Modulation of hyperoxia-induced TNF-alpha expression in the newborn rat lung by thalidomide and dexamethasone.

The effect of high oxygen concentrations on lungs of neonatal rats was studied. In addition, some oxygen-exposed animals were treated with either dexamethasone or thalidomide. No gross histologic changes were noted in the lungs following exposure to 95% oxygen nor were there changes in the total number or the phenotypic distribution of BAL cells obtained from these lungs compared to lungs from air exposed (control) neonatal rats.

Intravasal azoospermia: a surgical dilemma.

Objectives: To determine the incidence of intravasal azoospermia (IVA) and evaluate which factors before and during surgery influence outcome, by prospectively and intentionally performing bilateral vasovasostomies (VVs) only in men with intraoperative IVA.

Patients And Methods: Using a multilayer technique, 472 men underwent microsurgical reconstructive procedures. Intravasal fluid was examined for sperm by the surgeon and a pathologist.

Glutathione ethyl ester supplementation prevents mortality in newborn rats exposed to hyperoxia.

Human premature neonates suffer from respiratory distress syndrome due to immature lungs and require assisted ventilation with high concentrations of oxygen. Hyperoxic exposure and/or antioxidant deficiency causes an increase in the lung levels of reactive oxygen species (ROS) leading to oxidative stress-induced cellular damage. In this study, we explored the protective role of the nonenzymatic antioxidant glutathione, by administering glutathione ethyl ester (GSHEE), in newborn rats exposed to hyperoxia (>95% FiO(2)).

A concerned critique of psychoanalytic education.

The author explores some central problems in contemporary psychoanalytic education. He compares strengths and limitations of the two dominant models of psychoanalytic training, the traditional Eitingon model and the French model, and reviews current efforts to modify these models in order to overcome their limitations. In examining problems common to both educational systems, the author highlights the following issues: a tendency to infantilise psychoanalytic candidates, a persisting trend towards isolation from the scientific community, a lack of consistent concern for the total educational experience of candidates, authoritarian management and a denial of the effects of external, social reality on psychoanalytic education.

Impact of diabetes on cardiac structure and function: the strong heart study.

Background: Whether diabetes mellitus (DM) adversely affects left ventricular (LV) structure and function independently of increases in body mass index (BMI) and blood pressure is controversial.

Methods And Results: Echocardiography was used in the Strong Heart Study, a study of cardiovascular disease in American Indians, to compare LV measurements between 1810 participants with DM and 944 with normal glucose tolerance. Participants with DM were older (mean age, 60 versus 59 years), had higher BMI (32.

Repair of traumatic aortic valve disruption and descending aortic transection.

Traumatic aortic transection after acute deceleration injury remains a highly lethal condition. Concomitant aortic valve disruption is exceedingly rare, and can complicate the timing of surgical management. This report describes the management and outcome of a patient with these types of injuries.

BCG-induced urinary cytokines inhibit microvascular endothelial cell proliferation.

Purpose: Angiogenesis is thought to depend on a net balance of molecules that inhibit or stimulate microvascular endothelial cells. A variety of molecules that affect angiogenesis are induced locally by the administration of intravesical bacille Calmette-Guerin (BCG) for superficial bladder cancer. We sought to determine whether BCG-induced urinary cytokines alter the effects of patient urine on assays of angiogenic activity.

Plant phenolics decrease intestinal tumors in an animal model of familial adenomatous polyposis.

Epidemiological studies consistently indicate that consumption of fruits and vegetables lowers cancer risk in humans and suggest that certain dietary constituents may be effective in preventing colon cancer. Plant-derived phenolic compounds manifest many beneficial effects and can potentially inhibit several stages of carcinogenesis in vivo. In this study, we investigated the efficacy of several plant-derived phenolics, including caffeic acid phenethyl ester (CAPE), curcumin, quercetin and rutin, for the prevention of tumors in C57BL/6J-Min/+ (Min/+) mice.

A multicenter randomized trial comparing a percutaneous collagen hemostasis device with conventional manual compression after diagnostic angiography and angioplasty.

