Malignant mesothelioma of the tunica vaginalis testis.
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Aged↗
Biomedical subjects
L Newman
Publications and source records attributed to L Newman.
Parathyroid hormone (PTH) secretion: stimulation of PTH secretion by a peptide derived from the adenosine diphosphate-ribosylation factor.
Using preparations of dispersed bovine parathyroid cells, we have investigated the effect of a 16-residue synthetic peptide, ARF-16, which corresponds to the N-terminus of the ADP-ribosylation factor, on the secretion of PTH. We find it to be a very effective secretagogue for PTH secretion, acting in a dose- and time-dependent manner. At concentrations in the range of 15-25 microM, the ARF peptide stimulated PTH secretion to a greater degree than low extracellular calcium, and at 25 microM was more effective than isoproterenol. The stimulatory effect of ARF was not dependent on the extracellular calcium concentration over the range of 0.5-3 mM. Upon testing other synthetic peptides of similar size we found no effect on PTH secretion, indicating that the ARF-16 effect is specific. In an attempt to define the structural elements of ARF that are required for activity, we tested several analogs of ARF with amino acids deleted from the N- and C-terminus. Deletion of the 2 N-terminal residues yielded a peptide with substantially reduced activity. Further deletions from the N-terminus yielded an inactive peptide. Similarly, a peptide with deletions of 3 residues from the C-terminus was inactive. Thus, the activity of ARF-16 requires both the N- and C-terminal sequence, suggesting that the 16-residue peptide is the minimal sequence required for full activity. Measurements of cAMP concentrations indicate that the stimulatory effect is not mediated via this second messenger. The ARF peptide does not alter intracellular calcium, suggesting that its effect is not mediated by calcium. Although cells incubated with ARF are vigorously stimulated to secrete PTH, this effect is reversible, as demonstrated by washing cells free of ARF, whereupon PTH secretion returns to basal levels. These results indicate that the peptide is not entering the cells, but is effecting secretion through a low affinity interaction at the cell surface. Other experiments, in which the capacity for ARF stimulation was abolished after a brief exposure of the cells to trypsin, support this conclusion. Characteristics of the ARF stimulatory effect, such as dose dependency and reversibility, lead us to conclude that the peptide is probably acting on the regulated secretory pathway. As the effect is not dependent on extracellular calcium levels and is not mediated via cAMP, we believe that this peptide will be a useful additional tool for future studies of the mechanisms of PTH secretion.
ADP-Ribosylation Factors↗
Lack of correlation between nasal cultures positive for Staphylococcus aureus and the development of S. aureus exit-site infections: results unaffected by routine mupirocin treatment of nasal S. aureus carriage.
Whether nasal carriage of Staphylococcus aureus is associated with an increased risk of S. aureus exit-site infection remains controversial. We performed nasal cultures prior to peritoneal dialysis catheter placement in all of our patients beginning in September 1990. We also performed nasal cultures on a cohort of patients already on peritoneal dialysis. Patients with positive cultures received a prescription for a ten-day course of intranasal mupirocin. Exit-site and nasal cultures were performed on every subsequent office visit until the end of the study in April 1993. The initial visit and three widely-spaced subsequent visits were chosen for data analysis. There were 68 patients entered into the study. Data from a total of 272 visits were analyzed. The patients ranged in age from 18-80 years. There were 27 diabetics. We found no correlation between initial positive nasal cultures and the subsequent development of a S. aureus exit-site infection. All identified nasal carriers were treated with mupirocin. However, the subsequent development of a S. aureus exit-site infection could not be correlated to a prior S. aureus carrier state or lack thereof.
Administration, Intranasal↗
An institutional review of the management of choledocholithiasis in 1616 patients undergoing laparoscopic cholecystectomy.
At Georgia Baptist Medical Center, 1616 patients underwent laparoscopic cholecystectomy between December 1989 and December 1992; and 103 perioperative endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed, 79 preoperative and 24 postoperative. Endoscopic sphincterotomy with stone extraction was performed in 49 patients (4.7%). Normal ERCP was noted in 46 patients (44%), four patients failed stone extraction preoperatively, and two patients failed extraction postoperatively (5.7%). Four patients had small stones (< 2 mm) managed expectantly without sphincterotomy. Ten laparoscopic common bile duct explorations and eight open common bile duct explorations were performed without retained stones after these procedures. The incidence of detected choledocholithiasis requiring intervention was 4.4 per cent, which is significantly lower than the published incidence of 8 to 15 per cent. It is assumed that a higher percentage of stones may have been detected with liberal or routine use of cholangiography. The clinical significance of these potentially missed stones have not been manifest in our series to date. The authors believe that although improved patient selection may lower the percentage of normal ERCP, this combination of minimally invasive techniques provides a satisfactory approach to choledocholithiasis.
Cholangiography↗
An infarcted Warthin's tumour presenting with facial weakness.
