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Duodenal and jejunal atresia with agenesis of the dorsal mesentery: "apple peel" small bowel.

Two newborn infants with duodenal and jejunal atresia and agenesis of the dorsal mesentery represent our surgical experience with "apple peel" small bowel or "christmas tree" demormity. The first patient had the typical appearance of this condition. The postoperative course was complicated by hyperbilirubinemia, septicemia, and disseminated intravascular coagulation. The infant is in satisfactory condition 1.5 years after operation. The second patient had agenesis of the dorsal mesentery without spiraling of the bowel around its vascular stalk. The child died after 1 month, with complete absence of extrahepatic bile ducts as seen at a second laparotomy. Neither child had been subjected to gastrostomy.

Duodenal Diseases↗

Agenesis of the dorsal mesentery without jejunoilial atresia ("apple peel small bowel").

Agenesis of the dorsal mesentery with apple peel or Christmas tree deformity but without small-bowel atresia can occur beyond the neonatal period. The recognition of this entity is imperative as it is also associated with a marginal artery which may be the only blood supply to the majority of small bowel. Preservation of this vessel is necessary to avoid catastrophic bowel death.

Child, Preschool↗

The use of prothrombin activating snake venoms to measure human prethrombin 2: absence of prethrombin 2 in serum.

The activation of the prothrombin intermediate, Prethrombin 2, has been studied in order to establish test systems that would enable identification of Prethrombin 2 in serum and Factor IX concentrates. While activation of Prethrombin 2 by Taipan Snake Venom (TSV) was slow and incomplete, inclusion of approximately molar amounts of prothrombin fragments F1 or F1.2 markedly enhanced the amount of thrombin formed by TSV. This effect could also be obtained by the inclusion of serum. Neither normal serum nor Factor V deficient serum contain any identifiable Prethrombin 2. On the other hand substantial amounts of Prethrombin 2 are present in Factor IX concentrates used for the treatment of Christmas Disease (Hemophilia B).

Chromatography, DEAE-Cellulose↗

Epidemiology of reindeer parasites.

Every Christmas we sing about Rudolph the red-nosed Reindeer, but do we give much thought to why his nose is red? The general consensus is that Rudolf has caught a cold, but as far as I know no proper diagnosis has been made of his abnormal condition. I think that, rather than having a cold, Rudolf is suffering from a parasitic infection of his respiratory system. To some this may seem a bit far-fetched as one would not expect an animal living with Santa Claus at the North Pole to be plagued by parasites, but I shall show otherwise.

Journal Article↗

Recent research in DNA repair, mutation and recombination: a report of the DNA Repair Network meeting, held at City University, London on 18 December 1995.

The now traditional one day Christmas DNA Repair meeting was held at City University, London for the third year in succession. With over 130 participants and a programme consisting of a total of 24 pre-offered presentations the meeting reached record dimensions. Attendees were from 24 institutions throughout the United Kingdom, and with several distinct research groups contained within the large contingents from the ICRF Clare Hall Laboratories and the MRC Cell Mutation Unit in Brighton, this indicates the increasing interest and depth of UK research in DNA repair. One slight disappointment of the meeting was the fall in the numbers of non-UK participants. Although the meeting in 1994 (Strike, 1995) saw an increase in presentations from Continental Europe (six countries including France, Germany. The Netherlands and Switzerland), the trend did not continue this year, with only Denmark being represented. The 24 contributors consisted of approximately equal numbers of postgraduate students, postdoctoral researchers and more "established' scientists reflecting the continuing policy of encouraging younger members of the repair community to present their work. The mix of presenters was particularly well illustrated by two excellent and consecutive talks by Professor Bryn Bridges (MRC Cell Mutation Unit) and Alison Mitchell, a postgraduate student in Stephen West's laboratory (ICRF, Clare Hall). The organisms under study were as equally disparate and included Archaebacteria, Escherichia coli. Saccharomyces cerevisiae, Schizosaccharomyces pombe, Aspergillus, mice and men. The range of topics was also varied and included bacterial mutagenesis, NMR studies of Ada protein, preferential DNA repair, cell cycle checkpoint genes, reconstitution of nucleotide excision repair and V(D)J recombination in vitro, creation of repair deficient transgenic mice and mismatch defects in human cells. The result was a very successful meeting which was characterized by the consistently high quality of both talks and posters.

