Antigenic evidence for simultaneous expression of two different lipooligosaccharides by some strains of Haemophilus influenzae type b.

Isolates of Haemophilus influenzae type b (Hib) can be divided into three antigenic groups based on their reactivities with a set of two monoclonal antibodies (MAbs) directed against epitopes in the oligosaccharide region of Hib lipooligosaccharide (LOS) (P. A. Gulig, C. C. Patrick, L. Hermanstorfer, G. H. McCracken, Jr., and E. J. Hansen, Infect. Immun. 55:513-520, 1987). Approximately 24% of Hib strains react with both of these LOS-specific MAbs. Immunoprecipitation experiments involving several of these strains indicated that the epitopes recognized by these MAbs resided in two different LOS molecules, both of which were synthesized by these particular Hib strains. In addition, Western blot (immunoblot) analysis of proteinase K-treated cell extracts of these strains that had been subjected to sodium dodecyl sulfate-polyacrylamide gradient gel electrophoresis revealed two different LOS staining patterns when they were probed independently with the two MAbs. Colony blot radioimmunoassay of hundreds of colonies of one of these Hib strains showed that each colony bound both MAbs. Immune electron microscopy confirmed that individual cells of this same Hib strain expressed both types of LOS molecule at the same time. An antibody accessibility radioimmunoassay was used to show that different Hib strains of this type varied in the relative amounts of each of the two MAbs that they could bind to their cell surfaces. These findings indicate that some Hib strains can synthesize two antigenically distinct LOS molecules simultaneously.     

Factors affecting Adolescents' behavior and attitudes toward destructive rock lyrics

In a study of rock music preferences, listening/watching behavior, and views on destructive rock lyrics, 894 adolescents in grades 9 through 12 in rural, urban, suburban public, and metropolitan parochial schools were administered a questionnaire. Demographic information on parents was also collected. It was found that 17.5% of the students were fans of rock music with lyrics that promote homicide, suicide, or satanic practices (HSSR). Loglinear and multiple regression analyses were used to analyze the data. Parents' marital status, student sex, race, and school environment (urban, rural, suburban, etc.) were found to be significant predictors of HSSR status. As compared with non-HSSR fans, the HSSR fans were more likely to have parents who were “Never married” or “Remarried” and less likely to have parents in the “married” category. The HSSR fans were more likely to be male, white, and enrolled in urban schools but not parochial schools than expected; HSSR status also significantly predicted other music-related attitudes and behaviors. The HSSR fans reported liking both the sound and the lyrics of rock music more often than did non-HSSR fans, as did females and urban students. The HSSR fans more often felt that children under 10 years of age should be allowed to listen to HSSR lyrics, and they more frequently expressed the conviction that HSSR music does not affect adolescents' homicidal or self-destructive behavior. The HSSR fans and females reported more nearly complete knowledge of lyrics than did non-HSSR fans and males. The HSSR fans reported that they watch more MTV than did any other group except rural students.     

A randomized multicenter study to determine the efficacy of activity restriction for preterm labor management in patients testing negative for fetal fibronectin.

OBJECTIVE: To assess the impact of activity restriction (AR) on the incidence of preterm birth in women treated for preterm labor testing negative for fetal fibronectin (fFN). STUDY DESIGN: Women who were diagnosed with preterm labor and tocolyzed with magnesium sulfate were concurrently screened with fFN for the purpose of subsequent management. Included were consenting patients with negative fFN, gestational age 23 0/7-33 6/7 weeks, cervical dilation < or =3 cm, and minimal vaginal bleeding. Patients were randomized to AR or no AR. Primary study outcome was incidence of preterm delivery and interval from randomization to delivery. RESULTS: A total of 73 women with negative fFN were randomized (36 with AR, 37 without AR). The overall preterm birth rate was 40%, with 44.4% of patients with AR and 35.1% of patients without AR delivering preterm, p=0.478. CONCLUSION: Maternal AR did not impact pregnancy outcome. The incidence of preterm birth in symptomatic women testing fFN negative was higher than previously reported.     

Misdiagnosis of hysteria

The diagnosis of hysteria is often incorrect and must be made with great caution. A retrospective study demonstrates that an erroneous diagnosis of hysteria is most likely to be given to females, the psychiatrically ill, patients who embellish and patients who present plausible psychogenic explanations for their illness. Movement disorders and paralysis are the neurologic disorders most frequently mislabeled as hysteria.     

Practical management of patients with non-small-cell lung cancer treated with gefitinib.

