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PubMed1986

Re-irradiation of advanced tumors of the head and neck with fast neutrons.

Twenty-eight patients who had received radical treatment with X rays to tumors of the head and neck presented with advanced recurrent tumors, 23 of them had also undergone surgery and 10 had more than one operation. Seven had also received chemotherapy. They were treated with neutrons to a tumor dose of 1560 cGy in 12 fractions over 26 days using the techniques of the Hammersmith Unit. Twenty-three of the tumors (82%) underwent complete regression that was maintained in 15 for at least 12 months. Despite the damage done by the previous radiation and surgery to the normal tissues, 15 patients had no complications following neutron therapy. In six patients, there was major necrosis, in seven others, this was minor. Eight tumors recurred. Five patients responded with partial regression of their tumors. The median survival was 20 months (range 4-69 months).

Fast Neutrons↗
PubMed2005

Synthesis, characterization, crystal structure, and electrochemical, photophysical, and protein-binding properties of luminescent rhenium(I) diimine indole complexes.

We report the synthesis, characterization, and photophysical and electrochemical properties of a series of luminescent rhenium(I) diimine indole complexes, [Re(N-N)(CO)3(L)](CF3SO3) (N-N = 3,4,7,8-tetramethyl-1,10-phenanthroline (Me4-phen), L = N-(3-pyridoyl)tryptamine (py-3-CONHC2H4-indole) (1a), N-[N-(3-pyridoyl)-6-aminohexanoyl]tryptamine, (py-3-CONHC5H10CONHC2H4-indole) (1b); N-N = 1,10-phenanthroline (phen), L = py-3-CONHC2H4-indole (2a), py-3-CONHC5H10CONHC2H4-indole (2b); N-N = 2,9-dimethyl-1,10-phenanthroline (Me2-phen), L = py-3-CONHC2H4-indole (3a), py-3-CONHC5H10CONHC2H4-indole (3b); N-N = 4,7-diphenyl-1,10-phenanthroline (Ph2-phen), L = py-3-CONHC2H4-indole (4a), py-3-CONHC5H10CONHC2H4-indole (4b)), and their indole-free counterparts, [Re(N-N)(CO)3(py-3-CONH-Et)](CF3SO3) (py-3-CONH-Et = N-ethyl-(3-pyridyl)formamide; N-N = Me4-phen (1c), phen (2c), Me2-phen (3c), Ph2-phen (4c)). The X-ray crystal structure of complex 3a has also been investigated. Upon irradiation, most of the complexes exhibited triplet metal-to-ligand charge-transfer (3MLCT) (d pi(Re) --> pi*(diimine)) emission in fluid solutions at 298 K and in low-temperature glass. However, the structural features and long emission lifetimes of the Me4-phen complexes in solutions at room temperature suggest that the excited state of these complexes exhibited substantial triplet intraligand (3IL) (pi --> pi*) (Me4-phen) character. The binding interactions of these complexes to indole-binding proteins including bovine serum albumin and tryptophanase have been examined.

Crystallization↗
PubMed2003

Pulmonary re-occurrence of post-transplant lymphoproliferative disease with hypogammaglobulinaemia.

UNLABELLED: We report the case of a 12-year-old boy, who developed Epstein-Barr virus (EBV) associated post-transplant lymphoproliferative disease (PTLD) 7 years after renal transplantation. He responded well to the reduced immunosuppressive therapy and treatment with ganciclovir. Two years later he developed severe pneumonia and hypogammaglobulinaemia related to EBV infection exacerbation. An X-ray film revealed persistent pneumonia in the right lung. Lung biopsy showed a large, diffuse EBV-associated B-cell lymphoma. This constellation suggested re-occurrence of the primary PTLD. CONCLUSION: We present a case of recurring Epstein-Barr virus-associated post-transplant lymphoproliferative disease with a remarkably late onset in addition to hypogammaglobulinaemia.

Agammaglobulinemia↗
PubMed1991

Long-term follow-up of coarctation of the aorta repaired by patch angioplasty.

