[Transbronchial lung cryobiopsy in interstitial lung diseases]. / Les cryobiopsies pulmonaires transbronchiques dans les pneumopathies infiltrantes diffuses.

In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.

Coconut oil protects cortical neurons from amyloid beta toxicity by enhancing signaling of cell survival pathways.

Alzheimer's disease is a progressive neurodegenerative disease that has links with other conditions that can often be modified by dietary and life-style interventions. In particular, coconut oil has received attention as having potentially having benefits in lessening the cognitive deficits associated with Alzheimer's disease. In a recent report, we showed that neuron survival in cultures co-treated with coconut oil and Aß was rescued compared to cultures exposed only to Aß. Here we investigated treatment with Aß for 1, 6 or 24 h followed by addition of coconut oil for a further 24 h, or treatment with coconut oil for 24 h followed by Aß exposure for various periods. Neuronal survival and several cellular parameters (cleaved caspase 3, synaptophysin labeling and ROS) were assessed. In addition, the influence of these treatments on relevant signaling pathways was investigated with Western blotting. In terms of the treatment timing, our data indicated that coconut oil rescues cells pre-exposed to Aß for 1 or 6 h, but is less effective when the pre-exposure has been 24 h. However, pretreatment with coconut oil prior to Aß exposure showed the best outcomes. Treatment with octanoic or lauric acid also provided protection against Aß, but was not as effective as the complete oil. The coconut oil treatment reduced the number of cells with cleaved caspase and ROS labeling, as well as rescuing the loss of synaptophysin labeling observed with Aß treatment. Treatment with coconut oil, as well as octanoic, decanoic and lauric acids, resulted in a modest increase in ketone bodies compared to controls. The biochemical data suggest that Akt and ERK activation may contribute to the survival promoting influence of coconut oil. This was supported by observations that a PI3-Kinase inhibitor blocked the rescue effect of CoOil on Aß amyloid toxicity. Further studies into the mechanisms of action of coconut oil and its constituent medium chain fatty acids are warranted.

Adverse events associated with regional ophthalmic anaesthesia in an Australian teaching hospital.

This study prospectively audited 3339 peribulbar and 2688 sub-Tenon's eye blocks in an Australian teaching hospital with regard to the occurrence of adverse events. Complications were classified into three groups: ocular complications directly due to the eye block technique, systemic medical complications possibly associated with block technique and adverse events which were unlikely to have been associated with block technique. Five serious ocular complications were associated with peribulbar block compared to none with sub-Tenon's block (P = 0.07).

Identification of genes associated with ovarian cancer metastasis using microarray expression analysis.

Although the transition from early- to advanced-stage ovarian cancer is a critical determinant of survival, little is known about the molecular underpinnings of ovarian metastasis. We hypothesize that microarray analysis of global gene expression patterns in primary ovarian cancer and metastatic omental implants can identify genes that underlie the metastatic process in epithelial ovarian cancer. We utilized Affymetrix U95Av2 microarrays to characterize the molecular alterations that underlie omental metastasis from 47 epithelial ovarian cancer samples collected from multiple sites in 20 patients undergoing primary surgical cytoreduction for advanced-stage (IIIC/IV) serous ovarian cancer. Fifty-six genes demonstrated differential expression between ovarian and omental samples (P < 0.01), and twenty of these 56 differentially expressed genes have previously been implicated in metastasis, cell motility, or cytoskeletal function. Ten of the 56 genes are involved in p53 gene pathways. A Bayesian statistical tree analysis was used to identify a 27-gene expression pattern that could accurately predict the site of tumor (ovary versus omentum). This predictive model was evaluated using an external data set. Nine of the 27 predictive genes have previously been shown to be involved in oncogenesis and/or metastasis, and 10/27 genes have been implicated in p53 pathways. Microarray findings were validated by real-time quantitative PCR. We conclude that gene expression patterns that distinguish omental metastasis from primary epithelial ovarian cancer can be identified and that many of the genes have functions that are biologically consistent with a role in oncogenesis, metastasis, and p53 gene networks.

Sub-Tenon block: a learning curve of 100 cases.

This study measures the learning curve for accomplishing sub-Tenon blocks for ophthalmic surgery applicable to anaesthetists skilled in peribulbar techniques. We defined criteria for a good block in terms of chemosis, subconjunctival haemorrhage, globe movement and the need for additional peribulbar block. The overall success rate, by our definitions, was 72% and 56% for the two operators. The overall requirement for an additional peribulbar block was 10%. The rate of additional blocks and reduction in globe movement reached a plateau after about 60 procedures for both operators. The rates of chemosis (6% and 12% overall) and subconjunctival haemorrhage (6% and 12% overall) did not trend with increased experience. The results applied to both a cataract and a vitreo-retinal surgery casemix.

A quality assurance index for brachytherapy treatment plan verification.

