Improved diagnosis of "nondelineated" thyroid nodules by oblique scintillation scanning and echography.

The scan of the thyroid gland in oblique projections has enabled us to visualize 11 "cold" thyroid nodules which were not delineated on a traditional anterior view among 825 patients studied in a 2-yr period. Accurate localization of the nodule in the oblique projection facilitated accurate placement of the transducer for echography. The combination of the isotope imaging studies and ultrasound then permitted one to differentiate solid and cystic "cold" nodules. Diagnosis and choice of therapy are therefore enhanced by the addition of oblique views, when needed, and echography.     

Phase II study of carboplatin in recurrent ovarian cancer: severe hematologic toxicity in previously treated patients

Summary Carboplatin (CBDCA) is a second-generation cisplatin analog that has shown activity in early clinical trials. Its spectrum of toxicity is quantitatively and qualitatively different from that of the parent compound. Between November 1984 and September 1986 we conducted a phase II trial of CBDCA in 46 women with epithelial ovarian cancer. All patients had undergone at least one prior chemotherapy regimen; 41 (89%) had previously received cisplatin (mean cumulative dose, 540 mg/m²). The CBDCA dose was based on renal function and was injected i. v. once every 4 weeks. Patients were stratified on the basis of baseline creatinine clearance: those with a baseline creatinine clearance of 60 ml/min received 400 mg/m² CBDCA; those with a creatinine clearance between 30 and 60 ml/min received an initial dose calculated according to a previously published formula [2, 3] that corrected for renal insufficiency and projected nadir platelet counts of 75,000/mm³. Of 41 evaluable patients, 6 (15%) had an objective response [2 complete responses (CRs); 4 partial responses (PRs)]; 5 of the 6 responders had previously responded to cisplatin treatment. No responses were observed in 12 patients who had not responded to prior cisplatin therapy. Significant hematologic toxicity was seen. Of 18 patients with a creatinine clearance of 60 ml/min (dose, 400 mg/m²), 6 had nadir platelet counts of <25,000/mm³, 4 with symptomatic bleeding. Of the 21 evaluable patients for whom the dose-modification formula was applied, 10 had nadir platelet counts of <75,000/mm³; 5 had counts of <50,000/mm³. CBDCA has activity even in patients who have previously undergone extensive cisplatin therapy; however, its toxicity is variable and thrombocytopenia is dose-limiting. We did not confirm the ability of the above-mentioned formula to calculate the CBDCA dose and accurately predict the nadir platelet count for all patients. Other factors, such as prior radiotherapy, may also be important in the dosing of CBDCA in pretreated patients.Supported in part by a grant from Bristol Myers Company Pharmaceutical Research and Development Division, CRU CA 16087 and CRU-96.N. Colombo is the recipient of a fellowship from the American Italian Foundation for Cancer Research.     

Combined esophageal and gastric ph-metry in healthy volunteers influence of cable through les and effect of misoprostol

In order to evaluate whether combined esophageal and gastric pH-metry is feasible without interference due to the transcardial cable, four 24-hr ambulatory esophageal pH-metries were carried out in seven healthy volunteers in a randomized order. In two studies only one glass electrode was used. It was placed 5 cm above the lower esophageal sphincter. In the two other studies an additional electrode was placed in the corpus region 10 cm below the lower esophageal sphincter. In order to obtain a wide range of pH values, misoprostol (400 g) was given at 9am and 9:15pm in two studies. In the two other studies placebo was given. Misoprostol exerted only a weak and short-lasting effect on gastric acidity. The four measuring conditions did not differ with respect to medians of esophageal reflux time and duration of single reflux episodes, Kendall's coefficient of concordance yielded a high reproducibility for both variables (P < 0.0025). Thus, combined esophageal and gastric pH-metry is feasible and highly reproducible.This work was supported by Swiss National Foundation grant 3.827.0.86 and by Deutsche Forschungsgemeinschaft grant Em 36/1-3.     

Assessment of the superior labrum of the shoulder joint with CT-arthrography and MR-arthrography: correlation with anatomical dissection

Summary The ability to detect and categorize SLAP (Superior Labrum Anterior to Posterior) lesions of the scapular labrum is of practical importance to the orthopedic surgeon and the radiologist. The aim of this study, performed on cadaveric shoulders, was to determine whether CT arthrography or MR arthrography is able to show normal anatomical variation of the glenoid labrum and detect labral abnormalities. CT arthrography, MR arthrography followed by anatomical dissection were performed on twenty three fresh frozen cadaveric shoulders and analysed by a radiologist and two orthopaedic surgeons. As Gadolinium intra-articular injection is not allowed in France, we used an iodinated contrast media for both MR arthrography and CT arthrography. In this study, the sensitivity of MR arthrography seemed higher than CT arthrography (respectively 4 and 3 labral lesions diagnosed out of five), although no significant statistical conclusions can be made due to the small number of cases. In conclusion, under such specific conditions, MR arthrography seems to be the method of choice for the detection and classification of labral lesions.

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Bourrelet glénoïdal supérieur : corrélation radio-anatomique

Résumé La possibilité de détecter et de classer les lésions du bourrelet supérieur de la cavité glénoïdale de la scapula (SLAP lesions: Superior Bourrelet Anterior to Posterior) est une nécessité pour le radiologue et l'orthopédiste confrontés à des patients présentant des douleurs de l'épaule. Le but de cette étude réalisée sur des épaules cadavériques, était de déterminer les valeurs respectives de l'arthro-scanner et de l'arthro-IRM dans la détection des variations anatomiques normales et des anomalies pathologiques du bourrelet glénoïdal supérieur. Un arthro-scanner, une arthro-IRM, puis une dissection anatomique ont été réalisées sur 23 épaules fraîches et les résultats de ces examens ont été analysés par un radiologue et deux chirurgiens orthopédistes. L'injection intra-articulaire de gadolinium n'étant actuellement pas autorisée en France, un produit de contraste iodé à été utilisé pour l'arthro-scanner et l'arthro-IRM. Dans cette étude, la sensibilité de l'arthro-IRM semblait meilleure que celle de l'arthro-scanner (respectivement 4 et 3 lésions diagnostiquées sur 5), bien que ce résultat ne soit pas statistiquement significatif compte tenu du petit nombre de cas. En conclusion, dans les conditions spécifiques de notre étude, l'arthro-IRM semble être la méthode de choix pour la détection et la classification des lésions du bourrelet glénoïdal supérieur.

