Etiology of severe pneumonia in the very elderly.

The etiology of severe pneumonia requiring mechanical ventilation in the very elderly has been imprecise because of lack of comprehensive studies and low yield of diagnostic approach. Overall, 104 patients 75 yr of age and older with severe pneumonia were studied prospectively at two university-affiliated hospitals. Microbial investigation included blood culture, serology, pleural fluid, and bronchoalveolar secretions.

Adenosine and adenosine triphosphate modulate the substrate binding affinity of glucose transporter GLUT1 in vitro.

Evidence indicates that a large portion of the facilitative glucose transporter isoform GLUT1 in certain animal cells is kept inactive and activated in response to acute metabolic stresses. A reversible interaction of a certain inhibitor molecule with GLUT1 protein has been implicated in this process. In an effort to identify this putative GLUT1 inhibitor molecule, we studied here the effects of adenosine and adenosine triphosphate (ATP) on the binding of D-glucose to GLUT1 by assessing their abilities to displace cytochalasin B (CB), using purified GLUT1 in vesicles.

The prevalence of asthma in children of elementary school age in western New York.

To determine the prevalence of caregiver-reported asthma in children 4 to 13 years old in metropolitan western New York State, surveys were conducted during 1997-1999 in the Buffalo, Niagara Falls, Iroquois, and Gowanda school systems. Questionnaires (3,889) were sent to the homes of elementary school children in nine schools in western New York. The caregivers were asked to complete a 13-item questionnaire for the child.

Office evaluation of children with recurrent infection.

This discussion provides an overview of the diagnostic approach to children with recurrent infections for the evaluation of a possible immunodeficiency. This article sets the stage for more detailed discussions of specific immunodeficiencies and therapeutic approaches used to reconstitute immune function in patients with these disorders.

Unilocular cervical lymphatic cyst in an adult.

Unilocular cervical lymphatic lesions are rare clinical entities. These endothelial-lined, fluid-filled structures must be distinguished from true cysts (epithelial lining), and pseudocysts (no cellular lining). This article presents a case report of a unilocular cervical lymphatic cyst in an adult.

Deletion and tandem duplication of exons 2 - 7 in the epidermal growth factor receptor gene of a human malignant glioma.

The epidermal growth factor receptor (EGFR) gene is frequently amplified and rearranged in malignant gliomas with expression of oncogenic deletion mutants (DM). The most common mutant EGFRvIII, which contains a deletion of exons 2 - 7, is constitutively autophosphorylated and inefficiently downregulated. Other less common EGFR mRNA species in gliomas contain tandem duplication of exons, which encode the tyrosine kinase (TK) and calcium mediated receptor internalization (CAIN) domains of the molecule.

Neurosurgical Invasive Techniques for Cancer Pain: A Pain Specialist's View.

Neurosurgical techniques for management of cancer pain can be divided into two categories: reconstructive and ablative. For patients with pain from spinal metastatic disease, the newer surgical methods of anterior decompression and stabilization provide reliable pain control while preventing serious neurologic progression. Minimally invasive techniques for vertebral stabilization, such as vertebroplasty, may also effectively relieve pain from spinal metastases associated with low morbidity.

Lipoblastoma: better termed infantile lipoma?

Lipoblastoma is a rare adipose tumor occurring exclusively in childhood. There have been no reports of metastases, making the designation "blastoma" confusing, since this term is usually reserved for malignant tumors. Two recent cases treated at our institution confirm its benign nature.

Fatigue in multiple sclerosis and its relationship to depression and neurologic disability.

We studied multiple sclerosis fatigue (MSF) and its relationship to depression and disability. Seventy-one patients [50 relapsing-remitting, 21 secondary progressive] were grouped by Fatigue Severity Scale (FSS) into MS-fatigue (MSF) (FSS>/=5; n=46) or MS-nonfatigue (MSNF) (FSS View Article and Find Full Text PDF

Septic Arthritis of the Hip in Children.

Recent advances in the management of septic arthritis of the hip in children include a better understanding of the effects of infection on articular cartilage; improvements in diagnostic tests, including erythrocyte sedimentation rate, C-reactive protein analysis, and ultrasonography; and more efficacious home intravenous and oral antibiotic therapy. Early diagnosis is essential to successful treatment. Needle aspiration is the most specific diagnostic test; however, false-negative results are possible.

Oncogenic epidermal growth factor receptor mutants with tandem duplication: gene structure and effects on receptor function.

A number of epidermal growth factor receptor (EGFR) deletion mutants have been identified in gliomas, in which the EGFR gene is frequently amplified and rearranged. We have previously characterized the structure of a gene in A-172 human glioma cells that encodes a 190-kDa EGFR mutant with tandem duplication of the tyrosine kinase (TK) and calcium-mediated internalization (CAIN) domains. Here we describe a 185-kDa tandem duplication mutant (TDM) that is expressed in KE and A-1235 glioma cells, along with certain functional characteristics of the mutants.

