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Magic bullets shotguns or cocktails to treat or prevent Alzheimers disease

For the most part, the single target approach to drug discovery has failed to identify magic bullets that significantly impact the clinical manifestations of CNS diseases (Roth et al. 2004). Even when a magic bullet that is purportedly selective for a single target proves efficacious in a certain disease setting, in time, a more complete understanding of its pharmacology often shows that efficacy can be attributable to 1) interaction with several molecular targets or 2) a more complex physiologic effect than was originally intended. For example, it is now clear that selective drugs targeting G-protein coupled receptors (GPCRs) are, for the most part, not nearly as selective as previously thought they bind with high affinity to a number of GPCRs (Roth et al. 2004). In addition, there is growing evidence that the beneficial effect of HMGCoA reductase inhibitors (statins) is not completely attributed to its cholesterol lowering effects and may be enhanced by effects on isoprenoid levels...

Barretts Esophagus

Patients with Barrett's esophagus (BE) are advised to undergo endoscopic surveillance with multiple biopsies to detect HGD and or early adenocarcinoma (AC). Several endoscopic methods have been used to remove HGD, including photodynamic therapy (PDT) and Argon Plasma Coagulator (APC), but the disadvantage is the lack of final histological assessment. Moreover, PDT with photofrin caused severe esophageal stenoses in 34 of patients. EMR could become a therapeutic alternative to esophagectomy in these patients (Table 6-2).

Preface to the Second Edition

Although numerous persons have provided advice and assistance in preparing this work, I am especially indebted to KEK Rowson for his hard work on the earlier edition, and to Tamie Ando, Tom Barrett, Charlie Calisher, Joe Esposito, Jon Gentsch, Joe Icenogle, Sy Kalter, Fred Murphy, Stuart Nichol, Pat Nuttall, Bernard Roizmann, Chuck Rupprecht and Jim Winton for their expert advice.

The Quadriceps Active Mechanism

The quadriceps contraction may be of importance in injuring the ACL. Barrett and coworkers have calculated that an eccentric quadriceps contraction can generate up to 6000 N. This far exceeds the strength of the ACL at 1700N. This force can be observed in basketball in the jumpstop landing. Ireland believes that there is a position of no return for ACL injury. The body position is body forward-flexed, hip-abducted, knee that is internally externally rotated with valgus the foot is pronated. This position can be reviewed in the video of the badminton player. Barrett and coworkers have reproduced this mechanism of active quadriceps contraction in the laboratory. In the video, the cadaver knee is clamped, the quadriceps mechanism is held with the dry ice clamp,

Management of Refractory GERD Persistent Symptoms on PPI Twice Daily

Author's Reply Because GERD is a chronic disease patients with correctly diagnosed GERD should be on acid suppressive therapy indefinitely. Studies indicate that 70 to 80 of patients with healed esophageal lesions will relapse when switched to H2RAs or daily PPI therapy is discontinued. With the exception of patients with Barrett's esophagus, in whom we recommend high dose PPI twice daily with without bedtime H2RA, we discuss with patients the possibilities of tapering down the PPI treatment, switching to H2RAs based on their symptoms.

Patient Assessment and Perioperative Considerations

Upper endoscopy is the third important component of the work-up. It enables the physician to assess for the stigmata of reflux (ie, esophagitis) and to look for other foregut pathologies, including gastric and esophageal ulcers, infections, bile reflux gastritis, peptic strictures, Barrett's esophagus (BE), and upper GI cancers. Biopsies can be obtained, strictures dilated, and other interventions employed as indicated. The presence or absence of foregut abnormalities often has a significant impact on the decision to perform an antireflux procedure.

Supplemental Reading

Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 2003 196 51-7. Atwood SE, Barlow AP, Norris TL, Watson A. Barrett's oesophagus effect of antireflux surgery on symptom control and development of complications. Br J Surg 1992 79 1050-3. Bowrey DJ, Peters JH, DeMeester TR. Gastroesophageal reflux disease in asthma effects of medical and surgical antireflux therapy on asthma control. Ann Surg 2000 231 161-72. Carlson MA, Frantzides CT. Complications and results of primary minimally invasive antireflux procedures a review of 10,735 reported cases. J Am Coll Surg 2001 193 428-39. DeMeester SR, DeMeester TR. The diagnosis and management of Barrett's esophagus. Adv Surg 1999 33 29-68. Dixon MF, Neville PM, Mapstone NP, et al. Bile reflux gastritis and Barrett's oesophagus further evidence of a role for duodenogastro-oesophageal reflux Gut 2001 49 359-63. Farrell TM, Smith CD, Metreveli RE, et al....

