The promise and perils of exhaled breath condensates.

The exhaled breath condensate (EBC) approach provides a convenient and noninvasive approach for sampling the pulmonary epithelial lining fluid (ELF). Increased EBC concentrations of more than a dozen inflammatory markers and hydrogen ions have been reported in lung diseases associated with inflammation. However, the usefulness of EBC is compromised by uncertainties concerning the sources of the EBC droplets and by the extreme and variable dilution of ELF droplets with condensed water vapor ( approximately 20,000-fold).

Insulin signaling pathways in cortical dysplasia and TSC-tubers: tissue microarray analysis.

To evaluate the possible roles of the Akt/PKB-mTOR-p70S6K-S6 and cap-dependent translation (eIF4G) pathways in the pathogenesis of tuberous sclerosis complex (TSC)-associated cortical tubers and focal cortical dysplasia (FCD), we performed qualitative and semiquantitative immunohistochemical evaluation on surgically resected corticectomy specimens to detect phosphorylated molecules as activated downstream targets of the signaling pathways. A tissue microarray paraffin block was constructed from 63 archival specimens of surgically resected TSC tubers, FCDs with balloon cells, cortical dysplasia without balloon cells, and histologically normal-appearing neocortex obtained from cases with Rasmussen encephalitis, cystic-gliotic encephalopathy, and temporal lobe epilepsy. Abnormal neuroglial cells were positive for phospho-S6 and phospho-eIF4G with various staining intensities in FCDs and TSC tubers.

Concurrent cerebral american trypanosomiasis and toxoplasmosis in a patient with AIDS.

We report a case of concurrent cerebral infection with Trypanosoma cruzi and Toxoplasma gondii in a patient with acquired immunodeficiency syndrome (AIDS). A 22-year-old El Salvadoran man initially improved during receipt of antitoxoplasmosis therapy, but he had rapidly progressive hemiplegia. Magnetic resonance imaging showed an abnormal finding in the left internal capsule, and cytological analysis of cerebrospinal fluid revealed T.

Intraaneurysmal flow visualization by using phase-contrast magnetic resonance imaging: feasibility study based on a geometrically realistic in vitro aneurysm model.

Object: The aim of this study was to evaluate the feasibility of complex intraaneurysmal flow visualization with the currently available phase-contrast magnetic resonance (MR) imaging modality.

Methods: A geometrically realistic in vitro aneurysm model, in which detailed flow velocity analysis had already been conducted using laser Doppler velocimetry was used for this in vitro hemodynamic simulation, so that the results of phase-contrast velocity measurements could be compared with the previous reliable results. On a 1.

A low serum iron level is a predictor of poor outcome in hemodialysis patients.

Background: Iron administration has been implicated as a cause of poor clinical outcome in maintenance hemodialysis (MHD) patients. However, the role of low iron levels in the clinical outcome of MHD patients is not clear.

Methods: We examined the predicting value of baseline serum iron level on prospective mortality and hospitalization in a cohort of all 1,283 MHD patients from 10 DaVita dialysis facilities in Los Angeles County, CA.

Fine-needle aspiration of an adenoid cystic carcinoma of the larynx mimicking a thyroid mass.

Adenoid cystic carcinoma (ACC) is most often primary in the major and minor salivary glands but can also arise from the submucosal seromucinous glands of the larynx and trachea. We report a case of adenoid cystic carcinoma of the larynx that presented as a diffuse swelling in the thyroid area. Fine-needle aspiration (FNA) was consistent with a neoplastic process, which was difficult to classify further but was felt to be of thyroid origin.

Impact of CNS treatment on mood in adult survivors of childhood leukemia: a report from the Children's Cancer Group.

Purpose: This study assessed the relationship between CNS treatment and psychologic mood using the Profile of Moods State (POMS), a standardized measure of affect, among a large sample of young adult survivors of childhood acute lymphoblastic leukemia (ALL; N = 555).

Patients And Methods: Survivors of childhood ALL (ages 18 to 33 years at study entry) participated in a structured telephone interview eliciting demographic, health, and behavioral data and the POMS. Treatment data included total dose of CNS irradiation (CRT) and intrathecal methotrexate (MTX) obtained from medical records.