Pancreaticoduodenectomy for metastatic renal cell carcinoma: report of a case.

Metastasis to the pancreas from a distant primary cancer is uncommon, most cases being detected in the advanced stages of disease, often multiple in number, and diffusely displayed beyond surgical salvage. A solitary metastasis in the head of the pancreas is rarely encountered and although potentially amenable to surgical resection, surgeons are hesitant to perform pancreaticoduodenectomy for metastatic disease. Renal cell carcinoma is one malignancy with a propensity to metastasize to the pancreas.

Intracranial stent placement to trap an extruded coil during endovascular aneurysm treatment: technical note.

Objective: The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi detachable coil (GDC) during treatment of an internal carotid artery (ICA) cavernous segment aneurysm.

Methods: A 49-year-old woman presented for endovascular coiling of a left superior hypophyseal artery aneurysm.

Profound apoptosis-mediated regional myocyte loss and compensatory hypertrophy in pigs with hibernating myocardium.

Background: Myocyte apoptosis is seen in ischemic heart disease, but whether it can occur after reversible ischemia or independent of necrosis and replacement fibrosis is unknown.

Methods And Results: Pigs were instrumented with a stenosis of the left anterior descending coronary artery to chronically reduce coronary flow reserve over a period of 3 months. At this time, there was viable dysfunctional myocardium having the physiological features of hibernating myocardium.

Hand function following single ray amputation.

We retrospectively studied primary and reconstructive single ray resection at 16 to 150 months after surgery (median, 41 months) in 25 patients (18 males) whose average age was 28 years. Cases were reviewed 16 to 154 months after surgery (median, 41 months). The injuries involved 14 dominant and 11 nondominant hands.

Turnover rates at regulatory phosphorylation sites on myosin II in endothelial cells.

Assembly and motor activity of non-muscle myosin II can be regulated by phosphorylation. Because myosin II-containing structures undergo continuous assembly, disassembly, and remodeling in living cells, especially during cell migration, myosin II should undergo frequent phosphorylation and dephosphorylation. This study examines the turnover of phosphate on myosin II in stationary and migrating endothelial cells.

Assessing the aorta with transesophageal echocardiography. Update on imaging capabilities with today's technology.

Improved ultrasound imaging with transesophageal echocardiography is now readily available, so prompt, portable, convenient, and safe assessment of aortic disease is possible. The procedure offers a diagnostic approach that may be more useful and less expensive than other imaging studies. Many experts recommend transesophageal echocardiography as the procedure of choice in patients with possible aortic dissection, especially those who are in clinically unstable condition.

Is cutaneous malignant melanoma associated with the use of antibacterial soaps?

Since 1960, the incidence of melanoma has increased dramatically in Caucasians worldwide, and during the past decade has risen at a rate of 6% a year in the USA. A hypothesis regarding this increased incidence suggests that the prevalent use of antibacterial soaps that contain photosensitizing compounds may be a risk factor for the development of cutaneous malignant melanoma. These antibacterial soaps were introduced in the 1960s and compounds with photosensitizing properties are still present in various soaps throughout the industrialized world.

MRI findings in 32 consecutive lipomas using conventional and advanced sequences.

Intracranial lipomas are histologically benign and usually incidental magnetic resonance imaging findings that must be differentiated from ominous lesions. The authors describe 32 lipomas in 30 patients using conventional spin-echo (CSE) T1-weighted images (T1WI), CSE proton density (PDWI), CSE T2-weighted images (T2WI), fast spin-echo (FSE) T2WI, and FSE fluid-attenuated inversion recovery (FLAIR). Lipomas occurred most commonly in the trigonal choroid plexus, cerebral convexity, pericallosal, and quadrigeminal cistern regions.

A multi-state survey of videotaping practices for major trauma resuscitations.

The objective of this study was to determine the prevalence and problems, both perceived and actual, associated with videotaping major trauma resuscitations. A cross-sectional two-part survey of trauma centers was conducted. Part 1 determined demographic information and videotaping status.

Differential 18F-2-deoxyglucose uptake in viable dysfunctional myocardium with normal resting perfusion: evidence for chronic stunning in pigs.

Background: Viable, chronically dysfunctional myocardium can have normal or reduced resting flow. We previously produced hibernating myocardium with reduced resting flow in pigs with a chronic stenosis and hypothesized that hibernation is preceded by chronic stunning with normal resting perfusion.

Methods And Results: Pigs instrumented with a proximal left anterior descending coronary artery (LAD) stenosis were studied 1 or 2 months later in the closed-chest anesthetized state.

Issues affecting the lives of older persons with developmental disabilities.

Efforts to bring the aging developmentally disabled and mentally handicapped population into the mainstream of professional training and services are encouraging. The impact of managed care on the provision and quality of services for aging developmentally disabled persons who cannot advocate for themselves must be closely researched and monitored so that public funds are used to promote comprehensive and continuous care for this vulnerable population.