bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivering an effective outpatient service in gynaecology: an assessment of patient preference
Authors: Marsh Fiona , Taylor Lydia , Kremer Christian , Black Jean , Duffy Sean
Published: December 2003

Objectives  To assess whether patients would prefer to undergo outpatient or day‐case hysteroscopy for the investigation of abnormal uterine bleeding.

Design  An anonymous questionnaire.

Setting  A general gynaecology clinic in a large UK teaching hospital.

Subjects  250 consecutive patients attending the gynaecology clinic.

Main outcome measures  These were patient preference for either outpatient or day‐case hysteroscopy, and the reasons for the decisions.

Results  The questionnaire was completed by189 patients (76% response rate). Of these 52% chose outpatient hysteroscopy, 26% chose day‐case hysteroscopy, 17% wanted to let the doctor decide and 5% needed more information. We found that women in employment and those who had previously undergone review were significantly more likely to opt for outpatient hysteroscopy. The most common reason for preferring outpatient hysteroscopy was that the entire process was quick, whereas the main reason for NOT favouring it was the potential for discomfort. The main appeal of day‐case hysteroscopy for patients was that no pain would be felt during the procedure; the most common reason for disliking day‐case hysteroscopy was the possible wait for up to 3 hours in the day‐case unit before hysteroscopy was performed.

Conclusions  When given the choice, women prefer to undergo outpatient rather than daycase hysteroscopy for the investigation of abnormal uterine bleeding. From the patient's perspective, the most common reasons for preferring outpatient hysteroscopy are (in order of priority): the speed of the entire process; the uninterrupted sequence of counselling, investigation and information regarding results, and the shorter wait in hospital before the hysteroscopy is performed.
A case–control study comparing 3.6‐mm and 3.1‐mm flexible hysteroscopes
Authors: Marsh Fiona , Jackson Tracy , Duffy Sean
Published: December 2003

Objective  To determine whether a 3.1‐mm diameter flexible hysteroscope causes less patient discomfort and requirement for cervical dilatation than a 3.6‐mm hysteroscope.

Setting  The outpatient hysteroscopy clinic of a large teaching hospital in the UK.

Participants  159 women with abnormal uterine bleeding who required an outpatient hysteroscopy.

Design and intervention  A cohort of patients undergoing hysteroscopy with a 3.6‐mm hysteroscope was matched for age, parity and menopausal status with a cohort of patients undergoing hysteroscopy with a 3.1‐mm hysteroscope.

Main outcome measures  Pain scores using a 10‐cm visual analogue scale, and women's description of pain using a Likert‐scale question.

Results  Significantly more postmenopausal women undergoing a 3.6‐mm required dilatation of the cervical canal compared with those undergoing a 3.1‐mm hysteroscopy (P = 0.02). In both the premenopausal and postmenopausal groups significantly more women undergoing a 3.1‐mm hysteroscopy had a pain score of zero compared with those undergoing a 3.6‐mm hysteroscopy. In the postmenopausal cohort significantly fewer women in the 3.1‐mm group (31% compared with 51% in the 3.6‐mm group) had pain scores of more than three (P = 0.007). There were also significantly more postmenopausal women in the 3.1‐mm group (64% compared with 23% in the 3.6‐mm group) who described either mild pain or no pain whatsoever (P = 0.0003).

Conclusion  Decreasing the diameter of the device used in flexible hysteroscopy from 3.6 mm to 3.1 mm results in a significant reduction in pain and discomfort for both premenopausal and postmenopausal women and significantly reduces the requirement for cervical dilatation in postmenopausal women.
Evaluation of laparoscopic management and clinical outcome in women with premature ovarian failure
Authors: Hirota Yutaka , Ohara Satoshi , Nishizawa Haruki , Tada Shin , Udagawa Yasuhiro
Published: December 2003

Objective  To analyse the results of laparoscopic ovarian biopsy and the laparoscopically observed morphological features of the ovary in premature ovarian failure (POF), in relation to clinical outcome, and to construct an appropriate guideline for clinical management utilizing laparoscopy.

Design  A retrospective study of patient records.

Setting  Fujita Health University Hospital.

Subjects  19 women with POF, treated between 1991 and 2000.

Main outcome measures  The ovaries from 12 patients who underwent laparoscopy were classified, according to morphological features, as sclerotic, atrophic or hypoplastic. The detection rate for a primordial follicle was assessed for each ovarian type, and the correlation between morphological features and patient clinical outcome was investigated.

Results  Induction of ovulation was successful in eight of 19 patients (42.1%). Among the 12 patients who underwent laparoscopy, ovulation induction was successful in four, but not in the remaining eight. The rate of detection of a primordial follicle was 50.0% for the four women with successful ovulation induction and 14.2% in the eight other women. With regard to ovarian type, primordial follicles were detected only in sclerotic ovaries. It was shown that cyclic therapy with estrogen and progesterone (CTEP) had appreciably favourable effects, and then the combined therapy with CTEP‐primed gonadotrophin‐releasing hormone (GnRH) agonist and human menopausal gonadotrophin–human chorionic gonadotrophin (hMG–hCG) was a reasonable therapeutic method.

