Long-term followup of patients with renal cell carcinoma treated with radio frequency ablation with curative intent.

Purpose: We defined the role of radio frequency ablation in the treatment of renal cell carcinoma.

Materials And Methods: A total of 16 patients with biopsy proven renal cell carcinoma were treated with radio frequency ablation in an outpatient setting and followed for a minimum of 4 years.

Results: Of the 16 patients 5 died before 4 years of followup of unrelated causes.

Thymoma in a child: case report and review of the literature.

Thymic lesions comprise approximately 2-3% of all pediatric mediastinal tumors and include thymic cysts, hyperplasia, carcinoma, and thymomas. Thymomas, which represent less than 1% of all mediastinal tumors, are rare mediastinal tumors in the pediatric population. Fewer than 30 cases in children have been described in the literature.

On the quest for Six Sigma.

A review of patient safety from a surgical perspective with emphasis on erosion of hierarchy, human factors, and an institutional implementation of multidisciplinary team training to create highly effective dynamic teams. Suggestions include further opportunities to enhance patient safety in surgical patients.

Identification of BRCA1-IRIS, a BRCA1 locus product.

Breast cancer is the most common malignancy among women, and mutations in the BRCA genes produce increased susceptibility to these malignancies in certain families. Here we identify BRCA1-IRIS as a 1,399-amino-acid BRCA1 gene product encoded by an uninterrupted open reading frame that extends from codon 1 of the known BRCA1 open reading frame to a termination point 34 triplets into intron 11. Unlike full-length BRCA1 (p220), BRCA1-IRIS is exclusively chromatin-associated, fails to interact with BARD1 in vivo or in vitro and exhibits unique nuclear immunostaining.

Estimating prognosis for nursing home residents with advanced dementia.

Context: Survival varies for patients with advanced dementia, and accurate prognostic tools have not been developed. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival.

Objectives: To identify factors associated with 6-month mortality in newly admitted nursing home residents with advanced dementia and to create a practical risk score to predict 6-month mortality in this population.

Comparison of image quality between conventional and low-dose nonenhanced head CT.

Background And Purpose: Increasing use of CT for evaluating neurologic disease may expose patients to considerable levels of ionizing radiation. We compared the image quality of low-mAs head CT scans with that of conventional nonenhanced scans.

Methods: Conventional head CT scans were obtained in 20 patients (all >65 years with history of non-CNS malignancy) by using a multidetector technique: 170 mA and 1-second scanning time (ie, 170 mAs), 140 kVp, table speed of 7.

Quantitative determination of expression of the prostate cancer protein alpha-methylacyl-CoA racemase using automated quantitative analysis (AQUA): a novel paradigm for automated and continuous biomarker measurements.

Despite years of discovery and attempts at validation, few molecular biomarkers achieve acceptance in the clinical setting. Tissue-based markers evaluated by immunohistochemistry suffer from a high degree of inter- and intraobserver variability. One recent advance in this field that promises to automate this process is the development of AQUA, a molecular-based method of quantitative assessment of protein expression.

Care of the dying doctor: on the other end of the stethoscope.

The challenges of caring for a dying doctor reflect both common issues in helping the terminally ill and unique problems in working with a physician-patient. The dying doctor must deal with a familiar environment and set of problems from a radically different perspective and must negotiate overlapping and conflicting personal and professional roles. Some of the cardinal virtues of physicians--professional identity, expertise, perfectionism, selflessness, and stoicism--may pose both strengths and liabilities in the patient's role.

Increase of KL-6 in sera of uveitis patients with sarcoidosis.

Background: KL-6 is a human glycoprotein secreted by type II alveolar cells in lung, and its serum levels increase in pneumonia of various causes. KL-6 is a member of the MUC-1 family, which is expressed in lung, cornea, and conjunctiva. The purpose of the present study was to investigate the clinical usefulness of quantifying serum KL-6 levels for diagnosing sarcoidosis in patients with uveitis.

Lessons from dietary studies in Adventists and questions for the future.

Comparisons of diets and disease rates between Adventists and non-Adventists, and prospective cohort studies among Adventists, have contributed greatly to our general understanding of nutrition and health. The most fundamental conclusion drawn from the Adventist Health Studies has been that maintaining a lean body weight throughout life is central for optimal health. Other contributions have included the value of nut consumption for prevention of coronary artery disease, and the roles of red meat and dairy products in the etiologies of cardiovascular disease and cancer.

Durability of aortouniiliac endografting with femorofemoral crossover: 4-year experience in the Evt/Guidant trials.

Objectives: We evaluated mid-term results of the multicenter EVT/Guidant aortouniiliac endograft (AI) trial and ascertained the durability of this endovascular technique in patients unable to undergo standard bifurcated endografting.

Methods: From November 1996 to December 1998, 121 patients were enrolled to receive the AI device on the basis of complex iliac artery anatomy contraindicating bifurcated endografting. Clinical data were centrally collected, and radiographic data were evaluated by core facility.

From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients.

Objective: To evaluate the evolution of knowledge concerning the stress response in surgical patients and to determine the therapeutic benefit of stress reduction therapy.

