Meningeal Granular Cell Tumour in a Green Tree Python (Morelia viridis).

Granular cell tumours (GCTs) are uncommon neoplasms mostly reported in man, dogs and horses. The origin of GCT is thought to be Schwann cells, with the associated characteristics of neural crest morphology. Neoplastic cells often demonstrate positive immunoreactivity for S100, LC3, vimentin and p62. They are also periodic acid-Schiff (PAS) positive and diastase resistant. A female green tree python (Morelia viridis) was presented for severe constipation and hyporexia of 4 month's duration and, despite treatment, died the next day. A 4.8 × 3.4 mm intracalvarial GCT was identified, compressing the overlying cerebrum without invasion. Neoplastic cells were immunoreactive to S100 and had brightly eosinophilic cytoplasmic granules that were PAS positive and diastase resistant. Electron microscopy revealed numerous cytoplasmic lysosomes in neoplastic cells. GCTs are reported rarely in non-mammalian species with three reports in birds. This represents the first report of a GCT in a reptile.

[Rehabilitation of construction industry workers considering special workplace demands--results of the "RehaBau" pilot study]. / Arbeitsplatzorientierte Rehabilitation von Bauarbeitern--Ergebnisse der Pilotstudie "RehaBau".

In a descriptive study, 122 construction industry workers were treated in an especially workplace-oriented inpatient rehabilitation measure. Effects were assessed by written questionnaires using the SF-36 questionnaire, the questionnaire for employees self-assessment (FBS) and further standardized instruments for job strain and demand at time intervals of 0, 4 and 13 months from rehabilitation participation. Along with high rehabilitation satisfaction, improvement of quality of life and decreasing disability complaints are reported, which keep stable and significant for at least one year and thus are indicators of sustainable rehabilitation success.

Laser scanning microscopy study on adsorption of biologically relevant proteins on implant materials.

The adsorption of proteins at implant surfaces plays a key role in osseointegration and is therefore of great importance in biomaterial science. Laser scanning microscopy (LSM) is described, a method that is used here for the first study of the adsorption of proteins on implant surfaces. These LSM measurements provide information on the surface morphology, and the spatial distribution of adsorbed proteins can be deduced.

High-cell-density fermentation for production of L-N-carbamoylase using an expression system based on the Escherichia coli rhaBAD promoter.

A high-cell-density fed-batch fermentation for the production of heterologous proteins in Escherichia coli was developed using the positively regulated Escherichia coli rhaBAD promoter. The expression system was improved by reducing of the amount of expensive L-rhamnose necessary for induction of the rhamnose promoter and by increasing the vector stability. Consumption of the inducer L-rhamnose was inhibited by inactivation of L-rhamnulose kinase encoding gene rhaB of Escherichia coli W3110, responsible for the first irreversible step in rhamnose catabolism. Plasmid instability caused by multimerization of the expression vector in the recombination-proficient W3110 was prevented by insertion of the multimer resolution site cer from the ColE1 plasmid into the vector. Fermentation experiments with the optimized system resulted in the production of 100 g x L(-1) cell dry weight and 3.8 g x L(-1) of recombinant L-N-carbamoylase, an enzyme, which is needed for the production of enantiomeric pure amino acids in a two-step reaction from hydantoins.

A system for the study of visuomotor coordination during reaching for moving targets.

Prehensile behavior is a popular task in current research on human motor control. Most studies on reaching used stationary target objects and, therefore, most models do not address the challenges the motor system must respond to when reaching for moving objects. The machines used in earlier studies to produce object motion offered a limited range of trajectories and restricted control over various movement parameters. We have developed a device that allows a great variety of object trajectories along a flat-table surface and gives the experimenter full control over all movement parameters. A linear positioning system is used to move a sled beneath the table surface. Magnetic coupling transfers the sled's movement to the target object on the tabletop. This arrangement allows fast movements of the object (up to 5 m/s) and at the same time protects subjects from any harm due to the moving parts. The system is connected to LC shutter glasses, a 3-D movement registration device, and a switch that detects the onset of hand motion. This allows the selective withdrawal of vision during the reaching task or the introduction of changes in the object motion depending on the subject's reactions.

Angiostatic effects of suramin analogs in vitro.