A method is described which provides an independent verification of a brachytherapy treatment plan. The method is applicable to any common geometric configuration and utilises a simple equation derived from a common form of non-linear regression. The basis for the index value is the relationship between the treatment time, prescribed dose, source strength and plan geometry. This relationship may be described mathematically as: Total Treatment Time proportional to (Prescribed Dose/Source Strength) x (a geometric term) with the geometric term incorporating three geometric components, namely the distance from source positions to points of dose normalisation d, the total length of the dwell positions L, and the number of source trains or catheters N. A general equation of the form GF = k (d)(-alpha) (L)(-beta) (N)(-gamma) is used to describe the plan geometry, where GF is what we have termed the geometric factor, k is a constant of proportionality and the exponents are derived from the non-linear regression process. The resulting index is simple to calculate prior to patient treatment and sensitive enough to identify significant error whilst being robust enough to allow for a normal degree of geometric distortion.

[A rare dyspnea in internal medicine: platypnea-orthodeoxia after pneumonectomy]. / Une dyspnée exceptionnelle en médecine interne: la platypnée-orthodéoxie après pneumonectomie.

BACKGROUND: A right-to-left shunting across a patent foramen ovale is a rare cause of acute respiratory failure after pneumonectomy. CASE REPORTS: We report two cases of posture dependent dyspnea (platypnea-orthodeoxia) secondary to postoperative right-to-left shunting across a patent foramen ovale. Both cases occurred three months after pneumonectomy, the first in a 63-year-old man and other in a 52-year-old man. CONCLUSION: A platypnea-orthodeoxia (dyspnea induced by the upright position with arterial deoxygenation relieved by recumbency) should lead to the diagnosis which is confirmed by echography or cardiac catheterization. The prognosis is good after surgical closure of the patent foramen ovale. The physiopathologic mechanism is poorly understood. We report two cases of platypnea-orthodeoxia.

Radiographic evaluation of anterior cruciate ligament graft failure with special reference to tibial tunnel placement.

Graft failure in anterior cruciate ligament (ACL) reconstruction can result from anterior placement of the tibial tunnel. Conventional radiographic evaluation of this problem does not take into account potential changes in tibio-femoral relationship caused by ACL instability. A retrospective radiographic evaluation of failed as well as successful ACL reconstructions was carried out. Both published radiographs as well as those obtained of patients treated by the authors were evaluated for tibial tunnel placement, roof impingement, and tibial position relative to the femur. In the second part of the study, the radiographs were obtained under standard conditions in both failed ACL reconstructions and normal knees. The results of both parts of the study indicate that lateral radiographs of the extended knee with ACL instability are likely to show subtle anterior tibial subluxation. The subluxation can give the impression of roof impingement on the graft. However, the majority of the failed knees had similar tibial tunnel placement compared with successful reconstructions and would appear unimpinged once corrected for subluxation. The diagnosis of graft impingement by the femoral intercondylar roof has to take into account potential tibial subluxation. Impingement as a cause graft failure may be less common than previously thought.

[Horton disease of pulmonary localization]. / Maladie de Horton avec localisation pulmonaire.

A case of Horton's disease with interstitial pulmonary involvement is reported. Transbronchial biopsy of the lung and biopsy of the temporal artery provided evidence of giant cell lesions. Outcome was favourable with general corticosteroid therapy with regression of the pulmonary disease.

Cloning, sequence analysis and expression pattern of mouse desmocollin 2 (DSC2), a cadherin-like adhesion molecule.

Desmocollins are cadherin-like adhesion molecules of desmosomes. We have determined the full cDNA sequence of a murine desmocollin, the homologue of human and bovine type 2 desmocollins (DSC2), and studied its tissue distribution and expression in stratified epithelia. An 8.5 day mouse embryo cDNA library was screened yielding overlapping clones which encoded the mouse DSC2. This gene has an open reading frame of 2710 base pairs (bp) encoding a polypeptide of 902 amino acids (aa). The polypeptide comprises a signal peptide, a precursor peptide, and a mature protein of 766 aa having an extracellular domain of 549 aa, a single transmembrane domain and a cytoplasmic domain of 184 aa. Like other desmocollins, murine DSC2 has two products, Dsc2a and Dsc2b, produced by alternative splicing of a 46 bp exon which encodes 11 COOH-terminal aa followed by an in-frame stop codon. Inclusion of this exon forms Dsc2b which is 54 aa shorter than Dsc2a. Mouse Dsc2a shows 75.7% amino acid identity to human and 63.3% identity to bovine Dsc2a. The mouse desmocollin is also homologous to the cadherins; 32.2% to the most closely related typical cadherin, human N-cadherin. DSC2 is ubiquitously expressed in epithelial tissues and the heart of adult mice and from the blastocyst stage of development. In situ hybridization shows that the gene is most strongly expressed suprabasally in stratified epithelia, similar to the expression of bovine DSC2.