Intramural hematoma of the esophagus: Unusual complication of variceal sclerotherapy

A patient is described who developed severe retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. This lesion resolved within 2 weeks of conservative treatment.     

Responses of visual cortical neurons to curved stimuli and chevrons

Single cells were recorded in area 17 of anaesthetized and paralyzed cats and their responses to curved stimuli and chevrons compared. Striate cells exhibited three different response patterns. A first group responded optimally to a straight line (i.e. zero curvature) and responded similarly to chevrons and to curved lines. A second group responded to all curvatures and was broadly tuned for the straight line when tested with chevrons. A third group responded only to large curvatures, many (2/3) to both signs of curvature and a number (1/3) to only one sign. Cells in this group responded differently to chevrons and curved lines. Cells in these three classes differed both in length-response curve and in width of orientation tuning. Laminar analysis revealed that the three classes are distributed differently across cortical layers. These data shed new light on the finding of Malpeli and coworkers that orientation is extracted at least twice in a cortical column.     

Estimating the Cost-Effectiveness of Quality-Improving Interventions in Oral Anticoagulation Management within General Practice

OBJECTIVES: A clinical trial, "Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT)," significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advice for adapting oral anticoagulation therapy. The quality improvement in INR control versus baseline was similar in the four groups. The aim of the current study was to calculate the cost-effectiveness and influencing factors of the four quality-improving interventions compared with usual care. METHODS: Activity-based costing techniques with questionnaires were used to determine the global costs per patient per month in the different intervention groups. Effectiveness data were obtained from the BISOAT study. Cost-effectiveness was expressed as cost per additional day within a 0.5 range from INR target. RESULTS: The one-time cost of multifaceted education was 49,997 euro for the whole study. Monthly continuous costs per intervention ranged between 37 euro and 54 euro per patient. Using the CoaguChek in combination with the multifaceted education was associated with net savings and quality improvement, hence dominated usual care. Sensitivity analyses showed improved cost-effectiveness with extended duration and with increased program size. CONCLUSION: Implementation of the combination multifaceted education with the use of the CoaguChek is a cost-effective new organizational model of oral anticoagulation management in general practice.     

Microcontaminant accumulation, physiological condition and bilateral asymmetry in zebra mussels (Dreissena polymorpha) from clean and contaminated surface waters

Chemical and biological monitoring of pollution in the aquatic environment is essential to assess the quality of surface waters. Zebra mussels (Dreissena polymorpha) have been used extensively to monitor pollution in freshwater environments, especially in bioaccumulation studies, whereby pollutant levels in tissues have been used as a measure of exposure. However, there is a need for good biomarkers that reflect the impact of exposure to pollutants. Bilateral asymmetry, commonly used as a measure of developmental instability, has a high potential as a biomarker to monitor stress caused by pollution. Nevertheless, until recently, no studies have evaluated bilateral asymmetry as a biomarker in zebra mussels. Biomarkers related to the energy metabolism may give a good indication of the physiological cost of exposure to pollution. In this study, we investigated whether the physiological condition (energy reserves and condition indices) and bilateral asymmetry of shells of zebra mussels are potentially useful biomarkers to monitor the impact of micropollution, such as trace metals, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and di(p-chlorophenyl) dichloroethylene (p,p'-DDE) in the freshwater environment. Bilateral asymmetry of the zebra mussel shells was examined with respect to levels of pollutants accumulated in the mussels and compared to the physiological condition of the mussels. Levels of PCBs and several trace metals (especially Cd, Cu and Zn) were very high in four of the six sampling locations and in some locations the physiological condition of the mussels was significantly depressed. Nevertheless we did not find any relation (on individual or population level) with bilateral asymmetry of zebra mussel shells. Therefore our results suggest that bilateral asymmetry of zebra mussel shells is not a good measure for the impact of pollution in freshwater ecosystems. The energy reserves and condition indices, on the other hand, gave a valuable indication of the physiological condition of zebra mussels and are useful to monitor the impact of pollution if physiological and environmental factors are taken into account.     

Clinical results of pre-operative irradiation in case of adenocarcinoma of the kidney (author's transl)

145 patients with adenocarcinomas of the kidney were submitted to tumor resection and irradiation. The irradiation was executed before the operation (in most cases with a focal dose of 1200 to 1600 rd in two days or 2400 to 3500 rd in 2 1/2 to 3 1/2 weeks) and/or after the operation. The survival rates of the different therapy groups were examined with regard to the tumor extension and to its degree of differentiation. It was found out that the pre-operative short term irradiation was somewhat superior to the pre-operative long term irradiation except in case of very extensive, hardly operable tumors. On the whole, the combined pre- and post-operative irradiation seems to be more advantageous than the post-operative irradiation alone.     

