Malignant colonic polyps: is polypectomy adequate treatment?

The management of patients with endoscopically removed malignant intestinal polyps is controversial. The risk of residual disease should be assessed against the risk of a surgical operation. The authors report 35 cases of malignant polyps (5.5% of 641 colonoscopically removed adenomas). Sixteen patients had carcinoma in situ and received no further treatment and 19 had invasive carcinoma (sessile in 6, pedunculated in 13). Of these 19, 7 did not undergo surgery--because of old age in 2, minimal invasion in 3, a low rectal location in 1 and refusal in 1. Twelve patients (3 with sessile, 9 with pedunculated polyps) underwent a surgical resection, and residual disease was present in 3 (25%), 1 with positive nodes. Reported criteria of increased risk of residual disease--cancer in lymphatics or veins, incomplete excision, tumour at resection margin, sessile and villous tumours--were present in nine. All three patients with residual disease had microscopically involved margins of resection. The authors believe that the increased risk of recurrence justifies the risk associated with subsequent surgical resection unless the patient is otherwise a poor operative risk.     

Whole-body inflammation in trauma patients. An autopsy study

In a review of autopsy specimens and reports in 35 trauma cases, we found signs of generalized inflammation and tissue damage with increases in organ weights in organs not primarily injured. These abnormalities occurred independent of the time of death and were also found in patients who died of brain injury alone. The most pronounced signs of inflammation and increases in organ weights were found when the adult respiratory distress syndrome, hypovolemic shock, or multiple organ failure were the causes of death. These findings are similar to those found in several organs of rabbits after four hours of complement activation in combination with 20 minutes of hypoxia. Therefore, the autopsy findings in this series of trauma patients might represent the morphologic features of adult respiratory distress syndrome and multiple organ failure in an early, preclinical stage.     

Fate of bone grafts in acetabular roof reconstructions assessed by roentgenography and scintigraphy

Autogeneic bone grafts--26 femoral heads, four femoral and two iliac bone grafts--were used in 32 total hip arthroplasties, mainly on patients with complete dislocation of the hip, to reconstruct deficiencies of the acetabular roof by a standardized procedure. At the follow-up examination after 24 to 101 months (median, 52 months), roentgenography demonstrated lateral resorption of the graft in 20 of 32 hips, but resorption involved bone support of the socket in only three of the hips. Analysis of serial roentgenograms showed that resorption was not a function of time. Complete incorporation of the grafts was observed in 27 hips; partial incorporation was shown in three. Roentgenographically, two grafts were not incorporated. None of three grafts of a cortical nature was incorporated. Graft uptake of radioactive tracer was found by 99mTc-diphosphonate emission scintigraphy in 16 of 21 hips, but did not correlate with progressive bone resorption, nonunion, or loss of bone structure. High quality serial roentgenograms showing good bone detail provided the best information about the integrity of the acetabular roof reconstructions.     

Psychiatric rehabilitation in a French-speaking setting: current practices, future challenges]

This paper aims to assess current interventions in psychiatric rehabilitation in the French-speaking world and to discuss future developments. We review examples of policies and practices in Quebec and Europe and discuss the role and involvement of professionals; namely, the psychiatrists and the nursing staff. We also present different rehabilitation strategies and techniques used in the French-speaking world, such as case management, social-skills training, cognitive therapies for psychotic symptoms, family interventions, and return-to-work interventions. In conclusion, we invite psychiatrists to play a more active role in rehabilitation. We recommend the creation of small, specialized units closely linked to the needs of clients, and we propose to integrate social and medical interventions, rather than opposing them.     

黄连细胞二步法悬浮培养生产黄连生物碱类成分的探索

为提高用植物细胞培养生产镒生代谢产物的单位产量，作者对黄连细胞采用二步法悬浮培养生产黄连生物碱进行了探索。结果显示：黄连细胞采用一步法悬浮培养６周，细胞干，鲜重产率分别为２０．９６ｇ／Ｌ和１７４．９２ｇ／Ｌ，增重约７００％，细胞中总生物碱含量为１４．７９ｍｇ／ｇ．ｃｅｌｌ ｄｗ，培养基中生物碱量为１２．９６ｍｇ／Ｌ，每升培养液共可收获生物碱３２３ｍｇ。采用先在生长培养基中培养３周，在合成碱量为１２     

Lead exposure and intelligence in 7-year-old children: the Yugoslavia Prospective Study.