Conclusions  There was a clear relation between the rate of detection of primordial follicles and the morphological features of the ovaries. Therefore, laparoscopy should be done an early stage to determine the type of ovary. Furthermore, in establishing whether or not there is a primordial follicle in the ovary, laparoscopy seems to have an important role in the planning of treatment.
Clinical experiences with laparoscopically assisted vaginal hysterectomy in patients who are candidates for abdominal hysterectomy
Authors: Berker Bulent , Dokmeci Fulya
Published: December 2003

Objective  To report our 3‐year experience with laparoscopically assisted vaginal hysterectomy (LAVH) in patients who were candidates for abdominal hysterectomy.

Design  Between 1997 and 2000, 50 LAVH procedures were done by the authors. All the patients underwent LAVH because of the contraindications to the vaginal route. A 10‐mm infraumbilical trocar, and two 5‐mm trocars, one for each lower quadrant, were placed in all patients. An initial careful inspection of both ureters was carried out but no dissection of ureters was performed, in order to reduce operative time and minimize the risk of bleeding or ureteral vascular compromise. After the dissection of the broad, round and infundibulopelvic ligaments, the bladder was displaced inferiorly with blunt and sharp dissections. The remainder of the surgery was done vaginally, following the entrance to anterior and posterior vaginal fornices.

Results  The average operating time was 87 min with a range of 64–96 min. LAVH was not converted to an abdominal procedure in any patient. There were no intraoperative or postoperative complications. The mean uterine weight was 260 ± 45 g and the mean blood loss was 350 mL. The patients remained in the hospital for a mean of 2.5 ± 1 days.

Conclusions  We believe that LAVH is not a substitute for vaginal hysterectomy; however LAVH should be a surgical option at all centres, to be used when the indications are appropriate, especially when vaginal hysterectomy is not possible.
Laparoscopic removal of dysgenetic gonads containing a giant seminoma, in an adult patient with testicular feminization syndrome
Authors: Atabekoglu Cem S. , Berker Bulent , Dunder Ilkkan
Published: December 2003

Objective  To report the case of an adult woman who had testicular feminization syndrome and developed a giant manifest seminoma in an undescended intrapelvic gonad.

Methods  The clinical records of the patient were reviewed.

Results  With the diagnosis of a suspicious adnexal mass, laparoscopy was performed in a patient with testicular feminization syndrome and revealed a right gonadal tumour, 10 × 8 cm in size. The gonads were then removed by laparoscopic surgery. Histopathological examination revealed a seminoma in the right gonad. Postoperatively, tumour markers were normal, and abdominal and pelvic computerized tomographic scans and chest radiographs were negative for possible metastatic disease. The patient made an uneventful postoperative recovery and was discharged on postoperative day 2. No adjuvant radiation therapy was given.

Conclusion  Although the possibility of a malignant gonad is one of the major concerns associated with a large pelvic mass in adult patients with testicular feminization, we believe that a laparoscopic approach provides a favourable alternative to an open surgical procedure.
Should endometrial biopsy be a routine investigation for recurrent early‐pregnancy loss?
Authors: Badawy Ahmed M. , El‐Gharib Mohamed E. , Zalata Khalid
Published: December 2003

Objective  We are investigating the role of endometrial histologic pattern in patients with recurrent abortions.

Study methods  The study comprised 123 women who suffered recurrent abortions. All women were scheduled for hysteroscopy in the periovulatory period in addition to the other routine investigations of recurrent abortion. During hysteroscopic evaluation of the cavity, all suspicious lesions were biopsied and subjected to histopathological examination.

Results  Seventy‐one women (57.7%) demonstrated normal cavity. Endometrial polyps were found in 12 women (8.9%) and submucous myomas were verified in eight women (6.5%). Intrauterine adhesions were found in 14 women (11.4%). Different congenital anomalies of the uterus were demonstrated in 18 women (14.6%): arcuate uterus (2.4%), bicornuate uterus (2.4%), incomplete uterus (6.6.%) and complete septum (3.2%). Tuberculous endometritis was demonstrated in two cases.

Conclusion  It seems that hysteroscopy and endometrial histology give valuable information in patients with recurrent abortion.
Richter's hernia as an unusual complication of laparoscopic sterilization: a case report and review
Authors: Sharma B. , Greenwood P. , Pereira J. , Kumar V.
Published: December 2003

Umbilical port site hernia, with minor procedures like laparoscopic sterilization, especially with port of 10 mm or less are very rare. Those involving bowel mainly occur as Richter's hernia, which may be very difficult to diagnose as only a part of bowel wall is involved and the rest of the bowel might be functioning. Therefore the bowel sounds may persist. It is a serious complication as it may cause bowel obstruction, incarceration, necrosis and perforation resulting in peritonitis. Open surgery with reduction of the hernia is the usual mode of treatment, if the bowel is viable, whereas resection is needed if the bowel wall is not viable. High index of suspicion in these cases can lead to early diagnosis, and thus delaying the above life threatening complications.
Haemodynamic, biochemical and haematological changes during hysteroscopic myomectomy
Authors: Darwish Atef M. , Zareh Hassan Zein E. A.
Published: December 2003

Objective  To record circulatory volume changes, hyponatraemia, decrease in plasma osmotic pressure, changes in blood picture and coagulation profile in correlation with the size of myoma during hysteroscopic myomectomy.

Design  A cross‐sectional prospective comparative study.

Setting   Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.

Subjects   Fifty patients undergoing hysteroscopic myomectomy where a balanced general anaesthetic technique was used.