The long-term complications of patch plasty repair for coarctation of the aorta were assessed retrospectively in 119 patients who were operated upon from 4 days to 13 years of age. There were 7 late deaths and 17 patients were lost to follow-up. Thus 95 patients were followed up for a minimum period of 3 years (mean 6.3 years). In addition, graded exercise tests were performed on 15 patients and 11 normal controls, measuring systolic blood pressure response and arm-leg blood pressure gradients. In this series, 16 patients (17%) were hypertensive, while 25 (26%) had a resting systolic arm-leg gradient greater than 20 mm Hg. Re-coarctation occurred more frequently when surgery had been undertaken under 1 month of age. Review of chest X-rays revealed calcification in the patch in 4 patients, one of whom subsequently went on to aneurysm formation. In a second child aneurysm formation was detected at repeat operation. Exercise tests showed a significantly higher systolic arm pressure in patients (mean: 165.3 mm Hg) when compared to controls (mean: 139.2 mm Hg) (P = 0.017) and a significant increase in arm-leg systolic gradient viz. 36 and 5.9 mm Hg, respectively (P = 0.0016). A good correlation was found between the systolic arm pressure and the systolic arm-leg gradient after exercise (r = 0.822; P = 0.0001). We conclude that the most important long-term complication following an aortic patch plasty, is re-stenosis. The development of an aneurysm was observed only twice. We believe that this apparently rare occurrence, as assessed on chest radiographs; is related to the young age (53% under 1 year) at which the repairs were carried out. Another possible reason may be that the follow-up period is not yet long enough.

Aortic Coarctation↗
PubMed2000

Topography and topology of the teleost telencephalon: a paradox resolved.

Analysis of vasculature in the telencephalic pallium of a teleost allows the considerable depth of the sulcus externus, which lies at the lateral extent of the ependymal attachment, to be appreciated. The depth of this sulcus is compelling evidence for a simple eversion process (an outfolding of the pallial wall of each hemisphere) during telencephalic development in all ray-finned fishes that is not complicated in teleosts by secondary migration of pallial cell groups. A simple eversion process is known to occur in some ray-finned fishes with relatively simple telencephalic cytoarchitecture but has been disputed in teleosts based on the pattern of olfactory tract projections. A resolution to the conflicting hypotheses of pallial relationships across ray-finned fishes and in comparison with other craniate radiations is presented here, based on a re-examination of hodological and histochemical data mandated by this sulcal anatomy.

Animals↗
PubMedDate not supplied

[10 years results with a Monobloc hip endoprosthesis cup with multilayer titanium mesh coating for cement-free implantation].

PURPOSE: Can a cementless hemispheric acetabular component which is made of ultra-high-density polyethylene (UHMW-PE) and a heat-bounded porous titanium mesh coating be recommended 10 years after implantation? METHODS: Between 1986 and 1988, 279 total hip arthroplasties in which the cementless socket had been used were performed in 261 patients. The results of 145 patients with 159 hip sockets (55.5%) were reviewed clinically and radiologically for comparison after a minimum of 10 years. The clinical and radiological re-examination was documented in a standardized questionnaire in which several scores were integrated. All X-rays were stored and analysed by a special hardware and software computer system. RESULTS: The mean age of the female patients (n = 85) was 63.1 years and of the male patients (n = 60) 60.9 years. The mean follow-up period was 10 years and 3 months. The Merle d'Aubigné hip score increased from 10.9 to 16.5 points at the follow-up evaluation. Radiolucent lines and cysts according to the zones of DeLee/Charnley were seen only in 2% of all cases. The mean polyethylene wear (head disarrangement) was measured with 1.79 mm after 10 years and 1.92 mm after 11 years. In total, 16 revisions (5.7%), 13 (4.6%) aseptic and 3 (1.1%) septic, out of 279 implanted sokets had to be performed. In particular, the acetabular cup with a diameter of 48 mm demonstrated a high loosening rate (4 of 9). The 10-year survival analysis (Kaplan-Meler) was measured with 92.8%. CONCLUSION: Our results with a cementless socket with titanium mesh coating show insignificant radiolucent lines and an exceptional high 10-year survivorship in which the particular implant philosophy is of great importance for the long-term success. In conclusion, the acetabular component can be recommended for further implantation.

Acetabulum↗
PubMed2005

From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam.

