Multilayered epithelium may be found in patients with Barrett's epithelium and dysplasia or adenocarcinoma.

To determine if multilayered epithelium (MLE) is a useful prognostic indicator for a benign natural history of Barrett's epithelium, we evaluated endoscopic biopsies from patients with Barrett's epithelium without and with dysplasia and/or adenocarcinoma and from non-Barrett's controls for the presence of MLE. MLE was found in 6% of non-Barrett's controls, 30% of Barrett's patients with no dysplasia, and 14% of Barrett's patients with dysplasia and/or adenocarcinoma. MLE was significantly associated with shorter lengths of Barrett's epithelium in both Barrett's groups.

Shortening MR image acquisition time for volumetric interpolated breath-hold examination with a recently developed parallel imaging reconstruction technique: clinical feasibility.

A recently developed parallel magnetic resonance (MR) imaging technique, parallel imaging with an augmented radius in k space, was used to accelerate the volumetric interpolated breath-hold examination (VIBE) performed in 20 patients referred for clinical liver imaging. Nonaccelerated MR images were also acquired in these patients. A five-point scale was used to score the quality of the images.

Reproducibility of linear tumor measurements using PACS: comparison of caliper method with edge-tracing method.

The aim of this study was to evaluate inter- and intra-observer reproducibility when making electronic caliper linear tumor measurements on picture archiving and communications systems (PACS) and compare them with linear measurements obtained from circumferential tracing of tumor perimeter. Three radiologists measured 64 masses from 30 patients on body CT scans in two separate settings. Long axis and perpendicular short axis were measured using electronic calipers.

Paw withdrawal thresholds and persistent hindlimb flexion in experimental mononeuropathies.

Hypersensitivity of the foot produced by a number of sciatic mononeuropathies was assessed and compared. A new tool was used, the strain-gauge algometer, that delivers a noxious stimulus and gives a direct measurement of the force for paw withdrawal. In addition, we report observations of another alteration of the flexion reflex, persistent hindlimb flexion.

Interictal EEG discharges, reproductive hormones, and menstrual disorders in epilepsy.

We evaluated reproductive endocrine function in women with unilateral temporolimbic epilepsy and normal control subjects to assess the effects of epilepsy, epilepsy laterality, and antiepileptic drug use on the cerebral regulation of hormonal secretion. The findings indicate that reproductive endocrine function differs between women with epilepsy and normal control subjects. Significant differences exist at all levels of the reproductive neuroendocrine axis, that is, hypothalamus, pituitary, and peripheral gland.

Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study.

Objectives: To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis.

Methods: Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained.

2003 Wolff Award: Possible parasympathetic contributions to peripheral and central sensitization during migraine.

Background: Neurologic signs of increased parasympathetic outflow to the head often accompany migraine attacks. Because increased parasympathetic outflow to the cranial cavity induces vasodilation of cerebral and meningeal blood vessels, it can enhance plasma protein extravasation and the release of proinflammatory mediators that activate perivascular nociceptors. We recently showed that activation of intracranial perivascular nociceptors induces peripheral and central sensitization along the trigeminovascular pathway and proposed that these sensitizations mediate the intracranial hypersensitivity and the cutaneous allodynia of migraine.

Inflammation induces ectopic mechanical sensitivity in axons of nociceptors innervating deep tissues.

A variety of seemingly diverse pain syndromes are characterized by movement-induced pain radiating in the distribution of a peripheral nerve or nerve root. This could be explained by the induction of ectopic mechanical sensitivity in intact sensory axons. Here we show that inflammation led to mechanical sensitivity of the axons of a subset of mechanically sensitive primary sensory neurons.

Transmitted cardiac pulsations as an indicator of transjugular intrahepatic portosystemic shunt function: initial observations.

Purpose: To determine if cardiac pulsations are visible and quantifiable on spectral waveforms during Doppler ultrasonographic (US) evaluation of transjugular intrahepatic portosystemic shunts (TIPS), and if so, whether their magnitude declines with shunt dysfunction.

Materials And Methods: Baseline and pre-revision US images obtained in 15 patients with venographically confirmed TIPS malfunction were retrospectively examined for spectral waveform pulsation. Cardiac pulsatility was quantified by using the venous pulsatility index (VPI), the venous equivalent of resistive index.