The use of adult stem cells in regenerative medicine.

The cellular component of the tissue engineering paradigm is arguably the most important piece of the complex task of regenerating or repairing damaged or diseased tissue. Critical to the development of clinical strategies is the need for reliable sources of multipotent cells that can be obtained with limited morbidity. The adult stem cell population may be well suited for this task.

Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments.

Previous studies of infected human bites have been limited by small numbers of patients and suboptimal microbiologic methodology. We conducted a multicenter prospective study of 50 patients with infected human bites. Seventy percent of the patients and assailants were young adult men.

Acute ischemic cerebrovascular syndrome: diagnostic criteria.

Background: Existing diagnostic classification systems for cerebrovascular disease are based primarily on clinical impression of temporal features, clinical syndrome, inferred localization, or ischemic mechanism. Diagnostic certainty of the ischemic pathology based on supportive or refuting laboratory or radiological evidence has been of secondary importance.

Summary Of Comment: Acute ischemic cerebrovascular syndrome (AICS) describes a spectrum of clinical presentations that share a similar underlying pathophysiology: cerebral ischemia.

Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note.

The authors sought to evaluate the feasibility and accuracy of three-dimensional (3D) fluoroscopic guidance for percutaneous placement of thoracic and lumbar pedicle screws in three cadaveric specimens. After attaching a percutaneous dynamic reference array to the surgical anatomy, an isocentric C-arm fluoroscope was used to obtain images of the region of interest. Light-emitting diodes attached to the C-arm unit were tracked using an electrooptical camera.

Three-dimensional blood flow analysis in a wide-necked internal carotid artery-ophthalmic artery aneurysm.

Object: The aim of this study was to evaluate axial and secondary flow structures in a wide-necked internal carotid artery-ophthalmic artery aneurysm, one of the most common locations for endovascular coil placement.

Methods: A clear acrylic aneurysm model was manufactured from a three-dimensional computerized tomography angiogram. Intraaneurysm blood flow analysis was conducted using an acrylic aneurysm model together with laser Doppler velocimetry and particle imaging velocimetry.

Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia.

Object: In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN).

Methods: Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45-88 years) were treated with dedicated LINAC radiosurgery for TN.

Balanced expression of mitochondrial apoptosis regulatory proteins correlates with long-term survival of cardiac allografts.

Abnormal regulation of apoptosis is observed in ischemic injury and may contribute to the pathogenesis of atherosclerosis. However, its role in cardiac allograft vasculopathy (CAV), the fundamental lesion of chronic rejection (CR) in heart transplantation, remains uncertain. To clarify this issue, apoptosis was quantitated in myocardium and coronary arteries from 5 cardiac allograft donors (NL) and explanted hearts of 24 patients with ischemic cardiomyopathy (IsCM) and 15 patients with CR.

Heat shock proteins are present in mallory bodies (cytokeratin aggresomes) in human liver biopsy specimens.

Mallory bodies (MBs) are aggresomes, composed of cytokeratin and various other proteins, which form in diseased liver because of disruption in the ubiquitin-proteasome protein degradation pathway. Heat shock proteins (hsp's) are thought to be involved in this process because it was discovered that MB formation is induced by heat shock in drug-primed mice. It has been reported that ubiquitin and a mutant form of ubiquitin (UBB(+1)) are found in aggresomes formed in the neurons in Alzheimer's disease and in the liver MBs in various liver diseases.

FK506 vs. cyclosporin. Pathologic findings in 1067 endomyocardial biopsies.

Introduction: Whether FK506 or cyclosporin is better for chronic immunosuppression in heart transplant patients has been debated. We examined endomyocardial biopsies from patients treated with these two drugs to determine if there was a difference in frequency of histologic cellular rejection episodes and Quilty lesions. The Quilty lesion (AKA cyclosporin effect) may be an atypical form of rejection, and is thought to be related to the use of cyclosporin immunosuppression.

Novel stimulatory role for insulin-like growth factor binding protein-2 in prostate cancer cells.

