susceptibility with genes involved in B cell differentiation (BACH2) and DNA repair (RAD51B). The finding that the RAD51B gene exhibited different associations based on serologic subtype adds to the expanding knowledge base in defining subgroups of RA.

Raman spectroscopy in bioanalysis

Recent advances in instrument design have allowed researchers to use smaller, more efficient components in designing Raman spectrometers. Advances in instrumentation have increased the performance of Raman instruments and increased their usage in bioanalysis. This paper reviews recent improvements in instrument design and discusses several applications of Raman spectroscopy to diagnosis in biology, chemistry and medicine.

Myocardial citrullination in rheumatoid arthritis: a correlative histopathologic study

Introduction

The aim of this study was to explore the presence and localization of myocardial citrullination in samples from rheumatoid arthritis (RA) patients compared to rheumatic and non-rheumatic disease control groups.

Methods

Archived myocardial samples obtained during autopsy from 1995 to 2009 were assembled into four groups: RA; scleroderma; fatal myocarditis; and non-rheumatic disease controls. Samples were examined by immunohistochemistry (IHC) for the presence and localization of citrullination and peptidyl arginine deiminase enzymes (PADs) by a single cardiovascular pathologist blinded to disease group and clinical characteristics.

Results

Myocardial samples from seventeen RA patients were compared with those from fourteen controls, five fatal myocarditis patients, and ten scleroderma patients. Strong citrullination staining was detected exclusively in the myocardial interstitium in each of the groups. However, average and peak anti-citrulline staining was 59% and 44% higher, respectively, for the RA group compared to the combined non-RA groups (P < 0.05 for both comparisons). Myocardial fibrosis did not differ between the groups. In contrast to citrullination, PADs 1 to 3 and 6 were detected in cardiomyocytes (primarily PADs 1 and 3), resident inflammatory cells (primarily PADs 2 and 4), and, to a smaller extent, in endothelial cells and vascular smooth muscle cells. PAD staining did not co-localize with anti-citrulline staining in the interstitium and did not vary by disease state.

Conclusions

Staining for citrullination was higher in the myocardial interstitium of RA compared to other disease states, a finding that could link autoimmunity to the known increase in myocardial dysfunction and heart failure in RA.

Lateral skull base surgery: the otology group experience

Lateral skull base surgery has remained the surgical frontier of new developments in the treatment of lesions heretofore difficult to access. Examination of surgical results stimulates technical innovation and provides an intervention risk-benefit ratio assessment for particular lesions useful in management planning. With this in mind, we report the updated collective experience with lateral skull base surgery at the Otology Group over the past 20 years. Two hundred ninety-eight patients underwent surgical intervention for lateral skull base lesions. In 81 patients these lesions were malignant; in 217, benign. Of the benign lesions, 165 were glomus tumors: 139 glomus jugulare, 19 glomus vagale, and 7 glomus tympanicum. The remainder comprised 21 menigniomas, 14 neuromas, two neurofibromas, and a small group of much rarer entities. The philosophy of surgical approach, results, and follow-up are discussed.

Synchronous Presence of Nasopharyngeal Carcinoma and Marginal Zone (MALT-Type) B-Cell Lymphoma in the Pharynx

Synchronous malignancy of squamous cell carcinoma and malignant lymphoma in the head and neck region is extremely rare. Nasopharyngeal carcinoma is a nonlymphomatous, squamous cell carcinoma that occurs in the nasopharyngeal epithelium. Reported herein is a unique case of nasopharyngeal carcinoma occurring simultaneously with MALT-type lymphoma in an 83-year-old woman, who complained of deglutition dysfunction. Endoscopic examination of respective organs revealed a submucosal tumour on the posterior wall of pharynx. Biopsy of the hypopharynx was taken and sent for histological examination, which revealed two different neoplasms. Immunohistochemical and molecular analysis confirmed the diagnosis of nasopharyngeal carcinoma coexisting with a MALT-type lymphoma.