BACKGROUND: In early 2001 there were indications that tuberculosis (TB) was increasingly becoming a problem among drug addicts and homeless persons in Rotterdam, after a periodical screening was discontinued in 1997. A contact investigation around a homeless drug addicted man in Rotterdam with infectious pulmonary TB is described. Contact investigation: A total of 507 drug addicts, homeless persons, and staff of facilities for these risk groups were examined with tuberculin skin testing (TST) and chest radiography. DNA fingerprinting of mycobacteriological cultures through Restricted Fragment Length Polymorphism methodology and molecular epidemiology investigation through cluster analysis were performed. OUTCOME: TST showed an infection prevalence of 29%, especially among staff of services for drug addicts and homeless persons. Six persons with active intrathoracic TB were identified. Cluster analysis demonstrated no relation with the initial case but showed intense transmission of TB among drug addicts and homeless persons in Rotterdam by multiple sources. As a consequence of the findings, a proposal to the Council of the City of Rotterdam resulted in the re-introduction of a comprehensive TB screening programme among these risk groups with mobile digital X-ray units (MXUs). CONCLUSION: This contact investigation gradually obtained the characteristics of a screening of drug addicts and homeless persons. Novel technologies, such as MXUs, facilitate appropriate and efficient outreach approaches to TB control among difficult-to-reach groups. This method and knowledge of individual fingerprints and clusters of TB patients are indispensable for underpinning proposals for change of local TB control strategies and convincing local authorities of the rationale.

Carrier State↗
PubMed1996

Sulfadiazine-associated nephrotoxicity in patients with the acquired immunodeficiency syndrome.

We performed a computerized search on sulfadiazine-associated nephrotoxicity reported in human immunodefiency virus (HIV)-infected patients in the international literature. Including an original case report, we summarized 35 acquired immunodefiency syndrome (AIDS) patients from 1987 to 1995 in an analysis comparing their features to historical HIV-negative controls from the 1940s and 1950s. Likely due to a high prevalence of potential risk factors, incidence of sulfadiazine-associated renal impairment was 1.9%-7.5% in AIDS patients and 1%-4% in HIV-negative controls. Its occurrence appeared to be delayed in HIV-infected patients with a median of about 3 weeks of medication compared with about 10 days in HIV-negative subjects. Correspondingly, the cumulative sulfadiazine dose at manifestation doubled in AIDS patients with a median of 84 g versus 40 g in controls. Patients usually presented with flank or lumbar pain, oliguria, and (macro) hematuria. Urinalysis showed typical "sheaves of wheat" crystalluria, erythrozyturia, and, less commonly, leukozyturia and proteinuria. Echogenic (mostly peripelvic) densities, renal stones, and hydronephrosis are frequent findings on ultrasound examination, whereas X-ray examination possesses a low diagnostic sensitivity. The principle aim of therapy in these patients is to (re)institute the physicochemical urinary solubility of sulfadiazine and its metabolites. For this purpose, forced rehydration and, most importantly, urine alkalinization proved to be effective measures without an absolute need to withhold the drug. Provided prophylactic and therapeutic recommendations are complied with, outcome of this drug-related side effect is usually excellent, and rare relapses will similarly respond well.

AIDS-Related Opportunistic Infections↗
PubMed2006

Pulmonary edema and lung injury after severe laryngospasm.

A young male with no pre-operative medical illness underwent corrective surgery for a deviated nasal septum under general anesthesia. At the end of surgery, patient was extubated but went into severe laryngospasm that did not improve with gentle Intermittent Positive Pressure Ventilation (IPPV) and small dose of Suxamethonium. As the situation worsened and patient developed severe bradycardia and de-saturation, re-intubation was done that revealed pink froth in the endotracheal tube. His portable chest X-ray was suggestive of non-cardiogenic pulmonary edema. With an overnight supportive treatment, using mechanical ventilation with Positive End-Expiratory Pressure (PEEP), morphine infusion and frusemide, patient improved and was subsequently weaned off from ventilator.

Adult↗
PubMed2006

Experimental determination of the nN --> sigma*P-O interaction energy of O-equatorial C-apical phosphoranes bearing a primary amino group.

