Pericardial effusion complicating a percutaneous central venous line in a neonate

A premature infant developed pericardial effusion four days after the insertion of a 25-gauge silastic percutaneous central venous catheter. The effusion contained parenteral nutrition fluid and resolved rapidly after withdrawal of the catheter. Pericardial effusion is a potential complication of percutaneous, as well as surgically placed, central venous catheters.     

The STR system in the human phenylalanine hydroxylase gene: true fragment length obtained with fluorescent labelled PCR primers

We present a simple, fast, non-radioactive method for the analysis of the polymorphic short tandem repeat (STR) system in the human phenylalanine hydroxylase gene. Previously, sizing of the STR marker involved radiolabelling of PCR amplified fragments and resolution on denaturing polyacrylamide gels using M13 sequencing ladder as a standard. However, this method consistently gave sizes 2 bp longer than the known sequence. The fluorescent method presented here employs internal lane standards and enables accurate sizing of the fragments. To avoid confusion, we suggest that the true fragment lengths are used as reference values in the future. The analysis of STR alleles is valuable for population genetic studies and for targeted mutation screening in phenylketonuria (PKU). It can replace RFLP-based haplotype analysis for carrier detection, and we report its use for prenatal diagnosis in a Northern Irish family with PKU. The analysis of 250 Northern Irish chromosomes, including 128 PKU alleles, showed no significant difference between normal and PKU alleles, with fragment lengths of 238 and 242 bp most common in both groups.     

Molecular analysis of PKU in Ireland

Classical phenylketonuria (PKU: McKusick No. 261600) is caused by mutations occurring at the phenylalanine hydroxylase (PAH) locus on chromosome 12 and has a prevalence in Ireland of 1 in 4500. We examined 304 independent alleles from 350 patients for the presence of six mutations and have characterized VNTR alleles within the minisatellite region 3' to the PAH gene in patients carrying the most prevalent mutation. R408W was the most common mutation found, with a relative frequency of 42%. All other mutations had relative frequencies of <10%. VNTR analysis showed that the R408W mutation is associated with the VNTR-8 allele in the Irish population, indicating that R408W is associated with RFLP haplotype 1. This differs from that reported from eastern Europe where R408W is associated with RFLP haplotype 2/VNTR-3; an observation which has led several groups to propose a Balto-Slavic origin for this mutation. These results support the hypothesis of a second, independent founding event for the R408W mutation on an RFLP haplotype 1 VNTR-8 chromsome background in the Irish/Celtic population.     

Fructosamine and glycated haemoglobin in the assessment of long term glycaemic control in diabetes

Fructosamine and glycated haemoglobin were measured simultaneously in 147 children with diabetes. If glycated haemoglobin is considered as the 'gold standard' for long term glycaemic control, then fructosamine is a poor indicator of actual glycated haemoglobin values, with wide 95% confidence (fiducial) limits. This shows that it is impossible to accurately predict glycated haemoglobin concentrations and therefore, by implication, longer term glycaemic control, from measurements of fructosamine. As the major studies on the prevention of microvascular complications in diabetes have used glycated haemoglobin levels to assess glycaemic control, it is suggested that this measurement should be used in all children with diabetes in preference to the measurement of fructosamine.     

Oral and hypothalamic injections of barbiturates, benzodiazepines and cannabinoids and food intake in rats.

To evaluate and compare CNS sites of action of chemicals which stimulate feeding, intakes were measured after ventromedial hypothalamic (VMH) and lateral hypothalamic (LH) administration of pentobarbital sodium (PBS), diazepam (D) and the d- and l-isomers of Δ⁹-tetrahydrocannabinol (THC); and intragastric administration of D and d- and 1-THC. In rats fed ad lib PBS (8 and 16 μg) increased intake tenfold (p<0.05) 0.5 hr after injection in the VMH, but not the LH. Intragastric administration of 2.5 and 5 mg/kg D increased intake twofold (p<0.01) at 0.5 and 2 hr but did not affect 24 hr intake. VMH injections of D (10 and 20 μg) caused a 15-fold increase (p<0.05) at 0.5 but not 24 hr, but LH injection of D did not affect 0.5 or 24 hr intake. Intragastric administration of 4 mg/kg 1-THC increased (p<0.01) food intake at 1 and 2 hr, but 24 hr intake was not affected; d-THC had no effect. VMH, but not LH, injection of 1-THC (0.25 μg) caused a 24-hr increase in intake. d-THC (0.25 μg) caused a decrease (p<0.05) in feeding at 0.5 hr, but not 24 hr when administered in the VMH, and increased (p<0.05) feeding at 24 hr when injected in the LH. The VMH appears to mediate the action of both PBS and D, but the increased feeding caused by systemic 1-THC is not duplicated by VMH administration, thereby suggesting an alternate site of action.     

Developing communication competency in the context of cancer: a critical interpretive analysis of provider training programs

We conducted a critical interpretive analysis of 47 studies from the Cochrane Review of the communications training literature to capture the empirical indicators used to judge provider communication competency and to describe how the indicators were characterized in the context of a cancer care system. Of the 47 studies reviewed, few showed any resemblance to recommendations from two international consensus conferences of experts in the communication research field. Some of the challenges in moving forward with cancer-related communication skills involve deciding what we want people to learn, providing learning across various experiences, identifying learning models, and finding alternate ways of motivating people to learn. Once core competencies are clearly articulated, we can determine the best approaches for developing cancer-specific training programs.