Interventions   Patients were divided into two groups according to the size of the submucous myoma. Group A included 25 patients having small submucous myomas (3 cm or less). Group B included those having larger myomas (more than 3 cm). Hysteroscopic myomectomy was done using glycine 1.5% as an irrigating solution for all cases. Haemodynamic measurements included pulse, mean arterial blood pressure and central venous pressure (CVP). Cardiodynamic measurements using non‐invasive thoracic electrical bioimpedence (TEB) included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), end diastolic volume (EDV), end diastolic index (EDI), ejection fraction (EF), peak flow (PF), peak flow index (PFI) and systemic vascular resistance (SVR), arterial blood gases (PaO2, PaCO2), oxygen saturation by pulse oximeter and end tidal CO2 by capnogram. Serum sodium and potassium concentration, blood osmolarity, prothrombin time (PT), prothrombin concentration (PC), partial thromboplastine time (PTT), haemoglobin concentration (HB), haematocrite value (HCT) and platelet count (PLT) were also measured. Absorbed fluid volume and intrauterine pressure (IUP) were also measured.

Main outcome measures   Changes in haemodynamics, caerdiodynamics, blood gases and haematological measurements as measured preoperatively and every 15 min for 75 min.

Results   The trial showed statistically significant variations regarding haematological and biochemical variables, but it was not associated with clinical signs of hyponatraemia. No signs of cardiac overload or cerebral confusion in both groups. Group B was associated with significant hyponatraemia, increased CVP, hypo‐osmolarity, increased PT and PTT, and increased most of the cardiodynamic parameters.

Conclusions  Hysteroscopic myomectomy, despite being the most risky hysteroscopic procedure, can be safely performed in most cases following the safety precautions. Intraoperative fluid absorption, especially with large myomas, is the trigger of some systemic changes. The procedure should be performed by an experienced hysteroscopist using a quick technique with the least possible glycine volume and minimal intrauterine pressure to achieve the goal of a safe out‐patient minimal access surgery.
The analgesic efficacy of intraperitoneal local anaesthetic instillation after laparoscopic gynaecological procedures
Authors: Kayacan Nurten , Arici Gülbin , Karsli Bilge , Zorlu Gürkan , Erman Meliha
Published: December 2003

Objective  Patients undergoing laparoscopic procedures may experience postoperative pain. We evaluated the effectiveness of intraperitoneal local anaesthetic instillation after laparoscopic gynaecological procedures.

Design  Randomized, double‐blinded, placebo‐controlled trial.

Methods  Patients were randomly assigned to one of three groups of 20 patients each. Those in group A received ropivacaine, 20 ml 0.75%, and those in group B received bupivacaine, 20 ml 0.5% intraperitoneally. Those in group C (the control group) received 20 ml 0.9% saline. Pain was assessed, using a visual analogue scale (VAS) and a verbal rating scale (VRS), at 30 min, 60 min, 2 h and 4 h after surgery. Total analgesic consumption and the time to first need for analgesia were also noted.

Results  VAS and VRS pain scores were significantly lower in the ropivacaine and bupivacaine groups compared with the placebo group. Patients in group A (ropivacaine) experienced less pain than those in group B (bupivacaine) for all measurements. The time to first need for analgesia was significantly later for the ropivacaine and bupivacaine groups compared with the placebo group. The total analgesic consumption was also significantly lower in those groups than in the placebo group.

Conclusion  The results indicated that both ropivacaine and bupivacaine were effective at preventing pain and the need for postoperative analgesic when intraperitoneally instilled. However, ropivacaine is the better choice because of its higher efficacy.
Laparoscopic appendicectomy: an important skill for the gynaecologist
Authors: Calandra Claude , Barabash Ian D.
Published: December 2003

Objective  To demonstrate that laparoscopy is an important skill for gynaecologists to acquire. Laparoscopy is now one of the most commonly performed gynaecological procedures, commonly as an investigative tool for acute or chronic pelvic pain. In Australia, thousands of these procedures are performed each year.

Methods  We outline here the main authors’ experience and teaching of his trainees, outlining the technique for the performance of this surgery, in three separate clinical entities.

Conclusion  The performance of laparoscopic appendicectomy is an important facet of gynaecological training and can be performed by all gynaecologists with basic laparoscopic training.
Audit of laparoscopic surgery for tubal pregnancy in a district general hospital
Authors: Ali N. S. , Arthur P. , Prashar S.
Published: December 2003

Objective  To measure the proportion of tubal pregnancies managed laparoscopically and those suitable for laparoscopic surgery based on departmental guidelines in a district general hospital in the northwest of England.

Design  A retrospective audit of the surgical management of tubal pregnancies over a 12‐month period.

Setting   A district general hospital.

Participants   All women operated on for tubal pregnancy in Sharoe Green Hospital between 1 January 2001 and 31 December 2001.

Methods   Cases of tubal pregnancy requiring surgery during 2001 were identified from the computerized theatre log. The case notes of these women were reviewed and assessed as to whether they were managed appropriately by laparotomy and laparoscopic surgery.

Audit standard   All cases (100%) to be managed appropriately with laparoscopic surgery in accordance with Royal College of Obstetricians and Gynaecologists (RCOG) guidelines.

Results   Fifty‐two possible cases were identified. Five were not tubal pregnancies upon review of the notes and therefore excluded. Nine case notes could not be traced by the audit department. The remaining 38 cases of tubal pregnancy were reviewed. A total of 18% of cases underwent appropriate laparotomy and 82% were deemed suitable for operative laparoscopy. Only 39% of tubal pregnancies deemed suitable were managed by appropriately by laparoscopic surgery.