Prospective evaluation of multilayered epithelium in Barrett's esophagus.

Objective: We recently identified a distinctive type of multilayered epithelium in two patients with Barrett's esophagus, which shows morphological characteristics of both squamous and columnar epithelium. This study was performed to prospectively evaluate the prevalence of multilayered epithelium in patients with Barrett's esophagus.

Methods: Mucosal biopsies were obtained from the squamocolumnar junction (Z-line) of 58 patients with endoscopic evidence of esophageal columnar epithelium and from the gastroesophageal junction in 21 patients without endoscopic evidence of esophageal columnar epithelium.

Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis.

Background & Aims: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. We aimed to assess whether clinical, biological, and histologic parameters in quiescent UC predict time to clinical relapse.

Methods: Seventy-four patients with clinically and endoscopically determined inactive UC were followed up for 1 year or for a shorter period if they had a relapse.

Factors that influence the decision to do an adequate evaluation of a patient with a positive stool for occult blood.

Objective: The factors that influence the decision to do an adequate evaluation for a positive test for fecal occult blood in a middle-aged or elderly patient are largely unknown. Our study was undertaken to determine whether factors such as the number of positive Hemoccult II card windows, age, gender, family history of colon cancer, the patient's concern that he or she might have colon cancer, or history of rectal bleeding influence the evaluation performed.

Method: A mass screening program for colon cancer was performed using unrehydrated Hemoccult II cards in the Boston area.

An association between migraine and cutaneous allodynia.

Recent animal studies on the mechanism of migraine show that intracranial pain is accompanied by increased periorbital skin sensitivity. These findings suggest that the pathophysiology of migraine involves not only irritation of meningeal perivascular pain fibers but also a transient increase in the responsiveness (ie, sensitization) of central pain neurons that process information arising from intracranial structures and skin. The purpose of this study was to determine whether the increased skin sensitivity observed in animal also develops in humans during migraine attacks.

Long-term retention of transient news events.

Many retrospective analyses of remote memory have demonstrated recency effects in that memory for events proximal to the time of testing is superior to memory for events from remote time periods. However, the rate at which information decays over time and the specific pattern of forgetting may vary depending upon the distinct attributes of stimuli used as indices of memory. Studies examining long-term forgetting of well rehearsed, conceptually integrated information underscore preservation of remote events, some of which are thought to be permanently stored in memory.

Lateral asymmetry in activation of hypothalamic neurons with unilateral amygdaloid seizures.

Purpose: Reproductive disorders are unusually frequent among women with temporal lobe seizures. The particular type of disorder may be related to the laterality and focality of epileptiform discharges. Here we examined whether unilateral amygdaloid seizures activate hypothalamic neurons involved in reproductive function and reproductive endocrine secretion in female rats and whether such activation shows lateral asymmetry.

Three patterns of catamenial epilepsy.

Purpose: On the basis of the neuroactive properties of estradiol and progesterone and the menstrually related cyclic variations of their serum concentrations, we propose the existence of three hormonally based patterns of seizure exacerbation. Because previous reports both support and refute the concept of catamenial epilepsy, we test the hypothesis by charting seizures and menses and measuring midluteal serum progesterone levels to estimate the frequency of epileptic women with catamenial seizure exacerbation.

Methods: One hundred eighty-four women with intractable complex partial seizures (CPS) charted their seizure occurrence and onset of menstruation on a calendar for one cycle during which they had a midluteal blood sample taken for serum progesterone determination on day 22.

Inventory-derived task handedness preferences of nine professions and their associations with self-report global handedness preferences.

The handedness preference (laterality) of 1,196 professionals grouped in nine professions previously reported using self-reported global handedness and scores on a modified Edinburgh Handedness Inventory was further defined by evaluating the association between profession and the 10 manual tasks of the inventory. The previously reported ranking of professions in order of increasing righthandedness of laterality score arose from the handedness of specific inventory tasks. A similar association was found for self-reported global handedness.

Utilization patterns of tricyclic antidepressants in a multidisciplinary pain clinic: a survey.