Acute Experimental Hyperthyroidism Does Not Affect Basal and Volume-Induced Atrial Natriuretic Peptide Secretion in Healthy Subjects

Background. Excess circulating thyroid hormones are associated with increased cardiac atrial natriuretic peptide (ANP) secretion but the exact mechanisms involved have not been fully elucidated in vivo. Methods. To examine whether thyroid hormone regulation of ANP secretion is the result of a direct action on the myocardium and/or of an indirect action through alterations in the peripheral circulation, plasma ANP levels (baseline and volume expansion-induced) were evaluated in 14 healthy men, before and after triiodothyronine (T₃) administration. Results. T₃ administration was followed by a significant increase in serum T₃ levels and a significant decrease in serum TSH levels, without significantly affecting ANP levels. Systemic vascular resistance, plasma rennin activity (PRA), and aldosterone (ALDO) levels, as well as indices of left atrial function, were not significantly altered, despite a significant increase in cardiac output. Plasma volume expansion, induced by a 1500 ml normal saline (NSal) infusion, both before and after T₃ administration, was followed by a significant decrease in PRA and ALDO and a significant increase in plasma ANP levels, without significantly affecting the mean blood pressure (BP) and heart rate (HR) in each study period. The NSal-induced response, measured as the integrated area under the curve corrected for baseline values (-AUC), was not different after T₃ administration for ANP, ALDO, PRA, HR, and mean BP. Conclusion. In vivo thyroid hormone-induced myocardial ANP secretion is the result of an indirect action mainly through hemodynamic changes that increase atrial stretch.

Support vector machines based analysis of brain SPECT images for determining cerebral abnormalities in asymptomatic diabetic patients

PURPOSE

An image processing method was developed to investigate whether brain SPECT images of patients with diabetes mellitus type II (DMII) and no brain damage differ from those of normal subjects.

MATERIALS AND METHODS

Twenty-five DMII patients and eight healthy volunteers underwent brain 99mTc-Bicisate SPECT examination. A semi-automatic method, allowing for physician's interaction, was developed to delineate specific brain regions (ROIs) on the SPECT images. Twenty-eight features from the grey-level histogram and the spatial-dependence matrix were computed from numerous small image-samples collected from each specific ROI. Classification into 'diabetics' and 'non-diabetics' was performed for each ROI separately. The classical least squares-minimum distance (LSMD) classifier and the recently developed support vector machines (SVM) classifier were used. System performance was evaluated by means of the leave-one-out method; one sample was left out, the classifier was trained by the rest of the samples, and the left-out sample was classified. By repeating for all samples, the classifier's performance could be tested on data not incorporated in its design.

RESULTS

Highest classification accuracies (LSMD: 97.8%, SVM: 99.1%) were achieved at the right occipital lobule employing two features, the standard deviation and entropy. For the rest of the ROIs classification accuracies ranged between 84.5 and 98.6%.

CONCLUSION

Our findings indicate cerebral blood flow disruption in patients with DMII. The proposed system may assist physicians in evaluating cerebral blood flow in patients with DMII undergoing brain SPECT.

Gigantic hepatic amebic abscess presenting as acute abdomen: a case report

Introduction

Amebiasis is a parasitic disease caused by Entamoeba histolytica. It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases. Liver abscess is the most common extra-intestinal manifestation. The large number of clinical presentations of amebic liver abscess makes the diagnosis very challenging in non-endemic countries. Late diagnosis of the amebic abscess may lead to perforation and amebic peritonitis, resulting in high mortality rates.

Case presentation

This report describes a 37-year-old white man, suffering from hepatitis B, with a gigantic amebic liver abscess presenting as an acute abdomen due to its rupture. Rapid deterioration of the patient's condition and acute abdomen led to an emergency operation. A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII. Surgical drainage of the hepatic abscess was performed; two wide drains were placed in the remaining hepatic cavities and one on the right hemithorax. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. The diagnosis of amebic abscess was made by the pathologists who identified E. histolytica in the debris.

Conclusion

Acute abdomen due to a ruptured amebic liver abscess is extremely rare in western countries where the parasite is not endemic. Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.

