Gallstone ileus 30 years status postcholecystectomy.

Gallstone ileus is an uncommon cause of small bowel obstruction which occurs in patients with chronic cholecystitis and gallstones who develop a cholecystoenteric fistula. Although gallstone ileus is relatively rare, it has a substantial mortality rate due in part to patient comorbidities and delays in treatment. We describe the case of a 94-year-old woman who presented with nausea, vomiting, mild abdominal tenderness, leukocytosis, and a 2.5-cm obstruction in her small bowel. Even though this patient underwent a total cholecystectomy 30 years prior, a 2.5-cm gallstone was surgically removed from her ileum. This case illustrates the importance of including gallstone ileus in the differential diagnosis for patients who present with small bowel obstruction even decades postcholecystectomy.

Recurrence and spontaneous remission of membranous nephropathy after renal transplantation.

Membranous nephropathy is the most frequent cause of nephrotic syndrome in adults and the reason for renal failure and dialysis in 5%. After renal transplantation, recurrent membranous nephropathy occurs in 10 - 30%. There is no established therapy for recurrent membranous nephropathy. This case report describes a probably spontaneous clinical remission of a recurrent membranous nephropathy after renal transplantation. The message of the case report is that there could be spontaneous remissions of membranous nephropathy also after renal transplantation and that remissions seen after various therapeutic maneuvers as described in case reports and case series might either be the consequence of that therapy or represent spontaneous remission.

Methoxy poly(ethylene glycol)--low molecular weight linear polyethylenimine-derived copolymers enable polyplex shielding.

Targeted gene delivery relies on the development of materials that allow for the formation of small neutrally charged particles of sufficient colloidal stability preventing non-specific interactions with cells. In order to identify a copolymer composition that combines adequate plasmid DNA (pDNA) compaction with an efficient charge-shielding effect, we synthesized a series of copolymers by covalent linkage of activated 5 or 20 kDa linear methoxy poly(ethylene glycol) (mPEG) or 10 kDa two-arm-mPEG to non-toxic low molecular weight (2.6 and 4.6 kDa) linear polyethylenimine (lPEI) at different molar ratios (mPEG-lPEI copolymers). All of the copolymers condensed pEGFP-N1 pDNA to form nanoparticles with hydrodynamic diameters between 150 and 420 nm - sizes that were maintained for the entire duration of measurement. PEGylated complexes exhibited a reduced particle stability in comparison to the unmodified lPEI-pDNA polyplexes, determined by gel retardation assays and DNase I experiments. Copolymer-pDNA complexes exhibited a zeta potential between -4 and 6 mV, strongly depending on the dispersion medium applied (0.15M NaCl or 5% glucose supplemented with serum-free cell culture medium). The transfection efficacy, determined in CHO-K1 (between 0.28+/-0.08% and 1.92+/-0.46%) and HeLa (between 1.02+/-0.19% and 3.53+/-0.30%) cells, was significantly reduced compared to lPEI-pDNA particles (between 3.2+/-1.3% and 38.8+/-5.5%). The architecture of the copolymer, the molecular weight of the lPEI residue, and the supplementation of endosomolytic agents (saccharose, chloroquine) all failed to impact the efficacy of gene transfer. Uptake studies, based on Confocal Laser Scanning Microscopy (CLSM) imaging and flow cytometry analysis, suggest that the use of mPEG5/3-lPEI2.6, mPEG10/2-lPEI2.6, and mPEG20-lPEI4.6 lowers unspecific internalization of the corresponding transfection complexes. This provides an ideal basis for the development of transfection vehicles for targeted gene transfer.

Synthesis and biological testings as inhibitors of HMGCoA reductase of the seco-acid of tuckolide and its C-7 epimer.

The seco-acid of the natural macrolactone, tuckolide (decarestrictin D) and the C-7 epimer have been prepared in enantiomerically pure form from D-gluconolactone and poly(3-hydroxy butyric acid). The key steps are Horner Emmons olefination and stereoselective reduction of the resulting enone to provide both epimers at C-7. None of the seco-acids inhibit microsomal HMGCoA reductase of pea or rat liver. It may be concluded that the cholesterol biosynthesis inhibiting effect of tuckolide is unlikely to proceed via HMGCoA reductase inhibition.

Surfactant-Increased Glyphosate Uptake into Plasma Membrane Vesicles Isolated from Common Lambsquarters Leaves.

