Molecular approaches to the identification of Bulinus species in south-west Nigeria and observations on natural snail infections with schistosomes.

The current study considers the distribution of a small sample of 138 Bulinus snails, across 28 localities within eight Nigerian states. Snails were identified using a combination of molecular methods involving both DNA sequencing of a partial cytochrome oxidase subunit 1 (cox1) fragment and restriction profiles obtained from ribosomal internal transcribed spacer (its) amplicons. The results showed that the majority of Bulinus samples tested belonged to the species Bulinus truncatus while only two were Bulinus globosus. The use of RsaI restriction endonuclease to cleave the ribosomal its of Bulinus, as a method of species identification, was adopted for the majority of samples, this being a quicker and cheaper method better suited to small laboratory environments. Polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat within each of the collected Bulinus samples was employed to determine the extent and distribution of infected snails within the sample areas. Successful amplification of the Dra1 repeat demonstrated that 29.7% of snails were infected with schistosomes. Sequencing of the partial schistosome its from a small subset of snail samples suggested that some snails were either penetrated by both Schistosoma haematobium and Schistosoma bovis miracidia or hybrid miracidia formed from the two species.

Inter-specific parasite competition: mixed infections of Schistosoma mansoni and S. rodhaini in the definitive host.

Competition between parasite species has been predicted to be an important force shaping parasite and host ecology and evolution, although empirical data are often lacking. Using the Mus musculus-Schistosoma mansoni and Schistosoma rodhaini host-parasite systems we characterized mate choice and inter-specific competition between these two schistosome species. Simultaneous infections revealed species-specific mate preferences for both species as well as suggesting mating competition, with male S. rodhaini appearing dominant over male S. mansoni. S. rodhaini homologous pairs were also shown to have increased reproduction per paired female in the presence of a competitor in simultaneous infections. Overall total reproductive success was, however, similar between the two species under conditions of direct competition due to the greater initial infectivity of S. mansoni in comparison to S. rodhaini. Inter-specific competition was also implicated as increased parasite virulence to the host. The potential effects of such interactions on parasite and host ecology and evolution in nature are discussed.

A phylogeny based on three mitochondrial genes supports the division of Schistosoma intercalatum into two separate species.

Two recognized strains of Schistosoma intercalatum, one from the Democratic Republic of Congo (DRC), formerly Zaire, and the other from Cameroon, have been investigated using DNA sequences from 3 mitochondrial genes, cytochrome oxidase subunit 1 (cox1), NADH dehydrogenase subunit 6 (nad6) and the small ribosomal RNA gene (rrnS). In addition, partial DNA sequences from the nuclear large subunit ribosomal RNA gene (lsrDNA) were included within the study. Although partial lsrDNA alone reveals little taxonomic information, phylogenetic analysis of the mitochondrial data demonstrates a clear dichotomy between the 2 purported strains and it is proposed that they should be treated as distinct taxa. The 'original' S. intercalatum now falls relatively basal in the S. haematobium group, while the proposed new species is more derived and sister taxon to S. bovis and S. curassoni.

Application of single strand conformational polymorphism (SSCP) analysis with fluorescent primers for differentiation of Schistosoma haematobium group species.

To assess the utility of single-stranded conformational polymorphism (SSCP) analysis for the differentiation of schistosomes, using methods adapted for a Perkin Elmer ABI Prism 377 automated sequencer, 3 isolates of Schistosoma haematobium, 2 of S. intercalatum and single isolates of S. curassoni and S. bovis were selected for study. Two fluorescently labelled, double-stranded polymerase chain reaction products, amplified from the mitochondrial cytochrome oxidase subunit 1 (CO1) gene and the nuclear ribosomal second internal transcribed spacer (ITS2), were generated from single male and female worms. Changes in electrophoretic mobility of fragments within an SSCP profile revealed variation at individual, isolate and species levels. The mutational basis between representative SSCP profiles was confirmed by direct sequencing, demonstrating that single point substitutions were detectable. SSCP analysis has considerable potential as an alternative molecular method of identification and characterization of schistosomes. More broadly, fluorescence-based SSCP analysis is applicable to almost any gene target from any species of parasite and is a powerful molecular tool for genetic profiling.

