Outpatient upper gastrointestinal endoscopy: large,prospective study of the morbidity and mortality rate at a single endoscopy unit in England

Background: There are few prospective studies that look at the standards of the practice of esophago‐gastroduodenoscopy (EGD) and its associated morbidity. Patients and methods: Data were recorded prospectively for 1287 consecutive day‐case diagnostic EGD procedures. Thirty days later, 1155 of 1287 patients were successfully contacted. Results: The standards of care, as per various national recommendations, were met. Seven hundred and fifty‐four patients (401/572 [70%] men; 353/715 [49%] women; P = 0.001) chose pharyngeal anesthesis (PA) as premedication. Two women had general anesthesia. There were no immediate clinical complications. Thirty days later, 119/1155 (10%) patients who were contacted reported a problem, one requiring hospital admission. Fifty‐one of 119 had EGD performed under midazolam sedation (MS). Twenty‐five of 119 patients required consultation with a health‐care professional. No death occurred. Seventy‐nine percent of patients contacted who underwent their procedure with PA compared with 95% who had MS, said they would prefer the same premedication if EGD was required again in the future (P = 0.001). In subjects who had PA, 25% of women and 12% of men said they would prefer MS if EGD were required again (P = 0.001). Conclusions: Diagnostic EGD is a safe procedure, but carries a small complication rate. Patients’ gender, age, or patients’ preference for sedation or endoscopist did not affect the morbidity rate. Although the majority, particularly men, chose to have EGD performed unsedated, a significant number, particularly women, would prefer MS if EGD was required again.     

Familial pulmonary valve stenosis, atrial septal defect, and unique electrocardiogram abnormalities.

The familial association of pulmonary stenosis, atrial septal defect, and unique electrocardiographic abnormalities involving a mother and two children is reported. Familial pulmonary stenosis not occurring as part of a named syndrome or without associated multiple congenital abnormalities is rare. The constellation of pulmonary stenosis, atrial septal defect, and the particular electrocardiogram abnormalities present here is to our knowledge previously unreported. The pattern of inheritance is consistent with an autosomal dominant mode of transmission.     

Four exons encode a 93-base-pair insert in three neural cell adhesion molecule mRNAs specific for chicken heart and skeletal muscle.

The neural cell adhesion molecule (N-CAM) is detected in chicken brain as three polypeptides of 180 kDa, 140 kDa, and 120 kDa that arise from a single gene by alternative splicing. Heart tissue, however, contains components of 150 kDa, 140 kDa, and 130 kDa; neither the differences in molecular mass among these components nor the difference between neural and cardiac N-CAM could be accounted for by variations in glycosylation alone. A cDNA clone isolated from an embryonic chicken heart library, [lambda N101B, 1.8 kilobases (kb)] contained a 93-base-pair (bp) insert not found in neural N-CAM cDNAs. In the N-CAM gene this sequence mapped within a large region between exons 12 and 13 and was derived from four exons (12A-D) of 15, 33, 42, and 3 bp. Exons 12C and 12D together coded for 15 amino acids very similar to the second half of the muscle-specific insert (MSD1) found in N-CAM cDNA from human muscle cell cultures [Dickson, G., Gower, H. J., Barton, C. H., Prentice, H. M., Elsom, V. L., Moore, S. E., Cox, R. D., Quinn, C., Putt, W. & Walsh, F. S. (1987) Cell 50, 1119-1130]; the sequences of 12A and 12B, however, were much less similar to the corresponding region of the MSD1 sequence. Two oligonucleotides, one specific to exons 12A plus 12B and one specific to exon 12C both recognized mRNA species of 6.4 kb, 4.3 kb, and 3.0 kb in chicken cardiac and skeletal muscle and no mRNA species in smooth muscle or brain. The 3' end of clone lambda N101B contained a sequence coding for a potential phosphatidylinositol linkage signal as does the smallest form of brain N-CAM. In heart cell membranes only the 130-kDa N-CAM polypeptide was released by phospholipase C, suggesting that this form of N-CAM is encoded by clone lambda N101B. The other heart N-CAM species (150 kDa and 140 kDa) may be transmembrane forms that include the 12A-D (and possibly other) inserts. Tissue-specific forms of N-CAM can thus be formed by alternative use of multiple small exons that may alter the conformation of the extracellular region of the molecule. Differential use or switching of these small exons in conjunction with the differential expression of larger exons specifying regions associated with the cell membrane and cytoplasmic domains may signal key events in embryogenesis and histogenesis.     

