Familial ileal perforation: prenatal diagnosis and postnatal follow-up.

We report sibs (a brother and a sister) who presented prenatally with ultrasound findings of meconium peritonitis and postnatally were found to have perforation of the terminal ileum. The sister presented with fetal ultrasound findings of severe ascites and peritoneal calcifications. She had no prenatal intervention and was born at 38 weeks' gestation.

Chronic exogenous insulin and chronic carbohydrate supplementation increase de novo VLDL triglyceride fatty acid production in rats.

We have investigated hepatic de novo lipogenesis and the ratio of apoB-48/apoB-100 during chronic carbohydrate supplementation with or without administration of exogenous insulin in rats. Two groups received chronic (2 weeks) carbohydrate supplementation either as 10% glucose or 10% fructose (wt/v) in their drinking water. Two other groups received exogenous insulin chronically, in addition to the monosaccharides above.

Current perspectives on radiation-induced breast cancer.

Purpose: An approach to screening and detection of radiation-induced breast cancer is offered. Primary and secondary prevention strategies are suggested and the need for prospective clinical trials is emphasized.

Methods: Data are reviewed from published evidence of radiation-induced breast cancer secondary to atomic bomb radiation, occupational, and therapeutic exposure, especially that incurred during successful treatment of Hodgkin's disease (HD).

Overexpression of transforming growth factor-beta1 and insulin-like growth factor-I in patients with idiopathic hypertrophic cardiomyopathy.

Background: Idiopathic hypertrophic cardiomyopathy (HCM) is characterized by regional myocardial hypertrophy. To investigate involvement of growth factors on myocardial hypertrophy in HCM patients, we evaluated gene expression and cellular localization of transforming growth factor-beta1 (TGF-beta1), insulin-like growth factors (IGF-I and IGF-II), and platelet-derived growth factor-B (PDGF-B) in ventricular biopsies obtained from patients with HCM (n=8), aortic stenosis (AS) (n=8), or stable angina (SA) (n=8) and from explanted hearts with ischemic cardiomyopathy (TM) (n=7).

Methods And Results: Levels of TGF-beta1, IGF-I, IGF-II, and PDGF-B transcripts were quantified with the use of multiplex RT-PCR.

VLA-4 integrin cross-linking on human monocytic THP-1 cells induces tissue factor expression by a mechanism involving mitogen-activated protein kinase.

Adhesion molecules such as VLA-4 are important not only for monocyte adhesion to extracellular matrix proteins, but also for subsequent cell activation. Monocyte adherence to fibronectin or engagement of VLA-4 has been demonstrated to stimulate production of potent inflammatory mediators such as tumor necrosis factor-alpha, interleukin-1, and the procoagulant tissue factor protein. However, the intracellular signaling cascades leading to gene expression have not been elucidated.

Omphalocele in Miller-Dieker syndrome: expanding the phenotype.

We report on a patient prenatally diagnosed with omphalocele, mild cerebral ventriculomegaly, nuchal fold thickening, and cystic changes in the umbilical cord who was found postnatally to have lissencephaly type I. Prenatal chromosome analysis showed a normal male karyotype; however, postnatal high resolution banding and FISH analysis, using a probe for locus D17S379 in chromosome region 17p13.3, demonstrated a deletion at 17p13.

Phase I studies of fluorouracil, doxorubicin and vinorelbine without (FAN) and with (SUPERFAN) folinic acid in patients with advanced breast cancer.

Purpose: The Breast Cancer Site Group of the National Cancer Institute of Canada - Clinical Trials Group (NCIC-CTG) undertook two parallel phase I studies to determine the maximum tolerated dose (MTD) and recommended phase II dose of vinorelbine in combination with doxorubicin and fluorouracil (with or without folinic acid) in metastatic breast cancer.

