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PubMed2001

Second malignancies in children: the usual suspects?

The aim of this article is to provide an up to date review of second malignant neoplasms (SMN's) following treatment for childhood cancer, referring to their incidence, the role of genetic factors, and how the primary malignancy and treatment received influence the type, site and prognosis of SMN's. The role of genetic factors will be discussed as far as they impact upon a predisposition to later development of SMN's. The primary malignancies that have important associations with SMN's will then be discussed, in particular Hodgkin's disease, retinoblastoma and acute lymphoblastic leukaemia. The important second malignancies will be highlighted, including tumours of the CNS and thyroid, osteosarcoma, secondary acute myeloid leukaemia and melanoma. Emphasis will be put upon identifying which patients are most likely to suffer from these tumours. An important part of the article are case histories. These are provided in combination with illustrations as a useful adjunct to the text, with a particular emphasis on radiological features, diagnosis and screening. Finally, the important but different roles of causal agents, in particular chemotherapy and radiotherapy are highlighted.

Adolescent↗
PubMedDate not supplied

Mechanical heart valve prostheses: identification and evaluation (erratum).

Mechanical heart value prostheses have been in use since the 1950s. Many prostheses have been used for a while and then discontinued. Today, there are a large number and variety of prostheses in use and an even larger variety that are in place in patients. These may be explanted at any time for a number of reasons. It is essential for the practicing pathologist to be able to identify the prosthesis and be aware of some of its reported complications and modes of failure. This article, and a second one on bioprosthetic heart valves, is designed as a ready reference guide to heart valve prostheses, their important identifying features, their common complications, and modes of failure. It should help in the accurate identification of explanted prosthetic valves and more definitive reports. This accuracy of identification as well as tracking of abnormalities noted will, we hope, permit the identification of new failure modes and the recording of causes of failure of new (or even modified) prosthetic heart valves.

Heart Valve Prosthesis↗
PubMed2005

Therapeutic scope of modulation of non-voltage-gated cation channels.

Although widely regarded as attractive drug targets, less than a tenth of known ion channels are currently commercially exploited as therapeutic targets. Historically, drug discovery efforts on ion channel targets have been encumbered by a lack of molecular and structural information, sub-optimal screening technologies and a paucity of discriminating pharmacological tools. Although challenges remain, recent scientific and technological advances in the area of ion channel research and screening offer the exciting prospect of a new, more-predictive era of ion channel drug discovery. In this article, focusing primarily on non voltage gated cation channels, we describe the continuing evolution of approaches to ion channel drug discovery, highlight recent developments in the ion channel field and consider their potential impact on discovering and ascribing function to ion channel targets. We discuss the renaissance of known ion channel targets, such as nicotinic acetylcholine receptors and calcium-activated potassium channels, as well as the emergence of the transient receptor potential (TRP) channels as a gene family of cation channels with broad therapeutic potential.

Animals↗
PubMed1989

Nursing staff development and facility design for medical-psychiatry units.

Successful operation of a medical-psychiatry unit requires special considerations in nursing staff development and facility design. This article will discuss in detail issues related to the selection, training, and development of a medical-psychiatry unit nursing staff. Organizational details regarding establishing schedules and staffing patterns are examined in detail. Additional areas reviewed are special adaptations in the architectural and physical facility design as well as the medications, equipment, and supplies needed to provide optimal medical and nursing care to the medical-psychiatric patient population. The essential diagnostic and clinical services that should be available for patients on a medical psychiatry unit are also defined.

Combined Modality Therapy↗
PubMed2004

Cancer information resources: digital and online sources.

The Internet is becoming an increasingly important source of information on cancer. This article highlights major sites of credible information on cancer and describes the types of information each of these sites contains. Large directories that help point the visitor to additional cancer-related sites are described, as are searchable databases of information on cancer as a disease, its diagnosis, and treatment. Sources of information on chemical carcinogens, mechanistic studies, and applied cancer toxicology are also described. These Internet sources of cancer information address the needs of toxicologists, environmental and occupational health scientists, cancer researchers and clinicians, government regulators, the public, and cancer survivors and their caregivers.

Animals↗
PubMed2006

Standards for digital photography in cranio-maxillo-facial surgery--Part II: Additional picture sets and avoiding common mistakes.

As stated in the first part of this publication standardized clinical photographs are essential for planning, documentation and demonstration of surgical procedures in craniomaxillofacial surgery (Ettorre et al., 2006). This article expands the previously defined standards in facial digital photography. Additional picture sets for special topics are introduced and some common mistakes are discussed. Guidance for the prevention of pitfalls is provided and the photographic principles are reviewed. Finally the authors give recommendations for dealing with structured data storage and protection of medical photographs. The use of asset management systems such as Cumulus and Portfolio is introduced and recommended.