Animals↗

A new dihydroxanthenone from a plant-associated strain of the fungus Chaetomium globosum demonstrates anticancer activity.

Bioassay-guided fractionation of a cytotoxic EtOAc extract of the fungal strain, Chaetomium globosum, inhabiting the rhizosphere of the Christmas cactus, Opuntia leptocaulis, of the Sonoran desert afforded a new dihydroxanthenone, globosuxanthone A (1), a new tetrahydroxanthenone, globosuxanthone B (2), two new xanthones, globosuxanthone C (3) and D (4), 2-hydroxyvertixanthone (5), and two known anthraquinones (6 and 7). The structures of the new compounds 1-4 were elucidated by NMR and MS techniques, and the relative stereochemistry of 1 was determined by X-ray crystallographic analysis. Of the compounds encountered, 1 was found to exhibit strong cytotoxicity against a panel of seven human solid tumor cell lines, disrupt the cell cycle leading to the accumulation of cells in either G2/M or S phase, and induce classic signs of apoptosis.

Anthraquinones↗

Shifting crystalline pseudohypopyon secondary to lens absorption with spontaneous openings in the anterior lens capsule.

This is the first reported case of a crystalline pseudohypopyon presenting as a layer of "snowdrift deposits" that settled inferiorly in the anterior chamber of the eye of a 55-year-old man and was associated with freely floating crystals in the aqueous humor, producing a "snowy Christmas Eve" appearance. The cause was spontaneous openings in the center of the anterior capsule with leaching of the crystalline substance into the anterior chamber. A dense membranous cataract was left after the lens material was partly absorbed. There was no history of trauma, surgery, or known systemic disease, and the patient presented with a unilateral, mobile, 4.0 mm white pseudohypopyon with no global pain, photophobia, or lacrimation. Although the eye was not injected on admission, repetitive head shaking resulted in dusky-red perilimbal hyperemia. A B-mode ultrasound revealed an advanced retinal detachment, and electroretinographic recordings were undetectable. Visual acuity decreased to hand motions in the affected eye, and the patient ultimately required anterior chamber paracentesis. Such sediments should be differentiated from other forms of true or pseudohypopyons because the course, treatment, and prognosis are different for each.

Absorption↗

Natural and unnatural triggers of myocardial infarction.

Previous analyses have suggested that factors that stimulate the sympathetic nervous system and catecholamine release can trigger acute myocardial infarction. The wake-up time, Mondays, winter season, physical exertion, emotional upset, overeating, lack of sleep, cocaine, marijuana, anger, and sexual activity are some of the more common triggers. Certain natural disasters such as earthquakes and blizzards have also been associated with an increase in cardiac events. Certain unnatural triggers may play a role including the Holiday season. Holiday season cardiac events peak on Christmas and New Year. A number of hypotheses have been raised to explain the increase in cardiac events during the holidays, including overeating, excessive use of salt and alcohol, exposure to particulates, from fireplaces, a delay in seeking medical help, anxiety or depression related to the holidays, and poorer staffing of health care facilities at this time. War has been associated with an increase in cardiac events. Data regarding an increase in cardiac events during the 9/11 terrorist attack have been mixed. Understanding the cause of cardiovascular triggers will help in developing potential therapies.

Age Factors↗

Monte Carlo simulation of animal-product violations incurred by air passengers at an international airport in Taiwan.

Our aim was to evaluate the inspection of arriving passengers for the illegal transport of animal products through the international airport into Taiwan. Passenger-violation data were retrieved from the Bureau of Animal and Plant Health Inspection and Quarantine (BAPHIQ) in Taiwan. Monte Carlo simulations with 5000 iterations were applied to estimate the predicted violation numbers considering factors such as passenger's nationality/ethnicity, sex, and monthly statistics of violations. The results showed that Chinese-related passengers and passengers from South East Asian countries have a relatively higher potential risk for incurring violations during the period from Christmas to Chinese Lunar New Year. Most monthly estimated violation risks are significantly higher than observed violation risks in 2001 and 2002, except April, July, and August. Due to the low sensitivity of the current detection system (reflected by the higher estimated violation risks and a two-fold detection increase after the implementation of an inspection service using detector dogs), we recommend additional preventive measures be taken.

