Calcifications simulating sialolithiasis of the major salivary glands.

Calcifications found in routine and normal radiographs of the oral and facial region may turn out to be an interesting diagnosis. Although most of the radiopacities may be sialoliths, other differential diagnoses must not be exempted, such as calcified lymph nodes, phleboliths and other vascular calcifications, tuberculosis of lymph nodes or of the salivary gland itself. Several cases are presented which simulated pathological calcifications of the orofacial region and were diagnosed primarily as sialoliths, but further examinations revealed other pathology. These cases together with several suggested diagnostic modalities are discussed in this paper.

Ensembl 2006.

The Ensembl (http://www.ensembl.org/) project provides a comprehensive and integrated source of annotation of large genome sequences. Over the last year the number of genomes available from the Ensembl site has increased from 4 to 19, with the addition of the mammalian genomes of Rhesus macaque and Opossum, the chordate genome of Ciona intestinalis and the import and integration of the yeast genome. The year has also seen extensive improvements to both data analysis and presentation, with the introduction of a redesigned website, the addition of RNA gene and regulatory annotation and substantial improvements to the integration of human genome variation data.

Effects of low-dose aspirin on blood pressure and endothelial function of treated hypertensive hypercholesterolaemic subjects.

The main objective of this study was to assess whether aspirin 100 mg QD can improve blood pressure (BP) control and endothelial function in subjects with arterial hypertension (AH) and hypercholesterolaemia. In total, 21 patients of both sexes (52.1+/-11.5 years) with treated AH and hypercholesterolaemia on antihypertensive and statin therapy were included in the treatment group. In the control group, 20 matched patients of both sexes (51.3+/-12.7 years), but without statin therapy, were recruited. Treatment group subjects received aspirin (100 mg QD) for a duration of 12 weeks at randomization (Treatment phase-1), followed by single blind matching placebo for 12 weeks (Placebo phase) and then again received aspirin (100 mg QD) for an additional 12 weeks (Treatment phase-2). The control group participated in Treatment phase-1, but did not continue Placebo phase and Treatment phase-2. At randomization and at the end of each study phase, mean 24-h systolic BP (SBP) and diastolic BP (DBP) were assessed by 24-h ambulatory blood pressure monitoring (ABPM) and endothelium-dependent (flow mediated, FMD) and -independent (nitroglycerin induced, NTG) vasodilatations of brachial artery were measured using high-resolution ultrasound. In Treatment phase-1, reduction of SBP and DBP (DeltaSBP 5.7+/-2.6 mmHg, P=0.008; DeltaDBP 3.8+/-1.7 mmHg, P=0.014) and improvement of FMD (4.1+/-0.6%, P=0.019), in Placebo phase an elevation of SBP and DBP (DeltaSBP -6.2+/-2.9 mmHg, P=0.002; DeltaDBP -4.2+/-1.9 mmHg, P=0.031) and worsening of FMD (-3.8+/-0.9%, P=0.027), and in Treatment phase-2 reduction of SBP and DBP (DeltaSBP 4.9+/-2.3 mmHg, P=0.005; DeltaDBP 4.1+/-1.3 mmHg, P=0.024) and improvement of FMD (4.5+/-1.3%, P=0.009) were observed in the treatment Group but not in the control group. Addition of low-dose aspirin to antihypertensive medications and statins in hypertensive and hypercholesterolaemic subjects can reduce both SBP and DBP by improvement of endothelial function.

Penetrating grease gun injury in the face.

We present the case of a sailor who sustained a penetrating grease gun injury to his face, and the challenging subsequent series of events.

Ensembl 2005.

The Ensembl (http://www.ensembl.org/) project provides a comprehensive and integrated source of annotation of large genome sequences. Over the last year the number of genomes available from the Ensembl site has increased by 7 to 16, with the addition of the six vertebrate genomes of chimpanzee, dog, cow, chicken, tetraodon and frog and the insect genome of honeybee. The majority have been annotated automatically using the Ensembl gene build system, showing its flexibility to reliably annotate a wide variety of genomes. With the increased number of vertebrate genomes, the comparative analysis provided to users has been greatly improved, with new website interfaces allowing annotation of different genomes to be directly compared. The Ensembl software system is being increasingly widely reused in different projects showing the benefits of a completely open approach to software development and distribution.

Impaired nitric oxide production, brachial artery reactivity and fish oil in offspring of ischaemic heart disease patients.