Objectives: A new percutaneous collagen hemostasis device was compared with conventional compression techniques after diagnostic catheterization and angioplasty. Background. Peripheral vascular complications after diagnostic catheterization or more complex interventional procedures, as well as the discomfort of manual compression and prolonged bed rest, represent significant morbidity for invasive cardiac procedures.

Microsurgical testis biopsy: a novel technique for retrieval of testicular tissue.

Purpose: In vitro fertilization with intracytoplasmic sperm injection has resulted in a dramatic increase in the need for diagnostic and therapeutic testis biopsies. We developed a microsurgical testis biopsy technique which allows identification of testicular vessels and individual seminiferous tubules. We compare the results of this technique to our prior series of nonmicroscopic biopsies.

Effect of aging on bladder function and the response to outlet obstruction in female rats.

Bladder dysfunction in the aging population is a significant problem. However the concomitant presence of other diseases in many patients can make it difficult to distinguish between changes in bladder function and other influences. The present study was designed to study, in aging rats, bladder function and the effect of partial bladder outlet obstruction (BOO) on bladder function.

Synergistic effects of insulin-like growth factor-I and human chorionic gonadotropin in the rat ovary.

Insulin and low doses of lutenizing hormone (LH) activity (human chorionic gonadotropin [hCG]) act synergistically in the rat to produce anovulation, large ovarian cysts, and elevated plasma androstenedione levels. Further, both insulin and insulin-like growth factor-I (IGF-I) affect the ability of gonadotropins to enhance both ovarian theca and granulosa cell function in vitro. The present series of experiments were performed to determine if recombinant human IGF-I (rhIGF-I) can act in a manner similar to insulin when combined with subovulatory doses of hCG in adult normally cycling rats.

Transthoracic cardioversion of atrial fibrillation: comparison of rectilinear biphasic versus damped sine wave monophasic shocks.

Background: Clinical studies have shown that biphasic shocks are more effective than monophasic shocks for ventricular defibrillation. The purpose of this study was to compare the efficacy of a rectilinear biphasic waveform with a standard damped sine wave monophasic waveform for the transthoracic cardioversion of atrial fibrillation.

Methods And Results: In this prospective, randomized, multicenter trial, patients undergoing transthoracic cardioversion of atrial fibrillation were randomized to receive either damped sine wave monophasic or rectilinear biphasic shocks.

The doctor-patient relationship in the home.

The rapid growth of the geriatric sector of the population has, in part, led to the explosion of the home care industry and the rebirth of the house call. Understanding the population being served is always the first step in providing excellent care. Older people who are frail and homebound have physical, social, and emotional needs that require careful assessment and team intervention in the home.

Ethics in fetal medicine.

In this chapter we provide an overview of current ethical issues in fetal medicine. We begin with an introduction to the language and concepts of ethics. We then show how ethical principles can be applied to fetal medicine.

Left ventricular geometry and function preceding neurally mediated syncope.

Background: Neurally mediated syncope has been associated with increased left ventricular (LV) fractional shortening (FS) during tilt testing, which is consistent with the hypothesis that the stimulation of LV mechanoreceptors leads to reflex hypotension and/or bradycardia. However, FS does not represent true LV contractility because of its dependence on afterload and preload.

Methods And Results: To elucidate the role of increased contractility in the mediation of neurally mediated syncope, we compared echocardiographic measures of LV performance corrected for end-systolic stress (ESS) in 21 patients (13 women and 8 men) with unexplained syncope who had either positive (n=10) or negative (n=11) responses to a tilt-table test.

Splenectomy-sparing, long-term maintenance with anti-D for chronic immune (idiopathic) thrombocytopenic purpura: the New York Hospital experience.

For nonsplenectomized children and adults with chronic or acute immune (idiopathic) thrombocytopenic purpura (ITP), anti-D has been shown to be a safe and effective treatment, providing hemostatic platelet increases in more than 70% of patients. Children had the best results, but all patient groups responded. In our recently published series, the effect of anti-D therapy lasted for more than 21 days in 50% of the responders and for more than 1 month in 37%.

Splenectomy-sparing strategies for the treatment and long-term maintenance of chronic idiopathic (immune) thrombocytopenic purpura.

