Association genetics of carbon isotope discrimination, height and foliar nitrogen in a natural population of Pinus taeda L.

Loblolly pine, Pinus taeda L., is one of the most widely planted, commercially and ecologically important tree species in North America. We took an association genetics approach, using an unimproved population of 380 clonally replicated unrelated trees, to test 3,938 single nucleotide polymorphisms (SNPs) in as many genes for association with phenotypic variation in carbon isotope discrimination, foliar nitrogen concentration and total tree height after two growing seasons. Best linear unbiased prediction (BLUP) was used with a spatial adjustment to remove environmental variation from phenotypic data derived from a common garden experiment. After correction for multiple testing, a total of 14 SNPs were associated with the traits of carbon isotope discrimination (n = 7), height (n = 1) and foliar nitrogen concentration (n = 6) using 380 clones. Tails of the population phenotypic distribution were compared for allele frequency differences, revealing 10 SNPs with allele frequency in at least one tail significantly different from the overall population. Eight associated SNPs were in sequences similar to known genes, such as an AP2 transcription factor related to carbon isotope discrimination and glutamate decarboxylase associated with foliar nitrogen concentration, and others were from unknown genes without homologs in Arabidopsis.

Electrical stimulation for gastroparesis. Gastric motility restored.

BACKGROUND: Gastroparesis is a disabling, and sometimes fatal, disease that often does not respond to medical treatment. This single-surgeon prospective study examines the safety and 6-month efficacy of electrical stimulation for the treatment of gastroparesis. METHODS: Sixteen patients with medically refractory gastroparesis underwent laparoscopic implantation of an electrical stimulator device (Enterra Therapy, Medtronic, Minneapolis, MN, USA) consisting of a subcutaneous stimulator and two gastric wall leads. Gastric emptying scans (GES) confirmed the diagnosis of gastroparesis. Patients were evaluated preoperatively using a self-administered GI symptomatology questionnaire and RAND 36 Health Survey. Once patients were >6-months from implantation, a repeat GES was obtained and patients completed a postoperative GI symptomatology questionnaire and RAND 36 Health Survey. Ten of 16 patients in this case series were >6-months from implantation. One was lost to follow-up. An F-test was used to establish equality of standard deviations between the 16 patients evaluated preoperatively and the subset of 10 patients evaluated postoperatively. A Student's t-test was used to evaluate the significance of differences in pre- and postoperative results. RESULTS: Average operating time was 117 min with no intraoperative complications. The majority of patients were discharged on postoperative day 1. There were two complications in the postoperative period. Patients experienced a significant decrease in nausea and vomiting as measured by the GI symptomatology questionnaire. Half of all patients no longer required gastric prokinetic medications and there was a subjective reduction of pyrosis, early satiety, and epigastric pain. A significant increase in quality of life as measured by the RAND 36 Health Survey was seen, and six of eight patients no longer demonstrated gastroparesis on GES. CONCLUSION: Laparoscopic implantation of an electrical stimulation device is a safe and effective treatment by subjective and objective standards for the management of medically refractory gastroparesis.

QRS prolongation: a sensitive marker of ischemia during percutaneous transluminal coronary angioplasty.

The purpose of this study is to measure QRS duration changes in the human model of ischemia during percutaneous transluminal coronary angioplasty (PTCA) and compare these results to the commonly used ischemia markers, chest pain, and classical ST-T changes. Using a computerized method, QRS duration was measured in 51 patients undergoing elective PTCA. Three milliseconds (msec) or more prolongation of the QRS at peak inflation was considered to be an ischemic response. The results were compared to chest pain and ST-T changes and were analyzed for inflation site within individual coronary arteries. Forty-two patients had a pathological prolongation of the QRS during PTCA. Thirty-two patients developed chest pain, while 19 had ischemic ST-T changes. QRS duration was more prolonged in PTCA to proximal or middle segments of major arteries or their large branches, while it was less prolonged in distal segments or smaller branches. Using our method, QRS prolongation was an ischemia marker in most patients during PTCA and was more sensitive than chest pain or ST-T changes. QRS duration was more prolonged with occlusion of proximal and middle segments of major arteries. Cathet. Cardiovasc. Intervent. 50:177-183, 2000.