For a prospective study of lead exposure and early development, we recruited pregnant women from a lead smelter town and from an unexposed town in Yugoslavia and followed their children through 7 years of age. In this paper we consider associations between lifetime lead exposure, estimated by the area under the blood lead (BPb) versus time curve (AUC7), and intelligence, with particular concern for identifying lead's behavioral signature. The Wechsler Intelligence Scales for Children-Version III (WISC-III) was administered to 309 7-year-old children, 261 of whom had complete data on intelligence, blood lead, and relevant sociodemographic covariates (i.e., Home Observation for the Measurement of the Environment (HOME), birth weight, gender, sibship size, and maternal age, ethnicity, intelligence, and education). These showed anticipated associations with 7-year intelligence, explaining 41-4% of the variance in Full Scale, Performance, and Verbal IQ. Before covariate adjustment, AUC7 was unrelated to intelligence; after adjustment, AUC7 explained a significant 2.8%-4.2% of the variance in IQ. After adjustment, a change in lifetime BPb from 10 to 30 micro/dl related to an estimated decrease of 4.3 Full Scale IQ points; estimated decreases for Verbal and Performance IQ were 3.4 and 4.5 points, respectively. AUC7 was significantly and negatively related to three WISC-III factor scores: Freedom from Distractibility, Perceptual Organization, and Verbal Comprehension; the association with Perceptual Organization was the strongest. Consistent with previous studies, the IQ/lead association is small relative to more powerful social factors. Findings offer support for lead's behavioral signature; perceptual-motor skills are significantly more sensitive to lead exposure than are the language-related aspects of intelligence.     

腹式全子宫切除术不同术式对排便功能影响的探讨

目的:探讨筋膜内和筋膜外全子宫切除术对女性排便功能的影响。方法:76例全子宫切除患者分为筋膜外全切除组(A组)56例,筋膜内全子宫切除组(B组)20例,对两组术后病人的排便次数,难易程度的变化进行分析。结果:76例全子宫切除病人42.1％出现不同程度排便困难,A组52.62%,B组为10%,两组具有显著性差异(P<0.05)。结论:全子宫切除术后可影响女性排便功能,筋膜内全子宫切除术对排便功能影响小,是一种较好手术方式。     

Environmental and developmental signals modulate proline homeostasis: evidence for a negative transcriptional regulator.

In many plants, osmotic stress induces a rapid accumulation of proline through de novo synthesis from glutamate. This response is thought to play a pivotal role in osmotic stress tolerance [Kishor, P. B. K., Hong, Z., Miao, G.-H., Hu, C.-A. A. and Verma, D. P. S. (1995) Plant Physiol. 108, 1387-1394]. During recovery from osmotic stress, accumulated proline is rapidly oxidized to glutamate and the first step of this process is catalyzed by proline oxidase. We have isolated a full-length cDNA from Arabidopsis thaliana, At-POX, which maps to a single locus on chromosome 3 and that encodes a predicted polypeptide of 499 amino acids showing significant similarity with proline oxidase sequences from Drosophila and Saccharomyces cerevisiae (55.5% and 45.1%, respectively). The predicted location of the encoded polypeptide is the inner mitochondrial membrane. RNA gel blot analysis revealed that At-POX mRNA levels declined rapidly upon osmotic stress and this decline preceded proline accumulation. On the other hand, At-POX mRNA levels rapidly increased during recovery. Free proline, exogenously added to plants, was found to be an effective inducer of At-POX expression; indeed, At-POX was highly expressed in flowers and mature seeds where the proline level is higher relative to other organs of Arabidopsis. Our results indicate that stress- and developmentally derived signals interact to determine proline homeostasis in Arabidopsis.     

Phospholipid determination in platelets,plasma and red cells of patients with chronic myeloproliferative disorders

Abstract: Red cell phospholipids (PLs) were assessed in 11 patients with essential thrombocythemia and 5 patients with polycythemia vera. Platelet and plasma PLs were also determined in 10 of these patients, and the results were compared with studies performed in 16 healthy volunteers. The amount of platelet PLs in patients was similar to controls (556 ± 90 nmol/10⁹cells, versus 481 ± 91 nmol/10⁹cells), as was the percentage of the main specimens of these compounds, including phosphatidylserine (11.1 ± 0.8%), which is relevant for platelet procoagulant activity. We did not find differences between red cell PLs of patients (300 ± 60 nmol/10⁹cells), versus controls (289 ± 71 nmol/10⁹cells), and the sphingomyelin/phosphatidylcholine ratio in these cells was the same in both groups (0.75 ± 0.1). Finally, we did not detect any alteration in the amount of plasma PLs specimens.