Ductoscopy-assisted microdochectomy

Until 10 years ago, examination of the ductal system of the breast required excision of all the major ducts, in a block of tissue. With mammary ductoscopy, direct visualization of the ducts in vivo has been possible. In the present series of 40 cases, ductoscopy was used to guide the infusion of methylene blue dye, through the endoscope, to find the index duct, which is then removed through a small incision just inside the areola.     

High-risk human papillomavirus detection: a split-sample comparison of hybrid capture and chromogenic in situ hybridization

The American Society for Colposcopy and Cervical Pathology (ASCCP) has proposed high-risk human papillomavirus (HPV) testing as the "preferred" triage for women with atypical squamous cells of undetermined significance. We studied 401 atypical squamous cells of undetermined significance liquid-based cervicovaginal cytology split samples for HPV by chromogenic in situ hybridization (CISH) and by Hybrid Capture (HC) II (Digene, Gaithersburg, MD); 202 underwent HC II followed by CISH, and 199 underwent CISH followed by HC II. Of 401 vials, 101 (25.2%) were positive for HPV by 1 or more methods. HC II labeled 83 of 401 (20.7%) samples as positive, while 38 of 401 (9.5%) were positive by CISH. Positive attributes of CISH include the provision of a cytomorphologic link in assessing HPV positivity and comparative ease of use in laboratories without trained molecular diagnosticians. Greater efficacy and quantitative design are advantages of HC II. Comparing data by sequence of testing showed a lower likelihood of positive test results on the second ancillary test than on the first ancillary test, regardless of age or testing method (odds ratio, second/first = 0.58; P = .003). This finding suggests that liquid-based cervicovaginal cytology samples are not homogeneous throughout. Correlative studies with histology and polymerase chain reaction may clarify predictive values for both methods.     

Current concepts of hemostasis: implications for therapy

The revised model of coagulation has implications for therapy of both hemorrhagic and thrombotic disorders. Of particular interest to anesthesiologists is the management of clotting abnormalities before, during, and after surgery. Most hereditary and acquired coagulation factor deficiencies can be managed by specific replacement therapy using clotting factor concentrates. Specific guidelines have also been developed for perioperative management of patients using anticoagulant agents that inhibit platelet or coagulation factor functions. Finally, recombinant factor VIIa has been used off-label as a hemostatic agent in some surgical situations associated with excessive bleeding that is not responsive to conventional therapy.     

Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: implications for aortic valve-sparing surgery

OBJECTIVE: Sparing the aortic valve has become a surgical option for patients who require repair of aortic root ectasia and have normal valve leaflets. Surgical approaches to valve sparing differ with regard to preservation of the native sinuses of Valsalva. The role of the sinuses and the importance of maintaining them remain controversial. METHODS: By using a time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging technique, aortic root and aortic blood velocity data were acquired from 2 patients with Marfan syndrome 6 months after aortic valve-sparing surgery with straight Dacron grafts and contrasted with data from 6 normal volunteers. RESULTS: In normal aortas vortical blood flow became apparent in the individual sinuses after peak systole. The vortices filled the available space behind the valve leaflets and persisted until diastole, expanding and moving inward during aortic valve closure. In contrast, no vortices were observed in the postoperative patients with Marfan syndrome with negligible sinuses. CONCLUSIONS: Changes in supravalvular flow accompany loss of sinus architecture. Whether the presence, size, and velocity of supravalvular vortices affects the function or durability of the preserved aortic valve remains to be studied.     

Pharyngitis due to Burkholderia cepacia. Person-to-person transmission

Burkholderia cepacia is a Gram-negative bacillus that is widely distributed in nature; it is isolated from the ground, water, plants and vegetables. Generally, it produces nosocomial infection due to contamination of disinfectants, medical equipment, prosthetic material and drugs, such as anesthetics or liquids used in urological irrigation. The most probable mechanism of transmission is through hospital material or through fomites among people after contact for several weeks or months. Recently, it has been considered as an important pathogen in immunocompromised patients, or in those with significant underlying diseases, such as chronic granulomastosis or cystic fibrosis. We present a case of pharyngitis due to B. cepacia and its transmission within a few days in two immunocompetent twin siblings without previous underlying diseases. The infection disappeared after specific treatment for this microorganism was started. We believe that samples should be taken from the pharynx and nasal pits in patients with acute upper respiratory tract processes that do not respond to empiric antibiotic treatment, before classifying them as viral infection without etiologic diagnosis.     

