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Recent advances on the development of bacterial poles.

In rod-shaped bacteria, a surprisingly large number of proteins are localized to the cell poles. Polar positioning of proteins is crucial to many fundamental cellular processes. Formation of the pole occurs at the time of a prior cell division event and involves coordination of the cell division machinery with septal placement of newly-synthesized peptidoglycan. Development of polar peptidoglycan and outer membrane depends on the formation of the cytokinetic FtsZ ring at midcell. By contrast, positioning of at least two polar proteins depends on signals independent of both the assembly of the FtsZ ring and the synthesis of septal and polar peptidoglycan. We propose a model for distinct but interrelated developmental pathways for polar cell envelope synthesis and positional information recognized by polar proteins.

Bacteria↗

Laparoscopic-assisted upper pole ureterocalicostomy using renal inversion and autotransplantation.

Despite various described methods of reconstruction after upper ureteral injury, many cases are complex and remain a surgical challenge. Careful preoperative evaluation and planning are crucial in the selection of the appropriate procedure, particularly in patients in whom preservation of the renal mass is imperative. We report a case of severe upper ureteral injury and subsequent fibrosis, with no usable renal pelvis and focal upper pole dilation, that was managed with renal inversion and upper pole ureterocalicostomy. The option of autotransplantation was provided by laparoscopic nephrectomy and ex vivo reconstruction, minimizing patient morbidity and maximizing a successful outcome. This case illustrates the expansion of laparoscopy from the mere extirpative to a role in complex reconstruction. To our knowledge, this reconstructive strategy has never been previously reported and may be applicable in a limited number of situations.

Anastomosis, Surgical↗

Solving an enigma: arterial pole development in the zebrafish heart.

It is a widely held belief that the arterial pole of the zebrafish heart is unusual among models of comparative cardiogenesis. This is based, in part, on the report that the bulbus arteriosus undergoes a striated-to-smooth muscle phenotypic transition during development. An implication of this is that the zebrafish, a model almost ubiquitously accepted in other fields of comparative biology, may be poorly suited to the study of conotruncal abnormalities in human disease. However, while the use of atrioventricular-specific molecular markers has allowed extensive characterization of the development of the atrium and ventricle, the lack of any bulbus-specific markers has meant that this region of the zebrafish heart is poorly characterized and quite possibly misunderstood. We have discovered that the fluorescent nitric oxide indicator 4,5-diaminofluorescein diacetate (DAF-2DA) specifically labels the bulbus arteriosus throughout development from approximately 48 h post-fertilization. Therefore, using DAF-2DA and an immunohistochemical approach, we attempted to further characterize the development of the bulbus. We have concluded that no such phenotypic transition occurs, that contrary to current thinking, aspects of zebrafish arterial pole development are evolutionarily conserved, and that the bulbus should not be considered a chamber, being more akin to the arterial trunk(s) of higher vertebrates.

Animals↗

Retinal vasculitis and posterior pole "hypopyons" as early signs of acute bacterial endophthalmitis.

PURPOSE: To report a case of acute postoperative bacterial endophthalmitis presenting with retinal vasculitis and posterior pole "hypopyons." DESIGN: Observational case report. METHODS: Observational case report. RESULTS: In a 73-year-old woman, acute postoperative endophthalmitis presented with retinal vasculitis, diffuse retinal hemorrhages, and several posterior pole "hypopyons" that were collections of yellow-white inflammatory debris. The inflammation was located primarily in the posterior one third of the vitreous, and except for severely impaired visual acuity, the classic signs of acute postoperative endophthalmitis were not present until the next day. An immediate pars plana vitrectomy with intravitreal injection of vancomycin, amikacin, and dexamethasone was performed. Vitreous and aqueous cultures grew coagulase-negative Staphylococcus species. After intravenous and topical therapy for endophthalmitis, the inflammation subsided. Eight weeks after the initial cataract surgery, the best corrected visual acuity of the patient was 20/25. CONCLUSION: Acute postoperative bacterial endophthalmitis may present with atypical clinical signs and inflammation located primarily in the retina and posterior vitreous.

Acute Disease↗

Placing all closed loop poles of missile attitude control systems in the sliding mode via the root locus technique.

This paper presents a robust control method for uncertain nonminimum phase systems with external disturbances. A systematic design algorithm is developed which links the sliding mode control and the root locus technique. Complete closed-loop pole placement is achieved in addition to the placement of the reduced order equivalent system poles. An integration function is employed in the sliding variable formulation. The output tracking error is guaranteed to vanish. The proposed method was successfully applied to control the angle of attack of a missile attitude control system.

Journal Article↗

The use of a cystoscopically placed cobra catheter for directed irrigation of lower pole caliceal stones during extracorporeal shock wave lithotripsy.