Peroxide-enhanced anal endosonography: technique, image interpretation, and clinical applications.

Because current techniques for examination and imaging of perianal fistulas tend to underestimate the extent, location, and course of perianal fistulas--information essential for decisions about surgical management--the use of hydrogen peroxide was investigated as an image-enhancing contrast agent for confirmation of the presence of and improvement in the depiction of fistulas during endoanal ultrasonography (US). After conventional endoanal US was performed with a side-fire 7.5- or 10.0-MHz rotating endoprobe, external perianal openings were cannulated and approximately 1 mL of peroxide was administered. After reinsertion of the endoprobe, the entire course of the echogenic fistula, including its relation to the internal and external sphincters and the levator ani muscle, was depicted in real time in three dimensions. This depiction of fistulas permits accurate classification, which facilitates surgical planning. In experience with more than 60 patients, peroxide-enhanced endoanal US was found to be a useful technique for documentation of the presence, number, and internal course of perianal fistulas and for characterization of abnormalities seen at endosonography performed without use of contrast enhancement. In addition, the technique permitted surgeons to stratify patients into treatment groups and has been especially useful for planning surgical treatments.

Intraoperative ultrasound.

Intraoperative ultrasound is an exciting arena for real-time depiction and evaluation of relevant anatomy and pathology. The information provided by this technique often is pivotal to the surgeon, and not infrequently impacts the nature and extent of the surgical procedure. As more radiologists develop an interest and become facile with IOUS, and as more surgeons appreciate the benefits of this modality, the numbers and applications for this technique will continue to expand. This, coupled with continued commercial and technical improvements, and increasing demand for minimally invasive surgery, ensures that the future of IOUS will be a bright one.

Long-term care and a good quality of life: bringing them closer together.

Long-term care policies and programs in the United States suffer from a major flaw: They are balanced toward a model of nursing home care that, regardless of its technical quality, tends to be associated with a poor quality of life for consumers. This article proposes quality-of-life domains-namely, security, comfort, meaningful activity, relationships, enjoyment, dignity, autonomy, privacy, individuality, spiritual well-being, and functional competence. It argues that these kinds of quality-of-life outcomes are minimized in current quality assessment and given credence only after health and safety outcomes are considered. Five trends are reviewed that might lead to a more consumer-centered emphasis on quality of life: the disability rights movement, the emphasis on consumer direction, the growth of assisted living, increasing attention to physical environments, and efforts to bring about culture change in nursing homes. Building on these trends, the article concludes with strategies to move beyond current stalemates and polarized arguments toward forms of long-term care that are more compatible with a good quality of life.

State-of-the-art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

OBJECTIVE: To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullary cancer is unresectable because of either distant metastasis or local vascular involvement. The advent of gray scale and color Doppler ultrasonography has improved the ability of ultrasonography to detect vascular involvement. METHODS: Twenty-three consecutive patients with periampullary cancer were enrolled for prospective staging of their disease by comparing helical computed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesenteric vein, splenic vein, and superior mesenteric artery involvement was graded 0 to 4, grade 0 being no vascular involvement and grade 4 being total occlusion of the vessel. Agreement between ultrasonography and computed tomographic angiography for determining vascular involvement was measured by chi2 analysis. RESULTS: Two patients (9%) were excluded because excessive overlying bowel gas hampered the ability of ultrasonography to visualize the pancreas. For the remaining 21 patients, there was significant agreement between ultrasonography and computed tomographic angiography for detecting vascular involvement in all vessels (P < .001; portal vein, kappa = 0.67; superior mesenteric vein, kappa = 0.67; splenic vein, kappa = 0.85; and superior mesenteric artery, kappa = 0.59). Ultrasonography was in agreement with computed tomographic angiography in all cases of unresectability. Both modalities were equally poor in preoperatively showing lymphadenopathy and metastases. CONCLUSIONS: Provided that there is adequate visualization on ultrasonography of the head of the pancreas in the periampullary region, then state-of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detecting the unresectability of periampullary cancer. If performed as the initial investigation and the region of the pancreatic head is clearly shown, and if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.