Adult↗
PubMed1995

Forces and factors that contribute to the structural stability of membrane proteins.

While a considerable amount of literature deals with the structural energetics of water-soluble proteins, relatively little is known about the forces that determine the stability of membrane proteins. Similarly, only a few membrane protein structures are known at atomic resolution, although new structures have recently been described. In this article, we review the current knowledge about the structural features of membrane proteins. We then proceed to summarize the existing literature regarding the thermal stability of bacteriorhodopsin, cytochrome-c oxidase, the band 3 protein, Photosystem II and porins. We conclude that a fundamental difference between soluble and membrane proteins is the high thermal stability of intrabilayer secondary structure elements in membrane proteins. This property manifests itself as incomplete unfolding, and is reflected in the observed low enthalpies of denaturation of most membrane proteins. By contrast, the extramembranous parts of membrane proteins may behave much like soluble proteins. A brief general account of thermodynamics factors that contribute to the stability of water soluble and membrane proteins is presented.

Amino Acid Sequence↗
PubMed2005

Effects of copper and cross-linking on the extracellular matrix of tissue-engineered arteries.

In many cases, the mechanical strengths of tissue-engineered arteries do not match the mechanical strengths of native arteries. Ultimate arterial strength is primarily dictated by collagen in the extracellular matrix. but collagen in engineered arteries is not as dense, as organized, or as mature as collagen in native arteries. One step in the maturation process of collagen is the formation of hydroxylysyl pyridinoline (HP) cross-links between and within collagen molecules. HP cross-link formation, which is triggered by the copper-activated enzyme lysyl oxidase, greatly increases collagen fibril stability and enhances tissue strength. Increased cross-link formation, in addition to increased collagen production, may yield a stronger engineered tissue. In this article, the effect of increasing culture medium copper ion concentration on engineered arterial tissue composition and mechanics was investigated. Engineered vessels grown in low copper ion concentrations for the first 4 weeks of culture, followed by higher copper ion concentrations for the last 3 weeks of culture, had significantly elevated levels of cross-link formation compared to those grown in low copper ion concentrations. In contrast, vessels grown in high copper ion concentrations throughout culture failed to develop higher collagen cross-link densities than those grown in low copper ion concentrations. Although the additional cross-linking of collagen in engineered vessels may provide collagen fibril stability and resistance to proteolysis, it failed to enhance global tissue strength.

Amino Acids↗
PubMed2005

Motivational interviewing and clinical psychiatry.

OBJECTIVES: Our objectives were as follows: 1) to survey the literature on motivational interviewing (MI), "a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence" and a well-established method of brief intervention, especially in the field of addictions treatment; 2) to review hypothesis about its mode of action; and 3) to discuss its possible impact on clinical psychiatry, in particular, on teaching communication skills. METHOD: Literature reviews and metaanalyses of numerous clinical trials of MI for addictions treatment have already been published and are briefly summarised. So far, no literature survey exists for MI applied to psychiatric patients. This review is limited to a synthesis of the articles relevant to psychiatry and to comments based on our team's experiences with MI. RESULTS: There is no evidence that MI achieves better results than our other established techniques for treating addictions; it may simply work faster. The explanation for the method's rapid effectiveness remains speculative. Outcomes concerning the application of MI to psychiatric patients, although preliminary, are promising. Methods of assessing the integrity of MI treatment are more developed than in most psychotherapies, which permits the learning progress of trainees to be measured. CONCLUSIONS: MI offers a complement to usual psychiatric procedures. It may be worthwhile to teach it, not only for addictions but also for other broad treatment issues, such as enhancing patients' medication compliance and professionals' communication skills. Questions remain concerning MI's feasibility in psychiatry settings.

Humans↗
PubMed1998

The human thymus. A chimeric organ comprised of central and peripheral lymphoid components.

