Measurement of angular distributions of Drell-Yan dimuons in p+p interactions at 800 GeV/c.

We report a measurement of the angular distributions of Drell-Yan dimuons produced using an 800 GeV/c proton beam on a hydrogen target. The polar and azimuthal angular distribution parameters have been extracted over the kinematic range 4.5

Measurement of Upsilon production for p + p and p + d interactions at 800 GeV/c.

We report a high statistics measurement of Upsilon production with an 800 GeV/c proton beam on hydrogen and deuterium targets. The dominance of the gluon-gluon fusion process for Upsilon production at this energy implies that the cross section ratio, sigma(p+d-->Upsilon)/2sigma(p+p-->Upsilon), is sensitive to the gluon content in the neutron relative to that in the proton. Over the kinematic region 0

Measurement of angular distributions of Drell-Yan dimuons in p+d interactions at 800 GeV/c.

We report a measurement of the angular distributions of Drell-Yan dimuons produced using an 800 GeV/c proton beam on a deuterium target. The muon angular distributions in the dilepton rest frame have been measured over the kinematic range 4.5

The role of polymethylmethacrylate bone cement in modern orthopaedic surgery.

Polymethylmethacrylate remains one of the most enduring materials in orthopaedic surgery. It has a central role in the success of total joint replacement and is also used in newer techniques such as percutaneous vertebroplasty and kyphoplasty. This article describes the current uses and limitations of polymethylmethacrylate in orthopaedic surgery. It focuses on its mechanical and chemical properties and links these to its clinical performance. The behaviour of antibiotic-loaded bone cement are discussed, together with areas of research that are now shedding light upon the behaviour of this unique biomaterial.

J/psi polarization in 800-GeV p-Cu interactions.

We present measurements of the polarization of the J/psi produced in 800-GeV proton interactions with a copper target. Polarization of the J/psi is sensitive to the ccmacr; production and hadronization processes. A longitudinal polarization is observed at large x(F), while at small x(F) the state is produced essentially unpolarized or slightly transversely polarized. No significant variation of the polarization is observed versus p(T).

The prevalence of spinal trauma associated with brachial plexus injuries.

Severe closed traction lesions to the adult brachial plexus are caused by high energy transfer injuries, in which injuries to other systems are common. Of the 149 patients urgently operated on for lesions of the brachial plexus between 1 June 1997 and 1999, 18 (12%) suffered significant injury to the spinal column. Accurate diagnosis of the spinal injury was made in 13 cases of these before transfer to our unit.The injury to the spine was not necessarily a contraindication to urgent exploration of the brachial plexus.

A proximal referencing system for the Charnley low friction arthroplasty.

Dislocation is a serious complication of total hip arthroplasty occurring in up to 9% of cases. Recurrent dislocation accounts for 4% of revisions in the Swedish Hip Arthroplasty Study. Soft tissue balancing is one of the factors, independent of the surgical approach used, that is involved in producing a stable total hip replacement. We describe a proximal referencing system for use with the Charnley low friction arthrosplasty (LFA), which optimises this factor. The dislocation rate, using this method, is 0.3% (in 333 cases performed by a single surgeon over a 5 year period). This system should prove valuable to orthopaedic surgeons in training, ensuring they achieve correct soft tissue balance in total hip arthroplasty. (Hip International 2002; 12: 303-7).

Population-based study of microinvasive adenocarcinoma of the uterine cervix.

OBJECTIVE: To analyze lymph node status and survival rates of women with microinvasive cervical adenocarcinoma (International Federation of Gynecology and Obstetrics stages IA(1) and IA(2)). METHODS: The Surveillance, Epidemiology, and End Results (SEER) Public-Use Database was used to identify cases of microinvasive cervical adenocarcinoma diagnosed between 1988 and 1997. Variables analyzed included stage, extent of surgery, lymph node status, radiation therapy, and age. Statistics included analysis of trends, analysis of variance, log-rank test, one-sided binomial confidence interval estimation, and power analysis. RESULTS: Among 301 reported cases, 131 had stage IA(1) and 170 IA(2) disease. Simple hysterectomies were done in 54 women with IA(1) and 64 with IA(2) disease and radical hysterectomies were done in 50 and 83 women, respectively. Only one of 140 women who had lymphadenectomy had a single positive lymph node. There were four tumor-related deaths (one with IA(1), and three with IA(2) disease). There were no deaths among 96 women (47, IA(1); 49, IA(2)) treated by simple hysterectomy alone. The mean follow-up was 46.5 months (range 1--119). The censored survival rate was 98.7% overall (99.2% IA(1), 98.2% IA(2)). Power analysis estimated that 720 patients would be required in each group to detect a 2% difference in survival. Using one-sided 95% confidence interval estimations, the risk-adverse events rate for IA(1) was no more than 3.57%, and 4.50% for IA(2) disease. CONCLUSION: Prognosis is excellent for microinvasive adenocarcinoma of the uterine cervix. In 96 cases (31.9%), simple hysterectomy alone proved adequate.

