Changes in the volume and length of the medial gastrocnemius after surgical recession in children with spastic diplegic cerebral palsy.

Background: Morphology is an important determinant of muscle force and power generation. Children with spastic diplegic cerebral palsy (SDCP) have reduced muscular strength, which in part is caused by inadequate muscle growth. There is a widespread concern that surgery to correct soft tissue deformities may exacerbate the underlying muscle weakness and further retard muscle growth.

Barrett's oesophagus: intestinal metaplasia is not essential for cancer risk.

Objective: Barrett's oesophagus is the main identifiable risk factor for oesophageal adenocarcinoma. It has been suggested that only patients with intestinal metaplasia are at risk of cancer, but the British Society of Gastroenterology (BSG) guidelines suggest that glandular mucosa is all that is needed. The aim of this study was to quantify the risk of adenocarcinoma in columnar-lined lower oesophagus, with or without specialized intestinal metaplasia.

Occupational capacity following surgical revascularization for lower limb claudication.

Objectives: Little is known about patient's ability to return to work following surgical revascularization for lower limb claudication. A retrospective cohort study was performed to determine the effect of lower limb surgical revascularization on subsequent employment status.

Design And Methods: Patients who had undergone surgical revascularization between February 2001 and February 2005 and who were aged <65 years, were identified from a prospective database and contacted via a postal questionnaire.

The NAD(P)H:quinone oxidoreductase I C609T polymorphism modifies the risk of Barrett esophagus and esophageal adenocarcinoma.

Purpose: The role of genetic susceptibility to esophageal adenocarcinoma and its precursor lesion Barrett esophagus has not been fully elucidated. This study investigated the effect of polymorphisms in the manganese superoxide dismutase (MnSOD) and NAD(P)H:quinone oxidoreductase 1 (NQO1) genes in modulating the risk of developing Barrett esophagus or esophageal adenocarcinoma.

Methods: A total of 584 patients (146 esophagitis, 200 Barrett esophagus, 144 esophageal adenocarcinoma, and 94 controls) were genotyped for the MnSOD C14T and NQO1 C609T polymorphisms using polymerase chain reaction and restriction fragment length polymorphism analysis.

Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review.

Objectives: To determine the diagnostic accuracy of duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography, alone or in combination, for the assessment of lower limb peripheral arterial disease; to evaluate the impact of these assessment methods on management of patients and outcomes; and to evaluate the evidence regarding attitudes of patients to these technologies and summarise available data on adverse events.

Design: Systematic review.

Methods: Searches of 11 electronic databases (to April 2005), six journals, and reference lists of included papers for relevant studies.

Multiple peripheral pneumococcal mycotic aneurysms without aortic involvement: a unique case confirmed with the novel use of a molecular diagnostic technique.

Mycotic aneurysms confer a high morbidity and mortality. Streptococcus pneumoniae aneurysms usually affect the aorta and are rare, although bacterial cultures from aneurysm tissue may be difficult following prior antimicrobial therapy. We report a unique case of mycotic femoral and popliteal artery aneurysms following pneumococcal pneumonia and meningitis, which were managed by resection, revascularization with autologous vein, and intravenous benzylpenicillin.

Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein.

Background: Unlike surgery, endovenous laser ablation (EVLA) abolishes great saphenous vein (GSV) reflux but does not specifically interrupt the GSV tributaries at the groin. The fate and clinical significance of these tributaries were assessed in a prospective study.

Methods: Eight-one legs (70 patients) underwent colour flow duplex ultrasonography 12 months after GSV ablation for primary varicose veins.

Advancing Health Promotion Priorities: Stories of Capacity Building from the Canadian Heart Health Initiative (CHHI).

The purpose of this paper is to explore how public health professionals built capacity to carry out health promotion despite a low level of investment and competition for financial resources with acute-oriented healthcare services. Three data sources are used in this analysis: key-informant interviews with project participants, final reports from three provincial Heart Health projects in Canada (Prince Edward Island, Ontario and Manitoba) and major provincial health policy documents prior to and during each project. We use a narrative policy analysis to identify contextual factors influencing health promotion priority and progress through capacity building.

A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease.

Objectives: To determine the diagnostic accuracy and cost-effectiveness of duplex ultrasound (DUS), magnetic resonance angiography (MRA), and computed tomography angiography (CTA), as alternatives to contrast angiography (CA), for the assessment of lower limb peripheral arterial disease (PAD).

Data Sources: Ten electronic databases were searched in April 2004, with an update in May 2005. Six key journals and bibliographies of included studies were also searched and experts in the field were consulted.

The morphology of the medial gastrocnemius in typically developing children and children with spastic hemiplegic cerebral palsy.

We collected 3D ultrasound images of the medial gastrocnemius muscle belly (MG) in 16 children with spastic hemiplegic cerebral palsy (SHCP) (mean age: 7.8 years; range: 4-12) and 15 typically-developing (TD) children (mean age: 9.5 years; range: 4-13).

Endovenous laser ablation (EVLA) of great saphenous vein to abolish "paradoxical reflux" in the Giacomini vein: a short report.