Methods: Cohorts of five patients were to receive: (a) fluorouracil 500 mg/m2 and doxorubicin 50 mg/m2 on day 1 only and escalating doses of vinorelbine (15, 20, 25, 30 mg/m2) on days 1, 8 and 15 every 3 weeks (FAN regimen), or (b) fluorouracil 340 mg/m2 and folinic acid 200 mg/m2 on days 1, 2, 3, 4 and 5, doxorubicin 40 mg/m2 on day 1 only and escalating doses of vinorelbine (15, 20, 25, 30 mg/m2) on day 1 and again on day 5 every 4 weeks (SUPERFAN regimen). Eligibility included measurable or evaluable metastatic breast cancer and having received neither previous chemotherapy for metastatic disease nor anthracycline-containing adjuvant therapy.

Abdominal sonography in asymptomatic executives: prevalence of pathologic findings, potential benefits, and problems.

Abdominal ultrasonography was performed on 1000 asymptomatic executives over a period of 6 months as part of a comprehensive health examination. The use of ultrasonography in these persons was evaluated with regard to the prevalence and variety of pathologic conditions detected as well as potential benefits, risks, and use as a screening tool. Significant sonographic diagnoses included renal cell carcinoma in four patients (0.

A self-expanding bifurcated endovascular graft for abdominal aortic aneurysm repair. An initial study in a canine model.

Approximately 50,000 abdominal aortic aneurysms (AAAs) are surgically repaired annually in the United States. Endovascular grafts (EVGs) combine a stent and a vascular graft offering great potential for reduced morbidity, mortality, and hospital stay because of minimally invasive endoluminal placement through catheters. Because most AAAs extend into one or both iliac arteries, a bifurcated EVG (bEVG) was developed, consisting of a proximal aortic trunk divided into two distinct lumens or sockets to receive two smaller diameter leg (iliac) components.

Cardiomyocyte transplantation improves heart function.

Background: Transplantation of cultured cardiomyocytes into myocardial scar tissue may prevent heart failure.

Methods: Scar tissue was produced in the left ventricular free wall of 15 rats (weight, 450 g) by cryoinjury. Seven animals had operation only and survived for 8 weeks (sham group).

Human pediatric and adult ventricular cardiomyocytes in culture: assessment of phenotypic changes with passaging.

Objectives: The purpose of this study was to assess morphologically and biochemically the phenotypic changes which occur in vitro with passaging of human pediatric and adult ventricular cardiomyocytes.

Methods: Human ventricular cardiomyocytes from 3 children (1 to 2 years of age) and an adult patient (65 years of age) undergoing open heart surgery and an adult heart transplant patient (55 years of age) were isolated, cultured, purified, and passaged. Growth curves and 3H-thymidine uptake studies were performed.

Pulmonary and thymic carcinoid tumors.

Carcinoid tumors of the lung and bronchi are usually benign lesions with no influence on life expectancy, although occasionally, they are malignant with a poor prognosis. Between these two extremes are atypical carcinoids, which can be slow-growing tumors with an average 5-year survival of 60% and an average 10-year survival of 40%. The myriad names used to describe these lesions complicates the understanding of their behavior, especially as the term carcinoid is used to describe the complete spectrum of disease or exclusively the benign well differentiated lesions with an excellent prognosis.

In vivo survival and function of transplanted rat cardiomyocytes.

Recent studies have demonstrated the feasibility of transplanting fetal mouse cardiomyocytes into the hearts of adult syngeneic mice. However, the function of the transplanted cardiomyocytes and their capacity to survive in fibrous connective tissue were not assessed. In the present study, we evaluated the viability and contractility of transplanted fetal and neonatal rat cardiomyocytes in the connective tissue of the adult rat hindlimb.

Cardiovascular disease and sleep apnea.

A number of novel and important observations have recently arisen that emphasize the interaction between sleep apnea and cardiovascular function. New evidence of a role for obstructive sleep apnea as an independent factor in the genesis of hypertension and nocturnal myocardial ischemia has been described. Advances have been made in the understanding of the acute impact of sleep-disordered breathing on hemodynamic function, and a better understanding of the interaction between sleep-disordered breathing and congestive heart failure is now emerging.

