Ventricular tachycardia an atypical presentation of Ebstein's disease.

Ebstein's anomaly (EA) is a rare congenital malformation, characterized by an apical displacement and dysplasia of the septal leaflet of the tricuspid valve with a right ventricular atrialization compromising its function. This malformation includes electrical conduction abnormalities, and very rarely ventricular arrhythmias. We report the case of a 22-year-old male, presenting with dizziness and palpitations. The electrocardiogram showed a sustained monomorphic ventricular tachycardia (SMVT). The presentation of the disease with ventricular tachycardia associated with hemodynamic instability is extremely rare. We placed a surgical implantable cardiac defibrillator when the diagnosis of EA, SMVT, and right ventricular systolic impairment was confirmed. 

Analysis of a nuclear localization signal in the p14 splicing factor in Trypanosoma cruzi.

There are only a few reported nuclear localization signals (NLS) in trypanosomes despite intensive research on nuclear metabolic processes such as mRNA processing and transcription during the recent past. Moreover, there are only two reports for a monopartite (La protein) and bipartite (H2B histone, ESAG8) NLS in Trypanosoma brucei. We decided to investigate a NLS in Trypanosoma cruzi by selecting p14, a small RNA recognition motif (RRM) containing protein involved in the splicing process in the nucleus. Its small size (117 amino acids), and an optimized streamlined workflow for analysis in T. cruzi, allowed us to define a region of basic amino acids (RRKRRR) located at the C-terminus that is necessary for nuclear localization. However, the NLS for p14 appeared to be more complex since the signature RRKRRR alone is necessary but not sufficient to direct heterologous proteins, such as GFP, to the nucleus. Since p14 interacts strongly with splicing factor SF3b155, a much larger protein, we designed a p14 variant unable to interact with it. The results allowed us to discard the notion that p14 is entering the nucleus, or is retained within, as the sole consequence of being part of a larger complex. Extensive mapping showed that all of the information for nuclear import resides within the small p14 protein in a bipartite NLS composed of the signature RRKRRR and a region of the RRM domain. Thus, NLS definition in T. cruzi is more complex than previously described.

Allosensitization of islet allograft recipients.

BACKGROUND: The immune monitoring of islet transplant recipients includes the assessment of panel reactive antibodies (PRA). A negative association of PRA+ with allogeneic solid organ graft survival has been recognized, but scattered data is available for islet transplantation. METHODS: We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006. RESULTS: Pretransplant PRA+ was observed in 10 subjects in the old trials and associated with kidney transplantation and/or pregnancies. Thirteen subjects displayed PRA+ at follow-up, eight of whom were de novo. Overall, PRA+ did not correlate with islet graft outcome: long-term graft survival was observed in the presence of basal or persistent PRA+ and graft dysfunction occurred also in the absence of PRA+. Loss of graft function was associated with PRA+ after lowering of immunosuppression or after infection episodes. Loss of C-peptide did not affect kidney graft function even in simultaneous islet-kidney transplant recipients. Mostly, PRA remained negative under adequate immunosuppression. Patients whose immunosuppression was discontinued invariably developed PRA+. CONCLUSIONS: Monitoring of PRA under immunosuppression may have little clinical value under adequate immunosuppression in islet transplant recipients. The implications of allosensitization after discontinuation of immunosuppression need to be evaluated to define the real clinical impact in this patient population.

Macrobenthic community colonization and community development in dredged material disposal habitats off coastal Louisiana.

We examined marine benthic macroinvertebrate colonization and community structure at multiple spatial scales (study areas, reference and disposal sites, and depth zones within sites) within a 3-day period at three relatively widely separated (ca 60 km) dredged material disposal areas (Mermentau and Atchafalaya Rivers and Freshwater Bayou) in coastal Louisiana. Study areas had different histories of dredged material disposal, but all three are subject to frequent natural habitat disturbances (e.g. freshets). Nine phyla and 51 taxa were represented among the three study areas at reference (R) and disposal (D) sites (Freshwater Bayou: 21(R), 18 (D); Mermentau River: 14 (R), 17 (D) and Atchafalaya River: 38 (R), 40 (D)). Only 15 taxa were common to all three study areas. At the Freshwater Bayou, average taxa richness and abundance responded to water depth, not sites. These response variables averaged higher mean values at the Mermentau River disposal than at the reference site. No consistent pattern in the average of these response variables was detected between sites at the Atchafalaya River. Multidimensional scaling ordination and non-parametric multivariate inferential analysis provided a distinctly different picture of community structure within study areas compared to parametric analyses. A relatively moderate to strong separation in community structure between sites was detected depending on study area. Non-parametric multivariate inferential analysis detected significant differences in internal community structure at the scale of stations and sites within study areas. The weight of evidence suggests that frequent natural disturbances explain differences in macrobenthic animal community structure more than effects of dredged material disposal.

