The postoperative anatomy of the Senning interatrial diversion was defined by two-dimensional contrast echocardiography in ten patients. A modified apical four-chamber view proved most valuable, allowing for simultaneous visualization of both the systemic venous atrium and the pulmonary venous atrium. The anatomy was confirmed with two-dimensional contrast echocardiography utilizing catheters placed in the systemic venous atrium and pulmonary venous atrium at the time of surgery. In addition, in several of the patients, we were able to detect atrial or ventricular level shunts which were not clinically apparent. One patient who was judged to have a significant shunt by two-dimensional contrast echocardiography had no anatomic site found at autopsy to explain the shunting. We conclude that two-dimensional contrast echocardiography can define the postoperative anatomy following Senning repair allowing for immediate and future evaluation. Shunting at the atrial and ventricular levels can also be detected, but the method is very sensitive and difficult to quantitate or correlate clinically.

Child, Preschool↗

PubMedDate not supplied

Ventricular arrhythmia associated with respiratory syncytial viral infection.

Respiratory syncytial virus (RSV) is a common cause of lower respiratory infections in infants. Cardiac arrhythmias are an uncommon complication in infants with RSV bronchiolitis. Presumably, the arrhythmias may be secondary to RSV pericarditis, myocarditis, or some other infection of the heart. We report on a patient with RSV bronchiolitis who had clinical myocarditis complicated by ventricular tachycardia.

Bronchiolitis↗

PubMedDate not supplied

Evaluating risk assessment implementation in child protection: issues for consideration.

The use of systematic risk assessment models by Child Protective Services is a rapidly growing phenomenon. Despite their popularity, we know little about the effect of implementation on casework practice. This article examines some issues that agencies might consider when evaluating the impact of risk assessment implementation on service delivery. The authors recommend an approach that includes the use of qualitative and quantitative measures in a process and an outcome evaluation to determine the degree to which the model has been implemented as intended and the impact of implementation on the case work process. Though this approach is likely to provide agencies with detailed information of the impact of risk assessment implementation, caution is recommended when interpreting the results from an evaluation of a risk assessment model in a field setting.

Child↗

PubMedDate not supplied

Regulation of Antennapedia transcript distribution by the bithorax complex in Drosophila.

The homoeotic genes of Drosophila seem to be involved in the establishment of developmental pathways and the specification of different anatomical segment identities. For example, it has been proposed that a function of the Antennapedia+ (Antp+) locus is to direct embryonic cells to follow a mesothoracic developmental pathway. Using cloned cDNA probes of the Antp+ (ref. 6) locus and an improved in situ hybridization method, we found that the neural cells of the embryonic and larval mesothorax possess higher levels of Antp+ transcripts than the neural tissue of the other segments. Here we present further evidence that Antp+ products are associated with formation of the mesothorax, obtained by analysing the distribution of Antp+ transcripts in bithorax mutants. Embryos homozygous for any one of several bithorax mutations display a transformation of the epidermis of the more posterior segments into the homologous tissue of the mesothorax. For example, the metathorax and first seven abdominal segments of embryos that completely lack the bithorax gene complex show a cuticular phenotype characteristic of the normal mesothorax. By in situ hybridization of an Antp+ cDNA probe to tissue sections of these embryos, we have found that the neural cells of the transformed segments accumulate Antp+ transcripts to a level characteristic of the normal mesothorax.

Animals↗

PubMedDate not supplied

Two homoeo box loci mapped in evolutionarily related mouse and human chromosomes.

