Surgical aspects of chronic peritoneal dialysis in the neonate and infant under 1 year of age.

Since 1982 eight patients under 1 year of age with end-stage renal failure have been treated by chronic peritoneal dialysis (CPD) following insertion of an abdominal Tenckhoff catheter. We routinely perform a partial omentectomy now, and in males undertake bilateral exploration of the groins at the time of catheter insertion, with herniotomy or ligation of the patent processus vaginalis as required. Up to January 1990, 19 straight double-cuff catheters had been inserted with a total follow-up of 244.5 patient months. The median age at the initial catheter insertion was 14.6 weeks (range, 2 days to 11 months) and the median weight was 3.89 kg (range, 2.2 to 5.5). Peritonitis was the most common complication, with 46 episodes, representing one episode of peritonitis per 5.3 patient months on dialysis. The frequency of peritonitis has decreased in the last 6 months since all patients have been dialysed by two caregivers. The present rate of peritonitis is 1 episode per 10 patient months on dialysis. One patient has died of septicemia secondary to associated congenital abnormalities, one patient has regained renal function, and two patients have been transplanted, one successfully. Five patients are currently dialysing via their abdominal Tenckhoff catheters and awaiting transplantation. We conclude that neonates and infants under 1 year of age can be treated satisfactorily by CPD to enable successful preparation for transplantation later in childhood.     

Sonography of congenital midline brain malformations

The authors present an excellent overview of the anatomic and sonographic findings in the neonate which are associated with the presence of congenital midline malformations of the brain.     

Effect of perioperative blood transfusion on recurrence of colorectal cancer

The aim of the present study was to examine the outcome of 517 patients undergoing curative surgery for colonic and rectal cancer, and to compare the recurrence and mortality rates in transfused and non-transfused groups of patients. The two groups were evenly matched for age, sex, Dukes' stage and histological differentiation. There were significantly more rectal tumours in the transfused group (P less than 0.01), but the distribution of colonic lesions did not differ. Life table analysis revealed that the transfused patients had a 20 per cent greater probability of recurrence at 5 years (P less than 0.005) and there were 16 per cent more cancer related deaths (P less than 0.01). Even when all rectal cancers were excluded, a similar trend was seen for the colonic lesions: a 24 per cent greater probability of recurrence at 5 years (P less than 0.025) and 15 per cent more cancer related deaths (P less than 0.02). We conclude that blood transfusion may be associated with increased mortality and recurrence in patients undergoing curative surgery for colorectal cancer.     

Blind spot size depends on the optic disc topography: a study using SLO controlled scotometry and the Heidelberg retina tomograph

AIMS—To find out whether the size of the blind spot area, determined by static perimetry, depends on the surface topography of the optic disc and its surrounding area.
METHODS—Ten eyes were examined; all had a parapapillary atrophy adjacent to the temporal side of the disc. Microperimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. The horizontal meridian of the optic discs was examined in 0.5° steps using five stimulus sizes (Goldmann I to V), each with 10 different degrees of brightness. Optic disc topography was measured with the Heidelberg retina tomograph (HRT).
RESULTS—Stimuli with a high luminance level (Goldmann IV, 4 dB), presented on the horizontal meridian, were seen up to 0.75° centrally (that is, towards the optic disc centre) from the temporal edge of the parapapillary atrophy but up to 1.85° centrally from the nasal optic disc border (p<0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy.
CONCLUSIONS—The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less `blind' than the shallow temporal part, probably because of more intensive light scattering by the prominent nasal part of the disc. These considerations should also apply to other scotomas.

     

Galectin-3 does not reliably distinguish benign from malignant thyroid neoplasms

AIMS: To determine whether galectin-3 is a sensitive indicator of thyroid malignancy. It has been suggested as a potential marker for differentiating thyroid carcinoma from benign or non-neoplastic lesions in preoperative fine-needle aspirates (FNAs). METHODS: Galectin-3 protein expression was assessed by immunohistochemistry in formalin-fixed thyroid tissues from 124 patients with histological diagnoses of papillary carcinoma (n = 38), follicular carcinoma (n = 19), follicular adenoma (n = 32) and dominant nodules of multinodular goitre (n = 35). Expression of galectin-3 was also assessed by Western blotting in 24 fresh thyroid tissues. RESULTS: Galectin-3 expression was observed in the majority of carcinomas (papillary 92%; follicular 74%). However, a large proportion of follicular adenomas (72%) and multinodular goitres (57%) also expressed galectin-3. In addition, galectin-3 expression was observed in epithelial cells of normal thyroid tissue and Hashimoto's thyroiditis. Galectin-3 immunopositivity was significantly greater in papillary carcinomas than in dominant nodules or follicular adenomas (P < 0.0001, P = 0.0005, respectively). However, galectin-3 expression was no greater in follicular carcinomas than in follicular adenomas (P = 0.8735). Western blotting analysis confirmed both the specificity of the antiserum and expression of galectin-3 in multinodular goitres, follicular adenomas/carcinomas and papillary carcinomas. CONCLUSION: The data demonstrate that galectin-3 is not a reliable immunohistochemical marker to distinguish benign from malignant thyroid follicular lesions.     