Conclusion   The majority of cases of tubal pregnancy were not managed appropriately with laparoscopic surgery in Sharoe Green Hospital. The proportion of tubal pregnancies suitable for laparoscopic surgery in a district general hospital is approximately 82%.
Purohit technique of vaginal hysterectomy: a new approach performed in 214 patients
Authors: Purohit Ram K.
Published: December 2003

Objectives   To study the feasibility, safety and efficacy of the newly designed Purohit technique for vaginal hysterectomy.

Design   Prospective observational study.

Setting   Urban private hospital.

Methods   The study involved 214 consecutive patients without prolapse. Inclusion criteria were: all benign disease of the uterus with a uterus of up to 20 weeks’ gestational size; patients were also included who had relative contraindications to the vaginal hysterectomy route, and who needed removal of movable adnexal cyst (5–7 cm) or oöphorectomy. Patients with endometriosis were excluded. Initially, vaginal hysterectomy was attempted in all patients included in the study, by means of the Purohit vaginal hysterectomy technique. Uterine arteries were secured by means of the Purohit uterine artery technique.

Outcome measures   These were: intraoperative and postoperative complications, duration of operation, need for laparoscopic assistance, postoperative pain, duration of hospital stay and readmission.

Results   The mean (± SD) weight of the removed uteri was 191.91 ± 101.52 g (range 40–950). Vaginal hysterectomy was successfully completed in 213 consecutive patients (99.53%), and failed in only one patient (0.46%) in whom laparoscopic assistance was needed to release the upper ligaments. Morcellation was required in 13.55%. Vaginal salpingo‐oöphorectomy was completed without difficulty in all 24 attempted procedures, including two patients with twisted ovarian cyst. Intraoperative bleeding was less than 100 ml in 87.85% of patients; 0.93% required blood transfusion. The mean haemoglobin loss was 0.5 g dl−1 (0.2–4.0). No major electrical injury occurred. The mean (± SD) operating time was 60.6 ± 26.53 min (25–180). Mild postoperative pain was experienced by 98.59% of patients, and the mean hospital stay was 2.7 ± 1 days (1–10). In the second postoperative week, 2.33% of patients developed haematocele above the vault of size 20–100 ml; two patients required readmission for drainage of the haematocele.

Conclusion   The Purohit technique is safe, and 99.53% of women with benign disease of a uterus of up to 20 weeks’ gestational size, excluding endometriosis, underwent vaginal hysterectomy, with or without salpingo‐oöphorectomy, carried out by means of this technique.
Spatial Data Infrastructure Requirements for Mobile Location Based Journey Planning
Authors: Smith Jessica , Mackaness William , Kealy Allison , Williamson Ian
Published: December 2003

A growing number of services are now being offered over mobile devices. They typically combine positioning technology, wireless technology and spatial analysis methods applied to detailed geographical, time based data to offer services in support of time critical, spatial, mobile decision making. A collection of research issues need to be addressed in the successful delivery of such services that extend beyond issues of sophisticated network algorithms. Specifically, careful attention needs to be given to: (1) people and user environments; (2) access to networks; (3) policy, privacy and liability; (4) standards and interoperability; and (5) data quality. Spatial Data Infrastructure (SDI) is the collective term for these interconnected issues and has been a traditional area of research associated with geographic information science. In this paper the particular SDI requirements for the successful delivery of Location Based Services (LBS) are explored through the development of a prototype LBS for journey planning. The initial implementation and testing of this prototype has revealed that the SDI context is well suited as a framework within which to examine the related LBS issues. From a more technical perspective, the testing has revealed that data structure and the means by which large data sets are mined (in order to gather information to present to users) is critical to the success of timely information delivery over limited bandwidth media.
A GIS‐Coupled Hydrological Model System for the Watershed Assessment of Agricultural Nonpoint and Point Sources of Pollution
Authors: Di Luzio Mauro , Srinivasan Raghavan , Arnold Jeffrey G
Published: December 2003

This paper introduces AVSWAT, a GIS based hydrological system linking the Soil and Water Assessment Tool (SWAT) water quality model and ArcView“ Geographic Information System software. The main purpose of AVSWAT is the combined assess‐ment of nonpoint and point pollution loading at the watershed scale. The GIS component of the system, in addition to the traditional functions of data acquisition, storage, organization and display, implements advanced analytical methods with enhanced flexibility to improve the hydrological characterization of a study watershed. Intuitive user friendly graphic interfaces, also part of the GIS component, have been developed to provide an efficient interaction with the model and the associated parameter databases, and ultimately to simplify water quality assessments, while maintaining and increasing their reliability. This is also supported by SWAT, the core of the system, a complex, conceptual, hydrologic, continuous model with spatially explicit parameterization, building upon the United State Department of Agriculture (USDA) modeling experience. A step‐by‐step example application for a watershed in Central Texas is also included to verify the capability and illustrate some of the characteristics of the system which has been adopted by many users around the world.
Evaluating the Audit Explosion
Authors: Power Michael
Published: December 2003

This paper reviews the claim that there has been an audit explosion in recent years and seeks to refine the argument in terms of its institutional and behavioral effects and its underlying causes and consequences. A framework for greater comparative sensitivity is suggested, both in cross‐national and cross‐sectoral terms, which focuses on variation in the knowledge base, formal organization, and operational dimensions of auditing. Finally, a preliminary framework for evaluating the design of auditing practices is developed that could inform a post‐Enron critical discussion of the problems and the potential for auditing in the future.
AIDS Audit – HIV and Human Rights: An Australian Pilot
Authors: Watchirs Helen
Published: December 2003