Steroidogenic relationships of gonadotrophin hormones in the ovary of the hen (Gallus domesticus)

The effects of chicken luteinizing hormone (cLH: IRC-2 and PRC AE1-1), turkey LH (B221B and HS-5-18), bovine follicle-stimulating hormone (bFSH: HS-2-17), chicken FSH (cFSH: PRC DC3(2) and AGCQSQ113445C), and turkey FSH (B150A and HS-1-153) on steroid output were evaluated by in vitro incubation of various ovarian tissues with the gonadotrophins. Output of androstenedione and estradiol was determined by 3-hr incubations of individual whole small follicles, classified by size and color as follows: small white (SWF, less than 1 mm), large white (LWF, 2-3 mm), and small yellow follicles (SYF, 5-10 mm). The effects of gonadotrophin preparations were also evaluated in large preovulatory follicles (F1-F5). Androstenedione and estradiol output was measured in incubation media from 100,000 theca cells and progesterone content was determined in the incubation media of 100,000 granulosa cells. All incubations were conducted in 1 ml of Medium 199 at 37 degrees. Steroid output was quantitated by radioimmunoassay of incubation media. Potency estimates were derived by calculation of a peak stimulation index. The standard reference preparation was bLH (NIAMDD-LH-B4). Steroidogenesis was stimulated by three avian LH preparations. preparations. PRC AE1-1 was the most potent, with IRC-2 and B150A showing approximately 50% of the biological activity of PRC AE1-1 in most tissues. Turkey LH HS-5-18 was generally not potent. The presence of multiple isohormones of LH was implied, as various LH preparations exhibited different potency estimates in different tissues. The effects of FSH on steroidogenesis were not significant in most cases. Although the addition of cFSH AGCQSQ113445C failed to significantly increase output of estradiol from small follicles, potency estimates of this preparation were 0.15, 0.20, and 0.13 relative to NIAMDD-LH-B4 follicles was more highly stimulated by LH than by FSH, and thus it would seem that FSH does not play a significant role in steroidogenesis in the hen's ovary. The results of this study suggest that steroid biosynthesis in the hen's ovary may be regulated by multiple forms of LH.     

Partial lung shield for TBI

In this study, AP/PA setup was used with a 4 MV linear accelerator. The prescribed dose is 1000 cGy, with a dose per fraction of 200 cGy. One of the simplest lung dose determinations is the nomograph relating dose correction factor and patient thickness. To save time in taking port film in every treatment, lung block is used in alternating fashion: anterior blocks are used in the second and fourth fraction and posterior block is used in the third and fifth fraction. If we set the average correction factor for the lower density lung to 1.18, the six open fields will deliver an average of 708 cGy to the lung. To limit the lung dose to 10 Gy, each blocked field should deliver 73 cGy. Measurements showed that a thickness of slightly less than 1 cm of cerrobend provides approximately 65% transmission, which approximates the desired 73% broad beam transmission. The proper transmission of the partial lung shield is verified by measurements made for the patients with diodes placed at the entrance and the exit side of the lung. While we describe a particular setup, the procedure can be modified to accommodate different dose fraction. There are many ways to deliver the TBI dose, and the method of constructing the partial lung shield described here is one of the many methods that may be used to limit the dose to the lung.     

Clasping using Wiptam wrought wire

Wiptam wires, attached by various methods to cobalt chromium bases, were tested under circumferential loading and compared with cast cobalt chromium clasps. The results showed that after 200 cycles all clasps have distorted, and effective mechanical retention was impaired.     

The effect of two alternative methods of canine exposure upon subsequent duration of orthodontic treatment

Objectives. The aim of this study was to compare the effectiveness, in terms of orthodontic treatment duration, of two methods of canine exposure.
Design. This was a retrospective study using patients' records and lateral cephalometric radiographs.
Sample and methods. 50 patients were selected, 25 in each group. In all subjects the impaction was categorized as being 'intermediate'. The methods of canine exposure were: (i) simple surgical exposure; (ii) surgical exposure and placement of an orthodontic attachment, followed by flap replacement.
Results . The treatment duration until the canine was in the line of the arch was 17·7 months in the simple exposure group and 19·3 months in the bonded attachment group. The mean treatment duration (from exposure to debond) was 28·8 months for both groups.
Conclusions . In terms of treatment duration, no significant difference could be demon-strated between the two methods of surgical exposure to palatally impacted canines.