Outcome trajectories for assisted living and nursing facility residents in Oregon.

OBJECTIVE: To compare assisted living residents and nursing home residents on outcome trajectories for three outcomes: ability to perform activities of daily living (ADLs), psychological well-being, and pain and discomfort. DATA SOURCES/STUDY SETTING: A representative sample of one-third of the census from 38 participating assisted living facilities (N = 605) and two-fifths of the census from 31 participating nursing facilities (N = 610). STUDY DESIGN: A longitudinal design using hierarchical linear models to examine how setting (being in an assisted living setting or in a nursing home) affected growth trajectories for each outcome studied when adjusting for other resident characteristics. DATA COLLECTION: Residents or their proxies were interviewed and chart reviews done at baseline, six months, and one year. All baseline data were collected between August 1995 and May 1996. PRINCIPAL FINDINGS: We found differences in case mix between assisted living and nursing facility residents but no differences in outcome trajectories for ADLs, psychological well-being, and pain and discomfort. For ADLs and pain and discomfort on average, residents in both settings experienced change over the study period. For psychological well-being, residents experienced no change on average. CONCLUSIONS: The lack of difference in growth trajectories for ADLs, pain and discomfort, and psychological well-being between the two settings was noteworthy.

What older people want from long-term care, and how they can get it.

Seniors' long-term care preferences resemble those of younger persons with disabilities, but the two groups are treated differently. Younger persons with disabilities pursue the goal of social integration, whereas safety and efficiency receive undue emphasis and ageist differences prevail in the way older persons are served. Among the changes needed to help older consumers get what they want are empowering older persons and their agents to make better decisions, including providing them with more structure and better consumer information; revising attitudes toward safety and protection; and developing more vigorous advocacy by and for seniors.

Assessment in long-term care.

Long-term care has begun to rely heavily on assessment as a basis for determining eligibility and payment for services, as well as for planning needed care. Mandated assessments have been introduced into nursing homes and will soon be required for home health care and rehabilitation. Many states use a formal structured assessment process to establish clients' eligibility for institutional or community-based care. The common feature of such assessment is attention to physical functioning, but other domains are also relevant, including affect, social function, cognition, pain and discomfort, and satisfaction. Taken together, this cluster is often referred to as quality of life. While some measures attempt to infer this information from clients' behavior, it is best obtained directly from clients' responses whenever possible. The other major component of a long term care assessment relates to obtaining information on clients' preferences and values. These data are important both for weighting the individual components of an assessment and for directly addressing preferences about the care and lifestyle available.

Hepatic colon cancer metastases in mice: dynamic in vivo correlation with hypoechoic rims visible at US.

PURPOSE: To use videomicroscopy of tumor-bearing livers of live mice to depict tumors directly to determine the exact nature of rims seen on corresponding ultrasonographic (US) scans. MATERIALS AND METHODS: Seventy-six hepatic colorectal cancer metastases were studied in exteriorized livers of 18 mice by using intravital microscopy, US, and histologic examination of the same tumors. RESULTS: Hypoechoic rims correlated with distended sinusoidal spaces in vivo. These spaces surrounded only locally invasive tumors (mean diameter, 0.85 mm) that had obstructed the supplying terminal portal venules. These spaces, containing adherent leukocytes and tumor cells, gave rise to new tumor vasculature. Results of histologic examination of rims (portal inflammation, congested or compressed sinusoids, cell atrophy) correlated with leukocyte endothelial adherence, occluded sinusoids, and new vessel formation in vivo. CONCLUSION: Unlike results from previous studies, dynamic in vivo observations of peritumoral rims demonstrated distended sinusoidal spaces giving rise to new tumor-penetrating vessels. These sinusoids arose around locally invasive tumors and were associated with more advanced intrahepatic disease. These dynamic observations provide a pathophysiologic explanation for previous histologic correlates of peritumoral rims.