Endoscopic GERD Treatment Trials Overview

The vast majority of clinical studies that have evaluated endo-scopic treatment modalities for GERD have been open-label trials or anecdotal reports. Despite the fact that several of these endoscopic technologies were introduced into clinical medicine over 3 years ago and thousands of GERD patients have been treated, only a single randomized sham controlled study has been performed and published (Corley et al, 2003). A number of criticisms therefore are well-directed towards the conclusions drawn by their authors from the results of these other clinical trials. Patients who have been enrolled in these clinical trials all have symptoms ofheartburn, regurgitation, and require antacid medication. Ambulatory 24-hr pH results are > 4.0 for total acid exposure. However, patients with a hiatal hernia > 2.0 cm and or esophagitis > grade 2 LA classification are excluded from study participation. Complications of stricture formation and Barrett's esophagus are also exclusionary factors.

Richard E SamplinerMD

Barrett's esophagus (BE) is a change in the lining of the distal esophagus from the normal squamous epithelium to an intestinal-like mucosa that includes goblet cells. BE is a complication of gastroesophageal reflux disease (GERD), and its importance lies in its potential for the development of adenocarcinoma (AC) of the esophagus and esophagogastric junction. These two simple statements carry a great deal of meaning, which translates into major management issues. The diagnosis of BE is confirmed only when there is an abnormal appearing segment in the distal esophagus at endoscopy and the biopsy documents intestinal metaplasia. Because BE is a complication of reflux, the primary therapy is aimed at controlling GERD. The role of medical and surgical therapy will be discussed in this chapter. The malignant predisposition of BE raises a different and complex issue of preventing the development of AC of the esophagus. The current estimate of the incidence of AC of the esophagus in...

Left Thoracoabdominal Approach for Carcinoma of the Lower Esophagus and Gastric Cardia

Kocher Maneuver

Tumors located aborally to the carina, i.e., Barrett's carcinoma or carcinoma of the esophagogastric junction, may be removed by a left-sided thoracotomy instead of the more usual right-sided access combined with an abdominal approach. The extent of lymphadenectomy is limited to the middle and lower mediastinum.

Ablation with Thermal Electrocoagulation

Thermal coagulation of the Barrett's mucosa can be accomplished using bipolar and heat probes with an overall success rate of approximately 75 . Sampliner and colleagues (2001) treated 58 patients with non-dysplastic Barrett's epithelium with up to six sessions of multipolar electrocoagulation. Over a short follow-up period, 78 had endoscopic and histologic reversal of Barrett's epithelium. Similar results were obtained in another study, by Kovacs and colleagues (1999), with 27 patients and 4.5 months of follow-up. The mucosa is treated until there is a uniform white coagulum, and the treatment is repeated monthly until ablation of the Barrett's mucosa is achieved. The rate of residual or recurrent columnar lined epithelium is approximately 20 to 30 , and the follow-up periods range from 4.5 months to 3 years. Advantages to thermal ablation include its wide availability, inexpensive cost, and relatively few major side effects (Eisen, 2003). Most published trials demonstrate the...

Ablation with Argon Plasma Coagulator

Table 15-2 lists the eradication rates for argon plasma coagulator in some published series success (Mork et al, 1998 Van Laethem et al, 1998). Successful or complete eradication (CE) is defined as histologic ablation of Barrett's epithelium at the time of follow-up. Identification of Barrett's epithelium underneath the regenerated squamous epithelium (Barrett's neo-epithelium) is considered a failure of ablation. The majority of studies ablated non-dysplastic Barrett's epithelium with argon plasma coagulator, showing an overall average CE of 73 , a Barrett's neo-epithelium rate of approximately 24 , and an overall major complication rate of 2.7 . Pereira-Lima and colleagues CE of Barrett's Epithelium ( ) CE complete eradication at time of follow-up ND non-dysplastic Barrett's epithelium NR not reported. CE complete eradication at time of follow-up ND non-dysplastic Barrett's epithelium NR not reported. Mean Follow-Up (mo) CE of Barrett's Epithelium ( ) Barrett's Neo-Epithelium ( ) AC...

