Esophageal atresia and tracheoesophageal fistula: surgical experience over two decades.

Background: Despite improvements in survival, for infants born with esophageal atresia tracheoesophageal fistula, or both, the morbidity associated with repair of these anomalies remains high.

Methods: This report retrospectively analyzes 81 patients with esophageal atresia, tracheoesophageal fistula, or both presenting to our institution between 1975 and 1995, with a focus on anastomotic complications.

Results: There were 46 male and 35 female patients with a mean gestational age of 37 weeks and mean birth weight of 2443 g.

Critical values: ASCP practice parameter. American Society of Clinical Pathologists.

Appropriate use of critical values improves patient outcome by ensuring that physicians are promptly notified of immediate life-threatening conditions. Conversely, overuse squanders resources and actually may impair patient outcome. A generic critical values list derived from interlaboratory surveys is an excellent starting point, but every laboratory must customize its list to meet the needs of the organization that it serves.

Oligosaccharides interfere with the establishment and progression of experimental pneumococcal pneumonia.

Oligosaccharides that block the adherence of bacteria to epithelial cells in vitro--lacto-N-neotetraose (LNnT) and its alpha2-3- and alpha2-6-sialylated derivatives--were tested for their abilities to attenuate the course of pneumococcal pneumonia and to prevent colonization of the nasopharynx in animal models. Intratracheal administration of these agents concurrently with bacteria dramatically decreased pneumococcal load in the lungs of rabbits and conferred protection from bacteremia. The oligosaccharides ameliorated pneumonia and bacteremia when given therapeutically 24 h after infection was established.

Monoclonal antibodies to the extracellular domain of prostate-specific membrane antigen also react with tumor vascular endothelium.

Prostate-specific membrane antigen (PSMA), initially defined by monoclonal antibody (mAb) 7E11, is a now well-characterized type 2 integral membrane glycoprotein expressed in a highly restricted manner by prostate epithelial cells. 7E11 has been shown to bind an intracellular epitope of PSMA that, in viable cells, is not available for binding. Herein, we report the initial characterization of the first four reported IgG mAbs that bind the external domain of PSMA.

Epstein-Barr virus latent membrane protein-1 oncogene deletion in post-transplantation lymphoproliferative disorders.

Epstein-Barr virus (EBV) latent membrane protein 1 (LMP1) is a multifunctional oncoprotein. A 30-bp deletion of the 3' end of the LMP1 gene (del-LMP1) has been identified in some EBV isolates. This deleted LMP1 gene encodes a protein, altered on the carboxy terminus, which is thought to have greater oncogenic potential than the wild type.

Kaposi's sarcoma-associated herpesvirus sequences in benign lymphoid proliferations not associated with human immunodeficiency virus.

Background: Kaposi's sarcoma-associated herpesvirus (KSHV) DNA sequences have been identified in approximately 95% of Kaposi's sarcoma (KS) lesions and primary effusion lymphomas (PELs), suggesting a pathogenetic role for this virus in these lesions. However, KSHV has also been identified in a variety of specimens, including lymph nodes, peripheral blood B cells, semen, and prostate tissue, with varying frequencies. This suggests that KSHV, like Epstein-Barr virus, may be ubiquitously distributed.

Emerging Pathogens Associated with Infectious Diarrhea.

In recent years, emerging microbial pathogens associated with infectious diarrhea have caused significant morbidity and mortality. Although sporadic cases of infectious diarrhea have occurred worldwide in the past, recent outbreaks in the United States traced to contaminated water or food have raised concerns about the safety of the water supply and the adequacy of surveillance of the food supply and foodborne diseases. In 1993, Cryptosporidium parvum, an important cause of unrelenting diarrhea and severe weight loss in AIDS patients, was associated with the largest outbreak of infectious diarrhea caused by contaminated municipal water that has ever been reported in the U.

Clinical experience and future directions for low-density lipoprotein apheresis in the United States.

The United States Liposorber Study was a 22 week randomized controlled study of low-density lipoprotein (LDL) apheresis with an optional follow-up phase. The procedure was found to acutely lower LDL cholesterol by up to 81%, have good tolerability, and produce a reduction in the frequency of cardiovascular events. Studies outside the United States have found therapy with LDL apheresis to be associated with a favorable clinical outcome including improved myocardial perfusion, but variable regression of coronary artery disease (CAD).

Herpes zoster polyradiculopathy.

Herpes zoster infection, resulting from reactivation of the dormant varicella zoster virus in the dorsal root ganglia, usually causes a painful dermatomal vesicular rash. Rarely, associated peripheral motor weakness is present, the mechanism of which is unclear. Three patients are reported who had focal limb muscle weakness associated with zoster infection.

Physiological consequences of testicular sperm extraction.

Testicular sperm extraction (TESE) may provide spermatozoa for attempts at fertility with assisted reproduction; however, the physiological effects of TESE on testicular function are not well understood. In order to evaluate the effects of TESE on the testis, 64 patients were evaluated after TESE for non-obstructive azoospermia with physical examinations, serial scrotal sonography, histological analyses and evaluation of the success of repeated sperm retrieval attempts. At 3 months after TESE, 82% of evaluated patients had ultrasonographic abnormalities in the testis suggesting resolving inflammation or haematoma at the biopsy site.