As the general experience with extracorporeal shock wave lithotripsy (ESWL) for renal calculi broadens, it is increasingly evident that the clearance of stone fragments in lower pole calices needs to be improved. The stone-free rate after treatment for lower caliceal stones is consistently less than that for other upper tract locations. Use of a cystoscopically placed cobra catheter for directed irrigation during ESWL resulted in an increase of our lower caliceal stone-free rate at 1 and 3 months of followup to 71% (15 of 21) compared to 33% (8 of 24) of randomly selected controls at 1 month and 54% (13 of 24) at 3 months. We conclude that pre-ESWL placement of a cobra catheter into the lower pole calix and intermittent irrigation during the procedure are potentially useful adjuncts in the successful treatment of lower caliceal calculi.

Cystoscopy↗

Inferior pole collecting system anatomy: its probable role in extracorporeal shock wave lithotripsy.

In addition to the gravity-dependent position, we believe that other particular anatomical features may be important in the retention of stone debris in the lower calices after extracorporeal shock wave lithotripsy (ESWL). We analyzed the inferior pole collecting system anatomy in 146, 3-dimensional polyester resin corrosion endocasts of the pelviocaliceal system. The inferior pole was drained by multiple calices disposed in 2 rows in 56.8% of the cases and by 1 midline caliceal infundibulum in 43.2%. In 60.3% of the cases there was a lower infundibulum equal to or greater than 4 mm. in diameter and 39.7% had a lower infundibulum smaller than 4 mm. in diameter. In 74.0% of the cases an angle of greater than 90 degrees was formed between the lower infundibulum and the renal pelvis, and in 26.0% the angle was 90 degrees or smaller. We believe that the physician should consider these anatomical features when suggesting ESWL to treat calculi in the lower calices.

Female↗

Renal calculi in lower pole calices: what is the best method of treatment?

Percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy (ESWL*) can be used in the treatment of lower pole caliceal calculi. In a retrospective analysis these 2 therapies were compared for treatment of solitary lower pole caliceal calculi to evaluate morbidity. During a 2-year period 23 patients treated with percutaneous nephrolithotomy and 24 who underwent ESWL with the Siemens Lithostar were analyzed in regard to the success rate, effectiveness quotient, complication rate, length of hospitalization and disability period. Followup consisted of ultrasound and/or a plain film of the kidneys, ureters and bladder 1 day and 1 to 3 months postoperatively. A nephrotomogram was included in the ESWL group. Complete removal of all stone fragments was achieved in 93.6% of the patients treated percutaneously without retreatment. In the ESWL group the success rate was 79.2% with a 41.6% retreatment rate. On the other hand, the ESWL group had a shorter hospitalization and an earlier return to normal physical activities. Among the patients who underwent a percutaneous operation 13% had complications compared to 4.1% in the ESWL group. The recurrence rate was higher in the former group (13% within a median of 18 months, compared to 8.3% within a median of 11 months in the ESWL group). The mean stone diameter was 1.42 cm. in the percutaneous group and 1.22 cm. in the ESWL group. Stone composition was similar in both groups. Since ESWL is an effective noninvasive procedure without the need for routine anesthesia and hospitalization, and with prompt return of the patient to a normal life it must be considered the method of choice for lower caliceal stones less than 2 cm. in diameter. However, percutaneous nephrolithotomy will continue to have a primary role in the management of larger stones.

Adolescent↗

Traumatic amputation of the left lower renal pole in children.

Four children between 5 and 10 years old suffered traumatic amputation of the left lower renal pole following flank trauma. All patients were evaluated with excretory urography and isotope renography. The renal scan clearly demonstrated failure of perfusion of the lower renal pole and urinary extravasation, and was believed to be more valuable than the standard excretory urogram as a diagnostic tool. All children were managed similarly: delayed (72 to 96 hours) exploration, simple removal of the amputated segment and insertion of a Penrose drain. They all have done well. The patients were normotensive at followup and had excellent function of the remaining portion of the kidney.

Amputation, Traumatic↗

Hypertension secondary to massive upper pole hydronephrosis.

Hypertension secondary to hydronephrosis is uncommon, and when a duplex system is involved it is rare. A patient presenting with hypertension and an abdominal mass on the left side was found to have a non-functioning, massively dilated upper pole of a duplex system causing hyperreninemic hypertension. Treatment consisted of an upper pole partial nephrectomy. This unique case is discussed and the literature regarding hypertension secondary to hydronephrosis is reviewed.

Adult↗

Field test of the 'dose pole' for praziquantel in Zanzibar.

A graduated pole for height measurement, estimating the number of praziquantel tablets needed for treatment, was field-tested on 1289 children in Zanzibar. A bathroom-type scale performed better than the dose pole in delivering the optimal dose (40-60 mg/kg) and the 2 methods performed similarly in delivering a dose considered appropriate (30-60 mg/kg).

Anthelmintics↗

Spatial cone activity distribution in diseases of the posterior pole determined by multifocal electroretinography.