The reaction of a chlorophosphorane (9-Cl) with primary amines produced anti-apicophilic spirophosphoranes (5, O-equatorial phosphoranes), which violate the apicophilicity concept, having an apical carbon-equatorial oxygen configuration, along with the ordinarily expected O-apical stereoisomers (6) with the apical oxygen-equatorial carbon configuration. Although the amino group is electronegative in nature, the O-equatorial phosphoranes were found to be stable at room temperature and could still be converted to their more stable O-apical pseudorotamers (6) when they were heated in solution. X-ray analysis implied that this remarkable stability of the O-equatorial isomers could be attributed to the orbital interaction between the lone-pair electrons of the nitrogen atom (n(N)) and the antibonding sigma(P-O) orbital in the equatorial plane. A kinetic study of the isomerization of 5 to 6 and that between diastereomeric O-apical phosphoranes 13b-exo and 13b-endo revealed that 5b bearing an n-propylamino substituent at the central phosphorus atom was found to be less stable than the corresponding isomeric 6b by ca. 7.5 kcal mol(-1). This value was smaller than the difference in energy (11.9 kcal mol(-1)) between the O-equatorial (1b) and the O-apical n-butylphosphorane (2b) by 4.4 kcal mol(-1). This value of 4.4 kcal mol(-1) can be regarded as the stabilization energy induced by the n(N) --> sigma(P-O) interaction. The experimentally determined value was in excellent agreement with that derived from density functional theory (DFT) calculations at the B3PW91 level (4.0 kcal mol(-1)) between the nonsubstituted aminophosphoranes (5g is less stable than 6g by 10.1 kcal mol(-1)) and their P-methyl-substituted counterparts (1a is less stable than 2a by 14.1 kcal mol(-1)).

Amines↗
PubMed1993

X-ray fluorescence determination of bromine traces in pharmaceutical formulations containing sodium diclofenac.

The X-ray fluorescence spectroscopy (XRF) on solid samples is applied to the organic bromine impurities assay on pharmaceutical formulations of sodium diclofenac (DCF). A wide range of Br contents (7-1564 ppm) in the tablets is obtained, depending on manufacturer source and batch preparation. As the impurities concern only the sodium diclofenac employed, and the presence of Br might be a toxicity index arising from the synthetic procedure, the assay of each DCF batch is suggested.

Bromine↗
PubMed2002

Re-refinement using reprocessed data to improve the quality of the structure: a case study involving garlic lectin.

The structure of dimeric garlic lectin was previously determined to an effective resolution of 2.8A using X-ray intensity data processed by the XDS package and refined using X-PLOR [Chandra et al. (1999), J. Mol. Biol. 285, 1157--1168]. Repeated attempts to grow better crystals with a view to improving the definition of the structure did not succeed. The available raw data were then reprocessed using DENZO. The structure was re-refined with both X-PLOR and CNS separately using the reprocessed data, which extended to a resolution of 2.2A. These two sets of refinements and the two sets using the XDS-processed data afforded an opportunity to compare the performance of different data-processing and refinement packages when dealing with data from weakly diffracting crystals. The best results were obtained when CNS was employed for refinement using data processed by DENZO. The quality and the resolution of the map and the definition of the structure improved substantially. In particular, the amino-acid residues at the variable locations in the sequence, and hence the isolectins, could be identified with a high degree of confidence. It could be established that the crystal asymmetric unit contains two identical heterodimers. The new refined structure also provided a better definition of other finer structural details.

Amino Acid Sequence↗
PubMed1988

X-ray diffraction studies on muscle during rapid shortening and their implications concerning crossbridge behaviour.

In isometric contraction, a high proportion of crossbridges are always in the attached state and crossbridge cycling is slow. During shortening, crossbridges must be entering the detached state at a higher rate, as they come to the end of their working strokes. The size of the population of detached crossbridges will then depend on the re-attachment rate and it is therefore of some interest to find out whether a significant detached population can be detected. Observations on the equatorial X-ray diffraction pattern indicate that this is the case at higher speeds of shortening, for example at a speed where the detachment rate must be of the order of 200 per second. In a muscle under these conditions, the 59 A and 51 A actin layer line reflections decrease in intensity compared to their values during isometric contraction. This decrease does not appear to be associated with a change in structure of the actin-troponin-tropomyosin complex, since the second actin layer-line reflection remains virtually unchanged in intensity. Thus the change is likely to arise from either a different total number of attached crossbridges, or a different number of attached crossbridges in the tension generating state. The result provides some further evidence for specific helical labelling of the actin structure by crossbridges during contraction, as do some recent electronmicroscope studies of rapidly frozen contracting muscle.