PURPOSE: The use of gefitinib, the first drug approved to inhibit the epidermal growth factor receptor tyrosine kinase, is indicated in patients with non-small-cell lung cancer with tumors progressive after chemotherapy. The unique mechanism of action of this agent leads to distinctive patterns of response and toxicity in persons with lung cancer. Many of the principles of management relevant to gefitinib are distinct from those with conventional cytotoxic drugs. To meet this need, we present practical guidelines on the use of gefitinib in patients with non-small-cell lung cancer. METHODS: This article reviews gefitinib's indications, dosing, response phenomena, and patterns of relapse in individuals with radiographic response. RESULTS: We present our recommendations for the management of rash and diarrhea caused by this agent. CONCLUSION: This information can guide practitioners and help them inform their patients about what to expect when they receive gefitinib.     

Transitions between normal intraventricular conduction,bundle branch block,and ventricular tachycardia: Report of a case

Electrocardiographic observations on a patient with myocardial infarction and severe cardiac decompensation revealed transitions between normal intraventricular conduction, bundle branch block, and ventricular tachycardia. The terminal cardiac mechanism was progressive slowing of the ventricular rate and ventricular standstill.     

Effects of growth hormone on glucose and fat metabolism in human subjects.

This article focuses on in vivo data from tests performed in normal subjects and in patients who had abnormal growth hormone (GH) status. Experimental data in human subjects demonstrate that GH acutely inhibits glucose disposal in skeletal muscle. At the same time GH stimulates the turnover and oxidation of free fatty acid (FFA), and experimental evidence suggests a causal link between elevated FFA levels and insulin resistance in skeletal muscle. Observational data in GH-deficient adults do not indicate that GH replacement is associated with significant impairment of glucose tolerance, but it is recommended that overdosing be avoided and glycemic control be monitored.     

Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Background and aims Since the introduction of endovascular aortic aneurysm repair (EVAR) for aortic aneurysms, the number of juxtarenal aortic aneurysms (JRA) has been growing steadily due to selection bias (neck morphology for EVAR). This case-match study compares the perioperative outcome and midterm results of suprarenally clamped JRA with infrarenal aortic aneurysms (AAA). Methods From 1997 to 2004, patients who received open surgery with suprarenal clamping for JRA were included in the study and compared to matched patients with infrarenal clamping (AAA). Measurements analyzed were the in-hospital mortality and morbidity. Midterm results were obtained through clinical investigation and magnetic resonance angiography imaging. Results Thirty-five patients (mean age, 68.4 years; 30 male and 5 female) received suprarenal cross-clamping for JRA. The overall in-hospital mortality for JRA and for the controls (AAA) with elective aortic repair was 4.5% (6.1% JRA; 3% AAA, p = 0.058). The morbidity of JRA was elevated according to the rate of pulmonary complications (p = 0.021) and the need for re-operation (p = 0.019). The mean follow-up time was 2.3 years (range, 8–96 months). At follow-up, 28 patients (80%) from the JRA group and 29 patients from the AAA group (82.9%) were alive. Conclusion Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms.     

CT19PTRICUSPID VALVE REPAIR IN ‘TORRENTIAL TRICUSPID REGURGITATION’ FOLLOWING PERMANENT PACEMAKER LEAD EXTRACTION – A CASE REPORT

Introduction Traumatic tricuspid regurgitation secondary to blunt chest trauma has been reported in literature. We report our experience with a case of ‘Torrential Tricuspid Regurgitation’ following permanent pacemaker lead extraction which was successfully treated with tricuspid valve repair and annuloplasty. Report A 67 year old woman was treated for Sick sinus syndrome with permanent pacemaker implant. She had three generator changes for end of life and repositioning.Erosion of generator, led cardiologist to plan lead and generator extraction with the surgical backup. During lead extraction a small piece of papillary muscle was avulsed. The patient remained hemodynamically stable in the theatre. However in ward she developed right sided cardiac failure not responding to conservative therapy. A transthoracic echo (TTE) revealed torrential tricuspid regurgitation with a freely mobile posterior leaflet with attached chordae and avulsed papillary muscle.During surgery the tricuspid valve was successfully repaired and transesophageal (TOE) images showed trivial to mild tricuspid regurgitation at the end of repair procedure. Additional procedure also included ligation of both atrial appendages and implantation of epicardial leads and pacemaker. Patient made good recovery from operation. Conclusion To the best of our knowledge this is first report of repair of tricuspid valve in ‘Torrential Tricuspid Regurgitation’ following pacemaker lead extraction. We share our experience with tricuspid valve repair technique and annuloplasty.