Atrial tachycardia as the presenting sign of a left atrial appendage aneurysm.

A patient presented with atrial tachycardia. The work-up, guided by the tachycardia morphology, led to the diagnosis of left atrial appendage aneurysm. Surgical removal of the atrial appendage resulted in cure of the tachycardia and associated symptoms.

Blind protected specimen brush and bronchoalveolar lavage in ventilated children.

OBJECTIVE: To determine whether nonbronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) are contributive for diagnosing ventilator-associated pneumonia in mechanically ventilated children. DESIGN: Prospective study. SETTING: Fifteen-bed pediatric intensive care unit in a university hospital. PATIENTS: A total of 103 mechanically ventilated children, ranging in age from 7 days to 8.8 yrs, most with a high clinical suspicion for bacterial pneumonia. INTERVENTIONS: All the children underwent nonbronchoscopic PSB and BAL. Nonbronchoscopic PSB was performed with a plugged double-sheathed brush and BAL with a double-lumen plugged catheter. Endotracheal secretions and blood cultures were also collected. Open-lung biopsy was performed for any child who died within 7 days after the inclusion in the study, according to the parental consent. MEASUREMENTS AND MAIN RESULTS: The PSB specimens were submitted for bacteriologic quantitative culture (positive threshold, 10(3) colony-forming units [cfu]/mL). The BAL samples were processed for microscopic quantification of the polymorphonuclear cells containing intracellular bacteria (positive threshold, 1%) and quantitative culture (positive threshold, 10(4) cfu/mL). According to diagnostic categories based on clinical, biological, radiologic, and pathologic criteria, 29 children had bacterial pneumonia and 64 did not Ten children were classified as having an uncertain status. Of the 29 children with bacterial pneumonia, 26 (90%) met one of the following three criteria: a) PSB specimen culture, > or =10(3) cfu/mL; b) intracellular bacteria in cells retrieved by BAL, > or =1%; and c) BAL fluid culture, > or =10(4) cfu/mL. In contrast, 56 (88%) of the 64 patients without pneumonia did not. CONCLUSION: The results of this study indicate the following: a) nonbronchoscopic PSB and BAL were feasible in a large population of mechanically ventilated children; b) nonbronchoscopic techniques were contributive for diagnosing ventilator-associated pneumonia in children; and c) a combined diagnostic approach, using nonbronchoscopic PSB and BAL, was superior to using either test alone.

Evolutive aortic stenosis in hemodialysis patients: analysis of risk factors.

Cardiovascular diseases represent the major cause of death in hemodialysis patients. However, little information is available about the repercussion of uremia on cardiac valves. We retrospectively investigated the incidence rate of aortic stenosis (AS), from 1991 to 1996, in 110 hemodialysis patients followed by Doppler-echocardiography. Progressive AS was diagnosed in 16 patients who had a decrease in their indexed aortic valve area from 1.24 +/- 0.09 to 0.66 +/- 0.21 cm2/m2 of BSA in 16.8 +/- 1.9 months. The mean incidence of AS per year was of 3.3%, ranging from 1.5 to 8.0%. Eight patients died in less than 3 years after the diagnosis of AS with a mean survival time of 23.0 +/- 9.5 months. Survival curves using Kaplan-Meier estimates showed a statistically significant decrease in the survival rate of patients with AS compared with patients without valvulopathy (p < 0.001). They were older than patients with normal valve, 68.6 +/- 11.1 versus 56.7 +/- 16.0 years, respectively. Men were 4 times more affected than women and showed a significantly more rapid progression to AS than women. The calcium-phosphorus product was higher in AS patients, 5.43 +/- 0.98 than in patients without AS, 3.95 +/- 0.50 mM. It was mainly due to hyperphosphatemia without hypercalcemia and the hyperphosphatemia was associated with biological signs of hypoparathyroidism or adynamic bone disease in 62% of the cases. Plasma vitamin D3 was also higher in patients with AS, 20.5 +/- 13.5 ng/ml than in those with normal valves, 9.6 +/- 6.3 ng/ml. Logistic regression showed that age, vitamin D3 and hyperphosphatemia correctly predicted 56% of the AS cases. In conclusion, AS is frequent and of poor outcome in hemodialysis patients. Age, relatively high plasma vitamin D3 levels, and hyperphosphatemia, mostly due to hypoparathyroidism, must be considered as risk factors.

