World Health Organization initiative to estimate the global burden of foodborne diseases.

Foodborne diseases are a multi-sectoral public health risk closely linked with the agricultural and animal health sectors. Many foodborne diseases are zoonotic in nature. The World Health Organization (WHO) seeks to measure for the first time the real impact of foodborne diseases through the advice of its independent expert body, the Foodborne Disease Burden Epidemiology Reference Group (FERG). Through the FERG, the WHO works on both assembling and appraising existing data as well as supporting countries in conducting their own studies into the national burden of foodborne disease. This is complemented by efforts to ensure thatthe findings are meaningful and useable to policy-makers and other research end-users to implement informed policy and interventions. For the Initiative to operate effectively and achieve its objectives, linkages and collaboration at all levels, especially at the human-animal interface, need to be fostered.

Bianisotropy and spatial dispersion in highly anisotropic near-infrared resonator arrays.

We measure, simulate, and analyze the optical transmission through arrays of Ag nanorod pairs and U-shaped nanostructures as a function of polarization and angle of incidence. The bianisotropic nature of the metamaterials is exhibited in data and in simulations, and we argue that the electric field rather than the magnetic field excites the low frequency "magnetic" mode. We also observe spatial dispersion in the form of frequency shifts as a function of incident angle which we attribute to coupling effects between neighboring structures. A simple model based upon coupled electromagnetic dipoles is found to provide a qualitative description for the main features observed in the spectra.

Optical plasmonic resonances in split-ring resonator structures: an improved LC model.

We systematically investigate the resonant behavior of arrays of Ag nano-structures ranging from isolated simple rods, to U-shapes, to single split ring structures. We show that the lowest order plasmonic resonance associated with a rod red shifts as we create a U and SRR into the position normally associated with a simple LC mode. A second mode red shifts and grows in intensity as we extend the arms of the U-shape, and a third mode appears in the spectra as we close the arms and form a split ring structure. We performed simulations of the structures and examine the E-field and current density. The simulations show that the current path is different for these modes. We examine the behavior of the lowest order mode in detail, discuss the effects of skin depth, and present an improved LC model to describe this resonance.

Enhanced fluorescence from periodic arrays of silver nanoparticles.

Electron beam lithography was used to fabricate silver nanoparticle arrays and study the effects of geometrical properties of particles on metal-enhanced fluorescence. Nanoparticle size, shape, interparticle spacing, and nominal thickness were varied in a combinatorial pattern for investigation of the particle plasmon resonance effect on enhancement of fluorescence from three different fluorophores; Fluorescein, Cy3, and Cy5. A specific geometric property for optimal enhancement from each fluorophore was determined. For interparticle spacings greater or equal to 270 nm, the enhancement matched what is expected for a single-particle model. For those particles smaller than 210 nm, the enhancement was lower than for the larger spacing in the range studied. Triangular-shaped particles gave similar enhancement to those of square-shaped particles. This combinatorial pattern by e-beam lithography was found to be useful for studying how individual parameters enhance the fluorescence that are important for rational design of enhanced fluorescence sensors.

Carotid artery angioplasty for restenosis following endarterectomy.

INTRODUCTION: The higher complication rate associated with the surgical treatment of restenosis following carotid endarterectomy (CEA) has led several authors to advocate angioplasty as the treatment of choice in the management of restenosis. We describe our experience with internal carotid artery angioplasty for post-endarterectomy restenosis over 7 years. PATIENTS AND METHODS: From January 1994 to April 2001, all patients with a >90% restenosis following CEA were considered for angioplasty. Thirty angioplasties were carried out in 25 patients, 80% (24/30), for asymptomatic recurrent stenosis. There was no difference between those who had intervention for recurrent stenosis (n=31) and those who did not (n=545) in age, sex, smoking status or incidence of diabetes or hypertension. A significantly greater number of patients who underwent angioplasty were hypercholesterolaemic (p<0.05, Chi-squared test). RESULTS: Mean time from surgery to angioplasty was 13 months (range 1-23). Angioplasty was technically successful in 29 cases (97%). Three patients (10%) experienced transient neurological symptoms during the procedure. There were no strokes. Ninety-six percent (28/29) of patients were followed up with duplex scanning. Mean follow-up was 20 months (range 2-48). Three patients developed a greater than 90% restenosis. CONCLUSION: Angioplasty is an acceptable alternative to surgery in the management of internal carotid artery restenosis following endarterectomy.

