Plasma adiponectin levels and clinical outcomes among haemodialysis patients.

Background: Adiponectin (ADPN) levels are consistently elevated among patients with advanced chronic kidney disease, but its relationship with cardiovascular outcomes in this population remains controversial.

Methods: We measured baseline and yearly plasma ADPN in 182 prevalent haemodialysis patients recruited to the Haemodialysis (HEMO) Study from two Boston centres. Plasma ADPN at baseline and during follow-up was studied in relation to prevalent cardiovascular disease (CVD) and cardiovascular and all-cause mortality.

Unusual case of 2 renal cell carcinoma metastases ipsilateral to an occluded internal carotid artery.

Hemodynamic factors may play a role in the seeding and subsequent growth of cerebral metastasis. The authors present a case with 2 foci of cerebral metastasis in the same vascular territory ipsilateral to an occluded internal carotid artery. A 65-year-old man with chronic left frontal lobe infarct and left internal carotid artery occlusion was diagnosed with 2 large hemorrhagic metastases in the left middle cerebral artery territory.

Rhabdomyoma of the head and neck demonstrated by prenatal magnetic resonance imaging.

A case of fetal rhabdomyoma (myxoid type) of the head and neck demonstrated on prenatal magnetic resonance imaging (MRI) is presented. This benign tumor of skeletal muscle is uncommon and should not be confused with its malignant counterpart-rhabdomyosarcoma. With the increasing use of ultrafast MRI, the radiologist is more likely to encounter head and neck masses in the fetus.

Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude.

Background: Abnormalities in pulse wave amplitude (PWA) have been described in subjects with atherosclerosis and may be a marker of future cardiac events. We evaluated the relationship between changes in PWA of the finger and peripheral endothelial function.

Methods: We performed measurements of PWA with a novel finger plethysmograph (peripheral arterial tonometry [PAT]) and compared the findings with a simultaneous noninvasive measurement of peripheral endothelial function with brachial artery ultrasound scanning (BAUS) in 89 subjects.

Postoperative cardiac tamponade in the modern surgical era.

Background: Pericardial effusions resulting in cardiac tamponade (CT) are uncommon after open heart surgery (OHS) and are associated with significant morbidity and mortality. Characteristics and outcomes of patients who develop postoperative CT are poorly defined. Our objective was to further analyze the population at risk for developing postoperative CT, identify potential perioperative and surgical risk factors, and evaluate the impact of CT on patient outcomes.

Intraoperative transesophageal echocardiography: correlation of echocardiographic findings and surgical pathology.

Before the introduction of transesophageal echocardiography (TEE) in the operating room, intraoperative echocardiography relied on epicardial imaging. The disadvantages of this approach included interference with the surgical procedure, limited windows, and potential distortion of cardiac structures. Consequently, multiplane TEE has now emerged as the intraoperative imaging method of choice.

In-situ polymerase chain reaction: foundation of the technology and today's options.

"In situ PCR" is the marriage of two established technologies in molecular genetics, the polymerase chain reaction (PCR) and in situ hybridization (ISH). It is based on the amplification within intact cells or tissue sections of specific gene sequences, or mRNA species, to levels detectable by ISH and/or immunohistochemistry. Methods to achieve in situ PCR, while sharing fundamental steps, have differed between different laboratories.

Comparison of transillumination and histologic slide measurements of choroidal melanoma.

Objective: To compare transillumination and histologic slide measurements of choroidal melanomas in 479 eyes randomized to enucleation in the Collaborative Ocular Melanoma Study.

Design: Transillumination defects were measured during gross examination of enucleated eyes. Tumor basal diameter and height were measured on histologic slides and each tumor was assigned to 1 of 8 distinct shape categories.

Neonatal Trichomonas vaginalis infection.

Clinical infection with Trichomonas vaginalis (T. vaginalis) in the neonate is an unusual occurrence. We present a case of T.