It is rare for benign salivary gland neoplasms to cause facial nerve weakness. We present such a case occurring in a 70-year-old patient with an infarcted Warthin's tumour and review the benign causes of facial nerve impairment.
Adenolymphoma↗
Is laparoscopic herniorrhaphy an effective alternative to open hernia repair?
While the inguinal approach to hernia repair remains the standard of care, laparoscopic hernia repair techniques are rapidly evolving. The first 102 laparoscopic hernia repairs were reviewed. Reported herein are the types of hernias repaired, length of hospital stay, early recurrence rate, complications, and assessment of postoperative pain. The long-term recurrence rate has yet to be determined. From these results, it is felt that in select patients, laparoscopic hernia repair is an effective surgical alternative in the treatment of inguinal hernia.
Activities of Daily Living↗
Cryptogenic constrictive bronchiolitis. A clinicopathologic study.
Four women with a chronic respiratory illness characterized by chronic cough, dyspnea, mild to severe physiologic abnormalities, relatively normal chest radiographs, and lack of response to bronchodilators or prednisone were identified and prospectively evaluated. Constrictive bronchiolitis, defined as concentric narrowing of the bronchiolar lumen, mural scarring, smooth muscle hyperplasia, and mucus stasis, was the major histologic finding on open lung biopsy in all cases. Each presented with an illness clinically distinct from asthma, connective tissue disorders, occupational or environmental lung disease, bronchiectasis, diffuse panbronchiolitis, cystic fibrosis, and emphysema. None of the patients smoked cigarettes. None had clinical evidence of a recent viral lower respiratory tract infection. The physical examinations were normal except for rales heard on chest examination in two patients. Chest radiographs showed increased bronchovascular markings in three patients. Lung function was normal in one patient, two of the patients had a reduced diffusing capacity associated with moderate hypoxemia and an obstructive ventilatory defect, and one patient exhibited a mixture of restrictive and obstructive defects. None have experienced significant progression of their disease over 1 to 5 yr of follow-up. However, complete return to normal function did not occur. We hypothesize that patients with the constellation of findings described represent a distinct and definable clinicopathologic entity and further clarifies the spectrum of "small airways disease." Establishing the diagnosis appears important for prognostic and possibly therapeutic reasons.
Adult↗
Impact of socioeconomic status on hospital use in New York City.
This DataWatch examines the potential impact of socioeconomic differences on rates of hospitalization, based on patterns of hospital use in New York City in 1988. The research suggests that lack of timely and effective outpatient care may lead to higher hospitalization rates in low-income areas. For certain conditions identified as ambulatory care sensitive, hospitalization rates were higher in low-income areas than they were in higher-income areas where appropriate outpatient care was more readily available. Further study is needed to determine the relative impact of various economic, structural, and cultural factors that affect access to care.
Adolescent↗
Increased TNF-alpha and IL6 mRNA expression by alveolar macrophages in chronic beryllium disease.
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Berylliosis↗
Laparoscopic herniorrhaphy without pneumoperitoneum.
To study the feasibility of gasless laparoscopy using the Laparolift device (Origin Medsystems), appropriate animal studies were carried out using a porcine model. After preliminary success in the laboratory, a petition was made to the institutional review boards of our hospitals. A laparoscopic herniorrhaphy was performed successfully in a consenting male patient with a right indirect inguinal hernia. To further delineate the role of mechanical planar lifting in surgical procedures, further investigation appears safe and is warranted.
Hernia, Inguinal↗
Reduction of HIV transmission during laparoscopic procedures.
Laparoscopic surgery has recently been encouraged as an alternative to open procedures in patients infected with the human immunodeficiency virus (HIV). The laparoscopic technique reduces exposure to blood products and sharp instruments; however, it exposes the surgical team to the HIV-infected patient in a manner not encountered during open procedures. The evacuation of the pneumoperitoneum during laparoscopic procedures releases aerosolized HIV-infected blood and peritoneal fluid into the operative suite. Evacuation of the penumoperitoneum into a closed system and appropriate precautions during instrument changes will diminish the exposure of the surgical team to aerosolized HIV-infected blood and peritoneal fluid.
HIV Infections↗
Meralgia paresthetica: a complication of laparoscopic herniorrhaphy.
Laparoscopic herniorrhaphy is a new and presently evolving technique applied to the repair of inguinal defects. Many different authors have described various methods by which this can be achieved. Some of these include the transabdominal preperitoneal approach, the plug technique, the intraperitoneal onlay of mesh, and the extraperitoneal approach. The authors have performed 252 laparoscopic hernia repairs utilizing a form of the transabdominal preperitoneal procedure that is referred to as the "transperitoneal anatomic approach." The development of new procedures or the modification of existing procedures can create new problems or alter the pattern of traditional complications. These problems must be thoroughly evaluated and reported if repetition of these errors is to be avoided. Five cases of meralgia paresthetica are reported that resulted from staple entrapment of the lateral femoral cutaneous nerve during laparoscopic herniorrhaphy. An understanding of the preperitoneal inguinal anatomy and precise placement of staples will allow avoidance of this complication.