Considerations When Choosing Ablative Therapy

Most of the published literature on ablative therapy for Barrett's epithelium lacks control groups and randomization. The primary endpoint is usually absence of Barrett's TABLE 15-4. Photodynamic Therapy in Dysplastic Barrett's Epithelium and Early Cancer CE of Barrett's Epithelium ( ) epithelium (or downgrading from dysplastic Barrett's epithelium) or intramucosal carcinoma at the time of follow-up. Without adequate long term follow-up, it is impossible to document answers to critical questions, such as the following (1) the durability of the neo-epithelium, (2) the decrease in the need for endoscopic surveillance, or (3) the elimination or decrease in cancer death rates, and (4) the cost-effectiveness of ablative therapy. 2. Nonsurgical candidates with intramucosal cancer or high grade Barrett's epithelium should be offered ablative treatment. There is a separate chapter on palliative therapy for carcinoma of the esophagus (see Chapter 22, Palliation of Esophageal Cancer). There is...

Limited Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition

Jejunal Interposition

In patients with early tumors, staged as uT1a or b on preoperative endosonography or severe dysplasia in the distal esophagus (Barrett's esophagus), a limited resection of the proximal stomach, cardia and distal esophagus with interposition of a pedicled isoperistaltic jejunal segment offers excellent functional and oncological results. Indications Severe dysplasia in the distal esophagus (Barrett's esophagus) Long Barrett's segment above the carina Intraoperative esophagoscopy identifies the cranial limit of the Barrett's segment by diaphanoscopy. This also marks the proximal limit of resection. Approximately 1 cm proximal to the cranial limit of the Barrett's segment, a pursestring clamp is placed and the esophagus is divided.

Recent Evolution ofthe 3DEM Field

Although 3D reconstruction methods for EM were developed almost 40 years ago (DeRosier and Klug 1968), obtaining high-resolution information with this technique seemed impossible until 2 decades later, tte reason was related to the use of negative staining, which largely altered the relation between the sample in its native state and its images. Another limitation came from the low spatial coherence provided by the available electron sources, thermoionic electron guns, tte low coherence produced a fast decay in the signal amplitude, so much so that the images barely contained any information beyond 20-A resolution, tte qualitative jump to high resolution came with the popularization of field-emission guns as electron sources, ttese guns produce highly coherent electron beams, and consequently the images contain useful information all the way to high frequencies.

Game disease and development

Game preservationists struggled through the early 20th century to safeguard the natural world, to keep it safe from harm at the hands of unprincipled game hunters, greedy settlers and local farmers, using two tools, game reserves and shooting regulations. In Africa, by and large, they had considerable success in preventing local people from hunting, certainly from hunting with guns and hunting in game reserves. They were less successful in reconciling the dilemma of the impact of colonial development on nature, for the very apparatus of the colonial state that they used to pursue their ends was also the chief mechanism for the destructive transformation of landscapes that they deplored. Conservationists, typified by the SPFE, were a pressure group within the elite of a colonizing power. They worked within its imperial mindset, and yet the fruits of imperial development were themselves profoundly destructive to their interests.

Sinister Applications

In the 1930s and 1940s, a wide range of topics were analysed in half a dozen German institutes with the help of the Abwehrfermente 9 . There were tests for various forms of cancer the final objective was cancer therapy. Tests for psychiatric diseases such as schizophrenia were developed the Abwehrfermente were also used for effective shock treatment of psychotic patients. Tests were worked out to diagnose the various psychological types proposed by the psychiatrist E. Kretschmer 10 . (To test how patients dealt with fear, guns were fired behind their heads and pictures were taken one schizophrenic patient is quoted as saying over and over again We want poison gas why do they not give us poison gas ''). The Abwehrfermente were used by Abderhalden's son Rudolf 9 to diagnose various infectious diseases. They were even used to distinguish races of

Daniel M LabowMD and Murray F BrennanMD

Gastric cancer (GC) is an international health problem with an incidence approaching 800,000 people per year. Although uncommon in North America (25,000 cases per year), GC carries a poor prognosis, with more than 12,000 deaths estimated in 2002 (Jemal et al, 2002). This poor outcome is attributed to advanced stage at diagnosis, which precludes a curative resection. However, in the United States patients are being diagnosed at an earlier stage. Gastric adenocarcinoma (AC) is the predominant histology ( 95 ), followed by leiomyosarcoma gastrointestinal stomal tumors, lymphoma, and carcinoid. The incidence of gastroesophageal (GE) junction malignancy has risen steadily over the past decade. The treatment and behavior of this disease differs from true GC and, thus, for the purposes of this chapter, we will focus on the management of primary gastric AC. There are separate chapters on Barrett's esophagus (Chapter 14, Barret's Esophagus) esophageal cancer (Chapter 22, Palliation of...