Animal Diseases↗

A comparison of thermography, radioisotope scanning and clinical assessment of the knee joints in haemophilia.

Thermography, radioactive scanning and clinical assessment of the knee joints of a series of patients with haemophilia or Christmas disease have been performed. A positive correlation was found between the abnormalities of the thermograms, radioactive scans and the clinical signs in acute haemarthrosis, but not in chronic haemophilic joint disease nor in patients without clinical joint disease. No correlation between the thermograms, radioactive scans and the number of previous joint bleeds was shown. Thermography and radionuclide scanning provide rapid means of quantifying changes within the haemophilic joint and may be useful in assessing treatment of haemophilic haemarthrosis.

Adolescent↗

Changes in cytoskeletal proteins in childhood cataract lenses

Purpose: Approximately 50% of congenital and childhood cataracts seen in the clinic is of undetermined origin. Biochemical analysis of the cataracts is rare. This study analyzes lens proteins to determine the mechanism of congenital and childhood cataracts. Method: We analyzed the lens proteins from 10 young patients after cataract operations, using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), densitometry analysis, and Western immunoblotting.Results: Densitometry of separated proteins showed a decrease in the high molecular protein bands of posterior subcapsular cataract (PSC). Specifically, spectrin (235 kDa), filensin (100 kDa), and vimentin (57 kDa) were absent from the SDS-PAGE of PSC. Increases in filensin and vimentin were observed in a Christmas tree cataract and lamellar cataracts. Western immunoblots confirmed the densitometry of SDS-PAGE.Conclusion: These results suggest that changes in cytoskeletal proteins may contribute to congenital and childhood cataracts.

Journal Article↗

Outbreak of pulmonary tuberculosis in children.

A case of miliary tuberculosis in a 4-year-old child led to contact tracing, revealing 32 children with evidence of tuberculous infection. 3 adult cases were also identified. The source case was a mother who passed on the infection at two Christmas parties. Limited exposure to the organism caused infection, suggesting a virulent strain and a susceptible subgroup. A range of complications of primary tuberculosis in children was seen. Minor side-effects of the chemotherapeutic agents occurred in most children but only 3 suffered substantial toxic effects. The limited range of agents marketed in a presentation suitable for young children was a serious difficulty.

Adolescent↗

[Coronary artery bypass with extracorporeal circulation in a patient with hemophilia B].

A 64-year-old patient with factor IX deficiency (Christmas disease) underwent quadruple coronary bypass grafting for angina pectoris. Excessive bleeding was prevented by infusion of factor IX concentrates from one day before surgery until the 19th postoperative day. The surgical procedure and the cardiopulmonary bypass were carried out in the same manner as in patients without any haemorrhagic disorder. No haemorrhagic complication occurred, neither during nor after the operation.

Blood Coagulation Tests↗

Forensic aspects of everyday practice: legal issues that every practitioner must know.

In their education and training, mental health care professionals are taught the intricacies and nuances of providing medical care to individuals with any and all psychological or psychiatric problems. This training, however, as comprehensive as it is from a medical perspective, does not and cannot prepare psychiatrists for the complex legal world that effectively has changed the manner and method in which mental health care is provided. As a result of the invasive meddling of the legal process into the mental health field, every patient is potentially a plaintiff in a lawsuit or a complainant in a licensure matter. The practitioner must navigate around the legal roadblocks without the benefit of a law degree. The questions as to who can provide consent, the adequacy of consent, the release of information, and the other issues set forth in this article only scratch the surface of the pervasive intertwining of the law with the mental health field. As most psychiatrists say in their parting advice to a patient, "call me if you have any problems," in this age of complex and potentially harmful interfacing between the psychiatric profession and the law, the psychiatrist must follow his or her own advice. When faced with an uncertainty as to the adequacy of consent, the release of information, or any legal issue, a psychiatrist must place a call to his or her insurer, health care attorney, or medical board to obtain guidance and direction. When there is a letter, a call, a subpoena, or almost anything other than a Christmas card from an attorney, the psychiatrist also should place a call to his or her insurer or health care attorney to ensure that he or she does not find himself or herself in Dr. Peters' position. Being accused before a licensure board or in a courtroom of failing to adequately obtain consent, failing to release information, or, conversely, releasing too much information is not a recommended mental health activity. Being in Dr. Peters' position and being accused of medical malpractice in which a patient has suffered emotional or physical damage or has committed suicide is also not a recommended activity for a psychiatrist. Although avoidance of attorneys and the legal process is not possible for the practitioner, with the proper information and legal resources, the child and adolescent psychiatrist can navigate around the legal potholes.