Mediation of Trypanosoma cruzi invasion by heparan sulfate receptors on host cells and penetrin counter-receptors on the trypanosomes.

Trypanosoma cruzi attaches and invades a large variety of mammalian cells by receptor-mediated interactions, one of them involving the binding of parasite trans-sialidase to host sialyl receptors. Three proteoglycan-deficient mutants of Chinese hamster ovary (CHO) cells were used to probe the role of host heparin and heparan sulfate glycosaminoglycans (GAG) in T. cruzi invasion.

Mediation of Trypanosoma cruzi invasion by sialic acid on the host cell and trans-sialidase on the trypanosome.

Trypanosoma cruzi attaches and invades a large variety of mammalian cells. The nature of the cell receptors and of the corresponding parasite counter-receptors that mediate T. cruzi-host cell interaction are not known.

Identification of a lectin activity in Pneumocystis carinii.

Pneumocystitis carinii is known to adhere to pulmonary alveolar epithelial cells in vivo and to epithelial cell lines in vitro by a mechanism unknown at the molecular level. P. carinii is now found to adhere to rabbit and human red blood cells leading to rosette formation and hemagglutination.

Morbidity among pediatric motor vehicle crash victims: the effectiveness of seat belts.

It is well established that seat belts reduce mortality and morbidity among children. Data are presented for 413 children injured severely enough in motor vehicle crashes to require hospitalization. Of the unrestrained children, 4.

A novel T. cruzi heparin-binding protein promotes fibroblast adhesion and penetration of engineered bacteria and trypanosomes into mammalian cells.

T. cruzi invades mammalian cells in various organs after migrating through the ECM. These activities appear to be mediated by a unique 60 kd protein exposed on the T.

Emerging issues in medical ethics.

Ethical principles are influenced by personal values and beliefs, and by societal context. They are not immutable. In medicine, as new technologies have developed and changes in health-care delivery have resulted, historically held views about the responsibilities, obligations and relationships between health-care providers and patients have been challenged.

Newer beta-lactam agents and the Bacteroides fragilis group.

A continuing nationwide susceptibility survey of the Bacteroides fragilis group, begun in 1981, is being conducted at the New England Medical Center. Review of susceptibility testing in years 1986 through 1988 is reported here. Totals of 557 strains in 1986, 506 in 1987, and 534 in 1988 were obtained from seven centers in the United States.

Comparative activities of newer beta-lactam agents against members of the Bacteroides fragilis group.

A nationwide susceptibility survey of 557 isolates of the Bacteroides fragilis group was continued in 1986. The most active beta-lactam drugs were imipenem and ticarcillin-clavulanic acid, which had 0.2 and 1.

Anatomy of the proximal femur as seen with three-dimensional magnetic resonance imaging.

Magnetic resonance imaging (MRI) is being applied successfully to the study of the musculoskeletal system with notable recent advances, including the use of three-dimensional imaging techniques. The authors introduce three-dimensional MRI as a technique for examining proximal femoral anatomy and suggest its use as an improvement on current methods for prosthetic hip design. The proximal femurs of 14 cadavers were scanned using a three-dimensional FISP technique and the images were subsequently manipulated on a three-dimensional MRI image-processing workstation to produce rotated surface reconstructions and multiplanar reformatted images.

Experimental trials with Gd(DO3A)--a nonionic magnetic resonance contrast agent.

Gd(DO3A), a member of a new family of nonionic MRI contrast agents, was evaluated in vivo in a rat model. In 10 animals, enhancement of an intracerebral glioma was studied following Gd(DO3A) injection. Correlation with tissue pathology was obtained in all cases.

Susceptibility of the Bacteroides fragilis group in the United States: analysis by site of isolation.

An ongoing survey of the susceptibility of the Bacteroides fragilis group of bacteria was continued at New England Medical Center in 1984 and 1985. A total of 1,229 strains were obtained from eight centers in the United States. These results were compared with those for 1,847 isolates tested in 1981 through 1983.