The homoeo box is a 180-base pair (bp) DNA sequence conserved in Drosophila homoeotic genes, which regulate early development. These DNA sequences are present in open reading frames and have been identified in specific gene transcripts in Drosophila and Xenopus embryos; they possess structural features in common with genes encoding some DNA-binding proteins. Homologous homoeo box sequences have been detected in species ranging from insects and annelids to vertebrates. The high degree of sequence conservation (70-90%) among different species suggests a strong evolutionary relationship and implies a common role in embryonic development. To test this hypothesis, one approach we have used is to examine the patterns of genetic organization of homoeo box sequences in mouse and human for any similarities; the second approach is to localize the chromosomal map positions of homoeo box sequences in the two species. A similar genomic organization and chromosomal distribution of homoeo box sequences would argue for a conserved function and might shed light on their mechanism of action. Here, we describe experiments which show that two homoeo box loci map, respectively, to evolutionarily related regions on mouse chromosome 11 and human chromosome 17.

Animals↗

PubMedDate not supplied

Transcripts encoded by a homoeo box gene are restricted to dorsal tissues of Drosophila embryos.

In Drosophila elaboration of positional identity along the anterior-posterior and dorsal-ventral embryonic body axes involves early zygotic gene functions that are expressed in response to maternal cues present in the unfertilized egg. Zygotic loci that are required for the specification of positional identity along the anterior-posterior body axis have been described in detail. Less is known about the zygotic loci responsible for differentiation of the dorsal-ventral pattern; however, several genes that might be involved have been identified. Zerknüllt (zen) is an example of a zygotic gene required for correct differentiation of dorsally derived embryonic tissues. On the basis of homoeo box cross homology, we have now isolated a gene, called S60, that derives from the zen region of the Antennapedia complex (ANT-C). Transcripts encoded by S60 transiently accumulate in the dorsal-most tissues of developing embryos. This pattern of expression suggests that S60 corresponds to zen. Since S60 contains a homoeo box, it is possible that differentiation of the anterior-posterior and dorsal-ventral embryonic patterns involves similar molecular mechanisms.

Amino Acid Sequence↗

PubMedDate not supplied

Maternal regulation of zerknüllt: a homoeobox gene controlling differentiation of dorsal tissues in Drosophila.

The homoeobox gene zerknüllt (zen) plays an important role in the differentiation of dorsal tissues during Drosophila development. zen- embryos show transformations in the dorsal-most regions of the fate map, and lack several tissues that normally derive from these regions, including the amnioserosa and optic lobe. zen displays a simple dorsal on/ventral off pattern as early as cleavage cycle 10-11 (ref. 2). We have prepared a polyclonal antibody against a full-length zen protein, and used this to examine its pattern of expression in mutants that disrupt dorsal-ventral polarity. Most or all of the maternally expressed genes that are involved in this process have been previously identified and fall into two classes, so called 'dorsalizers' and 'ventralizers' (see refs 4-7, reviewed in ref. 8). On the basis of our analysis of zen expression in each of these maternal mutants we propose that one or more of the dorsalizing genes encodes a repressor which inhibits the expression of zen in ventral regions of developing embryos. The ventralizing gene cactus might play an important role in restricting the activity of this repressor to ventral regions, thereby permitting the activation of zen in those dorsal tissues where its function is critically required.

Animals↗

PubMedDate not supplied

Pharmacovigilance in a genomic era.

Explore the source record for details and available documents.

Adverse Drug Reaction Reporting Systems↗

PubMedDate not supplied

Cost effectiveness of alternative Helicobacter pylori eradication strategies in the management of duodenal ulcer.

Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin) are most costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole) and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

Amoxicillin↗

PubMedDate not supplied

Purification of hog kidney renin with immobilized monoclonal antirenin.