Gastroesophageal Reflux

This is an extremely common entity in CF patients, occurring in about 20 to 25 of young patients (< 5 years) and up to 80 of older patients. Increased numbers of transient relaxations of the lower esophageal sphincter (LES), and decreased basal pressure at the LEs both play a role. Patients with chronic CF chest disease also have abnormal pressure gradients between the abdomen and thorax, exacerbated by cough and at times postural change. All this can lead to the problem of erosive esophagitis, and the complications of esophageal peptic stricture or Barrett's esophagus. Chest complications related to reflux can be significant in these patients and include aspiration pneumonia and laryngitis. Treatment needs to be aggressive and the index for investigating low. Treatment options include positional change such as elevating the head of the bed and avoiding head down tilting during chest percussions. Medications are limited to histamine-2 receptor antagonists (H2RAs) and proton pump...

Conclusion And Outlook

B. Brenner, S. L. Briggs, A. Delaunois, J. D. Durbin, U. Giese, H. Guo, M. Radloff, G. S. Gil, S. Sewing, Y. Wang, A. Weichert, A. Zaliani and J. Gromada, Endocrinology, 2005, 146, 3696. 23 A. G. Weichert, D. G. Barrett, S. Heuser, R. Riedl, M. J. Tebbe and A. Zaliani, WO Patent 063194 A1, 2004. 27 A. G. Weichert, D. G. Barrett, S. Heuser, R. Riedl, M. J. Tebbe and A. Zaliani, WO Patent 063179 A1, 2004.

[10 Using Genomic Microarrays to Study Insertional Transposon Mutant Libraries

D., Andersen-Nissen, E., Hayashi, F., Strobe, K., Bergman, M. A., Barrett, S. L. R., Cookson, B. T., and Aderem, A. (2003). Toll-like receptor 5 recognizes a conserved site on flagellin required for protofilament formation and bacterial motility. Nat. Immunol. 4, 1247-1253.

Relationship of the WB I and WAIS

Zimmerman and Woo-Sam (1973, Table 2.1) and Matarazzo (1972, Table 10.21) present data summarizing the relationships between W-B I and WAIS IQs found in diverse studies published from 1956 to 1964. In five of these studies, both instruments were administered to groups ranging in size from 28 college students (Duncan & Barrett, 1961) to 179 brain-damaged patients (Fitzhugh & Fitzhugh, 1964a) the total number of subjects in the five studies was 356.

Initial Treatment PPIs

Author's Reply We focused primarily on the medical therapy of GERD but would be happy to expand on this issue. We consider that patients with alarm symptoms (eg, dysphagia, weight loss, gastrointestinal bleeding, or anemia) should be endoscoped. Also, patients with long-standing reflux disease (ie, more than 5 years) and over the age of 40 years should consider having a one-time endoscopy to rule out Barrett's esophagus.

Vomiting Laxative and Diuretic Abuse

As a result of recurrent self-induced vomiting. Higher rates of dysphagia, Barrett's esophagus, and esophageal stricture are reported in bulimic patients compared with controls. As with salivary gland swelling, alcohol abuse also increases the risk of esophageal pathology (Cuellar and Van Thiel, 1986).

Management of Esophageal Strictures

Helpful in locating diverticula, hiatal hernias and tortu-ousity that may be less clearly seen during endoscopy. Endoscopy can be used to identify esophageal ulceration and Barrett's esophagus and allow for brushings and biopsy samples to be taken. Both studies are capable of characterizing the stricture, which is essential to the dilatation process. Strictures that are < 2 cm, straight and patent are known as simple strictures. Strictures that are > 2 cm, tortuous and not easily traversed by the endoscope are known as complicated strictures. During endoscopy, the endoscope or an open biopsy forcep can be used to help approximate the length and width of the stricture.