A novel nuclear protein, MGC5306 interacts with DNA polymerase beta and has a potential role in cellular phenotype

A novel protein MGC5306 has been identified in yeast-two-hybrid analysis by screening a HeLa cDNA library with a truncated DNA polymerasebeta (polbetaDelta) as bait. The polbetaDelta is expressed in various types of cancers. Co-immunoprecipitation-Western blot analysis confirms not only its interaction with polbetaDelta but also with wild-type polbeta. Binding to polbeta indicates potential function of MGC5306 in repair pathway. Transfection of cells with MGC5306-GFP and Western blot analysis with anti-MGC5306 antibody reveal its nuclear localization. MGC5306 is expressed in human carcinomas and tumor cell lines but not in normal tissues, suggesting MGC5306 is most likely involved in carcinogenesis. An antigrowth activity and modulations of cell cycle events are identified in cells expressing siRNAMGC5306.     

Pharmacokinetics of ciprofloxacin in healthy Mexican volunteers

Ciprofloxacin (CAS 85721-33-1) is a gyrase inhibitor used against a wide number of bacteria which develops a very low bacterial resistance. Its pharmacokinetics has been extensively studied using two main methods, liquid chromatography and microbiological assay. The pharmacokinetics of ciprofloxacin administered orally was evaluated in healthy Mexican volunteers after a dose of 500 mg. Ciprofloxacin was assayed from plasma by a specific HPLC method reading absorbance at 280 nm. Pharmacokinetic parameters were similar to reported values, including a previous study on Mexican healthy volunteers with the microbiological assay. AUC was 12.11 mg h/l, Cmax 2.44 mg/l, tmax 0.79 h and half-life 3.8 h. tmax was slightly shorter than those in other studies. Ciprofloxacin presented no adverse reactions and can be dosed to people with Amerindian origin in the same dose regimes as prescribed to Caucasians in order to achieve minimal inhibitory concentrations against a wide range of microbial pathogens.     

Prevalence of mobile phone use while driving vehicles

OBJECTIVE: To estimate the prevalence of mobile telephone use while driving vehicles in the city of Lleida (Spain). METHODS: A random sample of 1536 cars passing through six intersections regulated by traffic lights in Lleida were selected (three with urban traffic and three with interurban traffic). Cyclists, motorcyclists and driving school cars were excluded. The variables studied were mobile telephone use, age, (18-40; 41-60; >61), sex, the presence of passengers, type of intersection (urban traffic/interurban traffic), day of the week (working day/weekend or holiday) and hour of the day (rush hour/non-rush hour). The prevalence of mobile telephone use was calculated in percentages with a 95% CI. The relationship among the dependent variable (mobile telephone use) and the other independent variables was studied using odds radios (OR) and 95% CI. RESULTS: A total of 1536 direct observations were made and mobile telephone use was detected in 50 drivers. The prevalence was 3.3 (95% CI, 2.4-4.3). The prevalence was higher in men (OR = 2.2; 95% CI, 1.0-5.7), in drivers aged more than 60 years old (OR = 2.2; 95% CI, 0.5-8,4) and in those aged 18-40 years old (OR =1.5; 95% CI, 0.8-3.0), in unaccompanied drivers (OR = 3.0; 95% CI, 1.5-6.3), in urban intersections (OR = 2.7; 95% CI, 1.2-5.9), on workdays (OR = 2.0; 95% CI, 0.9-4.4) and at the rush hour (OR =1.4; 95% CI, 0.8-2.4). CONCLUSIONS: The prevalence of mobile telephone use while driving vehicles can be considered high, because of the increase in car accidents. The profile of drivers using mobile telephones corresponds to men aged 18-40 years or more than 61 years, in urban intersections, without passengers, during workdays and at the rush hour. We recommend the implementation of measures to decrease the use of mobile telephones while driving.