This article explores the Australian pilot of a human rights audit using ten indicators in the specific area of HIV/AIDS. The new methodology has three main roles: a monitoring device to measure human rights protection in a jurisdiction's legal system against international standards; an intervention to raise local dialogue and consciousness of rights‐based legislation; and an advocacy tool to stimulate law reform. It uses a tripartite process balancing independent experts, government, and community representatives. This approach attempts to overcome some of the democratic deficits identified by Power's hypothesis on the explosion of regulatory audits (1997).
Social Accountability Audits: Challenging or Defending Democratic Governance?
Authors: Courville Sasha
Published: December 2003

Current criticisms of the role of audit in society have painted a bleak picture about its use as a regulatory tool, highlighting negative consequences for democratic governance. This paper examines social accountability audits in light of these concerns. Two case studies of social certification systems are examined in detail: Fairtrade Labelling Organizations International (FLO) and Social Accountability International (SAI). These systems are evaluated using the lenses of accountability, ownership, trust, and reflexivity before concluding that social auditing processes, if done well and situated within stakeholder‐based institutions such as FLO and SAI, can aid democratic and legitimate governance processes.
Chisholm on Perceptual Knowledge: Foundationalism versus Coherentism
Authors: Lehrer Keith
Published: December 2003

Abstract: Chisholm refuted phenomenalism as a theory of the justification of perceptual beliefs. He argued, following Thomas Reid, that some perceptual beliefs were justified in themselves, which provided a foundation for empirical knowledge. The question that remains is whether the foundational justification provided offers an adequate explanation of how justification is connected with truth. The search for a truth connection led me from foundationalism to a coherence theory of justification that, contrary to my intentions, was inspired by an observation of Chisholm himself.
Chisholm's Epistemic Principles
Authors: Sosa Ernest
Published: December 2003

Abstract: An exposition and discussion of Chisholm's “epistemic principles.” These are compared with relevant views of Wilfrid Sellars and Richard Foley. A further comparison, with the approach favored by Descartes, is argued to throw light on the status of such principles.
Can Internalism Be Saved?
Authors: Kornblith Hilary
Published: December 2003

Abstract: Richard Feldman argues that a good deal more of Chisholm's approach can be saved than I allow in “Roderick Chisholm and the Shaping of American Epistemology.” More than this, Feldman argues that there are other, and still more defensible, forms of internalism. I argue here that the problems I presented for Chisholm's view are not so easily sidestepped either within Chisholm's system or by other forms of internalism.
Chisholm on freedom
Authors: Mele Alfred R.
Published: December 2003

Abstract: This critical examination of Roderick Chisholm's agent causal brand of libertarianism develops a problem about luck that undermines his earlier and later libertarian views on free will and moral responsibility and defends the thesis that a modest libertarian alternative considerably softens the problem. The alternative calls for an indeterministic connection in the action‐producing process that is further removed from action than Chisholm demands. The article also explores the implications of a relatively new variant of a Frankfurt‐style case for Chisholm's views of free will and moral responsibility and for libertarianism in general. It is suggested that Chisholm's efforts will and should continue to offer important assistance to libertarians who are determined to succeed where he apparently fell short.
Characterization of the clinical characteristics, electrolytes, acid–base, and renal parameters in male cats with urethral obstruction
Authors: Lee Justine A. , Drobatz Kenneth J.
Published: December 2003

Objective:To characterize the clinical characteristics, electrolyte changes, acid–base changes, and renal parameters in a consecutive population of cats with urethral obstruction.

Design:Retrospective clinical study.

Setting:University Veterinary Teaching Hospital.

Animals:Two hundred and twenty‐three male cats that presented consecutively with urethral obstruction between 1997 and 1999.

Interventions:None.

Measurements and main results:The medical records of 223 cats with urethral obstruction were reviewed for signalment, previous medical history, indoor/outdoor status, body weight, clinical signs, physical examination findings, renal function tests (blood urea nitrogen and creatinine), and blood gas and electrolyte analysis. The majority of cats were relatively stable without serious metabolic derangements. Only 12% (24/199) of cats had severe hyperkalemia (>8.0 mmol/L). Hyperkalemia did not occur in isolation; the majority of these cats had concurrent acidemia and low ionized calcium concentrations. Potassium was significantly inversely correlated with pH, bicarbonate,pCO2, sodium, chloride, and ionized calcium, but positively correlated with blood urea nitrogen and creatinine. Ionized calcium was positively correlated with pH and bicarbonate. Of the animals with a potassium concentration greater than 8.0 mmol/L, 75% (18/24) had an ionized calcium concentration of less than 1.0 mmol/L. Seventy‐nine percent (19/24) of cats with a potassium concentration greater than 8.0 mmol/L had a blood pH<7.20. Similarly, 74% (23/31) of cats with a pH<7.20 had an ionized calcium concentration <1.00 mmol/L.

