The frequency of fungal infection in biopsies of oral mucosal lesions

To determine the frequency of fungal infection in biopsies of oral mucosal lesions. MATERIALS AND METHODS: Histopathology reports issued between 1991–1995 inclusive were reviewed. During this period, a single section of each mucosal biopsy had been stained using the periodic acid-Schiff (PAS) technique. RESULTS: A total of 223 (4.7%) biopsies contained PAS-positive fungi: 191 individuals were affected, 124 (64.9%) of whom were male. There was a significant (P < 0.01) positive association of fungal infection with moderate and severe epithelial dysplasia, median rhomboid glossitis and squamous papillomas. Where a subsequent biopsy was available, 21.9% dysplasias which were infected with fungi worsened in histological severity, as compared with 7.6% of dysplasias which were not infected at any stage. There was a significant negative association of fungal infection with benign fibrous overgrowths (P < 0.01), benign hyperkeratoses, lichenoid reactions and pyogenic granulomas (P < 0.05). The difference in frequency of infection between the tongue and other sites was also significantly higher (P < 0.01). CONCLUSIONS: There is a statistically significant association between histologically-determined fungal infection and epithelial dysplasia, and we recommend that a PAS stain be performed whenever oral epithelial dysplasia is diagnosed, especially in male patients. On histological confirmation of dysplasia, anti-fungal therapy should be considered in the management of these lesions.     

Abdominal and hepatic uptake of 99mTc-pyrophosphate in neonatal necrotizing enterocolitis

Abdominal 99mTc-pyrophosphate (99mTc-PYP) scans were obtained in 15 neonates: 12 with neonatal necrotizing enterocolitis (NEC), two with osteomyelitis, and one with myocarditis. Ten of the babies with NEC had at least one positive scan; of these 10 studies, seven (Group A) showed both diffuse abdominal uptake and localized hepatic activity, two (Group B) showed abdominal uptake and questionable hepatic uptake, and one (Group C) demonstrated diffuse abdominal uptake only. The other two babies with NEC had normal scans (Group D). Pneumatosis intestinalis was unquestionably present in two patients from Group A and one from Group B. Upon resolution of the clinical findings, all NEC patients had normal scans. A patient with myocarditis had hepatic uptake of 99mTC-PYP while the abdominal scan in the two infants with osteomyelitis was normal. These preliminary observations suggest that further study of a relationship between abdominal scan findings and the course of NEC is warranted.     

A controlled comparison of techniques for locating the internal jugular vein using ultrasonography

Fifteen techniques for localization of the internal jugular vein ( IJV ) were evaluated in each of 25 subjects using ultrasonography to simulate actual cannulation. Ultrasound images were used to determine puncture of the IJV , puncture of the carotid artery (CA), the distance from the skin to the center of the IJV , the width of the IJV lumen, the relationship of the CA to the IJV , and the lateral distance of the IJV from the axis of the sound beam. No technique proved best in successful IJV puncture. Techniques did differ statistically in rates of CA puncture. Techniques using the CA pulse as a landmark had lower CA puncture rates. Rotation of the head, extension of the neck, and breathholding had no influence on IJV cannulation rates. It is concluded that no one technique is clearly superior to the others. Facility with one technique may be more critical to successful cannulation than the technique itself.     

Morton neuroma: sonographic evaluation

One hundred consecutive patients with symptoms suggestive of Morton neuroma were examined with sonography, and 134 intermetatarsal masses were demonstrated. Forty-five patients underwent surgical exploration, which revealed Morton neuromas. The typical sonographic appearance is that of an ovoid, hypoechoic mass oriented parallel to the long axis of the metatarsals. Most masses were between the second and third or third and fourth metatarsals and seemed to produce symptoms when reaching a diameter of 5 mm.     

Strategies for studies of neurotoxic mechanisms involving deficient transport of L-glutamate: antisense knockout in rat brain in vivo and changes in the neurotransmitter metabolism following inhibition of glutamate transport in guinea pig brain slices

This communication briefly reviews characteristics of glutamate transport in the central nervous system and is involved in the aetiology of slow neurodegenerative diseases. Data in the literature suggest that antisense oligonucleotides targeted against glutamate transporters and administered in vivo over a period of days could be used to test the hypothesis. Data from our laboratory have indicated that single intraventricular doses of antisense oligonucleotides can also results in significant reductions in the numbers of substrate binding sites associated with glutamate transporters and may even cause subtle changes in their characteristics. In order to study metabolism in brain tissue, we have used 13C-nuclear magnetic resonance spectroscopy to analyse extracts of slices of guinea pig cerebral cortex exposed to glutamate transport inhibitor L-anti,endo-methanopyrrolidine dicarboxylate (L-a,e-MPDC). The results have shown-for the first time in an experimental model that preserves the relationship between glia and neurones within the context of brain tissue-that inhibition of L-glutamate transport can exert a significant influence on neurotransmitter-related metabolism. These findings suggest that metabolic disturbances caused by deficient glutamate transport could play a significant role in the death of neurones under pathological conditions in vivo.     

Indications for induction of labour: a best-evidence review

Background  Rates of labour induction are increasing.
Objectives  To review the evidence supporting indications for induction.
Search strategy  We listed indications for labour induction and then reviewed the evidence. We searched MEDLINE and the Cochrane Library between 1980 and April 2008 using several terms and combinations, including induction of labour, premature rupture of membranes, post-term pregnancy, preterm prelabour rupture of membranes (PROM), multiple gestation, suspected macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, fetal anomalies, systemic lupus erythematosis, oligohydramnios, alloimmunization, rhesus disease, intrahepatic cholestasis of pregnancy (IHCP), and intrauterine growth restriction (IUGR). We performed a review of the literature supporting each indication.
Selection criteria  We identified 1387 abstracts and reviewed 418 full text articles. We preferentially included high-quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised trials and observational studies.
Main results  We included 34 full text articles. For each indication, we assigned levels of evidence and grades of recommendation based upon the GRADE system. Recommendations for induction of labour for post-term gestation, PROM at term, and premature rupture of membranes near term with pulmonary maturity are supported by the evidence. Induction for IUGR before term reduces intrauterine fetal death, but increases caesarean deliveries and neonatal deaths. Evidence is insufficient to support induction for women with insulin-requiring diabetes, twin gestation, fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease and fetal gastroschisis.
Authors' conclusions  Research is needed to determine risks and benefits of induction for many commonly advocated clinical indications.     

Human brain neurons express a novel splice variant of excitatory amino acid transporter 5 (hEAAT5v)

Excitatory amino acid transporter 5 (EAAT5) is a protein that is known to be alternately spliced and to be abundantly expressed in the retina by populations of neurons including photoreceptors and bipolar cells. EAAT5 acts as a slow glutamate transporter and also as glutamate-gated chloride channel, the chloride conductance being large enough for EAAT5 to serve functionally as an “inhibitory” glutamate receptor. However, there has been a long-standing view that the classically spliced form of EAAT5 is not abundant or widespread in the brain and so it has not been extensively investigated in the literature. We recently identified a human-specific splicing form of EAAT5 that was not expressed by rodents but was shown to be a functional glutamate transporter. We have examined the expression of this form of EAAT5, hEAAT5v at the mRNA, and protein level in human brain, and show that populations of human cortical pyramidal neurons and cerebellar Purkinje cells show significant expression of hEAAT5v. Accordingly, we infer that EAAT5 may well be a player in modulating neuronal function in the human brain and propose that its localization in both glutamatergic and GABAergic neurons could be compatible with a role in influencing intracellular chloride and thereby neuronal parameters such as membrane potential rather than acting as a presynaptic glutamate transporter.