     

Lactobacillus johnsonii La1 antagonizes Giardia intestinalis in vivo

This study describes the in vivo activity of Lactobacillus johnsonii La1 (NCC533) in Giardia intestinalis-infected gerbils (Meriones unguiculatus). Daily administration of lactobacilli in the drinking water from 7 days before inoculation with Giardia trophozoites efficiently prevented G. intestinalis strain WB clone C6 from infecting gerbils. More specifically, shedding of fecal Giardia antigens (GSA65 protein) was diminished in the La1-treated group, and resolution of infection was observed by 21 days postinoculation. Histology and analysis of enzymatic markers of microvillus membrane integrity revealed that probiotic administration also protected against parasite-induced mucosal damage. In addition, a cellular response to Giardia antigens was stimulated in spleen cells from La1-treated gerbils. Results show for the first time the antigiardial effect of probiotic lactobacilli in vivo and provide further insight into the antagonistic properties of lactic acid bacteria against protozoa involved in intestinal infections.     

Nursing competence in adolescent health: anticipating the future needs of youth.

The health problems of youth have dramatically shifted in the last 30 years from biological to social causes of morbidity and mortality. To assess the adequacy of nurses' knowledge and skills in adolescent health, a national survey of 445 nurses, including members of the American Public Health Association, the American School Health Association, and the National Association of Pediatric Nurse Associates and Practitioners, was undertaken in 1985. Results indicated that even among nurses who work with young people the most, areas of greatest knowledge and skill deficiencies included common social morbidities of adolescents. In addition to self-assessed inadequacies in knowledge and skills, nurses identified excessive time demands as a primary obstacle to the provision of health services to adolescents. To assure adequate preparation of nurses, it is recommended that accreditation criteria for baccalaureate and graduate programs specify essential adolescent health content for curricula compared to current accreditation criteria that generalizes "across the life span." Focusing on the enhancement of educational opportunities in adolescent health, nurses identified strategies for further education that would bridge the gap between the health needs of youth and nurse's self-perceived competencies in providing these services.     

Transynaptic regulation of low-affinity p75 nerve growth factor receptor mRNA precedes and accompanies lesion-induced collateral neuronal sprouting.

The bilateral sympathetic innervation of the rat pineal gland from the two superior cervical ganglia (SCG) is a useful model system to investigate the mechanisms by which intact neurons compensate for neuronal losses. Cutting of the internal carotid nerve (ICN) on one side has been shown to result in the removal of approximately one-half of the innervation to the pineal gland within 2 days. This denervation is followed by the development of collateral neuronal sprouting from the contralateral "intact" SCG, most of which takes place during the next 2 days. Using a solution hybridization protection assay, levels of low-affinity NGF receptor p75NGFR mRNA (pg/microgram total RNA) were found to be increased 25%, with no change in cyclophilin mRNA, in the SCG contralateral to the lesion performed 1 or 3 days earlier. In situ hybridization with a 35S riboprobe complementary to p75NGFR mRNA demonstrated a large increase in this mRNA in some cells of this intact SCG at both 1 and 3 days after a contralateral ICN cut lesion. The clustering of these cells toward the rostral portion of the SCG suggests that they may overlap with the population of sympathetic neurons which provides innervation to bilaterally innervated structures such as the pineal gland. The nature of the signals involved in the regulation of NGF receptor mRNA levels and their role in initiating and maintaining collateral sprouting remain to be fully established. Nevertheless, the time course of the changes in mRNA levels suggests that regulation of the low-affinity NGF receptor gene may be involved in the sequence of events associated with the collateral sprouting response by intact sympathetic nerve cells following partial denervation.     

Oestrogen positive feedback reduces arcuate proopiomelanocortin messenger ribonucleic Acid

Oestradiol-17ß, in its positive feedback mode, as well as stimulating the release of luteinizing hormone-releasing hormone. (LHRH), also stimulates LHRH mRNA synthesis in medial preoptic neurons. Our aim was to determine whether the action of oestradiol might be mediated in part by inhibiting arcuate proopiomelanocortin (POMC) neurons which terminate on LHRH neurons. Female rats were ovariectomized at about 1000 h of dioestrus, given a subcutaneous injection of oil or oestradiol benzoate and killed at 1600 h the same day (presumptive dioestrus), presumptive pro-oestrus and oestrus and at 1000 h of presumptive pro-oestrus. In situ hybridization of brain sections was carried out with a [³⁵S]UTP-labelled riboprobe containing 538 bases of a cDNA identical to exon 3 of the POMC gene, which includes the ß-endorphin coding domain. The amount of POMC mRNA in cells of the anterior arcuate nucleus, as assessed by grain counts, was significantly decreased in oestradiol benzoate- compared with oil-treated animals at 1600 h of pro-oestrus, but at none of the other times studied. This finding, together with other data, suggests that the positive feedback stimulation of LHRH mRNA synthesis by oestradiol-17ß may be due, in part, to the disinhibition of LHRH neurons consequent on inhibition of POMC mRNA biosynthesis in arcuate neurons.