Actins↗
PubMed1990

Structural comparisons of the native and reactive-centre-cleaved forms of alpha 1-antitrypsin by neutron- and X-ray-scattering in solution.

alpha 1-Antitrypsin is the best-characterized member of the serpin (serine-proteinase inhibitor) superfamily. Its solution structure was studied by high-flux neutron-scattering and synchrotron X-ray-scattering. Neutron data show that its absorption coefficient A1% 280,1cm is 5.4. The neutron radius of gyration RG at infinite contrast for native alpha 1-antitrypsin is 2.61 nm, characteristic of a moderately elongated structure, and its cross-sectional RG is 1.34 nm. The internal inhomogeneity of scattering densities within alpha 1-antitrypsin is high at 29 x 10(-5). The X-ray RG is 2.91 nm, in good agreement with the neutron RG of 2.82 nm in 1H2O. This RG is unchanged in reactive-centre-cleaved alpha 1-antitrypsin. These parameters are also unchanged at pH 8 in sodium/potassium phosphate buffers up to 0.6 M. The neutron and X-ray curves for native alpha 1-antitrypsin were compared with Debye simulation based on the crystal structure of reactive-centre-cleaved (papain) alpha 1-antitrypsin. After allowance for residues not visible in the crystallographic electron-density map, and rejoining the proteolysed site between Met-358 and Ser-359 by means of a relatively minor conformational re-arrangement, good agreement to a structural resolution of 4 nm is obtained with the neutron data in two contrasts and with the X-ray data. The structures of the native and cleaved forms of alpha 1-antitrypsin are thus similar within the resolution of solution scattering. This places an upper limit on the magnitude of the presumed conformational changes that occur in alpha 1-antitrypsin on reactive-centre cleavage, as indicated in earlier spectroscopic investigations of the Met-358-Ser-359 peptide-bond cleavage. Methods for scattering-curve simulations from crystal structures are critically assessed. The RG data lead to dimensions of 7.8 nm x 4.9 nm x 2.2 nm for native alpha 1-antitrypsin. The high internal inhomogeneity and the asymmetric shorter semi-axes of 4.9 nm and 2.2 nm suggest that the three oligosaccharide chains of alpha 1-antitrypsin are essentially freely extended into solvent in physiological conditions. This conclusion is also supported by the Debye simulations, and by modelling based on hydrodynamic parameters.

Binding Sites↗
PubMed2003

Sensitivity and specificity of postoperative upper GI series following gastric bypass.

BACKGROUND: Routine postoperative GI series has been common before discharging gastric bypass patients. 78,000 operations were performed in the USA in 2002. At 75 dollars each, the total annual expenditure for the upper GI series approaches 6 million dollars. This study examines the value of performing routine upper GI series. MATERIALS AND METHODS: From 1996 to 2000, 396 open gastric bypass procedures were performed by one surgeon at the University Medical Center. 242 randomly selected charts were retrospectively reviewed for signs and symptoms possibly related to leak or obstruction. Radiology reports were compared with clinical findings. RESULTS: 82% of patients (192/242) were discharged following unremarkable postoperative courses and normal x-rays. 18% (44/242) exhibited one or more clinical signs suspicious of leak or obstruction. These included fever, tachycardia, tachypnea, inordinate pain, elevated white cell count or GI hemorrhage. Leak was reported in 5, and obstruction in 5. 4 patients with reported leaks were re-operated: 2 were positive for unconfined leak requiring surgical treatment; 2 had negative laparotomies. The 2 patients (0.82%) with free leakage had dramatic clinical deterioration, and x-rays were confirmatory rather than diagnostic. 1 patient with a minimal confined leak was treated non-operatively. 8 films were misread as showing a leak when none was present: 2 underwent negative laparotomy, the others being correctly interpreted after review. 8 of 10 initial interpretations were falsely positive. CONCLUSION: Routine postoperative GI series following gastric bypass is not beneficial. All true leaks are demonstrated when x-rays are indicated. We recommend GI series only when clinically indicated. GI series had low positive predictive value for leak.

Adult↗
PubMed2005

Case of double superior vena cava.

A 23-year-old male patient who had no history of any previous medical illness was noted to have a widened mediastinum on chest X-ray undertaken as part of a routine medical evaluation. A computer tomographic (CT) scan confirmed the widened mediastinum to be due to a double superior vena cava (SVC). No further investigations were undertaken. The patient was noted to be well when re-assessed 3 years later.

Adult↗