Thirty patients with a reduced central vision due to diseases of the posterior pole were examined with the VERIS system developed by Sutter and Tran (Vis Res 1992;32:433-446) to characterize the topography of electroretinographic (ERG) changes in comparison to the results in 30 normal volunteers. Diagnoses included Stargardt's macular dystrophy (SMD, n = 10), age-related macular degeneration (AMD, n = 5), cone dystrophy (CD, n = 5), central retinal vein occlusion (CRVO, n = 5), and autosomal dominant optic atrophy (ADOA, n = 5). The 61 local responses obtained from each subjects were grouped by eccentricity to form five concentric rings. The foveal ERG, originating from a central area of 2 degrees radius, was non-recordable or markedly diminished in all patients except those with optic atrophy, where amplitudes were found to be in the normal range. In patients with advanced stages of SMD, functional defects were larger and involved more peripheral areas than in patients with early stages of SMD or with AMD. A reduction of response amplitude even in the most peripheral ring (17-30.5 degrees eccentricity) was found in cone dystrophies and--moderately--in patients with advanced SMD and central retinal vein occlusion only. Prolonged implicit times were found in all but the patients in early stages of SMD and they were maximal in patients with CRVO. This study shows that the multifocal ERG (MFERG) can contribute to differential diagnosis of retinal diseases of the posterior pole especially in cases with a normal photopic Ganzfeld ERG.

Adult↗

Ureteral duplication with lower pole ectopia to the vas: a case report of an exception to the Weigert-Meyer law.

We report an unusual case of ureteral duplication with lower-pole ectopia and ureterolithiasis, which violates the Weigert-Meyer law. The duplicated ureter arose from a lower-pole calyx and drained inferiorly into the ipsilateral vas. A presentation of the case is followed by a comparison to the only known similar one, reported in 1988. A possible embryologic hypothesis for this anomaly is discussed.

Abnormalities, Multiple↗

Growth of calcium phosphate on poling treated ferroelectric BaTiO3 ceramics.

Barium titanate (BaTiO3; BTO) is ferroelectric and piezoelectric after poling treatment. In this study, the bioactivity of BTO was investigated after a poling treatment by examining the formation of crystal growth on specimen surfaces in vitro. Negatively charged BTO surfaces showed calcium phosphate (Ca-P) crystal growth, while deposition of sodium chloride was observed on the positively charged BTO surfaces. After 30 days immersion in Eagle's MEM, the thickness of Ca-P crystal on negatively charged BTO surfaces increased to 0.8-0.9 microm. These data indicate that incorporating selectively polarized BTO on implant surfaces is a promising means for improving the bioactivity of implant materials.

Barium Compounds↗

Long-term follow-up of patients with chronic uveitis affecting the posterior pole treated with combination cyclosporine and ketoconazole.

PURPOSE: Combined treatment with cyclosporine (CsA) and ketoconazole in autoimmune diseases has received little attention. This article reports the outcome of a pilot study in patients receiving combination therapy for chronic uveitis affecting the posterior pole. METHODS: Six patients initially treated with CsA and oral prednisone were observed prospectively on a combination of CsA, prednisone, and ketoconazole. Data were analyzed for visual acuity, number of flare-ups, and signs of systemic toxicity. RESULTS: Patients were treated with CsA for a mean of 13 months and CsA-ketoconazole for a mean of 33 months. Although patients had a number of flare-ups before combination therapy, only two flare-ups in two patients were noted during combined therapy (P = 0.055). Three patients showed signs of renal toxicity on CsA, and two continued to show signs of toxicity on CsA-ketoconazone. One patient stabilized and maintained normal renal parameters. Using CsA, three of six patients showed elevations of systolic and diastolic pressure. After switching to CsA-ketoconazole, the patient's systolic pressure remained unchanged, and the diastolic pressure returned to normal in all patients (P = 0.03). No toxicity related to ketoconazole alone was observed. CONCLUSION: A combination of CsA and ketoconazole is effective in the treatment of chronic uveitis affecting the posterior pole. It appears to be more effective in preventing recurrences than does CsA alone and does not lead to an increased risk of renal toxicity.

Adult↗

Pole test is a useful method for evaluating the mouse movement disorder caused by striatal dopamine depletion.

We evaluated the behavioral recovery of mice with 6-hydroxydopamine (6-OHDA)-induced lesions using a pole test. T(LA) (locomotor activity time) 1, 2, and 3 days after intracerebroventricular 6-OHDA injection (T(LA)(1-3D)) was correlated significantly with the levels of dopamine (DA), dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) in the striatum 7 days after the injection of 6-OHDA, but 5-hydroxyindoleacetic acid (5-HIAA) and serotonin (5-HT) had no correlation with T(LA)(1-3D). The mice whose T(LA)(1-3D) was more than the median showed about 60% depletion of striatal DA and increased DA turnover, and recovered from movement disorders 4 days after injection. These results show that presynaptic neuroadaptations and behavioral recovery exist in this animal model. Thus, the pole test appears to be useful in predicting the extent of the lesion to select a mouse in which the receptive fields of the dopaminergic cells are denervated.

Animals↗