Introduction: Reflux in the GSV due to sapheno-popliteal incompetence associated with ascending (paradoxical) reflux in the Giacomini vein is a rare but well described pattern of reflux. Treatment of this type of reflux is controversial and only surgical treatment has been described.

Report: We describe 2 patients in whom this type of reflux was successfully abolished following endovenous laser ablation (EVLA) of the GSV with the SPJ and Giacomini vein regaining competency.

Changes in carotid plaque echomorphology with time since a neurologic event.

Purpose: Symptomatic carotid plaques are characterized by reduced fibrous tissue content, increased lipid content, intraplaque hemorrhage, and cap rupture. This confers an increased stroke risk. Plaque remodelling reduces this risk, however, and this study has evaluated differences in echomorphology at varying times after a neurologic event.

Initial experience in endovenous laser ablation (EVLA) of varicose veins due to small saphenous vein reflux.

Objective: Conventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates (up to 50%), many resulting from inadequate surgery. This prospective audit examines the safety and efficacy of EVLA in the treatment of this.

Method: 65 patients (68 limbs) with varicosities due to primary or recurrent sapheno-popliteal junction (SPJ) and small saphenous vein (SSV) reflux underwent out-patient EVLA (810 nm diode laser).

The effect of anaesthesia on the assessment of hamstring length in spastic cerebral palsy.

The decision to surgically lengthen the hamstring muscle group in a child with spastic cerebral palsy is based, in part, on the range of motion measurements made in the clinic, particularly, the popliteal angle. This measurement is often repeated when the child is under anaesthesia, before surgery. We were interested to know whether a systematic difference exists between the popliteal angles measured under these conditions, and to understand under which condition the measurement is more reliable.

The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial.

Serial casting aims to improve an equinus gait pattern in children with spastic cerebral palsy (SCP). We evaluated the effect of short-term stretch casting on gait in children with SCP, compared to the natural history. A crossover trial, consisting of a control phase and a casting phase, was conducted with children randomised into two groups.

Accurate, practical and cost-effective assessment of carotid stenosis in the UK.

Objectives: To determine whether less invasive imaging tests [ultrasound (US), magnetic resonance angiography (MRA), computed tomographic angiography (CTA) and contrast-enhanced MRA (CEMRA)], alone or combined, could replace intra-arterial angiography (IAA), what effect this would have on strokes and deaths, endarterectomies performed and costs, and whether less invasive tests were cost-effective.

Data Sources: Electronic databases covering the years 1980-2003 inclusive, updated to April 2004. Key journals from 1990 to the end of 2002.

Botulinum toxin and cerebral palsy: time for reflection?

Botulinum toxin A (BTX-A) is increasingly being used in early management of spasticity in ambulant children with cerebral palsy (CP), with the aim of improving function, promoting muscle growth, and delaying the need for surgical intervention. However, there is a lack of evidence about the long-term outcome of BTX-A injections. The focus on spasticity as the predominant problem in younger children with spastic CP may not fully consider the associated muscle weakness.

Fusogenic membrane glycoprotein-mediated tumour cell fusion activates human dendritic cells for enhanced IL-12 production and T-cell priming.

Fusogenic membrane glycoproteins (FMG) are a family of viral genes that, when expressed in tumour cells, trigger extensive cell to cell fusion and subsequent cell death. Gene therapy approaches using FMG are also potentially immunogenic, since syncitia generated ex vivo can be therapeutic as antitumour vaccines in murine models. This study has addressed the mechanisms responsible for the immunogenicity of FMG-mediated cell death, and its applicability to human immune priming.

The use of CD 34(+) mobilized peripheral blood as a donor cell source does not improve chimerism after in utero hematopoietic stem cell transplantation in non-human primates.

In utero hematopoietic stem cell transplantation is a therapeutic procedure that could potentially cure many developmental diseases affecting the immune and hematopoietic systems. In most clinical and experimental settings of fetal hematopoietic transplantation the level of donor cell engraftment has been low, suggesting that even in the fetus there are significant barriers to donor cell engraftment. In postnatal hematopoietic transplantation donor cells obtained from mobilized peripheral blood engraft more rapidly than cells derived from marrow.

Minimally invasive treatment for varicose veins: a review of endovenous laser treatment and radiofrequency ablation.

Varicose veins are a common problem, conventionally treated by an operation. Within the last few years, minimally invasive techniques have been developed as alternatives to surgery in an attempt to reduce morbidity and improve recovery time. Radiofrequency ablation and endovenous laser ablation are the most promising of these new techniques.

Gene therapy to manipulate effector T cell trafficking to tumors for immunotherapy.

Strategies that generate tumor Ag-specific effector cells do not necessarily cure established tumors. We hypothesized that the relative efficiency with which tumor-specific effector cells reach the tumor is critical for therapy. We demonstrate in this study that activated T cells respond to the chemokine CCL3, both in vitro and in vivo, and we further demonstrate that expression of CCL3 within tumors increases the effector T cell infiltrate in those tumors.