Radiologic features of complications arising from dropped gallstones in laparoscopic cholecystectomy patients.

OBJECTIVE: Because laparoscopic cholecystectomy has become the accepted treatment for symptomatic cholelithiasis, radiologists frequently encounter patients who have had this surgery. Although the radiologic features of postoperative bile duct injury are well documented, the imaging features of less well-known complications remain poorly described. One such unusual complication is abscess formation caused by dropped gallstones. CONCLUSION: Although the incidence of dropped gallstones is an uncommon complication of laparoscopic cholecystectomy, it should be recognized as a potential source of both intraabdominal and intrathoracic abscess formation in any patient presenting months to years after undergoing laparoscopic cholecystectomy. These abscesses are not necessarily confined to the right upper quadrant.

Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough.

Six existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryoablation, ethanol ablation, and chemoembolization--are reviewed and debated by noted authorities from six institutions from around the world. All of the authors currently believe that surgery remains the treatment of choice for patients with resectable hepatic tumors. However, the clinical results of each of the minimally invasive techniques presented have exceeded those obtained with conventional chemotherapy or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumor.

Natural infection with schistosomes of the Schistosoma haematobium group in a dog in Zambia.

Post-mortem examination of an adult male Jack Russell dog from Zambia revealed that it was heavily infected with schistosomes. The dog had been admitted, with a history of retching, 4 days before its death. At necropsy, the liver was found to be enlarged, with multiple pin-point yellowish-white foci scattered diffusely throughout the organ. Multiple pin-point recent and old haemorrhages were seen on the mucosal surface of the gastrointestinal tract, particularly in the stomach and proximal duodenum. Large numbers of schistosome worm pairs and eggs were found in all mesenteric, gastric and hepatic veins. Histological examination of the intestines, mesenteric lymph nodes, liver, spleen, pancreas, stomach and lungs revealed numerous strongly fibrotic, encapsulated, epithelioid-giant cell granulomata containing dead, degenerating and viable eggs. A few examples of the Splendore-Hoeppli phenomenon were also detected. The eggs collected at necropsy had a terminal spine and an average length and breadth of 187.6+/-14.1 microm and 57. 3+/-4.1 microm, respectively. DNA analysis of female worms indicated that the schistosomes were either Schistosoma haematobium or a hybrid of Schistosoma mattheei and S. haematobium.

Choosing an adult foster home or a nursing home: residents' perceptions about decision making and control.

Representative samples of 260 Oregon foster care residents and 179 cognitively intact nursing home residents were queried retrospectively about the nature and circumstances surrounding their decision to move to a foster care or nursing home, including the alternatives they considered, the circumstances leading to the move, their perception of the decision-making process and who influenced it, the characteristics important to them in choosing the care environment, and their perception of their own control over the move. Statistically significant differences were identified in the characteristics of the setting that each group deemed important, the circumstances surrounding the decision, the people influencing it, and the perceived control over the decision.

Goals of home care: therapeutic, compensatory, either, or both?

This article classifies home care goals into two broad categories: therapeutic goals, in which home care providers strive for measurable improvement on parameters of physical, psychological, or social functioning and compensatory (or empowering) goals, in which home care providers strive to provide services to compensate for functional impairment, thus enabling consumers to pursue their own goals. Therapeutic goals are loosely associated with "medical models" of care and compensatory goals with "social models." From a consumer perspective therapeutic and compensatory goals are important, and artificial distinctions between the two should be eliminated. However, this merger should be effected in such a way that therapeutic approaches can be incorporated into programs with relatively low unit costs.