Postoperative day 3 serum human chorionic gonadotropin decline as a predictor of persistent ectopic pregnancy after linear salpingotomy.

Objective: To evaluate the ability of preoperative clinical, ultrasonographic, intraoperative findings and pre-postoperative serum human chorionic gonadotropin (hCG) levels to predict persistent ectopic pregnancy (EP).

Study Design: Retrospective cohorts study.

Setting: Tertiary care, university hospital.

Polyclonal Staphylococcus epidermidis intravascular catheter-related infections.

During a 4-month period we prospectively investigated the frequency of polyclonal catheter infections with Staphylococcus epidermidis. Of each catheter with pure growth of S. epidermidis, six colonies were genotypically analyzed with pulsed-field gel electrophoresis.

The efficacy of atorvastatin in treating patients with hypercholesterolaemia to target LDL-cholesterol goals: the LIPI-GOAL trial.

Objective: LIPI-GOAL is a multicentre, open-label, non-comparative treat-to-target study, conducted from March 1998 to May 1999, that assessed the percentage of patients reaching 1992 European Atherosclerosis Society (EAS) low-density lipoprotein cholesterol (LDL-C) targets with atorvastatin 10-80 mg/day in subjects with hypercholesterolaemia, defined as LDL-C > 160 mg/dl after a 12-week step I diet.

Methods And Results: Patients were treated towards the following LDL-C goals: < 135 mg/dl in patients with atherosclerotic disease present and/or coronary heart disease (CHD) risk >40%/10 years, or LDL-C < 155 mg/dl in all others. All subjects started treatment with atorvastatin 10 mg/day for 6 weeks.

Progressive bouts of acute abdomen: pet the peritoneum.

The recent discovery of the mutated gene responsible for Familial Mediterranean Fever (FMF) is supposed to facilitate its diagnosis which up till now is a clinical one because there are no specific laboratory tests. The sensitivity of genetic testing is limited because these tests search only for known mutations. In this case report we describe a patient with periodic abdominal pain in whom the diagnosis of FMF was wrongly discarded because of lack of a durable effect of colchicine and negative genetic testing.

Respiratory muscle function and drive in chronic obstructive pulmonary disease.

Respiratory, and particularly inspiratory, muscle function is altered in COPD. Many of these alterations are secondary to a mechanical disadvantage related to hyperinflation. Other factors, including corticosteroid therapy and nutritional depletion, are also deleterious to muscle function.

A phase I study of a new polyamine biosynthesis inhibitor, SAM486A, in cancer patients with solid tumours.

Because tumour cell proliferation is highly dependent upon up-regulation of de-novo polyamine synthesis, inhibition of the polyamine synthesis pathway represents a potential target for anticancer therapy. SAM486A (CGP 48664) is a new inhibitor of the polyamine biosynthetic enzyme S-adenosylmethionine decarboxylase (SAMDC), more potent and specific than the first-generation SAMDC inhibitor methylglyoxal (bis) guanylhydrazone (MGBG). Preclinical testing confirmed promising antiproliferative activity.

1alpha,25-dihydroxyvitamin D3 induces an autoantigen-specific T-helper 1/T-helper 2 immune shift in NOD mice immunized with GAD65 (p524-543).

Prevention of type 1 diabetes in NOD mice by 1,25-dihydroxyvitamin D3 [1alpha,25(OH)2D3] is accompanied by a T-helper (Th) 1/Th2 cytokine shift in the pancreas. The aim of this study was to investigate whether this immune shift also occurs outside of the pancreas and whether it is limited to autoantigen-specific immune responses. NOD mice treated with 1alpha,25(OH)2D3 (5 microg/kg every 2 days) or control vehicle were immunized with GAD65 (p524-543) or ovalbumin (OVA) in the rear footpads.

Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy.

Objectives: In monochorionic twin pregnancy in which one twin is a nonviable fetus, selective feticide may be considered. We aimed to occlude the umbilical cord with a bipolar forceps for doing so.