Noise Induced Hearing Loss

Noise Damage Audiogram

The workplace is not, of course, the only source of potential noise-induced loss. Home power tools, chain saws, loud headphones, and firearms are other common menaces to hearing. When these devices are used, ear protection is the answer. (Obviously, the volume to one's headset should be kept down ) In-the-ear plugs and muff-type protectors are available at sports stores. They may be worn together to increase protection, although perspiration may be a problem. Noise levels might be decreased as much as 30 dB HL. For musicians who must hear without distortion, audiologists can fit specialized ear-protection molds that attenuate all the frequencies equally. It is important to advise the patient with chronic noise-induced loss that the damage is permanent and irreversible and emphasize the need to remedy the situation. The negative peak we see in early losses will deepen and widen over time if exposure continues, as shown in Figure 7.2

TABLE 62 Indications for Endoscopic Mucosal Resection

Barrett's esophagus (visible areas of high grade dysplasia) Short Barrett, noncircumferential complete ablation Long Barrett, circumferential surgery Elderly patients and or comorbidities EMR PDT (circumferential mucosectomy under evaluation) Barrett's esophagus (nonvisible areas of high grade dysplasia) Surgery TABLE 6-3. Selected Studies on Endoscopic Mucosal Resection in Barrett's Esophagus TABLE 6-3. Selected Studies on Endoscopic Mucosal Resection in Barrett's Esophagus AC adenocarcinoma BE Barrett's esophagus Bl bleeding EGJ esophagogastric junction EMR endoscopic mucosal resection EUS endoscopic ultrasonography HGD high grade dysplasia IMC intramucosal carcinoma LGD low grade dysplasia NOS not otherwise specific PDT photodynamic therapy Pts patients VLD variceal ligator device. *Persistence of HGD. AC adenocarcinoma BE Barrett's esophagus Bl bleeding EGJ esophagogastric junction EMR endoscopic mucosal resection EUS endoscopic ultrasonography HGD high grade dysplasia IMC...

Sanjay JagannathMD and Marcia I Canto MD MHS

Barrett's esophagus, defined as the replacement of normal esophageal squamous epithelium with specialized columnar metaplasia characterized by goblet cells (Sampliner, 1998), is a condition that often arises in the setting of chronic gastroesophageal reflux disease. The presence of Barrett's epithelium is clinically important because it represents a premalignant condition that predisposes to the development of esophageal adenocarcinoma (AC). There is a separate chapter on endoscopic ultrasound and fine needle aspiration (see Chapter 5, Endoscopic Ultrasound and Fine Needle Aspiration). The incidence of esophageal AC is the highest among all cancers in the United States and Western Europe. The estimated 5-year survival of esophageal cancer (EC) is a dismal 5 to 10 , and, currently, it represents the seventh leading cause of cancer death worldwide. The overall risk of developing EC in the setting of Barrett's epithelium is estimated to be approximately 0.5 per year however, the relative...

Canine dermal papillomavirus Synonym for canine papillomavirus

Appel MJ (1987) In Virus Infections of Carnivores. Amsterdam Elsevier, p. 133 Barrett, T (1999) In Encyclopedia of Virology, Second edition, edited by A Granoff and RG Webster. London Academic Press, p. 1559 Kennedy S et al (2000) Emerg Inf Dis 6, 637 Montali RJ et al (1983) J Am Vet Med Assoc 183, 1163

Ablation with Laser Therapy

Two types of lasers have been used to ablate Barrett's epithelium, Nd YAG (1064 nm depth ofinjury 3 to 4 mm), and KTP (532 nm depth of injury 1 mm) (Eisen, 2003). Table 15-1 summarizes selected studies evaluating the success of laser therapy to achieve complete ablation of Barrett's epithelium. Most trials report eradication rates of approximately 70 to 80 with laser therapy and complication rates of 0 to 17 (Luman et al, 1996 Weston and Sharma, 2002). Bonavina and colleagues (1999) prospectively evaluated Nd YAG laser eradication of Barrett's epithelium. They documented eradication in 8 of 12 patients with tongues of Barrett's, 1 of 4 patients with circumferential Barrett's epithelium, and in both patients with short-segment Barrett's epithelium. In addition, 1 patient progressed in a 6-month period to develop AC underneath regenerated squamous epithelium. It is apparent that in some patients, although the superficial mucosa regenerates with normal squamous epithelium (also known as...