The introduction of laparoscopic cholecystectomy--audit of transition period with late follow-up.

The operative treatment of 356 consecutive patients with gallstone related disease who presented in the thirty months following the introduction of laparoscopic cholecystectomy was reviewed. A standard questionnaire, with emphasis on total hospital stay (including convalescence), late postoperative morbidity and time to return to work/full activity was sent to all patients. Two hundred and ninety-eight patients responded (83%). The median duration of follow-up was 19 months, (range 6-36 months). Patients who underwent laparoscopic cholecystectomy spent significantly less time in hospital post-operatively (median 3 days, interquartile range 2-4) than either those who required conversion to open cholecystectomy (median 7.5 days, interquartile range 5.5-10) or those who had planned open cholecystectomy (median 9.5 days, interquartile range 5-13), (p < 0.001, Kruskal-Wallis). Planned gall bladder extraction through the umbilical port site was associated with a significantly higher probability of wound infection compared with extraction through the epigastric port site (chi 2 = 4.977, P < 0.05). The median time to return to work/full activity was significantly shorter after laparoscopic cholecystectomy (median 21 days, interquartile range 14-42), than after open cholecystectomy (median 42 days, interquartile range 21-60) or following conversion to open cholecystectomy (median 56 days, interquartile range 35-60). We conclude that laparoscopic cholecystectomy requires a significantly shorter hospitalisation than open cholecystectomy and facilitates early return to work/full activity.

Treatment with coumarin to prevent or delay recurrence of malignant melanoma.

Both coumarin (1,2-benzopyrone) and warfarin (4-hydroxycoumarin) have been shown to prevent the recurrence of malignant melanoma. Their action is macrophage-dependent and the dosage is critical. In 1984 a multicentre, prospective, randomised, double-blind trial of coumarin, given as a daily 50-mg dose for 2 years after surgery in patients with high-risk melanoma, was started. the patients had lesions greater than 1.70 mm thick and TNM stage IB or stage II disease. To date there are 4 recurrences in the coumarin-treated group of 13 patients, and 10 recurrences in the placebo-treated group of 14 patients (P < 0.01). There were no toxic effects.

Fine needle aspiration cytology of thyroid nodules: review of 36 months experience.

Studies suggest that fine needle aspiration of thyroid nodules is a sensitive and specific tool for the detection of thyroid cancers thus preventing unnecessary operations. This technique was introduced in our institution in 1987 and performed where indicated under strictly defined criteria. We reviewed the aspirates performed over a 36 month period to critically evaluate the role of this procedure. Review was limited to F.N.A.s of nodules considered to be potentially malignant by conventional criteria and hence all the following criteria needed to be fulfilled: (1) solitary or dominant nodules in a multinodular goitre, (2) cold on isotope scanning, (3) solid or complex cystic nodule on ultrasonography. During the period May 1987 to May 1990 88 aspiration procedures were performed on 77 patients. 93% of the 77 patients had adequate aspirates and of these approximately 30% were considered suspicious or malignant. The overall resection rate was 23.4% which is approximately one third of the rate expected should suspicion have been based solely on conventional imaging criteria. The yield of neoplasia (adenoma and carcinoma) at resection was 89%. We found FNA to be a very useful adjunct in the management of nodular thyroid disease when used in conjunction with clinical laboratory and radiological evaluation. It is safe, inexpensive and provides useful additional information towards making appropriate decisions in an area beset with uncertainty.

Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right.

Many recent reports in the North American literature have documented an increase in the ratio of proximal to distal colorectal cancers with an increase in right-sided lesions. In order to assess trends in the distribution of large bowel carcinoma at our hospital we reviewed the files of 1553 patients who presented with primary colorectal carcinoma over a 30-year period. Thirty-nine percent of patients were over 70 years old and 51% were in the 50-69 year age group. Seventy five percent of the carcinomas were left-sided, 22% right-sided and caecal carcinomas accounted for 18%. This distribution varied only slightly over the study period. Left-sided lesions were more common in males (55%: p less than 0.005), and right-sided lesions were more common in females (57%: p less than 0.005). Caecal carcinoma was more common in patients over 69 years old than in younger patients (p less than 0.001). In elderly females (greater than 69 years) 30% of colorectal carcinomas occurred in the caecum. These findings may have important implications for the investigation of patients with suspected colorectal disease or for screening programmes.