Patients with idiopathic thrombocytopenic purpura (ITP) have vulnerability to additional bleeding, leaving them susceptible to severe hemorrhaging. Low platelet counts contribute to this rare, but significant outcome, but may not be the sole determinant. Although the only current treatment of ITP felt to be curative is surgical removal of the spleen, the long-term outcome for these patients is not well defined.

APC and intestinal carcinogenesis. Insights from animal models.

The APC protein is a crucial regulator of intestinal cell growth, and mutations in the APC gene are a common initial event in the process of human colorectal carcinogenesis. Animals bearing germline mutations in Apc are therefore important models for human colorectal cancer. These animals have been used both to understand the biology of human colorectal cancer and to screen for agents able to prevent malignant transformation of susceptible intestinal cells.

Focal angiogen therapy using intramyocardial delivery of an adenovirus vector coding for vascular endothelial growth factor 121.

Background: Adenovirus (Ad) vector-mediated gene therapy strategies have emerged as promising modalities for the "biological revascularization" of tissues. We hypothesized that direct intramyocardial, as opposed to intracoronary, administration of an Ad vector coding for the vascular endothelial growth factor 121 cDNA (Ad(GV)VEGF121.10) would provide highly focal Ad genome levels, and increases in VEGF, ideal for inducing localized therapeutic angiogenesis.

The short term outcome of elderly patients with hip fractures.

A prospective outcome study was performed of 100 hip fracture patients at an urban medical center in the United States. After hospitalization 19% were discharged to a rehabilitation facility and 59% were discharged home. At a mean follow-up of 8 months, 81% of patients lived at home, compared to 89% who lived at home prior to the fracture.

A severe sexual inhibition in the course of the psychoanalytic treatment of a patient with a narcissistic personality disorder.

This case report illustrates how an analysis of oedipal conflicts gradually resolved a severe and extended inhibition of sexual desire that developed as a new symptom in the termination phase of psychoanalytic treatment. The enactment in the countertransference of castration anxiety, against which the patient was successfully defending himself by projective identification, produced an extended stalemate, which was resolved once the countertransference was transformed into transference interpretations. This treatment also illustrates the intimate connection between pre-oedipal and oedipal conflicts in the advanced stages of the treatment of narcissistic personalities, and the need for very careful assessment of the patient's sexual functioning before deciding on terminating the psychoanalysis of a patient with a successfully resolved narcissistic personality structure.

Provider service organizations: a method to establish physician prerogatives.

The face of health care is changing daily because of pressures brought about by dissatisfied consumers, physicians, and employers. We believe that physicians need to take back from insurers the administration of the medical profession. Physicians must assume the financial risks necessary to create a medical system that will benefit themselves, their patients, and their patient's employers.

Regional treatment of hepatic micrometastasis by adenovirus vector-mediated delivery of interleukin-2 and interleukin-12 cDNAs to the hepatic parenchyma.

We hypothesize that adenovirus (Ad) vector-mediated delivery of the human interleukin-2 (IL-2) cDNA (AdIL2) or the murine IL-12 cDNA heterodimer (AdIL12) would produce high concentrations of cytokines in the local hepatic milieu to induce host responses sufficient to inhibit the growth of experimental colon carcinoma-derived hepatic metastases. Ad vectors administered intravenously, which is a route known to deliver >90% of the vector to the hepatic parenchyma, achieved significant levels of each cytokine locally, with minimal levels in the sera. To examine the therapeutic effect, the AdIL2 and AdIL12 vectors were evaluated in a hepatic metastasis model that was established by injecting 3 x 10(4) cells from the poorly immunogenic syngeneic C26 colon carcinoma cell line into the right lobe of the livers of BALB/c mice.

Physician partnering: a provider network primer.

The face of health care is changing daily due to pressures brought about by dissatisfied consumers, physicians, and employers. The authors of this article believe that the only way to bring about a better health care system is for physicians to take back the administration of the medical profession from the insurers. Physicians must take the financial risks necessary to innovate a medical system that will benefit themselves, their patients, and their patients' employers.