Ischemia detection in women: the diagnostic value of exercise QRS duration changes.

AIM: To compare the diagnostic accuracy of exercise electrocardiographic (ECG) ST-T changes and QRS duration changes as a means of ischemia detection in a female population. METHODS AND RESULTS: A total of 101 women from a pool of 318 referred for ECG stress testing underwent standard testing using ST-T criteria with the additional measurement of QRS duration before and at peak exercise using a new computerized optic scanner for precise QRS duration measurement. The diagnostic accuracy of the test was determined using planar thallium stress testing as a "gold standard." For the overall population, the sensitivity of ST-T criteria was 47% with a specificity of 58%. The sensitivity of QRS duration changes was 91% with a specificity of 89%. For Group 1 (age 27-50) the sensitivity of the ST-T criteria was 40% with a specificity of 58%. The sensitivity of the QRS duration changes was 80% with a specificity of 83%. For Group 2 (age 51-83), the sensitivity of the ST-T criteria was 43% with a specificity of 56%. The sensitivity of the QRS duration changes was 94% with a specificity of 90%. CONCLUSION: In our female population exercise, QRS duration changes using our computerized method were better markers of ischemia than standard ST-T criteria.

Ischemia detection after myocardial infarction: diagnostic value of exercise-induced QRS duration changes evaluated by a new computerized method.

A new computerized optical scanner was used to measure QRS complex duration during exercise stress testing, both pre- and postdischarge, as a means of ischemia detection after acute myocardial infarction. Thallium stress testing was used as a standard of comparison. Each patient underwent predischarge exercise testing (while receiving anti-ischemic drug therapy) and a postdischarge test 1 month later (without anti-ischemic drug therapy), as well as thallium stress testing within 4 months of infarction. In the population of 68 patients, 42 of the predischarge tests and 43 of the postdischarge tests showed an ischemic response of QRS prolongation. When compared with thallium testing for QRS prolongation criteria, the sensitivity was 95% with a specificity of 77% predischarge and 89% with a specificity of 65% postdischarge. According to ST-T criteria, only 12 of 68 patients were positive for ischemia predischarge; this number increased to 29 postdischarge (predischarge sensitivity 24% and specificity 90%, with postdischarge sensitivity 68% and specificity 87%), when compared with thallium testing. Measuring QRS duration during exercise increased the sensitivity of detection of ischemic patients over that of ST-T criteria by 71% predischarge and 21% postdischarge, with a 22-23% loss of specificity, and was apparently not influenced by anti-ischemic drug therapy.

Pseudoaneurysm of the left ventricular outflow tract with reentry into the ascending aorta: an iatrogenic left ventricular ascending aortic fistula.

We report a patient with an iatrogenic pseudoaneurysm of the left ventricular outflow tract with reentry into the ascending aorta above the level of a prosthetic aortic valve. This pathology has not been previously described and was well demonstrated by transthoracic echocardiography.

QRS prolongation measured by a new computerized method: a sensitive marker for detecting exercise-induced ischemia.

This study compared thallium stress testing and exercise changes in QRS duration using a computerized 'optic scanner' in three groups. Group 1 consisted of 108 subjects with positive exercise ECG tests by ST-T segment criteria and with proven coronary artery disease. Group 2 included 19 subjects with nondiagnostic exercise ECG ST-T changes and with proven coronary artery disease. Group 3 was formed by 38 healthy controls. Group 1: Mean increase in exercise QRS width of 12.4 +/- 14 ms. Group 3: Mean decrease in exercise QRS width of 4.9 +/- 9.3 ms (p < 0.0001). Group 2: Mean QRS prolongation of 7.8 +/- 9.2 ms, which was significantly different from the controls (p < 0.0001) but not from group 1. When compared to thallium stress testing, exercise QRS prolongation had a sensitivity of 93%, specificity of 71%, relative risk of 5, and positive predictive value of 86%. QRS duration measurement can improve the diagnostic accuracy of the exercise ECG stress test.

[Left atrial ball thrombus].