Fatal gastric artery dissection and rupture occurring as a paraesophageal mass: a case report and literature review.

Gastric artery aneurysms are rare, and the majority occur as life-threatening hemorrhage with few premonitory signs or symptoms. We report an unusual hemorrhagic manifestation of a ruptured gastric artery aneurysm, occurring as a pleural effusion and an apparent paraesophageal mass. Acute intraperitoneal and mediastinal bleeding from the extravisceral portion of the left gastric artery resulted in hemorrhagic shock, prompting an emergency laparotomy. Extensive medial degeneration in the gastric artery probably contributed to dissection and rupture.

Acute renal failure of renovascular origin: cure by aortorenal reconstruction after 25 days of anuria.

A case of dialysis-dependent acute renal failure due to bilateral renal artery occlusion is described. Renal function was improved dramatically by revascularization after 25 days of anuria and no further dialysis was required.

Prevention of early recurrence of high risk malignant melanoma by coumarin. Irish Melanoma Group.

Coumarin (1,2-benzopyrone) as a daily oral dose of 50 mg was evaluated in a multicentre prospectively randomized, double-blind, placebo-controlled trial to prevent early recurrence of malignant melanoma TNM Stage IB (Breslow thickness greater than 1.70 mm) and Stage II. Intake for the trial started in 1984 and was stopped prematurely, after review, in 1987. There were two recurrences in 13 treated patients and 10 in 14 controls which was significant (P 0.01). The sites of the metastases differed in each group, being local and in bone in the treated group, and in lymph nodes, skin and lung in the control group. There were no toxic effects associated with coumarin treatment and all patients without recurrence are now receiving coumarin.

Diagnostic and prognostic problems in early gastric cancer.

Although common in Japan, early gastric cancer is rarely seen in Western countries and generally accounts for only 7 to 10 percent of all gastric malignancies. Eleven patients with early gastric cancer seen over a 10 year period have been reviewed for clinical and pathologic features, method of diagnosis, treatment, and prognosis. The symptoms usually consisted of vague epigastric pain or dyspepsia, but anorexia, weight loss, anemia, and hypoalbuminemia were not commonly seen. Barium meal examination was not helpful in the diagnosis in 50 percent of the patients. The diagnosis was made by endoscopic biopsy of abnormal areas of the stomach, although in 6 of 11 patients, there was no macroscopic suspicion of malignancy. All patients were treated by surgical resection. The tumor was confined to the mucosa in five patients and had infiltrated the submucosa in six patients. The lymph nodes were free of tumor in every patient. At last follow-up, seven patients had survived more than 5 years after operation and were well, although recurrent tumors developed in two patients 3 and 4 years postoperatively but were detected early by endoscopic surveillance. Early gastric cancer has a good prognosis after surgical resection, but the symptoms are vague and the diagnostic tests can be misleading. A vigorous approach to investigation, treatment, and follow-up is necessary to achieve satisfactory results.

Solitary familial desmoplastic trichoepithelioma. A study by conventional and electron microscopy.

Solitary desmoplastic trichoepitheliomas from a mother and two daughters were studied by conventional and electron microscopy. Differential diagnosis by conventional microscopy is briefly discussed. The lesions consisted of cords and nests of basaloid cells set in fibrotic stroma and confined to the dermis. In addition, each lesion contained horn cysts and focal areas of calcification. Horn cysts were occasionally identified in continuity with infundibulae of normal hair follicles. Semithin sections showed cords and nests of cells in continuity with the horn cysts. Ultrastructurally, a continuous basal lamina surrounded the cords of basaloid cells and connected to horn cysts. Individual cells contained tonofilaments and were attached to adjacent cells by desmosomes. Hemidesmosomes were present at peripheral cell membranes bounded by basal lamina. There was no glandular differentiation. Our observations by electron and conventional microscopy support a conclusion that desmoplastic trichoepitheliomas are derived from hair appendages.