Objectives: Tricyclic antidepressants (TCA) have been shown to provide analgesia for a variety of neuropathic and headache pain syndromes regardless of the presence of depression. There is a high incidence of depression in patients with chronic pain, thereby making tricyclic antidepressants particularly suitable for chronic pain patients. We wanted to study patterns of use of tricyclic antidepressants in our Pain Management Center (Beth Israel Hospital, Boston, MA, U.

Assessment of preclinical problem-based learning versus lecture-based learning.

Academic performance on a standardized oral comprehensive exam (OCE) was compared for students taught basic science in a problem-based learning (PBL) curriculum and a lecture-based learning (LBL) curriculum. The OCE was administered to the graduating classes of 1991-1994 (n approximately 20/class) six months after completion of their basic science courses. The OCE contained six components including: Organization and Thoroughness, Diagnosis, Primary Treatment Plan, Alternate Treatment Plan, Science and Medical Knowledge, and Dental Knowledge.

Pancreatic duct stricture length at ERCP predicts tumor size and pathological stage of pancreatic cancer.

Objective: To determine whether findings on endoscopic retrograde cholangiopancreatography (ERCP) could provide useful prognostic information in resectable pancreatic cancer.

Methods: We retrospectively identified 18 patients with resectable pancreatic cancer (defined as no evidence of metastatic disease or vascular involvement on CT scan) who had undergone ERCP prior to an attempt at curative resection between 1991 and 1996. Common bile duct and pancreatic duct stricture lengths were measured on ERCP and compared with the size of the resected tumor.

Decreased inotropic but relatively preserved relaxation response to cyclic adenosine monophosphate-dependent agents in myopathic human myocardium.

Background: Increased intracellular concentrations of cyclic adenosine monophosphate (AMP) stimulate a positive inotropic and lusitropic response in healthy myocardial tissue. Heart failure results in an attenuated inotropic response to cyclic AMP-dependent agents. This study compares the inotropic versus relaxation response to cyclic AMP-dependent and cyclic AMP-independent agents in myocardium from patients with end-stage heart failure and control patients without heart failure.

Gadolinium-enhanced MR imaging demonstrates abduction-caused hip ischemia and its reversal in piglets.

Purpose: To determine if gadolinium-enhanced MR imaging can detect early reversible ischemia of the capital femoral epiphysis and physis induced by hip hyperabduction in piglets.

Materials And Methods: Thirteen 1- to 3-week-old piglets were placed in maximal bilateral hip abduction and then studied with dynamic gadolinium-enhanced MR imaging 1-6 hr later to assess ischemia of the 26 femoral heads. The piglets were then allowed to ambulate freely for 1 or 7 days and reimaged in neutral position to assess reperfusion.

Handedness distributions in nine professional groups.

The relationships between profession and handedness were studied in approximately equal numbers of accountants, architects, dentists, lawyers, librarians, mathematicians, orthodontists, orthopedic surgeons, and psychiatrists (ns = 133 +/- 36; N = 1196). Handedness was estimated using laterality scores derived from the Edinburgh Handedness Inventory and self-reported global handedness preference scores. Architects and lawyers had the most lefthanded average laterality scores.

Long-term impact of recombinant human erythropoietin on transfusion support in patients with chronic renal failure.

Published reports on the impact of recombinant human erythropoietin (r-HuEpo) on transfusion requirements of patients with chronic renal failure have been limited to small populations and relatively brief follow-up. In this study we reviewed the effects of this drug on 86 patients with well-characterized transfusion requirements, followed for 18 months at seven dialysis centers. The median red blood cell transfusion requirements per patient per year decreased from 14 in 1987 and 1988 to 11 in 1989, when r-HuEpo was licensed in the United States (p <.

Diurnal variation of urinary leukotriene E4 and histamine excretion rates in normal subjects and patients with mild-to-moderate asthma.

Background: Leukotriene E4 (LTE4) and histamine excreted into the urine reflect the in vivo synthesis and release of cysteinyl leukotrienes and histamine, respectively. We examined the diurnal variation of the excretion rate of these mediators over 4 consecutive days in normal subjects (n = 5) and patients with stable mild-to-moderate asthma (n = 8).

Methods: Sixteen consecutive 6-hour urine samples were collected over 4 days.