Submicroscopic deletions in the Y chromosome of infertile men.

Recent investigations have suggested a high prevalence of Y chromosome submicroscopic deletions in men with severely impaired spermatogenesis. We evaluated the frequency of Y chromosome deletions in 160 infertile men using a series of 36 sequence-tagged-sites, emphasizing intervals 5 and 6 of the long arm of the Y chromosome. Peripheral leukocyte DNA was extracted and amplified with two parallel techniques to minimize potential overestimation of the frequency of deletions.

Attenuation of acute lung injury caused by hind-limb ischemia-reperfusion injury by butyrolactone anti-inflammatory agent FL1003.

Objective: Activation of systemic inflammation after reperfusion of ischemic tissue results in severe acute lung injury. Neutrophil activation and oxygen radical generation have been implicated in the pathogenesis. This study tested the hypothesis that treatment with FL1003, a butyrolactone with in vitro antioxidant properties, will down-regulate this response and abrogate acute lung injury.

Acute renal failure in the first trimester resulting from uterine leiomyomas.

A primigravid woman with multiple uterine leiomyomas was seen at 8 weeks' gestation with acute renal failure and hypertension. After placement of bilateral nephrostomy tubes, renal function improved and blood pressure normalized. The pregnancy was complicated by maternal abdominal discomfort, intrauterine growth restriction, and perinatal death.

Determinants of pain expression in hospitalized burn patients.

This study examines the relationship between extent of injury, degree and type of psychological distress and self-report of pain in burn survivors. One hundred eighty burn patients were interviewed within 2 weeks of their burn trauma. Using a visual analogue scale to assess subjective pain and pain relief, and self-report measures of post-traumatic stress symptoms and general psychological distress, we assessed the relationship between PTSD symptoms, general distress and pain.

Sedation with intravenous midazolam in the pediatric intensive care unit.

Physical and emotional distress can have important effects on patients in the pediatric intensive care unit (ICU). Intravenous (IV) infusion of benzodiazepines is an important adjunct to assisted ventilation and other potentially distressing ICU procedures. Combined with intermittent or continuous infusion of opioids, the benzodiazepines provide smooth control of anxiety, pain, and agitation.

Surgical aspects of colorectal carcinoma.

Colorectal surgery remains the cornerstone of curative therapy for colorectal carcinoma. The development of new instruments permitting technical advances, however, as well as the advent of effective adjuvant therapies and the progress in staging and early detection, have changed some of the indications for surgery as well as surgical methods. Even so, emphasis has always been placed on thorough preoperative evaluation and staging.

The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy.

The quality of the therapeutic alliance was compared in sessions of psychodynamic-interpersonal and cognitive-behavioral therapy, and the alliance's relationship to various session impacts was investigated. As part of the Sheffield Psychotherapy Project 2 (D. A.

Reduction in testicular temperature after varicocelectomy in infertile men.

Objectives: To study the effects of varicocelectomy on testicular temperature.

Methods: Testicular skin surface temperature was directly measured with an electronic thermometer calibrated to 0.01 degree C in 119 men before and after microsurgical varicocelectomy and in 45 control patients without varicocele.

Epstein-Barr virus latent gene expression in primary effusion lymphomas containing Kaposi's sarcoma-associated herpesvirus/human herpesvirus-8.

Primary effusion (body cavity-based) lymphoma (PEL) is a recently recognized subtype of malignant lymphoma that exhibits distinctive clinical and biological features, most notably its usual infection with the Kaposi's sarcoma-associated herpesvirus (KSHV). The vast majority of cases also contain Epstein-Barr virus (EBV). This dual viral infection is the first example of a consistent dual herpesviral infection in a human neoplasm and provides a unique model to study viral interactions.

Midfollicular anticardiolipin and antiphosphatidylserine antibody titers do not correlate with in vitro fertilization outcome.

Objective: To determine the prevalence of anticardiolipin and antiphophatidylserine antibodies in an IVF population and to correlate their presence and specific isotype with IVF cycle outcome.

Design: Retrospective clinical study using stored midfollicular sera for determination of antibody status.

Setting: University hospital infertility clinic.

Cu/Zn superoxide dismutase, catalase and glutathione peroxidase mRNA expression in the rat testis after surgical cryptorchidism and efferent duct ligation.

The testis is known to be highly sensitive to a number of physical stresses. Previous investigations suggest that oxidative stress may be an important mediator of testicular injury. The ability of the testis to manage oxidative stress may be limited by enzymatic clearance of reactive oxygen species (ROS).

In vivo cystometric evaluation of progressive bladder outlet obstruction in rats.

Purpose: Bladder outlet obstruction in man is a common medical disorder that may result from benign prostatic hyperplasia, urethral stricture disease, or congenital anomaly. The functional changes that develop in response to obstruction include detrusor instability, elevated voiding pressures, and the presence of a residual urine. The aim of this study was to document the development of progressive bladder outlet obstruction over time in a rat model using conscious, in vivo urodynamics.