An 80-year-old hypertensive woman with chronic atrial fibrillation was hospitalized because of recurrent syncope. Echocardiography revealed a large left atrial ball thrombus. Operative findings confirmed the echocardiographic diagnosis.

Male genital trauma: diagnosis and management.

Trauma to the male external genitalia represents a serious injury that must be managed promptly and completely. To avoid long-term loss of function, disability, and psychologic effects, wounds should be carefully assessed, protected from further injury, and referred for surgical and social follow-up.

Microwave therapy of benign prostatic hyperplasia.

Thermotherapy of the prostate proves to be a safe and effective treatment for patients with symptomatic prostatism secondary to BPH. Present treatment regimens yield results and side effects intermediate between drug therapy and prostatectomy. Future enhancements of the thermotherapy technique are likely to improve its results to the level of surgery.

Angiographic follow-up of coronary artery ectasia.

Of 1,125 patients catheterized over a period of 8 years, 68 (6%) had coronary ectasia. Twenty-five of them were catheterized at least twice and constituted the study group. The time between the first and last catheterization ranged from 2 to 8 years (mean +/- SD = 4.2 +/- 1.6). Coronary ectasia was more frequent in males (88%). The frequency of involvement was: the right coronary (47%), the left circumflex (30%), the left anterior descending (21%) and the left main arteries (2%). Proximal segments were most frequently involved (48%). Diffuse involvement was found in 29%. Severity of ectasia progressed in 6 segments (14%) and 2 new ectatic segments appeared over the follow-up period. During that period, 2 patients had myocardial infarction, 1 of them due to a total occlusion of an ectatic segment. There were no deaths. In conclusion, coronary ectasia has a relatively benign course.

Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure.

OBJECTIVE: To compare the ability of angiotensin converting enzyme inhibitors and beta blockers to slow the development of end stage renal failure in non-diabetic patients with chronic renal failure. DESIGN: Open randomised multicentre trial with three year follow up. SETTING: Outpatient departments of six French hospitals. PATIENTS: 100 hypertensive patients with chronic renal failure (initial serum creatinine 200-400 mumol/l. 52 randomised to enalapril and 48 to beta blockers (conventional treatment). INTERVENTIONS: Enalapril or beta blocker was combined with frusemide and, if necessary, a calcium blocker or centrally acting drug in patients whose diastolic pressure remained above 90 mm Hg. RESULTS: 17 patients receiving conventional treatment and 10 receiving enalapril developed end stage renal failure. The cumulative renal survival rate was significantly better in the enalapril group than in the conventional group (P < 0.05). The slope of the reciprocal serum creatinine concentration was steeper in the conventionally treated patients (-6.89 x 10(-5)l/mumol/month) than in the enalapril group (-4.17 x 10(-5)l/mumol/month; P < 0.05). No difference in blood pressure was found between groups. CONCLUSION: In hypertensive patients with chronic renal failure enalapril slows progression towards end stage renal failure compared with beta blockers. This effect was probably not mediated through controlling blood pressure.

The role of retroperitoneal lymphadenectomy in localized paratesticular rhabdomyosarcoma.

Between 1985 and 1990, 10 cases of embryonal paratesticular rhabdomyosarcoma were treated at our institution. Patient age ranged from 5 months to 16 years at presentation (mean 8.7 years). Chest and abdominal computerized tomography (CT) was performed on all patients. Lymphangiography was performed on 2 patients, and 6 underwent retroperitoneal lymphadenectomy, due to suspicious CT (2) and a positive lymphangiogram (1). All 6 patients had pathologically negative nodes, and they received vincristine, actinomycin D and cyclophosphamide for 8 to 13 months (mean 10.6 months). Four patients also received doxorubicin. The 10 patients are alive and the disease is in complete remission for a mean 6.02-year disease-free survival. These data support the hypothesis that retroperitoneal lymphadenectomy can be avoided for paratesticular rhabdomyosarcoma after radical inguinal orchiectomy when CT is negative for nodal involvement.

Aneurysm of the left main coronary artery: progression of dilatation with concomitant deterioration of coronary stenoses.

A left main aneurysm is a rare angiographic finding. We describe a 59-year-old male with a large aneurysm in the left main coronary artery. The aneurysm had enlarged in comparison to its diameter of 3.5 years previously, together with a progression of severity of his coronary stenoses.