Immunohistochemical localization of the differentiation marker E11 in dental development of rats

E11 antigen, originally characterized in a rat osteosarcoma cell line, is known to be expressed during late stages of the osteogenic cell lineage both in vitro and in vivo. The aim of the present study was to monitor the occurrence and distribution patterns of the E11 antigen using monoclonal antibodies (mAb E11 and MEP-1) during different stages of tooth germ development of new-born rats by means of immunohistochemistry. Both antibodies strongly bound to plasma membranes of ameloblasts in presecretory and secretory stages. In addition, odontoblasts and cells of the periodontium were immunoreactive for E11 and MEP-1. During maturation, the immunoreactivity of ameloblast plasma membranes decreased significantly. Our data suggest that E11 and MEP-1 might be important as markers for cell differentiation and mineralization processes during tooth germ development.     

Natural rhythm: evidence for occult 40 Hz gamma oscillation in resting motor cortex

Fast gamma oscillations, often at 40 Hz, have been demonstrated throughout the brain including the thalamus, auditory, visual and motor cortices. The function of gamma rhythms is elusive, but several authors have hypothesized that they contribute to the "binding" of diverse information into a single coherent percept, and to the synchronization of movement. In skeletal muscle a "Piper rhythm" around 40 Hz is commonly observed during maximal voluntary contraction, and has been shown to correlate with activity of similar frequency in a limited area of contralateral motor cortex. Gamma rhythms are detected primarily during complex cortical activity, and are seldom recorded at rest or coherently over wide areas. Here we use bihemispheric transcranial magnetic stimulation (TMS) to study time-dependent correlations between evoked motor potentials from non-homologous muscles in opposite limbs of normal volunteers. The results suggest the presence of an occult, synchronous 40 Hz rhythm across broad areas of resting motor cortex in both hemispheres.     

Cloning of a gene involved in regulation of exotoxin A expression in Pseudomonas aeruginosa.

We have cloned a gene from Pseudomonas aeruginosa that stimulates the expression of exotoxin A. A recombinant library of genomic DNA from strain PA103 constructed with a broad-host-range plasmid vector containing chromosomal insert fragments generated by Sau3A was used to transform the hypotoxigenic mutant strain PA103-29. A recombinant plasmid, pFHK6, was isolated from a PA103-29 transformant which displayed increased toxin production. From pFHK6, which contained a 20-kilobase-pair chromosomal insert, a 3-kilobase-pair XhoI fragment was isolated and subcloned into the plasmid cloning vector pVK101 to give pFHK10. In toxigenic P. aeruginosa strains containing pFHK10, toxin expression was increased 10-fold and high levels of iron in the culture medium only partially inhibited the overproduction. Expression studies suggested that pFHK10 did not contain the toxin structural gene. In addition, Southern analysis with the 3-kilobase-pair XhoI fragment suggested that the putative toxin regulatory gene is common among different strains of P. aeruginosa including previously reported nontoxigenic strains.     

Inhibition of CDK activity and PCNA-dependent DNA replication by p21 is blocked by interaction with the HPV-16 E7 oncoprotein

p21 inhibits cyclin-dependent kinase (CDK) activity and proliferating cell nuclear antigen (PCNA)-dependent DNA replication by binding to CDK/cyclin complexes and to PCNA through distinct domains. The human papillomavirus (HPV)-16 E7 oncoprotein (16E7) abrogated a DNA damage-induced cell cycle arrest in vivo, despite high levels of p21. Using cell lysates and purified proteins we show that 16E7 prevented p21 both from inhibiting CDK2/cyclin E activity and PCNA-dependent DNA replication, whereas the nononcogenic HPV-6 E7 had reduced effects. Inactivation of both inhibitory functions of p21 was attained through binding between 16E7 and sequences in the carboxy-terminal end of p21 that overlap with the PCNA-binding site and the second p21 cyclin-binding motif. These data imply that the carboxyl terminus of p21 simultaneously modulates both CDK activity and PCNA-dependent DNA replication and that a single protein, 16E7, can override this modulation to disrupt normal cell cycle control.     

Antimicrobial resistance of Salmonella isolates from swine

We examined the antimicrobial resistance of 1,257 isolates of 30 serovars of Salmonella enterica subsp. enterica isolated from swine. Serovars Typhimurium and Typhimurium var. Copenhagen were widespread and were frequently multidrug resistant, with distinct resistance to ampicillin, kanamycin, streptomycin, sulfamethoxazole, and tetracycline and to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline, respectively.