Observation of polarization in bottomonium production at square root of s = 38.8 GeV.

We present a measurement of the polarization observed for bottomonium states produced in p-Cu collisions at square root of s = 38.8 GeV. The angular distribution of the decay dimuons of the Upsilon(1S) state shows no polarization at small values of the fractional longitudinal momentum x(F) and transverse momentum p(T) but significant positive transverse production polarization for either p(T)>1.8 GeV/c or for x(F)>0.35. The Upsilon(2S+3S) (unresolved) states show a large transverse production polarization at all values of x(F) and p(T) measured. These observations challenge NRQCD calculations of the polarization expected in the hadronic production of bottomonium states.

Efficacy of treatment of inflammatory cytologic abnormalities detected by papanicolaou smears: a pilot study.

OBJECTIVE: To evaluate the efficacy of metronidazole versus no treatment for the empiric treatment of inflammatory cytologic changes. MATERIALS AND METHODS: Patients with inflammatory changes on Pap smear were serially assigned to receive no treatment or metronidazole by one of three regimens: 2 grams orally as a single dose, 500 milligrams orally twice daily for 7 days, or 5 grams (in gel form) vaginally twice daily for 5 days. Smears were repeated 3 months after treatment. RESULTS: The repeat smear was normal in 47 of 63 patients treated with a single dose, 40 of 62 patients treated orally for 7 days, 14 of 21 patients treated with vaginal gel, and 29 of 49 of the control group. Chi-square analysis showed no statistical significance between groups. CONCLUSION: There is no statistically significant difference in the resolution of cytologic inflammatory changes among the study groups. Empiric metronidazole treatment has no benefit.

Late second stage rupture of the uterus and bladder with vaginal birth after cesarean section: a case report and review of the literature.

Rupture of a uterine scar during labor with concomitant severe injury to the maternal bladder has been reported sporadically. Previously reported cases have been diagnosed under a variety of conditions, commonly at the time of repeat Cesarean delivery. A case of maternal bladder rupture diagnosed following forceps-assisted vaginal delivery after Cesarean is presented. Severe bradycardia developed suddenly in the second stage of labor. Rupture of the uterine scar was diagnosed after sudden onset of severe lower abdominal pain with delivery of the placenta. At laparotomy, extensive injury to the bladder was found and successful repair of both injuries was performed. A review of previously reported similar cases with their mechanism of injury and presentation is presented. Serious maternal bladder injury at the time of uterine rupture remains a risk of attempted vaginal delivery after prior Cesarean section.

Loss of heterozygosity and microsatellite instability at the MLL locus are common in childhood acute leukemia, but not in infant acute leukemia.

Rearrangements involving the MLL gene at chromosome 11q23 are associated with leukemia and are present in up to 70% of infant leukemias. Loss of heterozygosity (LOH) has been shown for anonymous polymorphic markers at 11q23 in adult leukemias. To study LOH at the MLL locus, we have identified two new polymorphic microsatellite markers: a GAA repeat (mllGAAn) in intron 6 of the MLL gene and a GA (mllGAn) repeat in the 5' flanking region of the gene, approximately 2 kb upstream of the translation initiation codon. The heterozygosity index of mllGAAn is 0.54, which renders it useful for analyzing LOH. We screened two groups of leukemia patients to study LOH at the mllGAAn marker. Group A (n = 18) was selected on the basis of presentation before 18 months. Cytogenetic and reverse transcription-polymerase chain reaction analysis showed that 9 of these 18 children had translocations involving MLL. No LOH was observed. Group B (n = 36) were randomly selected children who had presented with leukemia between 1993 and 1994. Cytogenetic analysis of this group showed a variety of different chromosomal abnormalities. LOH was shown in 9 of 20 individuals (45%) who were informative. Microsatellite instability (MSI) was demonstrated in 1 of 18 individuals in group A and 5 of 36 individuals (13.9%) in group B. MSI and LOH were observed simultaneously in three individuals. Loss of an allele was confirmed in one individual by fluorescence in situ hybridization. Individuals with MSI or LOH at mllGAAn were selected for analysis at anonymous polymorphic markers D11S1364 and D11S1356, which flank the MLL gene. No LOH or MSI was observed at these markers in those individuals who were informative. These results show that LOH at the MLL gene locus is a common event during leukemogenesis. Furthermore, the presence of MSI at this locus suggests that the region is a hotspot for genetic instability.