The human thymus is a lymphoepithelial organ in which T cells develop during fetal life. After maturation and selection in the fetal thymic microenvironment, T cells emigrate to peripheral lymphoid tissues such as the spleen, gut, and lymph nodes, and establish the peripheral T cell repertoire. Although the thymus has enormous regenerative capacity during fetal development, the regenerative capacity of the human postnatal thymus decreases over time. With the advent of intensive chemotherapy regimens for a variety of cancer syndromes, and the discovery that infection with the Human Immunodeficiency Virus (HIV) leads to severe loss of CD4+ T cells, has come the need to understand the role of the human thymus in reconstitution of the immune system in adults. During a recent study of the thymus in HIV infection, we observed many CD8+ T cells in AIDS thymuses that had markers consistent with those of mature effector cytotoxic T cells usually found in peripheral immune tissues, and noted these CD8+ effector T cells were predominantly located in a thymic zone termed the thymic perivascular space. This article reviews our own work on the thymus in HIV-1 infection, and discusses the work of others that, taken together, suggest that the thymus contains peripheral immune cell components not only in the setting of HIV infection, but also in myasthenia gravis, as well as throughout normal life during the process of thymus involution. Thus, the human thymus can be thought of as a chimeric organ comprised of both central and peripheral lymphoid tissues. These observations have led us to postulate that the thymic epithelial atrophy and decrease in thymopoiesis that occurs in myasthenia gravis, HIV-1 infection, and thymic involution may in part derive from cytokines or other factors produced by peripheral immune cells within the thymic perivascular space.

Adult↗
PubMed2006

Disputing taste: food pleasure as an achievement in interaction.

While identity has been a dominant topic in research on food choice, literature on identity in consumers' everyday life is scarce. In this article we draw on insights from discursive psychology to demonstrate how members of an online forum on food pleasure handle the hedonic appreciation of food in everyday interaction. We examined 40 discussions consisting of 1715 e-mails related to culinary topics. The analysis focuses on the way in which the participants of this forum work up and establish their identities as "gourmets". A dominant tool in performing this identity work is the discursive construction of independent access to knowledge of and experience with food items, so as to compete with or resist the epistemic superiority of a preceding evaluation. Data are presented with nine examples of the 73 manifestations of the construction of independent access. Contrary to sensory approaches to food choice, this study depicts the enjoyment of food as an interactional achievement rather than a pure physiological sensation. Wider implications of this study for the relation between food, identity and taste are discussed.

Cooking↗
PubMed1996

Guiding occlusal development with functional appliances.

Functional appliances have been used in orthodontics since their introduction by Pierre Robin almost one hundred years ago, however, our understanding of how they bring about orthodontic correction is still limited. This article is a brief overview of their history, mode of action, advantages and disadvantages, and includes the results of a study of attempts to control and minimise their side-effects using a recent development in functional appliances: the 'Teuscher Appliance'. This appliance combines a high-pull headgear with the activator, and is designed to reduce the often reported side-effects of functional appliances. The skeletal and dentoalveolar effects of treatment with the Teuscher Appliance on 40 consecutively-treated patients are reported and illustrated with four individual case reports. The results showed that the skeletal effect on the maxilla was a retardation of the normal forward and downward growth in 80 per cent of the cases, and that mandibular growth in 70 per cent of cases was forward. In patients whose mandibular growth was primarily in a vertical direction, such growth could be ascribed mainly to posterior rotation of the maxilla and/or the fact that the acrylic covering the lower posterior teeth to correct a deep bite was removed, promoting the eruption of these teeth and increasing the anterior vertical development. The dentoalveolar changes were characterised by retroclination of the maxillary incisors in 90 per cent of the patients, and were due to insufficient torque control by the built-in torque springs, which need further development. The mandibular incisors were well controlled by capping. The statistical analysis showed an inverse correlation between the initial incisor inclination and the change during treatment. This suggests that proclination of the lower incisors, as previously reported, is not a contra-indication to functional appliance treatment, provided the appliance is correctly designed. Overall, this study showed considerable individual response to treatment, and that the occlusal correction occurred through a combination of skeletal and dentoalveolar changes.

Adolescent↗
PubMed2004

Blood pressure and stroke: an overview of published reviews.

BACKGROUND: The last few years have seen a considerable increase in the amount of information available concerning blood pressure (BP) and stroke associations. This article provides an overview of published reviews of the effects on stroke seen in trials of BP-lowering drugs and compares these with the results available from cohort studies. SUMMARY OF REVIEW: We present a review of major overviews of prospective cohort studies and an updated meta-analysis of >40 randomized controlled trials of BP lowering, which included >188 000 participants and approximately 6800 stroke events. Cohort studies now indicate that in the Asia Pacific region as well as in North America and Western Europe, each 10 mm Hg lower systolic BP is associated with a decrease in risk of stroke of approximately one third in subjects aged 60 to 79 years. The association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, and stroke subtypes and for fatal and nonfatal events. The proportional association is age dependent but is still strong and positive in those aged 80 years. Data from randomized controlled trials, in which mean age at event was approximately 70 years, indicate that a 10 mm Hg reduction in systolic BP is associated with a reduction in risk of stroke of approximately one third. Per mm Hg systolic BP reduction, the relative benefits for stroke appear similar between agents, by baseline BP levels, and whether or not individuals have a past history of cardiovascular disease. There is, however, evidence of greater benefit with a larger BP reduction. CONCLUSIONS: The epidemiologically expected benefits of BP lowering for stroke risk reduction are broadly consistent across a range of different population subgroups. There are greater benefits from larger BP reductions, and initiating and maintaining BP reduction for stroke prevention is a more important issue than choice of initial agent.

