Double lumen esophagus: a rare complication of gastroesophageal reflux disease.

Double lumen esophagus or esophagogastric fistula is a very rare endoscopic finding. Approximately 11 cases have been reported in the past. Formation of an esophagogastric fistula is predisposed by previous esophagogastric surgery, persistent gastroesophageal reflux, esophageal ulcer or esophageal carcinoma.

Technique for removal of malpositioned Ex-PRESS glaucoma device.

Purpose: To report a simple technique for removal of malpositioned Ex-PRESS miniature glaucoma filtration device.

Patient And Methods: A patient who underwent removal of a malpositioned Ex-PRESS shunt from the right eye with wound revision.

Results: Description of step-by-step technique for removal of the Ex-PRESS shunt.

Mesenchymal stem cells in drug/gene delivery: implications for cell therapy.

Stem cells have been therapeutically utilized in replacement of hematopoetic cells for decades. This is in contrast to the recent emergence of adult stem cells as, perhaps, safe and beneficial therapeutics for multiple diseases and disorders. In particular, mesenchymal stem cells (MSCs) are currently used in multiple human clinical trials.

Activation of toll-like receptor 4 is necessary for trauma hemorrhagic shock-induced gut injury and polymorphonuclear neutrophil priming.

Interactions of toll-like receptors (TLRs) with nonmicrobial factors play a major role in the pathogenesis of early trauma-hemorrhagic shock (T/HS)-induced organ injury and inflammation. Thus, we tested the hypothesis that TLR4 mutant (TLR4 mut) mice would be more resistant to T/HS-induced gut injury and polymorphonuclear neutrophil (PMN) priming than their wild-type littermates and found that both were significantly reduced in the TLR4 mut mice. In addition, the in vivo and ex vivo PMN priming effect of T/HS intestinal lymph observed in the wild-type mice was abrogated in TLR4 mut mice as well the TRIF mut-deficient mice and partially attenuated in Myd88 mice, suggesting that TRIF activation played a more predominant role than MyD88 in T/HS lymph-induced PMN priming.

Cost effectiveness of child pneumococcal conjugate vaccination in GAVI-eligible countries.

Policy-makers increasingly rely on cost-effectiveness analysis, in addition to clinical effectiveness, when considering the introduction of new childhood vaccines. A previous analysis determined vaccination of infants with 7-valent pneumococcal conjugate vaccine (PCV) to be highly cost effective in preventing child mortality in countries eligible for financial support from the Global Alliance for Vaccines and Immunization (GAVI). We aimed to update this analysis by incorporating recent data on global disease burden, indirect effects and higher valency vaccines.

Monte Carlo simulation of irradiation and killing in three-dimensional cell populations with lognormal cellular uptake of radioactivity.

Purpose: The biological response of tissue exposed to radiations emitted by internal radioactivity is often correlated with the mean absorbed dose to a tissue element. However, experimental studies show that even when the mean absorbed dose to the tissue element is constant, the response of the cell population within the tissue element can vary significantly depending on the distribution of radioactivity at the cellular and multicellular levels. The present work develops theoretical models to simulate these observations.

Estrogen receptor hormone agonists limit trauma hemorrhage shock-induced gut and lung injury in rats.

Background: Acute lung injury (ALI) and the development of the multiple organ dysfunction syndrome (MODS) is a major cause of death in trauma patients. Earlier studies in trauma hemorrhagic shock (T/HS) have documented that splanchnic ischemia leading to gut inflammation and loss of barrier function is an initial triggering event that leads to gut-induced ARDS and MODS. Since sex hormones have been shown to modulate the response to T/HS and proestrous (PE) females are more resistant to T/HS-induced gut and distant organ injury, the goal of our study was to determine the contribution of estrogen receptor (ER)alpha and ERbeta in modulating the protective response of female rats to T/HS-induced gut and lung injury.

Post-traumatic stress disorder symptomology associated with witnessing unsuccessful out-of-hospital cardiopulmonary resuscitation.

Objectives: The objective was to assess symptoms of post-traumatic stress disorder (PTSD) associated with witnessing unsuccessful out-of-hospital cardiopulmonary resuscitation (CPR) on a family member.

Methods: Adult family members of deceased, adult, nontraumatic out-of-hospital cardiac arrest victims who were transported to a large, Midwestern hospital were contacted by telephone beginning 1 month after the event. Subjects were dichotomized as to whether or not they were physically present during the patient's resuscitation.

Decision making in adult deformity.

Spinal deformity affects adults and adolescents in different ways. Adult deformity patients are skeletally mature and tend to have relatively fixed curves, whereas adolescent patients are skeletally immature with flexible curves. As a result, adult patients typically present with back pain and neurological concerns, whereas adolescents present with cosmetic complaints.

Adenomyomatous polyp of the endometrium: a case report.

Background: Adenomyomatous polyps of the endometrium are rare, pedunculated lesions that contain smooth muscle in addition to the usual components of an endometrial polyp. Grossly, adenomyomatous polyps have the same appearance as an ordinary endometrial polyp and are characterized histologically by the intertwining of smooth muscle, endometrial glands and endometrial stroma.