Adult↗
A novel Yes-related kinase, Yrk, is expressed at elevated levels in neural and hematopoietic tissues.
While screening a chicken kidney cDNA library for the normal homolog of the yes oncogene, we isolated a clone that encodes a novel non-receptor type protein tyrosine kinase of the Src family. We named this gene product Yrk (York), as an acronym for Yes-related kinase. As predicted from the cDNA sequence, the Yrk protein consists of 536 amino acids and has all the canonical features of a Src kinase. At the amino terminus it contains a myristylation signal, followed by a unique domain, SH3 and SH2 motifs, an ATP binding site, a kinase region and a carboxy-terminal sequence with a potential regulatory tyrosine at position 530. The sequence of the Yrk protein showed 79% identity with human Fyn and 72% identity with chicken Yes. To eliminate the possibility that the Yrk protein is an avian homolog of mammalian Fyn, we isolated and sequenced the chicken fyn cDNA. The sequence data together with Southern and Northern blot analyses showed that the chicken yrk gene is distinct from the chicken fyn gene. Antibodies generated against the unique domain of the yrk protein expressed in bacteria precipitated a 60-kDa protein that was active in an immune complex kinase assay and was phosphorylated on tyrosine. Expression of the Yrk protein in adult chicken tissues was elevated in cerebellum and spleen. Relatively high levels of Yrk were also found in lung and skin.
Amino Acid Sequence↗
Copepods associated with a perirectal abscess and copepod pseudo-outbreaks in stools for ova and parasite examinations.
We observed copepods, an intermediate host for several human parasites, in material obtained from a perirectal abscess of a 22-year-old man with Crohn's disease. We subsequently noted copepod "outbreaks" in stool specimens submitted for ova and parasite examination. Copepods in the hospital tap water supply were the source for one "outbreak".
Abscess↗
Alternative management of choledocholithiasis.
This paper is presented to clarify the role of ERCP in conjunction with laparoscopic cholecystectomy. As the field of surgery moves more toward less invasive procedures, our management schemata may also need revision. With the popularity of laparoscopic cholecystectomy came a large increase in the number of patients treated with cholelithiasis, and therefore an increase in patients with choledocholithiasis. The authors believe that treatment options exist to avoid open common bile duct procedure in most cases.
Adult↗
Dysphoric distress in childbearing women.
Previous research on depression in childbearing women has focused on the presence or absence of clinical depression. Little attention has been paid to the distress caused by the presence of depressive symptoms in the absence of the full syndrome of clinical depression. A convenience sample of 202 healthy, married, primigravid women who were free of psychiatric symptoms were assessed at 10 to 14 weeks and 30 to 32 weeks of pregnancy and at 1 to 2 weeks and 14 weeks post partum. Depression symptoms were measured by using the Schedule of Affective Disorders and Schizophrenia, the standardized clinical interview for research and depression of The National Institute of Mental Health. Data from the Schedule of Affective Disorders and Schizophrenia indicated that only 5% of the women met criteria for clinical depression but approximately 50% of the sample reported clinical levels of three or more depressive symptoms. Anger, fatigue, psychic anxiety, and worry were the most frequently endorsed symptoms at each assessment point. The implications of these findings for symptom management and health promotion for childbearing women are discussed.
Adult↗
James Mackenzie Lecture 1991. Second among equals.
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Education, Medical↗
Com, the phage Mu mom translational activator, is a zinc-binding protein that binds specifically to its cognate mRNA.
Bacteriophage Mu controls an unusual DNA-modification function encoded by the mom gene, which is located in an operon that consists of two overlapping genes. The com gene, located proximal to the 5' end of the common mRNA transcript, encodes a polypeptide of 62 amino acids that is required for translation of mom. Analysis of the derived amino acid sequence reveals that Com contains zinc-binding finger motifs, suggesting that Com may be a zinc-activated regulatory protein. Atomic absorption analysis showed that there is about one zinc bound per molecule of Com. We have subcloned the com gene into an expression vector and thus have overproduced and purified the Com protein. By gel retardation analysis with various 32P-labeled RNAs (made by in vitro transcription with T7 RNA polymerase), we show that Com binds specifically to com-mom mRNA. A single C----U substitution mutation, located 26 nucleotides upstream from the mom translation start codon, abolishes Com binding. The nature of the Com target sequence was deduced from in vitro footprinting analyses. The results are consistent with the existence of a complex stem-loop structure within the overlap of the com-mom open-reading-frames. Com binding to its target site results in the destabilization of a proposed translation-inhibitor stem-loop (TIS) to expose the Shine-Dalgarno sequence and mom translation initiation codon. This suggests that Com interaction with a specific site on its cognate mRNA alters the mRNA secondary structure to activate translation of mom.
Amino Acid Sequence↗