Study Design: This was a multicenter experience in 10 consecutive patients either with twin-to-twin transfusion syndrome and one fetus affected by a condition not compatible with normal extrauterine life or with acardiac twinning.

Preliminary results of a phase I study with MTA (LY231514) in combination with cisplatin in patients with solid tumors.

MTA (multitargeted antifolate, LY231514) is a novel antimetabolite resulting from structure/activity studies of the lometrexol-type antifolates. It has been shown to inhibit various enzymes of folate pathways and has broad antitumor activity in a variety of in vitro and in vivo tumor models. Clinical phase 1 studies have been performed using different administration schedules, and subsequently the every-21-days schedule has been selected for further development.

Clinical and pharmacokinetic phase I study of multitargeted antifolate (LY231514) in combination with cisplatin.

Purpose: Multitargeted antifolate (MTA; LY231514) has broad preclinical antitumor activity and inhibits a variety of intracellular enzymes involved in the folate pathways. This study was designed to (1) determine the maximum-tolerated dose (MTD), dose-limiting toxicities (DLT), and pharmacokinetics of MTA combined with cisplatin; (2) determine a recommended dose for phase II studies; and (3) collect anecdotal information on the antitumor activity of MTA combined with cisplatin.

Patients And Methods: Patients with solid tumors received MTA intravenously over 10 minutes and cisplatin over 2 hours once every 21 days.

Regions in the human brain activated by simultaneous orientation discrimination: a study with positron emission tomography.

In order to compare regional cerebral activity involved in simultaneous as opposed to successive orientation discrimination, we used positron emission tomography to measure regional cerebral blood flow, in two threefold sets of conditions, in a large number of subjects. The first such triad involved simultaneous orientation discrimination, orientation identification and detection, with all tasks using the same pair of gratings. The second triad consisted of successive orientation discrimination with its corresponding identification and detection tasks.

The implications of hyperhomocysteinemia in a patient with type 1 diabetes.

We present a patient with type 1 diabetes mellitus, who had severe, progressive macrovascular disease despite an optimal control of modifiable risk factors. Screening for other risk factors revealed a markedly elevated plasma homocysteine level, that was secondary to pernicious anemia. The biological and clinical implications of this association are discussed.

Docetaxel is a potent cytotoxic drug in the treatment of advanced breast cancer.

Docetaxel (Taxotere) belongs to a new class of anti-neoplastic agents, the taxanes. As the structurally related compound, paclitaxel, it enhances microtubule assembly and inhibits depolymerization of tubulin, thereby disrupting mitosis and cell replication. From august 1994 till december 1995, we treated thirty patients with advanced or metastatic breast cancer in a protocol aiming at evaluating the efficacy of docetaxel, administered in second, third or fourth line chemotherapy.

The kinetic occipital (KO) region in man: an fMRI study.

We used functional magnetic resonance imaging to explore, in individual subjects, the properties of the kinetic occipital (KO) region, which previous position emission tomography studies have shown to be involved in the processing of kinetic boundaries. The KO region was significantly activated in 23/25 subjects tested in the subtraction of uniform motion from kinetic gratings. The KO region is genuinely specialized for processing kinetic boundaries since it is significantly more activated by kinetic gratings than by luminance-defined gratings, uniform motion or transparent motion.

Influence of dietary protein supplements on the formation of bacterial metabolites in the colon.

Background: To evaluate the influence of increased dietary protein intake on bacterial colonic metabolism in healthy volunteers.

Methods: Short chain fatty acids, ammonia, and volatile organic compounds in faecal samples, and phenols in the urine of five volunteers were measured after one week of basal nutrient intake and and after one week of a diet supplemented with a protein rich food (Fortimel; Nutricia, Zoetermeer, The Netherlands). Paired t tests and factor analysis were used for statistical analysis.

Multimodality image registration by maximization of mutual information.