The insulin-like growth factor (IGF) axis is a complex system composed of 2 mitogenic ligands, IGF-I and -II, 2 receptors, IGF-1R and IGF-2R, and 6 binding proteins, IGFBP-1 to -6. The IGFBPs exert their actions through their regulation of IGF bioavailability for IGF receptors. In addition, some IGFBPs have also been found to have direct cellular actions independent of IGFs.

Deep hypothermic circulatory arrest and global reperfusion injury: avoidance by making a pump prime reperfusate--a new concept.

Objective: We sought to determine whether damage after deep hypothermic circulatory arrest can be diminished by changing pump prime components when reinstituting cardiopulmonary bypass.

Methods: Fifteen piglets (2-3 months old) were cooled to 19 degrees C by using the alpha-stat pH strategy. Five were cooled and rewarmed without ischemia (control animals), and the other 10 piglets underwent 90 minutes of deep hypothermic circulatory arrest.

Patients' reasons for undergoing total hip arthroplasty can change over time.

The purpose of this study was to determine if a patient's reasons for undergoing a primary total hip arthroplasty (THA) changed at 1 year follow-up and, if the reasons did change, how does this change influence patient satisfaction with the procedure. Patients undergoing THA (101 patients) were evaluated with the McMaster Toronto Arthritis Patient Preference Disability (MACTAR) questionnaire and questions related to their expectations regarding the procedure. With the exception of pain and walking, most patients did not select the same preoperative and postoperative reasons for undergoing the procedure.

Slitlike syrinx cavities: a persistent central canal.

Object: The authors review their experience in the diagnosis and management of 32 patients with slitlike syrinx cavities.

Methods: There were 18 men and 14 women with a mean age of 40 years. Presenting symptoms that prompted magnetic resonance (MR) imaging evaluation were mechanical spinal pain (13 patients), radicular pain (seven patients), paresthesia (six patients), numbness (five patients), and muscle spasm (one patient).

Levonorgestrel implants (Norplant II) for male contraception clinical trials: combination with transdermal and injectable testosterone.

Recent studies demonstrate that combinations of androgens and progestagens are highly effective in the suppression of spermatogenesis in normal volunteers. To test whether progestagen and androgen delivery systems designed to produce steady serum levels will be as effective as other androgen plus progestagen combinations, we compared Norplant II and testosterone (T) transdermal patch to T patch alone on the suppression of spermatogenesis in normal men. Thirty-nine healthy male volunteers (age, 20-45 yr) were randomly assigned to one of two groups.

An analysis of dialysis training in the United States and Canada.

Background: Because the prevalence of end-stage renal disease (ESRD) has progressively increased in both the United States and Canada, patients with ESRD are likely to constitute progressively larger proportions of nephrology practices.

Methods: We mailed a questionnaire to US and Canadian nephrology program directors to determine methods used in dialysis training; 53% of US and 73% of Canadian programs responded.

Results: Training programs in the United States enrolled a larger median number of fellows and had a lower median faculty-fellow ratio compared with programs in Canada.

Improvement of nutritional status after initiation of maintenance hemodialysis.

Background: Recent data suggest that serum albumin concentrations increase during the several month-period that follows the initiation of maintenance hemodialysis (MHD) therapy. Some investigators have shown that the rate of increase in serum albumin level is related directly to 24-hour urine protein losses before the initiation of dialysis therapy. However, serum albumin levels increase even in patients starting MHD therapy without significant proteinuria, suggesting that this increase may be one manifestation of improving protein-energy nutritional status associated with commencing MHD therapy.

Randomized, controlled trial of darbepoetin alfa for the treatment of anemia in hemodialysis patients.

Background: Darbepoetin alfa (Aranesp; Amgen, Thousand Oaks, CA) is a new erythropoiesis-stimulating protein with a threefold longer terminal half-life than recombinant human erythropoietin (epoetin) in patients with chronic kidney disease (CKD). The purpose of this randomized, double-blind, noninferiority study is to determine whether darbepoetin alfa is as effective as epoetin for the treatment of anemia in hemodialysis patients when administered at a reduced dosing frequency.

Methods: Patients receiving epoetin therapy were randomized to continue epoetin administered intravenously (IV) three times weekly (n = 338) or change to darbepoetin alfa administered IV once weekly (n = 169).