A double-blind, randomized, parallel-group study of the pharmacokinetics and onset of action of Naprelan in patients following oral surgery.

Naprelan (Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) is a novel formulation of naproxen sodium designed to offer both a rapid onset and a sustained duration of analgesia. Its onset of action was assessed in a double-blind, double-dummy, randomized, parallel-group study of 129 patients who had just undergone oral surgery to remove impacted third molars. Patients received Naprelan (500 mg or 1,000 mg), naproxen (500 mg), codeine (30 mg), or placebo. Both doses of Naprelan compared favorably with the established Naprosyn (formulation of naproxen; Syntex Laboratories, Inc., Palo Alto, California) with respect to onset of action, which occurred within 30 minutes in the majority of patients. The relative adverse effect profile showed that both Naprelan doses were as well tolerated as Naprosyn, codeine, and placebo. Pharmacokinetic and pharmacodynamic analysis confirmed the findings of previous Phase I studies in healthy subjects.

Use of forest inventories and geographic information systems to estimate biomass density of tropical forests: Application to tropical Africa.

One of the most important databases needed for estimating emissions of carbon dioxide resulting from changes in the cover, use, and management of tropical forests is the total quantity of biomass per unit area, referred to as biomass density. Forest inventories have been shown to be valuable sources of data for estimating biomass density, but inventories for the tropics are few in number and their quality is poor. This lack of reliable data has been overcome by use of a promising approach that produces geographically referenced estimates by modeling in a geographic information system (GIS). This approach has been used to produce geographically referenced, spatial distributions of potential and actual (circa 1980) aboveground biomass density of all forests types in tropical Africa. Potential and actual biomass density estimates ranged from 33 to 412 Mg ha(-1) (10(6)g ha(-1)) and 20 to 299 Mg ha(-1), respectively, for very dry lowland to moist lowland forests and from 78 to 197 Mg ha(-1) and 37 to 105 Mg ha(-1), respectively, for montane-seasonal to montane-moist forests. Of the 37 countries included in this study, more than half (51%) contained forests that had less than 60% of their potential biomass. Actual biomass density for forest vegetation was lowest in Botswana, Niger, Somalia, and Zimbabwe (about 10 to 15 Mg ha(-1)). Highest estimates for actual biomass density were found in Congo, Equatorial Guinea, Gabon, and Liberia (305 to 344 Mg ha(-1)). Results from this research effort can contribute to reducing uncertainty in the inventory of country-level emission by providing consistent estimates of biomass density at subnational scales that can be used with other similarly scaled databases on change in land cover and use.

Picenadol in a large multicenter dental pain study.

STUDY OBJECTIVE: To estimate the analgesic dose of picenadol hydrochloride equal to codeine 60 mg in a dental pain model. DESIGN: Randomized, double-blind, parallel, dose-response study. SETTING: Four university-based dental clinics. PATIENTS: Four hundred eight adult patients with moderate or severe pain after extraction of one or more impacted molar teeth plus bone removal. INTERVENTIONS: Patients received orally administered single doses of picenadol 15 and 30 mg, codeine phosphate 30 and 90 mg, or placebo. METHODS: Single oral doses of picenadol 15 and 30 mg, an opioid agonist-antagonist, were compared with codeine 30 and 90 mg and placebo in 408 patients with moderate or severe pain from third molar extraction in a randomized, double-blind, parallel study. Assessments were performed for pain intensity, pain relief, and adverse events for up to 6 hours after drug administration. MAIN RESULTS: Picenadol 30 mg and codeine 90 mg were more effective than placebo based on sum of pain intensity differences, total pain relief, peak pain relief, and duration of analgesia (p < 0.05). Compared with placebo, the frequency of adverse events was highest for patients receiving codeine 90 mg (p < 0.05). No patients discontinued due to adverse events, and all such events resolved spontaneously. CONCLUSIONS: Picenadol 22 mg was estimated to be equianalgesic to codeine 60 mg, and picenadol 30 mg was safe in this dental pain model.

Single dose and multidose analgesic study of ibuprofen and meclofenamate sodium after third molar surgery.