Effect of 4 weeks of basic military training on peripheral blood leucocytes and urinary excretion of catecholamines and cortisol

In this study, we assessed the effects of a 4 week basic military physical training programme for male recruits of the Hellenic Air Force on the number and distribution of circulating immune cells and adrenergic and adrenocortical hormonal responses. One group of recruits (exercised, n = 48) participated in moderate intermittent physical exercise, whereas a second group (non-exercised controls, n = 9) performed only light work in the barracks. Both groups participated in the same non-physical, classroom-type training and testing. Military training by the exercised group resulted in significant increases in CD4+ T-lymphocytes, renal cortisol excretion and the urinary noradrenaline/adrenaline ratio, together with reductions in neutrophils and the neutrophil/lymphocyte ratio. In the exercised group, the urinary noradrenaline/adrenaline ratio correlated positively with the training-induced changes in CD4+ T-lymphocytes and negatively with changes in the neutrophil/lymphocyte ratio. No significant relationship was found between training-induced increases in cortisol excretion and any of the peripheral blood cell alterations. Our results indicate that 4 weeks of military training consisting of intermittent moderate exercise resulted in a significant increase in CD4+ T-lymphocytes and reduction in neutrophils. These changes were probably driven by alterations in hormonal status, including the significant impact of sympathetic nervous system activation.

Improvement of tardive dyskinesia following amisulpride treatment

Tardive dyskinesia (TD) is a persistent, disturbing side effect of antipsychotic drug treatment. It is established that clozapine and other second generation agents cause less TD and may also improve pre-existing TD. We report a case of significant improvement of TD after the administration of amisulpride, a potential D(2)/D(3) antagonist that has atypical properties. The possible effect of fast dissociation of D(2) receptors is being discussed.

Akinetic mutism followed by a manic reaction on introduction of steroid replacement for Addison's disease

Neuropsychiatric changes during exogenous corticosteroid administration are well-recognized. However, reports of neuropsychiatric reactions to corticosteroid replacement for Addison's disease are distinctively rare. We report on a patient with primary adrenocortical insufficiency, initially presenting with depressive symptoms, who developed akinetic mutism followed by acute manic illness shortly after the initiation of steroid replacement. Both disorders occurred with physiological doses of hydrocortisone and resolved spontaneously. The pathogenesis of the above neuropsychiatric reactions is discussed in the context of glucocorticoid receptor-related brain effects of glucocorticoids. In addition, this report points to the need for accurate psychiatric assessment of patients with Addison's disease upon introduction of replacement therapy.

Normalization of thyroid hormone levels in patients with either hyper- or hypothyroidism results in a profound change of atrial natriuretic peptide (ANP) levels

Atrial Natriuretic Peptide (ANP) is a hormone produced by cardiac atrial myocytes. Thyroid hormones may affect its release. The aim of this study was to analyze the effect of hyper and hypothyroidism on the secretion of ANP and its relationship with the changes of the renin-angiotensin-aldosterone system. Plasma ANP concentration as well as plasma renin activity (PRA) and aldosterone (ALDO) were measured in 21 patients with hyperthyroidism, 12 patients with hypothyroidism and 29 normal controls. Moreover, in 5 hyperthyroid and 8 hypothyroid patients hormones measurements were performed at diagnosis and 15, 30, 45 and 60 days after starting the appropriate therapy. Statistical analysis was performed employing the Wilcoxon two sample test to compare the ANP levels in normal and hyper or hypothyroid patients while the pairwise comparisons were evaluated using the Spermans rank correlation. Partial correlation and regression models were used to examine the joint effects of multiple predictors on ANP. ANP levels were significantly higher in hyperthyroid (mean+/-SEM, 17+/-1.7 pmol/L, +/-<0.001) and lower in hypothyroid patients (6.18+/-1.14 pmol/L, p<0.01) compared to normals (10.35+/-0.59 pmol/L). In the hyperthyroid patients following treatment with antithyroid drugs plasma ANP levels reached normal values after 15 days and remained stable thereafter. In the hypothyroid patients, ANP levels increased gradually following initiation of treatment with thyroxine, reaching values comparable to controls at day 45. PRA was significantly higher only in hyperthyroid patients compared to controls. ALDO concentrations were not different in all groups studied. No correlation was found between plasma ANP levels and T3, T4, TSH, PRA and ALDO levels in the individual groups, while a positive correlation for T3 (r=0.610, p<0.01), T4 (r=0.653, p<0.01) and pulse rate (r=0.704, p<0.01) and negative correlation with TSH (r=-0.519, p<0.01) was found when all groups were pooled together. In conclusion, our data indicate that thyroid hormones affect positively ANP secretion from cardiac myocytes. This effect may be, at least in part, indirect via hemodynamic alterations.