Conclusions:The majority of cats with urethral obstruction presented with mild electrolyte and blood gas changes and were relatively stable, although 12% of cats had multiple, life‐threatening metabolic derangements. Of 219 cats in this study, 205 (93.6%), where it could be determined, survived to discharge from the hospital, supporting the fact that most cats with urethral obstruction survive the acute episode with emergency treatment.
Vascular endothelial growth factor (VEGF) and chronic graft‐versus‐host disease (cGVHD) in salivary glands of bone marrow transplant (BMT) recipients
Authors: Souza Leandro Napier , Carneiro Marcelo Antunes , De Azevedo Wellington Morais , Gomez Ricardo Santiago
Published: December 2003

Background:  The purpose of this study was to compare the immunolocalization of vascular endothelial growth factor (VEGF) in salivary glands of bone marrow transplant (BMT) recipients with normal controls and between the different stages of chronic graft‐versus‐host disease (cGVHD). In addition, the impact of the immunolocalization of VEGF on the survival rate of BMT patients was investigated as well.

Methods:  Labial salivary glands obtained at the day 100+ from 36 consecutive patients, who underwent BMT, were included in the study. The streptavidin–biotin–peroxidase complex stain was used to detect VEGF in the salivary glands. Time of death after BMT was displayed by means of the Kaplan–Meier method for the following parameters: age and gender of the patients, donor gender, acute GVHD, cGVHD staging at the labial salivary glands, primary disease, platelet and neutrophils counts on day of biopsy, stem cell, oral mucositis, parenteral nutrition, oral lichenoid lesions of GVHD, conditioning regimen and immunolocalization degree of VEGF in labial salivary glands. The data were initially analyzed by means of the log‐rank test and then included in the Cox's proportional hazard model.

Results:  No differences on the immunolocalization of VEGF in the labial salivary glands of BMT recipients and control group or between the different stages of glandular cGVHD were noted. Both univariate and multivariate analysis of the survival rate showed significance of 5% only for platelet count over 100 × 109/l on the day of biopsy and male donor gender.

Conclusions:  Platelet count over 100 × 109/l and male donor gender are positive predictive factors on the survival rate after BMT. In addition, the immunolocalization of VEGF in salivary glands is not altered in BMT recipients at day 100+ and is not influenced by the stage of cGVHD.
Polymorphism of the MICA gene and risk for oral submucous fibrosis
Authors: Liu Chung‐Ji , Lee Yann‐Jinn , Chang Kuo‐Wei , Shih Yi‐Ning , Liu Hsin‐Fu , Dang Ching‐Wen
Published: December 2003

Background:  Oral submucous fibrosis (OSF), an insidious, pre‐cancerous, chronic disease that may affect the entire oral cavity and sometimes extend to the pharynx has been reported to be associated with immune function. The major histocompatibility complex (MHC) class I chain‐related gene A (MICA) is expressed by keratinocytes and other epithelial cells, and its encoded protein interacts with γ/δ T‐cells localized in the submucosa. The MICA gene has a triplet repeat (GCT) polymorphism in the transmembrane domain resulting in five distinct allelic patterns.

Methods:  We analyzed MICA polymorphism in 80 OSF patients and 351 randomly selected unrelated controls by using the ABI Prism 377‐18 DNA sequencer (Applied Biosystems) to analyze the sample DNA PCR products. The number of microsatellite repeats was estimated with Genescan 672 software (Applied Biosystems) with a standard size marker of GS‐350 TAMRA.

Results:  The phenotype frequency of allele A6 of MICA in subjects with OSF was significantly higher than that in controls (OR = 3.48; 95% CI = 1.8–6.71; P = 0.0002), as was the frequency of the allele (OR = 2.65; 95% CI = 1.44–4.86; P = 0.001).

Conclusion:  The results suggest that allele A6 in MICA might confer a risk for OSF.
Amiodarone‐induced peri‐oral photosensitivity
Authors: Shah N. , Warnakulasuriya S.
Published: December 2003

We describe a 70‐year‐old Caucasian man with recurrent history of blistering of peri‐oral skin during summer months. Following the diagnosis of a phototoxic reaction to Amiodarone, this was discontinued and an alternative drug to control his cardiac arrhythmia was prescribed. His peri‐oral lesions rapidly resolved, and there has been no further recurrence. A brief review on photosensitivity and the underlying mechanisms are discussed.
Mucinous adenocarcinoma with neuroendocrine differentiation of the mandibular ramus: report of a case
Authors: Hashitani S. , Sakurai K. , Noguchi K. , Natori J. , Urade M.
Published: December 2003

A rare case of mucinous adenocarcinoma with neuroendocrine differentiation of the mandibular ramus is presented. The patient, an 80‐year‐old man, was referred to our hospital with chief complaint of swelling and pain in the left buccal mucosa. CT and MRI examination showed an osteolytic tumor mass occupying the upper region of the left mandibular ramus. Macroscopically, the excised tumor was a relatively well‐defined, solid mass with diffuse bone resorption, measuring 3 cm × 3.2 cm × 3 cm. Microscopical examination showed that the tumor forming glandular structures with abundant mucous production and high cellular atypia. Immunohistochemical studies demonstrated the positive reactivities for pan‐keratin, cytokeratin 7, vimentin,α‐amylase, α‐smooth muscle actin, neuron‐specific enolase, glial fibrillary acid protein, calcitonin, and somatostatin in tumor cells. These findings suggested that the tumor was originated from heterotopic or misplaced salivary gland in the mandible.
Whole-Genome Analysis of Two-Component Signal Transduction Genes in Fungal Pathogens
Authors: Catlett Natalie L. , Yoder Olen C. , Turgeon B. Gillian
Published: December 2003