A new approach to the problem of multimodality medical image registration is proposed, using a basic concept from information theory, mutual information (MI), or relative entropy, as a new matching criterion. The method presented in this paper applies MI to measure the statistical dependence or information redundancy between the image intensities of corresponding voxels in both images, which is assumed to be maximal if the images are geometrically aligned. Maximization of MI is a very general and powerful criterion, because no assumptions are made regarding the nature of this dependence and no limiting constraints are imposed on the image content of the modalities involved.

[Acute and chronic pancreatitis in the elderly patient].

Normal pancreatic ageing is characterized by functional and morphological changes of the pancreatic parenchyma and of the ductal system, which, however, do not interfere with normal exocrine pancreatic function. It can be speculated that 'pancreatic lithiasis in the aged' as well as the 'senile idiopathic chronic pancreatitis', two conditions of chronic pancreatitis in the elderly, may represent more extreme forms of these normal age-related changes in pancreatic structure and function. In elderly people, acute and chronic pancreatitis are only rarely related to alcohol abuse, in contrast to the situation in a younger patient population.

[Prevalence of human T-lymphotropic virus, Type 1 and 2 in blood donors and patients with sexually transmissible diseases in Surinam].

Objective: To determine the prevalence of HTLV-1 and HTLV-2 infection in the population of Surinam in order to enhance the safety of blood transfusion in Surinam.

Design: Descriptive.

Setting: Academic Hospital, Paramaribo, Surinam.

Verapamil as prophylactic treatment for atrial fibrillation after lung operations.

Background: Atrial fibrillation is a frequently occurring arrhythmia after thoracic operations. Preventive strategies for this complication have been extensively evaluated after cardiac operations.

Methods: We performed a prospective, open randomized study, comparing intravenous verapamil and placebo in 199 patients after pneumonectomy or lobectomy at the University Hospital of Leuven.

Non-invasive variceal pressure measurements: validation and clinical implications.

Recently, it has become clear that the best way to reduce the mortality related to a variceal bleeding is to prevent it. Since however not all patients will bled, a way to predict a variceal hemorrhage is therefore urgently needed. The current endoscopic scores for the prediction of variceal bleeding are based on rather subjective markers.

A senescent pattern of pituitary function during critical illness and dopamine treatment.

Human critical illness is characterized by protein hypercatabolism, preservation of fat depots and by immune dysfunction. Optimized parenteral or enteral feeding and other advanced, supportive therapies remain unable to prevent ensuing wasting of vital organs and muscles and deficient healing processes. The anterior pituitary gland is a prime regulator of human metabolism and immune function through the orchestrated secretion of hormones, including growth hormone, thyrotropin, gonadotropins, prolactin and corticotropin.

[Long-term results following premature birth].

Along the second half of this century, survival rates of low birth weight infants, admitted to the K.U. Leuven Neonatal Intensive Care Unit, progressively increased to 67% for the < 1000 g birth weight group, to 84% for the 1000-1499 group, and to 92% for the 1500-1999 g group.

[Diabetes and pregnancy].

Diabetes and pregnancy are associated with an increased incidence of preeclampsia. The pathogenesis is not exactly known. However endothelial factors and more special the prostacyclin-thromboxane system may be involved.

Labor pain relief using bupivacaine and sufentanil: patient controlled epidural analgesia versus intermittent injections.

Objectives: To determine whether the use of patient-controlled epidural analgesia (PCEA) versus intermittent injections (CIT) resulted in local anesthetic dose reduction.

Study Design: PCEA and CIT using a mixture of 0.125% bupivacaine with sufentanil 1 or 0.

[Immune modulation by vitamin D analogs in the prevention of autoimmune diseases].

Vitamin D has been discovered at the beginning of this century. 7-Dehydrocholesterol is converted to vitamin D3 in the skin and after several hydroxylations it is further converted to the active hormonal form, 1 alpha,25-(OH)2D3. Vitamin D stimulates the absorption of calcium and phosphate and is an essential link in bone resorption and formation and calcium metabolism.