Case: A 32-year-old woman underwent a hysterectomy for refractory menometrorrhagia and was found to have a large, sessile, polypoid mass completely filling the endometrial cavity, consisting of multiple, thick-walled vessels; scant smooth muscle; and foci of endometrial glands and stroma.

Cost-effectiveness of pneumococcal conjugate vaccination in the prevention of child mortality: an international economic analysis.

Background: Routine vaccination of infants against Streptococcus pneumoniae (pneumococcus) needs substantial investment by governments and charitable organisations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate these data into an economic analysis of pneumococcal vaccination of infants in countries eligible for financial support from the Global Alliance for Vaccines & Immunization (GAVI).

Characterizing pseudoexfoliation syndrome through the use of ultrasound biomicroscopy.

Purpose: To determine the clinical utility of ultrasound biomicroscopy (UBM) in diagnosis of pseudoexfoliation (PEX) syndrome by characterizing the lens capsule and zonules before cataract surgery.

Setting: Veterans Administration Hospital, East Orange, and University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA.

Methods: Ultrasound biomicroscopy was performed on 10 patients clinically diagnosed with PEX syndrome.

Langerhans cell histiocytosis involving epiphysis of a long bone.

Eosinophilic granulomas of long tubular bones, a form of Langerhans cell histiocytosis, occurs in metaphyses and diaphyses with equal frequency. Epiphyseal location is unusual, with only 13 cases previously reported in the literature. The present case involves the epiphysis of the upper end of the left femur in a 12-year-old boy with pain and limp in the affected area.

Complementary and alternative medicine herbal therapies for atopic disorders.

More than 42% of patients with atopic disorders use some type of complementary or alternative medicine, underscoring the importance of determining the scientific validity of such treatments. This review summarizes herbal therapies from China, Japan, Korea, and India, and provides an introduction to some Western preparations. Although well-controlled scientific studies of many of the Asian herbal therapies have been carried out, and some basic studies have been performed for various herbal components (active ingredients), additional research is needed to assess the composite effects of many of these remedies.

Ethanol enhances medial amygdaloid induced inhibition of predatory attack behaviour in the cat: role of GABAA receptors in the lateral hypothalamus.

The present study tested the hypothesis that the suppressive effects of ethanol upon predatory attack behaviour in the cat involve a pathway from the medial amygdala to the lateral hypothalamus, and that these suppressive effects are mediated by gamma-aminobutyric acid (GABAA) receptors located in the lateral hypothalamus. Cannula electrodes were implanted into the lateral hypothalamus for elicitation of predatory attack behaviour and for microinjections of the GABAA receptor antagonist, bicuculline. Monopolar stimulating electrodes were implanted into the medial amygdala from which subseizure levels of electrical stimulation suppressed predatory attack behaviour.

Metabolism of homocysteine thiolactone in human cell cultures. Possible mechanism for pathological consequences of elevated homocysteine levels.

Editing of the non-protein amino acid homocysteine, a frequent type of error-correcting process in amino acid selection for protein synthesis by an aminoacyl-tRNA synthetase, results in formation of a cyclic thioester, homocysteine thiolactone. Here it is shown that human cells in which homocysteine metabolism is deregulated by a mutation in the cystathionine beta-synthase gene and/or by an antifolate drug, aminopterin (which prevents remethylation of homocysteine to methionine by methionine synthase), produce more homocysteine thiolactone, in addition to homocysteine, than unaffected cells. The thiolactone is incorporated into cellular and extracellular proteins, in addition to being secreted and hydrolyzed to homocysteine.

Management of post-polio respiratory sequelae.

Post-poliomyelitis respiratory impairment is extremely common and entails considerable risk of morbidity and mortality. Respiratory muscle weakness is the primary etiological factor but post-poliomyelitis individuals (PPIs) also have a high incidence of scoliosis, obesity, sleep disordered breathing, and bulbar muscle dysfunction, all of which can add to the risk. One hundred forty-five PPIs were managed by noninvasive alternatives to intermittent positive pressure ventilation (IPPV) via an indwelling tracheostomy.

Platelet-activating factor stimulates protein tyrosine kinase in hamster cheek pouch microcirculation.

We studied the interactions between platelet-activating factor (PAF) and protein tyrosine kinase (PTK) in the modulation of microvascular responses in the hamster cheek pouch using intravital microscopy and computer-assisted image analysis. Changes in arteriolar diameter and in integrated optical intensity (IOI; an index of vascular permeability) were measured. Fluorescein isothiocyanate-labeled dextran 150 (FITC-Dx 150) served as a tracer for macromolecular transport.

Immunologic effects of ursodeoxycholic acid in primary biliary cirrhosis.

Investigations were undertaken to determine the effect on lymphocyte reactivity of treatment of primary biliary cirrhosis with ursodeoxycholic acid (UDCA). Eight patients with stage 2 and 6 with stage 3 primary biliary cirrhosis were observed. Patients were treated with 300 mg of UDCA three times daily for 1 to 3 years.

Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach.

Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment.

Immunology of the eye.

The eye is one of the major targets of allergic disorders, accounting for over 20% of the conditions presenting to the allergist. It is also a major target organ of many systemic immunologic reactions (e.g.