Aged↗
PubMed1997

Reduction of synaptophysin immunoreactivity in the prefrontal cortex of subjects with schizophrenia. Regional and diagnostic specificity.

BACKGROUND: Multiple lines of evidence indicate that the prefrontal cortex is a site of dysfunction in schizophrenia. However, the apparent absence of gross structural abnormalities in this area suggests that the pathophysiological characteristics of schizophrenia may involve more subtle disturbances in prefrontal cortical circuitry, such as alterations in synaptic connectivity and transmission. In this study, immunoreactivity for synaptophysin, an integral membrane protein of small synaptic vesicles, was used to assess the integrity of cortical synaptic circuitry in schizophrenia. METHODS: Using immunocytochemical techniques and adjusted optical density measurements, we examined synaptophysin immunoreactivity in prefrontal cortical areas 9 and 46 and in area 17 (the primary visual cortex) from 10 pairs of case subjects with schizophrenia and control subjects. matched on a pairwise basis for age, sex, race, and postmortem interval, and in 5 matched pairs of nonschizophrenic psychiatric case subjects and normal control subjects. RESULTS: Compared with levels found in matched control subjects, synaptophysin immunoreactivity in areas 46 and 9 was significantly decreased (P < .001 and P < .008, respectively) across all cortical layers in the case subjects with schizophrenia. In contrast, no differences were observed in area 17. In addition, levels of synaptophysin immunoreactivity in areas 46, 9, and 17 did not differ between 5 nonschizophrenic psychiatric case subjects and their matched controls, suggesting that decreased synaptophysin levels in the prefrontal cortex of patients with schizophrenia may be specific to that disorder. CONCLUSION: Additional studies are required to determine if the decrease in levels of synaptophysin immunoreactivity is caused by a decrease in the number or size of presynaptic terminals, a decrease in the number of synaptic vesicle per terminal, or a decrease in the expression of synaptophysin. However, all of these potential explanations are consistent with a disturbance in synaptic transmission in the prefrontal cortex of patients with schizophrenia.

Adult↗
PubMed1999

Different somatic and germline HPRT1 mutations promote use of a common, cryptic intron 1 splice site. Mutation in brief no. 259. Online.

Aberrant hypoxanthine phosphoribosyltransferase (HUGO-approved gene symbol HPRT1; MIM# 308000) RNA splicing promoted by splice site mutation or loss is a common mechanism for loss of the purine salvage enzyme HPRT1 from human cells. We report here two in vivo somatic HPRT1 mutations in human kidney tubular epithelial cells that disrupt HPRT1 intron 1 splicing and lead to the inclusion of intron 1 sequence in mature mRNA. Analysis of these mutations and of 14 additional HPRT1 intron 1 inclusion mutations provides an explanation for use of a common, cryptic intron 1 splice donor site by all 16 mutations.

Germ-Line Mutation↗
PubMed1994

Lymph node metastasis from carcinoma of the distal one-third of the stomach.

BACKGROUND: A detailed and thorough pathoanatomic study of lymph node (LN) metastases of adenocarcinoma of the distal one-third of the stomach is lacking. METHODS: From December 1987 to March 1992, 190 patients who underwent radical gastrectomy was analyzed. All LN were dissected and labeled according to the Japanese General Rules for the Gastric Cancer Study. RESULTS: A total of 7052 LN with an average of 37.1 per specimen were removed. LN metastases were encountered in 121 patients (63.7%). The most frequent LN metastases were perigastric, above common hepatic artery, along left gastric artery, and hepatoduodenal ligament. The incidence of LN metastasis varied and was highest when tumor was located close to either curvature and extended to duodenum or midbody. The high incidence of LN metastases in the hepatoduodenal ligament was a unique pathologic feature of adenocarcinoma of the distal one-third of the stomach (P = 0.0012). Univariate and multivariate analysis revealed that depth of cancer invasion was the only factor related to LN metastases. CONCLUSIONS: Cancer in the distal one-third of the stomach had a high incidence of LN metastasis to hepatoduodenal ligament nodes. The LN metastasis is correlated with depth of cancer invasion.

Adenocarcinoma↗