The offspring of coronary heart disease (CHD) patients are at particularly high risk for developing CHD. Endothelial dysfunction is present in the majority of CHD and atherosclerosis patients. Fish oil, rich in n-3 fatty acids has been shown to augment endothelium-dependent vasodilatation in human peripheral and coronary arteries. The aims of this study are to investigate presence of endothelial dysfunction determined by the brachial flow-mediated diameter, nitric oxide, plasma lipids and fibrinogen, and the effect of high doses of fish oil on these parameters. Twenty-four healthy offspring of CHD patients (study group) were supplemented with 9 g/day Alsepa fish oil (each gram containing 180 mg EPA and 120 mg DHA), for a period of two weeks. Plasma nitric oxide, urine nitric oxide, fibrinogens and flow-mediated vasodilatation (FMD) were determined prior to fish oil therapy, two weeks into therapy and four weeks after the end of therapy with fish oil. Twelve healthy subjects (control group) with no family history of heart disease were studied as controls (day one only). The offspring had a lower increase in FMD and lower nitric oxide production, compared with the control group. No other parameters varied between the two groups. The administration of fish oil did not result in any changes in the studied parameters. In healthy offspring of CHD patients, early endothelial dysfunction was documented before evidence of atherosclerosis. Ingestion of fish oil over a 13-day period did not improve endothelial dysfunction.

Maurotoxin: a potent inhibitor of intermediate conductance Ca2+-activated potassium channels.

Maurotoxin, a 34-amino acid toxin from Scorpio maurus scorpion venom, was examined for its ability to inhibit cloned human SK (SK1, SK2, and SK3), IK1, and Slo1 calcium-activated potassium (K(Ca)) channels. Maurotoxin was found to produce a potent inhibition of Ca(2+)-activated (86)Rb efflux (IC(50), 1.4 nM) and inwardly rectifying potassium currents (IC(50), 1 nM) in CHO cells stably expressing IK1. In contrast, maurotoxin produced no inhibition of SK1, SK2, and SK3 small-conductance or Slo1 large-conductance K(Ca) channels at up to 1 microM in physiologically relevant ionic strength buffers. Maurotoxin did inhibit (86)Rb efflux (IC(50), 45 nM) through, and (125)I-apamin binding (K(i), 10 nM) to SK channels in low ionic strength buffers (i.e., 18 mM sodium, 250 mM sucrose), which is consistent with previous reports of inhibition of apamin binding to brain synaptosomes. Under similar low ionic strength conditions, the potency for maurotoxin inhibition of IK1 increased by approximately 100-fold (IC(50), 14 pM). In agreement with its ability to inhibit recombinant IK1 potassium channels, maurotoxin was found to potently inhibit the Gardos channel in human red blood cells and to inhibit the K(Ca) in activated human T lymphocytes without affecting the voltage-gated potassium current encoded by Kv1.3. Maurotoxin also did not inhibit Kv1.1 potassium channels but potently blocked Kv1.2 (IC(50), 0.1 nM). Mutation analysis indicates that similar amino acid residues contribute to the blocking activity of both IK1 and Kv1.2. The results from this study show that maurotoxin is a potent inhibitor of the IK1 subclass of K(Ca) potassium channels and may serve as a useful tool for further defining the physiological role of this channel subtype.

Color Doppler sonography: its real role in the evaluation of children with highly suspected testicular torsion.

The goal of this study was to assess the reliability of color Doppler imaging in boys who presented with acute scrotal pain and borderline clinical findings. The second purpose of the study was to evaluate the potential change in diagnostic accuracy as a result of employing radiological staff with varying levels of experience. Thirty-eight consecutive patients with highly suspected testicular torsion were enrolled in this prospective study. Clinical examination was followed by color Doppler US (7.5-MHz transducer). The staff of radiologists included four residents and three experienced radiologists. All patients underwent surgical exploration. All original reports of residents were reviewed by experienced radiologists and sensitivity with specificity were determined and compared. Original interpretations of color Doppler imaging yielded sensitivity of 77.8% and specificity of 85%, which changed after review to 88.9 and 90%, respectively. Clinical assessment was accurate only in 47.4%. Agreement between original and retrospective color Doppler diagnosis was obtained in 20 of 23 (86.9%) reviewed cases. Color Doppler US may prevent unnecessary surgery in the cases with conclusive normal and increased blood flow. In all other situations scrotal exploration should be performed.

The prevalence of gastroesophageal reflux in children with tracheomalacia and laryngomalacia.

OBJECTIVE: We conducted a retrospective study to determine the relationship between gastroesophageal reflux (GER) and large airways malacia in infancy. METHODS: One hundred sixteen children referred for chronic respiratory problems who were between the ages of 3 and 28 months were investigated. All of them underwent flexible bronchoscopy and chest radiography. Eighteen children had laryngomalacia, 13 had tracheomalacia, and 23 had combined laryngotracheomalacia. During bronchoscopy, BAL was performed. An analysis of macrophages in the BAL fluid for lipid content was performed. Fifty-four children with laryngomalacia and tracheomalacia constituted the study group, and 62 children were in the control group. Reflux studies were obtained for 40 children from the study group and 41 from the control group. RESULTS: In the study group, 28 children (70%) had GER documented by reflux studies compared with 16 children (39%) in the control group (p < 0.01). In the control group, GER was found mainly among those with recurrent bilateral pneumonia. The lipid-laden macrophage score was correlated with the documented GER. CONCLUSION: GER is prevalent among infants with large airways malacia, and treatment of this group with antireflux therapy should be considered.

