The concentration of 25 major, minor and trace elements in human bile was determined by inductively coupled plasma atomic emission spectrometry. Gallbladder bile was obtained during surgery from patients with cholesterol gallstones, pigment stones and with no biliary tract abnormalities (controls). Comparison of the concentration of elements (microgram per gram of solids) did not reveal any significant differences among the three patient groups. The in vitro nucleation time was not related to the concentration of any element measured.

Bile↗

PubMedDate not supplied

The effect of lead on protein and DNA metabolism of normal and lead-adapted rat kidney cells in culture.

Cultures of epithelial rat kidney cells were used to investigate the effect of lead on protein and DNA metabolism. Lead-adapted cells were cultured in 5 and 10 microM Pb(NO3)2 for several months and subsequently showed the same growth characteristics but a higher resistance to increased lead doses than untreated cells. Both normal and adapted cell types were exposed to lead nitrate in concentrations from 5 to 1000 microM for incubation periods of from 1 to 24 h. 3H-leucine incorporation was increased in 10 microM lead by up to 140% in normal but not in adapted cells, pointing to a resistance forming mechanism. Not only is the overall rate of protein synthesis increased, but separations of cytosolic proteins by SDS-polyacrylamide electrophoresis indicate the novel or increased synthesis of several proteins. A difference could also be observed in the DNA metabolism, where normal cells show a very pronounced increase of up to 900% after 24 h of incubation. This was not observed in adapted cells.

Adaptation, Physiological↗

PubMedDate not supplied

Bone remodelling: should we cry Wolff?

Wolff's Law describes the relationship between the structure and function of bone. Julius Wolff based his law on a comparison of the stress trajectories in Culmann's crane with the pattern of trabecular bone in the femoral neck. However, his analysis was based on a misinterpretation of mechanical data and a rejection of bone resorption. Wilhelm Roux was the first to accurately describe the adaptation of bone to altered load, so Roux's Law would be a more accurate eponym.

Anatomy↗

PubMedDate not supplied

Percutaneous vertebroplasty--initial clinical experience in osteoporotic and myelomatous compression fractures.

BACKGROUND: To review the clinical impact of vertebroplasty in osteoporotic and myelomatous compression fractures METHODS: Eleven compression fractures in eight patients were treated by percutaneous cement vertebroplasty over a three-year period, May 2000 to May 2003. RESULTS: Successful percutaneous stabilisation and cement injection was performed in all compression fractures. In five of eight patients (eight of eleven compression fractures) injection of cement yielded dramatic reduction in pain within 24 hours of the procedure. CONCLUSION: Preliminary experience suggests that percutaneous cement vertebroplasty is an effective well tolerated method of stabilisation of spinal wedge compression fractures resulting in dramatic reduction in associated pain in most cases.

Administration, Cutaneous↗

PubMedDate not supplied

Test characteristics of a level I or II fetal ultrasound in detecting structural heart disease.

At the University of California Davis Medical Center, a screening fetal ultrasound examination (level I or II) incorporates a comprehensive segmental evaluation of the fetal heart. This study evaluated the reliability of the fetal ultrasound exam in the detection of abnormal heart anatomy. Our retrospective study reviewed results of 614 antenatal patients that had a screening fetal ultrasound exam. All patients subsequently underwent a detailed targeted fetal cardiac ultrasound exam performed by a pediatric cardiac sonographer and reviewed by a board-certified pediatric cardiologist. Of these 614 patients, 60 fetuses had structural heart disease by the targeted fetal exam. The screening fetal ultrasound exam correctly identified 55 of the 60, with 5 false negatives (8.3% false-negative rate) and 1 false positive (1.7% false-positive rate). Our study suggests that if a screening fetal ultrasound exam incorporates a segmental evaluation of the fetal heart it can reliably detect abnormal heart anatomy. At our institution a targeted fetal cardiac exam is now used to confirm and provide detailed assessment of the heart anatomy when a screening fetal exam is positive for heart disease.

California↗

PubMedDate not supplied

Tuberous sclerosis.

Tuberous sclerosis is a multisystem disorder of autosomal dominant inheritance that has important eye signs which contribute substantially to the diagnosis. The disease has been recognized for over 100 years, classically by the occurrence of the triad of mental retardation, epilepsy and adenoma sebaceum of the face. Children with tuberous sclerosis often present with infantile spasms. Eye manifestations include retinal phakomata which may be granular, white and calcified, or flat, translucent and noncalcified. Additional findings include angiofibromas of the lids, poliosis, retinal and iris depigmentation, and atypical colobomata. Various systemic and ocular signs of tuberous sclerosis may develop over the years. For purposes of both patient management and genetic counselling, diagnosis based on early signs is important. The ophthalmologist may play an important role in this regard, as the characteristic phakomata can often be detected within the first two years of life.

Adolescent↗

PubMedDate not supplied

The infant with nystagmus, normal appearing fundi, but an abnormal ERG.

Many retinal disorders present during infancy with nystagmus, decreased vision, and normal-appearing fundi, but an abnormal ERG. The most common of these disorders are Leber's congenital amaurosis, achromatopsia, and congenital stationary night-blindness. Other disorders with similar ocular manifestations may be associated with a variety of life-threatening systemic abnormalities. This review describes the clinical, electrophysiological, and laboratory findings that can be used to distinguish among these conditions.

Blindness↗

PubMedDate not supplied

Fundus hemorrhages in infancy.

The anatomical location and appearance of retinal hemorrhages in the infant provide important clues in the diagnosis of underlying disorders. While neonatal retinal hemorrhages related to birth trauma are common, benign, and self-limited, other retinal hemorrhages in infancy may signify intracranial aneurysms, accidental or non-accidental injury, and a variety of ocular (e.g., Coats' disease, PHPV, ROP, retinal dysplasia, hypertension, myopia) or systemic disease (e.g., hematologic or cardiovascular disorders, infection, protein C deficiency). In this review, retinal hemorrhages are illustrated and classified according to location, appearance, and etiology. Prompt diagnosis of retinal hemorrhages in infants is crucial, because treatment may be required to prevent early deprivation amblyopia and blindness. Ophthalmological findings may also be a valuable contribution to the overall medical evaluation of the infant.

Choroid Hemorrhage↗

PubMedDate not supplied

Patterns of practice in emergency department management of chest pain of suspected cardiac origin: clinical utility of single stat creatine kinase (CK).

The patterns of practice and the clinical utility of a single stat creatine kinase (CK) level in the emergency department management of chest pain of suspected cardiac origin were examined by a prospective observational study using a two-part questionnaire, completed by physicians before and after availability of CK results. The results showed that of the 776 patients in the study, 135 were admitted to hospital with acute myocardial infarction (AMI), 285 were admitted for reasons other than AMI, 343 were discharged, and 13 died or were transferred to another hospital. Although initial and final diagnoses in the emergency department did not differ in 597 patients (77%), initial decisions to admit or discharge were made in only 244 (31%) patients without waiting for CK results, and in 401 (52%) cases, decisions on patient disposition were deferred. Of 218 patients who had elevated CK levels, 193 (89%) were admitted, 121 for AMI. Only five (< 1%) patients who would otherwise have been discharged were admitted because of elevated CK levels. Of the 343 discharges, 245 (71%) occurred after the physicians knew the CK results. It is concluded that emergency department physicians routinely make changes in their diagnostic and management decisions based on current information and as it becomes updated. This study also suggests that there appears to be a heavy reliance on a single CK assay, although the relative importance of this diagnostic test compared to other factors is not known. Further studies are necessary.

Alberta↗