Rapid detection of gastric Campylobacter pylori colonization by a simple biochemical test.

A simple and rapid urease test to detect Campylobacter pylori infection was evaluated with bacterial culture as the "gold standard." The test was compared with the Gram stain and the conventional Christensen urease test. The culture method detected C. pylori in 29 of 49 gastric biopsy specimens. The rapid urease test showed 27 positive samples within 1 h at 55 degrees C (specificity, 100%; sensitivity, 93%) and 18 at room temperature (specificity, 100%; sensitivity, 62%). The Gram stain exhibited a sensitivity of 86% and a specificity of 91%. The conventional Christensen urease test detected C. pylori in only 4, 10, and 18 samples after 24, 48, and 72 h, respectively (sensitivities, 12, 36, and 60%, respectively; specificities, 95, 95, and 83%, respectively). We conclude that the rapid urease test is simple and highly specific for the detection of C. pylori and that it can be performed with small amounts of sample.     

Clinicopathologic analysis of microscopically invasive breast carcinoma

Breast biopsy or mastectomy cases having diagnoses of carcinoma in situ with “microinvasion,” “minimal invasion,” “focal invasion,” or “suggestive of invasion” were reviewed and all histologically identified foci of invasive disease from each case were measured using an ocular micrometer. Cases in which any single focus of invasion was greater than 5 mm or the added size of separate invasive foci exceeded 10 mm were excluded, resulting in a study group of 75 patients. Invasive neoplasm was present in the initial biopsy in 69 of 75 cases (92%); however, residual invasive neoplasm was found in the subsequent lumpectomy/mastectomy from 14 of these (20%). In 59% of cases, two or more histologically separate foci of invasion were identified. Invasive foci consisted of isolated cells or cell clusters, each less than 1 mm (microfocal invasion), in 33% of cases. In 12 cases, the sum of individual invasive foci was 5 to 10 mm. Axillary lymph nodes (LN) from 5 of 69 patients (7%) contained metastatic carcinoma (four cases, one LN positive; one case, two LN positive). The cumulative sizes of all invasive foci in the LN-positive group were microfocal invasion (one case), 0.6 mm (one case), 1.1 mm, 2.5 mm, and 5.8 mm. The difference in frequency of axillary node metastasis between tumors with microfocal and measurable invasion (4.3% v 8.6%) was not statistically significant. Follow-up data were available on 55 cases (mean interval, 66.1 months). One (node-negative) patient had duct carcinoma in situ recurrence in the same breast 4 years after initial treatment. Another (with unknown node status) developed an axillary lymph node metastasis 13 months after initial treatment (96% disease-free survival). We conclude that microscopic stromal invasion in breast carcinoma, at least in the setting of significant in situ component, is often initiated from multiple foci. Patients with microscopically invasive breast carcinoma have a small but significant risk of axillary metastases, although a highly favorable survival.     

The spiritual needs of parents at the time of their child's death in the pediatric intensive care unit and during bereavement: a qualitative study.

OBJECTIVE: Death is common in pediatric intensive care units. A child's death can shatter parents' personal identities, disrupt their relationships, and challenge their worldviews. Spirituality is a human characteristic that engenders transcendence; seeks meaning, purpose, and connection to others; and helps to construct a coherent worldview. Greater attention to spiritual needs may help parents cope with their loss. Our objective is to gain a deeper understanding of parents' spiritual needs during their child's death and bereavement. DESIGN: Prospective, qualitative study. SETTING: University-affiliated children's hospital. Participants: Thirty-three parents of 26 children who died in the pediatric intensive care unit between January 1, 1999, and August 31, 2000. INTERVENTIONS: Semistructured, in-depth, videotaped interviews with parents 2 yrs after their child's death. MEASUREMENTS AND MAIN RESULTS: The main spiritual need described by parents was that of maintaining connection with their child. Parents maintained connection at the time of death by physical presence. Parents maintained connection after the death through memories, mementos, memorials, and altruistic acts such as organ donation, volunteer work, charitable fund raising, support group development, and adoption. Other spiritual needs included the need for truth; compassion; prayer, ritual, and sacred texts; connection with others; bereavement support; gratitude; meaning and purpose; trust; anger and blame; and dignity. CONCLUSIONS: Bereaved parents have intense spiritual needs. Health care providers can help to support parents' spiritual needs through words and actions that demonstrate a caring presence, impart truth, and foster trust; by providing opportunity to stay connected with the child at the time of death; and by creating memories that will bring comfort in the future.     

'The thief of womanhood': women's experience of polycystic ovarian syndrome

Previous research on polycystic ovarian syndrome (PCOS) has overwhelmingly been conducted within a medical or psychiatric framework, and has failed to explore women's own experience of the syndrome. Interviews were conducted with 30 women with PCOS recruited through a national self-help organisation. Thematic analysis of the interviews revealed pervasive reports of feeling 'freakish', 'abnormal', and not 'proper' women. These feelings were related to three symptoms commonly experienced by women with PCOS: 'excess' hair growth; irregular, absent or disrupted periods; and infertility. Smooth hairless bodies and faces, regular menstruation and the capacity to bear children were associated with femininity, and as a result of their symptoms women expressed feeling 'different' from other women and less 'feminine'. The results are discussed within a feminist framework and suggest that polycystic ovarian syndrome is a deeply stigmatising condition, 'a theft of womanhood', with far reaching implications for all women, whether or not they conform to 'feminine' norms.     