Huge renal arteriovenous malformation mimicking a simple para-pelvic cyst.

The presenting symptoms of renal arteriovenous malformation are usually gross hematuria and hypertension. Herein we present an unusual case of a huge renal arteriovenous malformation without these signs, but with an ultrasound picture mimicking a simple para-pelvic cyst. Other imaging tests, including duplex ultrasound, computerized tomography and aortography, demonstrated the vascular lesion. We suggest that duplex ultrasound should accompany routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests an intra-abdominal vascular lesion or bleeding.

Extracting weak phase information from B-->V1V2 decays

We describe a new method for extracting weak, CP-violating &Dmacr;phase information, with no hadronic uncertainties, from an angular analysis of B-->V1V2 decays, where V1 and V2 are vector mesons. The quantity sin (2)(2beta+gamma) can be cleanly obtained from the study of decays such as B(0)(d)(t)-->D*+/-rho(-/+), D(*+/-)a(-/+)(1), D(;) *0K(;) (*0), etc. Similarly, one can use B(0)(s)(t)-->D(*+/-)(s)K*-/+ to extract sin (2)gamma. There are no penguin contributions to these decays. It is possible that sin (2)(2beta+gamma) will be the second function of CP phases, after sin2beta, to be measured at B factories.

Interpretation of immediate exercise treadmill test: interreader reliability between cardiologist and noncardiologist in a chest pain evaluation unit.

STUDY OBJECTIVE: To determine whether attending physicians in a chest pain evaluation unit (CPEU) can perform and interpret exercise testing with the same accuracy as cardiologists. METHODS: Between January 1996 and November 1998, immediate exercise tests were performed and interpreted by internists with additional training in exercise testing who serve as attending physicians in a CPEU at a large university medical center. For quality assurance, all tests were overread by a cardiologist. Test results were compared for each reader, and all tests with discrepant readings were reinterpreted by an independent cardiologist who was blinded to the previous results. Patients' clinical course was monitored for at least 30 days after exercise testing. RESULTS: The study group consisted of 645 patients (347 men, 298 women). Discrepant interpretations were found in 11 (1. 7%) patients. The agreement was 98.4% (kappa value 0.9618). The majority of discrepancies were insignificant and were based on subtle differences in the definition of a nondiagnostic test or the degree of ST-segment shift. Of the 11 discordant readings, the blinded cardiologist concurred with 5 (45%) of the CPEU interpretations and 4 (36%) of the cardiologist interpretations. In 2 cases, there was disagreement by all 3 interpreters. There was no cardiac morbidity or mortality of any patient with a discrepant reading. CONCLUSION: Our results suggest that noncardiologists serving as attending physicians in a CPEU can accurately interpret exercise tests and overreading by cardiologists for quality assurance is unnecessary.

Huge renal arteriovenous malformation mimicking simple parapelvic cyst.

The presenting symptoms of renal arteriovenous malformations are usually gross hematuria and hypertension. Herein we present an unusual case of huge renal arteriovenous malformation without these signs, but with ultrasound picture mimicking simple parapelvic cyst. Other imaging test, including Duplex ultrasound, computerized tomography and aortography, demonstrated that vascular lesion. We suggest that Duplex ultrasound should accompany the routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests intra-abdominal vascular lesion or bleeding.

Sleep apnoea: clinical importance and facilities for investigation and treatment in the UK. Addendum to the 1993 Royal College of Physicians Sleep Apnoea report.

The potential importance of the obstructive sleep apnoea syndrome (OSA) has been recognized only in the last few years. Epidemiological studies suggest that symptomatic OSA occurs in 1-2% of middle-aged men and in approximately half that number of women. The relation of OSA to vascular disease is uncertain and the main indication for treatment is the relief of disabling sleepiness. Two recent evidence based analyses have produced diametrically opposed conclusions on the efficacy of treatment with nasal continuous positive airway pressure (CPAP). However, recent controlled studies confirm the overwhelming clinical experience of benefit. Facilities for the investigation and treatment of patients with OSA in the UK are subject to severe financial constraints and the availability of CPAP treatment lags markedly behind that in other countries for which data are available.

[Salivary gland endoscopy: a new technique for diagnosis and treatment of sialolithiasis].

The use of an endoscopic, minimally invasive technique for the removal of salivary gland stones from the submandibular or parotid duct is described. A 2.0-2.7 mm endoscope is inserted into an incision in the parotid or submandibular duct. When the stone is visualized through the endoscope it is removed using suction and forceps. We used this technique in 45 cases for removal of calculi, screening the ductal system to rule out residual calculi and determination of ductal dilatation. The success rate was 80% and there were no major postoperative complications. To the best of our knowledge these are the first such cases reported in Israel.