Suramin analogs are polyanionic naphthylureas structurally related to suramin, an antitumor agent with a narrow therapeutic window. The angiostatic activities of suramin and 16 suramin analogs were investigated using an easily quantifiable in vitro angiogenesis system. In addition, the antiproliferative activities of the analogs were studied in four different human tumor cell lines and in porcine aortic endothelial cells. The suramin analogs encompassed two main structural variations, i.e. their molecular size, and the number and substitution pattern of the sulfonate groups. Some suramin analogs with a reduced number of sulfonate groups (NF062, NF289 and NF326) showed significant dose-dependent angiostatic and also antiproliferative activities. The disulfonate NF062 was superior to suramin in inhibiting HT29 and T47D tumor cells while demonstrating a similar angiostatic potential as suramin. Therefore, the sulfonate groups in the para position of the amino groups of the naphthyl residues of suramin seem to be of special importance. The very small disulfonates (NF108, NF109, NF499, NF500 and NF241) and the asymmetric compound NF520, one half of the suramin molecule, are inactive. Therefore, a minimal molecule size seems to be essential for the biological activity. Suramin is a rather rigid molecule. The highly flexible analogs (NF527, NF528 and NF529) are inactive. This indicates that the molecular rigidity is important for the biological activity.

Biotechnological potential of P450 monooxygenases high-level production of bovine cytochrome P450c17 monooxygenase during medium cell density culture of a recombinant yeast, Saccharomyces cerevisiae GRF 18 (YEp-Toku1).

Bovine cytochrome P450c17 monooxygenase was produced in a 30-L fermenter by Saccharomyces cerevisiae GRF18 (YEp-Toku1), harboring the GAL10 promoter, and using conditions of medium cell density culture. Upon addition of D-galactose as an inducer and FeCl3 as a cofactor, cells began to produce the P450 hemoprotein. The yield of this enzyme reached a maximum after 31 h but its formation continued for more than 60 h after induction. The amount of P450c17 produced was 4.7-fold as compared to shake flask experiments.

Community care for adults with learning disability and their carers: needs and outcomes from the Leicestershire register.

A cross-sectional study, based on an epidemiological register, was carried out to describe the prevalence of disabilities, felt needs and use of services for adults with learning disability and to compare outcomes of reported morbidity, stress and satisfaction among their informal carers. Subjects included 2117 adults and 982 carers known to specialist services in Leicestershire. Behavioural and psychological problems and epilepsy were the main disabilities in adults. The leading unmet needs reported by residential carers were for daycare and other forms of residence, and those reported by informal carers were for financial help, long-term social support, respite care and housing adaptations. Informal carers reported 40% more limiting health disorders compared to the general population, with depression almost four times more common among female carers. Divisions between health and social care are causing inequality and hardship. Lifelong informal carers need options for independence. The increase over time in the prevalence of adults with severe learning disabilities adds to the evidence that more resources for care are needed. Epidemiological registers and methods should be developed to aid purchasing and provision for this client group.

Late onset mania in Down's syndrome.

Manic episodes have seldom been reported in individuals with Down's syndrome. The case of an individual with Down's syndrome who developed a manic episode in later life is described. This manic episode was subsequently followed by a first depressive episode.

Prolonged survival of orthotopically transplanted heart xenograft in infant baboons.