Spectrophotometry of amniotic fluid: a simple and rapid method for distinguishing between gestational sacs in second-trimester amniocentesis of twin pregnancies.

Objective: To evaluate the use of an alternative and simple spectrophotometric method that could replace the intraamniotic injection of dye in the second-trimester amniocentesis of twins.

Methods: Optical densities (OD) of amniotic fluid (AF) obtained at second-trimester genetic amniocentesis were measured at 360 nm. Comparison was made between 36 twin pregnancies and 60 singleton controls.

Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acid. Double-blind, randomized clinical trial.

This prospective, double-blind, randomized trial assessed the effectiveness of high-dose tranexamic acid given in the preoperative period on blood loss in patients undergoing cardiopulmonary bypass. One hundred fifty patients scheduled to undergo cardiac operations with cardiopulmonary bypass were randomized into three groups of equal size. The first group received 10 gm of tranexamic acid intravenously over 20 minutes before sternotomy and a placebo infusion over 5 hours.

Coronary sinus morphology in patients with atrioventricular junctional reentry tachycardia and other supraventricular tachyarrhythmias.

Background: Coronary sinus access by electrode catheters is easier in patients with atrioventricular junctional reentry tachycardia (AVJRT) than in patients with other supraventricular tachyarrhythmias. The reason for this has not been addressed.

Methods And Results: The size and shape of the proximal coronary sinus were measured in 15 patients with AVJRT and 14 control subjects after angiographic visualization.

A Corethane/polyester composite vascular prosthesis for vascular access. Comparison with expanded polytetrafluoroethylene grafts in a canine model.

An important need in hemodialysis is a self-sealing prosthesis for vascular access with at least equivalent patency and biostability to expanded polytetrafluoroethylene (ePTFE) alternatives. The authors have developed a Corethane/polyester composite (CPC) graft with an inner blood interfacing layer of spun Corethane fibers (10-15 microns diameter; pore size 30-60 microns) impregnated with a gelatin-heparin complex and an outer soft tissue interfacing warp-knitted polyester sheath. Twenty-six CPC grafts (6 mm internal diameter; 25-30 cm length) and eight Gore-Tex ePTFE grafts (same dimensions) were implanted as femoral artery-to-vein shunts in dogs on low dose (162 mg/day) aspirin, and subjected to weekly dialysis needle punctures for up to 52 weeks.

Prenatal diagnosis of retinal nonattachment in the Walker-Warburg syndrome.

We report on the prenatal ultrasonographic diagnosis of Walker-Warburg syndrome based on cerebral and ocular findings. The ultrasound study done at 37 weeks gestation documented hydrocephalus and retinal nonattachment consistent with this syndrome. The ability to detect retinal nonattachment prenatally may have implications for the prenatal diagnosis of other conditions which have early retinal nonattachment as one of their findings.

Comparative analysis of saphenous vein bypass vs. native coronary artery balloon angioplasty: technical differences and angiographic response.

To evaluate technical differences and angiographic response of saphenous vein bypass graft angioplasty in comparison to native coronary arteries, we retrospectively analyzed 54 patients undergoing this procedure at The Toronto Hospital between February 1988 and May 1993. These subjects were temporally matched to a cohort of successful native coronary angioplasties, with comparison of technical parameters, pre-existing qualitative/quantitative (Cardiac Measurement System) stenotic morphology, and angiographic response; including changes in minimum lumen diameter. Saphenous bypass graft angioplasty utilized larger balloons (CABG, 3.

Current perspectives on aromatase inhibitors in breast cancer.

Purpose And Design: One way to deprive hormone-dependent breast cancer of estrogen is to prevent its synthesis. This is achievable by inhibiting the aromatase cytochrome P-450 (P-450arom) enzyme complex responsible for the ultimate step in estrogen production. A new generation of specific and selective aromatase inhibitors is currently under investigation.