The Global Eradication Of Smallpox

Originally, the smallpox eradication strategy called for mass vaccination using jet immunization guns that could deliver hundreds of doses per hour. In order to eradicate smallpox in any given nation, epidemiologists considered it necessary to vaccinate 80 to 100 percent of the population. Public health workers soon encountered virtually insurmountable difficulties in maintaining stocks of vaccine and injector guns under primitive conditions in hot, humid climates. Simpler equipment, like the bifurcated needle (two-pronged), proved to be more reliable and efficient. As a result of shortages of personnel and equipment in eastern Nigeria, public health workers discovered, almost by accident, that a strategy called ''surveillance-containment'' effectively broke the chain of transmission. By concentrating limited resources on the most infected areas, the new strategy was successful even when only 50 percent of the population had been vaccinated. In October 1977, Ali Maow Maalin of Somalia...

Healthy Mood Management A Developmental Perspective

One half of all deaths in the United States, are tobacco, diet and exercise patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit use of drugs. Consider for a moment how many of these might be exacerbated by depressed mood. The relationship between negative mood states and smoking and drinking has already been described. It is highly likely that illicit use of drugs follows a similar pattern. Diet and exercise certainly are affected by depressed mood. Deaths from firearms present an interesting illustration of how strong, and yet invisible to most of us, the impact of depression is on our society few people are aware that for several decades over half the deaths from firearms in the United States have been suicides. Unprotected sexual behavior not only exposes individuals to sexually transmitted diseases, but also to unplanned pregnancies. And some proportion of motor vehicle accidents are related to alcohol and other substance...

Ablation with PDT

The most common photosensitizers used in Barrett's ablation along with their relevant clinical properties are listed in Table 15-3 (Eisen, 2003 Prosst et al, 2003). Clinical contraindications to PDT include known porphyria (or hypersensitivity to porphyrins), tumor infiltration into the respiratory tract, and the presence of an esophagopul-monary fistula. Relative contraindications may include symptomatic pleural or pericardial effusions and unstable Table 15-4 lists selected clinical trials showing the efficacy of PDT in dysplastic Barrett's epithelium and early ACs (Barr et al, 1996 Gossner et al, 1998). Overholt and colleagues (2001) in their pioneering trial used a balloon fiber-centering device meant to flatten the esophageal mucosa to theoretically help reduce overtreatment and stricture formation. Subgroup analysis showed an overall mean eradication rate of 90 for dysplastic Barrett's epithelium. One-third of patients in the study developed strictures, and 6 developed Barrett's...

Dividing the land

Could this approach be extended to Africans, allowing them to carry guns and to hunt animals that attacked their farms Some administrators favoured allowing natives to hunt Hesketh Bell, urged that buffalo be removed from the schedule of protected animals, although he doubted that even with this inducement, natives would voluntarily attack these formidable animals.45 Others worried about security if natives were allowed to bear arms, particularly precision weapons. To the Governor of Nyasaland, 'the practical possibilities of any such action are so grave that I hesitate to contemplate such a measure'.46 Laws against the importation and possession of arms and ammunition by Africans effectively prevented the substantial slaughter of game (although, of course, they promoted just those practices such as use of pits that sportsmen deplored for their cruelty).47 The idea of natives hunting with guns was anathema to most conservationists, because it would lead to the extinction of all game....

T axei Cobbold 1879

T. axei is a common cosmopolitan parasite of the abomasum of ruminants, including cattle, sheep and deer. It also occurs in the stomach and first part of the intestine of horses. Barrett et al. (1970) found T. axei in Spermophilis richardsoni in Montana and transmitted it experimentally to this ground squirrel. Eggs were deposited in the morula stage and were 79-92 X 31-41 mm in size (Shorb, 1940). First-stage larvae were 289-388 mm and infective larvae 619-762 mm in length, including the sheath (Keith, 1953). Ciordia and Bizzell (1963) considered 25 C to be the optimal temperature for the development of T. axei and four other species of trichostrongyloids. According to

Figure 166

Plain radiograph of a child with prune-belly syndrome showing a markedly protuberant abdomen. This syndrome, also referred to as Eagle-Barrett syndrome or triad syndrome, occurs almost exclusively in males. The three classic physical findings are the deficiency of the abdominal wall musculature, urinary tract anomalies characterized by an extremely dilated urinary tract, and bilateral intraabdominal testes. A wide spectrum in the severity of abnormalities is seen, with most children having some degree of renal dyspla-sia, along with bladder and ureteric dys-plasias (partial or complex lack of smooth muscle). (Courtesy ofPhilip Silberberg, MD.)