Orthotopic concordant xenotransplantation in a juvenile primate model was examined. Eighteen donor rhesus monkeys weighing 2.4 to 3.8 kg (mean 2.9 kg) were matched with juvenile baboons, aged 9 to 19 months (mean 12.7 months) and weighing 3.2 to 4.8 kg (mean 3.9 kg), using ABH blood type and mixed lymphocyte culture. Rhesus monkey hearts were orthotopically transplanted without immunosuppression into six control baboons (group I). In five baboons (group II), 4 mg/kg per day of antilymphocyte globulin was administered for 3 days before the operation and 5 days after the operation. Splenectomy was also performed, and 18 mg/kg per day of FK 506 was administered orally. Intravenous methotrexate, methylprednisolone, or both were used as rescue therapy. Seven baboons (group III) received the same immunosuppression as those in group II, but an intravenous dose of methotrexate (0.1 to 5 mg) was given twice weekly to suppress the proliferative response as monitored by in vitro immunologic assays. Baboons in group I had a mean survival of 8 days; all died as a result of classic cellular rejection. Baboons in group II had a mean survival of 48.4 days (p < 0.05 versus group I). Two died during rescue therapy for rejection, and three died of cytomegalovirus infection. Two group II baboons showed mild rejection at autopsy. Baboons in group III had a mean survival of 127 days, and one baboon was still alive after 286 days. Two died of cytomegalovirus infection, one of toxoplasmosis, one of Klebsiella pneumoniae, one of massive micropulmonary embolism, one of renal failure aggravated by ganciclovir. Only two of the baboons that died showed rejection (estimated as mild) at autopsy. The baboon still alive at 286 days had no rejection on myocardial biopsy on the two hundred forty-fourth postoperative day. FK 506 coupled with low-dose maintenance methotrexate and splenectomy has produced prolonged host survival in this xenotransplantation model. Results suggest that concordant xenotransplantation would be a suitable biologic bridge to allotransplantation.

More and better services for people with learning disabilities.

A prevalence study of disability, use of and need for services was undertaken to estimate the need for NHS and other forms of residential, day and respite care for people with severe learning disabilities. Subjects aged 20 or more were drawn from the Leicestershire Learning Disabilities Register (n = 1887). Information was collected by interview with a professional career. The age-specific prevalence was 2.9 per 1000 and the response rate was 88 per cent. A disability rating predicted consultant opinion on need for NHS residential care with a sensitivity and specificity of 82 per cent. Predictive disability factors included problems with behaviour, toileting, speech, epilepsy, postural deformity and use of a wheelchair. Planning targets per 100,000 population aged 20 or more were estimated as follows: NHS residential care--47 places; other residential care--103 places; respite care--36 people; day care--224 places. The need for residential care and medical support remains eminently predictable within the new philosophical framework of provision. Since 1971 the need for NHS residential places has decreased but remains important for people with high dependence. Day care targets have increased and diversified.

Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis. Clinical and surgical implications.

BACKGROUND: Secondary involvement of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet (subaortic structures) can occur in patients with aortic valve endocarditis. The secondary involvement of these structures occurs as a result of direct extension of the infection from the aortic valve or as a result of an infected aortic regurgitant jet striking the ventricular surfaces of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet. The abscess of mitral-aortic intervalvular fibrosa can expand to form an aneurysm. Subsequently, this mitral-aortic intervalvular fibrosa aneurysm can develop a perforation and communicate with the left atrium, resulting in the systolic regurgitation of blood from the left ventricular outflow tract into the left atrium. Secondary infection can also occur on the ventricular surface of the anterior mitral leaflet and result in the formation of an aneurysm or perforation of anterior mitral leaflet. METHODS AND RESULTS: This study examines the utility of transesophageal echocardiography in the detection of these subaortic complications in 55 consecutive patients with aortic valve endocarditis. A total of 24 patients (44%) had involvement of subaortic structures, including four with an abscess in the mitral-aortic intervalvular fibrosa, four with mitral-aortic intervalvular fibrosa aneurysm, seven with perforation of the mitral-aortic intervalvular fibrosa with communication into the left atrium, two with an aneurysm of the anterior mitral leaflet, and seven with perforation of the anterior mitral leaflet. The transesophageal echocardiographic findings were confirmed at surgery in 20 patients and at necropsy in two. By comparison, transthoracic echocardiography visualized these lesions in five of 24 patients (21%), including none of four with mitral-aortic intervalvular fibrosa abscesses, two of four with mitral-aortic intervalvular fibrosa aneurysms, one of seven with mitral-aortic intervalvular fibrosa perforations, one of two with anterior mitral leaflet aneurysms, and one of seven anterior mitral leaflet perforations. Eccentric mitral regurgitation-type systolic jets were noted in eight additional patients by transthoracic color flow imaging, and this finding suggested the possibility of these unusual subaortic complications. If these patients are included, then transthoracic echocardiography suggested the presence of these subaortic complications in 13 of 24 patients (54%). CONCLUSIONS: The results indicate that 1) involvement of the subaortic structures in patients with aortic valve endocarditis may be more common than previously recognized, 2) patients with aortic valve endocarditis and eccentric jets of mitral regurgitation on transthoracic echocardiography should undergo further evaluation by transesophageal echocardiography to exclude these unusual complications, 3) precise recognition of these complications is of value in the optimal medical and surgical management of these patients, and 4) these complications may be responsible for unexplained congestive heart failure and hemodynamic deterioration in some patients with aortic valve endocarditis.