The purpose of this study was to compare the analgesic efficacy and safety of meclofenamate sodium with ibuprofen after dental impaction surgery. This study was double-blind and used a unique methodology. Patients (N = 254) were first randomized into the single dose phase of the study that included placebo, meclofenamate 50 mg, meclofenamate 100 mg, ibuprofen 200 mg, and ibuprofen 400 mg, followed by a 7-day multidose phase in which patients in the placebo group were rerandomized into one of the active treatment cells. In the single dose phase, all active treatments were significantly more efficacious than placebo for every summary analgesic measure. A positive dose-response was seen for both active drugs with meclofenamate 100 mg and ibuprofen 400 mg exhibiting the greatest efficacy for pain relief, pain reduction, time to remedication, and overall evaluation. Side effects were reported by 26 patients. They were evenly distributed among treatment groups with headache and drowsiness being the most common. During the multidose phase, there were only small differences in efficacy measures among active treatment groups. However, meclofenamate produced a higher incidence of stomach cramps and diarrhea than did ibuprofen (8.8% and 7.2% versus 0.8% and 0.8%). This study indicates that higher doses of nonsteroidal anti-inflammatory drugs are most effective immediately after surgery and that lower doses of these drugs can be used after the first postoperative day. The side effect profile of nonsteroidal anti-inflammatory analgesics is best observed with the use of a multidose study design.

Comparison of etodolac, aspirin and placebo for pain after oral surgery.

Single oral doses of etodolac 50, 100 and 200 mg were compared with aspirin 650 mg and placebo in a double-blind, parallel group study of 189 outpatients reporting moderate or severe pain after oral surgery. Overall efficacy of test drugs was evaluated by sum of pain intensity difference (SPID) scores and total pain relief (TOTPAR) scores over 0.5-3, 0.5-6, 0.5-8 and 0.5-12 hours. Etodolac 200 mg provided significantly greater analgesia than aspirin by these measurements over all SPID and all but one TOTPAR interval, and was significantly more effective than placebo over all intervals. Etodolac 100 mg was superior to aspirin for SPID 0.5-8 and 0.5-12 hours, and superior to placebo for both SPID and TOTPAR over all time intervals. Onset of analgesia for etodolac 100 mg, 200 mg and aspirin was 1 hour or less for the majority of patients in each group; 42% receiving etodolac 200 mg reported onset of analgesia within 0.5 hour. Duration of analgesia for etodolac 200 mg appeared twice that of aspirin. A significant positive dose-response relationship was obtained for the three doses of etodolac. A low frequency of side effects was observed in all treatment groups.

The efficacy of etodolac for patients with pain following oral surgery.

The analgesic efficacy of etodolac for 161 patients reporting moderate to severe pain after oral surgery was evaluated. The patients were given single oral doses of one of the following test drugs--aspirin, 650 mg; etodolac, 50 mg; or etodolac, 200 mg--or placebo. There were at least 39 patients in each drug group. After medication, patients recorded pain intensity and pain relief at half-hour intervals for the first hour and then hourly for up to eight hours. Pain intensity differences, total pain relief, onset of analgesia, and each patient's overall opinion of the drug were analyzed. Time--effect curves were derived from the pain relief and pain intensity difference scores. Analgesic effects produced by both doses of etodolac were comparable with those of 650 mg of aspirin. All active drugs were significantly more effective than placebo, and the 200-mg dose of etodolac provided an earlier onset and longer duration of analgesia than the other test drugs.

Multiple hamartoma and neoplasia syndrome (Cowden's syndrome).

A case report involving a patient with Cowden's syndrome is presented. The patient's family is shown to be affected in a pattern consistent with an autosomal dominant form of transmission of this inherited disorder. The disorder can be diagnosed in its early stages by gingival and cutaneous manifestations; it is emphasized that the dentist is therefore perhaps the best-qualified health care professional to recognize the disease in its early stages and to alert the patient to be monitored for later predictable neoplasia which can perhaps be treated before metastasis develops.

Amelogenesis imperfecta: local hypoplastic type with pulpal calcification.

A case report of a patient with local hypoplastic type of amelogenesis imperfecta is presented. Developmentally absent canines and unerupted teeth in the anterior maxilla and calcifications in the apical third of the pulp chambers of the molars were noticed and discussed. A family history was analyzed as consistent with an autosomal dominant form of transmission of the disorder.

Mandibular prognathism and apertognathia associated with cleidocranial dysostosis in a father and son.

No reports to date have described apertognathia as an associated finding of cleidocranial dysostosis. The case of a patient with prognathism and apertognathia associated with cleidocranial dysostosis is reported. Periodontal, restorative, prosthetic, and oral surgical services were necessary to rehabilitate this patient orofacially. A review of the syndrome and of the patient's familial history is presented.

Biopsy technique for fibro-osseous and osteolytic lesions of the jaws.

A biopsy technique is presented for obtaining small tissue samples from fibro-osseous and osteolytic lesions which are not readily accessible for surgical biopsy. Trephine burs and a nonaspirating biopsy needle may be utilized for obtaining adequate tissue from fibro-osseous and osteolytic lesions for frozen section and routine histopathologic examination.