Summary Background Data: The stress response in surgical patients is associated with tissue catabolism, organ failure, and prolonged recovery. Understanding the neural-hormonal basis for these events has stimulated efforts to attenuate these undesirable effects.

Thoracoabdominal aneurysm repair: results with 337 operations performed over a 15-year interval.

Objective: To review perioperative results and late survival after thoracoabdominal aneurysm repair (TAA), in particular to assess the impact over time of epidural cooling (EC) on spinal cord ischemic complications (SCI).

Summary Background Data: A variety of operative approaches and protective adjuncts have been used in TAA to minimize the major complications of perioperative death and SCI. There is no consensus with respect to the optimal approach.

Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging.

The incidence of synchronous bilateral breast cancers has been reported to be between 3.4% and 7.4%, as detected on mammography, physical examination, or both.

The serpin SQN-5 is a dual mechanistic-class inhibitor of serine and cysteine proteinases.

SQN-5 is a mouse serpin that is highly similar to the human serpins SCCA1 (SERPINB3) and SCCA2 (SERPINB4). Previous studies characterizing the biochemical activity of SQN-5 showed that this serpin, like SCCA2, inhibited the chymotrypsin-like enzymes mast cell chymase and cathepsin G. Using an expanded panel of papain-like cysteine proteinases, we now show that SQN-5, like SCCA1, inhibited cathepsins K, L, S, and V but not cathepsin B or H.

Ligand binding characteristics of CXCR4 incorporated into paramagnetic proteoliposomes.

The G protein-coupled receptor CXCR4 is a coreceptor, along with CD4, for the human immunodeficiency virus type 1 (HIV-1) and has been implicated in breast cancer metastasis. We studied the binding of the HIV-1 gp120 envelope glycoprotein (gp) to CXCR4 but found that the gp120s from CXCR4-using HIV-1 strains bound nonspecifically to several cell lines lacking human CXCR4 expression. Therefore, we constructed paramagnetic proteoliposomes (CXCR4-PMPLs) containing pure, native CXCR4.

Diet and sudden cardiac death.

The purpose of this paper is to review the evidence that dietary factors, namely the ingestion of the n-3 (or w-3) polyunsaturated fatty acids of fish oils can prevent fatal cardiac arrhythmias (so-called sudden cardiac death) in experimental animals, and probably in humans as well. The mechanism for this striking effect results from the ability of these fatty acids to directly stabilize electrically every contractile myocyte in the heart. This is accomplished by modulation by the free n-3 fatty acids of the ionic currents in heart cells; particularly the voltage-dependent sodium currents which initiate action potentials and the L-type calcium currents, which initiate release of sarcoplasmic reticulum stores of calcium into the cytosol of heart cells.

Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women.

Background: Socioeconomic differences in allergic disease prevalence have been reported; asthma has been associated with poverty in the United States and hay fever and eczema with relative affluence elsewhere. It is not yet established to what degree such differences in disease prevalence reflect patterns of sensitization and specific allergen sensitivities.

Objective: We analyzed specific and total IgE measurements in a sample of 458 women, enriched for allergic disease, from the metropolitan Boston area to establish the relation of allergen sensitization to markers of socioeconomic status (SES) and to the prevalence and socioeconomic pattern of allergic disease in this community.

Partitioning of polyunsaturated fatty acids, which prevent cardiac arrhythmias, into phospholipid cell membranes.

It has been demonstrated in animal studies that polyunsaturated fatty acids (PUFA) prevent ischemia-induced malignant ventricular arrhythmias, a major cause of sudden cardiac death in humans. To learn how these PUFA, at low micromolar concentrations, exert their antiarrhythmic activity, we studied their effects in vitro on the contractions of isolated cardiac myocytes and the conductances of their sarcolemmal ion channels. These fatty acids directly stabilize electrically every cardiac myocyte by modulating the conductances of specific ion channels in their sarcolemma.

The C-terminal domain of thrombospondin-1 induces vascular smooth muscle cell chemotaxis.

Objective: Thrombospondin-1 (TSP-1), an acute-phase reactant implicated in vascular disease, is a 420-kd multifunctional glycoprotein chemotactic for vascular smooth muscle cells (VSMCs). TSP-1 has six domains of repeating homologous amino acid sequences: N-terminal, procollagen homology, type 1 repeat, type 2 repeat, type 3 repeat/RGD (T3), and C-terminal (COOH). The purpose of this experiment was to determine which domains of TSP-1 induce VSMC chemotaxis.

The art and science of continuous positive airway pressure therapy in obstructive sleep apnea.

Despite the high prevalence of obstructive sleep apnea (OSA) syndrome, no ideal therapy has emerged to date. Based on recent randomized trials, continuous positive airway pressure (CPAP) therapy is the treatment of choice. Although CPAP can prevent pharyngeal collapse in virtually all patients who choose to wear it, poor patient adherence with treatment limits its effectiveness.

In search of the tumour-suppressor functions of BRCA1 and BRCA2.

Hereditary breast and ovarian cancer syndromes can be caused by loss-of-function germline mutations in one of two tumour-suppressor genes, BRCA1 and BRCA2 (ref. 1). Each gene product interacts with recombination/DNA repair proteins in pathways that participate in preserving intact chromosome structure.