Can anatomical left ventricular mass be estimated reliably by M-mode echocardiography? A clinicopathological study of ninety-three patients.

To evaluate the accuracy of M-mode echocardiography in the assessment of left ventricular mass, we compared various echocardiography-derived regression equations for left ventricular mass to postmortem left ventricular weights in 93 patients (mean age 68 +/- 11 years) who had autopsy within 30 days of technically adequate two-dimensional guided M-mode echocardiography and who had normal left ventricular shape. The left ventricle was enlarged in 36 patients (39%) and was involved by chronic ischemic disease in 48 patients (52%). Only a modest correlation was found between M-mode echocardiography and anatomical left ventricular mass (range of correlation coefficients, 0.58 to 0.67). Each echocardiographic formula demonstrated increasing deviations as left ventricular mass increased. A previously suggested correction formula lessened overestimation, but considerable data dispersion remained. Regional wall-motion abnormalities, present in 22%, did not affect the correlation. We conclude that M-mode echocardiography, performed with standard methods, does not reliably estimate anatomical left ventricular mass, especially in patients with large hearts.

Embolism of brain tissue to the lung in a neonate. Report of a case and review of the literature.

Embolic cerebellar tissue was observed microscopically in the pulmonary and coronary arteries of a full-term male infant who died 1 hour after forceps delivery. Although embolization of brain tissue has been well documented after severe head trauma in adults and children, to our knowledge only 17 cases associated with birth trauma have been previously reported.

Mitral and aortic valve disease associated with ergotamine therapy for migraine. Report of two cases and review of literature.

Ergotamine has been associated with numerous vascular complications but only rarely with fibrosing disorders or valvular heart disease. Two patients are described in whom severe valvular dysfunction developed during ergotamine therapy for migraine headache. The surgically excised mitral and aortic valves were involved by a proliferative process that was strikingly similar to lesions described in patients with carcinoid heart disease and methysergide-associated valvular disease.

Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error.

Among 38 hearts from autopsies in which lymphocytic myocarditis contributed to death, 10 endomyocardial specimens from the apical septal aspect of each ventricle (760 specimens) and 6 slices of ventricular myocardium (228 slices) were evaluated for myocarditis by the Dallas criteria. For each case, the number of positive biopsy samples correlated well with the mean lymphocyte counts in biopsy tissues (P less than 0.0001) and the mean number of inflammatory foci per square centimeter in myocardial slices (P less than 0.001). Right ventricular biopsy specimens, however, were positive in only 63% of the 38 cases and 17% of the 380 specimens. Similarly, left ventricular biopsy tissues were positive in only 55% of the cases and 20% of the specimens. Sampling error was somewhat more prevalent among the 11 cases with isolated myocarditis than in the 27 with myocarditis and other illnesses. Even when 10 biopsy specimens per ventricle were evaluated, the frequency of false-negative results was 45% for the left and 37% for the right ventricle. Although myocarditis was noted in 68% of the 38 septal slices, it involved the subendocardium of the right ventricle (from which biopsy specimens are usually obtained) in only 24%. Because of the mild and focal nature of the inflammatory infiltrates and involvement of regions inaccessible to the bioptome, sampling error contributes appreciably to false-negative results in endomyocardial biopsy tissue from patients with myocarditis. Thus, when myocarditis is evaluated by biopsy alone, only positive findings are considered diagnostic.

Clinical and therapeutic monitoring of epilepsy in a mental handicap unit.

Within a group of hospitals for the mentally handicapped serving the Leicestershire district, a cohort of 215 epileptic patients was identified, who were followed up for four years. The anticonvulsant medication of each patient was reviewed regularly until an optimal balance between seizure control, absence of medication side-effects, and reduction of polypharmacy was attained. After four years 172 patients remained in the study. A significant reduction in polypharmacy was attained overall. Some groups of patients showed a significant reduction in the frequency of seizures, while a small group of patients with frequent seizures remained difficult to control.