Pregnancy complicated by primary aldosteronism.

Pregnancy is rarely complicated by aldosteronism. We report the case of a 32-year-old woman who became pregnant soon after primary aldosteronism was diagnosed. Only antihypertensive medication and oral potassium supplementation were required in addition to routine prenatal care. A healthy female infant was delivered at term. In this case, no adrenal adenoma was identified. We discuss management of aldosteronism in pregnancy and review the literature.

Genetic variation at a splicing branch point in intron 9 of the low density lipoprotein (LDL)-receptor gene: a rare mutation that disrupts mRNA splicing in a patient with familial hypercholesterolaemia and a common polymorphism.

Mutations in the coding sequence, splice junctions or promoter of the gene for the low density lipoprotein (LDL) receptor are known to be the underlying cause of familial hypercholesterolaemia (FH), but mutations of this type cannot be identified in all patients with a clinical diagnosis of FH. We show here that minor sequence changes elsewhere in introns can be deleterious. A minor rearrangement 30 bp upstream from the junction of intron 9 with exon 10 was detected as a heteroduplex in amplified genomic DNA from one out of 300 heterozygous FH patients. The mutation destroys the only consensus sequence for a splicing branch point in intron 9 and analysis of mRNA from cells from the patient showed that it causes retention of intron 9 or, more rarely, in the use of cryptic splice sites in exon 10. The effect of the mutation on mRNA splicing was confirmed by analysis of mRNA in cells transfected with LDL-receptor mini-gene constructs expressing exons 9 and 10, together with the normal or mutant intron 9. A common C/T polymorphism within this branch point in intron 9 of the LDL-receptor gene does not affect mRNA splicing in vitro and is not associated with significant differences in mean plasma cholesterol concentration in a healthy population.

Hematosalpinx with pelvic pain after endometrial ablation confirms the postablation-tubal sterilization syndrome.

Complications after endometrial ablation are uncommon, and published series show that the majority of women who are treated by this technique remain symptom free in the postoperative period. A 39-year-old woman with previous tubal ligation underwent laparoscopic-assisted vaginal hysterectomy for debilitating pelvic pain 1 year after endometrial ablation. Pathologic assessment of the surgical specimen showed bilateral hematosalpinges from continued cyclic occult bleeding. The symptoms and findings in this case confirm the postablation-tubal sterilization syndrome.

Characterization of mutations in the low density lipoprotein (LDL)-receptor gene in patients with homozygous familial hypercholesterolemia, and frequency of these mutations in FH patients in the United Kingdom.

Mutations in the gene for the low density lipoprotein (LDL) receptor have been identified in 15 patients with homozygous familial hypercholesterolemia (FH). Five patients are homozygous at the LDL-receptor locus; their mutant alleles include Glu387Lys and Pro664Leu in patients of Asian-Indian descent, Cys292Stop in a Greek Cypriot, Cys281Trp in a Turkish patient, and Gln 540Stop in a West Indian. The other 10 patients (9 of apparently British ancestry) are compound heterozygotes. Mutations have been identified in 18 of 20 possible alleles, including Glu80Lys (2 patients), Pro664Leu (3 patients), Asp69Gly, Cys176Arg, Cys227Tyr, Ser265Arg, Asp280Ala, Asp283Glu, Arg329Pro, Asp461Asn, Leu578Ser, a single bp deletion in exon 15, a 21 bp duplication of codons 200-206 and two large deletions. The seven mutations underlined above have not been described previously. The two uncharacterized mutant alleles fail to produce detectable amounts of mRNA. LDL-receptor activity in cultured cells from 13 of the 15 homozygous patients varied from undetectable to about 30% of normal, but there was no correlation between LDL-receptor activity and the untreated plasma cholesterol concentration in these patients. When genomic DNA from 295 patients with a clinical diagnosis of FH was screened for 29 mutations found in these and other FH patients of British ancestry, most were identified in only one or a few individuals. Four patients heterozygous for the Asp461Asn allele showed a wide range of clinical manifestations. These observations confirm the striking heterogeneity underlying FH in most populations and demonstrate the variability in phenotype between patients with the same mutation.