Dynamics of cadmium accumulation and effects in common carp (Cyprinus carpio) during simultaneous exposure to water and food (Tubifex tubifex)

In this study, the influence of exposure time and concentration on the accumulation of cadmium and the occurrence of adverse effects was investigated when carp were simultaneously exposed through contaminated water and food. As exposure concentrations increased (9, 105, and 480 microg/L through water and 9.5, 122, and 141 microg/g dry weight through food) the accumulation pattern of cadmium changed, with progressively more cadmium being accumulated in the liver and especially the kidney and less in the gills and the intestine. A strong concentration- and time-dependent effect of cadmium exposure on plasma calcium concentrations was observed, leading to a decrease, with approximately 16% in the mid group and up to 50% in the group exposed to the highest cadmium concentration. Also at the highest exposure concentrations, sodium and chloride levels as well as plasma osmolality were significantly reduced, indicating a disturbed ion homeostasis. Furthermore, an increase in plasma alanine transaminase activity indicated liver damage caused by the cadmium accumulation in this organ. At the end of the experiment, general stress responses such as decreased hematocrit, growth, and mortality (17%) also were observed. All together, these results suggest that plasma hypocalcemia as an ion-disruptive phenomenon is the most sensitive effect during cadmium exposure, although the occurrence and magnitude both depend on exposure time and concentration.     

Biochemical activity of reactive oxygen species scavengers do not predict retinal ganglion cell survival

PURPOSE: Retinal ganglion cells (RGCs) die as a result of axonal injury in a variety of optic neuropathies, including glaucoma. Reactive oxygen species (ROS) act as intracellular signaling molecules and initiate apoptosis in nerve growth factor-deprived sympathetic neurons and axotomized RGCs. Determination of the role of specific ROS relies on the use of small molecule or protein scavengers with various degrees of specificity. The pro- or anti-cell-death effect of several ROS generating and scavenging systems in cultured RGCs was correlated with their activity in cell-free assays. METHODS: Neonatal rat retinas were dissociated and incubated with ROS-generating systems for hydroxyl radical, superoxide anion (O2-), and H2O2. Scavengers tested were catalase, polyethylene glycol-superoxide dismutase (PEG-SOD), manganese (III) tetrakis(1-methyl-4-pyridyl)porphyrin (MnTMPyP), 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid (Trolox), deferoxamine, and U-74389G. Viability of retrogradely labeled RGCs was determined with calcein-AM 24 hours after plating. O2- and H2O2 scavenging in cell-free assays was measured with dihydroethidium and Amplex Red (Invitrogen, Carlsbad, CA), respectively. RESULTS: Systematic differences were found between ROS scavenging in cell-free assays and the ability of scavengers to protect RGCs in cell culture. Furthermore, many ROS scavengers lost specificity and protected against various ROS, whereas others failed to protect against their unique ROS target. These activities stray from commonly recognized specificities of individual ROS scavengers or generating systems and are important in understanding ROS biology. In addition, antioxidant defense mechanisms used by RGCs and other retinal cells interfere with responses expected from ROS scavengers in well-defined systems. Last, H2O2 induced intramitochondrial O2-, whereas paraquat produced O2- outside of the mitochondria, and these areas of generation can mislead interpretations of ROS scavenger activity and effectiveness. CONCLUSIONS: There is discordance between ROS effects in cultured RGCs and cell-free assays, with several mechanisms accounting for this divergence. To identify the roles of ROS signaling in cell death accurately, several approaches should be used. These include using a panel of ROS scavengers and generators, testing the panel in primary neuronal cultures, and quantifying ROS with cell-free assays.     

Adenocarcinoma of ileal neobladder 20 years after cystectomy

We present the case of a 67-year-old man with adenocarcinoma of the ileal neobladder 20 years after radical cystoprostatectomy for Stage pT2 transitional bladder cell cancer. A MEDLINE research revealed 9 other cases of the development of a neoplasm in the ileal part of an ileocystoplasty. This observation supports the hypothesis that in an ileal neobladder morphologic and molecular changes can be observed similar to those in the development of colorectal carcinoma. Patients who had an ileal neobladder created are at risk of glandular malignancy and should be closely followed up.     

Comparison of host response to polypropylene and non-cross-linked porcine small intestine serosal-derived collagen implants in a rat model

OBJECTIVE: To compare the host response, architectural integration and tensile strength of polypropylene and porcine small intestine submucosa-derived implants in a rat model. DESIGN: Experimental study. SETTING: Center for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium. SAMPLE: Forty-eight adult male Wistar rats weighing 220-250 g randomised to receive either implant. METHODS: Full thickness abdominal wall defects were primarily repaired with polypropylene mesh (Marlex) (MX group) or porcine small intestine submucosa (Surgisis) (SIS group). Animals were sacrificed at 7, 14, 30 and 90 days after implantation. MAIN OUTCOME MEASURES: The presence of herniation, infection and intra-peritoneal adhesions. Change in thickness and tensile strength of implant. Histopathological and immunohistochemical appearances of inflammatory response and collagen deposition. RESULTS: Implants from the SIS group showed a short term increase in thickness in the first 14 days. Formation of adhesions was significantly more intense in the MX group at 30 days, and more extensive in the SIS group at 90 days. Tensile strength increased over time in both groups but was significantly lower in the SIS group than the MX group at 30 days. Implants in the MX group showed a more pronounced inflammatory response and more pronounced new vessel formation than the SIS group. Collagen formation was initially more fibrous and better organised in the MX group but became greater in the SIS group at 90 days. CONCLUSIONS: Biologically derived implant material induced a less pronounced inflammatory response and differences in collagen deposition. At 30 days tensile strength was weaker in the biological implant group but was equivalent by 90 days. These differences may have implications for the in vivo performance of the materials.