Two-component phosphorelay systems are minimally comprised of a histidine kinase (HK) component, which autophosphorylates in response to an environmental stimulus, and a response regulator (RR) component, which transmits the signal, resulting in an output such as activation of transcription, or of a mitogen-activated protein kinase cascade. The genomes of the yeasts
Saccharomyces cerevisiae
,
Schizosaccharomyces pombe
, and
Candida albicans
encode one, three, and three HKs, respectively. In contrast, the genome sequences of the filamentous ascomycetes
Neurospora crassa
,
Cochliobolus heterostrophus
(
Bipolaris maydis
),
Gibberella moniliformis
(
Fusarium verticillioides
), and
Botryotinia fuckeliana
(
Botrytis cinerea
) encode an extensive family of two-component signaling proteins. The putative HKs fall into 11 classes. Most of these classes are represented in each filamentous ascomycete species examined. A few of these classes are significantly more prevalent in the fungal pathogens than in the saprobe
N. crassa
, suggesting that these groups contain paralogs required for virulence. Despite the larger numbers of HKs in filamentous ascomycetes than in yeasts, all of the ascomycetes contain virtually the same downstream histidine phosphotransfer proteins and RR proteins, suggesting extensive cross talk or redundancy among HKs.
SwoHp, a Nucleoside Diphosphate Kinase, Is Essential inAspergillus nidulans
Authors: Lin Xiaorong , Momany Cory , Momany Michelle
Published: December 2003

The temperature-sensitiveswoH1mutant ofAspergillus nidulanswas previously identified in a screen for mutants with defects in polar growth. In the present work, we found that theswoH1mutant swelled, lysed, and did not produce conidia during extended incubation at the restrictive temperature. When shifted from the permissive to the restrictive temperature,swoH1showed the temperature-sensitive swelling phenotype only after 8 h at the higher temperature. TheswoHgene was mapped to chromosome II and cloned by complementation of the temperature-sensitive phenotype. The sequence showed thatswoHencodes a homologue of nucleoside diphosphate kinases (NDKs) from other organisms. Deletion experiments showed that theswoHgene is essential. A hemagglutinin-SwoHp fusion complemented the mutant phenotype, and the purified fusion protein possessed phosphate transferase activity in thin-layer chromatography assays. Sequencing of the mutant allele showed a predicted V83F change. Structural modeling suggested that theswoH1mutation would lead to perturbation of the NDK active site. Crude cell extracts from theswoH1mutant grown at the permissive temperature had ∼20% of the NDK activity seen in the wild type and did not show any decrease in activity when assayed at higher temperatures. Though the data are not conclusive, the lack of temperature-sensitive NDK activity in theswoH1mutant raises the intriguing possibility that the SwoH NDK is required for growth at elevated temperatures rather than for polarity maintenance.
pH Response Transcription Factor PacC Controls Salt Stress Tolerance and Expression of the P-Type Na
+
-ATPase Ena1 in
Fusarium oxysporum
Authors: Caracuel Zaira , Casanova Carlos , Roncero M. Isabel G. , Di Pietro Antonio , Ramos José
Published: December 2003

Fungi possess efficient mechanisms of pH and ion homeostasis, allowing them to grow over a wide range of environmental conditions. In this study, we addressed the role of the pH response transcription factor PacC in salt tolerance of the vascular wilt pathogen
Fusarium oxysporum
. Loss-of-function
pacC
+/−
mutants showed increased sensitivity to Li
+
and Na
+
and accumulated higher levels of these cations than the wild type. In contrast, strains expressing a dominant activating

pacC
c

allele were more salt tolerant and had lower intracellular Li
+
and Na
+
concentrations. Although the kinetics of Li
+
influx were not altered by mutations in
pacC
, we found that Li
+
efflux at an alkaline, but not at an acidic, ambient pH was significantly reduced in
pacC
+/−
loss-of-function mutants. To explore the presence of a PacC-dependent efflux mechanism in
F. oxysporum
, we cloned
ena1
encoding an orthologue of the yeast P-type Na
+
-ATPase ENA1. Northern analysis revealed that efficient transcriptional activation of
ena1
in
F. oxysporum
required the presence of high Na
+
concentrations and alkaline ambient pH and was dependent on PacC function. We propose a model in which PacC controls ion homeostasis in
F. oxysporum
at a high pH by activating expression of
ena1
coordinately with a second Na
+
-responsive signaling pathway.
Use of cDNA Microarrays To Monitor Transcriptional Responses of the Chestnut Blight FungusCryphonectria parasiticato Infection by Virulence-Attenuating Hypoviruses
Authors: Allen Todd D. , Dawe Angus L. , Nuss Donald L.
Published: December 2003

Hypoviruses are a family of cytoplasmically replicating RNA viruses of the chestnut blight fungusCryphonectria parasitica. Members of this mycovirus family persistently alter virulence (hypovirulence) and related fungal developmental processes, including asexual and sexual sporulation. In order to gain a better understanding of the molecular basis for these changes, we have developed aC. parasiticacDNA microarray to monitor global transcriptional responses to hypovirus infection. In this report, a spotted DNA microarray representing approximately 2,200C. parasiticagenes was used to monitor changes in the transcriptional profile after infection by the prototypic hypovirus CHV1-EP713. Altered transcript abundance was identified for 295 clones (13.4% of the 2,200 unique cDNAs) as a result of CHV1-EP713 infection—132 up-regulated and 163 down-regulated. In comparison, less than 20 specificC. parasiticagenes were previously identified by Northern analysis and mRNA differential display as being responsive to hypovirus infection. A 93% validation rate was achieved between real-time reverse transcription-PCR results and microarray predictions. Differentially expressed genes represented a broad spectrum of biological functions, including stress responses, carbon metabolism, and transcriptional regulation. These findings are consistent with the view that infection by a 12.7-kbp hypovirus RNA results in a persistent reprogramming of a significant portion of theC. parasiticatranscriptome. The potential impact of microarray studies on current and future efforts to establish links between hypovirus-mediated changes in cellular gene expression and phenotypes is discussed.
EAP1
, a
Candida albicans
Gene Involved in Binding Human Epithelial Cells
Authors: Li Fang , Palecek Sean P.
Published: December 2003