A pregnancy complicated by mature abdominal burn scarring and its surgical solution: a case report.

Complications of pregnancy secondary to old abdominal burn scars are uncommon but have been reported. Common problems include failure of the scar to stretch (resulting in uterine displacement), maternal discomfort, and occasionally scar breakdown. We report the case of a 23-year-old patient who had a tight circumferential scar involving the majority of the abdomen. The uninvolved skin of the lower abdomen stretched remarkably, but the uterus was displaced inferiorly and anteriorly by the scar. The pregnancy progressed to term under careful supervision. After delivery, a flap created by the naturally expanded skin of the lower abdomen was used to replace a portion of the abdominal burn scar to prevent similar problems in future pregnancies. We know of no other reported case where the naturally expanded skin of pregnancy was used to reconstruct a mature burn scar.

Adult onset immunodeficiency caused by inherited adenosine deaminase deficiency.

Adenosine deaminase (ADA) deficiency is identified here as a cause of adult onset immunodeficiency. Two sisters who noted recurrent, predominantly chest infections in their twenties were found in their thirties to have CD4+ lymphopenia and lymphocyte ADA activity of approximately 5% of the lower limit of normal. Immune function, measured by proliferation of PBMCs in vitro to mitogens and specific Ags, was impaired. Inheritance of a polymorphic marker showed that both patients were heterozygous at the ADA locus. In the paternal allele there was a deletion resulting from homologous recombination between two alu elements that normally flank the first exon and the polymorphic marker. The recombination site was distinct from that in similar deletions described in two infants having severe combined immunodeficiency. This allele is predicted to result in a null phenotype. In the mutant allele inherited from the mother, a C to T transition in a CpG dinucleotide changed the codon for arginine 211, which lies in a conserved sequence close to the active site, to that for cysteine. This mutation has been observed previously in a child in whom the other allele was also a null mutation, but who was diagnosed as having partial ADA deficiency because immune function was apparently normal. The late onset of immunodeficiency in our patients suggests that immune function in children with partial ADA deficiency may deteriorate with time and that ADA deficiency should be regarded as a possible cause of adult onset immune dysfunction of unknown etiology.

Co-expression of renin-angiotensin system component genes in human atrial tissue.

OBJECTIVES: To detect co-expression of genes coding for components of the renin-angiotensin system and investigate the potential for variation in the level of angiotensin converting enzyme (ACE) gene expression in the right atrial appendage of patients undergoing heart surgery. DESIGN: The right atrial appendage was collected at the time of surgery from 30 randomly chosen patients and was rapidly frozen in liquid nitrogen prior to extraction of messenger (m)RNA. Surgical samples of heart valve (n = 6) and papillary muscle (n = 3) were also examined. METHODS: Aliquots of purified mRNA were reverse-transcribed for analysis of gene expression by a polymerase chain reaction amplification assay. Primers specific for angiotensinogen, renin, ACE, cardiac chymase, atrial natriuretic peptide, glyceraldehyde-3-phosphate dehydrogenase, adenosine deaminase and the transferrin receptor were used for a qualitative analysis of co-expression of these genes within the same sample. In a subgroup of eight patients, a quantitative comparison of the relative levels of ACE gene expression was performed using a competitive polymerase chain reaction. RESULTS: Angiotensinogen and ACE expression were detected in all atrial, valve and ventricular samples examined, at levels similar to those of 'housekeeping' genes such as the transferrin receptor. Atrial renin and chymase expression were more difficult to detect, being demonstrable in only 70 and 63% of the samples, respectively. Higher levels of chymase were detected in ventricular samples than in atrial tissues. A quantitative analysis of ACE expression in eight atrial samples provided evidence of interindividual variation in the relative level of atrial ACE expression. CONCLUSIONS: The essential components of the renin-angiotensin system are co-expressed at a low level in the right atrial appendage and are detectable in other regions of the human heart. Renin and chymase genes are expressed at a lower level than the angiotensinogen and ACE genes and exhibit regional differences in expression. Interindividual variation in the relative level of ACE expression can be detected by a competitive polymerase chain reaction.