Spleen cells from mice immunized with partially purified hog kidney renin were fused with mouse myeloma cells to produce a stable monoclonal hybridoma cell line that synthesizes an antibody against renin. A single monoclonal antibody was chosen for study and has been produced in large quantity and purified by affinity chromatography on protein A-Sepharose. The antirenin, which belongs to the IgG1 subclass, exhibits anticatalytic activity against both hog and rabbit renin. An immunoaffinity column prepared from antibody coupled to Sepharose has been used in the purification of renin from hog kidney. Although renin is quantitatively adsorbed from solution, it can be eluted from the column under gentle conditions. The highly purified renin, with specific activity of 2122 Goldblatt Units/mg protein, exhibits both charge (pH 4.1 to 5.1) and size (38,000 to 42,700) heterogeneity. Hog kidney renin dissociates in the presence of sodium dodecyl sulfate (SDS) and mercaptoethanol to heavy and light chains with molecular weights of 33,700 and 5,800, respectively. In the presence of SDS, a small amount of a nw form of renin is observed with a molecular weight of 19,500 which retains activity on renaturation. The monoclonal antibody should be a useful tool for the study of the renin-angiotensin system and especially for the purification of renin. The hybridoma cell line used in this study (F-32 VIII C4) has been donated to the American Type Culture Collection.

Animals↗

PubMedDate not supplied

Hemorrhagic complications of long-term anticoagulant therapy for ischemic cerebral vascular disease.

The main complication of anticoagulant therapy is bleeding. Although the use of long-term oral anticoagulants in patients with transient cerebral ischemia and/or minor stroke is controversial, anticoagulants are still used in some instances. We have carried out a literature review of the risk of hemorrhage during long-term oral anticoagulant therapy in patients with cerebrovascular disease to determine the rate of bleeding and the clinical and laboratory risk factors which predispose patients to bleeding. The risk of bleeding was substantial with major bleeding episodes ranging from 2% to 22% per year and fatal bleeds from 2% to 9% per year. Only hypertension emerged as an identifiable risk factor and its presence increased the relative risk of bleeding to more than two fold. Major bleeding was almost always intracranial, possibly because of associated hypertension or because of cerebrovascular disease per se. We could not detect a relationship between bleeding and the intensity of anticoagulant therapy, although major bleeding occurred frequently even with only moderately intense anticoagulant therapy. The net gain or loss in efficacy rate of treating patients with minor stroke with long-term oral anticoagulant therapy was examined and it was concluded that in order for such treatment to be beneficial, a risk reduction of more than 50% in stroke rate, and a major bleeding rate of less than 2% per year are required. Since the risk reduction for stroke and death with anticoagulant therapy is unlikely to be 50% and the risk of major bleeding likely to be more than 2%, the present evidence does not support the use of anticoagulant therapy in minor stroke.

Administration, Oral↗

PubMedDate not supplied

Acute hemolysis and renal failure following discontinuous use of rifampin.

Rifampin is frequently used in the treatment of mycobacterial infections. Intermittent or discontinuous therapy with rifampin has been associated with systemic symptoms referred to as the "flu syndrome" and, less frequently, acute hemolysis and acute renal failure. We report the case of a 73-year-old woman who experienced acute hemolysis and renal failure while being treated with rifampin and ethambutol for a respiratory infection caused by Mycobacterium fortuitum and M. avium-intracellulare. This patient had interrupted her therapy for periods of one week or more due to a rash and flu-like symptoms, which she ascribed to her medications. A review of the literature indicated that these adverse effects of rifampin appear to be immunologically mediated and that the symptoms of the flu syndrome may be due to mild intravascular hemolysis. Intermittent therapy with rifampin should be avoided and noncompliant patients should be given alternative treatment when possible.

Acute Disease↗

PubMedDate not supplied

The use of law for prevention in the public interest.

One of the most important functions of law and the legal system is to prevent harm by regulating conduct prospectively. Almost all law--whether in the form of a statute enacted by a legislative body or a judgment decreed by a court--is designed, at least in part, to avoid some socially undesirable future state of affairs. This chapter explores some of the more significant ways in which lawmaking (both legislative and judicial) may be regarded as a form of prevention and the legal system may be used for prevention in the public interest. Although the chapter focuses on litigation and legislation of particular interest to those in the fields of mental health and mental retardation, the legal processes and principles described extend to many other areas of law with implications for promoting health and preventing harm.

California↗