Tunable resonance fluorescence monochromator with sub-Doppler spectral resolution

A cesium-based resonance fluorescence monochromator with a spectral resolution of 200 MHz and a tunable response over the D(2) absorption line of cesium (380 MHz) is described. The narrow spectral response is achieved through excitation of a monokinetic population of the 6(2)P(3/2)( degrees ) state by arrangement of the excitation lasers in either a copropagating or a counterpropagating orientation. The narrow spectral response of the detector allows for excitation of specific hyperfine components involved in the 6(2)P(3/2)( degrees ) (F=3-5) to 6(2)D(5/2) (F=2-6) transition (917.23 nm). The selectivity gained through resolving specific hyperfine transitions allows for a photon detector that is both spectrally tunable and narrow. We report the sub-Doppler linewidths achieved through various laser beam orientations. We also describe how these beam geometries can be applied to spectrally narrow and tunable image detection.

Time-related decay of the benefits of biofeedback therapy

Although immediate results are good to excellent in great majority of patients who undergo biofeedback treatment (BFT) for chronic constipation and fecal incontinence, they tend to loose the benefit over a period of time. The purpose of this study was to evaluate the long-term sustainability of results after successful biofeedback treatment. Two groups of patients who successfully completed BFT at our institution from 1995 to 1997 were created based on the date of completion. The first had a mean follow-up of 35 months and the second group was followed for an average of 12 months. Both groups were questioned as to the presence of constipation and incontinence. The questioning was focused depending on the patient's diagnosis. This information was then compared with the initial BFT results. Overall, all patients were satisfied by the initial BFT results. All patients initially had an excellent or good response to BFT. However, after a mean of 35 months, in the first group, 19 of 22 patients had a near complete regression back to their pre-biofeedback status. In the 14 patients in the second group with mean follow-up of 12 months, 11 had a significant decay in benefits. Only time was a significant factor in the decay of BFT benefits. In conclusion, BFT is highly effective in the treatment of selected patients with complex defecation disorders. Although there is a high initial success rate, there is a clear loss of the immediate benefits over time. Other factors such as dietary habits, pelvic floor exercises, manometry, invasive EMG, and rectal sensation did not correlate with long-term outcomes. The comparison between the two groups reveals a linear model describing the time decay of the benefits of BFT. Based on the linear model, patients may need reevaluation after one year and may benefit from additional BFT.

Sealed-cell mercury resonance ionization imaging detector

A sealed, compact mercury atomic-absorption resonance ionization imaging detector has been developed and evaluated. The sensitivity of the detector as well as its ability to form two-dimensional images has been demonstrated. Images of faint light (1000 photons) have been recorded by image summation. It is shown that one can obtain high-quality images with a spatial resolution of at least 130 mum by detecting the ionic component of the imaging signal. Distortion, more noise, and poorer spatial resolution were observed when the electron component of the signal was detected. We studied the influence of voltage on the cell electrodes to find the conditions for optimum signal-to-noise ratio.

Selective patching in carotid endarterectomy: is patching always necessary?

BACKGROUND

The value of carotid patching in carotid endarterectomy in achieving low perioperative morbidity and long-term freedom from restenosis is controversial. We hypothesized that if large internal carotid arteries were closed primarily and smaller arteries selectively patched, there would be no difference in early or long-term results between the two groups.

METHODS

A retrospective analysis of 133 carotid endarterectomies performed by one surgeon in a community teaching hospital was performed to evaluate a selective approach to patching vs primary closure. Primary closure was performed if the arteriotomy could be closed without tension over a Javid shunt. Seventy-seven arteries underwent primary closure and 56 underwent patching (Vein-14, PTFE-17, Dacron-25). Postoperative (>6 month) duplex scans were available on 46/77 (60%) patients undergoing primary closure, and 33/56 (59%) of patients with patch repair.