Microwave thermography measures microwave radiation naturally emitted from the breasts. Since microwaves have considerably longer wavelengths than infrared emissions, they penetrate body tissues to a much larger extent and, therefore, provide thermal information from subcutaneous and parenchymal tissues, as well as from the skin surface, albeit with less spatial resolution (Barrett et al., 1980 Myers et al., 1980). Computer-assisted thermography is a technique that uses discrete temperature measurements taken at standardized locations on each breast. These thermal data then are entered into a computer programmed with one or several diagnostic pattern-recognition algorithms designed to calculate a likelihood of malignancy index. This produces objective and repeatable results that are independent of observer performance (Milbrath and Schlager, 1980 Ziskin et al., 1975).

Prune Belly Images

Prune Belly

Eagle-Barrett syndrome (prune belly syndrome) is also described as the triad syndrome absence of abdominal musculature, genitourinary tract abnormalities, and cryptorchidism. In this fetus there is a markedly distended abdomen due to a very distended bladder. It is now thought that the genitalia and urinary tract abnormalities are the precursor of the absence of abdominal musculature. Figure 3.30. Radiograph of abdomen showing the bulging of the flanks and abnormal gas pattern due to genitourinary tract abnormalities in an infant with Eagle-Barrett syndrome.

IM of the CardiaGEJ

The interest in the gastric cardia GEJ is because cardia cancer is increasing at about the same rate as Barrett's associated cancer and also dominates in white males and is inversely related to H. pylori infection. The question is whether IM of the cardia could be a precursor warning for a risk of cardia GEJ cancer. IM of the cardia is common in GERD patients (approximately 30 ), without Barrett's esophagus (BE), and may occur as part of H. pylori gastritis. IM of the GEJ may also occur in the general population as a wear-and-tear phenomenon as a result of chronic exposure of the GEJ to gastric contents (Katzka et al, 1998 Fletcher et al, 2001). There is no indication to routinely biopsy the GEJ in GERD or to otherwise to look for IM of the cardia or GEJ. If one is compelled to look for IM, the question to the pathologist should be framed as rule out IM of the cardia GEJ. That question should alert the pathologist that you did not identify Barrett's and thus is designed to avoid its...

Journal references

Type 1 diabetes new perspectives on disease pathogenesis and treatment. Lancet 2001 358 221-9. Barnett AH, Eff C, Leslie RDG, Pyke DA. Diabetes in identical twins a study of 200 pairs. Diabetologia 1981 20 87-93. Barrett T. Inherited diabetic disorders. CME Bulletin Endocrinology and Diabetes 1999 2 47-50.

The poacher at home

Other members of the SPFE delegation to see Lord Lyttelton, such as Colonel Delme Radcliffe, thought that even natives without guns should be prohibited from hunting because the effectiveness of their hunting techniques had already been improved by colonialism. Such commentators believed that some traditional balance between ill-armed and relatively unambitious indigenous hunters and abundant populations of their prey had been upset. Sir Henry Seton-Karr, a founder member of the SPWFE, laid the problem of diminishing game at the door of the 'depredations' of natives (along with their fellow ill-doers, unsporting settlers).42 It was certainly obvious by the first decade of the 20th century that colonialism was triggering diverse economic and social change. Buxton observed that 'Pax Britannicd had created new opportunities for killing game. There were Kamba hunters 'at every water hole' on the Athi Plains because the Maasai were not there to keep them away, and 'everything that walked...

Liver Biopsy

Now use disposable needles or guns to reduce costs and accommodate the larger numbers of biopsies being performed. The most commonly practiced technique is outpatient percutaneous biopsy, with or without conscious sedation, followed by an observation and monitoring period of 2 to 6 hours before discharging the patient. Prebiopsy ultrasound has been advocated as a reasonable safety measure to prevent inadvertent puncture of the gallbladder or large intrahepatic blood vessels.