Asymptomatic spondylodiscitis an unusual feature of ankylosing spondylitis

Six patients with ankylosing spondylitis were found to have asymptomatic spondylodiscitis. They have been followed for a mean of 17 years and have been free of symptoms or complications from this lesion. This benign asymptomatic course has not been stressed by previous authors.     

General anesthetics selectively modulate glutamatergic and dopaminergic signaling via site-specific phosphorylation in vivo

Isoflurane, propofol and ketamine are representative general anesthetics with distinct molecular mechanisms of action that have neuroprotective properties in models of excitotoxic ischemic damage. We characterized the effects of these agents on neuronal glutamate and dopamine signaling by profiling drug-induced changes in brain intracellular protein phosphorylation in vivo to test the hypothesis that they affect common downstream effectors. Anesthetic-treated and control mice were killed instantly by focused microwave irradiation, frontal cortex and striatum were removed, and the phosphorylation profile of specific neuronal signaling proteins was analyzed by immunoblotting with a panel of phospho-specific antibodies. At anesthetic doses that produced loss of righting reflex, isoflurane, propofol, and ketamine all reduced phosphorylation of the activating residue T183 of ERK2 (but not of ERK1); S897 of the NR1 NMDA receptor subunit; and S831 (but not S845) of the GluR1 AMPA receptor subunit in cerebral cortex. At sub-anesthetic doses, these drugs only reduced phosphorylation of ERK2. Isoflurane and ketamine also reduced phosphorylation of spinophilin at S94, but oppositely regulated phosphorylation of presynaptic (tyrosine hydroxylase) and postsynaptic (DARPP-32) markers of dopaminergic neurotransmission in striatum. These data reveal both shared and agent-specific actions of CNS depressant drugs on critical intracellular protein phosphorylation signaling pathways that integrate multiple second messenger systems. Reduced phosphorylation of ionotropic glutamate receptors by all three anesthetics indicates depression of normal glutamatergic synaptic transmission and reduced potential excitotoxicity. This novel approach indicates a role for phosphorylation-mediated down-regulation of glutamatergic synaptic transmission by general anesthetics and identifies specific in vivo targets for focused evaluation of anesthetic mechanisms.     

The value of two-step operative laparoscopy with interval pituitary suppression in the treatment of infertility caused by severe endometriosis

PURPOSE OF REVIEW: To appraise a new approach to laparoscopic surgery for infertility caused by advanced endometriosis. RECENT FINDINGS: Endometriosis is a common systemic and local disease with altered peritoneal function, which requires both systemic and local treatment. Medication alone cannot improve infertility, and laparoscopic treatment, particularly in severe endometriosis, has a high recurrence rate and is often limited by technical difficulties. Novel treatment strategies have therefore to be sought, especially in women who do not want in-vitro fertilization as a first option, either because they suffer from pain in addition to infertility or want to enhance their fertility over many cycles. SUMMARY: Two-step operative laparoscopy with interval pituitary suppression by means of gonadotrophin-releasing hormone analogues reduces the extent of endometriosis, as classified by the American Fertility Association, and appears to be a promising method of achieving optimal cytoreduction and facilitating complicated surgery in severe endometriosis, while protecting the ovary from unnecessary trauma. A large-scale well-designed study is needed to confirm that this treatment leads to improved pregnancy rates.     

AN EXAMINATION OF THE MECHANISM OF PNEUMOCOCCUS IMMUNITY BY MEANS OF BACTERICIDAL MEASUREMENTS : II. THE REACTION BETWEEN THE ANTICARBOHYDRATE ANTIBODY AND TYPE-SPECIFIC PRODUCTS OF THE ORGANISM

1. There is in the filtrate of a 5 day broth culture of Type III pneumococcus a type-specific substance which has a very powerful antibactericidal action. If the precipitinogen content of the broth filtrate and the specific carbohydrate is taken as the basis of comparison, it requires approximately one thousand times as much antiserum to neutralize the broth filtrate as is necessary to neutralize the specific carbohydrate. The active substance in the broth filtrate appears to be related to the specific carbohydrate. Its possible nature is discussed. 2. A similar substance, but in stronger concentration, was found in the filtrate of a lung from a Type III pneumonia autopsy. The influence of this substance on the disease is discussed. 3. One specimen of Type III convalescent blood, though comparatively weak in anticarbohydrate antibody (precipitin) was better able to neutralize the broth filtrate and the lung filtrate than a corresponding mixture of normal blood and antiserum. Two other specimens of Type II convalescent blood neutralized the Type III broth filtrate efficiently.     

METHEMOGLOBIN FORMATION BY STERILE CULTURE FILTRATES OF PNEUMOCOCCUS

1. Sterile filtrates of aerobic cultures of pneumococcus which contain hydrogen peroxide are capable of converting catalase-free solutions of crystalline oxyhemoglobin into methemoglobin. This action is dependent upon the hydrogen peroxide in the filtrates and occurs only in the absence of blood catalase. 2. In catalase-containing solutions of hemoglobin from laked corpuscles, the actual methemoglobin-forming system of Pneumococcus involves a labile constituent of the bacterial cell. This intracellular substance is itself susceptible to oxidizing agents and may be rendered inactive, if exposed to peroxide or similar substances previous to its introduction into oxyhemoglobin solutions. The activity of this function in the case of sterile filtrates of pneumococcus cultures depends, therefore, upon the liberation of cell constituents into the medium and upon the protection of these cellular substances from the oxidizing agents which are formed when pneumococcus cultures are freely exposed to air. When these cultural conditions are fulfilled sterile culture filtrates of Pneumococcus convert oxyhemoglobin into methemoglobin independent of the presence of blood catalase.     

Using Cost-Effectiveness Analysis to Address Health Equity Concerns

This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health—the objective underpinning conventional CEA—and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and—crucially—who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.     

Biotypes and serotypes of thermophilic campylobacters isolated from cattle, sheep and pig offal and other red meats.

In this study we examined 730 faecal samples of offal (mainly liver), mince-meat and sausage meat collected from abattoirs and retail butchers'' shops for campylobacters. Campylobacter jejuni or C. coli were isolated from 30.6, 10.5 and 6% of sheep, cattle and pig offal samples respectively. Specimens collected from abattoirs were, in general, more often contaminated than material obtained from retail butchers'' shops. Only 1.4% of minced meats and sausage meats contained campylobacters. Most isolates (89.5%) were C. jejuni biotype 1 (Skirrow & Benjamin, 1980) of serotypes 1 and 2 (Penner & Hennessy, 1980). This study shows that animal offal is frequently contaminated with C. jejuni of biotypes and serotypes commonly isolated from human beings with campylobacter enteritis.