Adolescent↗

Utilisation of glycogen, ATP and arginine phosphate in exercise and recovery in terrestrial red crabs, Gecarcoidea natalis.

Intermittent locomotion by terrestrial crustaceans may under specific circumstances increase walking distance and may allow partial re-oxidization of anaerobic products, and replenishment of ATP and arginine phosphate. The Christmas Island red crab G. natalis undertakes a substantial breeding migration each year. The leg muscles of G. natalis subjected to bouts of 2.5 min walking and 2.5 min rest were severely anaerobic. Adenylate energy charge and the large arginine phosphate stores were greatly reduced. Walking for 4 min with pauses of only 1 min exacerbated the anaerobiosis and utilised 50% of the endogenous muscle glycogen. Post-exercise, the adenylate energy charge recovered before the arginine phosphate charge and a large and persistent hyperglycaemia accompanied the restoration of glycogen. Arginine phosphate functioned as a large, longer term, energy reservoir-almost as part of the adenylate pool. Gluconeogenesis is yet to be generally substantiated in decapod crustaceans but G. natalis appears to remove lactate slowly and to reincorporate exogenous glucose into muscle glycogen in the same time frame as lactate removal from the haemolymph. The 4:1 exercise/pause regimen facilitated access to energy stores and increased walking distance, and it allowed L-lactate and H(+) efflux from the muscle during pausing. These responses are similar to those of G. natalis in the field, except during the migration when walking was entirely aerobic. Determinations of adenylate, fuel and arginine phosphate reserves and usage during the migration are required together with more detailed behavioral analysis to resolve the dichotomy in metabolic response.

Adenosine Triphosphate↗

The ecophysiology of air-breathing in crabs with special reference to Gecarcoidea natalis.

To succeed on land rather than in water, crabs require a suite of physiological and morphological changes, and ultimately the ability to reproduce without access open water. Some species have modified gills to assist in gas exchange but accessory gas exchange organs, usually lungs, occur in many species. In accomplished air-breathers the lung becomes larger and more vascularised with pulmonary vessels directing oxygenated haemolymph to the heart. The relative abundance of O(2) in air promotes relative hypoventilation and thus an internal hypercapnia to drive CO(2) excretion. Land crabs have a dual circulation via either lungs or gills and shunting between the two may depend on respiratory media or exercise state. During their breeding migration on Christmas Island Gecarcoidea natalis maintained arterial Po(2) by branchial O(2) uptake, while pulmonary O(2) pressure was reduced; partly because exercise doubled relative haemolymph flow through the gills. Related species rely on elevated haemocyanin concentration and affinity for O(2) to assist uptake but this compromises unloading at the tissues and thus the aerobic scope of tissues. Aquatic crabs exchange salt and ammonia with water via the gills but in land crabs this is not possible. Birgus latro has adopted uricotelism but other species excrete ammonia in either the urine or as gas. Land crabs minimise urinary salt loss using a filtration-reabsorption system analogous to the kidney. Urine is redirected across the gills where salt reabsorption occurs in systems under hormonal control, although in G. natalis this is stimulatory and in B. latro inhibitory. While crabs occupy a range of habitats from aquatic to terrestrial, these species do not comprise a physiological continuum but across the crab taxa individual species possess appropriate and specific physiological features to survive in their individual habitat.

Air↗

The effect of student participation in international study.

Comparative Nursing in England and France is taught at the University of Wisconsin Oshkosh every winter interim, usually departing shortly after Christmas and returning the second week in January. A convenience sample of 38 nursing alumni who have completed the same 2-week international study tour during the past 5 years completed the International Education Survey (IES) developed at the University of Wisconsin-Eau Claire School of Nursing. The IES examines the impact of the international experience on the professional nurse role, international perspectives, personal development, and intellectual development.

Curriculum↗