RESULTS

There were 2 perioperative neurologic deficits, both in the patch group. Restenosis of equal or greater than 50% at 11 months occurred in 5/46 (10.8%) of patients with primary closure and 2/34 patients (5.9%) with patch closure (p=ns). No patient in either group had a late neurologic event or required a redo operation.

CONCLUSIONS

Selective primary closure is not associated with increased risk of perioperative neurologic events or statistically significant evidence of late postoperative stenosis if primary closure is performed in large internal carotid arteries.

Temporal bone and lateral skull base malignancy: experience and results with 81 patients

OBJECTIVE

This study aimed to examine predictive factors and treatment outcome and to devise a staging method for malignant lateral skull base disease.

STUDY DESIGN

The study design was a retrospective review of all lateral skull base surgery cases.

SETTING

The study was conducted at a tertiary referral center.

PATIENTS

Of 317 lateral skull base lesions, 81 patients were found to have malignant disease. Three groups were identified, and the data were analyzed according to the following: epithelial malignancies, 30 patients; malignancies of salivary gland origin, 23 patients; and malignancies of mesenchymal origin, 28 patients. The mean age was 48.5 years with a range of 5-83 years. There were 42 males and 39 females. Our mean follow-up time was 54 months with a range of 1-180 months. Forty-three patients were alive without evidence of recurrent disease, 6 were living with disease, 25 were dead of disease, 3 died of other causes, and 4 were lost to follow-up.

INTERVENTIONS

All patients underwent surgery with curative intent. Forty-two received adjuvant radiation, and 8 received chemotherapy.

MAIN OUTCOME MEASURES

Treatment failure, survival, cranial nerve deficits, complications, and predictive factors were analyzed.

RESULTS

A 58% treatment success rate was observed. Epithelial and salivary malignancy had a poorer prognosis, and pain and facial nerve dysfunction at presentation carried a worse prognosis.

CONCLUSIONS

Lateral skull base malignancy is a rare entity that continues to challenge cranial base surgeons. Cranial nerve deficits and complications are frequent. The success rate of treatment is dependent on histology and disease extent.

Facial nerve outcome in lateral skull base surgery for benign lesions

OBJECTIVE

To statistically identify factors most important in affecting CN7 outcome in lateral skull base surgery for benign lesions.

STUDY DESIGN

A retrospective review of 217 nonmalignancy lateral skull base procedures from 1970 to 1995 at the Otology Group in Nashville.

METHODS

Charts were reviewed for epidemiology, histopathology, staging, type of CN7 mobilization (none, short, long, severance with reanastomosis, and resection), preoperative and postoperative CN7 function, surgery performed, and survival.

RESULTS

Average House-Brackman (HB) scores for mobilizations were as follows: short, 1.65: long, 2.74: and grafting, 4.33. Factors found to affect outcome in a statistically significant fashion were preoperative HB score, staging, type of CN7 manipulation, and surgical approach. Meningiomas were found to have a worse outcome than glomus tumors.

CONCLUSIONS

Complete resection of tumors should be performed with minimal manipulation of the facial nerve based on regional anatomy and tumor anatomy.

Obsessions and compulsions as a distinct cluster of symptoms in schizophrenia: a neuropsychological study

Using neurocognitive testing, the present study assessed whether obsessions and compulsions could represent a distinct cluster of symptoms in schizophrenia. We formulated our hypothesis based on data from nonschizophrenic patients, expecting to find that schizophrenic patients with obsessive-compulsive (OC) symptoms would experience more difficulties in the same cognitive areas as nonschizophrenic patients with obsessive-compulsive disorder (OCD). Patients had separate psychiatric and cognitive evaluations. The OC and non-OC schizophrenic subjects did not differ significantly on the positive and negative symptom scores. However, compared with non-OC schizophrenic patients, those with OC symptoms performed worse on cognitive areas thought to be impaired (i.e., visual-spatial skills, delayed nonverbal memory, and cognitive shifting abilities). In addition, the severity of OC scores correlated with poor performance in these areas of cognition. Our results support our hypothesis, specifically that OC symptoms may constitute a distinct cluster separate from psychosis in schizophrenia and raise the possibility of a distinct subtype of schizophrenia. The theoretical and clinical implications of these findings are discussed.