Plasma membrane vesicles were isolated from mature leaves of lambsquarters (Chenopodium album L.) to investigate whether this membrane is a barrier to glyphosate uptake and whether surfactants possess differential abilities to enhance glyphosate permeability. Amino acids representing several structural classes showed [delta]pH-dependent transport, indicating that the proteins necessary for active, proton-coupled amino acid transport were present and functional. Glyphosate uptake was very low compared to the acidic amino acid glutamate, indicating that glyphosate is not utilizing an endogenous amino acid carrier to enter the leaf cells and that the plasma membrane appears to be a significant barrier to cellular uptake. In addition, glyphosate flux was much lower than that measured for either bentazon or atrazine, both lipid-permeable herbicides that diffuse through the bilayer. Glyphosate uptake was stimulated by 0.01% (v:v) MON 0818, the cationic surfactant used in the commercial formulation of this herbicide for foliar application. This concentration of surfactant did not disrupt the integrity of the plasma membrane vesicles, as evidenced by the stability of imposed pH gradients and active amino acid transport. Nonionic surfactants that disrupt the cuticle but that do not promote glyphosate toxicity in the field also increased glyphosate transport into the membrane vesicles. Thus, no correlation was observed between whole plant toxicity and surfactant-aided uptake. Current data suggest that surfactant efficacy may be the result of charged surfactants' ability to diffuse away from the cuticle into the subtending apoplastic space, where they act directly on the plasma membrane to increase glyphosate uptake.

Site of clomazone action in tolerant-soybean and susceptible-cotton photomixotrophic cell suspension cultures.

Studies were conducted to determine the herbicidal site of clomazone action in tolerant-soybean (Glycine max [L.] Merr. cv Corsoy) (SB-M) and susceptible-cotton (Gossypium hirsutum [L.] cv Stoneville 825) (COT-M) photomixotrophic cell suspension cultures. Although a 10 micromolar clomazone treatment did not significantly reduce the terpene or mixed terpenoid content (microgram per gram fresh weight) of the SB-M cell line, there was over a 70% reduction in the chlorophyll (Chl), carotenoid (CAR), and plastoquinone (PQ) content of the COT-M cell line. The tocopherol (TOC) content was reduced only 35.6%. Reductions in the levels of Chl, CAR, TOC, and PQ indicate that the site of clomazone action in COT-M cells is prior to geranylgeranyl pyrophosphate (GGPP). The clomazone treatment did not significantly reduce the flow of [(14)C]mevalonate ([(14)C]MEV) (nanocuries per gram fresh weight) into CAR and the three mixed terpenoid compounds of SB-M cells. Conversely, [(14)C]MEV incorporation into CAR and the terpene moieties of Chl, PQ, and TOC in COT-M cells was reduced at least 73%, indicating that the site of clomazone action must be after MEV. Sequestration of clomazone away from the chloroplast cannot account for soybean tolerance to clomazone since chloroplasts isolated from both cell lines incubated with [(14)C]clomazone contained a similar amount of radioactivity (disintegrations per minute per microgram of Chl). The possible site(s) of clomazone inhibition include mevalonate kinase, phosphomevalonate kinase, pyrophosphomevalonate decarboxylase, isopentenyl pyrophosphate isomerase, and/or a prenyl transferase.

Uptake and metabolism of clomazone in tolerant-soybean and susceptible-cotton photomixotrophic cell suspension cultures.

Studies were conducted to determine the uptake and metabolism of the pigment synthesis inhibiting herbicide clomazone in tolerant-soybean (Glycine max [L.] Merr. cv Corsoy) and susceptible-cotton (Gossypium hirsutum [L.] cv Stoneville 825) photomixotrophic cell suspensions. Soybean and cotton on a whole plant level are tolerant and susceptible to clomazone, respectively. Preliminary studies indicated that I(50) values for growth, chlorophyll (Chl), beta-carotene, and lutein were, respectively, >22, 14, 19, and 23 times greater for the soybean cell line (SB-M) 8 days after treatment (DAT) compared to the cotton cell line (COT-M) 16 DAT. Differences in [(14)C]clomazone uptake cannot account for selectivity since there were significantly greater levels of clomazone absorbed by the SB-M cells compared to the COT-M cells for each treatment. The percentage of absorbed clomazone converted to more polar metabolite(s) was significantly greater by the SB-M cells relative to COT-M cells at 6 and 24 hours after treatment, however, only small differences existed between the cell lines by 48 hours after treatment. Nearly identical levels of parental clomazone was recovered from both cell lines for all treatments. A pooled metabolite fraction isolated from SB-M cells had no effect on the leaf pigment content of susceptible velvetleaf (Abutilon theophrasti Medic.) or soybean seedlings. Conversely, a pooled metabolite fraction from COT-M cells reduced the leaf Chl content of velvetleaf. Soybean tolerance to clomazone appears to be due to differential metabolism (bioactivation) and/or differences at the site of action.