200 Gy sterilised Toxoplasma gondii tachyzoites maintain metabolic functions and mammalian cell invasion, eliciting cellular immunity and cytokine response similar to natural infection in mice

200Gy gamma-irradiated Toxoplasma gondii RH tachyzoites failed to reproduce in vitro and in vivo. In short-term cultures, these parasites maintained a respiratory response, the ability to invade cells and preserved protein and nucleic acid synthesis. ELISA and Western blotting techniques demonstrated the similarity in humoral response between mice infected with gamma-irradiated tachyzoites and animals infected with naive parasites and treated with sulfadoxine, higher than mice immunised with formaldehyde-killed tachyzoites. Splenocyte stimulation by T. gondii antigen produced lymphoproliferative response and cytokine profile (IL-10, IL-12, IFN-gamma and TNF-alpha) similar to those produced by chronic natural infection. Mice immunised with irradiated tachyzoites had extended survival times after subsequent tachyzoite challenge, and displayed minimal cerebral pathology after cyst challenge. Irradiated tachyzoites lose their reproductive ability whilst maintaining metabolic function and may provide a novel tool for the study of toxoplasmosis and vaccine development.     

Facial reconstruction of a wrapped Egyptian mummy using MDCT

OBJECTIVE: Facial reconstruction of mummies and corpses in general is important in anthropological, medical, and forensic studies. The purpose of our study was to evaluate the role of MDCT examination for 3D facial reconstruction and report the results of multidisciplinary work performed by radiologists, anthropologists, and forensic police in reconstructing the possible physiognomy of an ancient Egyptian mummy. MATERIALS AND METHODS: Three-dimensional MDCT data were obtained from a well-preserved, completely wrapped Egyptian mummy from the collection of the Egyptian Museum in Torino, Italy, which dated from the XXII or XXIII dynasty (945-715 BC). Data were used as a model for the rapid prototyping stereolithographic technique, a method that allows the creation of a 3D model with digital data using synthetic materials such as a resin or nylon. RESULTS: The physical creation of the face was accomplished with boosting techniques performed by the progressive layering of plasticine on the nylon model according to the anthropometric data, the conditions of the soft residual dehydrated tissues, and the most accepted scientific and anthropological criteria. CT is the only noninvasive method for obtaining fundamental data for 3D reconstructions of the skull and the body, especially with wrapped mummies. CONCLUSION: Our multidisciplinary cooperative study produced a model of the face of an individual who lived nearly 3,000 years ago, which would not previously have been possible unless we unwrapped, destroyed, and altered the conservation of the bandages and the mummy.     

Diagnosis of orthopedic infection in clinical practice using Tc-99m sulesomab (antigranulocyte monoclonal antibody fragment Fab'2)

OBJECTIVE: The aim of the study was to analyze the use of Tc-99m-labeled antigranulocyte monoclonal antibody fragment Fab'2 (SMab, Leukoscan) in the diagnosis of acute osteomyelitis and articular prosthesis infection. One hundred seventeen patients (118 studies) have been included, 92 women and 25 men. Thirty-seven had a suspicion of osteomyelitis and 81 with suspicion of infection of a hip (35 patients) or a knee (45 patients) prosthesis. The mean age was 64 years. A 3-phase bone scan and a SMab scan were obtained in all patients. Antigranulocyte scans were obtained within 3 and 8 hours postinjection of 20 mCi (740 MBq) of Tc-99m-labeled antibody. Diagnosis of infection was based on bone biopsy in 8 cases and on at least 2 positive cultures in the remaining cases. Infection was ruled out with negative cultures or 1-year patient follow up with negative C-reactive protein and normal erythrocyte sedimentation rate. RESULTS: Sensitivity, specificity, accuracy, and negative predictive value of Tc 99m-SMab scintigraphy were: 75%, 95%, 87%, and 92% for long bone osteomyelitis and 80%, 89%, 87%, and 91% for articular prosthesis infection, respectively. Positive predictive values were 83% and 63%, respectively. CONCLUSION: Tc-99m-antigranulocyte monoclonal antibody fragment Fab'2 scintigraphy seems to be a useful method in the diagnosis of osteoarticular infection.     

Quantitative MRI comparison of systemic hemodynamics in Mustard/Senning repaired patients and healthy volunteers at rest

The purpose of the present study was to non-invasively compare ascending aortic blood flow and cross-sectional area (CSA) variations vs time in Mustard or Senning repaired (MSR) patients against those of healthy volunteers at rest. Velocity-encoded MR imaging was performed in 10 male patients (age range 18–24 years, median age 20.5 years) late after a Mustard or Senning correction, and in 10 male healthy volunteers (age range 21–25 years, median age 22.5 years), at the upper part of the ascending aorta. Both aortic cross-sectional area (CSA) and blood-flow variations were recorded over a complete cardiac cycle, with a 30-ms time of resolution. The body-surface area (BSA), the mean CSA over the systolic phase, and the BSA-normalized systemic ventricle power and work were significantly lower in the patient series compared with those of the volunteer series. The BSA-normalized right ventricle (RV) power and work of MSR patients were equal to 87 and 83% on average of those of the left ventricle (LV) of healthy volunteers. We conclude that, at rest, the mechanical performance of the systemic RV in MSR patients is significantly lower than that of the LV in healthy volunteers. Furthermore, the significantly lower aortic CSA found in MSR patients than in healthy volunteers may reveal an increase in the vasomotor tone.