Candida albicans
adhesion to host tissues contributes to its virulence and adhesion to medical devices permits biofilm formation, but we know relatively little about the molecular mechanisms governing
C. albicans
adhesion to materials or mammalian cells.
Saccharomyces cerevisiae
provides an attractive model system for studying adhesion in yeast because of its well-characterized genetics and gene expression systems and the conservation of signal transduction pathways among the yeasts. In this study, we used a parallel plate flow chamber to screen and characterize attachment of a
flo8
Δ
S. cerevisiae
strain expressing a
C. albicans
genomic library to a polystyrene surface. The gene
EAP1
was isolated as a putative cell wall adhesin. Sequence analysis of
EAP1
shows that it contains a signal peptide, a glycosylphosphatidylinositol anchor site, and possesses homology to many other yeast genes encoding cell wall proteins. In addition to increasing adhesion to polystyrene, heterologous expression of
EAP1
in
S. cerevisiae
and autonomous expression of
EAP1
in a
C. albicans efg1
homozygous null mutant significantly enhanced attachment to HEK293 kidney epithelial cells.
EAP1
expression also restored invasive growth to haploid
flo8
Δ and
flo11
Δ strains as well as filamentous growth to diploid
flo8/flo8
and
flo11/flo11
strains. Transcription of
EAP1
in
C. albicans
is regulated by the transcription factor Efg1p, suggesting that
EAP1
expression is activated by the cyclic AMP-dependent protein kinase pathway.
Recruitment of Tup1-Ssn6 by Yeast Hypoxic Genes and Chromatin-Independent Exclusion of TATA Binding Protein
Authors: Mennella Thomas A. , Klinkenberg Lee G. , Zitomer Richard S.
Published: December 2003

The Tup1-Ssn6 general repression complex in
Saccharomyces cerevisiae
represses a wide variety of regulons. Regulon-specific DNA binding proteins recruit the repression complex, and their synthesis, activity, or localization controls the conditions for repression. Rox1 is the hypoxic regulon-specific protein, and a second DNA binding protein, Mot3, augments repression at tightly controlled genes. We addressed the requirements for Tup1-Ssn6 recruitment to two hypoxic genes,
ANB1
and
HEM13
, by using chromatin immunoprecipitation assays. Either Rox1 or Mot3 could recruit Ssn6, but Tup1 recruitment required Ssn6 and Rox1. We also monitored events during derepression. Rox1 and Mot3 dissociated from DNA quickly, accounting for the rapid accumulation of
ANB1
and
HEM13
RNAs, suggesting a simple explanation for induction. However, Tup1 remained associated with these genes, suggesting that the localization of Tup1-Ssn6 is not the sole determinant of repression. We could not reproduce the observation that deletion of the Tup1-Ssn6-interacting protein Cti6 was required for induction. Finally, Tup1 is capable of repression through a chromatin-dependent mechanism, the positioning of a nucleosome over the TATA box, or a chromatin-independent mechanism. We found that the rate of derepression was independent of the positioned nucleosome and that the TATA binding protein was excluded from
ANB1
even in the absence of the positioned nucleosome. The mediator factor Srb7 has been shown to interact with Tup1 and to play a role in repression at several regulons, but we found that significant levels of repression remained in
srb7
mutants even when the chromatin-dependent repression mechanism was eliminated. These findings suggest that the repression of different regulons or genes may invoke different mechanisms.
Saccharomyces cerevisiae
Histidine Phosphotransferase Ypd1p Shuttles between the Nucleus and Cytoplasm for
SLN1
-Dependent Phosphorylation of Ssk1p and Skn7p
Authors: Lu Jade Mei-Yeh , Deschenes Robert J. , Fassler Jan S.
Published: December 2003

Sln1p is a plasma membrane-localized two-component histidine kinase that functions as an osmotic stress sensor in
Saccharomyces cerevisiae
. Changes in osmotic pressure modulate Sln1p kinase activity, which, together with Ypd1p, a phosphorelay intermediate, changes the phosphorylation status of two response regulators, Ssk1p and Skn7p. Ssk1p controls the activity of the HOG1 mitogen-activated protein kinase pathway. Skn7p is a nuclearly localized transcription factor that regulates genes involved in cell wall integrity and other processes. Subcellular compartmentalization may therefore play an important role in eukaryotic two-component pathway regulation. We have studied the subcellular localization of SLN1 pathway components and find that Ypd1p is a dynamic protein with a role in shuttling the osmotic stress signal from Sln1p to Ssk1p in the cytosol and to Skn7p in the nucleus. The need to translocate the signal into different intracellular compartments contributes a spatial dimension to eukaryotic two-component pathways compared to the prototypical two-component pathways of prokaryotes.