[Spontaneous splenorenal shunt in liver cirrhosis]. / Spontaner spleno-renaler Shunt bei Leberzirrhose.

A 52 year old patient was admitted to the hospital for further clarification of a cystic structure in the region of the spleen hilus noticed in the upper abdominal sonogram. The investigations revealed a spontaneous splenorenal shunt in hepatic cirrhosis.

[Factors interfering with the dexamethasone suppression test]. / Störfaktoren beim Dexamethason-Hemmtest.

The interpretation of the dexamethasone suppression test in endocrinology and psychiatry depends on several variables. False-positive results can be caused by stress, weight loss, alcohol withdrawal, treatment with diphenylhydantoin, phenobarbital, rifampicin, carbamazepine and lithium. Therapy with spironolactone, naloxone, alpha 1-mimetic agents and estrogen can be responsible for an increase in plasma-cortisol concentration. False-negative results are seen in patients with liver disease and can also result from therapy with benzodiazepines at high dosages, indomethacin and possibly methadone and ketoconazole.

Inhibition of pitted morning glory (Ipomoea lacunosa L.) and certain other weed species by phytotoxic components of wheat (Triticum aestivum L.) straw.

This study was conducted to determine if well-known phytotoxic effects of plant residues on crop growth could also be responsible for observed reductions of certain weed species in no-till cropping systems. An aqueous extract of field-grown wheat (Triticum aestivum L.) reduced the germination and root length of pitted morning glory (Ipomoea lacunosa L.) and common ragweed (Ambrosia artemisiifolia L.). Phytotoxicity was increased by about 70% when bioassays with the wheat extract on morning glory and ragweed were conducted in the presence of light. Phytotoxic substances were extracted from wheat with 2 N NaOH. The hydrolyzed extract was fractionated by thin-layer chromatography (TLC). The compound isolated by TLC having the greatest inhibitory effects on morning glory germination was identified using mass spectrometry and determined to be ferulic acid (4-hydroxy-3-methoxycinnamic acid). Ferulic acid at 5 × 10(3) M inhibited the germination and root length of morning glory 23 and 82%, respectively, and prickly sida (Sida spinosa L.) with carpels 85 and 82%, respectively. Crabgrass (Digitaria sanguinalis L.) germination was inhibited 100%. Ferulic acid had no effect on ragweed or prickly sida without carpels. Morning glory root and shoot biomass were reduced 52 and 26%, respectively, when morning glory was grown in sand and watered with a 5 × 10(3) M solution of ferulic acid. Ferulic acid in the presence of prickly sida seed carpels was found to undergo decarboxylation, forming a styrene derivative, 2-methoxy-4-ethenylphenol. The more phytotoxic styrene compound was produced by a bacterium isolated from the carpels of prickly sida seed. The study showed that ferulic acid and other compounds may indeed play a role in reducing the growth of certain weeds in no-tillage cropping systems.

Repeated dexamethasone suppression test during depressive illness. Normalisation of test result compared with clinical improvement.

Serial plasma cortisol concentrations were recorded under controlled conditions after an overnight dexamethasone suppression (DST) in 20 depressed patients with initially abnormal test results. The cortisol levels were related to clinical course. All 20 patients showed normalisation of hypothalamic-pituitary-adrenal (HPA) hyperactivity, a mean of 3.4 +/- 1.8 weeks before clinical recovery was achieved. In 4 clinically remitted patients the endocrine disturbance as evidenced by abnormal DST results preceded a depressive relapse. DST results did not appear to be affected by psychotropic drugs including benzodiazepines.

[Changes in the temporomandibular joint after orthodontic interventions]. / Kiefergelenksveränderungen nach kieferorthopädischen Operationen.

Temporomandibular joint alterations were reported which were determined on the basis of reproducible preoperative and postoperative roentgenograms. The films were produced with the help of the Hanel. C arch in the transcranial, lateral oblique projection. Displacements were demonstrated particularly in the anterior and the caudal directions. This method however does not allow a definite statement to be made concerning the postoperative position of the condyles.

[Kryptophthalmus syndrome (author's transl)]. / Kryptophthalmus-Syndrom.

This peper describes the rare cryptophthalmus syndrome combined with several other malformations of the urogenital tract and of the nose, in addition to dyscephalia and cutaneous syndactilism of fingers and toes. Because of a high incidence of parental consanguinity autosomal recessive heredity is discussed.